Principles of Hospital
Planning
Purnima Bhoi
KIIT School of Public Health
KIIT Deemed to University
INTRODUCTION
• Hospital building differs from other building types in the
complexity of functional relationships that must exist
between the various parts of the hospital.
• Apart from providing right environment for patients and
care providers , it should also be sensitive to the needs of
visitors.
• It is thus imperative to examine the emerging issues,
analyze the challenges, appreciate the emerging trends
and study the various strategic options available for
planning, designing and constructing a hospital
• Planning for healthcare institutions has become a complex reaction to
a complex situation .
• There are short range plans and long range plans to be solidified in a
fluctuating economy.
• There are various constraints, regulations, and requirements, all to be
met simultaneously.
• There is the consumer protection act, accountabilities to various other
statutory requirements, like pollution control act, bio medical waste
management etc..
• Finally, there is the urgent need for the hospital to sell its services.
• Consumer has a choice today
• More than ever before, the hospital administrator needs to know how
to look ahead, meet the competition and stay in business.
EMERGING ISSUES
1. Epidemiological and demographic changes
2. Enhanced expectations of patients
3. Emphasis on ambulatory/ day care
4. Enhanced standards
5. Changing function of hospital
6. Advancement in medical sciences
7. Outsourcing
STRATEGIC ESSENTIALS
Some of the strategic issues that must be considered are –
• Regionalization
• Pre- planning consideration
• Need assessment
• Plot ratio
• Design for flexibility and expandability
• Fulfill the demand functions
• Emphasize on patient focused hospital
• Focus on energy conservation
• Intelligent buildings
• Create a healing architecture
• Aesthetic – an essential requisite
• Hospital architecture
• Go green
UNIT 1
Steps in Hospital Planning
•Feasibility report
•Architect report
•Request for proposal
•Project consultation appointment
•Detailed project report (DPR)
•Notice Inviting Tender
• Allocation of work
• Construction of building, services, and facilities, equipment
• Purchase and manpower selection and recruitment
• Stage of commissioning
• Review process (Shake down Period)
HOSPITAL PLANNING TEAM/ COMMITTEE
Hospital planning starts with constitution of a
planning team.
• The Hospital Administration
• Specialists from various clinical branches
• Nursing Advisor
• Civil and Electrical Engineers
• Representative of local body
• Senior Architect
FEASIBILITY STUDY
• DATA COLLECTION (DEMOGRAPHIC PATTERN )
• NEED ASSESMENT
• ENVIRONMENTAL STUDY
• SITE SELECTION
• WATER SUPPLY & ELECTRICITY
• TRANSPORT & COMMUNICATION
Feasibility report
DATA COLLECTION (DEMOGRAPHIC PATTERN)
• Type of Residents – High, Middle, Low Class.
• Age distribution
• Affordability Status
• Extent of people to be covered – villages, towns
• Peoples, Beliefs, Attitude and Practices and Culture
• Availability of Rest Houses, Hotels & Daram Shalas.
NEED ASSESMENT
• What is the type of health need (Preventive, curative, rehabilitation, general care or specialty care)
• For which vulnerable group (old, children, women, specified disease group)
• Economic status and source of earning(Occupation)
• Extent of utilization of present health care facilities.
• Level of leadership and motivation among people
• Housing and education facility for hospital staff family.
ENVIRONMENTAL STUDY
•Area must have clear sun shine,
•avoid big buildings, trees near by.
•Climate should be moderate.
•No near by noise or smoke emitting
industries.
•Flow of fresh air.
•Away from roads with heavy traffic.
SITE SELECTION
• Availability of sufficient land depending on size of the
hospital and its future expansion.
• Must have good approaching roads.
• Soil condition suitable for construction, Not land fill
area.
• Proper drainage of rain water.
• Subsoil water and mineral level.
AVAILABILITY OF ELECTRICITY
• Electric sub station in close vicinity.
• Availability of 3 phase electric supply with adequate load (1 kw/ bed/
day)
• Dedicated electric supply line.
• Stand by generator.
WATER SUPPLY AND SANITATION
• Availability of deep subsoil water.
