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Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
Designing a good ivf service
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Designing a good ivf service


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  • 1. SawadThotathil
    Designing a Best in class IVF program Essentials – Components/Equipment/Infrastructure
  • 2. Designing a good IVF lab– a different approach
    Mostly the concern is about technological alternatives like microscopes, incubators etc
    Why is that an incorrect approach?
    A good program is a patient centered program
    A good lab only needs to support the patient centeredness
    So what do patients want?
  • 3. Reasons and ongoing pregnancy numbers for couples (n = 319) that discontinued fertility workup and/or fertility treatment before conceiving an ongoing pregnancy, divided according to the initiator (the couple or the fertility specialist).
    Brandes M et al. Hum. Reprod. 2009;24:3127-3135
    © The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email:
  • 4. Factors incorporated in design
    Evidence-Based Design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.
    Service offerings – Treatment offerings
    Quality of the service – Various dimensions of service quality
    Type of patient – Values, choices, affordability
  • 5. Design choices impact
    Layout and interiors
    Technology and equipment choices
    Systems and protocols– Functioning of the entire clinical unit including the people, their roles, protocols for activities and information technology
    Cost of establishment, running costs, pricing of services
    Elaboration of the patient centered or EBD approach in the following slides……
  • 6. Service offerings
    Standard - standard (IVF/ICSI)
    Biological plausible yet unproven (low oxygen culture, IMSI, metabolic screening of embryos)
    Experimental (Pre-implantation screening PGS of gene expression for embryo selection, in-culture video monitoring)
    Additional space , equipment and scientific staff
    Cost of project can double the cost of a standard IVF/ICSI lab ex: PGS
    IMSI can result in 15 to 20 % cost increase
    Example: Low oxygen culture is likely to be beneficial for embryo culture but you have to buy different type of incubators (some more costly), running costs are slightly higher for the gas
  • 7. Dimensions of service quality
    Patient centeredness – concerns and desires of the patient are the chief determinant of decision making by the treatment provider
    Timely – Care when it is needed
    Safety of patients and staff
    Effective – Service or treatment procedure has been proven in a clinical environment
    Efficient – avoiding wastage in materials, time etc because the costs are ultimately passed onto the patient
  • 8. Interiors
    Effect of construction materials on embryo growth
    Impact of interiors on patient experience – air quality, privacy, space etc
    Choosing materials require you to make choices regarding the various quality specifications identified for each type of requirement. Ex: Quality specifications for table tops may be different from those required in the flooring
    Information related to different materials have to be looked into as shown in the next 4 slides. Expert interpretation is required to avoid design errors
  • 9.
  • 10.
  • 11.
  • 12.
  • 13. Clinic layout and impact on patient experience
    Patient perception of quality of care is affected by the ambience
    Space and layout should take into account the workflow ,expected workload and patient experience
    1.Ex: Moving stretchers should go over a smooth surface without too many acute turns
    2.Ex: Privacy between beds
    3.Ex: Comfortable seating for partner besides bed
  • 14. Safety of embryos, patients and staff
    Embryos -Monitoring of equipment (data logging equipment that continuously monitor incubator parameters, liquid nitrogen levels in the cryotanks)
    Staff -Safety gloves and mask when handling liquid nitrogen
    Patients – Falls prevention especially in the post anesthetic period
  • 15. Effectiveness of service/treatment
    Technology choices as mentioned before
    More important dimension - How do providers use the technology as individuals and teams?
    Do you have standard operating procedures in place for quality control, embryo/patient safety? – Documentation is necessary for guidance, training
    Do you have performance measurement in place? – database and patient management software is necessary for patient reports, data analysis
  • 16. Timely care
    This can mean different things in different care settings
    Timely alerts, advises to patients
    Reminders also to staff to execute scheduled activities
    Timely care can be provided only if there is a team approach. Technology (ex: Concepta) can be used as an enhancer if budget allows
  • 17.
  • 18. Technical choices during construction
    Air conditioning or Air handling
    Electrical system design
    Gas supplies
  • 19. Air handling
    Particle filtration
    VOC removal
    Air changes per hour
    Temperature control
    Considerations in design -Noise levels, room size, external temperature, heat load in the room
  • 20. Electrical system design
    Categorize equipment and other needs
    Critical (zero tolerance to interruption)
    Critical (interruption allowed but needs back up within minutes)
    Non critical with back up.
    Non critical without back up
    Calculate the loads and allot for backup with UPS/Inverters/Generators as appropriate
  • 21. Gas supplies
    Quality of gas, adequacy of pressure at incubator end
    Number of incubators now and in the future
    Location of cylinders
    Back up cylinders?
    Length of piping – cost and drop in pressure
    Type of piping – copper pipes of numerous types available
  • 22. How do you go about it?
    Project consultant – Expert with project management skills and good knowledge/experience establishing multiple IVF units.
    Onsite Project lead – usually the architect
    Interiors -General
    Electrical design
    Electrical execution contractor
    Lab/OT floor/wall
    Lab/OT ceiling
    Air handling unit for Lab/OT
    Gas piping for Labs Gas piping for OT and Recovery
    Lab Equipment
    Lab furniture
    Data logger
    LAN and telephone points
    General furniture
    Theatre equipment
    Start to finish – 12 weeks provided budget is approved, determination on the part of the doctor and the space is constraint free for work
  • 23. Role of the Project consultant
    Understanding requirements
    Communicating with all stakeholders
    Give design inputs : from layout to technology to even lighting requirements
  • 24. Costs for mid size program (250 cycles per year)
    Lab equipment – roughly about 50 lakhs
    Other furnishing/civil/interiors/electrical/theatre equipment – another 20 lakhs
    Cost reduction possible but not recommended if you wish to create a good IVF program
    Key factors for success – contracting or hiring the right people from architect to nurse to embryologist
    Training and supervision for ovarian stimulation, oocyte retrieval and embryo transfer procedures
    Standard operating procedures, good protocols set by experts
  • 25. Real key to success
    Patient experience
    Satisfaction of patient needs
  • 26.
  • 27.
  • 28. Executive education
    • Harvard Business school, Boston
    • 29. Institute of Healthcare Improvement , Boston
    • 30. Department of Health, South Australia
    • 31. KPMG consulting, India
    Contact details
    • 9594369996
    • 32.
    • 33. Facebook and Linkedin “SAWAD THOTATHIL”
    • 34. Facebook group “ Enabling better healthcare”
  • SawadThotathil
    Facebook “sawadthotathil”
    Facebook group “ Enabling better healthcare’