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 Hospital Architecture,
Planning and Maintenance

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MBA – HOSPITAL MANAGEMENT

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Authored By:
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Arpita Jindal
Writer
Independent Consultant
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M.Pharm (Clin Pharm), PDCR, PDIPR

Ghaziabad
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Pondicherry University
Directorate of Distance Education
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© Copyright 2015 Publisher

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ISBN: 978-93-5119-712-6

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This book may not be duplicated in any way without the written
consent of the publisher and Pondicherry University except in the form
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of brief excerpts or quotations for the purpose of review. The
information contained herein is for the personal use of the DDE
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students, Pondicherry University and may not be incorporated in any

commercial programs, other books, databases, or any kind of
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software without written consent of the publisher. Making copies of this

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book or any portion, for any purpose other than your own is a violation
of copyright laws. The author and publisher have used their best
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efforts in preparing this book and believe that the content is reliable
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and correct to the best of their knowledge. The publisher makes no

representation or warranties with respect to the accuracy or
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completeness of the contents of this book.

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 Introduction

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In today’s era, hospitals are experiencing increased consumer pressure. Healthcare delivery has seen metamorphic changes
over the years. The planning, designing, and architecture of hospitals and healthcare institutes is reflective of the paradigm

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shift in the outlook of healthcare services from mere patient treatment to a concerted approach towards promoting healthy
living. The major reasons for this change are globalisation, increased expectations of patients and healthcare providers,
emphasis on ambulatory services, increased standards of healthcare and consumer awareness.

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Hospitals are among the largest and most complex of all modern day institutions. It becomes essential to carefully plan

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and design hospitals to facilitate smooth operations and fulfil customer requirements. Wilson Churchill once said, “First we
shape our buildings, thereafter they shape us”. This certainly stands true for hospital buildings. While a functional design

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would facilitate the growth of skills, economy, convenience, and comforts, an ill designed hospital could impede smooth
operations and affect the quality of health care.

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The book Hospital Architecture, Planning and Maintenance provides students with a holistic and comprehensive insight
into the planning and designing of hospitals. The prevalent best practices, emerging ideas such as integrated healthcare

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services and value added services have been described in various chapters of the book. The book has five major units on
hospital and hospital administrator, hospital planning and architecture, technical analysis of a hospital, hospital design
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and standards, and facilities planning and information system. The book also intends to explain various concepts, such as
planning and designing of hospital facilities; administrative and supportive services; and other facilities including inpatient,
ambulatory, and diagnostic services, to students. Towards the end, the book also discusses various technical factors affecting
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hospital design decisions, the existing hospital standards, and the need for hospital information system.
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  Syllabus

Syllabus

MBA (Hospital Management) - III Semester

Paper - XII

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HOSPITAL ARCHITECTURE, PLANNING AND MAINTENANCE
Paper Code: MBHM3002

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Objectives:

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‹‹ To understand the necessity of architecture and planning in Hospitals
‹‹ To get familiarised with the designing and maintenance of hospital systems

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UNIT I

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Hospital as a system: Definition of hospital – classification of hospitals – changing role of hospitals – role of hospital

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administrator – hospital as a system – hospital & community.

UNIT II

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Planning: Principles of planning – regionalization - hospital planning team – planning process – size of the hospital
– site selection – hospital architect – architect report – equipping a hospital – interiors & graphics – construction &
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commissioning – planning for preventing injuries – electrical safety

UNIT III
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Technical analysis: Assessment of the demand and need for hospital services – factors influencing hospital utilization –
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bed planning – land requirements – project cost – space requirements –hospital drawings & documents-preparing project
report.
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UNIT IV
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Hospital standards and design: Building requirement – Entrance & Ambulatory Zone – Diagnostic Zone – Intermediate
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Zone – Critical zone – Service Zone – Administrative zone – List of Utilities – Communication facility – Biomedical
equipment - Voluntary & Mandatory standards – General standards – Mechanical standards – Electrical standards –
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standard for centralized medical gas system – standards for biomedical waste

UNIT V
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Facilities planning: Transport – Communication – Food services – Mortuary – Information system – Minor facilities –
others.
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REFERENCES
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G.D.Kunders, DESIGNING FOR TOTAL QUALITY IN HEALTH CARE

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Gupta S.K;SunilKant Chandra Shekhar; R Satpathy, MODERN TRENDS IN PLANNING AND DESIGNING OF
HOSPITALS

Syed Amin Tabish, HOSPITAL AND NURSING HOMES PLANNING, ORGANISATIONS & MANAGEMENT

G.D.Kunders, HOSPITALS, FACILITIES PLANNING AND MANAGEMENT

DDE, Pondicherry University, Pondicherry v

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 Table of Contents

Unit I: Introduction to Hospital

1. Hospital and Hospital Administrator......................................................................................................................1

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1.1 Introduction...................................................................................................................................................................................... 2
1.2 Concept of Hospital....................................................................................................................................................................... 3

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1.2.1 Need for Hospital................................................................................................................................................................4
1.2.2 Objectives of Hospital.......................................................................................................................................................5

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1.2.3 Functions of Hospital.......................................................................................................................................................5
1.3 Classification of Hospitals............................................................................................................................................................ 6

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1.4 Changing Role of Hospitals ......................................................................................................................................................11
1.5 Concept of Hospital Administrator..........................................................................................................................................12

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1.5.1 Need of Hospital Administrator.................................................................................................................................. 13

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1.5.2 Objectives of Hospital Administrator........................................................................................................................ 14
1.5.3 Role of Hospital Administrator................................................................................................................................... 14
1.6 Hospital As A System..................................................................................................................................................................15

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1.7 Relationship Between Hospital And Community..................................................................................................................17
1.8 Summary.........................................................................................................................................................................................18
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1.9 Glossary...........................................................................................................................................................................................19
1.10 Terminal Questions......................................................................................................................................................................20
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1.11 Answers...........................................................................................................................................................................................20
1.12 Case Study: Improving Health Administration.....................................................................................................................21
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1.13 References and Suggested Readings ........................................................................................................................................22

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Unit II: Hospital Planning and Architect

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2. Hospital Planning....................................................................................................................................................23
2.1 Introduction....................................................................................................................................................................................24
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2.2 Concept of Hospital Planning...................................................................................................................................................25

2.2.1
Need For Hospital Planning........................................................................................................................................ 26
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2.2.2 Principles of Hospital Planning.................................................................................................................................. 27

2.2.3 Regionalisation................................................................................................................................................................. 28
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2.2.4 Hospital Planning Team................................................................................................................................................ 30

2.3 Hospital Planning Process..........................................................................................................................................................33
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2.4 Hospital Planning Considerations............................................................................................................................................38

2.4.1 Size of the Hospital......................................................................................................................................................... 40
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2.4.2 Site Selection..................................................................................................................................................................... 40

2.5 Summary.........................................................................................................................................................................................41
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2.6 Glossary...........................................................................................................................................................................................43
2.7 Terminal Questions......................................................................................................................................................................43
2.8 Answers...........................................................................................................................................................................................43
2.9 Case Study: Regionalisation of Us Healthcare Systems......................................................................................................44
2.10 References and Suggested Readings.........................................................................................................................................46
 Hospital Architecture, Planning and Maintenance

3. Hospital Architect....................................................................................................................................................47
3.1 Introduction....................................................................................................................................................................................48
3.2 Concept of Hospital Architect...................................................................................................................................................49
3.2.1 Need for Hospital Architect.......................................................................................................................................... 49
3.2.2 Role of Hospital Architect............................................................................................................................................ 50
3.2.3 Architect Report.............................................................................................................................................................. 51

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3.3 Equipping a Hospital....................................................................................................................................................................53
3.3.1 Interiors and Graphics................................................................................................................................................... 56

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3.3.2 Construction And Commissioning.............................................................................................................................. 58
3.4 Hospital Safety...............................................................................................................................................................................59

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3.4.1 Planning for Preventive Injuries.................................................................................................................................. 60
3.4.2 Electrical Safety............................................................................................................................................................... 61

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3.5 Summary.........................................................................................................................................................................................62
3.6 Glossary...........................................................................................................................................................................................63

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3.7 Terminal Questions......................................................................................................................................................................63

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3.8 Answers...........................................................................................................................................................................................64
3.9 Case Study: Hospital Architecture of Stobhill Hospital......................................................................................................65
3.10 References and Suggested Readings.........................................................................................................................................66

Unit III: Technical Analysis of a Hospital

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4. Technical Analysis ..................................................................................................................................................67
4.1 Introduction....................................................................................................................................................................................68
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4.2 Concept of Hospital Services.....................................................................................................................................................68

4.2.1 Assessment of the Need and Demand of Hospital Services................................................................................. 69
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4.3 Factors Influencing Hospital Utilisation.................................................................................................................................72

4.4 Technical Factors..........................................................................................................................................................................74
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4.4.1 Bed Planning..................................................................................................................................................................... 74

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4.4.2 Land Requirements......................................................................................................................................................... 75

4.4.3 Project Cost....................................................................................................................................................................... 76
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4.4.4 Space Requirements........................................................................................................................................................ 77

4.5 Hospital Drawings and Documents..........................................................................................................................................81
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4.5.1 Preparing Project Report.............................................................................................................................................. 81

4.6 Summary.........................................................................................................................................................................................83
4.7 Glossary...........................................................................................................................................................................................84
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4.8 Terminal Questions......................................................................................................................................................................84

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4.9 Answers...........................................................................................................................................................................................84
4.10 Case Study: Apollo Hospitals.....................................................................................................................................................85
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4.11 References and Suggested Readings ........................................................................................................................................86

Unit IV: Hospital Design and Standards

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5. Hospital Design.......................................................................................................................................................87
5.1 Introduction....................................................................................................................................................................................88
5.2 Concept of Hospital Design.......................................................................................................................................................88
5.2.1 Building Requirement..................................................................................................................................................... 90

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 Table of Contents

5.2.2 List of Utilities................................................................................................................................................................. 91

5.2.3 Biomedical Equipment.................................................................................................................................................... 93
5.3 Zones in a Hospital.......................................................................................................................................................................96
5.3.1 Entrance and Ambulatory Zone................................................................................................................................... 96
5.3.2 Diagnostic Zone............................................................................................................................................................... 98
5.3.3 Intermediate Zone........................................................................................................................................................... 99

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5.3.4 Critical Zone...................................................................................................................................................................101
5.3.5 Service Zone....................................................................................................................................................................102

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5.3.6 Administrative Zone.....................................................................................................................................................103
5.3.7 Communication Zone....................................................................................................................................................104

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5.4 Summary.......................................................................................................................................................................................105
5.5 Glossary.........................................................................................................................................................................................106

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5.6 Terminal Questions....................................................................................................................................................................107
5.7 Answers.........................................................................................................................................................................................107

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5.8 Case Study: Design of VIKRAM Hospital...........................................................................................................................108

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5.9 References and Suggested Readings.......................................................................................................................................108

6. Hospital Standards............................................................................................................................................... 109

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6.1 Introduction..................................................................................................................................................................................110
6.2 Concept of Hospital Standards................................................................................................................................................110
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6.2.1 Need and Importance of Hospital Standards.........................................................................................................111
6.3 Types of Hospital Standards...................................................................................................................................................112
6.3.1 General and Mechanical Standards...........................................................................................................................113
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6.3.2 Electrical Standards......................................................................................................................................................114
6.3.3 Standards for Centralised Medical Gas System.....................................................................................................116
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6.3.4 Standards for Biomedical Waste.................................................................................................................................118

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6.4 Summary.......................................................................................................................................................................................121
6.5 Glossary.........................................................................................................................................................................................122
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6.6 Terminal Questions....................................................................................................................................................................122

6.7 Answers.........................................................................................................................................................................................123
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6.8 Case Study: New Hospital Standards for Good Samaritan Hospital..............................................................................124
6.9 References and Suggested Readings.......................................................................................................................................125
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Unit V: Facilities Planning and Information System

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7. Facilities Planning................................................................................................................................................. 127

7.1 Introduction..................................................................................................................................................................................128
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7.2 Concept of Facility Planning...................................................................................................................................................128

7.2.1 Need of Facility Planning...........................................................................................................................................130
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7.2.2   Objectives of Facility Planning...............................................................................................................................131

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7.3 Types of Facilities......................................................................................................................................................................132

7.3.1 Transport.........................................................................................................................................................................132
7.3.2 Food Services..................................................................................................................................................................133
7.3.3 Mortuary..........................................................................................................................................................................134
7.3.4 Laundry Services...........................................................................................................................................................135
7.3.5 Parking Facility..............................................................................................................................................................136

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 Hospital Architecture, Planning and Maintenance

7.4 Summary.......................................................................................................................................................................................138
7.5 Glossary.........................................................................................................................................................................................139
7.6 Terminal Questions....................................................................................................................................................................140
7.7 Answers.........................................................................................................................................................................................140
7.8 Case Study: Plans to Improve Wexham Park Hospital Parking......................................................................................141
7.9 References and Suggested Readings.......................................................................................................................................141

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8. Hospital Information System (HIS) .................................................................................................................... 143

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8.1 Introduction..................................................................................................................................................................................144
8.2 Concept of Hospital Information System.............................................................................................................................145
8.2.1 Need for HIS...................................................................................................................................................................145

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8.2.2 Objectives of HIS..........................................................................................................................................................146

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8.2.3 Scope of HIS...................................................................................................................................................................147
8.3 Types of HIS...............................................................................................................................................................................149

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8.4 Framework of HIS.....................................................................................................................................................................150
8.5 Benefits and Limitations of HIS.............................................................................................................................................153

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8.6 Summary.......................................................................................................................................................................................154
8.7 Glossary.........................................................................................................................................................................................155

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8.8 Terminal Questions....................................................................................................................................................................155
8.9 Answers.........................................................................................................................................................................................155
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8.10 Case Study: Improving Performance through Implementation of Hospital Information System (HIS)..............156
8.11 References and Suggested Readings.......................................................................................................................................157
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chapter

1 Hospital and Hospital

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Administrator

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Structure

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1.1 Introduction

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Learning Objectives U
1.2 Concept of Hospital

1.3 Classification of Hospitals

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1.4 Changing Role of Hospitals

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1.5 Concept of Hospital Administrator

1.6 Hospital as a System

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1.7 Relationship between Hospital and Community

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1.8 Summary
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1.9 Glossary
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1.10 Terminal Questions

1.11 Answers
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1.12 Case Study: Improving Health Administration

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1.13 References and Suggested Readings

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Hospital Architecture, Planning and Maintenance

Notes Learning Objectives

After completing this chapter, you will be able to:
 Describe the need for a hospital
 Identify the objective and functions of a hospital
 Classify hospitals on the basis of their services
Discuss the changing role of hospitals

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 Explain the need, objective and role of hospital administrator

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 Define hospital as a system
 Describe the relationship between hospital and community

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1.1 Introduction

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For several decades, our civilisation has progressed in terms of technologies and living

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standards. The changes have led to the development of a society, which nurtures health and
human welfare as its main motto. The term ‘health’ has different interpretation for different

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persons. For someone, it means freedom from diseases whereas for someone, it may be the
normal functioning of body, mind and soul. For some people, it is merely a source of making
money. According to an old definition, “Health is completely defined as the state of absence of

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disease”. According to the World Health Organization (WHO), “health is a state of complete
physical, mental, and social well-being and not only the absence of illness or disability”. How
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can we get at the ultimate condition of health? Medical science plays an important role in
providing treatment and health care to the communities for their well being. The institutes,
which offer such facilities to people, are known as hospitals. Hospitals have specialised staffs
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and equipment to deal with various types of medical need.

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Initially, the western medical education was introduced in India by Christian Missionary
Organisation. It had laid down the foundation stone of Christian Medical College and
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Hospital in Vellore, before our independence in 1900. Gradually, several other hospitals
were founded in different parts of our country. The hospitals have significantly helped in
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establishing the contribution of pharmaceutical industries and pharmacy personnel towards

patient care. A pharmacy is meant to dispense medications to patients. Although there is
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no definite description of the facilities provided in a hospital, it is evident that the status
of pharmaceutical or clinical services provided to the patients needs to be adequate in any
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hospital.

Just as clinicians, pharmacy and pharmacists are also an integral part of a hospital. Apart
from providing medicines and drug-related information to the patients, they also ensure
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appropriate purchase of medicines by establishing safer systems for medicine storage and
supply. Inventory management, preparing hospital formulary and planning of budget
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utilisation are some of the responsibilities of a pharmacist other than patient care. In a
spoonful of sugar, the audit commission clearly specifies its expectation that a hospital should
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have patient-centred services, closely linked to the rest of the clinical team.
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The overall governing authority is the administration of a hospital. An administrator

is responsible for manpower, material and money, a combination of 3 Ms, to support the
healthcare professionals while providing better healthcare services to the patients. Except
some of the well established hospitals we have very few ones with these facilities. Even the
hospitals in our metropolitan cities i.e. Delhi, Chennai, Kolkata and Mumbai lack provisions
of sound patient care. We know that the administrator and all the members of a hospital
must work together for better results. Hospital administration is an important subject to

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 chapter 1  Hospital and Hospital Administrator

Notes the healthcare curriculum of the undergraduate and postgraduate students. A detailed study
about the management of hospital administration will help us to find a breakthrough in this
situation and improve the status of healthcare services to meet the world class standards.

In this chapter, you will study the concept of hospital by identifying the need for a hospital
along with its objective and functions. You will take a look at the classification of hospitals. In
addition, you will explore the changing role of hospital. Further ahead, you will study about

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hospital administrator. The chapter also discusses about hospital as a system. Towards the
end, you will study the relationship between hospital and community.

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1.2 Concept of Hospital

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(Source: http://www.beaconhospital.com.my/wp-content/uploads/beacon_building.jpg)
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A hospital plays a pivotal role in healthcare services. Hospitals are institutions with well
developed clinical facilities for inpatients as well as outpatients and have a well trained team of
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technical staff that caters to the needs of the patients. Round the clock services are provided
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to the inpatients of a hospital.

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Definition of Hospital
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A hospital can be defined as a domain or a public department having a main aim of providing
patient care through a team of trained healthcare professionals for the service of mankind by
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utilising their knowledge on modern and recent scientific techniques.

It is described as an organisation or institution that uses specialised scientific equipment and

employs a group of skilled personnel to care of patients while also offering the facilities for
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prevention, diagnosis, treatment, rehabilitation, teaching and research.

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Hospitals provide a wide range of services for serious, recuperating and fatal conditions using
several clinical and remedial aids in response to serious and fatal circumstances as a result
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of dreadful illnesses as well as wounds and heritable variances. By doing so, they also aid in
preparing requisite data for investigations, knowledge and administration.
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Possibly, the major occupation of our ancient hospitals was to segregate persons with
communicable and contagious ailments, in order to provide complete care and solace to the
sick or dying patients. Even in those times, a healthcare provider used to live their professional
life as per the teachings of Hippocrates, who left the world with his oath in the early 14th
century. The oath was “Whatever houses I may visit, I will come for the benefit of the sick and
I will keep them from harm and injustice”.

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Hospital Architecture, Planning and Maintenance

Notes The basic motto of ‘hospital dependence’ was formerly given by Downing (1958) and then by
Gordon and Groth (1961) to define psychologically unwell chronic patients, who are entirely
reliant on the hospital surroundings and their assistance.

Hospitals are primarily concerned with patient care and are continuously making close
linkages with the other areas of the health sector or community. As per the conventional
theory for the governance of hospital, every institute is well thought out to be accountable

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for the concern of the population. However, in urban areas it is quite tricky to connect a
wide range of inhabitants with any particular hospital to provide them with a larger number

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of healthcare services. The idea of communal aid would be more purposeful in the areas
with lesser socio-economic status. It would be beneficial too if a number of hospitals with
large topographical communities can be clubbed as a mass for a sound and cost effective

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services to all.

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1.2.1 Need for Hospital

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The main conventional motto of healthcare institutions is providing medical care to

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individuals.

Diseases are innumerable and more and more people are susceptible to various diseases due

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to our modern lifestyle. Due to modernisation, industrialisation, sedentary lifestyle, lack
of physical activities and stress, diseases have also evolved from infectious ones to lifestyle
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diseases. According to the World Health Organisation (WHO), more than 270 million people
are likely to suffer from diseases linked to unhealthy lifestyles and most of these people would
belong to China, India, Pakistan and Indonesia. Besides this, medical catastrophe and rampant
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epidemics are always on the threshold of dispersal. When the world was whacked in 2003
by SARS, approximately 800 lives were lost. Thus, it is apparent that we do require a huge
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number of hospitals, not mere structures with all medical facilities but an institution with
well trained and experienced clinical and non-clinical staff who can manage the modern
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equipments at the hospital.

Some specific reasons to justify the need of hospitals in your community are as follows:
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‹‹ Hospitals can provide some common and specific vaccinations to the people to protect
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them from infectious diseases.

‹‹ The vintage and commercial progress of a country is affected too, if the pioneers of
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that country are not well or are trying to cope up with their health conditions.
‹‹ A healthcare unit not only helps in treatment but also aids in conducting researches for
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the benefit of individuals, for example: finding a cure for cancer.

‹‹ Hospitals are also involved in educating the healthcare professionals such as clinicians,
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paramedical staff and pharmacists by conducting training, demonstrations, conferences

and workshops.
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‹‹ Usually medical universities have their own hospital set up, for educating the students.
This also allows them to apply their theoretical knowledge to the practical aspects in
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coordination with in a team of specialised healthcare practitioners, without affecting

the health of mankind.
‹‹ A country can also become self-sufficient without being dependent over other countries
for clinical facilities. Hospitals with different speciality can hire clinicians from different
areas and do not need to have access to the trained healthcare professionals from other
countries.

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 chapter 1  Hospital and Hospital Administrator

Notes 1.2.2 Objectives of Hospital

The ultimate objective of a hospital is to offer appropriate care and therapy to its patients. Its
prime slogan is provision of clinical, invasive and intensive care to its patients and elevation
of the living standards of the human beings. All the government hospitals are dedicated in
providing valued clinical services free of cost to all, irrespective of any categorisation (except

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the diagnostic services like CT scan and MRIs). Most of the hospitals have facilities for the
outdoor patients in all the specialisations offered by them. Round the clock emergency services

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are available all through the year in all the hospitals under the guidance of senior doctors.

The aim of a hospital is:

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‹‹ To provide clinical services of all and to cater the best possible medical facilities for
them.

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‹‹ To meet all the challenges in order to have a reputed design.

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‹‹ To be the mentor for providing outstanding health care services to all in several spheres
of clinical needs’ irrespective of any discrimination.

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‹‹ To provide effective and efficient services, affordable to the patients.
‹‹ To demonstrate care and respect while communicating with patients.

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‹‹ To educate and advise patients and their families.
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‹‹ To have effective coordination among health professionals from different discipline.
‹‹ To maintain a friendly and cheerful atmosphere so that it provides great working
experience for the professionals and memorable experience for the patients.
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‹‹ To take care of the need of the members and staff.

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‹‹ To support research activities to bring excellence and innovation in the process of

treatment.
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1.2.3 Functions of Hospital

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The primary function of a hospital is to attend, diagnose and treat both indoor and outdoor
patients effectively and efficiently with the help of a proficient clinical team. There are several
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other functions of a hospital. Some of them are listed below:

‹‹ Counselling and guiding indoor and outdoor patients
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‹‹ Making the physically challenged patients aware of the services and provisions available
for them (Government. and voluntary sector)
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‹‹ Providing counselling services for the family members of patients.

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‹‹ Motivating people for family planning and blood donation

‹‹ Creating a liaison among the patient, his or her relatives and the healthcare practitioner
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for providing an effectual clinical care to the patient

‹‹ Attending to the referral services from the doctors for indoor patients
‹‹ Managing all medico-legal cases coming under the adjoining police stations
‹‹ Restoring the details of unknown patients

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Hospital Architecture, Planning and Maintenance

Notes ‹‹ Providing referral services to patients.

‹‹ Attending unattended or unknown patients.
‹‹ Providing rehabilitation services to patients.
‹‹ Providing financial aid to the needy patients.
‹‹ Attending to the grievances or complaints of the patients

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‹‹ Focusing towards patient care for both an individual patient and the whole community,
despite of any caste, creed, race or economic status of the ill.

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‹‹ Minimising the increased epidemiology of certain chronic diseases through early
diagnosis and treatment

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‹‹ Ensuring timely supply of facilities and equipments and their utilisation for the
evaluation, control and maintenance of the conditions respectively.

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‹‹ Maintaining a strong liaison between the patient, healthcare professional and the

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administrator or policy makers of the institution
‹‹ Stimulating the advancement of medical science by several research and projects

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‹‹ Maintaining an effective system for compilation of clinical data of the patient including
their reports, drug allergies and medication history

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‹‹ Providing education to all including medical students, healthcare professionals and
nursing staff.
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‹‹ Developing several projects and safety programs for the upliftment and improvement
of ill health care.
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Self-Assessment Questions
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1. Initially, the western medical education was introduced in India by __________

organisation.
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2. A hospital is an institution which makes use of specialised scientific ___________and

functions through a team of trained staff for _________care.
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3. A hospital provides the following facilities:

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a. Diagnosis b. Rehabilitation
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c. Entertainment d. Therapy

4. People suffer from lifestyle diseases due to infections. (True/False)

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5. The primary function of a hospital is to attend, diagnose and treat both _______ and
outdoor patients effectively and efficiently.
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1.3 Classification of Hospitals

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Every hospital differs in terms of their structure, size, services, scientific equipments, team
of health professionals and other services. Based on these criteria, hospitals can be broadly
classified in to following categories:
‹‹ On the basis of the clinical objective of a hospital:
 Specialised hospitals: These are solely devoted towards their field ofspecialisation
and do not provide others services to the patients. Such hospitals cater to any

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 chapter 1  Hospital and Hospital Administrator

Notes specialised area such as cancer, tuberculosis, gall and kidney stones, heart diseases,
paediatrics or any other disease. For example, a hospital specialised for kidney and
gall stones provide all the services related to its field. It has facilities of detecting
and removing stone instead of having an Out Patient Department (OPD) to treat
general ailments such as fever.
 Maternity hospitals: These hospitals also provide services related to their

Y
specialisation i.e. gynaecology and obstetrics. All facilities regarding pregnancy
and child birth are offered in these institutions. Fig. 1.1 depicts a maternity hospital:

IT
S
R
E
IV
N
Fig. 1.1: A maternity hospital
U
(Source: http://cdn.timesofisrael.com/uploads/2012/12/Web_F2003FF1188.jpg)

 General hospitals: These hospitals usually serve humanity irrespective of any

specialisation in any particular field. Such hospitals include specialised team of
Y

healthcare professionals for paediatrics, communicable diseases such as cold and

cough, skin diseases, psychiatric diseases or mental disorders, cancer, family
R

planning, dental ailment and some other diseases under one roof. Fig. 1.2 depicts a
general hospital:
R
E
H
IC
D
N
O

Fig. 1.2: A general hospital

P

(Source: https://www.claseek.net/wp-content/uploads/2014/10/ChangeGeneralHospital1413005768.jpg)

 Teaching hospitals: Such hospitals are majorly devoted towards education and
research curriculum of graduate and postgraduate students for example, All India
Institute of Medical Sciences (AIIMS) New Delhi, Sri Mahant Indiresh Hospital
(SMIH) Dehradun and Post Graduate Institute of Medical Education and Research
(PGIMER) Chandigarh. The hospitals attached to the medical colleges come under
this category. Fig. 1.3 depicts a teaching hospital:

DDE, Pondicherry University, Pondicherry 7

Hospital Architecture, Planning and Maintenance

Notes

Y
IT
S
R
Fig. 1.3: A teaching hospital

E
(Source: http://www.henrybootconstruction.co.uk/wp-content/gallery/news2012/royal-hallamshire-hospital.jpg)

IV
‹‹ Non-teaching hospitals: Hospitals which are not attached to any medical college or
research based institutions are part of this category. These are majorly concerned for
serving the community for sound health benefits or outcomes.

N
On the basis of the ownership or type of the hospital:
U
‹‹ Government hospitals: Such type of hospitals comes under the aegis of governmental
administration. The main objectives of these hospitals are healthcare, education and
research. These are not oriented towards making profit through patient care as in case
Y

of private hospitals. Examples of such hospitals include AIIMS New Delhi, PGIMER
Chandigarh and SMS Jaipur. Some of these hospitals are associated with medical
R

colleges or research based institutions. Fig. 1.4 depicts a government hospital:

R
E
H
IC
D
N
O

Fig. 1.4: A government hospital

(Source: http://timesofindia.indiatimes.com/photo/29459237.cms)
P

‹‹ Private hospitals or Non-Governmental hospitals: These include hospitals which are

either set up with the sole aim of profit making or set up as charitable trust hospitals
with the aim social service. Charitable trust hospitals are non-profit organisations.

8 DDE, Pondicherry University, Pondicherry

 chapter 1  Hospital and Hospital Administrator

Notes
Fig. 1.5 depicts a private hospital:

Y
IT
S
R
Fig. 1.5: A private hospital

E
(Source: http://nazret.com/blog/media/blogs/new/fortis_hos.jpg)

IV
On the basis of medicine system, they are been broadly classified as:
‹‹ Allopathic hospitals

N
‹‹ Ayurvedic hospitals
‹‹ Homeopathic hospitals
U
‹‹ Unani hospitals
‹‹ Yoga and Acupuncture centres
Y

‹‹ Hospitals which offer other type of treatment and medicines

R

On the basis of cost of the hospitals, they are classed as:

R

‹‹ Elite hospitals: These are designed for privileged classes of our society. The facilities
provided are of very high standard and treatment is very costly. Fig. 1.6 depicts an elite
E

hospital:
H
IC
D
N
O
P

Fig. 1.6: An elite hospital

(Source: http://images.idiva.com/media/photogallery/2012/Mar/seven_hills_600x450.jpg)

DDE, Pondicherry University, Pondicherry 9

Hospital Architecture, Planning and Maintenance

Notes  Budget hospitals: These are low cost hospitals as compared to the other hospitals.
The objective of these privately run hospitals are to provide care to the community
and at the same time make profit by treating more patients.
‹‹ Nursing homes: These are set up like small hospitals which can take care of very few
patients only. Fig. 1.7 depicts a nursing home:

Y
IT
S
R
E
IV
N
U
Fig. 1.7: A nursing home
(Source: http://3.imimg.com/data3/NQ/WA/MY-9302744/bali-nursing-home-bali-medical-dental-centre-500x500.png)

‹‹ On the basis of bed size, hospitals are been categorised as:

Y

 Hospitals having more than 900 beds are classed as large hospital.
R

 Those having a bed size of more than 400 and less than 900 beds are part of
mediocre hospital.
R

 Hospitals having a bed size of 100-400 or less than 100 beds are classed as smaller
E

hospitals or private nursing homes respectively.

H

Self-Assessment Questions
6. Hospitals are classified based on the following category:
IC

a. size of the building

b. clinical objective
D

c. ownership
N

d. bed size
O

7. ________ hospitals are designed for privileged classes of our society.

8. AIIMS, New Delhi is a government hospital. (True/False)

P

10 DDE, Pondicherry University, Pondicherry

 chapter 1  Hospital and Hospital Administrator

Notes Activity
Assume you are a hospital staff and your senior has asked you to classify your hospital.
Note down the various criteria and options to catergorise the hospital.

1.4 Changing Role of Hospitals

Y
You have read earlier in this chapter that hospitals in the early days of its invention used

IT
to function only as places for the treatment of ill patients. Modern hospitals have grown into
institutes that have treatment facilities for several types of ailments under one roof. Changes in the
living standards of people have changed our lifestyle and have given birth to several ailments and

S
disorders such as obesity, blood pressure and diabetes. Earlier, our healthcare systems were majorly
oriented towards treatments for communicable diseases but nowadays along with communicable

R
diseases, several non-communicable diseases also need attention and proper treatment. All these
are outcomes of the changing demands and living standards of mankind.

E
The growth of hospitals in our country is slow but steady. Gone are the days when families

IV
had no option but to leave the patient to die due to lack of money for treatment. Now, there
are hospitals for all kind of communities where patients get their treatments irrespective of
their socioeconomic status. The role of a hospital is gradually changing from providing mere

N
treatment to providing care to the individuals. This changing role of hospital is interlinked with
availability of better expertise, increased information and data about the causes of ailments
U
and several measures for prevention. Nowadays, hospital has become a multifaceted institution
with newer roles and responsibilities as compared to the traditional ones. With these upcoming
changes, the roles and responsibilities of the administrators are becoming challenging day by day.
Y

In the wake of epidemic diseases, there is always an increased demand of number of beds,
R

medicines and equipments. To overcome this problem, hospitals need to initiate healthcare
programmes to spread awareness on preventive measures, early detection and control of the
R

disease. This way, educating the communities also becomes a part of its role.
E

Factually, hospitals are immobile buildings which are designed and made of concrete. When
a hospital is built, the civil and architectural plan imitates the kind of clinical care that would
H

be provided to the patients. Gradually, the demand changes and the hospital have to cope with
various discordant situations such as inappropriate or inadequate operation theatres, scarcity
IC

of power plugs, insufficient number of beds and inadequate staff. Therefore, the role is not
only restricted to providing care but also to meet the new demands and challenges through
constant modifications, improved facilities and expansion plans.
D

Self-Assessment Questions
N

9. Earlier, our healthcare systems were majorly oriented towards treatments for
_________ diseases:
O

10. In the wake of ___________ diseases, there is always an increased demand of number
P

of beds, medicines and equipment.

11. The role of a hospital is restricted to providing care. (True/False)

DDE, Pondicherry University, Pondicherry 11

Hospital Architecture, Planning and Maintenance

Notes Activity
Assume that you are a research student and prepare a short report on the changing trends
of healthcare system in India.

1.5 Concept of Hospital Administrator

Y
IT
S
R
E
IV
N
U
(Source: http://www.masters-in-health-administration.com/wp-content/uploads/2014/08/administration-data.jpg)

In many respects, the organisational pattern of hospitals resembles an industrial unit and the
Y

apparent difference is superficial. For example, in a commercial entity there may be a general
manager or the executive vice-president whereas in a hospital there is a Director. In India,
R

hospitals are usually governed either by the government or by a private management or trust,
under the supervision of a director or a superintendent. The number of personnel depends
R

upon the size of the hospital.

E

A hospital is generally managed by directors of the institutions or by the council advised and
appointed by the government. They delegate the active management of the hospital to an
H

administrator along with his staff. The administrator further delegates responsibilities to the
department heads.
IC

The main function of an administrator is to enforce the policies framed and laid down by the
board of trustees, which serves as the hospital’s daily operating body. Furthermore, he or
D

she is expected to play an active role in community PR since the hospital offers a variety of
supporting services in addition to clinical departments, including a nursing department, food
N

services, laboratory services, medical records department, and blood bank. The administrator
acts as a liaison between the medical staff and board of trustees. He operates the entire
institution such that the highest possible standards of both services and economy are assured
O

not only to the patients medical and scientific staff and the trustees.
P

12 DDE, Pondicherry University, Pondicherry

 chapter 1  Hospital and Hospital Administrator

Notes Fig. 1.8 depicts the administrative hierarchy of a hospital:

GOVERNING COUNCIL/BOARD OF TRUSTEES

SUPERINTENDENT/ DIRECTOR

Personnel Administrative Assistant

Y
Executive Committee Public Relations

IT
Associate Associate Associate Associate
Director/Head of Director/Head Director/Head Director/Head
clinical Services Specialized Services pharmacy Services Administrative

S
Services

R
-Medicine -Nursing Services -Manufacturing Unit -Grants &

E
Contracts

IV
-Surgery -Dietary Services -Drugs Purchase & -Credit

Distribution Services

N
-Radiology -Physiotherapy -Drug Information -Telephone

Services Services
U -Housekeeping
-Blood Bank -Medico legal & Medico- -Medical Record

Social services keeping Services

Y

-Pathology -Laundry
R

-Clinical/Research Laboratory

Fig. 1.8: Administrative hierarchy of a hospital

R
E

1.5.1 Need of Hospital Administrator

H

Clinicians, nurses and other healthcare teams have a lot to do at a medical centre other than
just treating the medical conditions of patients. Unless, they administer different functions,
IC

such as marketing, accounting, or budgeting to different departments, the health care industry,
cannot be successful in its endeavours. Health care setting administrators handle the overall
business by performing several duties as discussed later in this chapter.
D

As you have studied, a hospital is an active organisation for treating individuals and is healthcare
N

professionals operate in an interdisciplinary environment. The hospital administrator is the

one who is in charge of maintaining the seamless operations of this mutually beneficial
O

infrastructure. Such administrators really are the forerunners of the organisation they
oversee. The community and the institution are affected by their choices.
P

Running a hospital is a tough trade now as compared to the previous times and the functioning
pattern is changing from time to time. A skilled administrator is an important entity of

DDE, Pondicherry University, Pondicherry 13

Hospital Architecture, Planning and Maintenance

Notes a healthcare setting who can make sure that all the amenities are running efficiently and
thereby provide sound patient care. Depending on its size, a facility may have one or several
administrators. They are responsible for making sure that hospitals operate efficiently and
provide quality medical care to patients.

1.5.2 Objectives of Hospital Administrator

Y
The basic aim of a health care administrator is to accomplish the goal of the hospital and

IT
meet the challenges of changing health care system. He or she must continuously try to
improvise the status of the healthcare unit and must emphasise the principles of patient
oriented healthcare services to all the staff members.

