A PROJECT REPORT

ONDEMAND FORE CASTING OF ULTRA MODERN ALL

FACILITY HOSPITAL IN LUCKNOW WITH ITS

LOCATION PLANNING

SUBMITTED TO: SUBMITTED BY:PROF. VINOD KUMAR CHIB ANKIT KANNOJIA (JL13PGDM69) ANKIT PANDEY (JL13PGDM70) ANKITA CHANDRA (JL13PGDM71) ANKUR SHRIVASTAVA (JL13PGDM72) ANSHUL BAJPAI (JL13PGDM73) ANSHUMAN BHATTACHARYA (JL13PGDM74)

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ACKNOWLEDGEMENTAt the very outset we would like to express our deepest sense of gratitude to our

faculty Dr. V.K.Chib Sir, for having given us this wonderful opportunity to work

in such an exciting project in the domain of Operations Management. The Project

which related to the various Inventory and Operational Issues being faced by

Sahara Hospital, gave us valuable insights into how things actually work in the real

world. It gave us this wonderful opportunity to relate the concepts we have studied

with the practical world. And last but not the least our sincere regards to Dr. H.N.

Tripathi & Dr. S.N. Gupta for giving us time and sharing valuable information.

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Table of ContentsINTRODUCTION...........................................................................................................................4

Purpose & Back ground of the project........................................................................................4

Literature review..............................................................................................................................4

Concept........................................................................................................................................4

General.....................................................................................................................................5

District.....................................................................................................................................5

Teaching..................................................................................................................................5

Clinics......................................................................................................................................5

Specialised...............................................................................................................................5

Ultra Modern All Specialty Hospitals.....................................................................................6

Introduction of information and analysis sources............................................................................6

Planning of Hospital:...................................................................................................................6

a. Need of the Hospital in a particular location.......................................................................7

b. Site conditions:....................................................................................................................7

c. Economy of the area where the hospital is going to be located...........................................7

d. The catchments of the area for the patients to utilize the services:.....................................8

e. Availability of Manpower:...................................................................................................8

Planning & Co-ordination with other departments......................................................................9

Background Research................................................................................................................13

Functional & operations of hospital..............................................................................................13

Building Attributes................................................................................................................14

Efficiency and Cost-Effectiveness.........................................................................................14

Flexibility and Expandability................................................................................................15

Therapeutic Environment......................................................................................................15

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Sustainability.........................................................................................................................16

Conclusion:....................................................................................................................................16

LIMITATIONS & OPERATIONAL DIFFICULTIES OF HOSPIATLS:...............................16

LIMITATIONS OF THE PROJECT:........................................................................................17

INTRODUCTION

Purpose & Back ground of the project

Increase in demand of hospitals because of increase in number of patients suffering from

different ailments as in today’s time few diseases like diabetes, migraine, blood pressure problem

are very common .

There are very less number of hospitals serving high technology in medical science in lucknow,

so people usually rush to leelavati (delhi) ,apollo(new-delhi ) etc. to avoid this inconvenience we

are in need of high technology, modern edged high expertise hospital to serve more and more

people of Lucknow and nearby cities.

Though there are some hospitals such as SAHARA Hospital, Medical college & PGI in lucknow

but they are unable to fulfill the demand of lucknow. We have find that there is a huge demand

and supply gap in this sector. If a person is in emergency, it is sometimes possible that a patient

is unable to find a bed to get him treated.

We have come up with this hospital with the most ultra modern super specialty hospital with 500

bed capacity and most sophisticated diagnostic & imaging equipment such as an intra-operative

MRI scanner and high-speed, low-dose CT scanners & also latest life saving equipments, so that

patients with high level problems have not to rush to big hospitals. Though we know that a unit

of 500 bed will not suffice the demand but it may bring down & help more people in need.

Literature review

Concept

A hospital is a health care institution providing patient treatment by specialized staff and

equipment. Hospitals are usually funded by the public sector, by health organizations (for profit

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or nonprofit), health insurance companies, or charities, including direct charitable donations.

