Chapter_02_B.ppt

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Ch 02 Process of Hosp Plan.
Process of Hospital Planning
Stage A;
Functional content, Outline brief.
 Project team
 Assessment of functional content.
 Submission to owners (government,
private, organisation, etc.) for approval.

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 Site appraisals, gross floor areas
 Building space.
 Draft master plan.
 Estimation of cost and phasing
 Appraisal of work by owners.

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Stage B:
Operational policies, Development plan.
 Operational policies
 Departmental and interrelated activities
 Departmental and hospital policies
 Development of control plan
 Budget cost
 Continuous informal discussion with owners
through – Stage B

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Stage C:
Schedules of accommodation, sketches, final
cost estimate.
 Schedule of accommodation
 Sketch drawing
 Equipment schedules component estimates
 Costing of revenue and staffing estimates
 Final cost approval

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Schedule D:
Detail design working drawing, tender
action
 Working drawings
 Engineering details
 Bills of quantities
 Calling tenders.

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Schedule E:
Contract and construction
 Assessment of tenders
 Award of contract
 Construction
 Engineering commissioning
Schedule F:
Commissioning
 Staff assembly and training
 Equipment and suppliers assembly
 Testing of installations
 opening

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In general, a hospital project undergoes the
following phases:
1. Inception
2. Feasible studies
3. Outline proposals
4. Scheme design
5. Detail design
6. Tender action
7. Construction
8. Commissioning
9. Shake-down

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Hospital Design – Guiding Principles
In fulfilling the responsibility of rendering
essential service, hospital planning should be
guided by certain universally acknowledge
principles.
The following principles are developed in the
context of American System of Hospital, but
has relevance and usefulness to hospital
planning in India.

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1. Patient Care of High quality
It can be achieve by adopting following measures
 Provision of appropriate technical equipment
and facilitates necessary to support the
hospital’s objectives.
 An organization structure that assigns
responsibility appropriately and requires
accountability for the various functions within
the institution.

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 Continuous review of the adequacy of
care provided by physicians, nursing staff
and paramedical personnel and of the
adequacy with which is supported by
other hospital activities.
2. Effective Community Orientation:
It can be achieved through following
measures.

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 A governing board made up of persons who
have demonstrated concern for the community
and leadership ability.
 Policies that assure availability of services to
all the people in the hospital’s service area.
 Participation of the hospital in community
programmes to provide preventive care.
 A public information programme that keeps the
community identified with the hospital’s goals,
objectives and plans.

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3. Economic Viability
Should be achieved through following
measures
 A corporate organization that accepts
responsibility for sound financial
management in keeping with desirable
quality of care.
 Patient care objectives that are consistent
with projected service demands, availability
of operating finances and adequate
personnel and equipment.

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 A planned programme of expansion based
solely on demonstrated community needs.
 A specific programme of funding that will
assure replacement, improvement and
expansion of facilities and equipment without
imposing too much cost burden on patient
charges.
 An annual budget plan that will permit the
hospital to keep pace with times.

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4 . Orderly Planning
It can be achieve through the following:
 Acceptance by the hospital administrator
of primary responsibility for short and
long-range planning, with support and
assistance from competent financial,
organisational, functional and
architectural advisors.

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 Establishment of short and long-range
planning objectives with a list of priorities
and target dates on which such
objectives may be achieved.
 Preparation of functional programme that
describes the short and long-range
objectives and the facilities, equipment
and staffing necessary to achieve them.

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5. A Sound Architectural Plan
It can be achieved through:
 Engaging an architect experienced in
hospital design and construction.
 Selection of site large enough to provide
for future expansion and accessibility of
population.

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 Recognition of the need of uncluttered traffic
patterns within and outside the hospital for
movement of physicians, hospital staff,
patients, and visitors and for efficient
transportation of supplies.
 An architectural design that will permit efficient
use of personnel, interchangiability of rooms
and provide for flexibility.
 Adequate attention to important concepts such
as infection control and disaster planning.

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Circulation Pattern of Hospitals
Circulation is defined by the Merriam-Webster’s
Collegiate dictionary as ‘orderly movement through a
circuit; especially the movement of blood through the
vessels of the body influenced by the pumping action
of the heart.
In the above definition, ‘orderly movement through a
circuit’, here the important word is ‘orderly’.
It implies purpose, and purpose implies design.
So the importance of the design of circulation in a
healthcare facility.

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Hospitals, like small cities, contain main
circulation routes often described as
hospital streets.
The way in which the different parts of the
hospital are assembled, as a coherent
whole but with the parts differentiated,
make for analogies with urban design;
the way in which traffic moves, and the
routes that are taken by mechanical and
electrical services are fundamental
generators of the plan.

