Shaping your quality health care

Consultancy services

Creating conditions for professional care

Consultancy services

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Simed Consultancy services provides professional and creative solutions for health care institutions all over the world. With over a hundred years of experience, you can be sure that our team of consultants is dedicated to adding value to your ambitions in health care. Whether it is planning, project fi nancing, design or project management, we offer tailor-made services with a client focus. Exceeding your expectations in care is our goal.

Tailor-made consultancyUsing its many years of experience, Simed Consultancy services is able to help you realise your health care project. We are familiar with the current trends and market issues, relevant in both inter-national and local health care markets. With this background, we identify your specifi c needs and wishes and translate these into a tailor-made solution. With our knowledge, and through intensive contact with our clients, we can make an expert analysis of the task at hand and put this into a wider per-spective. Different factors are taken into consideration ranging from the economic aspects of running a hospital to patient throughput in a specifi c department. This enables us to provide an effi cient and customised solution to your proposed project.

Providing results-oriented consultancy, however, is not our primary objective. Our main aim is to implement achievable solutions that are completely in line with mutually determined framework condi-

tions. Sustainability is also an important principle for us. We see consultancy as a broad concept that includes planning, fi -nance and design, and which begins with a study to gain insight into the feasibility of your project, a comprehensive study for a business plan, fi nancial advice that is tailor-made to suit your circumstances, or an architectural design for your hospital.

The Consultancy services teamOur consultants are experienced special-ists with backgrounds in medicine, archi-tecture, design, technology, fi nance and construction. These individual qualities are exploited as a team when developing and realising a project. The interaction between the different qualities in our team provides us with the unique op-portunity to cover all planning aspects in one team. We are driven, results-oriented and provide solutions customised to your circumstances. Our team is specialised in planning health care infrastructures and we have planned many hospitals all over the world.

Good planning forms the basis of all our projects.

Our clients demand state-of-the-art working environments.

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Dirk Joubert (seated, left)Dirk Joubert (seated, left)Dirk JoubertConsultancy Manager with his team

Starting with a strong basis

Health care project planning

“ Our clients value our ‘one stop shopping concept’ with multidisciplinary teams”

Dirk Joubert is responsible for the Consultancy services department. Together with his colleagues and other relevant parties, he works on trans-lating a diverse range of client requests into realistic plans of approach. The resulting plan must meet all the client’s content and fi nancial requirements. “Thanks to the intensive contact with our clients, we can crystallise existing ideas, prioritise the various wishes and requirements, and clarify what is feasible”, Joubert explains.

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of the choices are worked out. The fi nancial feasibility and critical success factors enable our customer to make an informed decision before embark-ing on a full business plan.”

A solid basis: the business planThe business plan provides a solid basis for the fi nancing, design and implementation of the project. Joubert summarised the importance of a comprehensive business plan as follows: “Using the project strategy as determined in the feasibility study as a base, the project is then planned in more detail. The activity profi le, functional plan, necessary resources and budgets for the facility are speci-fi ed and decisions are made towards the implementation of the project, including the approach to marketing and management. Together with the anticipated investment and opera-tional cash fl ows, these plans are used as basis for investing in the project.”

Services tailored to the projectConsultancy services fulfi ls a bridg-ing function between the different parties involved in the project. Joubert clarifi es this function: “From their perspective as an independent party, our multidisciplinary teams can advise you and fulfi l a bridging function between members of staff, suppliers, fi tters, builders and other relevant parties. This is unique due to our broad experience in the different aspects of a project. We subsequently work according to certifi ed project management standards to ensure that each phase of the project is managed effi ciently.”

Professional project planning“Integration and client confi dence are the core concepts of the service we provide”, Joubert remarks. “By listening attentively and looking at the possibili-ties available, we can provide clients with a realistic scenario of our approach to their project. Our clients value our ‘one stop shopping concept’. This concept offers the client in-depth feasibility studies, business plans and functional project planning from an experienced team with a hands-on mentality that can handle any project successfully, whatever the size, complexity or location.”