Historically, hospitals were often founded and funded by religious orders or charitable

individuals and leaders. Today, hospitals are largely staffed by professional physicians, surgeons,

and nurses. Hospitals usually are distinguished from other types of medical facilities by their

ability to admit and care for inpatients whilst the others often are described as clinics.

General

The best-known type of hospital is the general hospital, which is set up to deal with many kinds

of disease and injury, and normally has an emergency department to deal with immediate and

urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities.

Some hospitals, especially in the United States, have their own ambulance service.

District

A district hospital typically is the major health care facility in its region, with large numbers of

beds for intensive care and long-term care.

Teaching

A teaching hospital combines assistance to patients with teaching to medical students and nurses

and often is linked to a medical school, nursing school or university.

Clinics

The medical facility smaller than a hospital is generally called a clinic, and often is run by a

government agency for health services or a private partnership of physicians (in nations where

private practise is allowed). Clinics generally provide only outpatient services.

Specialised

Types of specialised hospitals include trauma centres, rehabilitation hospitals, children's

hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such

as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac,

oncology, or orthopedic problems, and so forth. In Germany specialised hospitals are called

Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery).

Specialised hospitals can help reduce health care costs compared to general hospitals. For

example, Narayana Hrudayalaya's Bangalore cardiac unit, which is specialised in cardiac

surgery, allows for significantly greater number of patients. It has 3000 beds and in pediatric

heart surgery alone, it performs 3000 heart operations annually, making it by far the largest such

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facility in the world. Surgeons are paid on a fixed salary instead of per operation, thus the costs

to the hospital drops when the number of procedures increases, taking advantage of economies of

scale. Additionally, it is argued that costs go down as all its specialists become efficient by

working on one "production line" procedure.

Ultra Modern All Specialty Hospitals

An ultra modern hospital is a center for treatment of all kinds of diseases & is equipped with all

types of medical, diagnostic & surgery through modern and latest high end equipments and

technology. The no. of these hospitals are very limited in our countries and they are mostly

concentrated towards the metro cities.

These all types of Hospitals have a same function i.e. treatment of patients but they majorly

differ in their operations. A specialized & ultra modern all specialty hospitals deals with more

critical cases where as the rest are more for a general purpose. The critical case handling capacity

of a hospital is what makes it different from other hospitals and therefore it requires highly

specialized doctors, nurses, technicians & highly advanced medical care systems such as ICU,

ICCU, Trauma center and many more.

Though these various types of hospitals are designed for their specific purposes but they are

required to do many common jobs as well, such as emergency treatment, general medicine and

active during drastic situations.

Introduction of information and analysis sources

Planning of Hospital:

The hospital planning can be divided into Two Categories:

I. Feasibility study for the hospital to be located in a particular area

II. Actual planning of the buildings, equipments etc.,

I. In the feasibility study, we have to analyze the following:

a. The need of the hospital in that location

b. Site conditions

c. Economy of the area where the hospital is going to be located

d. The catchment of the area for the patients to utilize the services

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e. Availability of Manpower

f. Financial Resources

a. Need of the Hospital in a particular location: It is better to appoint a consulting firm,

who is specialized in hospital planning to survey the locality for the feasibility of the hospital. It

is better to appoint an outside expert so that we will not have preconceived opinion about the

project. In the survey, they should examine whether the local community will be able to use the

hospital and whether they can afford for the services given by the hospital. If the community is

wealthy, the hospital should have luxury otherwise the hospital should have moderate facilities.

Also we should see whether the hospital staff would have facilities for their people such as

schools, good transport and easy accessibility to that area etc.,

b. Site conditions: The selected site should be large enough for future expansion. It should be

suitable for building construction and it should not be water located area and should be easily

accessible from any direction. It should have bus routes and should be on the main road. The

availability of water supply should be considered and also the disposal of sewage should be

taken care of. If the water table is very high then the disposal of sewage will be of a problem.