S
Keeping the aforementioned objective in mind, a hospital administrator must plan accordingly

R
to meet up the loopholes of the system and try to achieve the best place for the hospital.
Administrators must create good linkages with various organisations, schools, colleges

E
and communities. In short, they must act as a liaison agent between the hospital and the
community. Apart from this, they should promote a conducive and cheerful atmosphere within

IV
the hospital so that a bond and sense of loyalty is developed among the hospital members.
They must be creative and an out of box thinker to achieve the various targets within a short
span of time. According to a saying “A doctor works for the betterment of an individual and

N
keeping him alive and a hospital administrator works for the betterment of the hospital to
keep it healthy and alive”.
U
1.5.3 Role of Hospital Administrator
Y

A hospital administrator is the chief official in a hospital. A hospital may have certain number
R

of officials in several sections to manage the managerial operations. All these officials are
answerable to the hospital administrator.
R

The main roles and responsibilities of a hospital administrator are as follows:

E

‹‹ He or she acts as an official representative of the hospital. The administrator is in

charge to ensure that the functioning of the hospital must comply with the rules and
H

requirements laid down by the government.

‹‹ Being an administrator, he or she is basically a part of the governing board.
IC

Administrators are responsible for supervising all activities within the hospital or
related to the hospital.
D

‹‹ The administrators should ensure that the hospital staff is aware of the aims, motives
and objectives of the hospital.
N

‹‹ They must implement all the decisions taken by the governing body for the upliftment
of the hospital.
O

‹‹ They are responsible for formulating rules and procedures and implementing those on
P

the hospital team.

‹‹ The administrator has to prepare and submit an annual progress report to the governing
body of the hospital.
‹‹ He or she acts as a linkage between the management and the employees of the hospital.

14 DDE, Pondicherry University, Pondicherry

 chapter 1  Hospital and Hospital Administrator

Notes ‹‹ It is the responsibility of an administrator to encourage a healthy rapport between the

employer and the employees.
‹‹ An administrator has to works in association with the other officials of the hospital
such as medical supervisor and nursing supervisor.
‹‹ Ensuring smooth and efficient functioning of the specialisation areas or sections of the
hospital is another function of the hospital administrator.

Y
‹‹ Maintaining contacts with the government organisations, employees, communities and

IT
media personnel also comes within the purview of the administrator.

A brief overview of the role of an administration:

S
‹‹ Maintaining community relations

R
‹‹ Maintaining physician relations
‹‹ Functioning of hospital

E
‹‹ Evaluating programs

IV
‹‹ Planning and allocating budget
‹‹ Controlling cost

N
‹‹ Assessing service quality
‹‹ Taking Continuous improvement initiatives
U
Self-Assessment Questions
Y

12. The main function of an ___________ is to enforce the policies framed and laid down
by the board of trustees or the governing body for the day to day working of the
R

hospital.

13. An administrator is basically a part of the _______ board.

R

14. Hospital administrators act as a linkage between the management and the patients of
E

the hospital. (True/False)

H

1.6 Hospital As A System

IC

India has a general health system streamed by resident states. The basic necessity of each state
is stated as “among its key obligations is the enhancement of public health, the increasing of
D

the standard of living and food provided for its citizens.” The Indian Parliament approved the
National Health Policy in 1983. In comparison to the public or the governmental healthcare
N

units, private health units are more popular, widely used and trusted by individuals these days.
As per various surveys, both urban and rural areas utilise private health services more as
O

compared to the government ones. What could be the reason behind this? The most evident
reason is better service. A hospital is a complex social organisation with a number of different
P

departments that need to function in coordination with each other. It is possible to provide
better services only when a hospital functions as a system. A hospital system is a hierarchical
chain with distinct objectives at each level that are connected to and reliant upon other units
and subunits.

DDE, Pondicherry University, Pondicherry 15

Hospital Architecture, Planning and Maintenance

Notes A hospital is an institution that incorporates all the expertise and efforts of different groups
of clinical and non-clinical staff in order to provide the patients highly specialised services.
Consequently, it is essential to integrate the diverse elements in a cohesive fashion and operate
via the authority of supervision and synchronisation. This justifies the hospital’s institutional
systematic operation. As hospitals also have external surroundings and links, they are also
called open systems. Fig. 1.9 depicts the various functions of a hospital as a system:

Y
OBJECTIVE

IT
INPUT PROCESS OUTPUT

S
PATIENT DEPARTMENTAL PATIENT SATISFACTION
SUPPLIES FUNCTION QUALITY OF CARE
INFORMATION OUT

R
MACHINES
STAFF PUBLIC RELATION
PROCESS
CONTROL

E
INPUT OUTPUT
RATE RATE
CONTROL MANAGER MONITOR

IV
FEED BACK

N
Fig. 1.9: Hospital as a system
(Source: imgres?imgurl=https%3A%2F%2Fround-lake.dustinice.workers.dev%3A443%2Fhttp%2Fwww.e-dendrite.com)
U
A hospital system comprises of synchronised activities which are carried out by several
categories of hospital staff using their skills and expertise.
Y

The functions of a hospital system can be broadly classed as clinical and organisational as
shown in Fig. 1.10:
R

THE ORGANIZATION FUNCTION

HOSPITAL CLINICAL
R

PATIENT CARE MAINTENANCE

FUNCTION SERVICES SERVICES
E

LEGAL & STATULORY LOGISTICS &

OUT PATIENT NURSING INPATIENT RESPONSIBILITY SUPPLIES
SERVICES SERVICES SERVICES
H

ORGANIZATION ETHICS &

PUBLIC RELATION
CODE OF CONDUCT

MARKETING HOSPITAL
CLINICAL SERVICES
IC

MANAGEMENT SAFETY

MANAGEMENT
QUALITY
INFORMATION
FINANCE & MANAGEMENT
SYSTEM
EMERGENCY O.T BUDGETTING
D

CCU/ ICU
SERVICES SERVICES
STAFF PLANNING &
MANAGEMENT DECISION MAKING
N

Fig. 1.10: Clinical and organisational function

(Source: Dr N.C Das, Hospital As a System)
O

With so many functions, a hospital becomes a complicated system but the survival of the
P

hospital will depend upon the level of patient satisfaction and acceptance as shown in
Fig. 1.11.

Thus, patient centred system becomes the basic and important requirement of a hospital
system.

16 DDE, Pondicherry University, Pondicherry

 chapter 1  Hospital and Hospital Administrator

Notes PATIENT CENTERED ACTIVITIES OF

HOSPITAL SYSTEM
OPD IN PATIENT EMERGENCY OPERATION

PATIENT
CARE

Y
SUPPORT UTILITY NURSING BUSINESS

IT
ADMINISTRATOR

S
PHYSICAL SAFETY EMOTIONAL
NEED NEEDS NEEDS

R
PATIENT
NEEDS

E
IV
STAFF PATIENT EDUCATIONAL
ATTITUDE SATISFACTION NEED

Fig. 1.11: Patient centred system

Self-Assessment Questions
N
U
15. A hospital system is a _________chain of units and sub-units interrelated and
interdependent, having clear cut objective at each level.
Y

16. Hospitals have external surroundings and links as well and hence called closed
system. (True/False)
R

Activity
R

Prepare a report on how a hospital functions as a system.

E
H

1.7 Relationship Between Hospital And Community

IC

A hospital is known by the services it provides to the patients. People are part of community
and they are the ones who can elevate the status of any hospital by showing trust and
faith and through excellent word of mouth. A hospital is a social organisation and its core
D

value is caring. One of the ways to establish this core value is by serving and supporting
the community. Hospitals are set up with the objective of treating people of surrounding
N

communities but the services of a hospital is never restricted to any local area. Therefore, the
responsibility of a hospital is to take care of the society at large. Its mission should be to help
O

people irrespective of caste, creed or economic status.

Hospitals contribute to the stability and development of local economy by improving the health
P

conditions of the communities. They can play an important role in community development
activities. There are various diseases which are prevented through mass vaccination. During
natural calamities, epidemic outbreak and emergency situations such as mass injury during
accidents, hospitals and the heath care professionals are the ones who can save the community.

DDE, Pondicherry University, Pondicherry 17

Hospital Architecture, Planning and Maintenance

Notes Community benefit programmes such as regular health screenings, counselling related to
nutrition, disease prevention services, family planning services and imparting knowledge on
basic healthcare and hygiene can be conducted by the health care institutions.

Various hospitals and health care centres throughout the country can coordinate to carry out
mass scale immunisation programme. For example: Pulse polio immunisation campaign was
promoted by the government of India to fight poliomyelitis. All children below the age of five

Y
years were to be vaccinated through oral dose on the same day. It has been a very successful
campaign and WHO has already removed India from the list of polio-endemic countries.

IT
India will be polio free if no new case is testified till 2014.

Community benefits are tracked by collecting information, conducting surveys and preparing

S
databases. The information is shared through various media promotions, awareness
programmes and mass communications. When communities become aware of the benefits,

R
they start to take part in more numbers. Non-profit health institutions get tax benefits by
showing community benefits.

E
Hospitals are made for the community and communities make a hospital famous. More and more

IV
hospitals are working towards community benefits. Central government, state government,
non governmental institutions, social organisations and international institutions are joining
hands with various hospitals to promote community development and benefits.

Self-Assessment Questions

N
U
17. One of the ways to establish the core value of a hospital is by serving and supporting
the___________.
Y

18. Community benefit programmes are

a. regular health screenings
R

b. counselling related to nutrition

R

c. disease prevention services

E

d. treating lifestyle diseases

19. ________ ________ immunisation campaign was promoted by the government of

H

India to fight poliomyelitis.

IC

1.8 Summary
D

‹‹ World Health Organisation (WHO) defines ‘health’ as “a state of complete physical,

mental and social well-being and not merely an absence of disease or infirmity”.
N

‹‹ Initially, the western medical education was introduced in India by Christian Missionary
O

Organisation. It had laid down the foundation stone of Christian Medical College and
Hospital in Vellore, before our independence in 1900.
P

‹‹ A hospital can be defined as a domain or a public department having a main aim of

providing patient care through a team of trained healthcare professionals for the service
of mankind by utilising their knowledge on modern and recent scientific techniques.
‹‹ The main conventional motto of healthcare institutions is providing medical care to
individuals.

18 DDE, Pondicherry University, Pondicherry

 chapter 1  Hospital and Hospital Administrator

Notes ‹‹ The ultimate objective of a hospital is to offer appropriate care and therapy to its
patients.
‹‹ The primary function of a hospital is to attend, diagnose and treat both indoor and
outdoor patients effectively and efficiently with the help of a proficient clinical team.
‹‹ Every hospital differs in terms of their structure, size, services, scientific equipment,
team of health professionals and other services.

Y
‹‹ Based on the clinical objective, ownership, medicine system, cost and bed size, hospitals

IT
can be broadly classified in to different categories.
‹‹ The role of a hospital is gradually changing from providing mere treatment to providing
care to the individuals. The role is also to meet the new demands and challenges through

S
constant modifications, improved facilities and expansion plans.

R
‹‹ A hospital is generally managed by directors of the institutions or by the council
advised and appointed by the government. They delegate the active management of

E
the hospital to an administrator along with his staff.

IV
‹‹ The main function of an administrator is to enforce the policies framed and laid
down by the board of trustees or the governing body for the day to day working of
the hospital.

N
‹‹ A skilled administrator is an important entity of a healthcare setting who can
make sure that all the amenities are running efficiently and thereby provide sound
patient care.
U
‹‹ The basic aim of a health care administrator is to improvise the status of the healthcare
Y
unit and must emphasise the principles of patient oriented healthcare services to all the
staff members.
R

‹‹ Administrators are responsible for supervising all activities within the hospital or
related to the hospital.
R

‹‹ A hospital system is a hierarchical chain of units and sub-units interrelated and

E

interdependent, having clear cut objective at each level.

‹‹ Patient centred system becomes the basic and important requirement of a hospital
H

system.
IC

‹‹ A hospital is a social organisation and its core value is caring. One of the ways to
establish this core value is by serving and supporting the community.
‹‹ Hospitals contribute to the stability and development of local economy by improving
D

the health conditions of the communities.

N

‹‹ Central government, state government, non-governmental institutions, social

organisations and international institutions are joining hands with various hospitals to
promote community development and benefits.
O
P

1.9 Glossary
‹‹ Hospital: It is a domain or a public department engaged in providing patient care
through trained healthcare professionals by utilising specialised scientific equipment.
‹‹ World Health Organisation (WHO): It is a specialised agency (under United Nations
(UN)) engaged in the area of international public health.

DDE, Pondicherry University, Pondicherry 19

Hospital Architecture, Planning and Maintenance

Notes
1.10 Terminal Questions
1. Define Hospital and classify them.

2. Explain the function of hospitals.

3. Explain the role and objective of a hospital administrator.

Y
4. Write a short note on hospital system.

IT
5. Write a short note on changing role of hospitals.

6. Explain the relationship between hospital and community.

S
1.11 Answers

R
Q. Self-Assessment Questions

E
1. Christian Missionary

IV
2. equipments, patient
3. a, b, d

N
4. False
5. indoor
U
6. b, c, d
7. Budget
Y

8. True
R

9. Communicable
10. Epidemic
R

11. False
E

12. Administrator
H

13. governing
14. False
IC

15. Hierarchical
16. False
D

17. Community
N

18. a, b, c
19. Pulse, polio
O

Q. Terminal Questions
P

1. A hospital can be defined as a domain or a public department having a main aim of

providing patient care through a team of trained healthcare professionals for the
service of mankind by utilising their knowledge on modern and recent scientific
techniques. Refer to sections 1.2 Concept of Hospital and 1.3 Classification
of Hospitals.

20 DDE, Pondicherry University, Pondicherry

 chapter 1  Hospital and Hospital Administrator

Notes 2. The primary function of a hospital is to attend, diagnose and treat both indoor
and outdoor patients effectively and efficiently with the help of a proficient
clinical team. Refer to sub-section 1.2.3 Functions of Hospital.
3. A hospital is a busy place where people get medical care. For those working
in the healthcare industry, the workplace is multidisciplinary and complicated.
A hospital administrator is responsible of maintaining the efficiency of this

Y
mutually beneficial infrastructure. The administrator’s primary responsibility is
to plan an active role in community public relations as well as liaison between the

IT
medical staff and board of trustees. Refer to sub-sections 1.5.2 Objectives of
Hospital Administrator and 1.5.3 Role of Hospital Administrator.

S
4. A hospital system is a hierarchical chain of units and sub-units which are
interconnected and interdependent, having clear cut objective at each level. Refer

R
to section 1.6 Hospital as a System.
5. Modern hospitals have grown into institutes that have treatment facilities for

E
several types of ailments under one roof. Refer to section 1.4 Changing Role of

IV
Hospitals.
6. Hospitals contribute to the stability and development of local economy
by improving the health conditions of the communities. Refer to section

N
1.7 Relationship between Hospital and Community.
U
1.12 Case Study: Improving Health Administration
Y

Mainland hospital has been running healthcare plan for all types of people coming from
various classes in Delhi. Recently, there had been a change in the management of the hospital.
R

The newly appointed management discovered that the current administrative processes were
disjointed and disorganised, and thus, need to be improved. Patients often voiced dissatisfaction
R

with the quality of the medical treatment offered by the hospital and complained about having
to wait too long to see a doctor. Other issues that the patients dealt with were subpar hospital
E

hygiene, protracted hospital stays, a shortage of supplies, deficit in budgets, etc.

H

In order to provide high-quality healthcare while controlling expenses, the new management
carried out a thorough examination of the hospital’s present management and offered a
IC

number of suggestions. Firstly, the whole administrative team was centralised which included
doctors, nurses and several administrators. A separate department was set up to provide
medical advice through dedicated phone line in case of any emergency. Various new equipment
D

were installed so that patients can be properly diagnosed and complete treatment could be
provided. Monthly reports of all the expenditures were created to obtain transparency of
N

important health concerns and pinpoint wellness and preventive initiatives for general public
that can be run properly.
O

After about eight months, of implementing these measures a significant improvement was
noticed in the satisfaction of patients. This was seen as the direct result of, the hospital
P

administration becoming highly organised and patients receiving improved preventive care,
diagnosis, and treatment.

DDE, Pondicherry University, Pondicherry 21

Hospital Architecture, Planning and Maintenance

Notes Discussion Questions

1. What were the loop holes in the hospital’s administration in the given case study?

(Hints: The administrative procedures were uncoordinated, long wait to see the doctor, etc.)

2. What recommendations were made by the new management in the Mainland hospital?

Y

(Hints: Centralisation of administration team, installation of new equipment, etc.)

IT
1.13 References and Suggested Readings

S
‹‹ James, P., and Noakes, T. (1994). Hospital architecture. New York: Longman.

R
‹‹ Nickl-Weller, C., and Nickl, H. (2009). Hospital. Berlin: Braun.
‹‹ Verderber, S. (2010). Innovations in hospital architecture. New York: Routledge.

E
E-References

IV
‹‹ Health.gov.on.ca. (2014). Classification of Hospitals - Regulation 964 - General

N
Hospitals - Health Services in Your Community - MOHLTC. Retrieved from, <http://
www.health.gov.on.ca/en/common/system/services/hosp/hospcode.aspx>
U
‹‹ Scribd.com.(2014). Classification of Hospitals. Retrieved from, <https://www.scribd.
com/doc/58245155/Classification-of-Hospitals>
Y
‹‹ Work - Chron.com. (2014). What Are the Duties of a Health Care Manager &
Administrator? Retrieved from, <http://work.chron.com/duties-health-care-manager-
R

administrator-11944.html>
R
E
H
IC
D
N
O
P

22 DDE, Pondicherry University, Pondicherry

chapter

2 Hospital Planning

Y
IT
S
R
E
Structure

IV
2.1 Introduction

N
Learning Objectives U
2.2 Concept of Hospital Planning

2.3 Hospital Planning Process

Y

2.4 Hospital Planning Considerations

R

2.5 Summary

2.6 Glossary
R

2.7 Terminal Questions

E

2.8 Answers
H

2.9 Case Study: Regionalisation of US Healthcare Systems

IC

2.10 References and Suggested Readings

D
N
O
P
Hospital Architecture, Planning and Maintenance

Notes Learning Objectives

After completing this chapter, you will be able to:
 Define hospital planning and the need of planning
 Explain the principles of hospital planning
 Identify the need of regionalisation
Prepare a team for hospital planning

Y

 Discuss the process of hospital planning

IT
 Explain the factors to be considered for hospital planning

2.1 Introduction

S
R
In the previous chapter, we have covered the definition of a hospital, how hospitals are
classified, and how hospitals are evolving in their varied functions. We have also studied about

E
the concept of hospital administrator, hospital as a system and the relationship between a
hospital and community. This chapter will focus on hospital planning.

IV
A hospital is an important and fundamental component of our society. Being a medical and
social organisation, it provides curative and preventive healthcare to the public. It is a centre
of training for the medical workers and it facilitates continuous research related to new

N
diseases, their causes and treatment. Considering the complex functioning pattern, hospitals
are designed as a comprehensive system.
U
Patient care is the first and foremost objective of a hospital. Different patient demands
different type of treatment, care and preferences. Ranging from brief and specific care by one
Y

doctor to significant attention from a number of specialists and equipment; every requirement
has to be met with utmost seriousness and promptness. The working members and the health
R

professionals are also varied as far as their knowledge, occupation, competence and need
are concerned. Infrastructure and technical facilities would require constant maintenance,
R

recurring checks and upgrading. The biggest challenge is ensuring optimum utilisation of all
the resources. Therefore, hospitals should be constructed via proper planning and design with
E

the ability to take all these factors into account.

H

Careful planning should include sorting tasks, aims and activities to accomplish targets, which
provide a logical tactic to attain opted aims, appropriate size of the hospital and a suitable site
IC

selected by the experts. All planning related issues must be derived from market sensitivity,
new technologies and changing expectations with respect to healthcare delivery.
D

In this chapter, you will study the concept of hospital planning which includes the need for
planning, its principles, regionalisation and team selection. Further, the chapter discusses
N

about the process of hospital planning. Towards the end, you will study about the planning
considerations in terms of size of the hospital and site selection.
O
P

24 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes
2.2 Concept of Hospital Planning

EXAM 3 EXAM 2 EXAM 1

REST
ROOM RADIOLOGY WAITING

SCALE

Y
IT
RE
TREATMENT CAGES CE
DN MECH PT ENTRY
IO
N

FOOD STORAGE
PHARMACY
SURGERY

S
TREATMENT
DENTAL

LAB
GROOMING

R
W/D

RUN 1
ISO
RUN 3 OFFICE

E
RUN 2 CONTROLLED MANAGER
DRUGS

IV
FIRST FLOOR PLAN
01 2 4 6

N
(Source: http://files.dvm360.com/alfresco_images/DVM360/2013/11/15/12a0f28c-5537-4cd1
U -b07d-40649ca859cd/Concord_chapel_fp.jpg)

Hospital planning is defined as planning and designing of the architecture and logistics of
a hospital unit as per the needs of its customer, staff and the service providers. It includes
constructing hospital building with high capacity and surplus facility, designing interior with
Y

more flexible approach and high energy consumption facility, using digital electronic devices,
upgrading of department like pharmacy, way of finding techniques and rethinking patient
R

flow to improve their experience.

R

Over the past few decades, there have been continuous changes in the theories of planning
and designing of healthcare services, where specialised health units have newer patterns for
E

patient wards, competent plans for nursing sections and effective surroundings for sound
healing of patients.
H

For example: In 1944, Bhore committee suggested a mini aspect of bed: patient ratio of 5.5
beds/1000 patients in India with a project to achieve 1 bed/1000 patients. In 1962, this plan
IC

was prosecuted by the Mudaliar committee, where the main objectives were to have provision
of more beds in the community hospitals. The reason behind this planning was to cater to the
increasing population and to improve hospital facilities in the country.
D
N
O
P

DDE, Pondicherry University, Pondicherry 25

Hospital Architecture, Planning and Maintenance

Notes Fig. 2.1 show key aims of hospital planning:

Patient-oriented care is the foremost motto of the care process.

Effective plans for medical safety, ideal operational rapports,

monetary value and contemporary systems.

Y
Elasticity for growth and newer techniques in unanticipated
manner in life.

IT
Supportable layouts, reduced use of resources, extensive 24
hour usage and higher consumption.

S
Curative environment both friendliness and cordial.

R
E
Fig. 2.1: Aims of hospital planning

IV
2.2.1 Need For Hospital Planning

N
Hospital planning is the most important and prime requirement for designing any hospital
and its facilities while setting up a new hospital or upgrading an existing one. If the hospital
U
is not planned with proper care, it would fail to serve its purpose and would cause trouble to
the patients, staff and people who are associated with the hospital. Any project work demands
a proper planning. Without strategic planning, setting up a hospital is like moving without
Y

any direction. There is no scope of self-evaluation. Hospital planning is needed for the
following reasons:
R

‹‹ To provide patient-centred care and facilitate care and concern for the family
R

‹‹ To function efficiently, provide clinical safety, build optimal serviceable associations,

offer value for money, implement modern systems and ensure low maintenance
E

‹‹ To incorporate scope for expansion and deal with unexpected requirements of

H

upgrading to new technology

‹‹ To design environmentally sustainable set up, reduce energy usage, ensure round the
IC

clock service and manage high occupancy situation

‹‹ To create a healing environment with art and hospitality in a science and technology
driven establishment
D

Hospitals should be properly designed and well-constructed. Proper rooms with ventilations,
N

adequate number of beds, adequate stock and supply of medicines and other healthcare
facilities make ease for the patient. For example, Post Graduate Institute of Medical Education
O

and Research (PGIMER) in Chandigarh are a well-planned medical and research institute. It is
the best multi-speciality government hospital in India. It has different buildings or complexes
P

for different departments like paediatric ward for children, gynaecologist ward for women and
general ward for all persons. Likewise, there are X-ray diagnostic centre, ECG room and other
common service wards, centrally located in a planned manner for the convenience of patients.
The registration counter is near the entrance of the hospital. Different procedures and
facilities are available for Out Patient Department (OPD) and emergency patients. Stretchers
and wheelchairs are kept at the entrance of main gate and only ambulance is allowed to park
at the main gate. All these facilities provide convenience to the visitor and patients.

26 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes You should determine the facilities needed by people on the basis of the number and type of
patients. The following two techniques can be helpful in this:
‹‹ Diagnostic technique: This technique is implemented by estimating the need of the
public through questionnaire based surveys. Collect their feedbacks via questionnaire,
make an assessment of the collected statistics and identify the facilities.
‹‹ Estimation method: This method is implemented on the basis of several researches

Y
piloted. Refer to various compilations of scientific statistics for estimation of diverse
degrees of care provided by the hospital settings in different areas.

IT
Being an administrator, a healthcare planner or an organiser’s main motive should be to
match the real functional needs. Therefore, Hospital planning should be done by considering

S
the number and type of patients, environment, need for medical aids and other health care
resources.

R
2.2.2 Principles of Hospital Planning

E
IV
A hospital is always planned based on certain principles. Before constructing the hospital, you
must study and consider the various principles of hospital planning which have been depicted
in Fig. 2.2:

N
Characteristic patient care
U
Public oriented approach
Y

Monetary feasibility
R
R

Effective planning
E

Fig. 2.2: Principles of hospital planning

H

Let us now study these principles in detail.

IC

‹‹ Characteristic patient care: Healthcare units must be structured, teamed and

furnished to supplement the provision of characteristic clinical care to the community.
The treatment and attention given to the patients should be periodically examined via
D

constant assessment of current services and facilities provided. A hospital should have
an adequate number of experienced and skilled staff, ensuring appropriate care of the
N

patients. The staff should also be upgraded with the recent innovations in technology.
‹‹ Public oriented approach: While planning or designing a healthcare unit, the need and
O

expectations of general public should be kept in mind. A hospital must be established at

a suitable and easily accessible area.
P

For example, AIIMS, a government hospital in Delhi, is situated at a prime location

where common public can reach without much difficulty. It had been constructed with the
consideration of servicing maximum number of patients. That is why it takes a very nominal
charge for any treatment. Have you ever thought why the charges for the healthcare services
are so minimal? What points should an administration unit keep in mind while delineating
the charges?

DDE, Pondicherry University, Pondicherry 27

Hospital Architecture, Planning and Maintenance

Notes Whenever a hospital delineates the fees for the healthcare services, it should consider the type
of population, communal status, level of education and monetary capacity of the targeted
community. This can be done by selecting representatives from the public. A hospital must
have community benefit programs that aim at providing healthcare services to the public and
educating the community about better utilisation of resources at the hospital. Administrative
unit must also enquire about the needs of the public.

Y
‹‹ Monetary feasibility: A hospital should provide monetary feasibility to the public.
It should not be solely profit-oriented all the time. Thus, there should be an effective

IT
economic control system on board. A healthcare setting should categorise and adapt
techniques to be self-satisfying. Any structured innovations and alterations should be
done ethically and reasonably, taking the community’s viewpoints into consideration.

S
‹‹ Effective planning: The plan prepared while designing a hospital must reflect an

R
effective utilisation of resources and staff. Viability should be checked while planning
and certifying appropriate passage for the movement of patients, relatives, staff and the

E
service providers. The passage should be spacious enough to allow proper movement
of materials to be utilised for patient care. The structure must accommodate for future

IV
expansion. Disaster planning should also be done while planning and designing.

2.2.3 Regionalisation

N
The liberation of healthcare services should be regionalised. Regionalisation means different
U
service providers or health organistaions delivers health care services to different geographical
areas ensuring availability of essential services. The targeted community of approximately
10-15 lakhs people will be having the benefit of availing primary, secondary and tertiary care.
Y

This will aid in implementing federal circuit with decentralised regulatory management. Each
R

regulatory body must have a chairman, preferably a healthcare official, well equipped with
public health education.
R

The notion of health care regionalisation is not new. The first version of this was submitted
to the British Parliament in 1920 as part of the Consultative Council on Medical and Allied
E

Services report, which is often referred to as the Dawson Report. An organised, unified,
and categorised range of health services—both preventive and curative—was included in
H

the regionalisation process. Primary care was the main emphasis. Secondary or consultative
care was used to describe uncommon and complicated issues. This approach struck a balance
IC

between resource allocation and easy access to care. During World War II, the United States
also conducted trials of similar regional strategy. The United States initially attempted to
put it into practise in 1946 with the establishment of hospitals through the Hill-Burton Act
D

(Public Law 79-725), which authorised grants to create Regional Medical Programs (RMP)
to improve access to diagnostic and treatment advancements in the designated conditions.
N

‹‹ Need for regionalisation: There is a need of regionalisation for health care services
O

due to the following reasons:

‹‹ Urbanisation: Every country grows with its economy. Developing countries are
P

changing into developed countries. Likewise, rural areas are getting converted into
urban areas. Every government is trying to complete its urban model by providing
health services at the local level. That is why the government believes in implementing
regionalisation model for health services.

28 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes For example, Rohtak, in Haryana was considered a backward area but it has started
to develop after the construction of Post Graduate Institute of Medical Sciences
(PGIMS). The standard of living has improved. Job opportunities have increased for
the people of that area. It created a very good reputation of Rohtak district among the
other districts of Haryana.
‹‹ Population: There is a growing trend of increase in population in various countries.

Y
For example, population of India is increasing at a very high rate. It is not feasible
to provide health care services to the whole country from one hospital. Therefore,

IT
by implementing the regionalisation model, we can cater to the need of the whole
population.
‹‹ Emergency services: We can provide emergency services such as establishing trauma

S
centres through the regionalisation model. This will gradually emphasise the need of

R
other emergency centres. Fig. 2.3 depicts an emergency ambulance service:

E
IV
N
U
Y
R
R
E

Fig. 2.3: An emergency ambulance service

H

(Source: http://i.telegraph.co.uk/multimedia/archive/01888/emergency_1888733c.jpg)
IC

For example, the number of hospitals or facilities for emergency medical services is more in
the United States of America than in India. In the USA, whenever any accident occurs on the
road, the injured persons can be taken to the nearby trauma centre and his or her life can be
D

saved. In India, there is no such trauma centre and good medical facilities are not available in
every city. Therefore, the death rate from accidents is high in India than the USA.
N

Effects of Regionalisation
O

In the early 1980s, more emphasise was put on regional programs owing to the availability of
more resources and finance. Every state and national planning agencies and health departments
P

promoted regionalisation through regional health care which could be best described as
voluntary associations among hospitals and providers. The effects of regionalisation are
described in Fig. 2.4:

DDE, Pondicherry University, Pondicherry 29

Hospital Architecture, Planning and Maintenance

Notes Better services

Regionalisation provide better services to people. This model has increased density
of health care centres like hospitals, trauma centres and primary care centres in the city.

Expansion of intensive care units and trauma centres

Due to regionalisation, number of health care centres has increased drastically which is a

Y
symbol of growing economy.

IT
Increase in birth rate
Due to regionalisation, birth rate has increased and death rate has decreased. Earlier, infant
death rate was very high. For example, in India, infant death rate was around 50% but now
it has decreased to around 20% to 25%. It is because of health care centre available in

S
rural areas.

R
Increase in life expectancy
Regionalisation has increased average life expectancy. Earlier, it was very low due to lack

E
of treatment for several diseases or unavailability of health care services.

IV
Employment for medical professionals
Regionalisation has increased opportunities for medical professionals. It has provided better
and more job options to medical students.

N
Fig. 2.4: Effects of regionalisation
U
De-regionalisation
Y

De-regionalisation means establishing centralised hospitals or medical care units. All medical
and health care units are located at a particular place instead of different regions. There
R

are several studies that are in the favour of de-regionalisation. Philosophers have their own
beliefs behind these studies. Main reasons for favouring de-regionalisation are as follows:
R

‹‹ Regional medical centres may not be equipped with resources as well as instruments to
E

handle any complex or serious medical case. It is expensive for the government to set
up primary care centres at local levels.
H

‹‹ Monitoring all the regional centres is a difficult task. Mismanagement may cause
disastrous consequences in medical treatment.
IC

2.2.4 Hospital Planning Team

D

For preparing and designing a hospital plan, a team of members is appointed or allotted. Fig.
N

2.5 depicts the members of the hospital planning team:

O
P

30 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes Hospital administrator

Hospital engineer

Hospital architect

Y
IT
Financial expert

Clinical statistician

S
R
Representative of the government or local bodies

E
Nursing director or superintendent

IV
Social scientist

N
Fig. 2.5: Hospital planning team
U
Let us now study about the members of the hospital planning team in detail.
‹‹ Hospital administrator: The administrator of a hospital is the chairperson of the
Y

planning team. He is majorly involved in putting up hospital necessities to his team

for providing facilities to the patients, designing considerations and orientation of the
R

related units and facilities.

‹‹ Hospital engineer: An engineer is allotted for designing of the hospital plan. He or
R

she should have prior experience of designing and constructing hospitals. The engineer
works in close proximity with the administrator and the architecture.
E

‹‹ Hospital architect: A hospital architect must have knowledge about the facilities
H

required in a hospital so as to provide an effective design of the hospital as per the

requirement. The experience and expertise of the architect as well as the hospital
IC

engineer is a pre-requisite for an economical and effective hospital design.

‹‹ Financial expert: A financial expert helps an administrator to study the viability of
the project. He or she gives advice on the monetary issues related to the project and the
D

resources available for the same. The estimations provided by the financial expert aids
in working of a smooth project.
N

‹‹ Clinical statistician: A clinical statistician also influences the viability of the project.
O

He or she assists the team by providing vital inputs on the community image of the
area, disease related statistics and socio-economic status of the community. This helps
P

the administrator to decide on the types of amenities required and charges to be levied.

DDE, Pondicherry University, Pondicherry 31

Hospital Architecture, Planning and Maintenance

Notes ‹‹ Representative of the government or local bodies: A government representative

helps in the coordination of the project. He or she acts as a working link between the
population and the hospital.
‹‹ Nursing director or superintendent: A nursing director provides valuable inputs
to the team regarding the project plan, especially in terms of requirements for ward
planning.

Y
‹‹ Social scientist: A social scientist helps in identifying the anticipated needs and the
real needs of the community. His or her inputs during the project help in satisfying the

IT
community’s needs and expectations from the project.

Self-Assessment Questions

S
1. Planning includes ___________ , ___________ and ____________________.

R
2. What is the foremost aim of hospital planning?

E
3. What are techniques to determine to need of hospital planning?

IV
4. Hospital planning is needed for the following reasons:
a. To provide clinical safety

N
b. To provide patient-centred care
c. To increase energy usage
U
d. To create a healing environment

5. Estimation technique is implemented by estimating the need of the public through

Y

questionnaire based surveys. (True/False)

R

6. A hospital should provide __________ feasibility to the public.

R

7. ______________ means establishing centralised hospitals or medical care units.

8. Regionalisation of health care services is needed due to the following reasons:

E

a. Urbanisation
H

b. Profit making
IC

c. Population
d. Emergency services
D

9. Which of the following members are part of a hospital planning team?

a. Hospital engineer
N

b. Financial expert
O

c. Nursing director
d. Human resource manager
P

Activity
Visit any hospital located nearby and discuss the factors involved in its planning with the
hospital management.

32 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes Activity
Visit any state health office and discuss regionalisation and ratio of population per hospital.

2.3 Hospital Planning Process

Y
According to the definition, a health care unit is all about serving the community and society.
Planning has to be started with the basic necessities to provide a general layout for any

IT
project. Fig. 2.6 show some of the basic ideas that can be incorporated in the general layout.

Entrance for the hospital needs high perceptibility and

S
ease of accessibility.

R
Outdoor patients and indoor ones should be treated in
seperate departments.

E
Emergency unit should have a separate passage from
OPD and IPD but should have convenient passage for

IV
outsiders.

The entry and storage parks needs to be readily

N
accessible by the staff.
U
Drop outs and parking areas needs to be convenient for
all types of traffic.

Hospital staff parking should be separate from that of

Y

the patients and should to be open for 24*7 passages.

R

Fig. 2.6: Basic ideas for a general layout

R

As each of these separate folds of plans is added to the design, the logical layout of the
hospital begins to take the structure, with diverse types of approaches towards traffic control.
E

Hospital planning process must also include the following steps:

H

Conceptualisation
IC

It is the preliminary stage of planning and includes the decision to visualise and design a
hospital. The type of hospital that has to be built, location for the set-up of the unit and
nature of the hospital i.e. whether it would be a private healthcare unit, charitable non-profit
D

unit or governmental unit are to be decided at this stage along with the estimation of target
population.
N

Viability Report
O

The next step is understanding the feasibility of setting up the hospital and preparing a
P

viability report. Massive data is the pre-requisite for preparation of a project report. The
report provides a virtual layout of the entire health unit. To prepare this report, a technical
and skilled professional is required who have an in-depth knowledge about this. This report
will provide a brief overview of the feasibility of the project. Moreover, it will be used as a
tool to raise or allocate funds from the authorities.

DDE, Pondicherry University, Pondicherry 33

Hospital Architecture, Planning and Maintenance

Notes Approval of the Project by the Respective Authorities

After the preparation of the viability report, it needs to submitted to the respective authorities
who will grant revenues to carry out the proposal.

Selection of Site

Y
A suitable area is selected keeping the feasibility of the hospital in mind. The site should
be easily accessible to people and the area should be appropriate for accommodating all the

IT
buildings with provision for future expansion master plan layout. Fig. 2.7 depicts the master
plan layout of a hospital:

S
R
E
IV
N
U
Fig. 2.7: Master plan layout of a hospital
Y

(Source: http://www.ohb.scot.nhs.uk/assets/file/new%20hospital%20leaflet.pdf)
R

The main objective of preparing a master plan is to plan out the passage routes (both
internal and external) on the land so that various sections and buildings can be structured
R

and constructed without any inconvenience. It can be a written proposal, a layout sketch or a
working model of the plan. It must also include future expansion and designing plans and of
E

all the sections.