Feasibility studyIn the planning phase, the purpose is to out line the project and assess its feasi-bility. Joubert: “Developing the idea for a health care project starts by establishing what our customer wants to achieve and whether the plan is feasible. We start with a thorough market analysis, an evaluation of the project context and its stakeholders, and testing different sce-narios against this background. Based on the strategy selected, the intended profi le of the facility and fi nancial implications

Cooperation and consensus between several disciplines contributes towards the success of a project.

Discussing with doctors provides clear insight into the users’ requirements.

The consultancy process does not stop once the drawings have been completed; we also provide advice and support throughout the building stage.

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Making fi nance work for you

The Customer & Project Finance department advises clients on fi nancial structures and arranges fi nance where necessary. The department serves as an intermediary between the client, fi nancial institutions, insurers and other parties involved in project fi nancing.

Van Ebbenhorst Tengbergen explains how Customer & Project Finance works: “In order to reach a suitable fi nancing proposal, we make an assessment of all the relevant project information. Is it a public or private client? What part of the project has to be fi nanced? What are the desired deadlines and conditions? Does the client have a business plan? To what degree can the project costs be recov-ered? Every project has its own unique set of challenges and goals, and these are all specifi c questions that we address.”

According to Van Ebbenhorst Teng-bergen, it is also important to take the context of an assignment into account: “We do business in many different countries, also in emerging markets, so it is essential that we assess the potential risks. We therefore look at the available budgets, whether interest rate risks or currency risks are involved, the political stability in the client’s country, and of course Simed International’s past experience but also, and in particular, that of other parties involved such as fi nancial institutions. All these elements are hugely important with regard to the structuring of the fi nancing.”

Customer & project fi nance

“ We offer the best long-term fi nancial solutions”

Derk van Ebbenhorst Tengbergen Customer & Project Finance Manager

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Solutions for fi nancing issuesThere is a highly diverse product port-folio from which the consultants can choose a suitable type of fi nancing and a matching fi nancial institution for their clients.

Financing schemes can be divided into several categories:1. Commercial loans (suppliers’ and

buyers’ credits)2. Credit supplied by development banks

(local or multilateral institutions)3. Asset-based fi nancing, for example

leasing or mortgage4. Mixed credit with a subsidy element

Financing optionsAccording to Van Ebbenhorst Teng-bergen, several categories are often combined in order to create tailor-made fi nancing: “The suitability of a fi nancing instrument or partner depends greatly on what the project entails, but also on the country and, of course, the client. A reasonably simple buyers’ or suppliers’ credit may be adequate if the fi nancing is for a transaction that involves only the supply and installation of medical equipment. More complex projects, on

the other hand, usually involve several fi nancial institutions at once. This applies primarily when longer-term funding is required, for example in the case of project fi nancing and Public Private Partnerships (PPPs), or if it involves construction work, in which case we seek local fi nancers or fi nancers such as development banks, which are able to fi nance local building costs.”

With buyers’ credit, banks extend credit to the client whereas with suppliers’ credit, it is Simed International that supplies the client with credit. Van Ebbenhorst Tengbergen provides an example here of a fi nancing structure using buyers’ credit: “We arranged an attractive buyers’ credit structure for a client in Georgia. This structure involved an internationally operating Dutch bank, a Dutch credit insurance company and a local Georgian bank.” This made it possible to use a buyers’ credit structure and for the Dutch bank to support the fi nancing. However, without the contribution from local banks, which served as our ‘ears and eyes’ on the local market, this structure would not have been possible.

Subsidy schemes and payment structuresA wide range of subsidy schemes are available for emerging markets. These provide the extra budgetary support often needed to make a project feasible. Van Ebbenhorst Tengbergen and his fellow consultants make every effort to evaluate these schemes and carry out or oversee the application procedure for clients. In addition to arranging fi nanc-ing structures, Customer & Project Finance consultants also set up an at-tractive and practical payment structure as an integral part of the fi nancing. Van Ebbenhorst Tengbergen: “We are familiar with all types of payment instruments. It is the aim of Customer & Project Finance to link the client’s wishes with the options available within the fi nancial world. We are genuine entrepreneurs and always look for the best long-term fi nancing solutions.”

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Herman OlthaarHealth Care Technology ConsultantWim HeesbeenHealth Care Technology Consultant

Planning every detailFacility planning

The basis of many projects at Simed International is functional planning, which takes into consideration the various functions within a hospital as well as how the departments complement each other, the hospital environment, users, patients, fi nancial possibilities and the culture of the country. Together, all these factors must ultimately form a united whole, and it is for this that the Health Care Technology Consultants within the Consultancy services department are responsible.