• Adequate water supply from corporation/ Jal board (400 liters/ bed/
day. Good maintained sewerage system (300-400 liter/ bed/ day)
• Easy access to sewerage treatment plant.
• Facility for Bio- Medical Waste Disposal near by.
TRANSPORT AND COMMUNICATION
• Better to have close access to Rail Head or Bus
Stand.
• 24 hours public transport and private taxis
available.
• Near by telephone exchange
• Easy access to transmission towers for
uninterrupted communication.
Financial Evaluation (cost of land, cost of site clearance, cost
of landscaping and horticulture, cost of civil construction,
cost of hospital equipment, cost of manpower, etc)
• How much it will cost to create the facility.
• Is the proposed financial resources and income capable of
supporting the proposed capital and revenue budgets.
• Investment strategy
• Pricing strategy
Cont..
• Gross revenue per bed day
• Average earning per bed year
• Operational budget
• Salaries and wages,
• medical and surgical supplies,
• pharmacy supplies,
• linen and laundry supplies,
• dietary- raw food,
• engineering services goods and supplies,
• printing and stationary etc.)
Contd…
• Purchased services
• Water
• Power
• Telephones
• Internet
• Wire less communication
• Cable network rentals
• Administrative costs, licences and other service charges
• Taxes, insurance, interest liability
• Maintenance, depreciation cost
• Continuing education
Project Planning and Implementation
A. PROJECT OUTLINE
• Why to undertake the project
• Justify with statistics
• How people are going to be benefited
• Acceptance of project by local people
• Minimum size of the project
B. DETAILED PROJECT REPORT (DPR)
• Provides the objectives, project formulation, and program conclusions.
• Details the physical facilities including space needs and functional
requirements.
• Provides proposed plan in both pictorial and narrative forms
• Cost of the plan, its financial capability and the suggesting phasing of the
master plan
Contd…
• The process of generating the Detailed Project Report comprises of the following
activities. This listing of activities forms the basis to determine the milestone activities
for the project’s PERT Chart and CPM (Critical Path Method) Scheduling
Need survey
Feasibility evaluation
Facility audit (in case of upgradation of existing hospitals)
Workload projections (in terms of no. of visits, laboratory tests, surgical operations etc.)
Functional brief (detailed room composition of the project, required phasing,
alterations, internal and external traffic flows, inter and intra departmental relationship
etc)
Review and acceptance of functional brief
Functional analysis
Preliminary cost estimate
Administrative and consultancy charges
Cont..
• Financial feasibility study
• Review and acceptance of Financial feasibility findings
• Review and acceptance of functional analysis and cost estimate
• Equipment plan
• Hospital’s manpower planning
• All this data when put together in a comprehensive document
constitutes the Detailed Project Report
• Once the DPR is accepted, the process of planning the hospital building
and its services commences.
C. PROJECT APPROVAL
• Once the project is prepared it should be sent to higher authorities for
approval
D. RESOURCE ALLOCATION
• Once the administrative approval is received an Expenditure Finance
Committee (EFC)memo is prepared
• The EFC memo is placed before the Standing Finance Committee (SFC)
for financial sanction.
E. LAND ACQUISITION
• LAND PURCHASE
• LAND CLEARANCE & NON-ENCUMBRANCE CERTIFICATE
• CHANGE OF LAND USE (Agriculture/ Residential/ Rural/ Urban)
• REGISTRATION & TRANSFER
• DEPARTMENTAL CLEARENCE FOR LAND USE
• Rural Development Department
• Urban Development Authority
• State Pollution Control Board
• Local Municipal Corporation
• Electricity Board/ Jal Board
F. CONSTRUCTION PLAN
• Design of Construction
• No. of floor
• Facility for each floor
• Designing of OPD, Emergency, Indoors , O.T and investigation facilities
Supportive and Ancillary Services
• Space for Expansion
• Auxiliary Areas, Parking, Canteen, Dispensary, etc
G. ARCHITECTURE BRIEF/REPORT
A brief of the complete construction plan to be given to the
architect.