H

Architect’s Plan
IC

DARK DR. DR. BUS.

ROOM GROOMING
OFFICE OFFICE OFFICE
D

KIDS
ICU CORNER
X-RAY
ROOM RECOVERY
N

STORAGE
LABORATORY

RECEPTION

TREATMENT EXAM
OPERATING
O

SERVICE SURGERY AREA ROOM

ROOM

LOBBY
PHARMACY

ENTRANCE PREP #3
EXAM
FOOD
P

ROOM
PREP
#2
DOG BATH
WARD EXAM
CAT EMGY ROOM MAIN
ISOLAT STR LNDRY LOUNGE BATH
SUITES ENTR #1 ENTRANCE

Fig. 2.8: Architect’s plan of a hospital

(Source: http://miamianimalhospital.com/wp-content/uploads/2011/07/Miami-Animal-Hospital-Floor-Plan.png)

34 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes An architect’s plan is the written illustration of the ‘needs’ of the client or investor, prepared
after discussion with several professionals of the designing team. The content of the
operational plan comprises of a detailed description of the project, accommodation schedule,
functional policies, staff and equipment necessities and interrelationship between several
sections of the unit. Fig. 2.8 depict an architect’s plan.

Preliminary Layouts

Y
It is one of the designing phases where the operational plans are converted into drawings.

IT
At this stage, a hospital administrator needs to function as a consultant for clarifying the
doubts of the engineers and architects involved in the project. Figure 2.9 shows a sample of
preliminary layout.

S
R
Genuine Interpretation of the Plan

E
This stage involves releasing notification of tenders and requesting for quotations. Selection
of tender plan and provision of contract with investors is an important step that is to be

IV
carried out prior to the actual execution of plan.

Equipment Planning

N
It includes listing of the suppliers and short listing the models of equipment after discussing
U
with experts from various fields. Subsequently, make arrangements for explanations and
demonstrations of different models, call for quotations and negotiations and finalise the
equipment.
Y

Staffing
R
R
E
H
IC
D
N

Fig. 2.10: Hospital staff

(Source: http://www.barnabashealthcareers.org/agency/)
O

It involves selection, recruitment and training of professionals for all the sections. Hospitals
have different type of staff as compared to the other organisations. It has specialists for
P

different kind of treatment. For example, it must have doctors with specialisation like
paediatrician, surgeon, cardiologist, ENT specialist, dentist and dermatologist. Apart from
doctors, nurses, ward boy, pharmacist, pathologist and other staff members are required to
run a hospital efficiently. For general management, hospital administrator, technical staff and
other operational staff are required. Fig. 2.10 show different type of employees of a hospital.

DDE, Pondicherry University, Pondicherry 35

Hospital Architecture, Planning and Maintenance

Notes Commissioning of the Hospital

It involves casting a team which consists of a head from respective departments of the
hospital such as administration, nursing, finance and stores. This team works in coordination
and planning with the staff as per the requirements of the hospital. The team will also be
concerned about developing a system and framing hospital policies.

Y
Shake-down Period

IT
It is the time period between the total commissioning of the hospital and achieving the
desired performance of the hospital. This may be prolonged and even run into few years. Well
planned projects always have a shorter shake-down period as compared to the cases which

S
lacked proper planning.

R
Prior to making a decision of building a hospital, the investors or stake holders of the
project have to carry out a viability analysis and financial feasibility study of the project plan.

E
Following data is required in this regard:

IV
‹‹ Demographic details: It basically comprises of the size of the community and age and
sex ratio, socio-economic status, educational background, mortality and morbidity rates
and sanitation level of the people.

N
‹‹ Environmental data: It considers the topography of the area, accessibility of the
hospital via roads, railways and other means of transport facility and climatic conditions
U
of that area, which helps the designer to plan for the appropriate cooling or heating
systems accordingly.
Y

Birth and Death Rate Statistics

R

Period Birth rate* Death rate*

R

1941-51 39.9 27.4

E

1951-61 41.7 22.8

1961-71 41.1 19
H

1971-81 37.2 15
IC

1991 29.5 9.8

2000 25.8 8.5

D

* The No. corresponds to a period of 1 Year for a:

N

i) Census Actuarial Report.

ii) Sample Registration System
O

iii) Family Welfare Programmed Year Book 1993-94

P

Source: Calculated from the Census of India date upto 1971-81, and Ministry of Health
and Family Welfare, Government of India for the remaining date

Fig. 2.11: Birth and death rate statistics

(Source: http://infochangeindia.org/population/statistics/population-birth-rate-and-death-rate.html)

36 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes It givesimportant information about mortality and morbidity rate, child-death rate, maternal
death rate, incidences and frequency of several diseases in that area. For example, in Fig.
2.11, you can see data related to India’s birth rate and death rate from 1941 to 2000. Birth
rates as well as death rate are decreasing since 1941. It is a good sign that the rate of death
is decreasing but the point of worry is the birth rate, which is also decreasing. Therefore, it
justifies the need of hospitals or medical care units in India.

Y
‹‹ Necessity and requirement: This study helps in recognising the preferences of the
population in terms of the type of medicines such as allopathic, homeopathic or any

IT
alternative medicine system.
‹‹ Particulars of prevailing services: It includes identifying the existing health care
services such as nursing homes, clinics, diagnostic centres and hospitals in that area.

S
‹‹ Monetary viability: It helps in determining the cost related to construction work,

R
interior decoration, furniture and fixtures, medical equipment and the other expenses
related to the nature of facilities to be incorporated in the premises. It also includes

E
analysing the costing for carrying out the work in phases.

IV
Nature of Hospital

N
U
Y
R
R
E
H

Fig. 2.12: Type of hospital

IC

(Source: http://www.allenbatchelor.com/project/center-for-primary-care-the-villages/)

This is to plan the type of hospital to be constructed. The demographic details and community
needs of the area gives an indication whether to opt for a general hospital, teaching hospital,
D

charitable non-profit hospital or research centres. The nature of hospital would let you decide
about the other factors and requirements. For example, according to Fig. 2.12 we have planned
N

for a primary care centre. Therefore, it would require the basic facilities for treatment of all
types of diseases and for treating accident victims. Being a primary care centre, it would not
O

be a large establishment. The capacity would depend on its budget. It would mostly have
general wards where patients can stay for one or two days and then would be referred to a
P

bigger hospital. It may or may not have operation theatre.

Future expansion plans: Future plans of expanding must always be taken into consideration
while designing. A hospital facility is dynamic; ideally a hospital is planned keeping in view
the future expansion requirements for nearly 20 years.

DDE, Pondicherry University, Pondicherry 37

Hospital Architecture, Planning and Maintenance

Notes Self-Assessment Questions

10. ____________ is the preliminary stage of planning and includes the decision to
visualise and design a hospital.

11. Which of the following steps are parts of hospital planning process?
a. Trial period

Y
b. Master plan layout

IT
c. Equipment planning
d. Hospital commissioning

S
12. ______ ______ ________ is the time period between the total commissioning of the
hospital and achieving the desired performance of the hospital.

R
13. Demographic details provide the topography of the area and accessibility of the

E
hospital via roads. (True/False)

IV
14. Birth rate as well as death rate is decreasing since 1941. (True/False)

N
2.4 Hospital Planning Considerations
U
The hospital area and its community are defined by a orchestration scheme representing the
estimated grade of importance, which takes into the magnetism and availability of every
hospital, as well as the environmental and socio-economic situation of the society.
Y

Some of the factors which are worth considering while planning a hospital are as follows:
R

Public Attention Over Individualistic Importance

R

A hospital is a public organisation. Its main aim is to meet the health related requirements
E

of the community. The amenities of a hospital should be readily available to the targeted
community, meeting the needs of all irrespective of their socio-economical background. It is
H

also a basic necessity for the hospital to organise public education programs and take feedback
from the people.
IC

Preventive Services Vs. Curative Services

D

A healthcare unit must take the responsibility for providing preventive amenities to the
community and must promote health education amongst them, apart from curative services.
N

Holding medical camps at the outskirts and school health education programs will help the
targeted population. Spreading awareness on health through talks by health professionals,
O

newsletters, media and street plays also help in promoting healthcare to the targeted
community.
P

Assistance for the Weaker Population

Our healthcare sector should have a basic responsibility towards the health requirement of the
weaker section of our community , especially women and children whose health requirements

38 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes are somehow neglected. Provisions for periodic antenatal check-up for pregnant women,
periodic home visits in rural areas by an Anganwadi professional and educating and advising
young and pregnant women about their health needs and safety are some of the programs to
be adopted and executed for providing healthy living concepts to the weaker class.

Rural Vs. Urban

Y
IT
S
R
E
IV
Fig. 2.13: Rural health care centre

N
(Source: http://rdtfvf.org/what-we-do/rural-hospitals/)
U
Y
R
R
E
H
IC

Fig. 2.14: Urban hospital

(Source: http://wikimapia.org/16276970/M-S-Ramaiah-Medical-Teaching-Hospital)

Each and every citizen of our country has a right to good health care. Therefore, the health
D

units must be accessible to all without any discrimination. Concentration of the hospital
professionals and healthcare services should be encouraged more in rural areas as compared to
N

the urban ones. Health services should be evenly distributed among rural and urban population
of our society. Fig. 2.13 and 2.14 shows rural and urban heathcare setup respectively.
O

Keeping all these considerations into account and to fulfill the target of establish a health
P

institute, it is very important to consider the following aspects:

‹‹ Size of the hospital
‹‹ Site selection

DDE, Pondicherry University, Pondicherry 39

Hospital Architecture, Planning and Maintenance

Notes 2.4.1 Size of the Hospital

The number of beds a hospital can hold determines its size. The required total number of beds
may be theoretically computed based on the region’s total population and the established bed-
to-patient ratio. Real-world scenarios make predicting the bed: population ratio challenging.
As a result, computations are made using the area’s direct and indirect population, the WHO’s

Y
recommended direct and indirect admission numbers, the patient’s estimated duration of stay
on average and the targeted occupancy rate (considered as 85). The total number of beds

IT
may be determined by subtracting the number of beds that are already available from the
earlier arrived figure if there are additional health institutions in the same area. Hospitals are
classified as follows based on the quantity of beds they have:

S
‹‹ Large hospital: Hospitals with more than 900 beds are classified as large hospitals.

R
‹‹ Mediocre hospital: Usually 400 to 900 beds are available in mediocre hospitals.
‹‹ Small hospitals: These hospitals have between 100 to 400 beds or less than 100 beds.

E
It is not required to build a hospital to hold the estimated number of beds. Instead of

IV
constructing a very big hospital with a capacity of more than 1000 beds, it is preferable to
have two distinct, average hospitals from the standpoint of functional efficiency. Conversely,
building a tiny hospital with less than 100 beds, where revenue would not be enough to cover

N
running costs, might not be the best course of action. Less beds may be needed to get the
hospital up and running, and additional beds can be added gradually. Two hundred to four
U
hundred beds, spread across many departments, are the ideal number for a general hospital.
It would be cost-effective to establish a very big hospital with more than 1000 beds in highly
populated prime regions where property is highly valued. There are several government
Y

hospitals with plenty of beds in India. For instance, with 2,250 beds, the Ahmedabad civic
hospital is currently the biggest hospital in India.
R

Therefore, the size of the hospital should be estimated based on the following factors:
R

‹‹ Population of the area

E

‹‹ Population density of the area

‹‹ Type of hospital
H

‹‹ Available budget
IC

‹‹ Operating cost and estimated earnings

D

2.4.2 Site Selection

N

Site selection is one of the important tasks as a suitable site contributes to the success and
utilisation of a hospital. The site should be chosen with utmost care, keeping in mind the
O

feasibility and accessibility of the same. A comprehensive report should be prepared on the
selected area. The following factors should be taken into consideration:
P

‹‹ Location of the site in terms of heart of the city, largely populated area, outskirts of
the city, urban area, rural area or open area
‹‹ Suitability for future expansion and growth

40 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes ‹‹ The transport facilities available for quick and easy access to the hospital
‹‹ The environmental factors such as wind, rain, sun, height of neighbouring premises,
sources of water supply and electricity
‹‹ Connectivity in terms of phone lines and mobile phones

We can take an example of NHS Orkney. They are planning to start a new hospital and have

Y
selected Grainbank as the site. The Grainbank site is located on the west side of Kirkwall
on farmland to the south of Grainbank House. The site inclines towards the Golf Club to

IT
the west. The Grainbank site provides two clear access routes with the primary access from
the A965 main Kirkwall to Stromness road and the secondary access from the Pickaquoy
road. This information depicts that they have selected the site after doing all feasibility and

S
accessibility study.

R
Self-Assessment Questions

E
15. A healthcare unit must take the responsibility for providing ______________
amenities to the community.

IV
16. Our healthcare sector should have a basic responsibility towards the health
requirement of the _________ section of our community

N
17. Hospitals with more than 900 beds are classified as mediocre hospitals. (True/False)

18. The size of the hospital should be estimated based on the following factors:
U
a. Population of the area
b. Population density of the area
Y

c. Birth rate of the area

R

d. Type of hospital
R

19. Suitability for future expansion and growth should be considered while selecting the
site for a hospital. (True/False)
E
H

Activity
Visit any hospital and write a note on the composition of a hospital planning team.
IC

Activity
D

Enumerate the several factors to be considered for an effective hospital plan.

N

2.5 Summary
O

‹‹ Hospital planning is defined as planning and designing of the architecture and logistics
P

of a hospital unit as per the needs of its customer, staff and the service providers
‹‹ While planning a hospital, the community requirements should be the foremost
consideration for all.
‹‹ You should determine the facilities needed by people using two techniques, diagnostic
method and estimation method.

DDE, Pondicherry University, Pondicherry 41

Hospital Architecture, Planning and Maintenance

Notes ‹‹ The various principles of hospital planning are:

 Characteristic patient care
 Public oriented approach
 Monetary feasibility
 Effective planning

Y
‹‹ Our health industry must have a basic responsibility towards the safety of the health

IT
of weaker parts of our community, especially women and children.
‹‹ All hospitals are public organisations and must be approachable and affordable to all the
sections of our society.

S
‹‹ The concept of the regionalisation of health services is very old and first draft for this

R
was presented to the British Parliament in 1920.
‹‹ Reasons for regionlisation are urbanisation, population and emergency services.

E
‹‹ A hospital planning team consists of hospital administrator, hospital engineer, hospital

IV
architect, financial expert, clinical statistician, representative of the government or
local bodies, nursing director or superintendent and social scientist
‹‹ The time, efforts and resources spent at the time of designing should be advantageous

N
to the public in the long run.
U
‹‹ Hospital planning process must also include the following steps:
 Conceptualisation
Y

 Viability report
 Approval of the project by the respective authorities
R

 Selection of site
R

 Master plan layout

E

 Architect’s plan
 Preliminary layouts
H

 Genuine interpretation of the plan

IC

 Equipment planning
 Staffing
D

 Commissioning of the hospital

N

 Shake-down period
‹‹ It is good to have a planned master design, considering the future requirements and
O

renovations of the healthcare unit while obtaining land for the project.
‹‹ The designing and construction of the premises and amalgamation of necessities
P

should be done in a planned and phased manner.

‹‹ Hospital planning should consider the following aspects:
 Size of the hospital
 Site selection

42 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes
2.6 Glossary
‹‹ Birth Rate: It refers to the total number of births per 1,000 of a population each year.
‹‹ Hospital Administrator: The administrator of a hospital is the chairperson of the
planning team.
‹‹ Life Expectancy: It is the average number of years a person can expect to live, if in

Y
the future they experience the current age-specific mortality rates in the population.

IT
‹‹ Planning: It includes sorting tasks, aims and activities to accomplish them.
‹‹ Regionalisation: The process of dividing an area into smaller segments called regions.

S
2.7 Terminal Questions

R
1. Explain concept of hospital planning and need of it.

E
2. Explain the principles of hospital planning.

IV
3. Describe regionalisation and de-regionlisation.

4. Explain hospital planning and the team involved in it.

N
5. What factors affect hospital planning?
U
2.8 Answers
Y

Q. Self-Assessment Questions
1. Sorting tasks, aims and activities to accomplish them
R

2. Patient-oriented care
R

3. Diagnostic Technique and Estimation Method

4. a,b,d
E

5. False
H

6. monetary
IC

7. De-regionalisation
8. a, c, d
D

9. a, b, c
10. Conceptualisation
N

11. b, c, d
O

12. Shake down period

13 False
P

14. True
15. preventive
16. weaker

DDE, Pondicherry University, Pondicherry 43

Hospital Architecture, Planning and Maintenance

Notes 17. False

18. a, b, d
19. True
Q. Terminal Questions
1. Patient-oriented, effective plans; elasticity, supportable layouts, and curative

Y
environment and techniques determine the need for hospital planning. Refer
to section 2.2 Concept of Hospital Planning and sub-section 2.2.1 Need for

IT
Hospital Planning.
2. Characteristic patient care, public oriented, monetary feasibility and effective

S
planning are some of the principles of hospital planning. Refer to sub-section
2.2.2 Principles of Hospital Planning.

R
3. The concept of the regionalisation of health services is very old and need of

E
regionalisation is due to urbanisation, increase in population and emergency
services. Refer to sub-section 2.2.3 Regionalisation.

IV
4. According to the definition, planning has to be started with the basic necessities
to provide a general layout for any project and the team includes hospital
administrator, hospital engineer and hospital architect. Refer to sub-section 2.2.4

N
Hospital Planning Team and section 2.3 Hospital Planning Process.
U
5. Factors effecting hospital planning are Rural or Urban and Preventive Services or
Curative Services. Refer section 2.4 Hospital Planning Considerations.
Y

Case Study: Regionalisation of Us Healthcare

2.9
R

Systems
R

One strategy to provide a large number of patients high-quality and cost-effective healthcare
is to regionalise or decentralise hospital care facilities. The US implemented its regionalisation
E

approach in two areas of paediatric medicine: paediatric trauma care and neonatal intensive
care.
H

The creation of an organised healthcare system “to enhance patient care by guiding patients
IC

to hospitals and medical care units with appropriate capabilities for a certain kind of disease
or damage” is implied by the term “regionalisation of healthcare.”

Economic factors drive the creation of a regionalised system, as shown by the kind of hospital
D

to be built or by differences in patient outcomes across hospitals within a certain area. These
N

regionalised systems have not developed in the same way as regional centres of care. Improved
results are the main emphasis of competitive market forces, which also establish regional
centres of excellence where patients may choose to get treatment.
O

Conceptual Framework
P

Regionalisation improves patient care by following mechanisms:

‹‹ Improved outcomes at high volume
‹‹ High-specialty centres and improved coordination of care within a given geographic area

44 DDE, Pondicherry University, Pondicherry

 chapter 2  Hospital Planning

Notes Numerous models, like the web system and the spoke and hub system, may benefit from
regionalisation. These are distinguished by a specialised centre backed by less specialised
institutions that handles the most complicated problems in patients within a certain
geographical area. The degree of hospital-to-hospital collaboration aids in the differentiation
of these two systems. A less coordinated, “de-regionalised” system known as the ‘mini-hub’
model may emerge in response to financial incentives, geography and hospital characteristics,
patient preferences, and a deficiency in collaboration between centres. The US attempted to

Y
use each of the three models to carry out its regional strategy.

IT
Types of Applied Regionalisation Studies and Their Outcomes
‹‹ Studies of individual hospitals: Improved outcomes at specialty hospitals

S
 The treatment of complicated illnesses at specialty hospitals may enhance their

R
offerings and patient care, according to a significant finding of regionalisation
study. It has also been found that oremature babies are born at a lower level or

E
volume in California.

IV
 There was a 19 to 272 increase in death risks in NICUs. The findings of more
recent research from Colorado, South Carolina, and Illinois were comparable to
those of earlier studies.

N
‹‹ Studies of geographic systems: Increased geographic coordination of care and
knowledge transfer
U
 The US regionalisation strategy enhanced care coordination and information
sharing across specialist, non-specialty, and central institutions, improving patient
Y
outcomes. When looking at it from a population standpoint, it is evident that
putting in place a trauma system increased the survival rate of patients with severe
R

injuries by 15 to 20.
 Similar improvements in death rates for children injured in accidents and those
R

who have been in cars collision have also been shown with regionalised paediatric
trauma treatment.
E

‹‹ Moderating factors for the development of regionalised systems

H

 There are a number of factors which helped the US to determine the degree of
regionalisation and the type of system that develops in any given geographic area
IC

‹‹ Financial incentives
 The US has strong economic position and could implement different types of
D

regionalised systems.
N

 Coordination of care between hospitals and patients

 Strong infrastructure (transport and roads) and communication system led to the
O

implementation of regional hospitals.

P

Conclusions
The United States can be seen as the one of the countries which has got benefits from
regionalisation of health care systems. It has decreased its mortality rate and death rate of
patients who are injured or those who have been in a motor vehicle crash.

DDE, Pondicherry University, Pondicherry 45

Hospital Architecture, Planning and Maintenance

Notes Discussion Questions

1. What model can be applied for implementing regionalisation?
(Hint: The spoke and hub system and the web system model can be applied to implement
regionalisation)
2. What are the factors for the development of regionalised systems?

Y
(Hint: Financial incentives, coordination of care between hospitals and patients

IT
and preferences for treatment location are important factors for development of
regionalisation).
3. What type of studies has been discussed in this case study?

S
(Hint: Studies of individual hospitals: Improved outcomes at specialty hospitals

R
Studies of geographic systems: Increased geographic coordination of care and

E
knowledge transfer)

IV
2.10 References and Suggested Readings
‹‹ James, P., and Noakes, T. (1994). Hospital architecture. New York: Longman.

N
‹‹ Nickl-Weller, C., and Nickl, H. (2009). Hospital. Berlin: Braun.
U
‹‹ Verderber, S. (2010). Innovations in hospital architecture. New York: Routledge.

E-References
Y
R

‹‹ Apolloglobalprojects.com. (2014). Hospital Planning & Design | Hospital Management.

Retrieved from, <http://www.apolloglobalprojects.com/services_planning-design.htm>
R

‹‹ Draeger.com. (2014). Hospital planners and architects. Retrieved from, <http://www.

draeger.com/sites/en_uk/Pages/Hospital/hospital-planners-and-architects.aspx>
E

‹‹ Ltd, H. (2014). Hospital Planning jobs India, Hospital Planning, Hospital Management
H

& Planning Consultant Jobs. Hospiconsultant.com. Retrieved from, <http://www.

hospiconsultant.com/initial-planning.htm>
IC
D
N
O
P

46 DDE, Pondicherry University, Pondicherry

chapter

3 Hospital Architect

Y
IT
S
R
E
Structure

IV
3.1 Introduction

N
Learning Objectives U
3.2 Concept of Hospital Architect

3.3 Equipping a Hospital

Y

3.4 Hospital Safety

R

3.5 Summary

3.6 Glossary
R

3.7 Terminal Questions

E

3.8 Answers
H

3.9 Case Study: Hospital Architecture of Stobhill Hospital

IC

3.10 References and Suggested Readings

D
N
O
P
Hospital Architecture, Planning and Maintenance

Notes Learning Objectives

After completing this chapter, you will be able to:
 Identify the need of a hospital architect
 Explain the role of a hospital architect
 Discuss about architect reports
Describe the interior and graphics of a hospital

Y

 Explain the process of construction and commissioning

IT
 Prepare a plan for preventive injuries
 Adopt adequate measures for electrical safety

S
3.1 Introduction

R
In the previous chapter, you have studied about the concept of hospital planning, the planning

E
process and planning considerations. This chapter will focus on the hospital architect.

Hospitals and medical treatment have long history of reforms in terms of concept and

IV
structure. Driven by social, economical, cultural and technological developments, the places
where ill and injured people are taken for their treatments have transformed from ‘almshouse’
or charitable guesthouses to institutes of scientific and technical excellence.

N
During the early era of civilisation, patients were attended at their homes only. Gradually, the
U
religious places such as temples and churches started caring for the sick and needy people.
After the invention of hospitals as organised entity, such units were located at distant places,
mostly on the boundaries of villages or cities. The basic concept of architecture used for
Y

such hospitals was a large court in the centre with small ancillary courts portrayed as the
wards. In 1700, Louis XV of Paris introduced the concept of forming a committee who will
R

look after the structure and functioning of the hospital. This change was implemented due
to the fact that fresh air and hygiene practice are the pre-requisites for being healthy and
R

hospitals should follow these factors. Accordingly, two proposals were initiated based on the
architectural needs of the hospital: radial system and pavilion system.
E

After this, Florence Nightingale identified that sanitation in the hospital wards was related to
the survival of patients. On the basis of this concept, she managed to reduce the death rate from
H

60% to 2% within a period of five months during the Crimean war of 1850. Nightingale was
considered as the mother of nursing and the hospital designs were influenced by her passion
IC

and dedication to patient care. She aimed for clean remedial surroundings with facilities such
as access to fresh air, daylight and outer views, proper food with medicines and clean sanitary
arrangements. Nightingale’s ideas were firstly applied in London at St. Thomas’ Hospital,
D

which was structured between 1861 and 1865. Her ideas were implemented in the hospitals of
those times for the next 100 years. In India, the modern system of treatment was introduced
N

in the 17th century.

O

For the last 60 years, there have been several changes in the designing and planning patterns of
the hospitals. Architecture is broadly defined as a set of plans related to building construction
that are prepared and reviewed at an organisational level before execution. These plans are
P

prepared by architects. Modern hospitals are complex and needs to be planned, built and
monitored by architects. Designs of the hospitals are regulated by them to accommodate
various sections of the hospital which should be in coordination with each other.. Building
such structure is a mammoth task and usually faces problems like lesser budgets with respect
to the required facilities, delayed completion of project and user dissatisfaction. Such problems
can be overcome through appropriate communication between the stake holders, investors
and architects.

48 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes In this chapter, you will study the concept of hospital architect by identifying the need for a
hospital architects and their roles. You will take a look at architect reports. Further, you will
explore the ways of equipping a hospital. Towards the end, you will study the safety related
issues of a hospital.

3.2 Concept of Hospital Architect

Y
IT
S
R
E
IV
(Source: http://www.e-architect.co.uk/images/jpgs/america/university_chicago_hospitals_vinoly0107.jpg)

N
An architect is defined as a person who proposes, develops and overlooks the creation of a
U
building structure as per the design. Basically, the word architect comes from a Latin word
‘architectus’, which means a chief builder.

A hospital architect reflects a system that narrates the flow and use of the hospital premises.
Y

In a broader aspect, an architect acts as a channel of interaction among the users, stakeholders
and investors in designing a structure that supports all the facilities and utilities for providing
R

round the clock sound medical care to the patients.

R

A hospital is a complex ‘enterprise’, which has several inputs and outputs at different levels.
In our viewpoint, a cohesive architecture must separate the two key ‘systems’: system for
E

patient remedy and system for its management. As part of patient remedy, the individuals
are admitted in the hospital, granted certain services for quick healing and discharged from
H

the hospital. The outdoor patients are attended by the doctors and other staff. Management
includes taking care of various issues related to human resources, infrastructure, equipment,
IC

and other facilities. An architect should be able prepare a plan, which accommodates all the
facilities to be provided as part of both the key systems and ensures coordination among them.
D

3.2.1 Need for Hospital Architect

N

An architect not only plans the designs and structure of buildings, offices and institutions but
also shoulders the responsibility for the safety of the individuals for whom the construction
O

is to be done. He or she takes the overall responsibility of the project. A hospital architect
is needed for preparing a sound architectural plan for constructing a hospital. It is very
P

important to engage an architect who is experienced in hospital design and construction.

There are certain other aspects where an architect can guide the whole team who is involved
in finalising the plan. Some of those issues are as follows:
‹‹ Visualising the needs related to future expansion
‹‹ Selecting and finalising the site which should be large enough for future expansion and
easily accessible by the population

DDE, Pondicherry University, Pondicherry 49

Hospital Architecture, Planning and Maintenance

Notes ‹‹ Understanding the logistics for organised movement of traffic and people and for
transporting material efficiently
‹‹ Adding a creative touch to the design
‹‹ Incorporating safety related measures during construction
‹‹ Paying attention to vital concepts such as infection control and disaster management

Y
For large projects, there should be a team of architects and engineers. The chief architect
must be qualified, skilled and experienced in handling such projects. Engineers and architects

IT
without any prior knowledge of hospital construction might be an asset to their group. In
India, the ministry or department of health at the federal or state levels employs expert
architects. They are assigned projects in the government sector. They are independent

S
architects who are experts and experienced in hospital projects and available in the open

R
market.

E
3.2.2 Role of Hospital Architect

IV
The hospital architect is essential in comprehending the hospital’s extensive technological
and organisational needs. He or she translates the administrative and clinical requirements

N
into the reality of architecture and engineering. Planning, planning, choosing a location,
overseeing building, maintaining utilities, and maintaining mechanical and electrical systems
are all included in the job functions of an architect. The challenge is to build a hospital with
U
imaginative and creative approach which fulfils the functional requirements as per the budget
available without compromising on the quality.
Y

Architects have an important role at every stage of the project, starting from designing the
plan to the completion of construction at the site. The working schedule or stages of an
R

architect can be categorised as designing phase, documenting phase and construction phase.
R

In the designing phase, a client or investor hires or engages an architect and elaborates the
goal of the hospital by explaining the type, size and purpose of the building and the facilities
E

to be included in the hospital. The architect designs the layout of the building based on the
input provided by the client, keeping patient safety in mind. He or she amalgamates technical
H

knowledge with creative elements but works in compliance with the safety and planning
regulations meant for designing. The architect must have regular or weekly meetings with
IC

his own team and the planning team to discuss the plan and designs and prepare the layout
within the stipulated period of time. Along with the design, the architect needs to give a cost
estimation to help the planning team in preparing the budget.
D

During the next phase, which is documentation, the major responsibility of an architect is to
N

get the complete plan and design of the building in print, using manual techniques or computer
aided techniques such as Microstation, AutoCad Architecture or any other 3D modelling
O

software. A complete designed layout of the building helps in checking the feasibility of
the project in real scenario. Several changes and remodelling may be required at this stage.
Sometimes changes are done due to restrained budget. Once the design and layout is finalised,
P

the architect becomes ready with his or her team for implementing the plan in reality.

The last phase is the construction phase, where the design on the paper is translated to the
engineers, contractors, labourers and the other experts. Once the work begins, the architect
needs to make regular visits to the site to monitor the construction and other jobs. Progress
meetings, negotiations with the contractors and resolving work related problems are also part
of this phase.

50 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes Once the construction is over, furniture and fixtures, equipment, other utility item are added.
The architect is involved till the completion of the whole project and even in the shake-down
period.

Architects are also involved in expansion of the hospital. The job becomes easier if the same
architect is called for the expansion work. A new architect will have to study the existing
design and the provisions for expansion for preparing a new plan.

Y
3.2.3 Architect Report

IT
It is been discreetly said that an architect’s decisions influence the safety of individuals

S
and public. Keeping this in mind, it is essential to engage a skilled architect designing such
structures, which are for the use of the community.

R
An architectural plan can be defined as a plan used by an architect to describe the place

E
or the building in terms of instructions for construction. It basically includes a layout or a
design, written documents and pictorial descriptions which comprise sketches or drawings

IV
of the structure. Drawings and citations are printed on papers or are also prepared as a soft
copy. The main purpose of the plan is to precisely and accurately explain the geographical
location of the site and the physical structure a building. The term “architectural plan” can

N
have several meanings:
‹‹ Layout plan of a construction project
U
‹‹ Documents of printed and pictorial description of the structures including drawings,
sketches and other essential details about the project
Y

‹‹ Floor design
R

‹‹ Scale drawing of any building or structure

An architect report is prepared to explain the feasibility of the identified site and construction
R

of the building as per the planned layout and budget. A detailed report includes photographs
and details of the site inspection and analysis. The report is used for estimation of expected
E

problems at the time of remodelling or expansions in future. Before preparing a report,

the architect must understand all the requirements from the planning team in terms of
H

total number of beds and their allocation, number of departments, number of employees,
departmental needs and functions, intradepartmental and interdepartmental connections,
IC

area requirements and major equipment. The points that are included in an architectural
report are:
D

‹‹ Overview of the project

‹‹ Site location and accessibility
N

‹‹ The type of the building to be constructed

O

‹‹ The expected tenancy of the building to be constructed, i.e. the approximate number of
individuals who would be staying at the building or using it.
P

‹‹ The applicable rules and regulations for construction

‹‹ Cost estimation
‹‹ Exterior design of the whole area
‹‹ Roadmap

‹‹ Parking details

DDE, Pondicherry University, Pondicherry 51

Hospital Architecture, Planning and Maintenance

Notes ‹‹ Landscaping

‹‹ Interior design of the building

‹‹ Interior floor designing of the building
‹‹ Electrical facilities including all safety norms
‹‹ Mention of special alarm systems such as fire alarm

Y
‹‹ Waste disposal mechanism

IT
‹‹ Drainage system

If an architect needs to work on an existing structure then the report should explain the

S
existing condition and compliance levels of the building, its site and the whole systems.
It should have the detailed description of inspection and analysis of the building and the

R
problems that may occur during repair, remodelling or expansion and the new proposed plan.
Photographs, drawings and sketches are provided to support the explanations.

E
Exhibit

IV
Sample of minutes document of architects’ meeting

EABO
N
U
Minutes of Meeting Held on October 1, 2009
1:00 p.m. - 5:00 p.m.
at PEO Offices
Engineers
Y
25 Sheppard Avenue West
Toronto, Ontario
Architects
R

Building Officials Attendess: Paul Roth, OAA (Chair)

Gina Cody, PEO (via teleconference)
David Craddock, OAA
R

David Dengler, PEO

John Dorris, OBOA
Bernie Ennis, PEO
E

A Joint Committee of: George Kotsifas, LMCBO

Tim Moore, TACBOC
Mike Seiling OBOA (via teleconference)
H

Professional Engineers Sheena Sharp, OAA

Ontario Dave Tipler, CEO
Consulting Engineers Ontario
IC

1.0 Opening of Meeting

Ontario Association of The meeting was called to order at 1:05 p.m.
Architects
D

2.0 Minutes/Notes From Previous Meeting

Ontario Building
Office Association There were no comments on the Minutes.
N

Large Municipalities Chief The Minutes were accepted as written.

Building Officials Group
Toronto Are a Chief Building 3.0 EABO Membership
O

Officials Committee
T. Moore reported that he will be replaced on the Committedd by
Jason Schmidt-Shoulkri in 2010.
c/o Professional Engineers Ontario
P

G. Kotsifas reported that he is considering searching for a

1000 - 25 Sheppard Avenue West replacement.
Toronto, Ontario
M2N 689
Tel: (416) 224-110
FaxL (416) 224-8168

(Source: http://www.oaa.on.ca/images/docs/1288762525_EABO_Minutes_-_1-Oct-09.png)

52 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes Self-Assessment Questions

1. ______________ __________identified that sanitation in the hospital wards was
related to the survival of patients.

2. ______________ is broadly defined as a set of plans related to building construction

that are prepared and reviewed at an organisational level before execution.

Y
3. One of the key systems of a cohesive architecture of a hospital is:

IT
a. Patient remedy
b. Material supply

S
c. Marketing
d. Finance

R
4. An architect helps in selecting and finalising the site which should be large enough

E
for future expansion and easily accessible by the population. (True/False)

IV
5. The working schedule or stages of an architect is not categorised as:
a. Designing
b. Inspection
c. Documenting

N
U
d. Construction

6. Which of the following is generally not included in an architect’s report?

Y

a. Site location
R

b. Machine specifications
c. Roadmap
R

d. Electrical connections
E

Activity
H

Prepare a sample format of an architect report.

IC

3.3 Equipping a Hospital

D

Equipping a hospital refers to adding objects or equipment that are essential for functioning
of the hospital. Equipment planning can be done for a new healthcare centre or for a pre-
N

existing health unit set up. The equipment are selected on the basis of the needs and demands
of the hospital. For building a new general hospital, it is estimated that about 40% of the
O

total project cost is consumed by all the equipment out of which 20% cost is allocated for
medical equipment.
P

It is important to plan and identify the essential equipment. Certain equipment are procured
by the architect or the contractor. In case of medical and diagnostic equipment, the planning
team has to collect descriptions and specifications of different items and understand the
feasibility of acquiring more sophisticated ones based on their cost and utility. The team has
to interact with the manufacturer or supplier, take quotations, carry out negotiations, finalise
the equipment and verify delivery and installation.

DDE, Pondicherry University, Pondicherry 53

Hospital Architecture, Planning and Maintenance

Notes Types of Equipments

Three types of equipment are widely used in hospitals. Fig. 3.1 show these equipment:

Built-in equipment

Y
Depreciable equipment

IT
Non-depreciable equipment

S
Fig. 3.1: Types of equipment

R
‹‹ Built-in equipment: These equipment are procured by the architect. Such equipment
are included in the contractual agreement. Examples of such equipment are:

E
 Furniture used in the hospital, such as cabinets, table chairs etc.