Design follows functionAccording to Heesbeen, functional planning forms the basis for the facility design: “Before any building can be designed, it should be defi ned what func-tions it needs to fulfi l. This is especially true for medical facilities. Moreover, proper equipment planning in an early stage of the project design allows for accurate budget estimates with which clients can make timely decisions on the balance between functionality and cost implications. Every room has its own function, every function its own equip-ment, and every piece of equipment its own detail.” Many aspects of health care are technology-driven, which requires com-prehensive technology management. The aim of technology management is to ensure the safe and effective use of medical devices in a complex hospital environment. Our team of consultants also take this into consideration when planning your facility.

Sustainable solutionsWim Heesbeen and Herman Olthaar are Health Care Technology Consultants. “In this department, we deal with the functional planning, the plan of ap-proach and the feasibility study in paral-lel”, Olthaar explains. “This culminates in a plan that leaves nothing to chance and guarantees the best results for the future. We organise the functional planning down to the last detail because the solution we offer must be future-proof. We opt for solutions that are sustainable, affordable and stable.” He continues: “It is only really possible to manage a client’s request thoroughly if you are open to their wishes and expec-tations.” Heesbeen responds by saying: “It is our aim to plan and equip health care institutions in such a way that they comply fully with both the functional and the commercial requirements of the client.”

“ The solution we offer must be sustainable, affordable and stable”8

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Specialised software – HIPSAt Simed International, we work with HIPS, which stands for Hospital Integrated Planning System. This is a unique software tool developed by Simed International for an integrated approach to planning for hospital facilities and hospital equipment. The database contains a great deal of The database contains a great deal of data on medical equipment, medical-related equipment, furniture and surgical, medical and other related instruments. Each article includes technical specifi cations, budget costs and technical data for installation purposes. The database also contains a comprehensive history of planned and completed projects which can be used as a reference for new projects. HIPS is linked directly with ADB, the activity database of the National Health Service in the United Kingdom, with AutoCad® for enhanced drawings and REVIT® for creating three dimensional model drawings.

HIPS: unique hospital planning software by Simed International.

The Room Book is a comprehensive list of all necessary medical equipment and provisions.

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Functional planningFunctional planning starts with an assessment of the services and capacity required. On the basis of this general profi le, the functional programme sum-marises all the services to be provided (clinical, clinical support and non-clinical support functions), the scope and type of patients that will be served by the project, and the relation to other facilities in the area. It also defi nes the operational policy of each of the functional units and the relationship between them.

Activity planning and capacity calculationsWorkload projections are required for the spatial programme and equipment planning. They also determine what the total capacity of the facility will be. The expected number of procedures and patient visits are basic parameters with which to determine the capacity for services and supporting facilities.

Equipment outline and budgetingThe functionality and capacity are translated into requirements for medical equipment and furniture. While the equipment is specifi ed at a later stage, it is important in this stage to clarify what level of equipment is needed and what major items are required in terms of budget and size. It provides an estimate for the budget per department.

Space planningSpace planning serves several pur-poses. It provides our architects with an overview of all functional areas to be included in the facility along with the net square meters to be assigned to each. Space planning ensures that no vital functions are omitted and that adequate space is assigned to each. To the customer, space planning represents a monitoring mechanism for the project cost and conformity to the agreed role.

Construction budgetingBased on the space planning and esti-mated volume, an indicative budget for the construction of the facility can be made. This should serve as a basis for the design and decisions taken during the design phase will be weighed against it.

An accurate inventory is one of the necessary conditions for an effi ciently functioning operating theatre.

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The logistical processes and facilities are brought together in the functional plan. In this way, the fl ow of patients, staff, visitors and supplies are optimally coordinated with the hospital services.

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Health care facility design

Designing tailor-made health care facilities for you

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The design of a facility should always be based on a strategic plan and facility planning as these determine the functions and activities of the facility.

Facility design comprises the following phases:– Conceptual design– Preliminary design– Final design

Health care facility design requires coordination and cooperation between different experts in their fi elds. The process requires input from a medical facility expert, medical technology specialist, an architect and engineers. The functional design provides the basis for the civil and architectural design and the requirements for mechanical and electrical installations.

