hospital designing and planning
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DR. D .H. SUKHWAL
HOSPITAL DESIGNING
& PLANNING
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To build a hospital that isfunctional, efficient and yet
economical withoutcompromising on the design
aspect
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Objectives
Provide a functional design thatensures efficient, safe and
appropriate work space. Accommodate technical
requirements for highly sophisticatedequipment.
Create clear, segregated paths formovement of people and materialwithin the building.
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Objectives..
Create a humane environment forpatients and staff.
Develop building systems that canaccommodate rapid change.
Blend technical and functional
requirements into a design thatbrings delight to those who use thebuilding and those who pass by it.
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STEPS
Decision to build the hospital
A detailed architects brief
Architect drawing up his plans withconsideration of landscape, facility mix, bedmix, availability of utilities in the vicinity
Inputs from other agencies like air-conditioning, electrical, plumbing, etc.required to finalize the working plan for thebuilding
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Inputs from the equipment vendorsespecially in specialty areas like Cath-labs, CT-scanners, MRI, linear
accelerators, operation theatres etc.essentialEmphasis to be given to support services
like kitchen, laundry, CSSD, back-up
electricityShould be properly planned: Vital
services with high capital costs &
recurrent expenses 6
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Planning & Design Team
Functional complexities in hospitals
are more than physical complexities;
so we require persons whounderstand not only the work processof individual departments but those
of the hospital operating system as awhole
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Planning & Design Team ..
Required: analysis of functionalneeds, understand
interrelationship of departments,area requirements, major
equipment, the grouping ofaccommodation and the mainoutline of traffic flow
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Standards followed
India: total area per bed is hardly
600 sq. ft. Western standards: 1,400 2,000 sq.
ft. per bed
WHO recommends an area of 800-
1200 sq. ft per bed
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Functionality is a prime
determinant of operationalefficiency in the total life
cycle cost of all hospital
structures
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..
Functions
Locations
Relationship
Utilization
Functional planner is a trained
hospital administrator who is capable ofinterpreting complex relationships,internal traffic flows (personnel and
supplies)11
Staffing pattern
Space requirements
Work flow
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.. Technological requirements Operational procedures Product of beauty Reasonable cost Optimal utilityA functional design: promotes skill, economy,
conveniences & comforts.A nonfunctional design: impedesactivities ofall types, detractsfrom quality of care &
raisescosts
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functional planner
With Architect :
Physical evaluation of existing facilities
Space programming
Master site planning
Functional evaluation of existingfacilities
Preparation of workload projections
Functional programming
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Space programming
Based on functional program amended &approved by hospital a room by roomlisting is made of all areas in proposedproject
Net square footage is assigned to eachspace, & totals accumulated for everydepartment or functional entity using net
figures Appropriate calculations are then made to
set gross totals for each department or
functional entity as well as the total forentire ro ect 15
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Preparation of workload projections
Functional planner determines &formulates concepts of operation forproposed project according to previous
study findings. These concepts are incorporated in
functional program
These projections form the basis forfunctional programming, revenueprojections & staffing estimates
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Functional programming
Formulating recommendations for operationalconcepts
Detailed room composition of project, required
phasing, alterations, internal & external trafficflows, interdepartmental relationships &operating systems
Using approved recommendations & findings ofstrategic plan, findings of physical & functionalevaluations & workload projections, functionalplanner formulates the activity
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Written program explaining theabove requirements
With this written programs help,architect prepares schematicdrawings and sketch plans
Helps the architect to build afunctional, economical and efficienthospital.
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contains ..
Permission required from variousregulatory bodies
Spatial needs of various departments
Manpower required
Special requirements of various
departments Inter and intra departmental
relationships 20
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Flexibility for future expansion
Larger secondary areas for better
patient comfort Proper utilities for waiting areas
Nurse stations Storage
Changing rooms21
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Alcoves for stretchers/ wheelchairs Adequate transport facilities
Parking facilities
Proper light and ventilationTime & trouble spent during this
stage will be well repaid & enablewhole project to proceed smoothlywith minimum subsequent revision
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To primarily know the deficiencies in thehealth care market, so that we can decide
proper facility & bed mix
To help us finalize size of the project
For existing hospitals to undertakebenchmarking in areas like tariff
rationalization, compensation policies,
utilization reviews for various services etc.
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Households Medical professionals
Diagnostic centers
Nursing homes
Hospitals
Relevant data from census report,demographic surveys, government/
media publications etc.
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Brief description on major findings ofmarket research
Proposed facilities plan
Detailed project cost: land & building,medical & non-medical equipment,
furniture & fixtures, utilities, pr-operative
costs, contingencies, working capitalrequirement, means of finance
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Income and expenditure projectionsbased on the feedback from the
market research and availabledatabase
Profit and Loss/ Balance sheet/Cash
flow statements Break even analysis
Sensitivity analysis 26
Feasibility...
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Specialized healthcarearchitecture
Healthcare architecture requiresspecialized knowledge on part of architect& supporting engineering team
Stringent functional demandsImproves quality of environment for
patient & caregivers
Meets needs of people using suchfacilities in times of uncertainty, stress, &dependency on doctors & nurses
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Recognize & support patients' families &
friends by providing pleasant spaces
Project an underlying reassurance thatpatient is in hands of competent medicalstaff & in a technically sound healthcare
facility Convenience, caring encounters, service
orientation and quality of care
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Specialized healthcare
architecture..