IV
 Kitchen materials like taps, shelves etc.
 Sterilising equipment

N
Fig. 3.2 show sterilising equipment in a hospital:
U
Y
R
R

Fig. 3.2: Sterilising equipment

(Source: http://www.freelancedentalnurse.co.uk/dental/wp-content/uploads/2010/06/autoclave1-460x250.gif)
E

 Elevators
H

 Air conditioners
 Freezers
IC

 Surgical lights
Fig. 3.3 show surgical lights in a hospital:
D
N
O
P

Fig. 3.3: Surgical Lights

(Source: http://www.skytron.us/images/products/cvor_nautilus.jpg)

54 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes ‹‹ Depreciable Equipment: These have a life span of 5 years or more and hence are
classed as depreciable equipment. The huge articles of furnishings have fixed place in
the hospital but are liable to be moved from one place to another. Examples of such
equipment include:
 Surgical instruments
 Analytical and remedial tools

Y
 Laboratory and pharmacy apparatus

IT
 Office machines such as typewriter, telephones, computers etc.
 Refrigerators

S
 Beds, wheelchairs, trolleys etc.

R
 Rehabilitation kits.
 X-ray machines, ECG machines, MRI machines etc.

E
Fig. 3.4 shows a high-frequency X-Ray machine:

IV
N
U
Y
R
R
E
H

Fig. 3.4: X-ray machine

(Source: http://web.tradekorea.com/upload_file2/product/
IC

263/P00264263/cbe9caa5_07b5a6b5_a91b_4ae8_8d06_7b4ca83a97d9.jpg)

Fig. 3.5 show ECG machine:

D
N
O
P

Fig. 3.5: ECG machine

(Source: http://catalog.wlimg.com/1/86036/full-images/738596.jpg)

DDE, Pondicherry University, Pondicherry 55

Hospital Architecture, Planning and Maintenance

Notes
Fig. 3.6 show MRI machine:

Y
IT
S
R
E
Fig. 3.6: MRI machine

IV
(Source: http://cdn2.hubspot.net/hub/21795/file-29883430-jpg/images/t--_astock_photos-mri-ge_
1.5t_echospeed_lx_short_bore_mri.jpg)

Pumps, generators, boilers etc.

N
‹‹ Non-depreciable equipment: Equipment having a life span of less than five years
are part of non-depreciable equipment. These are also known as low cost equipment.
U
Examples of such equipment include:
 Kitchen apparatus
Y

 Surgical tools
 Bed sheets, blankets etc.
R

 Lamps, dustbins etc.

R

Whether it is a new project or a prevailing one, demand leads to the procurement of medical
tools. The demand is identified by the clinicians, who handle the tools. Nowadays, hospitals
E

are in the race of acquiring sophisticated electronic equipments without actually studying the
H

need of such items. The decision makers should invest into such costly machines only if they
can justify optimum use of them.
IC

3.3.1 Interiors and Graphics

D

Hospital is a terrifying place for most of the people, especially for children. The essence of
being in the vicinity of white walls and loud machineries scares children and bores elders.
N

Although, a caring clinician can wore down such hassles; but an addition of extra colour and
fun to the interiors can help in changing the mindset of the patients. Most of us consider
O

a hospital or a clinic to be a place with dull environment and standard interiors. Have you
ever waited for your turn in the OPD or the lobby of any hospital? How did you feel while
P

continuous staring at the boring decoration of the premises? To make the place more exciting
and cheerful, interior designing should be incorporated by each and every hospital for a better
patient experience. Even the staff of the hospital gets influenced by lively interiors.

56 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes Moving around inside the hospital is a matter of concern for patients and visitors. People
get confused while navigating through different sections of the hospital since it is complex
setup. The employees also have to waste a lot of time guiding people. To overcome this,
hospital architects and professionals introduced ‘environmental graphic design’ in the form
of ‘wayfinding’, which is also a part of interior design. Wayfinding includes all the ways
and means in which one can identify his or her location and navigate to the other places.
Visual signs, symbols, location finder are directional maps placed all over the hospital so that

Y
anybody can find the way without asking anyone.

IT
Some of the important points related to interior designing are as follows:
‹‹ A reputed architect or interior designer only can design the interior a hospital or a

S
clinic successfully. As inexperienced designer may end up creating a negative impact
on the people.

R
‹‹ The designer should prepare a complete list for all the medical tools and hygiene
auxiliaries that are required and plan the design accordingly.

E
‹‹ The designer has to identify a good dealer for the delivery of new surgical and hygiene

IV
auxiliaries or replacements of the existing ones.
‹‹ While designing the hospital or clinic, the illuminating system must be given prior
preference. Inadequate lighting will make the area dull and depressing. Proper lighting

N
arrangement will make the interior look bright and create an effective ambience.
U
‹‹ Furniture designs and type should match with the other arrangement and furniture
should preferably be of metal. Sofas with fabric or furniture with cushions will not last
long and require higher maintenance too.
Y

‹‹ The colour and design of the walls should be chosen very carefully. Walls should be
painted with bright colours but the area should not appear too colourful.
R

‹‹ Walls can have posters with information about dos and don’ts, awareness, prevention
R

and management of diseases.

‹‹ Flooring of the premises is also an important factor to be taken care of. The floors
E

should not be too slippery or uneven. If weather condition permits the wooden flooring
could be given preference for such premises.
H

For a sound healing environment of a hospital or a clinic, interior designing plays a very
IC

important role. The boring and scary place can be converted into a place keeping the following
terms in mind:
‹‹ Self awareness
D

‹‹ Individuality
N

‹‹ Privacy

‹‹ Harmless to environment
O

‹‹ Meaningful
P

‹‹ Place for relaxation

‹‹ Interaction with outside World
‹‹ Balanced

‹‹ Beautiful

DDE, Pondicherry University, Pondicherry 57

Hospital Architecture, Planning and Maintenance

Notes 3.3.2 Construction And Commissioning

Construction
An architect prepares a landscape of the whole project with lot of time, brainstorming and
effort. A well thought out and planned architect design helps the contractors to understand

Y
the actual work to be done and estimate the amount of time and investment required to do the
construction job. Based on this they can prepare their quotation and submit their best bid. The

IT
planning team chooses the contractor with the lowest bid but makes sure that the contractor
has sufficient experience and credibility to carry out the task.

S
A contract agreement is prepared between the owner or investor and the contractor which
specifies the scope of the job, monitoring procedure, time schedule, payment schedule, mode of

R
payment, penalty clauses and the other terms and conditions. The architect and the engineers
are involved in preparing the draft agreement which is then converted into a legal document.

E
After the contractual agreement is finalised, the actual construction job begins. The contractor

IV
organises machines, materials and manpower to execute the job. The contractor can also
outsource or subcontract various jobs but the overall responsibility lies with the contractor
only. The architect has to supervise the job from time to time and ensure that the work is

N
done as per the architectural design and plan. The architect should discourage any change or
modification in the design at the construction stage unless it is absolutely necessary due to any
U
unavoidable reason. Any modification would require redrawing, cost estimation, convincing
the planning team and approval from the investor.

Proper material handling, safe storage of equipment and adequate safety measures are some
Y

of the important factors to be taken care of during construction. Construction site safety
R

norms should be followed very strictly. Appropriate personal protective equipment should
be used by the all the workers, supervisors and anyone else who is visiting the site to avoid
R

any mishap. Installation of all complex and heavy equipment should always be guided by the
experts or appropriate authority.
E

The work can be carried out in phases if the authority decides to make the hospital functional
in phases or if there is problem in mobilising fund. In that case, the architect can prepare a
H

plan for phasing and supervise the work accordingly.

IC

Commissioning
Once the construction job is complete and the infrastructure and resources are in place, the
D

hospital is ready for commissioning. The commissioning can commence when the following
jobs are complete:
N

‹‹ All the facilities are incorporated and are ready to be used

O

‹‹ All the equipment have been installed

‹‹ The plant and machines have undergone trail runs
P

‹‹ The diagnostic and therapeutic equipment are tried and tested

‹‹ The staff has been recruited and engaged
‹‹ All staff and paramedical staff are trained as per requirement

58 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes A team is formed and assigned the job of commissioning. The hospital administrator, senior
staff, architect and supply officer are the key members of the team. The team starts the work
prior to the completion of construction and ensures all the aforementioned activities.

It may not be possible to make everything functional on the same day. For example,
installation and calibration of x-ray machine is a time taking process. The operation theatre
may require more time for preparation. Therefore, some of the services can be scheduled for

Y
later date. The OPD can start functioning from day one since the doctors are ready to provide
consultation. Paramedical services may be started partially. The wards can be made functional

IT
and admission of patients will be allowed only when all the departments are fully functional.

Commissioning is a crucial job because it creates the first impression among public. It should

S
be planned properly and carried out with utmost care.

R
Self-Assessment Questions
7. For building a new general hospital, it is estimated that about ____ of the total

E
project cost is consumed by all the equipment.

IV
8. ______________includes all the ways and means in which one can identify his or her
location and navigate to the other places.

N
9. In interior designing, the illuminating system need not be given any preference.
(True/False) U
10. A _________ _________ is prepared between the owner or investor and the contractor
which specifies the scope of the job, monitoring procedure, time schedule, payment
schedule, mode of payment, penalty clauses and the other terms and conditions.
Y

11. Installation and calibration of x-ray machine is a time taking process. (True/False)
R

Activity
R

Visit your nearest hospital, interact with patients and prepare a report on their choice of
E

interior design.
H

3.4 Hospital Safety

IC

People visit the hospitals to get treatment related to their diseases and injuries. Hospital takes
care of their health and well being. Have you ever thought how safe is your hospital?
D

Consider these situations which happen quite often in any hospital. A patient wanted to use
the wash room. There was nobody to attend him. He hurt himself while getting down from
N

the bed. A ward boy got injured while moving the trolleys to distribute food among patients.
A patient underwent an operation and came back within 10 days complaining stomach pain. It
O

was found through ultrasound that a large piece of cotton had remained inside her stomach.
Did you ever imagine that a hospital is one of the hazardous places to visit or work?
P

According to Occupational Safety and Health Administration (OSHA), there were 2,53,700
work related injuries and illnesses recorded by the US hospitals in 2011. Safety has always
been a major topic of concern in hospitals both for the patients and staff. Slip, trip, fall, lifting
patients, moving items and working with needles and sharp instruments are some of the
serious hazards in a hospital. Electrical and electronic equipment, appliances and connections
also pose threat to the people who are using them. While expressing care and concern for the
patients, the staff also puts their own safety at risk.

DDE, Pondicherry University, Pondicherry 59

Hospital Architecture, Planning and Maintenance

Notes Any mishap also demands hefty compensation from the management. Therefore, it is important
to promote a health care safety culture by making people aware of the hazards and taking
preventive measures to combat unsafe conditions and practices.

3.4.1 Planning for Preventive Injuries

Y
Culture of safety should be an integral element of health care services. Safety needs should
be assessed by recognising situations and circumstances which may pose danger or threat,

IT
identifying possibilities of errors and visualising adversities. Implement a safety and health
management system to prevent any kind of harm or injuries to the patients, employees and
other visitors. Some of the measures that should be adopted by hospitals for prevention of

S
injuries are:

R
‹‹ All areas should be well lit, free of clutter, noise free, free of obstacles and organised.
‹‹ Caution signs and symbols should be placed wherever needed. Danger zones and no

E
entry zones should be marked with proper instructions.

IV
‹‹ In all sections, entry and exits should be marked and followed to avoid any confusion.
‹‹ Emergency exits should be marked properly.

N
‹‹ All utility items such as trolleys and wheelchairs should be kept at the designated places.

‹‹ All fragile items should be marked so that they can be handled with care.
U
‹‹ Hand hygiene practice is important. Anyone who is in direct contact with the patient or
objects around the patient must use a hygienic dry rub or wash with a disinfectant soap
Y

prior to and after attending them.

‹‹ For slip, trip and fall prevention make arrangement of
call bell, provide footwear which
R

are non-slippery type and adjust the bed height to low level. During floor cleaning,
caution signs such as ‘wet floor’ can be put up.
R

‹‹ Procedures related to use and disposal of sharp tools or instruments should be prepared,
E

implemented and verified.

‹‹ Personal protective equipment such as gloves, masks protective eyewear, aprons and
H

gowns should be utilised.

IC

‹‹ Methods for labelling, packaging and storing medications should be standardised.

‹‹ Patient’s medical history and prescribed medication should be attached with the bed
and the attendant or nurse should be alerted to verify before administering medication.
D

‹‹ All ‘high alert’ drugs should be identified.

N

‹‹ Workspaces where medications are prepared should be clean, disinfected, orderly and
well lit.
O

‹‹ All high risk equipment should be provided with guards.

P

Safety measures can be implemented but the management has to take initiative to raise
awareness among the patients, visitors and stuff. All safety related procedures should be
put up in the appropriate places. Periodic safety training programs should be organised for
employees. Management need to verify data, find out non-conformities and take actions for
reducing non-conformities.

60 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes 3.4.2 Electrical Safety

A hospital is a place where a lot of electrical energy is used in the form of lighting, heating,
refrigerating, cooking and operating equipments, apparatus and appliances. Saline solution
and blood have the ability to conduct electric current. Patients are exposed direct electrical
access to the heart due to wetness of skin, catheterisation and intravenous puncture. At times,

Y
patients are unconscious and unattended and may not react to an electrical current. Due to all
these reason, electrical safety is necessary in any hospital.

IT
Electrical hazards are:
‹‹ Fire

S
‹‹ Burns

R
‹‹ Electrical shock
‹‹ Explosions of flammables

E
‹‹ Power failure

IV
‹‹ Breakdown of electrical equipment

Exposure to such hazards leads to damage of equipment and injury or even death to patients

N
and staff. Electrical safety measures that should be followed are:
U
‹‹ All electrical installations define appropriate safety measures. All those safety
arrangements should be made and followed.
‹‹ Earthing or grounding is an important aspect of electrical safety. Proper method
Y

should be followed to ensure earthing.

R

‹‹ Depending on the kind of treatment and use of electrical devices on patients, protective
devices must be provided in patient care areas.
R

‹‹ Fire protective devices and safety alarms should be installed at various locations.
E

‹‹ Electrical safety related instructions should be put up at several places.

‹‹ Emergency contact numbers should be displayed.
H

Some of the instructions which the employees must follow to avoid electrical hazards are:
IC

‹‹ The power switches should be in off position while plugging equipment into wall
sockets. Switch off and unplug by pulling the plug and not the cord.
D

‹‹ Always check for frayed or exposed wiring on equipment cords.

‹‹ Do not plug in equipment with wet hands or when the cord or plug is wet.
N

‹‹ Keep the access to electrical panels clear of any obstruction.

O

‹‹ Do not plug equipment into defective or broken sockets.

‹‹ The cords should be away from hot or sharp objects.
P

‹‹ Cords should not be laid in a manner which can cause a trip hazard.
‹‹ Avoid using extension cords unless authorised.

DDE, Pondicherry University, Pondicherry 61

Hospital Architecture, Planning and Maintenance

Notes Self-Assessment Questions

12. A Hospital is a hazardous place. (True/False)

13. Hospital management has to pay hefty ____________ for any mishap.

14. Which of the following measures should not be adopted by hospitals for prevention
of injuries?

Y
a. Caution signs and symbols should be placed.

IT
b. Hand hygiene practice should be followed.
c. Certain areas should be provided with obstacles.

S
d. Personal protective equipment must be used.

R
15. Which of these is not an electrical hazard?

E
a. Burns
b. Water leakage

IV
c. Explosions of flammables
d. Power failure

Activity
N
U
Visit a nearby hospital, make a list all the different types of hazards that you come across.
Note down the safety measures adopted by the hospital.
Y
R

3.5 Summary
R

‹‹ In 1700, Louis XV of Paris introduced the concept of forming a committee who will
look after the structure and functioning of the hospital.
E

‹‹ Nightingale was considered as the mother of nursing and the hospital designs were
influenced by her passion and dedication to patient care.
H

‹‹ Architecture is broadly defined as a set of plans related to building construction that

IC

are prepared and reviewed at an organisational level before execution.

‹‹ A hospital architect reflects a system that narrates the flow and use of the hospital
premises.
D

‹‹ A hospital architect is needed for preparing a sound architectural plan for constructing
N

a hospital and visualising the needs related to future expansion

‹‹ The hospital architect plays a vital role in understanding the comprehensive technical
O

and organisational requirements of the hospital. He or she is interprets the clinical and
administrative needs and converts them into architectural and engineering realities.
P

‹‹ Planning, designing, site selection, supervision of construction, taking care of utilities

and electrical and mechanical installations come under the job functions of an architect.
‹‹ The working schedule or stages of an architect can be categorised as designing phase,
documenting phase and construction phase.
‹‹ An architectural plan basically includes a layout or a design, written documents and
pictorial descriptions which comprise sketches or drawings of the structure.

62 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes ‹‹ An architect report is prepared to explain the feasibility of the identified site and
construction of the building as per the planned layout and budget.
‹‹ Equipping a hospital refers to adding objects or equipment that are essential for
functioning of the hospital.
‹‹ Three types of equipment are widely used in hospitals:

Y
 Built-in equipment
 Depreciable Equipment

IT
 Non-depreciable equipment
‹‹ Interior designing should be incorporated by each and every hospital for a better patient

S
experience.

R
‹‹ Hospital architects and professionals introduced ‘environmental graphic design’ in the
form of ‘wayfinding’, which is also a part of interior design.

E
‹‹ A contract agreement is prepared between the owner or investor and the contractor
which specifies the scope of the job, monitoring procedure, time schedule, payment

IV
schedule, mode of payment, penalty clauses and the other terms and conditions. After
the contractual agreement is finalised, the actual construction job begins.

N
‹‹ Once the construction job is complete and the infrastructure and resources are in place,
the hospital is ready for commissioning.
U
‹‹ Safety has always been a major topic of concern in hospitals both for the patients and
staff. Slip, trip, fall, lifting patients, moving items and working with needles and sharp
instruments are some of the serious hazards in a hospital.
Y

‹‹ Hospitals need to implement a safety and health management system to prevent any
R

kind of harm or injuries to the patients, employees and other visitors.

‹‹ Electrical safety is necessary in any hospital.
R
E

3.6 Glossary
H

‹‹ Architectural plan: It can be defined as a plan used by an architect to describe the place
or the building in terms of instructions for construction.
IC

‹‹ Hospital Layout: It indicates a manner in which machines and equipment are arranged
for production purposes.
D

‹‹ Site Location: It refers to a place where an organisation is located.

N

3.7 Terminal Questions

O

1. Explain the concept of a hospital architect.

P

2. List down the roles of a hospital architect.

3. Enumerate the importance of interiors in a hospital.

4. Write a note on hospital safety.

DDE, Pondicherry University, Pondicherry 63

Hospital Architecture, Planning and Maintenance

Notes
3.8 Answers
Q. Self-Assessment Questions
1. Florence Nightingale
2. Architecture

Y
3. a. Patient remedy
4. True

IT
5. b. Inspection
6. b. Machine specifications

S
7. 40%

R
8. Wayfinding

E
9. False
10. Contract, agreement

IV
11. True
12. True

N
13. Compensation U
14. c. Certain areas should be provided with obstacles.
15. b. Water leakage
Y

Q. Terminal Questions
1. A hospital architect reflects a system that narrates the flow and use of the hospital
R

premises. In a broader aspect, an architect acts as a channel of interaction between

the users, stakeholders and investors in designing a structure that supports all
R

the facilities and utilities for providing round the clock sound medical care to the
patients. Refer to section 3.2 Concept of Hospital Architect.
E

2. The hospital architect is essential in comprehending the hospital’s extensive

H

technological and organisational needs. He or she translates the administrative

and clinical requirements into the reality of architecture and engineering. An
IC

architect’s duties include planning, designing, choosing a site, supervising building,

maintaining utilities, and taking care of mechanical and electrical equipment.
Please see the subsection 3.2.2 Role of Hospital Architect.
D

3. Most of us consider a hospital or a clinic to be a place with dull environment

and standard interiors. To make the place more exciting and cheerful, interior
N

designing should be incorporated by each and every hospital for a better patient
experience. Even the staffs of the hospital get influenced by lively interiors. Refer
O

to sub-section 3.3.1 Interiors and Graphics.

P

4. Safety has always been a major topic of concern in hospitals both for the patients
and staff. Slip, trip, fall, lifting patients, moving items and working with needles
and sharp instruments are some of the serious hazards in a hospital. Electrical and
electronic equipment, appliances and connections also pose threat to the people
who are using them. While expressing care and concern for the patients, the staff
also puts their own safety at risk. Refer to section 3.4 Hospital Safety.

64 DDE, Pondicherry University, Pondicherry

 chapter 3  Hospital Architect

Notes
Case Study: Hospital Architecture
3.9
of Stobhill Hospital
Located north of Glasgow, Scotland, is Stobhill Hospital, an ambulatory care and diagnostic
facility. In 1904, Stobhill was established as a Poor Law Hospital. The hospital is now ranked
first among tiny hospitals worldwide. It was the first hospital in Scotland to achieve the title
of “world’s finest tiny hospital” in 2010.

Y
According to Margaret Watt, Scottish Patients Association, “The facility is quite beautiful.

IT
There is no reason why visiting patients shouldn’t make them feel good. It’s neither gloomy or
dim. It’s lovely and airy. In the future, every hospital should be built similarly to the Stobhill
location”

S
The building is designed in such an efficiently organised manner that it enhances the overall
patient satisfaction by cutting down on wait times. It is accomplished by shortening the

R
amount of time it takes for patients to move between various parts of the institution and
making sure they get at the appropriate location at the appropriate time with the least amount

E
of stress and worry.

IV
The architecture of the hospital attracts lots of people to visit the building. The luxurious
facility architecture is a great specimen for health college students and architects from the UK
and other countries. From reception to various departments, everything is well-designed with

N
enough space to deal with the crowd and any emergency situation that may arise. It also has
its own parking lot and patient transport system.
U
The day surgery, diagnostics, and outpatient departments are all easily accessible from the
entryway, which leads straight into a large atrium. The atrium is surrounded by a four-story
deep-plan structure that houses departments including radiation and surgery. A three-story
Y
structure to the south houses the MIU and outpatient consultation spaces. The lower scale
cellular housing is set up in a series of narrow plan “loops” around courtyards that provide
light and some vistas. Direct and discreet access to the MIU is made possible by a high bank to
R

the south of the building, which also acts as a visual barrier between it and the nearby mental
health unit. Compared to many hospitals of a comparable magnitude, this graphic stands out
R

for its compassion and clarity.

E

The building is completely mechanically ventilated. The building standalone facilities provide
personal requirements of the personnel, including food, drinks, and banking. Overall, the
H

facility architecture of Stobhill is an ideal one for hospital management students to learn how
to design the layout plan of a small-scale healthcare facility.
IC

Discussion Questions
D

1. What is the major point of attraction at Stobhill hospital?

N

(Hint: The excellent facility architecture of Stobhill is the major point of attraction at
Stobhill hospital)
O

2. With reference to the given case study, explain why facility architecture is important
for hospital growth?
P

(Hint: If done correctly, and sensibly, the design and the facilities of health care unit
can change the performance of the organisation. The building of Stobhill hospital is
designed in such an efficiently organised manner that it enhances the overall patient
experience by ensuring that patients arrive in the right place at the right time with the
minimum levels of stress and anxiety.)
(Source: http://www.ads.org.uk/healthierplaces/features/case-study-new-stobhill-hospital)

DDE, Pondicherry University, Pondicherry 65

Hospital Architecture, Planning and Maintenance

Notes
3.10 References and Suggested Readings
‹‹ James, P., and Noakes, T. (1994). Hospital architecture. New York: Longman.
‹‹ Nickl-Weller, C., and Nickl, H. (2009). Hospital. Berlin: Braun.
‹‹ Verderber, S. (2010). Innovations in hospital architecture. New York: Routledge.

Y
E-References

IT
‹‹ Ahrq.gov. (2014). 10 Patient Safety Tips for Hospitals | Agency for Healthcare Research
& Quality (AHRQ). Retrieved from, <http://www.ahrq.gov/patients-consumers/

S
diagnosis-treatment/hospitals-clinics/10-tips/index.html>

R
‹‹ Draeger.com. (2014). Hospital planners and architects. Retrieved from. <http://www.
draeger.com/sites/en_uk/Pages/Hospital/hospital-planners-and-architects.aspx>

E
‹‹ e-architect.
(2014). Hospital Buildings - Health Architecture - e-architect. Retrieved from,
<http://www.e-architect.co.uk/hospital-buildings>

IV
‹‹ Indmedica.com. (2014). Indmedica - Journal of the Academy of Hospital Administration.
Retrieved from, <http://www.indmedica.com/journals.php?journalid=6&issueid=24&

N
articleid=222&action=article>
‹‹ Weibell, F. (1974). Electrical safety in the hospital—1974. Ann Biomed Eng, 2(2), 126-
U
148. doi:10.1007/bf02368486
Y
R
R
E
H
IC
D
N
O
P

66 DDE, Pondicherry University, Pondicherry

chapter

4 Technical Analysis

Y
IT
S
R
E
Structure

IV
4.1 Introduction

N
Learning Objectives U
4.2 Concept of Hospital Services

4.3 Factors Influencing Hospital Utilisation

Y

4.4 Technical Factors

R

4.5 Hospital Drawings and Documents

4.6 Summary
R

4.7 Glossary
E

4.8 Terminal Questions

H

4.9 Answers
IC

4.10 Case Study: Apollo Hospitals

4.11 References and Suggested Readings

D
N
O
P
Hospital Architecture, Planning and Maintenance

Notes Learning Objectives

After completing the chapter, you will be able to:
 Explain the concept of hospital services
 Assess the demand and need for hospital services
 List the factors influencing hospital utilisation

Y
 Explain the method of bed planning
 Discuss the ways of assessing land requirements

IT
 Discuss the method of estimating project cost
 Explain the ways of calculating space requirements

S
 Describe the method of preparing a project report

R
4.1 Introduction

E
In the previous chapter, you have studied about the concept of hospital architect, equipping a

IV
hospital and hospital safety. This chapter will focus on the technical analysis.

Efficiency of a hospital is defined by effective utilisation of all assets and resources to

N
minimise the operating cost and offer competitive service charges without compromising
on the patient care services. Incompetence of healthcare settings is an essential factor in
U
the growth of healthcare expenses. From a strategic outlook, efficiency of a hospital can
be increased if the healthcare setting can accomplish competence by accommodating larger
number of individuals for treatment. An understanding of technical analysis can guide you
Y
to choose the appropriate hospital assets, allocate capital cost in the most optimum way and
utilise all the assets effectively. Modifications in the deployment of hospital assets results
R

from inappropriate judgement or finding irrespective of case and distinctive features of

the hospital. This becomes a major cause of increased expenditure and low efficiency in
R

the hospital. Technical analysis can be defined as a technique for estimation of the price of
the commodities in the market by evaluating the supply and demand of the same by the
E

individuals in future, which somehow reflects the inflation or deflation of market price. This
technique is utilised by investors to get an estimated picture of the future market in response
H

to their investments and utilisation of hospital funds.

In this chapter, you will study about the demand and need of hospital services. You will take
IC

a look at the various factors that influence hospital utilisation. Further, the chapter discusses
about various technical factors such as bed planning, land requirement, project cost and space
D

requirement. Towards the end, you will study about the documents and drawings related to
a hospital project.
N

4.2 Concept of Hospital Services

O

Hospitals are structured buildings comprising medical personnel and basic utilities in terms
P

of equipment, machineries and medicines, segregated in to specialised departments like

medicine, surgery, urology, etc. Such buildings and sections are dedicated towards providing
round the clock services to combat various diseases and medical conditions. To satisfy
community needs, hospitals provide a broad variety of inpatient and outpatient services. The
community healthcare settings are judged by the clinical supervisors and steps are taken
to provide adequate healthcare services to the community. There are also provisions of
financial aiding and control healthcare services for the communities. Hospital services can be

68 DDE, Pondicherry University, Pondicherry

 chapter 4  Technical Analysis

Notes defined as clinical, operational, diagnostic and supportive services which are provided to fulfil
the needs and demands of the individuals.

As discussed in earlier chapters, hospitals can be broadly classed as: Private hospitals (profit-
oriented), non-profit hospitals and government hospitals.

Hospitals provide personal health care services which are categorised into the following:

Y
‹‹ Promotion of health
‹‹ Prevention of diseases

IT
‹‹ Diagnosis and treatment
‹‹ Rehabilitation

S
The facilities offered within a hospital are:

R
‹‹ Inpatient healthcare services

E
‹‹ Out Patient Department (OPD) services

IV
‹‹ Emergency services
‹‹ Specialised or general surgical amenities

N
‹‹ X-ray and diagnostic services.
‹‹ Laboratory
U
‹‹ Blood bank

Some hospitals also provide services related to educating medical students, research and
Y

community benefit programs.

R

Services to be provided by any new hospitals should be determined and decided depending
on the need and demand of the population in and around the area of the hospital location.
R

A hospital may provide or add services which are not available within a state or even in the
country. It is always essential to conduct a study related to the need and demand of the
E

community and then propose the services to be rendered by the hospital.

H

4.2.1 A
 ssessment of the Need and Demand of Hospital Services
IC

Assessment of the health care needs and the ranges of services to be provided are done
through collection and study of various data. It is one of the preliminary tasks that should
D

be conducted before conceiving the idea of starting a new hospital. An existing hospital can
also analyse data to alter or add services depending on the need and demand of the society.
N

In the early nineteenth century, healthcare professionals were allotted to estimate the needs
and demands of the community on the basis of the mortality ratios and the socio-economic
O

condition of the community. In 1992, the Indian government started a programme named
“Health of the Nation” to estimate the demands in order to improve the health services as
P

per the needs. As the health services are getting costlier these days, implementation of such
techniques and programs are absolutely essential. Due to the increased costs, the healthcare
services are almost unaffordable by people with lower socio-economic status. This is the real
scenario of health services in both the developing and the developed countries.

Demand is basically about what a patient or an individual asks for. Medical practitioners
are also involved to certain extent in estimation and regulation of such demands. Demand

DDE, Pondicherry University, Pondicherry 69

Hospital Architecture, Planning and Maintenance

Notes from an individual for a facility can be dependent on the traits of an individual or on the
broadcaster’s interest in the facility. Assessment of health demands of people and functional
needs of a hospital cannot be done by merely asking the patients about the same. It is possible
to gauge the demand for hospital services by researching and referring to the statistical
returns from the existing conditions and the morbidity statistics of the area or the whole
country. The need for hospital services can be identified through quantitative assessment
of the variety and severity of illnesses in the population that call for medical attention in

Y
hospitals.

IT
The importance of assessing the health demands is more relevant than providing responses
to the unmet needs and supply. There is no easier way or technique for assessing the supplies
and services, other than utilising several epidemiological techniques for collection of data and

S
information and implementing them to make out the results. Fig. 4.1 shows the two methods
of assessment:

R
E
Methods of
assessment

IV
N
U
The empirical The analytical
method method
Y

Fig. 4.1: Methods of assessment

R

Let us now study these methods in detail.

R

‹‹ The empirical method: It follows the norms and trend of the past and applies set rules
to the problem with suitable alterations to match local conditions. New solutions and
E

new conditions are generally avoided in this method. There is a possibility of repeating
past faults.
H

‹‹ The analytical method: It is a more basic and systematic approach to the problem.
The controlling elements of the past norms are missing and hence this method
IC

helps to overcome some of the past faults. With the help of an epidemiological and
quantitative technique, the urgencies which include medical and cost-effectiveness and
patients' point of views can be determined. Data is analysed to offer new, research-
D

oriented approaches. A combination of these two methods should be applied to fulfil the
functional needs of a hospital.
N

Table 4.1 shows the elements to be considered and analysed:

O

Table 4.1: Elements to be considered and analysed

P

Elements Parameters
Morbidity Statistics
1. Prevalence of Communicable diseases
Degenerative diseases
Accident rates
Specific diseases or disorders
70 DDE, Pondicherry University, Pondicherry
 chapter 4  Technical Analysis

Notes Table 4.1: Elements to be considered and analysed

Elements Parameters
2. Measurement of Death rate
Birth rate
Maternal mortality rate

Y
Infant mortality rate

IT
3. Demographic Age and sex profile
Population density

S
Occupational characteristics
Extent of urbanisation

R
Extent of migratory population

E
Economic development of the area
Socio-economic statistics Economic status of the community

IV
Literacy and education standard
Social habits and socio-cultural grouping

N
Housing conditions
Style of living
U
Industrialisation
Hospital statistics Type of existing hospital services
Y

Admission rates
R

Disease-specific admission rates

Hospital beds in the region
R

Utilisation of existing health and hospital services

E

Extent and effectiveness of general practitioner service

H

Need, demand, and supply are interlinked and this linkage is always essential to achieve the
objective of any hospital.
IC

Self-Assessment Questions
1. Incompetence of healthcare settings is an essential factor in the growth of healthcare
D

__________.
N

2. Hospital services can be defined as ________, operational, diagnostic and supportive

services.
O

3. The healthcare services are almost affordable by people with lower socio-economic
status. (True/False)
P

4. The ________ method follows the norms and trend of the past and applies set rules
to the problem with suitable alterations to match local conditions.

Activity
Visit a nearby hospital and identify the nature of services provided by them.

DDE, Pondicherry University, Pondicherry 71

Hospital Architecture, Planning and Maintenance

Notes
4.3 Factors Influencing Hospital Utilisation
According to studies, it has been evaluated that the individuals with lower socio-economic
status are more exposed to diseases and mortality-morbidity conditions. It has also been seen
that hospitals and clinics are not used that frequently by the individuals of such communities.
Education and awareness level and monetary conditions are the major factors that affect the

Y
utilisation of healthcare services such as visiting the clinics or health centres for regular
check-ups or for getting preventive care in case of an epidemic. The attitude of health care

IT
professionals also contributes to the utilisation of hospital services.

There is no estimated population which a hospital should cover but various factors influence
the utilisation of a hospital and its services. Fig. 4.2 show the factors influencing hospital

S
utilisation:

R
Bed availability

E
Population coverage

IV
Age of people

N
Facilities of the hospital
U
Presence of other types of medical services
Y
Attitudes of doctors
R

Medical insurance policies

R

Lack of availability of qualified doctors

E

Illness pattern
H

Poor services
IC

Attitude of people
D

Fig. 4.2: Factors influencing hospital utilisation

N

Let us now study these factors in detail.

‹‹ Bed availability: Most of the hospitals in India have a low bed: population ratio.
O

Availability of more number of beds will ensure larger occupancy rate.

‹‹ Population coverage: Largely populated areas show more utilisation of hospital
P

services as compared to scarcely populated areas.

‹‹ Age of people: Age profile of population gives an indication of potential usage of
services. For example: Aged people require frequent and longer services from the
hospital.
‹‹ Facilities of the hospital: Hospitals with better facilities and more departments
attracts more crowds. For example: Christian Medical College (CMC), Vellore is a

72 DDE, Pondicherry University, Pondicherry

 chapter 4  Technical Analysis

Notes renowned multi-speciality hospital. It served 21.4 lac outpatients and 1.29 lac inpatients
in the year 2012.
‹‹ Presence of other type of medical services: Availability of dispensaries, nursing
homes, mobile clinics and private practitioners lessens the requirement of visiting a
hospital.
‹‹ Attitudes of doctors: Patients may not like to get admitted due to fear of staying in a

Y
hospital and getting separated from family members. Doctors can influence the patient
by emphasising the real need and counselling the patient.

IT
‹‹ Medical insurance policies: Medical insurance money can be claimed only with proper
utilisation of hospital for the appropriate need. People with such policies need to get

S
admitted to the hospital.
‹‹ Lack of availability of qualified doctors: Hospitals in remote areas may not have

R
sufficient number of qualified doctors and patients may experience delay in consultation.

E
Gradually, people will look for other options and may not visit the hospital for treatment.
‹‹ Illness pattern: People with chronic and serious diseases need to stay longer whereas

IV
the common types diseases demand shorter stay or can be treated from home. Hospital
utilisation varies depending on the type of disease.

N
‹‹ Poor services: If the hospital is not efficient enough in all types of supportive services
such as admission process, discharge procedure, diagnostic services and pathological
U
services, then people will have to stay in the hospital for longer duration.
‹‹ Attitude of people: It is the people who decide the type of treatment and where to
go for treatment or medical services. Factors like social and religious attitude, customs,
Y

traditions and faith and beliefs affect the choice of every individual.
R

Some more conditions that affect hospital utilisation are:

‹‹ Location of the hospital
R

‹‹ Mode of transport to reach the hospital

E

‹‹ Facilities available around the hospital premises, such as hotel accommodation

H

‹‹ Basic utilities such as water supply and power connection around the hospital area
‹‹ Climatic condition of the region
IC

‹‹ Pollution level of the region

D

Self-Assessment Questions
5. It has been evaluated that the individuals with lower ____________ status are more
N

exposed to diseases and mortality-morbidity conditions.

