HOSPITAL PLANNING

GUIDING PRINCIPLES FOR CONSTRUCTING A 100 BEDDED HOSPITAL

 CONTENTS OF THIS ASSIGNMNENT

Introduction

Concept of planning

Guiding Principles in Planning Hospital facilities & services

 High Quality
 Effective Community Orientation
 Economic Viability
 Sound Architectural Plans

Assumptions for building the hospital

Model of a health system

Methods of Planning and design

INTRODUCTION:

Today’s patients are better informed and know more about healthcare services.
What’s more, they want to be involved in the medical care process. This is why
they make their own decisions-they shop for and select the hospital; they choose
their doctor or change him or her. Having become cost conscious, they demand
quality care at a reasonable price.

Today, health care costs are rising dramatically. That is largely because of the
tremendous advances that have come about in treatment, technology and
equipment. People are happy that advanced treatment is now available for any
type of health problem. When it is a question of health, cost is not the issue.

When reiterates the fact that when it comes to health, people want the best- the
most modern and advanced treatment. That is precisely why people shop for
good hospitals that have competent doctors, advanced equipment, range of
services under one roof and total quality care coupled with courteous and caring
staff.

The first necessary step to achieve all these purposes is a well planned and well
designed hospital. Building efficient, functional and economical hospitals is the
need of the present day.

CONCEPT OF PLANNING:

In the establishment of a hospital, the first step is always a dream or an idea born
in the mind of an individual. All successful hospitals, without exception, are built
on a good triad of good planning, good design and construction and good
administration. The success of the hospital is generally measured by the quality
of patient care it provides and the efficiency with which it operates.

To be successful, a hospital requires a great deal of preliminary study and

planning.
1. It must be designed to meet the needs of the people it is going to serve and be
of a size that the promoters can afford to build in the first place and operate and
sustain later.

2. It must be staffed with competent and adequate number of efficient doctors,

nurses and other professionals.

3. The promoters must be made aware of and assume responsibility for the
creation of well planned and well designed hospitals that are efficient, functional
and economical so that they will render quality and adequate care to the
community they serve.

GUIDING PRINCIPLES IN PLANNING HOSPITAL FACILITIES AND SERVICES:

High quality patient care : This

can be achieved by:

1. Appointing competent and adequate number of medical, nursing and other

professional staff and providing necessary facilities, equipment and support
services

2. Establishing an organizational structure in which clearly defined responsibility

and authority are assigned to each job, particularly jobs relating to patient care.

3. Medical staff working as a team and in tandem, and interacting with each other
and with other health care professionals.

4. Continuous review of patient care

5. Providing continuing medical and other educational programmes to all

professionals to enable them to be updated with advanced technologies.

6. Establishing and enforcing standards in patient care.

 Effective community orientation:

This can be achieved by:

1. Governing board that is made of known and respected leaders of the

community.
2. Extending programmes and services of the hospital to the community.
3. Ensuring the hospitals participation in community programmes in
preventive care, teaching of good healthcare and practices, school health
programmes.
4. Hospital administrator, doctors providing assistance in planning and
implementing community health care programmes.
5. Providing a public information programme.

Economic Viability:

This can be realized by:

1.Accepting responsibility and accountability for a strong and viable financial

position that will command the respect and confidence of the community, donors
and investors.

2.Making available adequate operating finances for personnel and equipment

necessary for providing quality patient care.

3.A program to attract and retain competent and dedicated physicians, nurses and
other health care professionals to maintain high occupancy and full utilization of
services.

a. Planning new services and expansion programs based solely on

community needs.

b. A planned program for financing replacement of equipment and

improvement of facilities.
 c. An Annual budget that will provide for maintaining services at a high

level.

d. Community’s active participation in the hospital’s program through

sponsors, contributors and volunteers.

Sound Architectural Plans

This can be achieved by:

1. Engaging, early in the planning stage a competent architect who is

having experience in hospital design and construction.
2. Selecting a site that is readily accessible to public transport, water,
sewerage lines, population concentration, etc., and is large enough to
meet the present and projected service demands and requirements
for parking, access road, future expansion, etc.,
3. Determining the size of the hospital that is adequate for various
services, administrative and functional needs of departments, and
patient care and treatment.
4. Recognizing the importance of establishing traffic patterns for
movement of physicians, hospital personnel, patients, visitors, and
efficient transportation of food, linen, drugs and other supplies.
5. A design that will avoid duplication of services.
6. Paying attention to special services like outpatient, intensive care,
obstetrics, operating rooms, medical and surgical specialties, and to
such concepts as infection control, disaster planning, etc.,
Conceptual & Basic Design

The ideas generated at the conceptual study stage are translated into layouts,
taking cognizance of all design criteria, in line with functional and spatial
programmes.

Engineering Design

Detailing of the design facilitates its analysis from basic engineering disciplines i.e.

Civil Design takes into account specific requirement e.g. optimized grids,
construction floor strength for medical equipment, openings,
elevators etc.
Mechanical Design considers all essential service of water supply, drainage,
heating, ventilation, air-conditioning, and fire fighting systems.
Electrical Design takes cognizance of high and low voltage systems,
emergency power supplies, fire-detection systems, lighting, telephone and
paging systems, elevator control etc.
IT consideration enables incorporation of state-of the-art features into the
system.
Waste Management takes cognizance of potential quantum of wastes and
incorporates appropriate collection and storages, treatment and disposal
systems.