Water also should be portable so that the equipment and pipeline will not be corroded due to

salts. The soil condition of the site should be studied so that the foundation for the building can

be designed economically. Some times, if the soil is clay then the foundation cost will be very

high. In some places, we find that even if we put borewell upto 400 to 500 ft, there will not be

any water, which will increase the recurring cost for supply of water. Also we should see

whether the Corporation/Panchayat could supply enough quantity of water since consumability

of water in the hospital per bed per day will be approximately 300 – 400ltr. So buying water

from outside will be very expensive. Also we should see that electrical power supply (3 phase) of

industrial supply would be available in that locality. Other facilities like telephone, roads, and

central sewage should be considered before selecting the site.

c. Economy of the area where the hospital is going to be located: we should study the

earning capacity of the people in that area so that the hospital can be designed in a moderate way

or luxuries way. Always we should see that services should be affordable by the local

community.

The facility should be available for all categories of people.

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d. The catchments of the area for the patients to utilize the services: In the preliminary

survey, we should find out whether the people can use the services of the institution. We should

see the availability of hospitals in that area so that we can assess the people who are going to

utilize the facilities of the new hospital. Also we should see whether facilities are available such

as quarters etc., for the patients who are coming from little far away.

e. Availability of Manpower: We should ascertain whether enough paramedical staff and

other personnel like sweepers, watchmen, office staff etc are available locally. Otherwise it will

be very expensive to appoint people from outside. Also facilities like transport, education

institution and other basic facilities should be available for the staff nearby the institution.

f. Financial resources: Before starting up the project, we should study the financial resources

available. Mostly the finances for the project to be done by either banks or other financial

institutions such as HUDCO, LIC etc., we should plan in such a way that will be within our

resources so that the project will not be stopped in the middle. In most of the organizations, the

project will be started without proper planning of finances, which will delay the project or stop

the project. We should budget in such a way that the pay back period within 7-10 years. Then

only the project will be feasible. In hospitals, the medical equipments are very expensive and

often – new developments will be coming up. Unless the hospital is moderately equipped, it is

very difficult to complete with the neighboring organization. More time to be spent on planning

the preliminary things. In our country, we spend less time in planning and more time in

executive. By this there will be lot of changes in planning and also more of remodeling etc.,

which will cost more money.

III. Actual planning of the buildings, equipment etc :-,After preliminary studies and

survey etc., the planning of the building may be done. We should appoint an architectural firm

who is well versed in hospital designing. We have to prepare a master layout, so that the

positioning of the various buildings can be located in that site. Before preparing the master plan,

an advisory committee should be formed to get various, information from various department

heads. With this information we can prepare the spaces needed for each department such as

reception, waiting area, registration, examination rooms, treatment rooms, toilets, space for

laboratories, X-ray, Scan etc.,

Every specialty has got different types of planning. Some specialties may have bigger

examination room and lot of diagnostic equipment should be in the examination room. Before

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planning we should study the equipments and furniture to be provided for the particular

department so that we can plan the size of the room. Also we have to see what type of power

plugs, computer connection, UPS needed for each department so that all the things can be

planned for each type of room. According to the economic condition of the patient and demand

from the community, the inpatients room should be designed. In some places, we should have

more luxury rooms whereas in other places we may to need more common rooms. Facilities

should be provided in the hospital for public such as toilets, wider veranda, cafeteria, medical

stores, optical stores, gift stores etc., The nursing station should be in a central place, The

inpatients area should be very quite. The reception area should have welcoming atmosphere for

the people to come to the hospital. When we plan for specialty clinics, the requirements should

be discussed with people who are going to use the department and the layout of the various

facilities should be done according to the flow of patients. When we plan the buildings, we

should use the right materials so that the maintenance cost will not be in increased.