6. Which of the following factors influence the utilisation of a hospital and its services?
O

a. Attitudes of doctors
P

b. Age of people

c. Owner of the hospital

d. Illness pattern

7. The size and shape of the hospital building affect hospital utilisation. (True/False)

DDE, Pondicherry University, Pondicherry 73

Hospital Architecture, Planning and Maintenance

Notes
4.4 Technical Factors
In moviemaking, all the actions happen behind the scenes. Similarly, in case of a hospital there
are a lot of activities which are essential prior to the establishment of the healthcare setup.
Various factors are taken into consideration and a technical analysis is done against each
factor to identify the demand, cost or method of implementation. Fig. 4.3 shows the technical

Y
factors:

IT
Bed planning

S
Land requirements

R
Project cost

E
Space requirement

IV
Fig. 4.3: Technical factors

N
These factors are detailed in the next few sections.
U
4.4.1 Bed Planning
Y

Hospital bed planning is a complex issue and ensuring optimal bed utilisation is a major factor
which contributes to the overall efficiency of a hospital. Based on patient flow, bed occupancy
R

rate and arrangements of various sections, the hospital administrator and his or her team
occasionally evaluates the existing arrangement to strategically and purposefully plan for
R

modification in bed capacity. The main aim is to explain the necessities of the same for the
upcoming years and months before commissioning the plan in to reality.
E

The bed holding capacity must be planned accurately and appropriately to fulfil the
H

community’s demands. The quantity of beds is decided based on the standard rule of bed:
population ratio. It is difficult to achieve such a ratio and even if a hospital has achieved it,
IC

there is a constant demand of more number of beds due to rising population and increasing
urbanisation. Moreover, a hospital is not necessarily utilised only by the people of nearby
areas. If we consider them as direct population, then there are others who come and visit the
D

hospital from different parts of the state or country and are considered as indirect population.
Both types of population must be taken into account for bed planning.
N

The WHO has suggested an estimated number of patients who are likely to get admitted
in a year. It is thought that an occupancy rate of 85% is ideal. We are able to determine the
O

necessary number of hospital beds based on all of these variables. Refer to the following
calculation for bed planning:
P

Calculation for bed planning

Collected data:

Population (direct) - 4,00,000

Population (indirect) - 6,00,000

74 DDE, Pondicherry University, Pondicherry

 chapter 4  Technical Analysis

Notes Admission (from direct population) - 165 per 1000 per year (suggested by WHO)

Admission (from indirect population) - 55 per 1000 per year (suggested by WHO)

Average length of stay - 10 days

Desired occupancy rate - 85%

Y
Calculation:

Direct admission per year - (4,00,000 x 165)/1000 = 66,000

IT
Direct admission per year - (6,00,000 x 55)/1000 = 33,000

S
Total admission per year - 99,000

Total bed days per year 99,000 x.10 = 9,90,000

R
(based on average length of stay)

E
Total beds required for 100% occupancy 990000/365 = 2712

IV
Total beds required for 85% occupancy (2712 x100)/85 = 3190

If there is any other hospital in that region then the bed count of existing facility is deducted

N
from the total number of calculated beds and the final figure is reached. The hospital planning
team can then decide whether to go by the calculated figure or keep more beds for emergency
U
requirement. Technically, keeping more beds would decrease the rate of utilisation and work
out to be a costlier affair. Therefore, adding more beds can be a part of the expansion plan of
the hospital
Y

4.4.2 Land Requirements

R
R

Land area of any hospital is determined based on various factors. Availability of land depends
on the type of area chosen. For example: Rural or semi-urban areas may have plenty of
E

land available whereas the urban areas always have land scarcity or land of premium value.
Hospital may be developed horizontally or vertically depending on the availability of land.
H

The area of land cover to be covered is calculated as:

IC

Land cover percentage = (Total ground floor area of all buildings * 100)/Total land area

Land cover percentage is regulated by the government or municipal corporations. Floor Area
D

Ratio (FAR) is the ratio of total covered area of all the floors of a building to the total land
area. If FAR is one, it means that the buildings have utilised half the land area available.
N

Land requirement are dependent on factors, such as flat or upright positions, FAR rules and
the area of the land to be covered. The required land area of a hospital is based on the
O

estimated number of beds of that hospital.

P

Calculation

As per the international standard, the built-up area required per bed is = 125m2.

The allowances are as follows:

1. Allowance for plan (columns, walls etc.) = 5%

2. Allowance for movement (corridors, staircase, lifts etc.) = 20%

DDE, Pondicherry University, Pondicherry 75

Hospital Architecture, Planning and Maintenance

Notes 3. Allowance for utility = 8%

4. Allowance for general engineering (duct riser, open to sky etc.) = 3-5 %
Total allowances = 36%
Total built-up area per bed (with allowances) = 1.36 x125 = 170 m2 per bed
Ground floor area (GFA) per bed = Total built area per bed/Number of floors

Y
= 170 m2 /Number of floors

IT
External services:
External services (cables, pipes, water tanks etc.) = 15% of GFA

S
Foot path = 10% of GFA

R
Landscape = 15% of GFA

E
Total allowances for external area (except parking) = 40%
Total land area per bed (except parking) =
 1.4 x 170 m2/Number of floors

IV
= 238 m2/Number of floors
Assume that the total number of beds is M and number of floors is N. Therefore, the total

N
land area required = 238xM/N
Parking:
U
The number of parking per bed = 2.5 parking
Area of one parking = 15 m2
Y

Extra area required per bed = 2.5 x 15 = 37.5 m2

R

The extra area required per bed is added to the previous land area calculated if the parking
R

area is designed outside the building. It is not included if parking is underground or at the
basement of the building.
E

Example:
H

Land area required for a hospital of four floors and 200 beds:
1. If the parking area is part of the building then area required = (238 x 200)/4
IC

= 11,900 m2.
2. If the parking area is external to the building then land required for parking area =
D

37.5 x 200 = 7,500m2

N

Total land area required = 11,900 + 7,500 = 19,400 m2

(Source used for formula and calculations: https://www.haad.ae/HAAD/LinkClick.aspx?fileticket=QrTSgzeojXw%3D&tabid=853)
O

4.4.3 Project Cost

P

The cost of a hospital project will vary according to the complexity of the facilities to be
provided within the hospital. There can be a significant difference in the cost of land between
the rural and urban area. Certain hospitals may decide to incorporate extensive facilities for
the outpatients; some may have highly sophisticated inpatient department; and some may have
research or education facilities along with regular medical services. The range of services will
add to the cost component.

76 DDE, Pondicherry University, Pondicherry

 chapter 4  Technical Analysis

Notes There are four basic cost components:

Land cost and site acquisition cost

‹‹ Base cost of constructing the building: Base cost depends on the total space allocated
for all the buildings. It includes costs related to complete construction installation of all
facilities, circulation and interior and exterior design.

Y
‹‹ Escalation cost: It includes the additional cost due to appreciation of material and
equipment cost.

IT
Fees of consultant, architects, engineers and contractors

These are considered as direct project cost. Start-up cost, loan interest and legal fees are not

S
included in direct cost. Costing can be further divided under following heads:

R
‹‹ Site survey and investigation
‹‹ Site acquisition

E
‹‹ Landscaping

IV
‹‹ Construction with fixed accessories
‹‹ Equipping the hospital

N
‹‹ Furniture and fixtures
‹‹ Interior design
U
‹‹ Supervision and inspection
‹‹ Consultant’s fees
Y

‹‹ Architect’s fees
R

‹‹ Modification plan

As a standard rule, 7%-8% construction using fixed equipment should account for 12–15%
R

of the overall cost, depreciable equipment with a life expectancy of more than 10 years for
12%–15%, and depreciable equipment with a life expectancy of 5%–10% for 6%–8%.
E

The most common method of estimating the total cost of a hospital project is the ‘per
H

bed’ method. Most hospitals do not consider this method as costing varies according to the
facilities provided by the hospitals. The ‘per bed’ method would only give a ballpark figure
IC

to start with. It is a general assumption that the cost constructing of the cost of a bed at a
normal hospital range from three to ten lacs. Funding organisations are better able to plan
and distribute funds when they have an early estimate of the overall project cost.
D

Another important factor is the operating cost of a hospital which is worth considering at this
N

stage. The total operating cost of any hospital is estimated to surpass the project’s budget in
the first two to three years of operation. Therefore, planning and designing should be done in
O

a manner that helps in reducing the operating cost in future.

4.4.4 Space Requirements

P

The space requirement for a healthcare unit is directly related to the amount of space to be
allocated for various sections. For each type of area or location, the space estimation is mainly
dependent on the number of operational days, time taken or required and the dimensions
of the rooms and supportive areas needed to carry out the activities. Space requirement
can be estimated only when all the sections and departments have been finalised and their

DDE, Pondicherry University, Pondicherry 77

Hospital Architecture, Planning and Maintenance

Notes requirements, functions and activities have been cleared defined. Space planning for all the
equipments are to be done based on the specifications and guidelines of the manufacturer. The
required space is finally estimated based on the area allocated per bed.

Fig. 4.4 show the three main areas in a hospital:

Main areas

Y
in a hospital

IT
S
Outpatient Inpatient
department (OPD) department (IPD) Services

R
Fig. 4.4: Main areas in a hospital

E
Let us now study these areas in detail.

IV
‹‹ Outpatient department (OPD): It includes consultancy services, diagnostic facilities,
physiotherapy, pharmacy and emergency.

N
Fig. 4.5 shows the physiotherapy department in a hospital:
U
Y
R
R
E
H

Fig. 4.5: Physiotherapy department

(Source: http://www.sghgroup.com.sa/med_materials/Images/Physio.jpg)
IC

Fig. 4.6 shows a pharmacy:

D
N
O
P

Fig. 4.6: A pharmacy

(Source: http://palafoxpharmacy.com/images/pharmacy.jpg)

78 DDE, Pondicherry University, Pondicherry

 chapter 4  Technical Analysis

Notes Fig. 4.7 shows an emergency unit of a hospital:

Y
IT
Fig. 4.7: Emergency unit

S
(Source: http://www.lifebridgehealth.org/uploads/public/images/er7/Sinaiheader.jpg)

‹‹ Inpatient department (IPD): It includes wards, surgical units, intensive care unit

R
(ICU) or coronary care unit (CCU), cath lab, day care and pathology.

E
Fig. 4.8 shows an ICU:

IV
N
U
Y
R
R

Fig. 4.8: ICU

E

(Source: http://www.kerudihospital.com/images/photos/ICU_View.jpg)
H

Fig. 4.9 shows a cath lab in a hospital:

IC
D
N
O
P

Fig: 4.9: Cath lab

(Source: http://www.modulardevices.com/files/image/lab-915-27.gif)

DDE, Pondicherry University, Pondicherry 79

Hospital Architecture, Planning and Maintenance

Notes Fig. 4.10 shows a laboratory:

Y
IT
S
R
Fig. 4.10: A laboratory

E
(Source: http://www.redmanvan.com/wp-content/themes/redmanvan/images/laboratory.jpg)

IV
‹‹ Services: The central sterile supply department, labs, medical records department,
library, conference room, auditorium, housekeeping, engineering services, medical gas
manifold, change and lockers, and mortuary are all included in this area.

N
Each unit should be allocated with adequate space based on the volume of service, number
of staff, number of functional room, placement of equipment and furniture and storage of
U
supplies. The percentage space distribution among various sections is as follows:
‹‹ Wards – 37-45%
Y

‹‹ OPD – 12-18%
‹‹ Diagnostic and therapeutic sections – 18-22%
R

‹‹ Administrative section – 8-12%

R

‹‹ Other services department – 15-20%

E

Space calculation of each department is done based on the floor space allocated per bed. The
average floor space allocated per bed varies according to the sections. Refer to the following
H

table for space requirement of different units based on floor area per bed:
IC

Sections or area Square meter per bed

Nursing units 23-26
Nursery 1-1.5
D

Delivery suite 1.3-1.8

Operation theatre 2.5-4.5
N

Physical medicine 1-1.5

Radiology 2-3
O

Laboratory 2-3
Pharmacy .4-.5
P

CSSD .7-2.3
Dietary 2-3
Medical records .7-1.4
House keeping .4-.5
Laundry 1-1.5

80 DDE, Pondicherry University, Pondicherry

 chapter 4  Technical Analysis

Notes Sections or area Square meter per bed

Mechanical installations 4.5-7
Maintenance workshop .4-.5
Stores 2-3
Public areas .7-1
Staff facilities 1-1.5

Y
Administration 3.5-4.5
Circulation 10-13

IT
Self-Assessment Questions

S
8. Number of beds is decided based on the standard rule of ___________ratio.

R
9. _____________ is the ratio of total covered area of all the floors of a building to the
total land area.

E
10. Which of the following are direct costs for a hospital project?

IV

a. Construction cost

b. Fees of doctors

N

c. Escalation cost

d. Fees of consultant
U
11. The most common method of estimating the total cost of a hospital project is the
‘per bed’ method. (True/False)
Y

12. Space calculation of each department is done based on the floor space allocated
per ___________.
R
R

Activity
Visit a hospital and discuss the plans and techniques for bed planning with an administrator.
E

Collect data related to the number of beds and rate of occupancy to verify the method of
H

bed planning.
IC

4.5 Hospital Drawings and Documents

D

A consultant or chief architect along with his or her team prepares hospital drawings and
documents. A complete set of drawing has the architectural, structural, mechanical and
N

electrical drawings. Documents explain the services to be provided, policies and procedures,
land details, space required, functions and utilities of all the sections, the project development
and cost estimation of the project. All the written material and the drawings are presented in
O

the form of a project report.

P

4.5.1 Preparing Project Report

A hospital project report is an interpretation of the need of the investor or client, presented
in the form of written documents. It is generally prepared in consultation with medical
professionals, engineers and people who are experienced in handling hospital projects. A
typical project report has the following sections:

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Hospital Architecture, Planning and Maintenance

Notes ‹‹ Introduction: The report begins with a brief history behind the concept of the project,
details about the investor and aim and objectives of the proposed hospital.
‹‹ Site details: This section includes the geographical location of the site, total land
area and total space to be consumed. It also discusses about the facilities available,
connectivity, modes of transport available, nearest bus stop, railway station and airport.
Weather conditions are also explained.

Y
‹‹ Functional details: All functions and facilities of the hospital are explained here.
Details about all the departments and their functions, manpower requirement, bed

IT
allocation, work load, work flow and traffic flow are described in this section.
‹‹ Equipment and accessories: The section provides a list of all the medical equipment
to be procured along with the required quantity. Details about furniture and other

S
accessories are also mentioned.

R
‹‹ Zoning: It discusses how the departments and facilities would be grouped into different
zones.

E
‹‹ Policies: This section contains the documentation of the processes and procedures
pertaining to the mobility of workers and patients, different services, power supply, fire

IV
safety, infection control, pollution control, and waste disposal.
‹‹ Phasing: This section provides a plan of carrying out the whole project in phases.
Various activities and schedules are explained under each phase.

N
‹‹ Financial details: The project cost is estimated in this part. Cost break-up is shown
under land, construction, equipment and accessories. Information related to sources of
U
fund is also provided as per the requirement of the client.
‹‹ Expansion plan: Future expansion plans, provisions and facilities are discussed in this
Y

section.
‹‹ Drawings: All types of sketches and drawings are enclosed here. These are
R

‹‹ Structural: Drawings related to building’s position, size, footings, columns, beams,

girders, and slabs.
R

‹‹ Architectural: Drawings related to the layout of site, pathways and roadways, floor
E

and roof plans, wall elevations, door and window schedules, and external and interior
designs.
H

‹‹ Mechanical: Drawings related to all piping, plumbing, ventilation and air-conditioning.

‹‹ Electrical: Drawing related to electrical wiring, electrical panels, feeders and other
IC

electrical equipment
The project report is submitted to the hospital planning team for any modifications or
approval.
D

Self-Assessment Questions
N

13. All the written material and the drawings are presented in the form of a _______.
O

14. A hospital project report has the following sections:

a. Credentials of doctors
P

b. Site details

c. Financial details

d. Policies

15. Electrical drawings show piping layout, plumbing, ventilation and air-conditioning.
(True/False)

82 DDE, Pondicherry University, Pondicherry

 chapter 4  Technical Analysis

Notes
4.6 Summary
‹‹ An understanding of technical analysis can guide you to choose the appropriate hospital
assets, allocate capital cost in the most optimum way and utilise all the assets effectively.
‹‹ Hospital services can be defined as clinical, operational, diagnostic and supportive that
are provided to fulfil the needs and demands of the individuals.

Y
‹‹ Some hospitals also provide services related to educating medical students, research
and community benefit programs

IT
‹‹ Demand for hospital services can be estimated by studying and referring to the
statistical returns from the existing conditions and the morbidity statistics of the area

S
or the whole country.

R
‹‹ The need for hospital services can be identified through quantitative estimation of the
types and amount of illness in the community which require hospital services.

E
‹‹ There are two methods of assessing demand and need for hospital services:

IV
 The empirical method
 The analytical method

N
‹‹ Factors that influence the utilisation of a hospital and its services are bed availability,
population coverage, age of people, facilities of the hospital, presence of other type of
U
medical services, attitudes of doctors, medical insurance policies, lack of availability of
qualified doctors, illness pattern, poor services and attitude of people.
‹‹ Technical factors are bed planning, land requirements, project cost and space
Y

requirement Hospital bed capacity must be planned accurately and appropriately to

meet the needs of the community.
R

‹‹ Number of beds is decided based on the standard rule of bed:population ratio.

R

‹‹ Land requirement are dependent on factors, such as flat or upright positions, FAR rules
and the area of the land to be covered.
E

‹‹ There are four basic cost components:

H

 Land cost and site acquisition cost

IC

 Base cost of constructing the building

 Escalation cost
D

 Fees of consultant, architects, engineers and contractors

‹‹ The space requirement for a healthcare unit is directly related to the amount of space
N

to be allocated for various sections.

‹‹ Each unit should be allocated with adequate space based on the volume of service,
O

number of staff, number of functional room, placement of equipment and furniture

and storage of supplies.
P

‹‹ A consultant or chief architect along with his or her team prepares hospital drawings
and documents.
‹‹ All the written material and the drawings are presented in the form of a project report.
‹‹ A hospital project report is an interpretation of the need of the investor or client,
presented in the form of written documents.

DDE, Pondicherry University, Pondicherry 83

Hospital Architecture, Planning and Maintenance

Notes
4.7 Glossary
‹‹ Degenerative Diseases: It is a kind of illness in which the afflicted tissues or organs’
structure or function gradually deteriorates over time.
‹‹ Floor Area Ratio (FAR): It is the proportion of a building’s total covered area across
all floors to its entire land area.

Y
‹‹ Oncology: A branch of medicine that deals with tumour.

IT
‹‹ Telemedicine: It is the use of telecommunication and information technologies in
order to provide clinical health care at a distance.

S
4.8 Terminal Questions

R
1. Elaborate the concept of health services provided by the hospitals.

E
2. Write a note on the method used for assessing the needs and demands for the services.

IV
3. Write a note on the “land requirement - an important factor of a hospital”.

4. Mention the factors influencing the healthcare services of a hospital.

N
5. Define hospital project report.
U
4.9 Answers
Q. Self-Assessment Questions
Y

1. Expenses
R

2. Clinical
3. False
R

4. Empirical
E

5. Socio-economic
6. a, b, d
H

7. False
IC

8. bed: population
9. Floor Area Ratio (FAR)
10. a, c, d
D

11. True
N

12. Bed
13. Project, report
O

14. b, c, d
P

15. False
Q. Terminal Questions
1. Hospitals provide a wide range of inpatient and outpatient services to meet up
the demands of the community. Hospital service can be defined as the clinical,
operational, diagnostic and supportive services. Refer to section 4.2 Concept of
Hospital Services.

84 DDE, Pondicherry University, Pondicherry

 chapter 4  Technical Analysis

Notes 2. Assessment of the health care needs and the ranges of services to be provided are
done through collection and study of various data. It is one of the preliminary tasks
that should be conducted before conceiving the idea of starting a new hospital. An
existing hospital can also analyse data to alter or add services depending on the
need and demand of the society. Refer to sub-section 4.2.1 Assessment of the
Need and Demand of Hospital Services. 3. Land requirement are dependent

Y
on factors, such as flat or upright positions, FAR (floor area ratio) rules and the
area of the land to be covered. Refer to sub-section 4.2.2 Land Requirements.

IT
4. Education and awareness level and monetary conditions are the major factors
that affect the utilisation of healthcare services such as visiting the clinics or
health centres for regular check-ups or for getting preventive care in case of an

S
epidemic. Refer to section 4.3 Factors Influencing Hospital Utilisation.
5. A hospital project report is an interpretation of the need of the investor or

R
client, presented in the form of written documents. It is generally prepared
in consultation with medical professionals, engineers and people who are

E
experienced in handling hospital projects. Refer to sub-section 4.5.1 Preparing

IV
Project Report.

4.10 Case Study: Apollo Hospitals

N
Apollo hospitals group is a leading healthcare player and the largest hospital group in
U
Asia. The group is a frontrunner in providing integrated healthcare services in Asia. It has
established its presence through 10,000 beds across 51 hospitals in India and abroad. The
Y
group is able to strengthen their delivery model through continuous expansion.
‹‹ The case: A hospital was established in 1988 in Kolkata. It was facing numerous
R

problems, such as delayed construction, cost overruns, poor services and limited staff.
The hospital had very few well trained medical professionals. It had recorded poor
R

financial performance with an EBITDA margin of -4%.

E

‹‹ Apollo’s intervention and reform: Apollo hospital group took over the management
of the hospital in 2002 and it became Apollo Gleneagles hospital. After analysing the
H

whole model and studying various data, Apollo brought about changes in the following
ways:
IC

 Bed planning: The bed capacity of the hospital was increased by 380%. It added
239 beds by November 2003.
D

 Restructuring financial model: Introduced low cost borrowing to modify the

debt structure.
N

 Increased utilisation: Created centres of excellence by adopting best practices

in cardio thoracic surgeries, oncology, orthopaedic surgeries, neurosurgery and
O

others.
 Skilled manpower: Recruited more number of experience and skilled doctors with
P

positive attitude. This brought a substantial increase in consultant strength.

The hospital integrated with various primary clinics in highly populated residential
areas. It also joined hand with third party insurance companies. It also introduced
telemedicine networking services to help the patients belonging to remote areas.
Healthcare rules and practices were implemented.

DDE, Pondicherry University, Pondicherry 85

Hospital Architecture, Planning and Maintenance

Notes ‹‹ The outcome: The hospital has emerged as a profitable tertiary care hospital. It has
become famous for outstanding infrastructure, technological excellence, proficient
healthcare and earnest attitude. It not only caters to the need of the people of Kolkata
and India but also attracts patients from other countries. Around 20% of its patients
belong to other countries. The hospital has received certificate for clinical excellence
and processes from the Medical Council of India. Within a period of three year, the
net income has increased by 3 times and the EBITDA margin has improved from -4%

Y
to 23%.

IT
Discussion Questions

S
1. What were the major issues faced by the company and how the intervention of Appolo
helped the hospital?

R

(Hint: It was facing numerous problems, such as delayed construction, cost overruns,

E
poor services and limited staff. Appolo took various steps, such as efficient bed planning,
restrucing financial model, inreasing utilisation, and recruiting skiled manpower.)

IV
4.11 References and Suggested Readings

N
‹‹ James, P., and Noakes, T. (1994). Hospital architecture. New York: Longman.
U
‹‹ Nickl-Weller, C., and Nickl, H. (2009). Hospital. Berlin: Braun.
‹‹ Verderber, S. (2010). Innovations in hospital architecture. New York: Routledge.
Y

E-Referesnces
R

‹‹ Healthcarefacilitiestoday.com.(2014). New design guide aids VA hospital planning and

R

construction - Architecture. Retrieved from, <http://www.healthcarefacilitiestoday.

com/posts/New-design-guide-aids-VA-hospital-planning-and-construction-
E

Architecture--1212>
H

‹‹ E-architect. (2014). Hospital Buildings - Health Architecture - e-architect. Retrieved

from, <http://www.e-architect.co.uk/hospital-buildings>
IC

‹‹ Draeger.com. (2014). Hospital planners and architects. Retrieved from, <http://www.

draeger.com/sites/en_uk/Pages/Hospital/hospital-planners-and-architects.aspx>
D
N
O
P

86 DDE, Pondicherry University, Pondicherry

chapter

5 Hospital Design

Y
IT
S
R
E
Structure

IV
5.1 Introduction

N
Learning Objectives U
5.2 Concept of Hospital Design

5.3 Zones in a Hospital

Y

5.4 Summary
R

5.5 Glossary

5.6 Terminal Questions

R

5.7 Answers
E

5.8 Case Study: Design of Vikram Hospital

H

5.9 References and Suggested Readings

IC
D
N
O
P
Hospital Architecture, Planning and Maintenance

Notes Learning Objectives

After completing the chapter, you will be able to:
 Explain the concept of hospital design
 Identify the different requirement of a hospital building
 List the utilities provided in a hospital

Y
 List the biomedical equipment to be installed in a hospital
 Elaborate various zones of a hospital along with their functions and significance.

IT
5.1 Introduction

S
In the previous chapter, you have studied about the concept of hospital services, factors

R
influencing hospital utilisation, technical factors, hospital drawings and documents.
This chapter will focus on hospital design.

E
A hospital is a complex setup with a number of units and functions. It provides a wide range

IV
of services, which are interdependent. A hospital comprises outpatient department (OPD),
inpatient department (IPD) and Service departments. Each department of has several sections
which not only have to perform individually to its highest level but also have to be in excellent

N
coordination with various other sections.
The aim of a hospital setup should be minimising the effort of patients and medical professionals
U
and reducing error level while increasing the efficiency and effectiveness of the whole system.
The buildings should have all types of utilities needed in a hospital, accommodated in an
organised and systematic manner for smooth functioning. People can move around easily and
Y

reach every section without any confusion. Commuting time is minimised for all personnel.
In other words, a hospital should be designed to make patients feel at home and comfortable.
R

Hospitals should also keep provision of fresh air, outer views and appealing interior decoration.
Several researches have proven that a decent interior of a hospital can minimise a patient’s
R

healing time. A poorly designed hospital can delay the process of treatment, have negative
impact on people by producing stress and anxiety and create a bad word of mouth.
E

According to Hardy and Lammers, “A functional design can promote skill, economy, conveniences,
H

and comforts; a non-functional design can impede activities of all types, detract from quality of care,
and raise costs to intolerable levels”.
IC

Therefore, hospital architects or designers have a chance to combine architecture, technology

and creativity to establish a hospital with people-centric design.
D

In this chapter, you will study the concept of hospital design by identifying building
requirement, utilities and biomedical equipment. The chapter also discusses about the types
N

of zones to be created in a hospital and their functions.

O

5.2 Concept of Hospital Design

P

Consider the following example:

Shyam wanted to take out his six year old son, Ryan for a ride. Ryan was so excited that he
kept jumping on the bed. Unfortunately, he fell off the bed and started complaining of severe
pain in his ankle. Shyam had to rush him to the nearby hospital. This was his first visit to
that hospital and he was clueless about the procedure there. The security guard instructed
him about the parking area but there was no place to park his car. He wasted time looking
for another parking place. There was a long queue at the registration counter and when his

88 DDE, Pondicherry University, Pondicherry

 chapter 5  Hospital Design

Notes turn came the receptionist started asking him several questions about his prior visits and
treatments. Being a first time visitor, he was asked fill certain documents and then revisit the
counter. By this time, his restless son started screaming for food. Shyam looked for a cafeteria
in the lobby area but couldn’t find any. Another visitor guided him towards the cafeteria.
After feeding his son, he again stood in the queue to submit the documents. Finally, he headed
towards the cabin of a pediatrician. There again he had to wait for about half an hour. The
doctor advised for an x-ray and handed over a slip to Shyam. He could locate the x-ray centre

Y
which was in another building, only after asking 2-3 people. There he was asked to go back
to the counter at the main entrance for payment. Shyam was so frustrated that he started

IT
screaming at the staff over there. After making the payment he got the test done and went
back to the doctor to show him the reports. Doctor prescribed certain medicines for Ryan

S
since the x-ray did not show any fracture. Shyam decided to buy the medicines from a local
medical shop as he did not want to waste any more time locating the medical store inside the

R
hospital premises. For a simple treatment of hardly 30-40 minute, Shyam had to spend almost
5 hours to complete all these procedures.

E
Do you think, Shyam would visit the hospital again or recommend it to anyone? The hospital
had qualified doctors, x-ray facility, cafeteria, parking area and other facilities but it was not

IV
designed in an effective way.
A hospital consists of several specialties required for providing good healthcare services to

N
the community and the individual patient. Each specialty has its own use and requirements.
An ideal hospital design amalgamates functional necessities with the users’ needs and hence
U
the basic concept of hospital designing means ensuring the following aspects:
‹‹ Provide featured care: The hospital should endeavour towards providing featured
care to the patients and the community in terms of clinical services and boost up the
Y

patients’ gratification level too.

R

‹‹ Provide determined consolation: The in-house wards facility must have an appropriate
atmosphere for the patient in terms of their protection, suitability, confidentiality and
R

relief. A hospital must eliminate the factors such as slippery floors, noisy atmosphere
and inadequate lighting in the wards that can cause inconvenience to the patients.
E

‹‹ Gratification of the staff: Along with patient care, the satisfaction level of the staff
or the employees of a hospital is also an important factor. Staff satisfaction is directly
H

linked with patient care. It is human mentality that the level of satisfaction always
affects the services provided by people. Therefore, happy and content staff is loyal to
IC

its duties and responsibilities and demonstrates positive attitude while communicating
with patients and their relatives.
D

‹‹ Convenience of the family members of the patient: A hospital must include signs,
symbols, direction maps and guiding arrows to make it convenient for the visitors and
N

patients’ relatives or family members to identify and locate the departments. It should
have certain necessary amenities such as waiting room, washrooms, cafeteria, and help
O

desk for visitors.

‹‹ Safeguarding the budget and services: Along with the aforesaid factors, a hospital
P

must try and provide all the necessary services to the patients at affordable cost.
To fulfil all these objectives, a hospital design should take care of the following:
‹‹ Building requirement
‹‹ Utilities

‹‹ Biomedical Equipment

DDE, Pondicherry University, Pondicherry 89

Hospital Architecture, Planning and Maintenance

Notes 5.2.1 Building Requirement

Hospitals operate 24 hours a day and all the seven days in a week which means the buildings
are used continuously. Therefore, a coordinated and compact design serves the purpose well
and increases the comfort level of people associated with the place. All hospital buildings
must fulfil certain requirements irrespective of their site location, size or budget.

Y
While planning, designing and constructing a building or a hospital, the following requirements
must be kept in mind:

IT
‹‹ Environment: A hospital must be setup in an area which is easily accessible to the
people and community. The area should be relatively free from noise, smoke, dust, foul

S
odour and should not be sited very close to railway stations, stadium, airport or any
other crowded public places.

R
‹‹ Safety: A hospital must provide a safe atmosphere to the patients, staff and the other
individuals. The building should be designed in such a manner that it minimises the

E
possibility of health hazard due to construction work. All buildings must have wider

IV
exits and emergency exits. Fire and electrical safety systems must be in place.
‹‹ Security: A hospital must ensure security of all personnel and their properties within
the premises. Security guards must be on duty for 24 hours and list of important

N
contact numbers must be displayed in different locations.
‹‹ Patient Movement: The design of the hospital must incorporate wide areas for easy
U
movement of the patients, whether they are walking on their own or on stretchers,
wheelchairs or ward bed. Hospital corridors to be used by patients must have a minimum
width of approx 2.5 meters. The width of the corridors that are not meant to be used
Y

by the patients can be less than the earlier width. A ramp or lift should be provided at
both the ends of each floor for the patients.
R

‹‹ Lighting: All areas should have proper lighting system, neither too bright nor too dim.
R

It should be pleasant for the patient. Proper lighting helps in creating an enhanced
healing environment.
E

‹‹ Ventilation: Appropriate ventilation should be provided for allowing fresh air and
H

natural light. This creates a comfortable atmosphere for the patients and public.
‹‹ Water supply: A hospital should have appropriate water supply systems on all the
IC

floors with 24*7 supply facility. Separate water supply or coolers should be provided for
drinking purpose.
‹‹ Sanitation: Proper sanitary system with maintenance facilities should be available in
D

the hospital building. Sewage system, waste disposal system and drainage facilities
should be in good condition to provide clean and healthy environment to the patients,
N

employees and public.

O

‹‹ Maintenance: Building should be checked periodically for repair and maintenance.

Preventive maintenance measures can be adopted. The buildings should be kept in good
condition to prevent any disruption in the services.
P

‹‹ Material specification: The material used in the building should be of good quality.
Floor tiles, paints and ceiling tiles used should be easy to clean. Designs which allow
dust particles to get collected or settled must be avoided.
‹‹ Segregation: Separate wards must be available on the basis of sexes to ensure comfort
and privacy among patients. Toilets for the patients, staff and visitors must be separate
and again segregated for male and female.

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Notes ‹‹ Parking: A hospital should provide adequate parking area for the staff, patients and
their relatives. Parking places may have designated areas for four wheelers, two wheeler
and cycles.
‹‹ Zoning: The hospital must be segregated into different zones. Some hospitals create
coloured zones, such as yellow, blue, red and green zone with their specifications. It is a
way of providing easy identification to the patients and other individuals.

Y
‹‹ Positioning: All the specialties available in the hospital must be positioned accurately
to prevent any inconvenience. For example:

IT
 People should be able to locate the emergency department without any difficulty.
It must be either a separate building or placed on the ground floor of the main

S
building, with a separate entrance. The department should be built near the main
entrance of the hospital.

R
 The registration area or counter must be nearer to the main entrance of the

E
hospital.
 Operation theatres must be located in areas which is free of any disturbance and

IV
infection.
 Ambulatory services must be on the ground floor to prevent common passage of

N
inpatients and outpatients and to avoid chaos and inconvenience to the patients.
 Pharmacy should be located at several places in the hospital premises, to provide
an ease of access.
U
‹‹ Flexibility: Healthcare needs and the procedure of treatment keep changing. Therefore,
Y
the building should have a flexible design to allow minimal modifications as the system
may require.
R

‹‹ Expandability: Hospital should be an open-ended system with proper plan and

directions for future expansion.
R

5.2.2 List of Utilities

E
H

Hospital premises or buildings are provided with certain utilities or support systems, which
are essential in providing efficient care for the patients. Fig. 5.1 shows the major classification
IC

of utilities:

Classification of
D

Utilities
N
O

Major utilities Minor utilities

P

Fig. 5.1: Classification of utilities

Let us now study this classification in detail.

‹‹ Major utilities: Such items are tendered items i.e., can be procured only on the basis
of a tender application.

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Hospital Architecture, Planning and Maintenance

Notes ‹‹ Minor utilities: Such items can be obtained by local purchases or from retailers, for use.

The list of major utilities is as follows:

‹‹ Life maintenance systems
 Gas systems (air, oxygen, nitrous oxide, nitrogen, carbon dioxide etc.)
 Vacuum systems

Y
 Power supply systems

IT
‹‹ Infection regulator systems
 Sterilizers

S
 Ventilation and exhaust systems

R
 Water treatment systems
‹‹ Atmosphere regulator systems

E
 Air purification units

IV
 Exhaust fans
 Chillers

N
 Heat exchangers U
 Cooling towers
‹‹ Equipment controller
Y

 Electrical distribution system

 Pneumatic tube system
R

 Lifts / escalators
R

 Refrigeration tools
E

‹‹ Communication systems
 Patient call systems, for example, bells
H

 Fire alarm systems

IC

 Automation systems for earthquakes

 Gas alarms
D

 Telephone systems
N

The list of minor utilities is as follows:

‹‹ Syringes, cannulas and needles of all sizes
O

‹‹ Catheters of all sizes

P

‹‹ Coils and guide wires

‹‹ Medical hoses
‹‹ Endoscopic tools
‹‹ Blood pressure monitors (Sphygmomanometer)
‹‹ Glucose monitors (Glucometer)

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 chapter 5  Hospital Design

Notes ‹‹ IV sets, glucose bottles and arm boards

‹‹ Stethoscopes

‹‹ Medical scissors
‹‹ Forceps

‹‹ Single-use trays and kits

Y
‹‹ Medical diagnostic kits and reagents

IT
‹‹ Orthopaedic hammers
‹‹ Blood lancets or prickets

S
‹‹ Ear plugs for ENT use

R
‹‹ Ear syringes
‹‹ Ear wax removers

E
‹‹ Clinical swabs, applicators, specimen collectors, sponges, pads and cotton balls or

IV
cotton rolls
‹‹ Antiseptic wipes (including alcohol, antimicrobial, betadine and iodine)

N
‹‹ Splints

‹‹ Crutches and walkers

U
‹‹ Patient wheelchairs
‹‹ Patient transfer chairs, benches, boards, slides, discs, slings and sheets
Y

‹‹ Patient vital-sign monitoring devices

R

‹‹ Orthopaedic supports, braces, wraps, shoes, boots and pads

R

‹‹ Human specimen (urine or blood) collectors and containers

‹‹ Medical bandages, gauze, tapes and swabs
E

‹‹ Surgical sutures and staples and suture removal kits

H

‹‹ Thermometers
IC

5.2.3 Biomedical Equipment

D

Biomedical equipment can be defined as the compound equipment that are used for diagnosis,
remedial treatment or monitoring conditions, of any patient or individual. Fig. 5.2 shows the
N

classification of biomedical equipment:

O

Classification of
biomedical equipment
P

Analysis Remedial Monitoring General Research

Fig. 5.2: Classification of biomedical equipment

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Hospital Architecture, Planning and Maintenance

Notes Let us now study this classification in detail.

‹‹ Analysis: Used in detection of blood ranges, imaging and as a laboratory tool.
‹‹ Remedial: Used with radiation therapy and orthopaedic element in surgeries and
therapy thereafter.
‹‹ Monitoring: Used for observing body parameters for remedial purpose.

Y
‹‹ General: Used for daily patient care, operative or surgical instruments and minor
utilities.

IT
‹‹ Research: Used for research and education.