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The qualities a good circulation route should
possess:
1. It should have conceptual clarity. By this I
mean it should be designed with purpose, and
should not be leftover space or squeezed into
the gaps between other areas.
Geometry can be a recourse, but it should work
with other planning imperatives, and junctions
should be uniquely treated to avoid confusion
over which corner of the hexagon you have
reached.

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2. It should not be boring.
Try to make walking from one place to
another interesting, modulate those
corridors, colour them differently, hang
artwork along the way.
Niches, outside views, courtyards, all these
will help.

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3. It should enable way finding. In combination
with well-designed signage and maybe super
graphics, people should be able to find their
way to their destination with ease.
Colour-coding for floors or departments is
sometimes used.
4. They should be wide enough to handle
anticipated traffic. Stretcher traffic needs 8’-0”
width of corridor for easy movement (turning).
7’-0” will work, but use 8’-0” if you can.
Corridors between operation theatres make
sense even with 10’-0” width. There may be a
lot of stuff parked along the sides, despite
instructions to OT staff to the contrary.

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5. They should be indirectly lit. Patients on
stretchers get to look at the ceilings.
The sign put up by the traffic police at the
end of Marine Drive in Mumbai says,
“Drive carefully. Hospital ceilings are
boring.”
While not advocating rash driving, we
would advocate making the ceilings
interesting.

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There are two types of circulation in the hospital :
internal and external.
Internal circulation:
Internally , traffic routes are required for linking
major clinical departments for the use of staff
and patients, and for delivery of supplies to
these departments.
The circulation space involves corridors,
stairways, ramps and lifts.

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In high-raise buildings the problems of internal
circulation arise from wide dispersion of
ventricular circulation points.
It may be economical in effort to concentrate lifts
at one place than distribute them among
different parts of the building: four lifts banked
together will give the same service as eight
individual lifts scattered at different points.

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The internal traffic should remain orderly, and
thee is no undue criss-crossing of the patients,
staff, supplies and visitors.
Planning for efficient internal circulation should
therefore consider a central recognisable main
communication artery serving the whole
complex, which cannot be confused with
departmental corridors.
The entrance door to a department should be
approached through a “pause space” which
serves as a transition between the public and
private domain.

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External Circulation
Only one entrance to the hospital for vehicular
traffic from the main road is suitable.
Provide the entrance and exist points are wide
enough to take two lanes of traffic.
The volume of external traffic reaching a hospital
is quite enormous.
Appropriate areas have to be earmarked for
scooter, car, other vehicle parking facilities for
patients, visitors and staff.

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The main bulk of hospital stores are
delivered at one or two central points.
Independent access will be helpful in
transport of heavy or bulky articles
directly to the point at which required.
These could also be useful to bring in fire-
fighting vehicles in case of fire in the
hospital.

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The circulation routes will be influenced by
the orientation of the site, e.g., a site with
its broadside facing the main entrance
from the road, a narrow site at right angle
to the main road, or a site which is
irregular in spread and level.

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Hospital Operational Planning
An operational planning is a subset of
strategic work plan. It describes short-
term ways of achieving milestones and
explains how, or what portion of, a
strategic plan will be put into operation
during a given operational period, in the
case of commercial application, a fiscal
year or another given budgetary term.

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An operational plan is the basis for, and
justification of an annual operating
budget request.
Therefore, a five-year strategic plan would
need five operational plans funded by
five operating budgets.

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Operational plans should establish the
activities and budgets for each part of the
organisation for the next 1 – 3 years.
They link the strategic plan with the
activities the organization will deliver and
the resources required to deliver them.
An operational plan draws directly from
agency and program strategic plans to
describe agency and program missions
and goals, program objectives, and
program activities.

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Like a strategic plan, an operational plan
addresses four questions:
 Where are we now?
 Where do we want to be?
 How do we get there?
 How do we measure our progress?

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The OP is both the first and the last step in
preparing an operating budget request.
As the first step, the OP provides a plan for
resource allocation; as the last step, the
OP may be modified to reflect policy
decisions or financial changes made
during the budget development process.

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Operational plans should be prepared by
the people who will be involved in
implementation.
There is often a need for significant cross-
departmental dialogue as plans created
by one part of the organisation inevitably
have implications for other parts.

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Operational plans should contain:
 clear objectives
 activities to be delivered
 quality standards
 desired outcomes
 staffing and resource requirements
 implementation timetables
 a process for monitoring progress.

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