• Design Specific Functional Area
• Inter – relation between various areas
• Preparation of drawings and models
• Electricity and Air Conditioning
• Lifts, Fire Fighting
• Water Supply
• Finalization after discussion with planning team
It is written document which explains the operational policies, type of services
provided, inter relationships and interdependency of each facility. It includes –
Site information
Functional content
Workload
Staffing
Equipment
Policies and procedure
Zoning
Financial aspects
H. REQUEST FOR PROPOSAL (RFP) - Tendering and award
of contract and appointment of project consultant
A request for proposal (RFP) is designed to explain your
needs for a particular product or service and allow potential
vendors to bid for your business.
• A request for proposal is a project funding announcement
posted by an organization for which companies place bids.
• The RFP outlines the bidding process and contract terms and
guides how the bid should be formatted.
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• A global tender is issued in bid system.
• Bids are examined by the planning team.
• Finally the contract is awarded to prospective
contractor/ construction agency/ project consultant.
• RFPs allow the requesting company to get multiple
bidders.
STRATEGIC PLANNING - While the construction is on
progress, simultaneous strategic planning are started for
staffing, equipment's, machineries and furniture .
STAFFING
• MEDICAL DOCTORS
• SANITATION STAFF
• NURSING STAFF
• ADMN. STAFF
• TECHNICAL STAFF
• NURSING ASSISTANT
• KITCHEN STAFF
Strategic planning cont…
MACHINARY EQUIPMENTS
• MATERIAL PLANNING
• HEAVY EQUIPMENT
• STATIONARIES & REAGENTS
• LINENS, LAUNDRY EQUIPMENTS
• INSTRUMENTS
• TRANSPORT
• DRUGS AND DISPOSABLES
• FURNITURES
• INVESTIGATION MACHINES
COMMISSIONING
• Once the construction is completed
• Installation of air conditions, lifts
• Equipment's and Machinery
• Recruitment of Staff is done
• The hospital is commissioned
• Advertisement is made in paper
• Publicity in local area
• Date of inauguration is finalized
SHAKE DOWN PERIOD
After the commissioning of hospital some time is taken for
functional integration of different units, services, staff, patient
and community. This period is called shake–down period . In
this -
• Machine are tested
• Staff recruited and trained
• Standard operating procedures are made
• Maintenance service is put in place
• Materials, linen and stationary procured
• Then starts the routine and regular functioning of the hospital.
Not to forget that ..
• Technology requirement must be met.
• Clinical needs must be considered.
• Safety is a major factor.
• Standards and guidelines are essential.
• Importance of the role of Hospital Staffs in
construction and design must be considered.
Stages in Planning
1. Resource Mapping :
• Principles and methods for the allocation of healthcare resources
• In order to effectively provide a variety of healthcare services, healthcare service
providers are focusing on appropriately allocating healthcare resources
2. Area and Location of the Hospital:
• Site for the hospital
• With increasing demand on hospital beds, planning for expansion at a future date
should always be kept in mind right at the outset while choosing the site.
• The function of the hospital demands that a hospital should be situated in the heart
of society.
• Accessibility is the most striking need the location must be within easy reach of the
users.
• Defining catchment areas in large cities is a first step in deciding the location, subject
to availability of suitable sites.
3. Need and Demand Assessment (Catchment area, health seeking
behaviour)
• Needs assessments are commonly used at all levels of health care and, most often,
related to goal setting.
• Health needs assessment is the systematic approach to ensuring that the health
service uses its resources to improve the health of the population in the most
efficient way. While planning for a hospital we do the following assessment to know
the need and demand of catchment area:
• What is the catchment area (in and around location /population), Health seeking
behaviour
• What is the type of health need (Preventive, curative, rehabilitation, general care
or specialty care)
• For which vulnerable group (old, children, women, specified disease group)
• Economic status and source of earning(Occupation)
• Extent of utilization of present health care facilities.
• Level of leadership and motivation among people
• Housing and education facility for hospital staff family.
4. Design preparation
• No. of floor
• Facility for each floor
• Designing of OPD, Emergency, Indoors
• O.T and investigation facilities
• Supportive and Ancillary Services
• Space for Expansion
• Auxiliary Areas, Parking, Canteen, Dispensary,
5. Hiring manpower and schedule for training
A - Manpower Mapping
• Facility which will need for 8hr/12hr/24hr
• Development of HR Manual
• Leave policy
• Patient load in OPD/IPD as per business plan in 1st year/2nd year/3rd
year etc. and recruitment and training of staff accordingly
• HR benefits and Cost of those benefits
• Development of Organogram
• Skill mapping
• CTC mapping – based on market salary survey.