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Project Management
Liaison with all Agencies -Architects/contractors/equipmentvendors/utility service consultants and suppliers
Monitoring Project with PERT/CPM Managing Change in Project Plans - most vital &
complicated component due to various fall outsfrom change in project design
Managing equipment planning scheduleincluding cost-feature analysis, procurementprocess, installation etc.
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Project Management..
ArchitecturalDesigning
Project
ManagementTurn AroundStrategies
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Operational Audits:o Improvement of the lab
serviceso Operation theatre
utilization reviewso Manpower auditso Medical auditso Infection control programso Reorganization of profit
centerso Support service audits etc.
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Product Development
Benchmarking regarding market expectationfrom a hospital management system
Hospital best practices
Reviews of newer modules and upgradeversions and provide recommendation of anyenhancements/modification
Periodic comprehensive review and study of theexisting modules to update and upgradecontinuously
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Implementation
Implementation plan with solution A comprehensive system study
Gap analysis
Preparing specification for customization Site monitoring
Audits of the sites where software is already
installed to identify areas of problem Business development in terms of
identifying new leads, identify right businesspartner
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real test of any hospital is: quality of
healthcare it provides
minor defects in designing could makeoperation of a hospital inefficient
inefficient hospital costs significantly
more to operate staff & maintain:patients within it get less health
services for money they pay
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The initial cost of building a hospitalis insignificant when compared to
the cost of running and maintainingit over the years-
by one reckoning eighteen to
twenty times over a period of
twenty years
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Efficient, Functional andeconomicAl hospitAl
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Another study says that running cost of ahospital over 4 to 5 years from the date ofcompletion is about the same as the capital
cost
if the facilities are not planned & designedproperly the intangible cost can be enormous
efficiency with which physicians & theirassistants can function is greatlyhandicapped by obsolete design
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Patient comfort & provision for expansion is oftenoverlooked.
Growing efficiency & innovative ideas haverevolutionized hospital building construction to
meet special needs of patients
A pleasant environment that makes forenthusiastic & more productive staff also
benefits patients indirectly
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Many patients complain that hospitalsreduce privacy, individuality & more
importantly human dignity. Many of
these details & facilities can beincorporated with little or no extra cost.
So, patients needs & expectations
should be kept uppermost in mind & any
design should aim at his satisfaction &comfort
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These factors are again influencedby rapid changes and advances
that are taking place in fields oftechnology & medicine &constant need to modernize,
renovate, replace & expandhealthcare facilities
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A common understanding is required between; ON ONE HAND: ARCHITECT & ENGINEERS
ON OTHER HAND: PROMOTERS, DOCTORS,ADMINISTRATORS & PLANNERS
Next step is operational plan for each departmentto decide;
LOCATION of each department, requirement ofFLOOR SPACE, intradepartmental &interdepartmental RELATIONSHIPS, CIRCULATION,TRAFFIC FLOW and requirements IN RELATION TOequipment, personnel & patients
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Operational planning is a written documentfor any architectural project:- Services,number of beds, departmental functions,
departmental needs, major equipment, spacerequirements, required personnel,relationships and adjacencies are includedhere.
Dept-by dept description of needed space current and projected needs within the
facility
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Normally there is either no briefing of thearchitects or the brief given to him is inadequate
They are asked to prepare building schedules with
the help of doctors OR Observe other hospitals & take guidelines from
them. Both these are unsatisfactory methods.
Promoters must clearly tell architect therequirements of hospital & not the other way
round
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The proper sequence is;First: Develop operational planning that
defines major requirements & needs.
Next: Operational plan is developed into afunctional plan i.e. planning of thehospital on a functional basis-that lists
every room & suggests net sizes for majorfunctional rooms &total size of thedepartment.
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Functional grouping of high traffic areassuch as X-ray, laboratories, surgical & deliverysuites, physical therapy & clinics on two floors isdesirable
It permits concentration of hospital activities in amanageable unit.
When future expansion or change becomesnecessary, they can be accomplished withoutdisturbing other areas
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Operational Plan & Functional Planmust precede Architectural Plans
Otherwise; Within 510 years, it is found that cost
of construction equaled or surpassed
by operating expenses
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Hospitals must be planned forfuture
A fundamental rule is; hospital should beplanned for at least 10 to 15 years ahead orelse plans will be obsolete
Well planned systems must be built tokeep pace with the changes
`Smart` hospitals that respond to presentneeds while anticipating future change;should be built
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All departments are planned in such a way thatthey stand out individually
Each department with space around for
expansion. Future expansion is rendered easy with free
ended buildings with extendable corridors
Expensive permanent fixtures & fixedequipment such as plants & elevators are notlocated at free ends of the departments as they
would permanently block expansion plans 48
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Space Plan
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Architect finalizes his plans, with help of;
personal interviews with hospital administratorsexperienced in building hospitals
literature reviewFor a 100 bedded hospital, total space area
including the parking space, HVAC & wateris 1,05,319 sq ft which works out to be
9784.45 sq meter.Modern standards of constructing hospitals
requires; 800-1200 sq ft per bed.
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First floor
Administration department
Blood bank
General and Pediatric wards
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Second floor
Labour room
Obstetric ward
NICU Semi-private ward
CSSD just below the operation
theatre with provision for dumbwaiters between the CSSD and the OT
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3rd floor
ICU
Private wards
OT
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4th floor
Residential area just above ICU &
OT. So a doctor can easily attend
the patient when called
30% of the area is kept for
circulation