Planning & Co-ordination with other departments

• Land purchase

• Legal Opinion

• Encumbrance certificate – 30 years

• Clearance for the Urban land

• Income Tax clearance – appropriate

• Registration

- Change of use of land (Revenue)

- Name Transfer (Patta)

- Highways permission for approach

- Electricity Board

• Appointment of Architect

• Plan Approval

• Appointment of contractors (Civil, Electrical, Air-conditioning, Sanitary,Lift etc.,)

• Appointment of Engineers

• Chief Electrical Inspector

• Pollution Control Approval

• Furniture supplies

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• Equipment supplies

• Bankers (Financial Institutions)

Before we start the construction of the hospital, we have to purchase the required land for the

construction. We have to get legal opinion through a lawyer regarding the documents of the land.

Then the land is to be registered through Sub Registrar’s Office. We have to get clearance from

the Urban Land Department for the Exemption of the land from the Urban land ceiling. We have

to get Encumbrance certificate for atleast 30 years for the ownership of the land through

Registrar’s Office. We have to get Income Tax clearance if the land value is more than 5 lakhs

and clearance from Appropriate Authority if the value of the land is more than 20 lakhs in cities.

After the land is registered, we have to apply to the Revenue Department to change the use of the

land ie, from agricultural or industrial to hospital construction. After registration, the name of the

owner should be changed through revenue department by getting a patta. If the land is on the

highways, we have to get permission from the highways department for providing an approach

from the road to the proposed hospital land. We have to apply to the electricity board for power

supply permission for the construction. If the size of the project is big and consumes HT power

supply, which is more than 110KVA, we have to apply for HT power supply, for which, the

electrical inspector should certify and then only the Electricity Board will give the power supply.

For HT power supply, we have to provide our own transformer. For specialized works, such as

air-conditioning, sewage treatment plant etc., we need to have special consultants, so that the

work can be done economically. If finance is to be arranged through banks or from any other

financial institutions, we have to prepare the project report regarding the feasibility of the

project. We have to study about various financial institutions to know the variations in the rate of

interest and to minimize the interest rate for the loans.

Water Supply.

The sources for water supply are:

1. Borewell at the site

2. City supply

3. Private

The need of water for the hospitals is very high. The requirements of water should be calculated

considering the patient load, (inpatients and outpatients) and also the residential area. Normally

the water consumption per bed will be around 300- 400ltrs per day and for residents is about

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100-200ltrs per head per day. Hence we have to calculate the total requirements of water per

head per day to find out the total quantity of water requirements. The water to be used should be

tested for finding out the quality of water and the salts and other chemical ingredients in the

water. This water can be tested to get the percentage of impurities so that we can have

equipments to treat the water to make it soft. Some times if the water has got salts, which will

form scales in the pipelines and the pipelines will be blocked. We have to provide water-

softening plants to reduce the salts so that the pipelines can be maintained. For operation

theatres, sterilization rooms and laboratories, we have to use good water so that we can avoid the

scaling of the instruments, autoclave etc., When the total quantity of water is calculated, we have

to design the water tanks overhead tanks and underground reservoir etc., In one cubic meter we

can store 100ltr of water. Normally we should have atleast 2-3 days stock of water should be

stored. For providing water to various places, we have to use pipelines to different diameters

according to the requirements of water in that area. We use galvanized iron (G.I) pipelines of

different pressure capacities ie. A, B, C types of pipes, which represents the thickness of the

pipes. In some places, they use PVC pipes of Grade 4 KG pressure per sq.cm or 6 KG pressure

per sq.cms. For underground supplies, we can use PVC pipes of higher diameter. In some of the

buildings, the entire interior as well as exterior pipes, are used by PVC pipes. In some area, when

there is difference of temperature for interior and exterior lines, there may be expansion due to

heat. The joints in PVC lines may leak. When we use G.I pipes in the below ground level, we

have to paint with corrosion resistant paints and some times we use tar coated gunny to avoid

corrosion. Care should be taken to have proper joints to avoid leakages. The pipes also should be