Conceptual designThe conceptual design is based on the decisions taken in the facility planning phase. The conceptual design will result in a cluster plan in which the relation-ship between the departments and their locations will become clear. A room book is compiled in parallel with the cluster plan. A room book lists all rooms in the facility by department and indicates their function. Another important milestone is the room-to-room equip-ment planning. For each room, the equipment schedule is defi ned based on its pre-set functionality. This planning results in a bill of quantities for the medical and nonmedical equipment in the project. Together with cluster plans, work fl ow visualisations, mechanical & electrical and/or architectural concept, the information and design so far are summarised in an ‘architectural brief’. This is a document that serves as a guide-line for the architectural work involved in the preliminary design.

Preliminary designBased on the architectural brief contain-ing details of the conceptual design, the architect combines all components of the facility into a preliminary design. At this stage, essential issues such as functionality, logistical fl ows and urban planning are incorporated into a preliminary design. The structural engineer will subsequently review the de-signs for construction issues and loading capacity. During the preparation of the preliminary design, the architect works in close collaboration with the health care facility consultant. The consult-ant makes sure the design refl ects the functional plans agreed upon.

The knowledge and experience of doctors and health care specialists provides important input for the various plans.

All design aspects included in the plans are taken into consideration in order to achieve a good design.

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Providing a good visual presentation is an essential tool in showing all stakeholders a view of the proposed building.

A healing environmentA health care facility’s interior and environment also play a role when it comes to staff performance and patient recovery. What patients con-sider to be a ‘healing environment’, however, is determined by culture. In some cultures, patients prefer to be surrounded by family rather than by high-tech medical equipment, while in Europe, people are reassured by the presence of modern medical equip-ment. This type of cultural difference affects hospital design. In order to achieve the most suitable healing environment, the Consultancy team fi rst conducts a study to gain insight into the culture of the country in question, taking into account factors such as social conventions and customs. Local circumstances such as climate, prevailing construc-tion methods and local building materials are also taken into account when considering the appearance of the building. Furthermore, issues such as the presence or absence of a permanent water or energy sup-ply determine to a great extent the ultimate design. The strength of Simed International lies in the fact that projects are approached from various disciplines concurrently. This makes it possible to effectively analyse the often complex needs and requirements of clients, and to offer tailor-made solutions, be they in the form of a hospital extension in the Netherlands, a private clinic in Africa or a university hospital in Turkey.

Finetuning with the clientThis phase involves frequent meetings and discussions. The architectural drawings and the engineering design are brought in line with the required func-tionality. The equipment and technology in hospitals are often only used for a number of years, while the building itself is projected for at least thirty to forty years. In this respect, form does not follow function, but rather the fl exibility in the possible changes in function during lifetime. All these factors must be dovetailed with the wishes of the client.

Final architectural & structural designThe fi nal architectural design is based on the preliminary design and the discussions conducted with all parties in the project. Changes are incorporated and the design is further developed to become the fi nal design. The struc-tural engineer will calculate loading capacities and the consequences for the construction, and draw all structural components. At this stage, there has to be a clear understanding of the medical equipment, installations and specifi c materials to be used, and the implica-tions of these on the design and budget. Another important aspect is interior design. This can distinguish the facility from others and ensure that patients and staff feel at ease in the environment. Moreover, it is increasingly recognised that the interior design of health care institutions infl uences treatment outcomes and should be taken into consideration when developing any health care institution. The fi nal stage of the design is the preparation of contract packages, specifying all materials needed for the facility in a bill of quantities.

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ImplementationSimed International can offer project management to organise and manage all project activities and ensure that the project is completed within the defi ned scope, time and budget. We can assist you in the challenge to deliver a project within the defi ned constraints and optimise the alloca-tion and integration of the input needed to meet the requirements. During the project implementation, we can offer supervision of construc-tion and engineering to ensure that all works are carried out according to the specifi cations in the contract packages. This includes supervision of quality, progress and costs. As an independent partner, we have procured, supplied, delivered, installed and commissioned medical equipment for health care facilities worldwide. For impartial advice you can draw upon our extensive experi-ence. We can also take care of all the necessary steps from preinstallation drawings to end-user training to ensure proper installation and use of the equipment. The experienced consultants at Consultancy services oversee every facet of your health care project.