Some of the examples of bio-medical equipments include:

S
‹‹ X-ray machine

R
‹‹ CT scanner
‹‹ MRI scanner

E
‹‹ Mammography machine for detection of breast cancer

IV
‹‹ Heart and lung scanner or machine
‹‹ Arterial blood gas analyser

N
‹‹ Autoclave

‹‹ Ultrasonic washer
U
‹‹ Dental x-ray machine
‹‹ Ultrasound machine
Y

‹‹ IABP (Intra Aortic Balloon Pump) for cardiac surgeries

‹‹ Echocardiography machine
R

‹‹ PFT (Pulmonary Function Test) machine

R

‹‹ Patient monitor
‹‹ Cardiac monitor
E

‹‹ ECG machine
H

‹‹ Defibrillator
IC

‹‹ Anesthesia machine
‹‹ Ventilators

‹‹ Phlegm suction machines

D

‹‹ Endoscope/Laparoscope
N

‹‹ Syringe and infusion pump

‹‹ Infant warmer
O

‹‹ Fetal doppler
P

‹‹ Blood and fluid warmer

‹‹ Electromyogram machine
‹‹ Electroencephalogram (EEG) machine
‹‹ Pacemaker

‹‹ Infant resuscitator

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 chapter 5  Hospital Design

Notes ‹‹ Hemodialysis machine

‹‹ Centrifuge/Cryofuge

‹‹ Hot plate
‹‹ Cell counter
‹‹ Cell separator

Y
‹‹ Laminar flow
‹‹ Incubator

IT
‹‹ Urine analyzer
‹‹ Platelet agitator

S
‹‹ ELISA reader

R
‹‹ Immuno assay system

E
Self-Assessment Questions

IV
1. Hospital architects or designers have a chance to combine architecture, technology
and creativity to establish a hospital with _____________ design

2. The basic concept of hospital designing means ensuring the following aspects:

a. Provide featured care
N
U

b. Provide stress to patients

c. Gratification of the staff
Y

d. Safeguarding the budget and services
R

3. A hospital should be located very close to railway stations, stadium, airport or any
other crowded public places. (True/False)
R

4. While planning, designing and constructing a building or a hospital, which of the

E

following requirements must be kept in mind?

H

a. hospital must provide a safe atmosphere to the patients, staff and the other

individuals.
IC

b. Hospital corridors to be used by patients must have a minimum width of approx
2.5 meters.
D

c. A hospital must be setup in an isolated area.
N

d. Appropriate ventilation should be provided for allowing fresh air and natural light

5. __________ utility items are tendered items i.e., can be procured only on the basis of
O

a tender application.
P

6. _____________ equipment can be defined as the compound equipment that are

used for diagnosis, remedial treatment or monitoring conditions, of any patient or
individual.

Activity
Elaborate the concept and basic building requirements for hospital designing.

DDE, Pondicherry University, Pondicherry 95

Hospital Architecture, Planning and Maintenance

Notes
5.3 Zones in a Hospital
Certain functional units are linked with each other and needs to be placed accordingly. In a
hospital, the major units, clinical sections, supportive units and administrative departments are
grouped under different zones in such a manner that they are related in terms of functionality,
services and proximity. For example: The departments, such as the outpatient department and

Y
emergency or casualty department are constantly accessed by the public and should not be
located near the main inpatient areas or the wards. Among the supportive units, the x-ray and

IT
pathology services should be located in such a manner that these can be used by outpatients
as well as inpatient.

All zones are distributed over the hospital area and clearly demarcated for the convenience of

S
the patients and public. Fig. 5.3 shows the zones in a hospital:

R
Entrance and ambulatory zone

E
Diagnostic zone

IV
Intermediate zone

N
Critical zone
U
Service zone
Y

Administrative zone
R

Communication facility
R

Fig. 5.3: Zones in a hospital

E

Let us now study these zones in detail.

H

5.3.1 Entrance and Ambulatory Zone

IC
D
N
O
P

(Source: http://www.uwo.ca/surgery/plastics/images/SJHC.JPG)

The ambulatory or outpatient department is an important section of a hospital. The status

of the hospital depends on how efficient the OPD section is. Therefore, it can also be called
as the window of a hospital.

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 chapter 5  Hospital Design

Notes An ambulatory department has the required facilities with adequate number of clinical and
supportive staff. People, who are not admitted to the hospital, are provided consultation and
other services for scheduled duration. An OPD mainly has the following sections:
‹‹ Waiting area
‹‹ Clinics–general, medical, surgical, obstetrics and gynaecology, paediatrics, orthopaedic,
dermatology, ophthalmic, ENT and dental

Y
‹‹ Nursing station

IT
‹‹ Laboratory

‹‹ Injection room
‹‹ Minor operation theatre

S
Functions and importance of an ambulatory department:

R
‹‹ Provides a wide range of remedies and diagnosis on the basis of laboratory tests by

E
utilising minor techniques
‹‹ Diminishes the need of admission into the hospital, which in turn is cost-effective too

IV
‹‹ Minimises the hospital’s inpatient load.
‹‹ Benefits medical students, clinicians and other staff in terms of multifarious medical

N
experience
‹‹ Creates an entry point into the hospital
U
‹‹ Contributes in controlling birth rates and death rates
‹‹ Minimises the hospital admissions and conserves beds for the needy ones.
Y

OPD’s can be broadly classed as:

R

‹‹ Trauma OPD
 Emergency health care is provided to save life in case of disaster, road traffic
R

accident or any sudden illness.

E

 Emergency services can be utilised either by the patient or by the clinician for the
betterment of patients.
H

‹‹ Referral OPD
IC

 Patientswho are being referred from other hospitals or clinics are provided with
immediate care and attention in this OPD.
 It is also used for particular investigation or minor techniques.
D

‹‹ General OPD
N

 It usually shows huge inflow of patients.

O

 Some of them come for follow-ups after getting discharged from the hospital.
‹‹ Working pattern
P

A patient’s first point of contact is the reception or enquiry counter. After finishing the
proceedings of the registration counter, the person moves to waiting area. The patients
meet the doctor on the basis of the token numbers allotted. During consulting, he or
she may be sent for laboratory investigations, if required. Doctor prescribes medicines
on the basis of diagnosis. The patient may be asked to get admitted depending on his
or her condition.

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Hospital Architecture, Planning and Maintenance

Notes ‹‹ General problems faced by the patients at OPD

 Long queue at the registration counter or for meeting the doctor
 Reports not available on time and second visit required to collect reports.
 Barriers such as phone calls or intervention of other staff or patient, while
consulting the doctor

Y
 Poor facilities of the hospital

IT
5.3.2 Diagnostic Zone

S
R
E
IV
N
U
(Source: http://www.forensicmag.com/sites/forensicmag.com/files/legacy/u730/Fig2Autopsy032112_0.jpg)
Y

The diagnostic department is a high revenue generating section and acts an asset to the
R

hospital. The relevance of such sections or departments cannot be under ruled these days,
as the clinical practice is dependent on these examinations. Nowadays, clinicians are using
R

investigation as their preliminary step while initiating treatment of a patient. Diagnostic zone
consists of radio-diagnosis and ultrasound rooms, clinical laboratories and blood bank.
E

Functions
H

‹‹ Investigations aids in timely detection and diagnosis of medical conditions and other
comorbidities, if any.
IC

‹‹ Investigation provides a landmark about the treatment of the patient and its benefits,
which aids the clinician to plan for further treatment, accordingly.
D

‹‹ The reports and tests are also used for teaching purpose.
‹‹ The diagnostic labs are also used as centres for several research activities.
N

Outcomes or expectations
O

‹‹ Patients and clinicians expects an accurate and to the point report, to start the treatment
accordingly.
P

‹‹ Timely reports are always expected by the patients as well as the clinicians.
‹‹ A patient expects such investigations to be cost-effective.

Classification

The laboratory departments can be broadly categorised into following sub-categories to

prevent burden and chaos:

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 chapter 5  Hospital Design

Notes Biochemistry

This can be further classed as:

‹‹ Serology

‹‹ Toxicology

‹‹ Enzyme chemistry

Y
‹‹ Hormonal essay

IT
Microbiology

This can be further classed as:

S
‹‹ Mycology

R
‹‹ Virology

E
‹‹ Parasitology

‹‹ Bacteriology

IV
Pathology

N
This can be further classed as:
‹‹ Morbid anatomy
U
‹‹ Exfoliative cytology
‹‹ Histopathology/Cytopathology
Y

Hematology
R

This can be further classed as:

R

‹‹ Blood morphology
‹‹ Urine stool
E

‹‹ Blood bank
H

‹‹ Immuno haematology
IC

5.3.3 Intermediate Zone

D
N
O
P

(Source: http://i.ytimg.com/vi/TZAWW-zd7LA/0.jpg)

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 Hospital Architecture, Planning and Maintenance

Notes An intermediate zone in a hospital usually consists of:

‹‹ Wards or patient care areas
‹‹ Operation theatres

Wards

A ward is an important section of a hospital, where a patient stays after admission into the

Y
hospital. The design and patterns of the patient area, nursing station and the walkways makes
a ward design a unique one. A ward is made up of:

IT
‹‹ Beds provided for the patients (depending on the hospital design and space, wards can
have several beds).

S
‹‹ Additional areas within the rooms, separate pantries for all the wards, nursing stations

R
and separate bathrooms for staff and patients
‹‹ Patient movement space.

E
A ward should be designed in such a way that the nursing station, washroom and bed of the

IV
patient have lesser distance among them. The services depend on the size and space of the
ward. Bed capacity of a single ward can vary from 4 to 50 beds in a single room, with an
arrangement of a nursing station for every 15 beds for proper patient care. The ideal location

N
of a ward depends on the services offered. Besides paediatric, maternity, infectious diseases
and psychiatric service, patients admitted for all the other type of services can be allotted the
same ward.
U
Basically, wards are designed on the basis of following patterns:
Y

‹‹ Nightingale ward
R

‹‹ Rig’s design
‹‹ Nuffield’s ward
R

‹‹ Race track design

E

‹‹ Courtyard ward
H

‹‹ Harness type ward

Just like a cell is an essential part of the body, which makes up the organ system; patient care
IC

areas are the functional units of a hospital as well. These can be considered as temporary
homes for the patients.
D

Operation theatre (OT)

An operation theatre (OT) primarily consists of a room for operating the patient, anaesthetic
N

room to provide anaesthesia to the patient, medication room for administration of the medicine
such as antibiotics prior to initiation of the surgery to prevent hospital acquired infections,
O

post-operative room i.e. an ICU to transfer the patient for close monitoring and care for
the next 24-48 hrs and clinicians changing room. This is a crucial section of any hospital
P

and needs to be maintained properly. The equipment of the operation theatre needs to be
of the latest technology and must be sterilised. An appropriate sterile atmosphere must be
maintained in the OT as per the guidelines. Along with this, an OT must have high beam lights
on the ceiling above the operation table and a good ventilation system, providing an efficient
working atmosphere for the surgeons. A minimum temperature of 20-250C (normal room
temperature) must be maintained in the room. Apart from this, the walls of the room should
be plain and washable. Corners should be rounded and not edged to prevent accumulation of

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 chapter 5  Hospital Design

Notes dust in the corners. Electricity switches should be spark proof and a minimum of 4 sockets
should be there. All switches and sockets must be checked at regular intervals to prevent
any hassles during the surgery. An OT must ideally be located in an area which is free from
movements of the patients and other individuals, nearer to the ICU.

While designing, the zone concept must be utilised for an OT. Therefore, an OT can be
grouped into the following zones:

Y
‹‹ Clean zone

IT
‹‹ Sterile zone
‹‹ Protective zone

S
‹‹ Disposal zone

R
5.3.4 Critical Zone

E
IV
N
U
Y
R
R

(Source: http://www.fraserhealth.ca/media/SMH%20Emergency%20Equipment.jpg)
E

Critical zone is for serving all emergency cases. As understood by the word itself, emergency
means a life-threatening state or condition of an individual which requires an immediate
H

attention and care by the clinicians. If left unattended, the patient’s survival may be at stake.
Critical zone comprises the emergency department of a hospital, which has a key role in
IC

providing health care to patients’ who require immediate attention. It serves the community
with modern and efficient techniques by trained healthcare professionals.
D

Importance of emergency divisions in a hospital

‹‹ The emergency section is a very critical division providing patient care round the clock.
N

Its facilities and services affect the reputation of the institution within the community.
O

‹‹ It works round the clock under the supervision of a senior healthcare professional and
acts as a life saver during crisis.
P

‹‹ Road traffic accidents, cardiac ailments and neurological disorders are the most common
cases encountered by these divisions.

Location

The ideal location for an emergency department is on the ground floor of the institution
providing a separate entrance or a separate building near the main entrance of the hospital
premises. Basically, it should be easily accessible by the relatives of the patients. Hospitals

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 Hospital Architecture, Planning and Maintenance

Notes must have proper signage or direction sign at an appropriate distance to provide guidance so
that people do not waste time unnecessarily.

ICU (Intensive Care Unit)

Another department that comes under the critical zone is an intensive care unit (ICU). It
is referred as high dependency unit. Patients admitted to these sections are in very critical
state. They need constant care and monitoring by the health professionals and are always

Y
under strict observation of the clinical and nursing staff of the hospital. These units utilises

IT
modern life saving aids.

An ICU is usually situated close to the emergency department. It can have varied number of
beds depending on the size and capacity of the hospital including those which are used for

S
patients who need to be isolated. An ideal bed arrangement in an ICU can be in the form of
a semi-circle with the nursing station in the middle. This enables the staff to have a check on

R
all the patients at the same time. Generally, in large hospitals, there are separate ICU units

E
for different sections such as cardiology, respiratory, maternal etc. These are known as “ICCU
(Intensive Cardiac Care Unit), MICU (Maternal Intensive Care Unit), NICU (Neonatal

IV
Intensive Care Unit), PICU (Paediatric Intensive Care Unit) and RICU (Respiratory Intensive
Care Unit)”.

N
5.3.5 Service Zone U
Y
R
R
E
H
IC
D

(Source: http://www.animalmedical.net/images/photo-retail-store.jpg)

Service zone includes all types of support services that are provided to help the major
N

functioning departments. These are considered as behind the scenes job but are as crucial as
direct patient care services. A hospital is incomplete without these departments.
O

Support services range from arranging and serving food to patients, to maintaining cleanliness
P

and hygiene conditions of the hospital, to providing support to the staff and public. Following
departments are part of service zone:
‹‹ Central sterile and supply department (CSSD): Sterilisation is an essential service
that is required continuously in a hospital. This activity has been centralised for better
supervision, control and efficiency, and economical use of equipment. This department
mostly serves the operation theatres but also provides services to emergency, maternity
section and wards.

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 chapter 5  Hospital Design

Notes ‹‹ Medical store and general stores: Various stores are provided for addressing the
needs of patient and staff. Medical store is the most important one. Large hospitals
have a central store to keep materials like linen, drugs, dressings, and laboratory supply
in bulk.
‹‹ Housekeeping: This section is responsible for maintaining cleanliness, disinfection and
healthy environment. Mechanical or electrical laundry is used to clean, dry, press and

Y
store linen.
‹‹ Hospital Kitchen and dietary department: The hospital catering service is responsible

IT
for serving patients and employees with well-cooked and nutritious food. A cafeteria
serves the need of the outsiders as well.

S
‹‹ Engineering services: This department has to coordinate with outside agencies for
maintaining all major plant installations and electrical and mechanical equipment.

R
‹‹ Hospital workshop: Hospital should have its own workshop and in-house staff for

E
emergency services as well as small repair and maintenance of electrical and mechanical
equipment.

IV
‹‹ Public health engineering: This department ensures adequate water supply, drainage
and sanitation and waste disposal. All types of wastes produced in a hospital are
collected and removed through different methods.

N
‹‹ Mortuary: Mortuary is built for keeping dead bodies and performing autopsy. It has
U
facilities for walk in cooler and post mortem area.

5.3.6 Administrative Zone

Y
R
R
E
H
IC
D
N
O

(Source: http://www.constructioncanada.net/wp-content/uploads/2014/09/Opener.jpg)
P

The administrative zone is in charge of the hospital’s general operations. In order to provide
the best possible patient care, it manages the personnel, patients, and other resources. There
are two primary divisions in this department: general and medical. The general division
handles all issues pertaining to staff and patient perks as well as the general upkeep of the
facility. The section on medicine manages all official jobs related to diagnosis, treatment and
care of patients. Work related to patient admission, billing, payment collection and discharge
is part of the activities of this section. It requires patience, humanity and hospitality to solve

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 Hospital Architecture, Planning and Maintenance

Notes issues of the patients. One of the most common problems faced by the patients is delay in
getting discharged due to slow process of billing. This can be resolved by implementing
computerised billing systems.

Admission records

The records of the patients with complete details from the time of admission till the discharge
are maintained as written records or entered and stored in computerised system. The record

Y
keeping activity facilitates ease of finding information as and when required by the staff or

IT
the relatives of the patients.

Organization of the department

S
The overall administration of the hospital is the responsibility of medical superintendent or
a hospital administrator. For smooth functioning, the billing office is managed by the finance

R
executive, who is responsible for all the financial issues. He or she handles accounts of the
hospital too and reports finally to the administrator.

E
Discharge procedure: The procedure is as follows:

IV
‹‹ Ward patient is advised for discharge by the clinician.
‹‹ File moves from the billing section to the main counter/accounts for receiving money.

N
‹‹ Discharge procedure is initiated at the billing section.
U
‹‹ The concerned person verifies the charges which are entered.
‹‹ Final entry of charges is made.
Y

‹‹ Bill is generated.
R

‹‹ Final checking is done.

‹‹ Cash is received from patient’s side.
R

‹‹ Patient is discharged.
E

‹‹ Bills are dispatched to the accounts department for records.

H

5.3.7 Communication Zone

IC

Patient care involves several individuals such as nurse, clinician, ward boy, laboratory
technician and relatives of the patient. All need to share information about the patient and
D

discuss about the prevention and early cure of the disease. This exhibits an increased need of
communication techniques to support the healthcare services.
N

Telephonic service is a very common mode of hospital communication. Telephone connections

O

are provided in rooms, wards and department as decided by the hospital management. Large
hospitals have intercom system along with telephone. Communication system should be
P

designed in such a way that all patients, employees and other people can be warned during
any emergency.

A huge amount of investment is required to establish the newer and advanced modes of
communication systems in a healthcare system. The cheaper techniques like voicemail services
and e-mails are also not frequently used in majority of healthcare units. These are simpler
and require less investment. There is an enormous gap in the understanding the role of
communication systems in a health care unit.

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 chapter 5  Hospital Design

Notes Self-Assessment Questions

7. _________ is the window of a hospital.
8. ___________ zone consists of radio-diagnosis and ultrasound rooms, clinical
laboratories and blood bank.
9. An intermediate zone in a hospital usually consists of wards and out patient

Y
department. (True/False)
10. An appropriate ____________ atmosphere must be maintained in the OT as per the

IT
guidelines.
11. ICU (Intensive Care Unit) is also referred as _____________.

S
12. Which of the following services come under service zone?

a. Emergency

R

b. Housekeeping

E

c. Engineering services

d. Mortuary

IV
13. Work related to patient admission, billing, payment collection and discharge is part
of the activities of administrative zone. (True/False)

N
14. Communication system should be designed in such a way that all patients, employees
and other people can be warned during any ____________.
U
Activity
Y

Visit a nearby hospital, identify the various zones of a hospital and write a note on them.
R

5.4 Summary
R

‹‹ The aim of a hospital setup should be minimising the effort of patients and medical
professionals and reducing error level while increasing the efficiency and effectiveness
E

of the whole system.

H

‹‹ A hospital consists of several specialties required for providing good healthcare services
to the community and the individual patient. An ideal hospital design amalgamates
IC

functional necessities with the users’ needs.

‹‹ Hospitals operate 24 hours a day and all the seven days in a week which means the
buildings are used continuously. Therefore, a coordinated and compact design serves
D

the purpose well and increases the comfort level of people associated with the place.
N

‹‹ Hospital premises or buildings are provided with certain utilities or support systems,
which are essential in providing efficient care for the patients. The utilities can be
O

broadly classed as:

 Major utilities
P

 Minor utilities
‹‹ Biomedical equipment can be defined as the compound equipment that are used for
diagnosis, remedial treatment or monitoring conditions, of any patient or individual.
‹‹ In a hospital, the major units, clinical sections, supportive units and administrative
departments are grouped under different zones in such a manner that they are related
in terms of functionality, services and proximity.

DDE, Pondicherry University, Pondicherry 105

 Hospital Architecture, Planning and Maintenance

Notes ‹‹ The ambulatory or outpatient department is an important section of a hospital. The

status of the hospital depends on how efficient the OPD section is.
‹‹ An ambulatory department has the required facilities with adequate number of
clinical and supportive staff. People, who are not admitted to the hospital, are provided
consultation and other services for scheduled duration.
‹‹ The diagnostic department is a high revenue generating section and acts an asset to

Y
the hospital. Clinicians are using investigation as their preliminary step while initiating
treatment of a patient.

IT
‹‹ An intermediate zone in a hospital usually consists of:
 Wards or patient care areas

S
 Operation theatres

R
‹‹ A ward is an important section of a hospital, where a patient stays after admission into
the hospital.

E
‹‹ An operation theatre (OT) primarily consists of a room for operating the patient,
anaesthetic room to provide anaesthesia to the patient, medication room for administration

IV
of the medicine such as antibiotics prior to initiation of the surgery to prevent hospital
acquired infections, post-operative room i.e. an ICU to transfer the patient for close
monitoring and care for the next 24-48 hrs and clinicians changing room.

N
‹‹ Critical zone comprises the emergency department of a hospital, which has a key role
in providing health care to patients’ who require immediate attention.
U
‹‹ Intensive care unit (ICU) also comes under critical zone. Patients admitted to these
sections are in very critical state.
Y

‹‹ Service zone includes all types of support services that are provided to help the major
functioning departments.
R

‹‹ Support services range from arranging and serving food to patients, to maintaining
R

cleanliness and hygiene conditions of the hospital, to providing support to the staff
and public.
E

‹‹ The administration zone takes care of the overall functioning of the hospital. It
manages the staff, patients and other resources with an aim of providing best patient
H

care.
‹‹ Patient care involves sharing information about the patient and discuss about the
IC

prevention and early cure of the disease. Telephonic service is a very common mode of
communication.
D

‹‹ Communication system should be designed in such a way that all patients, employees
and other people can be warned during any emergency.
N

5.5 Glossary
O

‹‹ Ambulatory department: It is an important section of a hospital that contains the

required facilities with adequate number of clinical and supportive staff.
P

‹‹ Biomedical equipment: It is compound equipment used for diagnosis, remedial

treatment or monitoring conditions, of any patient or individual.
‹‹ Diagnostic department: It is a high revenue generating section of the hospital wherein
the diagnosis of a patient takes place.
‹‹ Hospital design: It involves the placement of different departments and sections in an
hospital as well as the layout of the hospital.

106 DDE, Pondicherry University, Pondicherry

 chapter 5  Hospital Design

Notes
5.6 Terminal Questions
1. Write a note on the building requirements for designing a hospital.
2. List out the biomedical utilities and equipment required in a hospital.
3. Write a note on:

Y

a. Ambulatory Zone

b. Critical Zone

IT

c. Administrative Zone
4. Elaborate the concept of hospital designing.

S
5.7 Answers

R
Q. Self-Assessment Questions

E
1. people-centric

IV
2. a, c, d
3. False
4. a, b, d
5. Major

N
6. Biomedical
U
7. Outpatient Department (OPD) or Ambulatory Department
Y
8. Diagnostic
9. False
R

10. sterile
R

11. high dependency unit

12. b, c, d
E

13. True
H

14. emergency
Q. Terminal Questions
IC

1. Hospitals operate 24 hours a day and all the seven days in a week which means
the buildings are used continuously. Therefore, a coordinated and compact design
serves the purpose well and increases the comfort level of people associated with
D

the place. All hospital buildings must fulfil certain requirements irrespective
N

of their site location, size or budget. Refer to sub-section 5.2.1 Building

Requirement.
O

2. The utilities can be broadly classed as major utilities and minor utilities. Refer to
sub-section 5.2.2 List of Utilities.
P

3. Biomedical equipment can be defined as the compound equipment that are used
for diagnosis, remedial treatment or monitoring conditions, of any patient or
individual. Refer to sub-section 5.2.3 Biomedical Equipment.
4. A hospital consists of several specialties required for providing good healthcare
services to the community and the individual patient. Each specialty has its own
use and requirements. An ideal hospital design amalgamates functional necessities
with the users’ needs. Refer to section 5.2 Concept of Hospital Design.

DDE, Pondicherry University, Pondicherry 107

 Hospital Architecture, Planning and Maintenance

Notes
5.8 Case Study: Design of Vikram Hospital
Vikram Hospital in Bengaluru, India, is an instance of a well-executed hospital design. Its
high-tech infrastructure not only ensures the comfort of patients but also utilises the available
space effectively. Vikram Hospital satisfies every need for a state-of-the-art, contemporary,
multispecialty hospital.
Vikram hospital is considered to be one of the paperless hospitals of India, where the

Y
patient’s data is instantly sent from the patient’s palm pilot to a Jaotech screen. Patients may
video conference with their physicians and family members using this screen. These Jaotech

IT
displays are also used for the charging procedure.
The hospital is designed on the theme, named as Heart Beats That Connect. It draws
inspiration from the heartline graph of the ECG. Integrating the signs with the building

S
elevations was the idea behind it. Thus, a striking image of a heartbeat rhythm is imprinted
on glass to identify the structure as a medical institution.

R
The interior design of the hospital incorporates a number of different features. The hospital

E
has 285 beds distributed across eight levels, each of which has a different colour assigned to it.
This colour pattern is carried throughout the inside of the level, from the coloured bands in

IV
the elevator lobbies to the coloured ceiling graphics in the semi-private apartments. This kind
of colour labelling makes it easier for hospital staff and patients to identify the floor.
The concept of Natural Healing serves as the foundation for the architecture of Vikram

N
Hospital. The hospital’s layout maximises the amount of natural light and sunlight that
enters the building. The hospital has placed a strong focus on planting trees and building
U
green barriers around it. In addition, the hospital has used certain kinds of glasses to reduce
the impact of heat and light within the building.
From the designing, Vikram hospital is able to satisfy the needs of its staff and patients. The
Y

latest technology and graphic visual elements helps the hospital to gain design and conceptual
strengths in the healthcare industry.
R

Discussion Questions
R
E

1. What is the strength of the Vikram hospital?

(Hint: Design and advanced technology are the main strengths of the Vikram hospital.)
H

2. What are the elements of ideal hospital design?

IC

(Hint: A hospital should be designed in a manner that patients get featured care.)

5.9 References and Suggested Readings

D

‹‹ Miller,R. L., Swensson E. S., Robinson, J. T. (2012). Hospital and Healthcare Facility
Design. New York City: W.W. Norton & Company.
N

‹‹ Malhotra N., Malhotra J. (2007). Step by Step Hospital Designing and Planning.
O

Daryaganj, New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.

P

E-References
‹‹ Hospital Overview. Retrieved from, <http://www.wbdg.org/design/hospital.php>
‹‹ How to Design a ‘Smart’ Hospital. Retrieved from, <http://www.
healthcaredesignmagazine.com/article/how-design-smart-hospital>

108 DDE, Pondicherry University, Pondicherry

chapter

6 Hospital Standards

Y
IT
S
R
E
Structure

IV
6.1 Introduction

N
Learning Objectives U
6.2 Concept of Hospital Standards

6.3 Types of Hospital Standards

Y

6.4 Summary
R

6.5 Glossary

6.6 Terminal Questions

R

6.7 Answers
E

6.8 Case Study: New Hospital Standards for Good Samaritan Hospital
H

6.9 References and Suggested Readings

IC
D
N
O
P
 Hospital Architecture, Planning and Maintenance

Notes Learning Objectives

After completing the chapter, you will be able to:
 Explain the concept of hospital standards
 Discuss the types of hospital standards

Y
6.1 Introduction

IT
In the previous chapter, you have studied about the concept of hospital design and the zones
in a hospital. This chapter will focus on hospital standards.

S
The role of healthcare facilities has changed considerably. It is no longer restricted to
educating the patient about the kind of lifestyle and food to be followed apart from the medical

R
procedures and medicines prescribed by the professionals. Healthcare, these days, has become
an important part of our community and comprises medical as well as educational issues.

E
Majority of the countries, both developed and developing, have experienced an increased need
for healthcare services. In India, the healthcare structure is quite complex. It is divided into

IV
public and private health care providers with a multiplicity of systems including allopathic,
ayurveda, homoeopathic and unani medical care. Through municipal corporations, state and
federal governments, and other local organisations, the public sector provide health services.

N
Conversely, the “not-for-profit” and profit hospitals make up the private health care industry.
Non-governmental organisations (NGOs), philanthropic organisations, missions, trusts, and
U
other organisations that offer healthcare services are examples of non-profit entities. A variety
of private practitioners own and run the for-profit healthcare facilities. India’s healthcare
system is mostly and significantly funded by the private sector. According to a number of
Y

surveys done by the National Sample Survey Organization (NSSO), between 60 and 80 percent
of Indians use private healthcare facilities in both urban and rural regions. The results also
R

demonstrate how expensive it is for Indian families to get private health care. The cost of
healthcare is over four to five times higher in private hospitals and institutes than it is in
R

public healthcare systems. It is evident that the public has high expectations for high-quality
medical treatment. Because of this, healthcare practitioners are under increasing pressure to
E

preserve and raise the standard of treatment while putting a priority on cost-effectiveness.
H

In industrialised nations like the USA and Australia, healthcare facilities prioritise quality
as a critical problem. In order to guarantee an improvement in the quality of healthcare
systems, hospital standards must unavoidably be emphasised. Hospital standards help to
IC

clarify what constitutes quality. in the context of healthcare delivery. The most important
step to improve healthcare quality is the articulation of hospital standards required for the
D

provision of healthcare. Standards not only define the degree of excellence, but also serve as a
basis of comparison between different healthcare institutions. Hospital standards also specify
N

the minimum provisions inside a healthcare unit, which could satisfy the community needs.
In this chapter, you will study about the concept of hospital standards. In addition, you will
O

study the various types of hospital standards.

P

6.2 Concept of Hospital Standards

A standard is, to put it simply, a written document that upholds the principles or regulations
necessary to establish order in a certain situation. Hospital standards are the essential
operations, procedures, practises, and frameworks that medical facilities must uphold in order
to continue offering high-quality healthcare services. Stated differently, hospital standards
are declarations that specify the standards of performance and/or the systems or procedures

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 chapter 6  Hospital Standards

Notes that need to be followed at a hospital in order to provide safe, excellent medical care. Hospital
standards are set by assessing the nation’s health care needs and priorities, the population’s
socioeconomic and cultural background, the local way of life and architecture, the climate
and logistics, and other geographical elements. The Indian Standard “Basic Requirements for
Hospital Planning” was created upon the Hospital Planning Sectional Committee’s completion
of the draught, by the Bureau of Indian Standards. The standard was later adopted by the
Medical Equipment and Hospital Planning Division Council.. The suggestions for a thorough

Y
and coordinated strategy for building and strengthening the nation’s infrastructure for health
care were established by the Indian National Health Policy (1983). The current health care

IT
system must be strengthened in order to achieve the aforementioned goal. It also has to be
made more effective and sensitive to the goals and health requirements of the general public.

S
Since every hospital is unique in its own aspects, it is neither desirable nor feasible to provide
a standard that would satisfy the needs of every hospital in the country. But in order to ensure

R
that the nation’s health care infrastructure is developed in a way that can be sustained with
the resources at hand, certain rules must be put in place. Reaching a particular service level

E
is hospital standards’ main goal. For instance, the hospital’s minimum room space criteria
would be understood to include the fundamental requirements for patient, equipment, and

IV
staff operations. Complex process descriptions are not necessary for good functional design
according to hospital standards. The following are a few more goals of hospital standards:
‹‹ Permit healthcare personnel to evaluate healthcare activities in the hospitals
‹‹ Improve

N
the capability of the health care institutions by expanding the health
promotional movements
U
‹‹ Formulate the proposals for the improvement of the healthcare activities in the hospital
Y
‹‹ Involve the personnel and patients in the improvement of the intensive care provided
by the hospitals
R

‹‹ Synchronise healthcare with other facilities

‹‹ Ensure the health and safety of hospital staff
R
E

6.2.1 Need and Importance of Hospital Standards

H

Setting standards for medical services is the primary strategy for preserving quality in
hospitals. A major focus for enhancing people’s health and quality of life is health promotion.
IC

Hospital standards are required to guarantee the quality of medical treatment given by various
hospitals and healthcare facilities within a nation. Additionally, it supports the methodical
integration of health promotion as a fundamental aspect of hospital operations.
D

Hospital standards make it easier to carry out health promotion initiatives and maintain
ongoing service quality monitoring. At the 9th International Conference on Health Promoting
N

Hospitals held in Copenhagen, Denmark, May 2001, the World Health Organization (WHO)
formed a working group after realising the need of hospital standards to advance healthcare
O

quality in hospitals. In light of this, a number of networks and organisations have come
forward to assist in the creation of hospital standards. The following goals are served by
P

hospital standards:
‹‹ Hospital standards ensure that every hospital has a documented health promotion
policy that is put into practise as a component of the hospital’s overall quality system.
‹‹ Hospital standards ensure that hospitals aim to improve health outcomes. The standards
must be oriented towards patients, relatives and staff.
‹‹ Hospital standards state a hospital’s duty to evaluate the patients’ requirements for
illness prevention, promotion of health, and rehabilitation.

DDE, Pondicherry University, Pondicherry 111

 Hospital Architecture, Planning and Maintenance

Notes ‹‹ Hospital standards state that the hospitals must provide patients with information on
their disease or health condition.
‹‹ Hospital standards should ensure that hospitals establish health promotion interventions.

‹‹ Hospital standards state the responsibility of medical practitioners and hospital staff
to develop the hospital as a healthy workplace.
‹‹ Hospital standards establish continuity and cooperation towards a planned approach to

Y
collaborate with other health service sectors and institutions.

IT
Self-Assessment Questions
1. _____________ can be defined as the key functions, activities, processes and structures

S
required to be maintained by hospitals to be able to provide quality healthcare services.
2. ______________ of India laid down the guidelines for comprehensive and integrated

R
approach to development and strengthening of national health care infrastructure.

E
3. Hospital standards state the responsibility of medical practitioners and hospital staff
to develop the hospital as a healthy workplace. (True/False)

IV
4. Realising the need for hospital standards to promote healthcare quality in hospitals,
___________ established a working group at the 9th International Conference on
Health Promoting Hospitals, Copenhagen in May 2001.

N
U
6.3 Types of Hospital Standards
Most hospitals attempt to fit the bill as ‘people’s choice hospital’. Such hospitals are operated
Y

efficiently and follow high standards of patient care. However, there are many hospitals,
mainly in semi-urban and rural areas where the basic hospital standards are not properly
R

applied. These hospitals must improve their level of compliance with hospital standards to
meet people’s expectations. Most patients these days are well aware of their basic rights and
R

can easily distinguish between good and commonplace hospitals. Therefore, the first step
towards building a hospital that aims to achieve total health and medical care spectrum is
E

to develop and implement hospital standards. A hospital needs a lot of prior research and
preparation to be effective. The demands of the patients and the security of the medical
H

staff must be taken into consideration while designing and planning the hospital. It has to be
manned by a sufficient number of skilled physicians, nurses, and other healthcare personnel.
IC

Hospitals adopt certain principles that guide the setting of standards for the administration
and functioning of the healthcare units. These standards are applicable to all the healthcare
institutions involved in providing care and remedial aid to the community, such as nursing
D

homes, government aided hospitals, profit based private hospitals, mental care institutions,
etc. Hospital standards are used to state the provisions for different facilities in a hospital.
N

Hospital standards that are common to most hospitals and healthcare institutions are shown
in Fig. 6.1:
O

General and Mechanical Standards

P

Electrical Standards

Standards for Centralised Medical Gas System

Standards for Biomedical Waste Management

Fig. 6.1: Types of hospital standards

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 chapter 6  Hospital Standards

Notes The standards are detailed in the next few sections.

6.3.1 General and Mechanical Standards

The general and mechanical standards reinforce the acceptable principles for the construction
and operation of a general hospital. These standards apply to patients, healthcare workers

Y
and healthcare services provided by a hospital.

Fig. 6.2 shows some of the major general and mechanical standards:

IT
Standards for patient safety and infection control

S
R
Standards for healthcare workers safety

E
Standards for patient rights

IV
Standards for laboratory and pathology services

N
Standards for manpower requirements
U
Fig. 6.2: General and mechanical standards
Y

Let us now study these standards in detail.