designed according to the discharge of water. In PVC pipes proper adhesive should used for

joining the pipes. The water lines has to be designed depending upon the horizontal distances of

the pipelines and the vertical heights. Necessary valves should be provided at different distances

so that the maintenance can be done without dismantling all

the pipes. Too many bends and joints should be avoided to reduce the friction. When we get

water supply through city lines, they will provide water meters. If the water contains sand

particles and salt content, the meter does not work properly. Always it is better to put a filter

media before the water meter to avoid the breakages of the meter. If there is a scarcity of water

and if its expensive then it is better to provide some way of water treatment plant for recycling

the water. The waster water can be treated either by chemical, mechanical or natural flow

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system. In some area, the treated water are used for flushing cisterns, gardens, road cleaning

works and other areas where we don’t touch the water. If possible the rain water can be collected

and stored.

In operation theatre and sterilization areas we need soft water for the safety of the equipments

and surgical instruments. In some area, if we have central airconditioning plants, the condensed

water can be collected from the air handling units, which is equal to distilled water, which can be

collected and used for the O.T. and sterilization rooms Sanitary Arrangements In sewage

disposal, we have got two types of disposal system. One for the grey water, which comes from

toilets, kitchen area and other one water from washbasin, bathrooms etc., Depending upon the

volume of sewage, we have to design the pipes. Usually for toilets outlets, we use stoneware

pipes. Nowadays PVC pipes also used for sewage disposal. The sewage can be disposed in 3

ways.

1. Leachpit – If it’s a small quantity

2. Septic Tanks

3. Mechanical treatment plant or with the modern developments of central flow ie., baffled tanks

with arobic and anirobic filters.

The capcity of the sewage disposal should be designed according to the quantity of the sewage.

Necessary manholes, gully traps and nahini traps should be used for avoiding the bad smell in

the atmosphere. The manholes are useful to remove the blocks in the pipelines. Proper filter

should be provided so that the plastic or solid materials can be avoided. In hospitals we find there

are lots of bio-medical waste, tissues, blood, cotton and other bio-medical waste. As per the

government rules, we have to collect all these materials separately in different colour bins so that

this can be disposed according to the rules. In big hospitals they have to provide their own

incinerators to dispose the bio medical waste. Now as per the government rules to avoid

pollution inside the city area, the government insists to have common incinerators outside the

city livings. Care should be taken in both water supply and sanitary installation at the

construction time itself to avoid maintenance problems. The location of the pipelines for both

water supply and sanity should be provided in such a way that the maintenance people have easy

way to attend the repairs. Necessary air vents should be provided to avoid air blocks in the

pipelines, which may sometimes blow of the pipelines.

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Background Research

For our study we have visited Sahara hospital, Gomti nagar and Ford hospital, Gomti nagar.

We choose these two hospital for our studies because Sahara being a modern all facility hospital

and ford being a specialty and general hospital. These two can be served as our base for planning

a new hospital in lucknow and will also serve us to differentiate between the flaws in the two

system and to accumulate the goods and minimize the constraints of the project. The criteria for

location planning for Sahara in ideal w.r.t. ford because of more space and free roads as it is

established in less crowded area.

Functional & operations of hospital

The hospital is, ideally, based on its functions:

bed-related inpatient functions

outpatient-related functions

diagnostic and treatment functions

administrative functions

service functions (food, supply)

research and teaching functions

Physical relationships between these functions determine the configuration of the hospital.

Certain relationships between the various functions are required—as in the following flow

diagrams.

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Building Attributes

Regardless of their location, size, or budget, all hospitals should have certain common attributes.

Efficiency and Cost-Effectiveness

An efficient hospital layout should:Promote staff efficiency by minimizing distance of

necessary travel between frequently used spaces

Allow easy visual supervision of patients by limited staff

Include all needed spaces, but no redundant ones. This requires careful pre-design

programming.