Equipment Planning

Choice of various categories of equipment i.e. clinical services in various

specialties, clinical support services eg. laboratories, blood bank etc. and
genanifold room has important bearing on all aspects of engineering design;
special consideration is, the real support services including the Central Sterile
Supply Department (CSSD), laundry, kitchen and more, given to preparing
department wise equipment schedule, coordinating its logistics and planning the
installation, testing & commissioning.
Assumptions for Building the Hospital for the Next Generation

1. Change has become a constant in our environment and the rate of change is
increasing, making the future more difficult and complex to predict.
2. The current health care system—operationally and financially—is not
Sustainable and this creates a mandate for change.
3. Significant change will be necessary. Incremental solutions will not accomplish
transformational change.
4. Due to the present state of health care and the mandate for change, a riskier
decision-making environment exists. As a result, there is a perception that
maintaining the status quo will lessen risk.
5. Characteristics of transformational change will include:

 Inclusivity and a need to seek input from future-oriented thought

Leaders and process experts
 Integration that links all components of the organization
 A system-based approach and an integrated plan to achieve outcomes
 Achievement of goals demonstrated by positive and measurable
results
6. The process of moving to a new future state will be evolutionary, eventually
creating an environment where change is consistently embraced.
7. The planning process for any project is as important as the final outcome
because it is through the process that buy-in to solutions is achieved.
8. Planning is dynamic in nature and grounded in the science of complex
adaptive systems (CAS).
9. The planning process for a hospital building project presents a singular
opportunity to effect transformational change to the platform from which the
Business of health care is delivered. This process does not end with design.
10. An effective planning process will lead to environments that are:
 Efficient and effective
 Patient and family focused
 Flexible and adaptable
METHODS OF PLANNING AND DESIGN

Objectives

(1) To present an overview of the planning and design process, to guide its
participants and especially those working in units and agencies for health planning
and designing in different countries;
(2) To present concisely the basic information that is important in the process of
planning and designing;
(3) to organize the overview and basic information in such a way that it can serve
as checklists for planning units, planning teams and professional designers, so that
they Call derive the maximum benefit and organize their own planning and
design; and
(4) To help strengthen and develop planning and design capabilities at the local
level.
.
In general, the people involved in this process are:

*Health planners, functional planners, financial planners and physical planners.

*Architects
*Engineers (such as civil, mechanical and sanitary)
*Quantity surveyors
*Finance managers
*Staff responsible for procurement of supplies
*Staff members such as doctors/nurses, clients/end users

Planning team and the process

(a) Needs assessment team

The planning and design process can be envisaged with the interaction of various
groups of people involved in the process. At the earliest stage, a needs
assessment team involving the planners, end users such as the hospital staff and
the community establishes an overall plan of the needs, range of services to be
provided, the target population or catchment area, the financial feasibility of the
project with cost benefit analysis and the scale of the hospital, etc.
 (b) Briefing team:

After the needs and the size of the hospital have been determined, the briefing
team involving architects, engineers, the staff and the community sit together
to prepare the key document, i.e. "the design brief" which translates the
requirements into functions, activities, space distribution and/or any other
information necessary for the design.

(c) Design team

This team consists of all the people involved in designing the facilities

and pools the expertise of

its members to produce the instruments for implementing construction, starting
from) preliminary investigation to the final designs with technical specification,
tendering documents and detailed working drawings and estimates of cost. This
team mainly consists of engineers, architects, quantity, surveyors, hospital staff,
the community and the approving authority.

(d) Construction team

This team consists of engineers, architects and builders. The construction team
implements the design from the approved drawings and technical
specifications within the prescribed time and cost and produces tile facility for
commissioning cause serious complications when left untreated.
 (e) Commissioning team

The commissioning team responsible to staff the hospital, commissions and

Procure the equipment, furniture and supplies and prepares it for operation.

(f)Planning team

By the end of the project, multitude of people would have made their
contribution to the project as part of a whole working team including the
community.

- The builder/contractor produces the hospital in its physical form using

Materials, labor and construction equipment,
- The procurement staf and the personnel staf form part of the commissioning
team which prepares the hospital for operation by procuring material and
recruiting staff.

Roles of members of the team

In each of the stages that comprise the planning and design process, each
member of the team has a role to play:
- The health planner establishes the need for the hospital, its role in the
community and the services it will offer.
- The functional planner establishes the functioning of the different departments
and of the hospital as a whole.
- The financial planner establishes the financial feasibility of the project and is
responsible for identifying and earmarking the funds for the Project.
- The physical planner establishes the relation of the hospital to the town and the
community it serves.
- The architect and the engineering consultants provide professional planning,
design and supervision of construction.
- The construction manager manages people and resources on site to ensure that
the project is completed on time within the budgeted amount.
- The client/user is the owner and final user of the hospital.
These people assume either active or consultative roles at the planning table,
depending on the task at hand, Table 1 gives a simplified version of the stages and
their corresponding inputs and outputs and the role of working professionals at
each stage, It is important to note that the engineering services should be planned
jointly with the layout, so that the final result is the logical outcome that meets
the needs of the actual users of the hospital, offering the best available health
care service to the population commensurate with the cost.

Stages in planning and designing a hospital