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Hospital management consulting

Enabling the future of health care providers

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Having a modern hospital with state-of-the-art equipment is not the only objective; a smooth-running organisation is also essential.

Managing a hospital is a complex task and although all countries are different, the principles of managing a hospital are similar all over the world. Many aspects have to be dealt with, such as translating a strategic plan into a realistic multi-annual policy and objectives, patient logistics, portfolio management com-bined with the availability of medical specialists and medical staff, fi nancial issues and medical insurance. Simed is also able to assist in this task using its knowledge and expertise on various management aspects ranging from management structure to interim management and hospital management consulting. Our clients range from academic hospitals to smaller commu-nity hospitals and from state-owned to private owned hospitals.

Hospital management servicesOur consultants are driven by the challenge to make things work for the client. This means we are fl exible and

pragmatic and we accept that different clients have different needs and that each requires a different approach. Our team of consultants are specialists with proven track records in hospital manage-ment services.

The main topics dealt with are:– Health care governance– Management structure– Strategy development– Portfolio management– Interim management– Execution of strategy and project

management– Change management– Management development pro-

grammes and training

Other activities include:– Development of an overall health

care strategy for local and national government

– Defi nition of health care insurance models

Training medical staff increases both user confi dence and service quality.

Mark SluiterSpecialist in the fi eld of hospital management.

“ A project is not fi nished when the building is completed”

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Presenting you our turnkey solutions

The integral approach

where the programme manager of the Maasstad Hospital in Rotterdam says about our work: “Simed International has distinguished itself through its spe-cialist knowledge and experienced staff working on major hospital projects”.

Tailor-made servicesNo project is a run-of-the-mill project to us and this can also be seen in the hospital that was requested by the Belgian navy for one of their ships. A 50-bed on-board hospital was de-signed in which the challenges posed by a ship, and the circumstances it was to be used in, had to be overcome. Our involvement in the design of a special-ised cardiac clinic in St Petersburg, Russia, or a clinic in Belgium, brings

Latest trends in equipmentEquipment planning for the “Hospital of the Future” in the Netherlands with its high technology and innovative way of working. This paper-poor hospital boasts the latest trends in equipment used to optimize workfl ow and effi -ciency. This is also the case in the latest hospital in Dubai, where a new state-of-the-art hospital is built with modern equipment and the latest techniques available with which to treat patients.

Current and future customer needsDuring the planning phase, it is some-times necessary to think about the relocation of equipment and depart-ments to different sites. This was done at two major sites in the Netherlands

Having shown in this brochure what we can do, we are proud to share with you some of the latest projects that Simed International has been involved with.

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high-quality design and experience to the customer.

Partner in professional projectsIn short, whether it is a feasibility study, business plan, full design with equip-ment plan and project management or support in hospital management, Simed International is your partner in health care projects. Simed International has a long experience in setting up hos-pital management, strategic reviews, change management, arranging staff recruitment and staff training, in many different countries over the world. This enables us to guarantee that our services have earned their place with many governments or private stake-holders everywhere.

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Simed International B.V. Middenwetering 1 P.O. Box 94863506 GL UtrechtThe NetherlandsT +31 30 265 22 00F +31 30 261 88 97 E simed@simed.comwww.simed.com

Simed International has branches in Belgium, China, Germany, Russia and the United States of America. For all contact information, please visit www.simed.com.

Published bySimed International, Utrecht, the NetherlandsConcept, editing and designTotal Identity, Amsterdam, the NetherlandsSieds de Boer, Yvonne van de Wal,Julius van der Woude

PrintingBadoux Houten, the Netherlands

Photography and illustrationSimed International, Utrecht, the NetherlandsRenders Fotografi e, Amsterdam, the NetherlandsGer Vendel, Amsterdam, the NetherlandsCo de Kruijf/Hollandse HoogteCablon Medical B.V.Nationale Beeldbank/Berbara HouwelingPhilipsMaasstad Ziekenhuis

Cover illustration: The Human Ear, Ger Vendel

© 2012, Simed International

Making health care work