Provide an efficient logistics system, which might include elevators, pneumatic tubes,

box conveyors, manual or automated carts, and gravity or pneumatic chutes, for the

efficient handling of food and clean supplies and the removal of waste, recyclables, and

soiled material

Make efficient use of space by locating support spaces so that they may be shared by

adjacent functional areas, and by making prudent use of multi-purpose spaces

Consolidate outpatient functions for more efficient operation—on first floor, if possible

—for direct access by outpatients

Group or combine functional areas with similar system requirements

Provide optimal functional adjacencies, such as locating the surgical intensive care unit

adjacent to the operating suite.

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These adjacencies should be based on a detailed functional program which describes the

hospital's intended operations from the standpoint of patients, staff, and supplies.

Flexibility and Expandability

Since medical needs and modes of treatment will continue to change, hospitals should:

Follow modular concepts of space planning and layout Use generic room sizes and plans as much as possible, rather than highly specific ones Be served by modular, easily accessed, and easily modified mechanical and electrical

systems Where size and program allow, be designed on a modular system basis, such as the VA

Hospital Building System. This system also uses walk-through interstitial space between occupied floors for mechanical, electrical, and plumbing distribution. For large projects, this provides continuing adaptability to changing programs and needs, with no first-cost premium, if properly planned, designed, and bid. The VA Hospital Building System also allows vertical expansion without disruptions to floors below.

Be open-ended, with well planned directions for future expansion; for instance positioning "soft spaces" such as administrative departments, adjacent to "hard spaces" such as clinical laboratories.

Therapeutic Environment

Hospital patients are often fearful and confused and these feelings may impede recovery. Every

effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as

possible. The interior designer plays a major role in this effort to create a therapeutic

environment. A hospital's interior design should be based on a comprehensive understanding of

the facility's mission and its patient profile. The characteristics of the patient profile will

determine the degree to which the interior design should address aging, loss of visual acuity,

other physical and mental disabilities, and abusiveness. Some important aspects of creating a

therapeutic interior are:

Using familiar and culturally relevant materials wherever consistent with sanitation and

other functional needs

Using cheerful and varied colors and textures, keeping in mind that some colors are

inappropriate and can interfere with provider assessments of patients' pallor and skin

tones, disorient older or impaired patients, or agitate patients and staff, particularly some

psychiatric patients .

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Admitting ample natural light wherever feasible and using color-corrected lighting in

interior spaces which closely approximates natural daylight

Providing views of the outdoors from every patient bed, and elsewhere wherever

possible; photo murals of nature scenes are helpful where outdoor views are not available

Designing a "way-finding" process into every project. Patients, visitors, and staff all need

to know where they are, what their destination is, and how to get there and return. A

patient's sense of competence is encouraged by making spaces easy to find, identify, and

use without asking for help. Building elements, color, texture, and pattern should all give

cues, as well as artwork and signage.

Sustainability

Hospitals are large public buildings that have a significant impact on the environment and

economy of the surrounding community. They are heavy users of energy and water and produce

large amounts of waste. Because hospitals place such demands on community resources they are

natural candidates for sustainable design.

Conclusion:

We got to know how operations is managed in a hospital and also various technical and uncertain

difficulties faced by hospitals. We learned that operations is the key in running any process

oriented industry. Operations is not only restricted to manufacturing industry but has a more

complex structure for service industry.

During our course we found out many limitations to the industry as well as our project.

LIMITATIONS & OPERATIONAL DIFFICULTIES OF HOSPIATLS:

Uncertain demand.

Excess reserves and buffer stock.

Managing staff.

Unexpected approximations for outbound inventory.

Inventory management.

Maintaining cleanliness & hygiene norms.

24 x 7 operations

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High degree of rules and norms

LIMITATIONS OF THE PROJECT:

Unavailability of proper data.

Unavailability of proper informative staff to provide relevant information.

Dependency on observational skill over factual documents.

Non disclosure policy of Hospital.

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