B - Recruitment of the manpower : profile, position, designation, experience,
skill, CTC, expected DOJ etc.
C- Schedule for training:
a) General training
b) Specific training
a) General training
• Fire safety and evacuation
• Patient handling
• Awareness of hospital policies and protocols for service provision
• Awareness of hospital HR policies and protocols
• Orientation towards hospital vision, mission, long term and short term objectives
• Orientation towards organisational structure
• Orientation towards organisational ethical practices and ethics comittee
b. Specific training
• Specific equipment handling and training for doctors
and nurses.
• HIS module training related to each category of staff
and doctors
• Training to billing staff and front office staff
• Soft skills and behavioural training
6. Purchase of Equipment
• Planning for Biomedical and non biomedical equipment purchase based on
clinical speciality provided by the hospital.
• Finalisation of the specification, quantity required, cost and expected date
of procurement.
• Releasing tender based on equipment specification and quantity with
predefined terms and conditions.
• Finalisation of the price, technical specification, and other terms and
conditions and releasing the PO (Purchase Order)
• Receiving the equipment and facilitate the installation
• Imparting installation training to the user, biomedical team, engineering
team, documentation of the user manual, PO Copy, Warranty card,
Software, CD etc.
• Asset coding of all the equipment and uploading the software
• Making asset available for consumer use and hospital use.
7. Commissioning of the hospital
• Formulation of a core team to drive the commissioning of the hospital
• Review of the progress based on the checklist designed for each department and
progress
• A separate plan for launch date/ list of invitee/promotion campaign/media
coverage
• Legal compliance is must to ensure the hospital/ healthcare facility have all
required licences and approval before receiving the patient
• Tariff finalisation for both OPD and IPD, their entry to HIS
• Mock drill of OP patient flow, and IP flow, different codes applicable for the
hospital, fire evacuation drill etc.
• Procurement of all required medicine and consumables based on hospital
formulary, procurement of OT instruments, procurement of linen, F&B Material
etc.
• Inauguration of the hospital : Stage A- OPD, Stage B- IPD Medical management,
surgical management
• Stabilizing the hospital operations
General principles of Hospital planning and design
1. Design must follow function – design should be in tune with the
business requirement, process flow, user friendly and help in
keeping the cost under control. The principle is that the shape
of a building or object should be primarily based upon its
intended function or purpose.
2. Protection – Protection from unwanted and unnecessary
disturbance in order to help in speedy recovery and safety of
patient.
• Patients come to healthcare facilities to get heal. Healing is best
possible in a peaceful environment where patient can stay in a
relaxed environment and sleep well without any disturbance.
• In patient care areas there should not have sound making agent
like chiller plant, DG set, Vehicle parking, laundry machines, AHU
units etc). Edges of room and furniture should not be sharp.
Electrical panel room should not be near to ward/ ICU.
3. Circulation – All the departments of hospital must be properly
integrated for easy movement of patients, their relatives and
staff.
4. Control – Control over the untoward incidents for eg. the nurse
station should be positioned strategically so that she can have
proper monitoring of patients, visitors, infant and children. The
security should be in a position to control the movement of
patients visitors and staff.
5. Separation – Separation of dissimilar activities. Core and non
core area should be separate.
Examples -
• Outpatients visiting diagnostic and treatment areas should not travel
through inpatient functional areas nor encounter severely ill inpatients.
• Typical outpatient routes should be simple and clearly defined.
• Visitors should have a simple and direct route to each patient nursing unit
without penetrating other functional areas.
• Separate patients and visitors from industrial/logistical areas or floors.
• Outflow of trash, recyclables, and soiled materials should be separated
from movement of food and clean supplies, and both should be separated
from routes of patients and visitors.
• Transfer of cadavers to and from the morgue should be out of the sight of
patients and visitors.
• Dedicated service elevators for deliveries, food and building maintenance
services.