R

1. Standards for patient safety and infection control

R

These include:
 Hand washing facilities in all OPD clinics, wards, emergency, ICU and OT areas
E

 Safe clinical practices to prevent infections and other harms to patients

H

 Written handing over system between health care staff

 Formation of an infection control team
IC

 Safe administration of injections following protocols

 Safe blood transfusion practices
D

 Safe disposal of biomedical waste

N

2. Standards for health care workers safety

O

There shall be proper provisions for:
 Protective gears like gloves, masks, gowns, caps, etc., for healthcare workers
P

 Promotion of hand hygiene by healthcare workers

 Display of Standard Operating Procedures (SOPs) at planned locations in the
hospitals
 Infection control practices and safe biomedical waste management
 Training of healthcare personnel in areas of patient safety, infection control and
Biomedical Waste Management (BWM)

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 Hospital Architecture, Planning and Maintenance

Notes 3. Standards for patient rights

The hospitals shall inform each patient of the patient's right to the following:
 Access to medical records
 Photocopies of his/her medical records
 Information about his/her health status in a comprehensible language

Y
 Refuse treatment

IT
 Uniform and respectful care
 Participation in decisions involving his/her health care with his physician

S
 Complain regarding the care received and get them resolved

R
 Refuse participation in experimental treatment or research
 Examine the surroundings for visual and auditory privacy

E
 Complain against any mental and/or physical abuse

IV
4. Standards for laboratory and pathology services

There shall be proper provisions for:

N
 Laboratory and pathology services in accordance with the needs and size of the
hospital
U
 Administrative direction of laboratory and pathology services by an authorised
person
Y

 Medical direction of laboratory and pathology services by hospital staff

R

5. Standards for manpower requirements

R

On the commencement of hospital services, the total manpower should be based on
1.5 persons per bed and should increase to 2 persons per bed when the hospital starts
E

functioning to its full capacity. Similarly, there are general and mechanical standards for
various other facilities in hospitals some of which are as follows:
H

 Standards for instruments, equipment and furniture requirements

IC

 Standards for dietary services

 Standards for telemedicine services
D

 Standards for medical records

 Standards for central supply services
N

 Standards for laundry service

O

 Standards for housekeeping services

 Standards for maintenance services
P

6.3.2 Electrical Standards

Electrical standards establish the criteria for levels of health care services or systems based
on risk to the patients, hospital staff and visitors in hospitals to minimise the hazards of
fire, explosion and electricity. It specifies the standards for the equipment intended to be

114 DDE, Pondicherry University, Pondicherry

 chapter 6  Hospital Standards

Notes used within patient care including hospital rooms, examining areas and treatment rooms. It
specifies electric standards for all areas in which a patient is likely to come into contact with
electrical devices.

Fig. 6.3 shows some of the electrical standards followed in hospitals:

Standards for electrical devices, equipment and their installation

Y
IT
Standards for device identification

S
R
Standards for electric conduits and cables

E
Standards for lighting

IV
Fig. 6.3: Electrical standards

N
Let us now study these standards in detail.
U
1. Standards for electrical devices, equipment and their installation:
 All electrical devices and equipment shall be listed, labelled and certified for its use
Y

by a recognised testing laboratory.

 Devices and equipment shall be installed in accordance with the instructions
R

provided by the manufacturer.

R

2. Standards for device identification:

 All receptacles and light switches connected to an emergency system shall have a
E

distinct marking or colour for highlighting that they are connected to an emergency
H

system.
 All receptacles in intensive care units shall be marked with the panel and circuit
IC

number supplying them.

 Boxes and enclosures on emergency system shall be distinctively marked.
D

 All panel boards shall have a circuit directory.

 Switchboard and panel boards in the hospital shall be marked to signal the device
N

or equipment from where the power supply originates.

O

 Electrical equipment shall be marked to caution people of potential electric hazards.

3. Standards for electric conduits and cables:

P

 Non-metallic conduits shall not be permitted for use in patient care areas of health
care facilities.
 Flexible metallic channels shall be permitted for use in case of the following:
„„ In case of prefabricated medical headwalls
„„ In case of specified office furnishings

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 Hospital Architecture, Planning and Maintenance

Notes „„ In case of walls or ceilings that are otherwise inaccessible and are not subject
to physical damage
„„ In case where flexible connection to equipment is inevitable
 Flat conductor cable (FCC) shall not be permitted for use in hospitals.
 Low voltage cables for fire alarm, nurse alarms, communication systems, etc., shall

Y
not be in conduit if power supplies are ‘limited’.

4. Standards for lighting:

IT
 Lightings shall be protected against accidental damage.
 Life safety wiring and critical outlet shall be allowed to share the same channel

S
with the normal branch in case of an emergency.

R
 Light switches in bathrooms shall be beyond 5 feet of the periphery of showers
and bathtubs.

E
 There shall be switching restrictions for light fixtures on the life safety branch.

IV
 There shall be provisions for disconnecting all ungrounded conductors in a multiple
wire branch circuit.

N
Exhibit
Indian Electricity Rules
U
Y
R
R
E
H
IC
D
N

(Source: http://image.slidesharecdn.com/introductiononindiancodesasappliedinelectricaldesign-131002130519-phpapp02/95/
introduction-on-indian-codes-as-applied-in-electrical-design-4-638.jpg?cb=1380737319)
O

6.3.3 Standards for Centralised Medical Gas System

P

The requirements for the gases used in hospitals for a variety of applications, including
storage and surgical treatment, are outlined in the standards for centralised medical gas
systems. Medical gases are essential components that directly contribute to sustaining a
patient’s life at a hospital. As a result, the medical gas utilised in these regions has to be
clean, very pure, and delivered at a constant pressure. To ensure a steady supply, hospitals

116 DDE, Pondicherry University, Pondicherry

 chapter 6  Hospital Standards

Notes make use of centralised medical gas system for vacuum and compressed air delivery to the
intensive care and therapy wards, general hospital wards, laboratories, blood transfusion
rooms, diagnostics rooms, etc. The main gases required in hospitals are as follows:
‹‹ Oxygen: Oxygen is used for patients in need of complementary oxygen through
mask. Oxygen is generally pulled off by a huge storage scheme of liquid oxygen at a
healthcare organisation, which gets condensed into a distilled supply of oxygen to the

Y
patient. Pressure is generally maintained at around 380 kilopascals. In smaller medical
units with a lesser patient volume, oxygen is generally stocked in several cylinders, the

IT
size and number of which are dimensioned according to the individual requirements.
‹‹ Nitrous oxide: Nitrous oxide is furnished in several surgical units because it has
anaesthetic properties required during pre-surgical processes. Nitrous oxide is

S
transported to hospitals in specified containers and transferred through pipeline

R
networks. Pressure in the containers is maintained at around 345 kilopascals.
‹‹ Nitrogen: Nitrogen gas is generally used for storing blood, sperms, cultures, etc.

E
Pressure is usually maintained at approximately 1.2 megapascals.

IV
‹‹ Carbon dioxide: Carbon dioxide is generally used to suspend tissues during surgical
procedures. It is also used during laparoscopic surgeries. Pressure of carbon dioxide is
maintained at around 345 kilopascals.

N
‹‹ Medical air: This gas is transported using air compressors to patient care areas in
hospitals. Air pressure in these containers is maintained at around 380 kilopascals.
U
Hospital standards for gas supply also specify the following:
‹‹ The medical gases used in hospitals must be clean, highly pure and supplied under
Y

stable pressure.
R

‹‹ The pipelines in the centralised medical gas system for the supply of gases within the
hospital area shall be properly marked as shown in Fig. 6.4:
R

O2
E
H

AIR
IC

N20
D

Co2
N

AIR-800
O
P

VAC

Fig. 6.4: Gas pipelines in centralised medical gas system

(Source: http://www.indiamart.com/medicare-gas/medical-gas-pipeline-installation.html)

‹‹ The centralised medical gas system shall have a through-going colour coordinated
audio visual monitoring system device to prevent cross connection at a medical gas
outlet.

DDE, Pondicherry University, Pondicherry 117

 Hospital Architecture, Planning and Maintenance

Notes A sample of centralised medical gas system in hospitals is shown in Fig. 6.5:

Y
IT
S
R
E
Fig. 6.5: Vacuum station for centralised medical gas system in hospitals

IV
(Source: http://www.central-uni.co.jp/e/ew_gas.html)

6.3.4 Standards for Biomedical Waste

N
Biomedical waste refers to any discard generated through the clinical operations, medical
U
procedures or laboratory research.

Fig. 6.6 shows the categories of biomedical waste:

Y

Animal waste
R
R

Biological laboratory waste

E

Human anatomical waste

H
IC

Human blood and body fluid waste

D

Sharps
N

Fig. 6.6: Categories of biomedical waste

O

Let us now study these categories in detail.

P

‹‹ Animal waste: This includes animal carcasses, tissues and body parts, blood and body
fluids, etc.
‹‹ Biological laboratory waste: This includes human or animal cell cultures, specimens
of microorganisms, vaccines, etc.
‹‹ Human anatomical waste: This includes any human body part, including tissues and
organs. However, it does not include teeth, hair and nails.

118 DDE, Pondicherry University, Pondicherry

 chapter 6  Hospital Standards

Notes ‹‹ Human blood and body fluid waste: This includes human blood items, saturated or
dripping blood, body fluids contaminated with blood and body fluids removed during
surgery, treatment or autopsy. It does not include urine or faeces.
‹‹ Sharps: This includes the needles, syringes, scalpels, razors and knives used during
surgeries. It also includes contaminated glass, pipettes, test tubes, microscope slides,
blood vials or any other material that could cause punctures or cuts.

Y
Standards for biomedical waste state the specifications and guidelines to be followed by
hospital management in the treatment, handling and disposal of biomedical waste generated

IT
in the hospitals.

Fig. 6.7 shows the standards followed for biomedical waste:

S
R
Standards for segregation of biomedical waste

E
Standards for containment and labelling

IV
Standards for disposal

N
U
Fig. 6.7: Biomedical waste standards

Let us now study these standards in detail.

Y

1. Standards for segregation of biomedical waste:

R

 Biomedical waste shall be stored in a safe environment at all times.

 Biomedical waste must not be mixed with chemical, radioactive or other laboratory
R

waste.
E

 Each category of biomedical waste shall be kept separately.

H

 Fluid waste shall be kept separately from solid waste.

2. Standards for containment and labelling:

IC

 Containers for biomedical waste should be suitable for the contents. There are
different types of containers and bags for disposal of biomedical waste.
D

Fig. 6.8 shows biomedical dustbins used in hospitals:

N
O
P

Fig. 6.8: Biomedical dustbins

(Source: http://3.imimg.com/data3/BD/JD/MY-4124102/biomedical-dustbins-250x250.jpg)

DDE, Pondicherry University, Pondicherry 119

 Hospital Architecture, Planning and Maintenance

Notes  Different types of packaging and labelling shall be used for different types of
biomedical waste.
 The containers for biomedical waste should display the biohazard symbol with the
words ‘Biohazard’ in a colour distinct from that of the container.
The label for biohazard waste is shown in Fig. 6.9:

Y
IT
S
R
Fig. 6.9: Biohazard symbol

E
(Source: http://www.uottawa.ca/services/ehss/docs/BiomedicalWasteDisposalProceduresSept07.pdf)

IV
The containers should bear specific labels with complete details about the waste
materials bearing the component and type of waste.

N
3. Standards for disposal

These waste materials should be tested prior disposal into the atmosphere to ensure
U
that it’s non-toxic to the atmosphere and community as well.

Exhibit
Y

Colour coding rules for biomedical waste

R

Colour coding Type of container Waste categories

R

Yellow Plastic bags Human anatomical waste, animal

waste, microbiological waste, soiled
E

waste,
Red Disinfected container plastic Microbiological, soiled, solid waste
H

bags Plastic Bags/puncture (e.g. waste IV tubes catheters etc.)

Blue/white Plastic bags/puncture proof Discarded medicines, incineration
IC

containers ash, chemical waste

Black Plastic bags/puncture proof Discarded medicines, incineration
containers ash, chemical waste
D

(Source: http://www.expertsmind.com/CMSImages/1822_Colour%20coding%20rules%20for%20biomedical%20waste%20
management.png)
N

Self-Assessment Questions
O

5. The first step towards building a hospital that aims to achieve total health and medical
P

care spectrum is to develop and implement hospital standards. (True/False)

6. __________________ reinforce the acceptable principles for the construction and

operation of a general hospital.

7. ___________ establish the criteria for levels of health care services or systems based
on risk to the patients, hospital staff and visitors in hospitals to minimise the hazards
of fire, explosion and electricity.

120 DDE, Pondicherry University, Pondicherry

 chapter 6  Hospital Standards

Notes 8. ________________________ state the specifications for the gases used in the hospitals
for various purposes, such as surgical treatment, storage, etc.

9. The medical gases used in a hospital are life-supporting element that gives direct
influence in maintaining the life of a patient. (True/False)

10. Match the standard pressure to be maintained by hospitals with the following gases:

Y

i. Oxygen and medical air a. 345 kilopascals

IT

ii. Nitrous oxide and carbon dioxide b. 380 kilopascals

iii. Nitrogen c. 1.2 megapascals

S
11. ____________ refers to any discard generated through the clinical operations, medical

R
procedures or laboratory research.

12. Human anatomical waste includes human or animal cell cultures, specimens of

E
microorganisms, vaccines, etc. (True/False)

IV
13. _____________ includes animal carcasses, tissues and body parts, blood and body
fluids, etc.

N
14. The containers for biomedical waste should display the biohazard symbol with the
words ____________ in a colour distinct from that of the container.
U
15. Biomedical waste can be mixed with chemical, radioactive or other laboratory waste.
(True/False)
Y

Activity
R

Compare the Indian biomedical waste standards with the US ones. Write a short note on
the comparison. Use the internet to avail necessary resources.
R

Activity
E

Compare the Indian electrical standards with the European ones. Write a short note on
H

the comparison. Use the internet to avail necessary resources.

IC

6.4 Summary
‹‹ Hospital standards can be defined as the key functions, activities, processes and structures
D

required to be maintained by hospitals to be able to provide quality healthcare services.

N

‹‹ Hospital standards are declarations that outline the procedures, frameworks, and
performance criteria that must be followed in order for a hospital to provide safe,
O

excellent medical care.

‹‹ India’s National Health Policy (1983) established the principles for a comprehensive
P

and coordinated strategy for building the country’s health care system.
‹‹ The primary objective of hospital standards is to achieve a desired service level.
‹‹ Hospital standards are necessary for ensuring the quality of healthcare services
provided by different hospitals and healthcare institutes in a country.

DDE, Pondicherry University, Pondicherry 121

 Hospital Architecture, Planning and Maintenance

Notes ‹‹ Hospital standards facilitate the implementation of health promotion programmes and
constant monitoring of service quality.
‹‹ Hospitals adopt certain principles that guide the setting of standards for the
administration and functioning of the healthcare units.

There are four types of hospital standards: mechanical, electrical, centralised medical gas
system, and biological waste management.

Y
‹‹ The general and mechanical standards reinforce the acceptable principles for the

IT
development and running of a general hospital. These guidelines are applicable to
patients, healthcare workers and healthcare services provided by a hospital.
‹‹ Electrical standards establish the standards for health care service levels or systems

S
that take into account the danger to patients, hospital employees, and visitors in order

R
to reduce the risk of fire, explosion, and electrical hazards.
‹‹ Standards for centralised medical gas system state the specifications for the gases used

E
in the hospitals for various purposes, such as surgical treatment, storage, etc.

IV
‹‹ Biomedical waste refers to any discard generated through the clinical operations,
medical procedures or laboratory research.
‹‹ Standards for biomedical waste state the specifications and guidelines to be followed by

N
the hospital management in the treatment, handling and disposal of biomedical waste
generated in the hospitals.
U
6.5 Glossary
Y

‹‹ Biohazards: These refer to biological substances that bear a threat on the health of
living organisms.
R

‹‹ Biomedical waste: It refers to any solid or liquid waste that has potential to infect
humans. It includes tissues, body parts, blood, body fluids, laboratory wastes, etc.
R

‹‹ Containment: It refers to the process of keeping something harmful under control or

E

within limits.
‹‹ Labelling: It refers to the process of
marking an item to provide information about the
H

content and composition of products.

IC

‹‹ Pathology: It refers to the branch of medical sciences dealing with the diagnosis of
diseases from laboratory analysis of body fluids, such as blood and urine.
‹‹ Telemedicine: It refers to the use of telecommunication services and information
D

technology for providing medical care at a distance.

N

6.6 Terminal Questions

O

1. What are hospital standards? Explain the need and importance of hospital standards.

2. Discuss the general and mechanical standards adopted by hospitals.

P

3. What are the basic electrical standards followed in hospitals?

4. Discuss the standards for centralised medical gas system in hospitals.

5. What are the different categories of biomedical waste? Discuss the standards for
biomedical waste.

122 DDE, Pondicherry University, Pondicherry

 chapter 6  Hospital Standards

Notes
6.7 Answers
Q. Self-Assessment Questions
1. Hospital standards
2. The National Health Policy (1983)

Y
3. True

IT
4. World Health Organisation (WHO)
5. True

S
6. The general and mechanical standards
7.

R
Electrical standards
8. Standards for centralised medical gas system

E
9. True

IV
10. i. (b), ii. (a), iii. (c)
11. Biomedical waste

N
12. False U
13. Animal waste
14. Biohazard
Y

15. False
R

Q. Terminal Questions
1. Hospital standards are declarations that outline the procedures, frameworks, and/
R

or performance criteria that must be followed in order for a hospital to provide

secure, excellent medical care. Hospital standards are essential to guarantee
E

the quality of medical treatment provided by different hospitals and healthcare

institutes in a country. Refer to section 6.2 Concept of Hospital Standards and
H

sub-section 6.2.1 Need and Importance of Hospital Standards.

2. The general and mechanical standards reinforce the acceptable guidelines
IC

for building and running a typical hospital. These guidelines are applicable to
healthcare providers, patients, and services. provided by a hospital. Refer to
section 6.3.1 General and Mechanical Standards.
D

3. Electrical standards establish the standards for healthcare service levels or

N

systems that take into account the danger to patients, hospital employees, and
visitors in order to reduce the risks of electrical, fire, and explosion. Refer to
section 6.3.2 Electrical Standards.
O

4. Standards for centralised medical gas system state the specifications for the gases
P

used in the hospitals for various purposes, such as surgical treatment, storage, etc.
Refer to section 6.3.3 Standards for Centralised Medical Gas System.
5. Biomedical waste refers to any discard generated through the clinical operations,
medical procedures or laboratory research. Standards for biomedical waste state
the specifications and standards that hospital administration must adhere to for
treating, managing, and getting rid of biological waste produced in hospitals.
Refer to section 6.3.4 Standards for Biomedical Waste.

DDE, Pondicherry University, Pondicherry 123

 Hospital Architecture, Planning and Maintenance

Notes
Case Study: New Hospital Standards for Good
6.8
Samaritan Hospital
Good Samaritan Hospital is a local hospital in southern India. In October 2013, an audit was
conducted at the hospital. It was concluded that the patients admitted in the hospital were
not provided with basic facilities including food and water, even though the patients were

Y
been advised to eat and drink enough to stay hydrated. Before the audit, another incident had
been reported by a hospital staff member through National Patient Safety Agency, where a

IT
patient's fluid level was not monitored correctly, resulting into dehydration.

During the audit, the records of four patients who were at risk of getting dehydrated were

S
examined. It was found out that the fluid balance sheets depicting their liquid intake and
urine output were not updated regularly. Fluid ingestion and excretion had not been recorded

R
on regular basis and total fluid intake by the end of the day was not produced further. The
auditors concluded that the patients’ daily hydration level was not observed and recorded as

E
planned by the physician.

IV
Further, in the investigation, it was found that one of the patients admitted in the hospital had
not been provided with anything to drink or eat in the last 18 hours, even though the doctors
had advised a semi-solid diet and maximum fluid intake to this patient. Once again his fluid

N
intake sheet was not maintained by the hospital staff. The hospital was informed about such
issues and suggested to take serious action to restore the procedures followed in the hospital.
U
As a result, Good Samaritan Hospital implemented a new set of standards to help restore the
recording of patients’ information by the hospital staff on a regular basis.

Also, the hospital was advised to submit a report about their negligence within a period of 14
Y

days specifying the action taken for the improvement of such conditions.
R

Later, another audit was conducted in May 2014 to check the progress of the hospital and its
adherence to the new hospital standards. It was concluded that the hospital administration
R

and staff had worked hard to implement the standards in the hospital. On inspecting the
patients, it was found that they had been provided with adequate and prescribed amount of
E

water to drink, which had also been duly reported by the hospital staff.
H

Discussion Questions
IC

1. Discuss the issues that the auditors found at Good Samaritan Hospital.

(Hint: Inadequate food and water administration to patients and lack of proper patients’
D

records.)
N

2. Do you think hospital standards are important for efficient functioning of hospitals?
O

(Hint: Hospital standards are necessary for ensuring the quality of healthcare services
provided by hospitals.)
P

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 chapter 6  Hospital Standards

Notes
6.9 References and Suggested Readings
‹‹ Basavanthappa, B. (2004). Fundamentals of nursing (1st ed.). New Delhi: Jaypee
Brothers.
‹‹ Charney, W. (2010). Handbook of modern hospital safety (1st ed.). Boca Raton: CRC
Press.

Y
‹‹ Stahl, M. (2004). Encyclopedia of health care management (1st ed.). Thousand Oaks,
Calif.: Sage Publications.

IT
E-References

S
‹‹ Cqc.org.uk. (2014). Standards for hospitals | Care Quality Commission. Retrieved

R
from, <http://www.cqc.org.uk/content/standards-hospitals>

E
‹‹ Euro.who.int. (2014). WHO/Europe | Home. Retrieved from, <http://www.euro.
who.int/>

IV
‹‹ Who.int.(2014). WHO | Management of health facilities: Hospitals. Retrieved from,
<http://www.who.int/management/facility/hospital/en/index2.html>

N
U
Y
R
R
E
H
IC
D
N
O
P

DDE, Pondicherry University, Pondicherry 125

P
O
N
D
IC
H
E
R
R
Y
U
N
IV
E
R
S
IT
Y
chapter

7 Facilities Planning

Y
IT
S
R
E
Structure

IV
7.1 Introduction

N
Learning objectives U
7.2 Concept of Facilities Planning

7.3 Types of Facilities

Y

7.4 Summary
R

7.5 Glossary

7.6 Terminal Questions

R

7.7 Answers
E

7.8 Case Study: Plans to Improve Wexham Park Hospital Parking

H

7.9 References and Suggested Readings

IC
D
N
O
P
 Hospital Architecture, Planning and Maintenance

Notes Learning Objectives

After completing this chapter, you will be able to:
 Explain the concept and importance of facility planning in a hospital
 Discuss the various facilities incorporated in a hospital

Y
7.1 Introduction

IT
In the previous chapter, you have studied the concept of hospital standards and the types of
hospital standards. This chapter will focus on facilities planning.

S
Facility planning is all about designing a layout or arranging physical facilities, such as
machinery, equipment and tools in a way so as to keep goods moving quickly while requiring

R
the least amount of handling. A healthcare organisation may increase productivity, decrease
accidents, and make effective use of personnel and floor space with the aid of a well-designed

E
and planned facility layout.

IV
Based on the need–supply gap, a healthcare facility should prepare a detailed layout plan
that should fulfil the organisation’s objectives. The planning of facilities is an integral part
of hospital architecture. Parameters, such as patient-mix and average length of stay should

N
be considered comprehensively while planning for hospital layout and design. Based on
forecasted patient-mix, facility planners may further plan the number and types of operating
U
rooms and other treatment spaces.

One of the major significant factors, which should be considered while facility planning, is
to determine the hospital’s capacity for providing space to design the outpatient department
Y

(OPD). OPD is often considered as the most profit generating departments in any hospital.
Therefore, the exact number of outpatient consulting rooms should be planned properly.
R

Designing a health care setting for patients is far more difficult than just about the selection
R

of the colour for the beddings, walls or the kind of furniture required. If done correctly, and
sensibly, the design and the facilities of that health care unit can change the performance of
E

the organisation and the tasks performed. More than this, an ideal, patient-focused healthcare
aura is needed to be maintained in the institution to enhance the treatment compliance.
H

A healthcare institution can be as small as a clinic to as large as a multispecialty hospital.

IC

These can be further classified on the basis of the employed facilities and the technologies for
patient care, such as the parking area, ease of patient movement area with the aid of signals
or floor maps, etc. Therefore, the design and layout of the healthcare setting and the facilities
D

are regulated by varied guidelines and standards. In this chapter, you will study the concept
of facilities planning and types of facilities provided by the hospitals.
N

7.2 Concept of Facility Planning

O

To carry out its operations smoothly, it is imperative for every hospital to have a proper
P

facility planning. It is also known as facility layout planning, which is the process of arranging
various physical assets, such machinery and equipment, within the hospital in a manner that
keeps supplies moving quickly and cheaply.

Some common definitions of facility layout planning are as follows:

As described by Moore, facility layout planning is the act of planning that intends for optimum
arrangement of facilities, as well as personnel, operating equipment, storage space, material

128 DDE, Pondicherry University, Pondicherry

 chapter 7  Facilities Planning

Notes handling equipment and all other supporting services. It also designs the best structure to
encompass these facilities.

According to Knowles and Thomson, facility layout planning involves:

i. “Planning and arranging machinery, equipment and services for the first time in completely new
facility

Y
ii. The improvements in layouts already in use in order to introduce new methods and improvements
in procedures”

IT
The concept of facility layout planning is not only confined to the initial movement of
machines and equipment, but also involves re-arrangement of the existing layout to improve

S
its performance. The design of a plant layout varies across different hospitals depending upon
their specialisation and location.

R
Since few decades, there have been repetitive vogues about theories of planning and designing

E
of healthcare facilities. Specialised health units need to have modern patterns for wards and
nursing sections with effective surroundings and facilities. While planning a facility layout,

IV
the hospital administration should focus on the following aspects:
‹‹ Patient-oriented care is the foremost motto of the care process, as patients are whole-
sole reason for the existence of hospitals in our community.

N
‹‹ Effective plans, medical safety, ideal operational rapports, monetary value, contemporary
U
systems are the other requirements of sound facility planning.
‹‹ Focus should be on applying supportable layouts and extensive usage of facilities.
Y

‹‹ The hospital should ensure to provide curative environment that comprises both
friendliness and cordiality, and not just combination of science and technology, as it is
R

meant for.

Fig. 7.1 shows the factors of facility layout planning:

R
E

Infrastructure
H

Machinery
IC

Nature of treatment
D

Management policies
N

Employee needs
O

Fig. 7.1: Factors of facility layout planning

P

Let us now study these factors in detail.

‹‹ Infrastructure: Refers to one of the most important factors that should be considered
by the hospitals while planning its layout. The nature and size of a hospital building
help to determine the space available for the layout. Apart from this, the hospital should
also consider special requirements, such as air ventilation, dust control and humidity
control, while planning its facility layout.

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 Hospital Architecture, Planning and Maintenance

Notes ‹‹ Machinery: Implies that the usage of equipment and machinery varies across different
hospitals. Some hospitals use machinery for general purpose, while others use machinery
only for some specific purposes.
‹‹ Nature of treatment: Facility layout planning also depends on the type of treatment
provided by the hospitals. For example, obstetrical services require special facilities
to ensure proper safety and care for the mother and the newborn child. Usually, such

Y
patients are kept in a separate hospital wing to avoid infection.
‹‹ Management policies: Indicate that management policies have significant impact on

IT
the planning of the facility layout. Some of these management policies are as follows:
 Degree of automation

S
 Future expansion plan

R
 Personnel policy
 Purchasing policy

E
‹‹ Employee needs: Imply that the hospital should also consider the needs of its

IV
employees while planning its layout. Therefore, there should be proper facilities for
employees, such as cloakrooms, washrooms, lockers and drinking water. Moreover,
proper provisions should be made for the disposal of waste.

7.2.1 Need of Facility Planning

N
U
As discussed earlier, a hospital needs to have a proper facility layout to carry out its processes
Y

smoothly. An effective facility layout planning strives to achieve the following objectives:
‹‹ Minimum material handling: A well-planned facility architecture guarantees that
R

machinery and equipment are positioned to need the least amount of handling possible.
In the end, this lowers the hospital’s material handling expenses.
R

‹‹ Elimination of bottlenecks: Adequate facility layout planning lowers bottlenecks

E

brought on by inadequate machine capacity and layout designing. These obstructions

result in a number of problems, including traffic jams, inefficient use of available
H

floor space, and mishaps. A well-designed facility plan may help a hospital avoid these
problems.
IC

‹‹ Reduction in delays: Alludes to the reality that a precise design of the facility’s
layout is essential to the prompt completion of various tasks. A well-designed facility
minimises the factors that lead to patient treatment delays. These factors include a lack
D

of room, the transfer of materials between departments, and ruined work.

N

‹‹ Improved quality control: Implies that a platform for efficient job monitoring in a
hospital is provided by a well-planned facility layout. An effective arrangement makes
O

inspection easier at several points in the healthcare service production process. As a

result, it guarantees that the product produced is of the appropriate quality.
P

‹‹ Efficient utilisation of staff: Implies that a well-planned facility architecture sets up

each individual task so that employees’ time is used efficiently.
‹‹ Improved employee morale: Alludes to the idea that if the company has a favourable
atmosphere, employees would be happy and enthusiastic. An effective facility layout
design boosts staff morale by guaranteeing:

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 chapter 7  Facilities Planning

Notes  Better working environment

 Reduced number of mishaps
 Increased earnings
 Better employee facilities

Y
7.2.2 Objectives of Facility Planning

IT
The main objective of facility planning in a hospital is to ensure smooth functioning of patient
care. In addition, facility planning aims at:

S
‹‹ Distinctive patient care: Healthcare units must be structured, teamed and furnished
to meet the specified aims of clinical care. There must be an effective structural design.

R
The patient care procedures should be periodically examined via constant assessment
of current services, facilities provided, etc. Along with this, a hospital should have an

E
appropriate number of experienced or skilled staff ensuring appropriate care of the
patients. The staff should also be upgraded with the recent innovations in technology.

IV
‹‹ Public orientation: While planning or designing a healthcare unit, patient needs should
be kept in mind to meet their expectations. A hospital must be established at a suitable

N
and easily accessible area. While delineating the fees for the healthcare services, the
types of population, communal status, education level and economic conditions of the
U
target audience should be considered elaborately. A hospital must also be involved into
community programs that not only aim at providing healthcare services to the public,
but also towards educating the community about the better utilisation of resources at
Y
the hospital and must enquire about their needs too.
‹‹ Monetary feasibility: A hospital should not be solely profit-oriented at all the times.
R

Thus, there should be an effective economic control system on board too. A healthcare
setting should be able to categorise and adapt facilities that are self-satisfying for the
R

patients. Any structured innovations and alterations should be done ethically and
reasonably, keeping the community’s viewpoints in consideration.
E

‹‹ Effective implementation: The plan implemented while designing a hospital must

H

reflect an effective utilisation of staff, resources and facilities. Viability should be opted
while planning, certifying appropriate ‘passage’ for the movement of patients, staff
IC

and patient’s relatives and friends. The passage should be spacious enough to allow
proper movement of materials to be utilised for patient care. Also, appropriate steps for
implementation of infection control measures should be adopted. The structure must
D

accommodate for future expansion and disaster planning should also be done while
planning and designing of facility layout.
N

Self-Assessment Questions
O

1. The design of a plant layout varies across different hospitals depending upon their
__________ and __________.
P

2. The nature and size of a hospital building help to determine the space available for
layout. (True/False)

3. A good layout facilitates inspection at various stages of healthcare service production.

(True/False)

4. List the main objectives of facility planning in a hospital.

DDE, Pondicherry University, Pondicherry 131

 Hospital Architecture, Planning and Maintenance

Notes Activity
Visit a nearby hospital and meet the administrator of the hospital. Discuss with him/her
about the facilities employed at the hospital for patient care. Prepare a report to plan out
whether the employed facilities are adequate as per the patient’s needs.

7.3 Types of Facilities

Y
IT
Hospitals provide a variety of other services in addition to basic medical and surgical care.
These services, together with auxiliary labs, supplies, and staff services, comprise the medical
and surgical mission of a hospital system.

S
The main offers of a hospital are its facilities. They are often created by figuring out what the
patients’ requirements are. The goal of these amenities is to turn the hospital into a one-stop

R
shop for medical needs.

E
As was previously said, hospitals are establishments that house staff members and essential
services in the form of medical and surgical departments. These medical departments handle

IV
both emergency care and basic clinical treatments for certain illnesses and ailments.

In addition to these fundamental services, hospitals provide a variety of medical amenities,

N
including ambulatory services, mortuaries, food and laundry services, and other essentials for
basic healthcare. However, a hospital’s primary goal or objectives will determine exactly what
combination of these services the hospital offers.
U
Today, hospitals are deeply committed to achieving utmost standards of excellence in medical
care quality. Therefore, their primary concern is now to ensure that the amenities related with
Y

health and comfort gain special attention to provide patients the finest treatment possible. Fig.
7.2 shows some of the basic amenities provided by the healthcare institutes:
R

Transport
R
E

Food services
H

Mortuary
IC

Laundry services
D

Parking facility
N

Fig. 7.2: Types of facilities

O

Let us now study these facilities in the next few sections.

7.3.1 Transport
P

A hospital usually has a fleet of ambulances to transport patients to and from the hospital.
An ambulance is required to be equipped with emergency treatment facilities, available day
and night. Today, transportation is counted as a basic health care facility or a distinct part of
a health care service to ensure timely treatment to patients. Apart from ambulatory services
that transport patients from one place to another, patients also require transportation facilities
to commute within the hospital premises.

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 chapter 7  Facilities Planning

Notes Fig. 7.3 shows an ambulance:

Y
IT
S
Fig. 7.3: Ambulance
(Source: http://www.allpar.com/squads/photos/ambulances/1988-mccoy-miller.jpg)

R
The choice for transporting a seriously ill patient, either within the hospital premises or to any

E
other hospital or place, is done after analysing the probable aids of transportation against the
possible hazards. Seriously ill patients are commuted to the healthcare sites in order to offer

IV
various patient care services. On the other hand, endowed care requires patients to commute
within the hospital passage, such as analytical sections, operation theatres or particular care
section.

N
While transferring patients, the staffs should be skilled enough to use equipment for providing
appropriate first-aid to the patients. Preferably, all vehicles that are used for aiding seriously ill
U
patients should include highly skilled personnel.
Y

7.3.2 Food Services

R

Food acts as an essential feature of patient amenities as it adds remedial value in various
diseases such as hypertension, diabetes, stomach illnesses, etc. Therefore, nutritional service
R

forms an eminent facility in the hospital. Distribution of food as per patient’s necessity is very
important for the fast and effective recovery. Providing appropriate type of food adds quality
E

to patient care. Patient satisfaction depends mainly on the type of diet granted by the hospital.
H

Fig. 7.4 shows food services in a hospital:

IC
D
N
O
P

Fig. 7.4: Food services

(Source: http://www.tbh.net/images/patient_information/media_releases/food_services05.jpg)

The characteristic features of providing food facilities in a hospital are as follows:

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 Hospital Architecture, Planning and Maintenance

Notes Principles of the Food Department

The following are the major principles of food section in a hospital:

1. Nourishment: The food section is responsible for granting the appropriate kind of
food with dietary benefits to the patient. A dietician prepares a diet plan for the patients
admitted to the hospital.

Y
2. Food therapy: Each specialised hospital must have a dietician who supervises the food
department and the activities of the kitchen. These dieticians are also liable to carry

IT
out the counselling for OPD patients with regard to the kind of food to be taken.
While counselling, a dietician should educate their patients about the benefits of the
nutritious food, hygiene and healthy conditions. It works as an added advantage for the

S
patients for maintaining good health. Along with the patients, hospital staff can also be

R
educated about the varied benefits of nutritious food.

E
Functions of Food Services in a Hospital

IV
‹‹ Designing food regimes for the patients, procurement of healthy and beneficial food
products for the patients and storage of food products
‹‹ Maintaining sanitary and safety conditions in kitchen

N
‹‹ Employing teaching programs and regulation for staff
U
‹‹ Maintaining co-ordination among staff, patients and their families
‹‹ Counselling patients regarding food habits
Y

‹‹ Preparing dietary plan in accordance to the clinical needs for indoor and outdoor
patients
R

‹‹ Arranging work related tasks, on job teaching plans, courses, etc.

R

‹‹ Preparing health guidance plans for patients, personnel, and community

E

Thus, food plays a vital role in the healthcare industry as it helps patients in recovering from
the disease. In addition, it is the quality of food provided by the hospitals that help it in
H

maintaining its image to a great extent, as food leaves an everlasting impact on the mind of
the patients.
IC

7.3.3 Mortuary
D

A morgue or mortuary is basically used for storing human corpses anticipating for identification
or removal for post-mortem or disposal by cremation, etc. The main objective of the hospital
N

mortuary is to comply with the standards and principles, as mentioned in hospital guidelines.
O
P

134 DDE, Pondicherry University, Pondicherry

 chapter 7  Facilities Planning

Notes Fig. 7.5 shows a mortuary in a hospital:

Y
IT
S
R
E
Fig. 7.5: A mortuary
(Source: http://www.copelandgroup.co.uk/sites/default/files/Mortuary%20store.JPG)

IV
A hospital mortuary must have:
‹‹ Shade-free lights for the autopsy and dissection table.

N
‹‹ Ventilation and exhaust systems with HEPA (High Efficiency Particulate Air) filters.
U
‹‹ Non-slippery flooring.
‹‹ Regulated number of personnel, allowed for attending the autopsy procedure.
Y

‹‹ A stipulated period of time (as regulated by the principles and authorities) to store
the dead bodies. (In case, if the body needs to be stored for a longer time period, then
R

it should be stored at a temperature of minimum -20°C, to avoid degradation of the

body.)
R

‹‹ Sufficient area for performing an autopsy and storage of body.

E

‹‹ Sufficient amount of tables or stretchers for easy movement while performing autopsy.
‹‹ A separate clerical section must be included in the autopsy room, which must include
H

data with complete details about:

IC

a. Time and date of receipt and release of the body

b. Name and signature of the person accepting the body from the mortuary
D

c. Details of the autopsy, if performed

N

7.3.4 Laundry Services

O

A laundry service in a hospital is one of the very important services. Most of the hospitals
run their own laundry at the hospital. Generally, a hospital makes use of a single laundry at a
P

time and in certain cases with hospitals having a bed-size of 150+ beds are advised to have a
self-owned laundry within the hospital premises.

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 Hospital Architecture, Planning and Maintenance

Notes Fig. 7.6 shows laundry services in a hospital:

Y
IT
S
Fig. 7.6: Laundry services

R
(Source: https://www.osha.gov/SLTC/etools/hospital/laundry/images/laund.jpg)

Within the hospital premises, the site of a laundry is also a point of concern as it aids in

E
regulation of contamination through linens and other hospital clothing. Apart from this,
another standard to be implemented in the hospital laundry area is to have a separate area or

IV
sections for both the clean as well as dirty clothings of the hospital. Linens and clothes of
critically ill patients or those used in surgical procedures must be disinfected, and then should
be passed on to the laundry in closed containers to avoid any kind of contamination.

N
The best suited location of the laundry in a hospital is the basement. This results into several
U
advantages, as it will make appropriate usage of the hospital space as well as reduces the noise
generated by the equipment used while laundry. Thus, it does not disturb the patients and
other members in the hospital. In addition, this will minimise the incidences of contamination
Y

by the dirty hospital clothes and linens.

R

7.3.5 Parking Facility

R

Today, the enormous growth in outpatient activity and visiting staff has forced hospitals to
E

provide sufficient parking spaces. All hospitals require having good parking facilities to ensure
convenient, safe and adequate parking for the patients, visitors and staff. A good parking
H

system can be a great marketing advantage for any hospital. Parking services include both
in-house and open-air sequestered asset in a healthcare setting.
IC

Fig. 7.7 shows the types of parking facility:

D

Types of
Parking Facility
N
O

Surface Multilevel Below-ground

parking parking parking
P

Fig. 7.7: Types of parking facility

Let us now study these types in detail.

‹‹ Surface parking: It is the least costly type of parking. Surface parking denotes to
parking vehicles on an extended area that is levelled equal to the hospital ground.

136 DDE, Pondicherry University, Pondicherry

 chapter 7  Facilities Planning

Notes Fig. 7.8 shows surface parking in a hospital:

Y
IT
S
R
Fig 7.8: Surface parking

E
(Source: https://www.unitypoint.org/peoria/filesimages/New%20Outpatient%20Entrance%20-%20web_thumb.jpg)

‹‹ Multilevel parking: It is a building designed for the parking purpose that consists of

IV
a number of floors or levels on which parking takes place.
Fig. 7.9 shows multilevel parking in a hospital:

N
U
Y
R
R

Fig. 7.9: Multilevel parking

E

(Source: http://wiegerinck.nl/wp-content/uploads/3390_Parkeergarage1.jpg)
H

‹‹ Below-ground parking: It refers to underground or basement parking where parking

space is designed below the ground level or in the basement of the hospital.
IC

Fig. 7.10 shows below-ground parking:

D
N
O
P

Fig. 7.10: Below-ground parking

(Source: http://www.healthcarefacilitiestoday.com/media/graphics/2013/2676.jpg)

DDE, Pondicherry University, Pondicherry 137

 Hospital Architecture, Planning and Maintenance

Notes Self-Assessment Questions

5. Hospital facilities make up the core of a hospital’s offerings. (True/False)6.
Today, transportation is counted as a basic health care facility or a distinct part of a
health care service to ensure timely treatment to patients. (True/False)

7. While counselling, a dietician should educate their patients about the benefits of the

Y
_______________________________.

8. A ____________________is basically used for storing human corpses anticipating

IT
for identification or removal for post-mortem or disposal by cremation, etc.

9. The best suited location of the laundry in a hospital is the basement. (True/False)

S
10. ___________________is a building designed for the parking purpose that consists of

R
a number of floors or levels on which parking takes place.

E
Activity

IV
Write a note on facilities required in a mortuary room of a hospital.

7.4 Summary

N
‹‹ To carry out its operations smoothly, it is imperative for every hospital to have a proper
U
facility planning. It is also known as facility layout planning.
‹‹ Facility layout planning depends on various factors:
Y

 Infrastructure

 Machinery
R

 Nature of treatment
R

 Management policies
E

 Employee needs
‹‹ An effective facility layout planning strives to achieve the objectives, such as the
H

following:
IC

 Minimum material handling

 Elimination of bottlenecks
D

 Reduction in delays
 Improved quality control:
N

 Efficient utilisation of staff

O

 Improved employee morale

 The main objectives of facility planning in a hospital are as follows:
P

138 DDE, Pondicherry University, Pondicherry

 chapter 7  Facilities Planning

Notes  Distinctive patient care

 Public orientation
 Monetary feasibility
 Effective implementation
‹‹ Apart from the basic medical and surgical services, hospitals provide several other

Y
facilities that along with supporting laboratories, equipment and personnel services
make up the medical and surgical mission of a hospital system.

IT
‹‹ A hospital usually has a fleet of ambulances to transport patients to and from the
hospital.

S
‹‹ Food acts as an essential feature of patient amenities as it adds remedial value in various
diseases, such as hypertension, diabetes, stomach illnesses, etc.

R
‹‹ A morgue or mortuary is basically used for storing human corpses anticipating for

E
identification or removal for post-mortem or disposal by cremation, etc.
‹‹ Within the hospital premises, the site of a laundry is also a point of concern as it aids

IV
in regulation of contamination through linens and other hospital clothing.
‹‹ All hospitals require having good parking facilities to ensure convenient, safe and

N
adequate parking for the patients, visitors and staff.
‹‹ There are generally three types of parking:
U
 Surface parking
 Multilevel parking
Y

 Below-ground parking
R

7.5 Glossary
R

‹‹ Below-ground parking: It refers to the underground or basement parking where

E

parking space is designed below the ground level or in the basement of the hospital.
‹‹ Facility layout: Indicates a manner in which machines and equipment are arranged for
H

production purposes
IC

‹‹ Facility layout planning: It is the act of planning that intends for optimum arrangement
of facilities, as well as personnel, operating equipment, storage space, material handling
equipment and all other supporting services.
D

‹‹ Multilevel parking: It is a building designed for parking purpose that consists of a

number of floors or levels on which parking takes place.
N
O
P

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 Hospital Architecture, Planning and Maintenance

Notes
7.6 Terminal Questions
1. Explain the concept of facility planning.

2. Discuss the need of facility planning.

3. Discuss food services as an essential feature of patient amenities.

Y
4. Define the role of morgue or mortuary as a hospital facility.

IT
5. Discuss the significance of hospital parking as one of the important hospital facility.

7.7 Answers

S
Q. Self-Assessment Questions

R
1. Specialisation, location

E
2. True

IV
3. True
4. Distinctive patient care, public orientation, monetary feasibility and effective
implementation.

N
5. True U
6. True
7. Nutritious food, hygiene and healthy conditions
Y

8. Morgue or mortuary
9. True
R

10. Multilevel parking

R

Q. Terminal Questions
E

1. Facility planning is all about designing a layout or arranging physical facilities,

such as machinery, equipment, and tools in a way so as to maintain a quick flow of
H

materials at minimum handling cost. Refer to section 7.2 Concept of Facilities

Planning.
IC

2. An effective facility layout planning strives to achieve the objectives, such as

minimum material handling, elimination of bottlenecks, reduction in delays,
improved quality control, efficient utilisation of staff and improved employee
D

morale. Refer to sub-section 7.2.1 Need of Facilities Planning.

N

3. Food acts as an essential feature of patient amenities as it adds remedial value in

various diseases, such as hypertension, diabetes, stomach illnesses, etc. Refer to
O

sub-section 7.3.2 Food Services.

4. A morgue or mortuary is basically used for storing human corpses anticipating for
P

identification or removal for post-mortem or disposal by cremation, etc. Refer to

sub-section 7.3.3 Mortuary.
5. All hospitals require having good parking facilities to ensure convenient, safe
and adequate parking for the patients, visitors and staff. Refer to sub-section
7.3.5 Parking Facility.

140 DDE, Pondicherry University, Pondicherry

 chapter 7  Facilities Planning

Notes
Case Study: Plans to Improve Wexham Park
7.8
Hospital Parking
Plans are in place to improve parking for patients at a hospital, which has been dogged with
problems. Wexham Park Hospital has held a consultation exercise to determine how to sort
out a parking situation, which has become an increasing issue. The hospital trust has recently

Y
added 80 spaces for patients and visitors to help with congestion at busy times, but its new
proposals involve increasing capacity at the site from 1,500 to more than 2,000 spaces.

IT
Car parking areas will also be redesigned to make accessing the hospital as easy as possible for
both staff and patients. Landscape architect Richard Hodgetts, who held a consultation event

S
at the hospital on Friday, October 3 and Monday, October 6, said, “For a long time, the hospital
has heard from patients that parking here is very difficult. It’s hard to find a space in the car

R
park, which means that by the time they’ve done that, they are stressed before they’ve even
walked into the building. Something has needed to be done, and so we hope that the new plans

E
will mean things are a lot better.” He added, “The feedback we’ve had has been very positive
about it. Staff are very happy about it, because they are affected by it as well as the patients.”

IV
After gathering people’s views, the hospital trust hopes to submit a planning application to
South Bucks District Council, with work then to be carried out early next year, and the new

N
parking arrangements in place by the end of April. Mr Hodgetts said, “The plans will also
mean that people will not be parking on the roads outside the hospital, which has caused
U
traffic problems in the past, and will mean that larger vehicles can get past a lot easier.” He
added, “It will probably be quite a messy few months while the changes are made, but the end
result should be a big improvement on what is in place at the moment.”
Y

Discussion Questions
R
R

1. What was the need for improving the parking facility for patients at Wexham Park
Hospital?
E

(Hint: With the increasing number of patients and staff, the hospital was facing
tremendous problem of parking. Therefore, the hospital felt the need for improving the
H

parking facility for patients.)

IC

2. What measures are taken by the hospital to deal with this problem?

(Hint: After gathering people’s views, the hospital trust hopes to submit a planning
application to South Bucks District Council, with work then to be carried out early next
D

year, and the new parking arrangements in place by the end of April.)
N

(Source: http://www.getbucks.co.uk/news/local-news/plans-place-improve-wexham-park-7891912)

7.9 References and Suggested Readings

O

‹‹ James, P., and Noakes, T. (1994). Hospital architecture. New York: Longman.
P

‹‹ Nickl-Weller, C., and Nickl, H. (2009). Hospital. Berlin: Braun.

‹‹ Verderber, S. (2010). Innovations in hospital architecture. New York: Routledge.

DDE, Pondicherry University, Pondicherry 141

 Hospital Architecture, Planning and Maintenance

Notes E-References
‹‹ Abell, J. (2014). Plans in place to improve Wexham Park Hospital parking. getbucks. Retrieved
from, <http://www.getbucks.co.uk/news/local-news/plans-place-improve-wexham-
park-7891912>
‹‹ Icfmt.net.(2014). Planning and Designing of Modern Mortuary Complex in Tertiary Care.

Y
Retrieved from, <http://www.icfmt.net/journal/vol4no1/designing_of_modern_
mortuary_complex.htm>

IT
S
R
E
IV
N
U
Y
R
R
E
H
IC
D
N
O
P

142 DDE, Pondicherry University, Pondicherry

chapter

8 Hospital Information

Y
System (HIS)

IT
S
R
E
Structure

IV
8.1 Introduction

N
Learning Objectives U
8.2 Concept of Hospital Information System (HIS)

8.3 Types of HIS

Y

8.4 Framework of HIS

R

8.5 Benefits and Limitations of HIS

8.6 Summary
R

8.7 Glossary
E

8.8 Terminal Questions

H

8.9 Answers
IC

8.10 Case Study: Improving Performance through Implementation of

Hospital Information System (HIS)
D

8.11 References and Suggested Readings

N
O
P
 Hospital Architecture, Planning and Maintenance

Notes Learning Objectives

After completing this chapter, you will be able to:
 Explain the concept of hospital information system (HIS)
 Describe the need for HIS
 Identify the objective of HIS
Describe the scope of HIS

Y

 List the types of HIS

IT
 Explain the framework of HIS
 List the benefits and limitations of HIS

S
8.1 Introduction

R
In the previous chapter, you have studied about the concept of facilities planning and the

E
various types of facilities. This chapter will focus on Hospital Information System (HIS).

IV
Managing and maintaining a hospital is a very expensive and demanding task. With the
passage of time, there has been change in the paradigm of diagnosis and treatment methods.
At the same time, patients’ level of expectation has risen, enabling hospitals to take a recheck

N
on their service model and workflow. The need of the hour is to deliver quality services at
reduced cost and extend the reach.
U
In medical treatment, there is no scope of applying trial and error method. Therefore, it is
important to utilise the accurate and precise technique of health care. Information has a very
large role to play in this process. Information has to be shared among different units of a
Y

hospital for better planning and management. Collecting information related to patient, past
medical history, method of treatment, duration of treatment, billing and payment, maintaining
R

record for future retrieval and avoiding duplication of information can contribute to faster
workflow and better treatment. As the volume of information grows the manual method of
R

handling all these activities becomes tedious, time taking and less efficient. A computerised
system can integrate and coordinate large amount of medical, financial and functional data in
E

the most effective way.

H

Hospital information system (HIS) is an information technology based software system

which provides anytime access to information and assist in decision making. More and more
IC

professionally run healthcare organisations and clinics are managing their medical and
administrative information with the help of HIS. An efficient hospital information system is
not only responsible for the daily administrative and monetary workouts but is also responsible
D

for the improvement of quality, safety and efficiency of a healthcare unit or a hospital.
N

Such systems have a broad database of managerial and monetary functions, and also a
sophisticated database developed for management especially designed to seize, alter and
O

stock data. It supplies majority of awareness to online users. It has proficiency for massive
organisation among all the departments of a hospital without disturbing the synchronised
awareness to online users. It holds a broad range of the hospital’s provisions from summarising
P

clinical data and records of earlier treatment to the date and time of generation of bills.

In this chapter, you will study the concept of hospital information system (HIS) by identifying
the need for HIS and its objective and scope. The chapter also discusses about the types of
HIS. Further, it explains the framework of HIS. Towards the end, it discusses the benefits
and limitations of HIS.

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 chapter 8  Hospital Information System (HIS)

Notes
8.2 Concept of Hospital Information System

Y
IT
S
R
E
(Source: http://www.gtechsa.com/images/healthcare_pic.jpg)

IV
Hospital management systems are designed to manage all types of information that are
generated and needed to help the hospital personnel to perform their jobs in an efficient
manner. These systems were first developed and introduced in the early sixties. The United

N
States of America has been the pioneer of generating such systems.

When this concept and system was developed the computers were quite slow. The computer
U
networking was not so advanced. Therefore, information could not be shared or accessed at
once or the way it is done these days. The system was largely used for managing the billing
process and hospital inventory. With evolution in computers and modernisation in hospital
Y

facilities, the HIS has also developed to handle all types of clinical and operation needs.
R

The complex setup and workflow pattern of a hospital in terms of its organisation and official
and medical co dependences’ demand for a complete united information structures in all
R

domains of organisational, medical and clerical tasks, with an added skill to assimilate several
test centres and clinical tools. Hospital information system is described as an integrated open
E

system, which takes care of the complete range of information requirement of a hospital
to help in diagnosis, treatment, management and patient awareness for enhanced patient-
H

centric services and better healthcare practices. It facilitates storage of large amount of data,
assimilation of information and communication of data across various units of a hospital. It
IC

has been designed as a robust, flexible and user-friendly tool to face the current and future
challenges of healthcare services and provide plausible benefits to a hospital.
D

8.2.1 Need for HIS

N

With the advancement of technology, IT system has penetrated into every field and
O

healthcare system is no exception. The HIS needed for better hospital management through
comprehensive information sharing.
P

Information Demands in a Healthcare Setting

Demands of information in a modern hospital can be broadly classed into five groups:
‹‹ Information to assist in stating purposes or aims and guiding future projections
‹‹ Information to assist in understanding short-ranged need, preparing plans and
managing work in organisations

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 Hospital Architecture, Planning and Maintenance

Notes ‹‹ Information to assist in reserving appointment and managing financial matters

‹‹ Information to assist in operation and monitoring quality
‹‹ Information to assist in assessing the effectiveness of procedure

At the district level, there is another set of demand in addition to the aforesaid ones.
The primary objective is to provide basic healthcare services to the community through

Y
economically viable methods.

IT
Information Demands at District Level
‹‹ Health schemes

S
‹‹ Regulation of transmissible diseases, effectual obstacles and control techniques for
non-transmissible diseases

R
‹‹ Health manpower

E
‹‹ Side effects of medicines

IV
‹‹ Suitable specifications of water, air and other environmental conditions
‹‹ Investment and provisions

N
The district level system collects detailed data from the hospitals or healthcare institutions
and assembles it for evaluation and clarification. Only condensed and mandatory data is sent
to the authorities.
U
Reasons for Using Hospital Information System
Y

The major reasons for using HIS are as follows:

R

‹‹ To enhance administrative efficacy and to minimise the total expense of health services
to the community
R

‹‹ To provide accurate, precise and complete data to meet the requirement of varied
E

divisions of a hospital
H

‹‹ To improve organisational effectualness in preparing, allotting and regulating the

insufficient and costly resources of the institution
IC

‹‹ To enhance clinical services for offering high-valued clinical care at an affordable price
‹‹ To enhance managerial activities through information technology
D

‹‹ To minimise paper or office work

N

8.2.2 Objectives of HIS

O

The main aim of HIS is to assist a hospital or a healthcare institution in attaining enhanced
functional competence and regulating information centred chores. A well planned and
P

accomplished hospital information system, as per the demands of a hospital, can enhance the
efficacy of the hospital staff, allowing each unit and centre to regulate its data administrating
and influencing the value of patient care.

A hospital should adopt a HIS to achieve the following main objectives:

‹‹ Synchronise all the processes within the hospital, minimise patient waiting time and
enhance the overall efficiency of the hospital

146 DDE, Pondicherry University, Pondicherry

 chapter 8  Hospital Information System (HIS)

Notes ‹‹ Establish communication between different services within the hospital

‹‹ Reduce office work and administrative times
‹‹ Avoid duplication of patient related information
‹‹ Provide necessary data for assessing health care needs for patients and the community

Y
8.2.3 Scope of HIS

IT
Hospital information can be planned as per the medical, organisational and monetary utilities.
All remedial actions, prescribed medication instructions and diagnostic details are sent to
medical units, paramedical units and administrative sections such as accounts, pharmacy,

S
stores, and other units through the designed software system and their response is received.

R
This way, the starting and ending time of all actions is logged in the system. Running schemes,
supply management method and ecological techniques can be merged too. These functional

E
units can be broadly classed into several stages, as shown in Fig. 8.1:

IV
Contract administration

N
Functional organisation
U
Strategic organisation
Y

Fig. 8.1: Various units

Let us now study these units in detail.

R

‹‹ Contract administration: This takes care of the arrangement of several medical,

R

functional, and beneficial techniques and also includes supply of medicines and food
amongst other things. The varied aspects to be measured under this stage are:
E

 Population count
H

 Invoice

 Stock
IC

 Residence of patients
 Price regulation
D

 Controlling hospital acquired infections

N

‹‹ Functional organisation: This aids in habitual organisational decisions for the

following tasks:
O

 Patient care
P

 Discharge from hospital

 Procurement

 Financial arrangement
 Education and teaching

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 Hospital Architecture, Planning and Maintenance

Notes ‹‹ Strategic organisation: How should the sources be utilised effectively to achieve the
modern aims of hospital management? A data management scheme integrated in the
HIS, grants data on this matter. Such schemes offer varied alternate techniques to select
the appropriate one.

An ideal data assimilation scheme must have the following features:

‹‹ Quality: The data must be correct and precise so that it can enable appropriate decision

Y
making.

IT
‹‹ Quantity: A huge amount of data is not needed by the patient. The system should
provide only the required data necessary for the specific role.
‹‹ Promptness: The data should be provided as and when required by the patients or the

S
community.

R
‹‹ Significance: Patients and employees require data that is essential for their units. For
example, a librarian would not like to have data about the hospital record room.

E
Hospital management system can be used in any hospital, healthcare centres, clinics, private

IV
nursing homes, dispensaries and pathology laboratories.

Self-Assessment Questions

N
1. _______________ has to be shared among different units of a hospital for better
planning and management.
U
2. Hospital information system is described as an integrated _______ system

3. HIS is used to enhance administrative efficacy and to maximise the total expense of
Y

health services to the community. (True/False)

R

4. What among these is not an aim of HIS:

R

a. Attaining enhanced functional competence

b. Regulating information centred chores
E

c. Reducing office work and administrative times

H

d. Increasing patient waiting time

IC

5. An ideal data assimilation scheme must have following features:

a. Population count
D

b. Patient record
c. Promptness
N

d. All of the above

O
P

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 chapter 8  Hospital Information System (HIS)

Notes
8.3 Types of HIS
Hospital information system can be categorised into three types namely, medical information
system, information system to support organisational act and administrative provisions
and regulation schemes and subsidiary scientific information system. All together, these
categories of information systems provide all the essentials of required data for the database

Y
management system.

Fig. 8.2 shows the various types of HIS:

IT
Types of HIS

S
R
Medical information Organisational information Subsidiary scientific
system system information system

E
Fig. 8.2: Types of HIS

IV
Let us now study these types in detail.
‹‹ Medical information system: These are planned majorly to provide assistance related

N
to patient care in a hospital. Details about patient, past medical history, clinical review
procedure, automated nursing utilities, patient monitoring records and recovery schemes
U
are maintained by this system. This helps to assess whether the quality paradigms are
maintained. For example, data related to the OPD patients’ age and task classifications
and diagnostic and radiological examination.
Y

‹‹ Organisational information system: This system is designed to aid in the non-

R

patient care tasks in the hospital. For example: monetary schemes, payment schemes,
procurement and supply regulation systems and other regulators. They are also planned
R

to combat the strategic policies that surpass routine organisational activities. They are
planned to depict long term projections, assess hospital functions and assess the benefit
E

programs provided to the public.

H

‹‹ Subsidiary scientific information system: Subsidiary scientific information systems

are designed to include the data schemes, which are neither medical nor managerial.
They are planned to fund medical and managerial units as well. Moreover, subsidiary
IC

scientific information system comprises several civil, mechanical, electrical and computer
designs that are linked to patient care facilities and functioning of the organisation.
D

Complete enhancement of hospital utilities and scientific discussions are also bestowed.

For example, data related to composition of hospital buildings, water supply system, drainage
N

scheme, air conditioning system and so on.

O

The competence of data procedures in a hospital is directly related to the degree of

communication amongst various data schemes.
P

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 Hospital Architecture, Planning and Maintenance

Notes Self-Assessment Questions

6. The three types of hospital information system are ______, ________ and
__________.

7. Organisational information system is designed to aid in the ___________ care tasks

in the hospital.

Y
8. Subsidiary scientific information systems are designed to include the data schemes,
which are neither medical nor managerial. (True/False)

IT
8.4 Framework of HIS

S
R
Two different approaches can be taken to develop HIS. Fig. 8.3 shows these approaches:

E
Approaches to
develop HIS

IV
Total systems Modular

N
approach approach
U
Fig. 8.3: Approaches to develop HIS

Let us now study these approaches in detail.

Y

‹‹ Total systems approach: In this approach, all information handling tasks of the
hospital are identified and an overall picture of the total data flow is created. The
R

system tries to include information related to every task and remove the tasks that
are not suitable for the system. This method requires vast resources for successfully
R

implementing a total hospital management system.

E

‹‹ Modular approach: In this approach, the hospital is divided in a set of nodes while
preparing the data flow diagram. Each node has its own procedure and is also linked
H

with the global operation of the hospital. The information processing requirement of
every node is recognised and incorporated in a modular style. This approach requires
IC

major planning for successful integration of all the modules with each other to ensure
proper functioning of the overall HIS.
D

The framework of HIS may differ based on the facilities and functional requirement of a
hospital. Three important entities are considered as the core of the system:
N

‹‹ The medical database: It is the central repository of patient records, which is

constantly getting updated.
O

‹‹ The database management system (DBMS): It allows creation, access and

maintenance of integrated databases.
P

‹‹ The teleprocessing monitor system: It facilitates all transactions with the DBMS and
communication among the other periphery modules.

Each of the nodes or modules is accountable for its own area and for adding patient related data
to the main database. For example, the admission module or subsystem should communicate
with the person who is entering data associated with the admission procedure. The admission

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 chapter 8  Hospital Information System (HIS)

Notes subsystem should ask for patient’s identification, personal details, referring doctor and so on.
For a new admission a new record is generated and for an earlier patient the existing record
is updated. Another subsystem such as clinical laboratory would have to communicate with an
automated system for patient data retrieval. The modules which are at the background and do
not demand instantaneous response would interact with the database in a batch mode.

Most of these subsystems would also store files related to their own area which can be used

Y
for patient care service, research and administrative needs of the hospital.

IT
Fig. 8.4 shows the framework of HIS:

Patient Scheduling Medical records Pharmacy

S
Admissions Clinical laboratory

R
E
Bed census Radiology

IV
Blood bank Pathology

Automated Dietary

N
Multiphasic
Screening Teleprocessing
Monitor Patient Monitoring
U System
Y
DBMS Databases
R

Patient accouning Batch Personnel/payroll

Control
Software
R
E

Patient statistics General administration

H

Public health
IC

Medical research

Fig. 8.4: Framework of HIS

D

The system should also have user level access facility which means not everybody can
N

access all information available. Depending on the hospital organisational structure and the
requirement, the system should grant different level of permission to the people who are
O

using the HIS.

In case of a small hospital or dispensary, the hospital information system can run on a stand-
P

alone computer. For large hospitals, the system runs through a shared computer network.

In case of large setup, there must be a dedicated HIS team to ensure proper functioning
and maintenance of the system. The head of the team must be qualified, well trained and
thorough about the IT system. Depending on the size of the organisation and the degree and
complexity of the automated system, these units might have some important staff members
along with the department head.

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 Hospital Architecture, Planning and Maintenance

Notes Fig. 8.5 shows some of the important staff members:

Administrator

Application expert and trainer

Y
Harware/network engineers

IT
Fig. 8.5: Some important staff members

S
Let us study about these staff members in detail.

R
‹‹ Administrator: The system or database administrator is accountable for management
of the whole system including trouble shooting, backup and restoration.

E
‹‹ Application expert and trainer: The application expert in collaboration with the
software provider is responsible for installation and functional issues. Trainers are

IV
responsible for training and supporting the hospital staff.
‹‹ Hardware/network engineers: Hardware/network engineers are accountable for

N
smooth functioning of hardware and network system of the hospital. They do all the
maintenance and troubleshooting tasks to keep the system up and constantly working.
U
Self-Assessment Questions
9. Which of the following methods can be applied to develop a hospital information
Y

system?
R

a. absolute
b. modular
R

c. parallel
E

d. classic
H

10. What among these entities is not considered as the heart of HIS :
a. The medical database
IC

b. The admission system

c. The database management system (DBMS)
D

d. The teleprocessing monitors system

N

11. The system or database ___________ is accountable for management of the whole
system including trouble shooting, backup and restoration.
O

Activity
P

Assume you are in charge of maintaining the HIS in your hospital. What approach or
framework will you apply to ensure efficient and effective functioning of the HIS? Compile
a report for the same. Use the internet to avail necessary resources.

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 chapter 8  Hospital Information System (HIS)

Notes
8.5 Benefits and Limitations of HIS
The major benefits of using HIS are as follows:
‹‹ Offers a user-friendly, flexible and menu-driven system
‹‹ Facilitates easy and immediate access of data from several points

Y
‹‹ Takes care of different types of enquiry
‹‹ Saves time due to computerisation and automation of tasks

IT
‹‹ Helps in smooth administration and organised workflow
‹‹ Ensures continuity in healthcare for outpatients

S
‹‹ Facilitates easy insertion, improvisation and deletion of data

R
‹‹ Saves lot of paper work

E
‹‹ Aids in planning and organising functional booklets like indents, treatment regimens,
invoices etc.

IV
‹‹ Helps in preparing working catalogues for the test centres, daily regimes of clinicians etc.
‹‹ Delivers accurate and precise information on the status of supply, lab tests, schedules

N
of nurses and clinicians etc.
U
‹‹ Helps in monitoring drug usage, drug trail and effectiveness of drugs
‹‹ Minimises transcription errors
‹‹ Eliminates duplication of entry
Y

‹‹ Facilitates sorting of data in several forms, such as laboratory reports in alphabetical

R

order or on the basis of the allotted numbers

R

Some of the limitations of HIS are:

‹‹ Purchasing the software and training employees is a costly affair.
E

‹‹ It requires people to have basic knowledge of computer operation.

H

‹‹ Employees need to be trained on the software system. New employees can only start
work once they are trained.
IC

‹‹ Doctors and nurses may find it difficult to accommodate time for data entry.
‹‹ Not everybody have good typing skills. Therefore, the process of data entry may
D

become slow.
N

‹‹ The system may face problem due to technology misuse.

‹‹ Any software system has its own risks in terms of data loss, virus attack and hardware
O

related problems.
P

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 Hospital Architecture, Planning and Maintenance

Notes Self-Assessment Questions

12. Which of the following is not a benefit of using HIS?
a. Increases paperwork
b. Saves time due to computerisation and automation of tasks
c. Minimises transcription errors

Y
d. Facilitates easy and immediate access of data from several points

IT
13. Which of the following are limitations of using HIS?
a. Purchasing the software and training employees is a costly affair.

S
b. Data can be sorted in several forms.

R
c. The system eliminates duplication of entry.

E
d. The system may face problem due to technology misuse.

IV
Activity
Compare the benefits and limitations of a HIS in India with that of any European country.

N
Write a brief note detailing the comparison. Use the internet to avail necessary resources.
U
8.6 Summary
Y
‹‹ Informationhas to be shared among different units of a hospital for better planning
and management.
R

‹‹ A computerised system can integrate and coordinate large amount of medical, financial
and functional data in the most effective way.
R

‹‹ Hospital information system (HIS) is an information technology based software system

E

which provides anytime access to information and assist in decision making.

‹‹ Hospital information system is described as an integrated open system, which takes care
H

of the complete range of information requirement of a hospital to help in diagnosis,

treatment, management and patient awareness for enhanced patient-centric services
IC

and better healthcare practices.

‹‹ HIS is needed to enhance administrative efficacy and to minimise the total expense of
D

health services to the community.

‹‹ The main aim of HIS is to assist a hospital or a healthcare institution in attaining
N

enhanced functional competence and regulating information centred chores.

‹‹ Hospital information can be planned as per the medical, organisational and monetary
O

utilities.
P

‹‹ Hospital management system can be used in any hospital, healthcare centres, clinics,
private nursing homes, dispensaries and pathology laboratories.
‹‹ Hospital information system can be categorised into three types namely, medical
information system, information system to support organisational act and administrative
provisions and regulation schemes and subsidiary scientific information system.

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 chapter 8  Hospital Information System (HIS)

Notes ‹‹ Two different methods can be applied to develop a hospital information system. They
are the ‘total’ systems approach and the ‘modular’ approach.
‹‹ In the ‘total’ approach, all information handling tasks of the hospital are identified and
an overall picture of the total data flow is created.
‹‹ The ‘modular’ method, the hospital is divided in a set of nodes while preparing the data
flow diagram.

Y
‹‹ Three important entities are considered as the core of the HIS framework, the medical

IT
database, the database management system (DBMS) and the teleprocessing monitor
system.
‹‹ Depending on the hospital organisational structure and the requirement, the system

S
should grant different level of permission to the people who are using the HIS

R
‹‹ In case of large setup, there must be a dedicated HIS team to ensure proper functioning
and maintenance of the system.

E
‹‹ Benefit of using HIS is that it offers a user-friendly, flexible and menu-driven system

IV
and facilitates easy and immediate access of data from several points
‹‹ Limitation of HIS is the purchasing cost of the software and the cost of training
employees.

8.7 Glossary N
U
‹‹ Hospital Information System (HIS): It is an information technology based software
system which provides anytime access to information and assist in decision making.
Y

‹‹ Database Management System (DBMS): It allows creation, access and maintenance

R

of integrated databases.
R

8.8 Terminal Questions

E

1. Define HIS and list down the reasons and benefits for using HIS.
H

2. Explain the basic framework of HIS.

IC

3. Describe the types of HIS.

8.9 Answers
D

Q. Self-Assessment Questions
N

1. Information
2. open
O

3. False
P

4. d. Increasing patient waiting time

5. c. Promptness

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 Hospital Architecture, Planning and Maintenance

Notes 6. medical information system, organisational information system, subsidiary

scientific information system
7. Non-patient
8. True
9. b. Modular

Y
10. b. The admission system
11. Administrator

IT
12. a. Increases paperwork
13. a. Purchasing the software and training employees is a costly affair.

S
b. The system may face problem due to technology misuse.

R
Q. Terminal Questions

E
1. Hospital information system is described as an integrated open system, which
takes care of the complete range of information requirement of a hospital to help

IV
in diagnosis, treatment, management and patient awareness for enhanced patient-
centric services and better healthcare practices. Refer to sub-section 8.2.1 Need
for HIS and section 8.5 Benefits and Limitations of HIS.

N
2. The framework of HIS may differ based on the facilities and functional requirement
of a hospital. Refer to section 8.4 Framework of HIS.
U
3. Hospital information system can be categorised into three types namely, medical
information system, information system to support organiszational act and
Y

administrative provisions and regulation schemes and subsidiary scientific

information system. Refer to section 8.3 Types of HIS.
R
R

Case Study: Improving Performance through

8.10 Implementation of Hospital Information
E

System (HIS)
H

Under the leadership of Manipal Education and Medical Group (MEMG), a pioneer in India’s
IC

healthcare and educational sectors, are Manipal Hospitals, multispeciality hospitals. MEMG
was founded almost fifty years ago. It now holds the position of third-largest healthcare
organisation in India, overseeing a network of 15 hospitals and 3 primary clinics that provide
D

patients from all over India and other countries complete healthcare services.

The Week magazine has ranked the hospital in Bangalore as the top multispecialty hospital.
N

‹‹ The case: Ten distinct procedures have been completed by the hospital on a single
O

patient in a span of seven hours. Nonetheless, the hospital’s organisational management

structure was underwhelming, despite it being one of the best in the country for both
P

curative and preventative patient care. It was entering patient records, test reports, lab
results, prescriptions, and billing information manually. The hospital personnel used to
waste a great deal of time looking for patients’ records since they had to do it constantly.

156 DDE, Pondicherry University, Pondicherry

 chapter 8  Hospital Information System (HIS)

Notes Nandkishor Dhomne, CIO, Manipal Health Enterprises said, “We had mostly manual
processes that delayed patient services by increasing their waiting time. Lack of controls, revenue
leakages, a lack of transparency in the processes and unreliable data also added to our woes.”
‹‹ The solution: Facing constant problems with the manual framework and incorrect
data or inadequate information, the hospital decided to tighten the loose ends. Mr.
Dhomne decided to implement an automated system—a web-based health information

Y
system (HIS).

Intersystem Trak Care was the health information system software that was finalised.

IT
The system has clinical and administrative modules to monitor every department of
the hospital, such as admissions, billing, patient care coordinators, patient monitoring,
human resources, lab, and pharmacy. The central database containing patient-related

S
data is accessible to these departments. This data includes patient details, past

R
medication, case history and appointments and hospital related information such as
schedules of doctors, timings and pharmacy stock.

E
‹‹ The implementation: According to Dhomne, if the system showed results, it would
succeed in the busiest of hospitals and turn into a success in every other hospital. He

IV
thus made the decision to start it with Bangalore’s Manipal Hospital, which had 800
beds and saw around 1,200 consultations per day. The HIS was successfully installed
and powered on.
‹‹ The

N
outcome: The HIS showed great results. The doctors’ time was utilised efficiently
U
to offer consultation to more patients. The hospital was able to track its inventory
online, allowing them to guarantee that there was always a surplus of inventory beyond
what was needed for reorders. It saw success when its income increased by a significant
Y

15%–25%. Both the hospital’s overall effectiveness and patients’ degree of satisfaction
increased.
R

Discussion Questions
R
E

1. On the basis of the case, discuss the basic problem faced by MEMG.

(Hint: In spite of being one of the top ranked hospitals, MEMG was following manual
H

data-entry methods for patients’ record that used to delay patient services by increasing
their waiting time.)
IC

2. What measures MEMG took for resolving the problems?

(Hint: Facing constant problem with the manual framework and incorrect data
D

or inadequate information, the hospital decided to implement a web-based health

N

information system (HIS).)

O

8.11 References and Suggested Readings

P

‹‹ James, P., and Noakes, T. (1994). Hospital architecture. New York: Longman.
‹‹ Nickl-Weller, C., and Nickl, H. (2009). Hospital. Berlin: Braun.
‹‹ Verderber, S. (2010). Innovations in hospital architecture. New York: Routledge.

DDE, Pondicherry University, Pondicherry 157

 Hospital Architecture, Planning and Maintenance

Notes E-References
‹‹ EMRConsultant. (2013). Hospital Information Systems (HIS) - EMRConsultant. Retrieved
from, <http://www.emrconsultant.com/emr-education-center/emr-selection-and-
implementation/hospital-information-systems-his/>
‹‹ Groups.csail.mit.edu. (2014). Chapter 7: Hospital Information Systems. Retrieved from,

Y
<http://groups.csail.mit.edu/medg/courses/6872/96/notes/sheldon.html>
‹‹ Ncbi.nlm.nih.gov. (2014). Introduction to hospital information... [Int J Clin Monit

IT
Comput. 1987] - PubMed - NCBI. Retrieved from, <http://www.ncbi.nlm.nih.gov/
pubmed/3585130>

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IV
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158 DDE, Pondicherry University, Pondicherry

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E
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R
Y
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Y