1. Hospital Business Plan Planning and Designing

2. Hospital Must Meet Two Basic Fundamental Needs
Must meet the needs of the patient it is going to serve adequately.
It must be in a size and proportions which the owners or promoters will be able to build and operate.

3. Basic Objectives Which Are To Be Met By The Hospital
Sound Architectural Plan
Economic Viability
Effective Community Orientation
Quality Patient Care

4. Principles of Hospital Planning
Protection from unwanted and unnecessary disturbances in order to help speedy recovery
Separation of dissimilar activities
Control the nurses station should be positioned strategically to enable proper monitoring of visitors entering and leaving the ward, infants and children should be protected from theft and infection etc.
Circulation all the departments of a hospital must be properly integrated.
Separate all departments, yet keep them all together; separate types of traffic, yet save steps for everybody; that is all there is to hospital planning.

5. Selection of Site Needs of the Community Ease of accessibility
Range of services offered
Availability of specialists
Availability of technology
Study of Existing Hospital(if any)
Requirements of Staff and Services

6. Type of Hospitals Primary Secondary Tertiary Private Partnership
Public Charitable Trust
Cooperative Society

7. Bed Planning
Bed: Population = A X S X X PO A= number of inpatient admissions/1000 population/year S= average length of stay PO= percentage occupancy

8. Planning of finances-
Funds required for constructing, furnishing and equipping the hospital.
Operating funds- salaries, loans and interest, other maintenance expenses.
Arranging financial assistance-patient fees, bed charges, and other modes of revenue generation process.

9. Equipment Planning Built in Equipment
These include counters and cabinets in laboratory, Pharmacy and other parts of the hospital, elevators, incinerators, coolers, fixed sterilizing equipment etc.These are usually included in the construction contract and the planning of these equipments is the architect's responsibility.
Depreciable Equipment
This includes equipment that has a life of five years or more and is not purchased through construction contracts. These are large pieces of furniture which have a relatively fixed location and are capable of being moved e.g., diagnostic and therapeutic equipment, laboratory instruments, office furniture etc.

10. Equipment Planning Non Depreciable Equipment
These are small items with a low unit cost and life span of less than five years. These are generally under the control of the store room and are bought through other than construction contracts. They include kitchen utencils,surgical instruments,linen,waste baskets etc.

11. Operation Program Admission Human resource Administration Stores
General engineering
Purchasing
Laundry
Maintenance
Clinical services
Waste disposal plant
Pharmacy
Fire and safety
Nursing services
Disaster plan
House keeping
information
Records
Dietary services
Public relations
Clinical engineering
Employee facilities
Sanitation

12. Planning of Departments
In Patient Department
Patient Room- These may be private/semi private rooms or multi-bed general wards. They should be designed to be safe and aesthetically pleasing so as to assist in quick recovery of patient. They must contain space for equipments, staffs and various need of the patient.
Nurses Control Station- should be located and designed in such a way that the nurses can observe the patient room.
The Work Area- related to handling materials necessary for patient care, maintaining communication and records etc.

13. Planning of Departments
Economical
High quality patient care
Comfort to the patient
Efficient operation of the unit
Meeting the needs of the visitors

14. Facilities and Space Required
Examination and treatment room with wash basin etc.
Cupboard for clean linen.
Basket for soiled linen with sink, waste receptacles.
Equipment storage room for walkers, IV stands etc
Space for storing stretchers and wheel chairs
Lockers for staff personal belongings
Staff toilet
Small laboratory

15. Out Patient Department
Preferably on the ground level with a separate entrance and adequate parking facilities.
It should be close to admitting area , MRD, emergency, radiology ,lab services and pharmacy.
Attention should be paid to circulation, which results in the smooth flow of various traffic lines Traversing the department.
Properly signed

16. Emergency Department
Should be located on the ground floor with easy access for patients and ambulances
Separate entrance for the department
Well marked with proper lighting and signs should be easily visible and accessible from the street.
Should be close to the admitting department, medical records and cashier’s booth, radiology department, lab services, blood bank, elevators and wards.

17. Intensive Care Unit
Should preferably be located on the ground floor with convenient access from the operation theatre suit and emergency department and easy accessibility for wards.
It consists patient area, staff area, support area.
Four basic requirements-
Direct observation of the patient by nursing and medical staff
Surveillance of physiological monitoring
Provision and efficient use of routine and emergency diagnostic procedures and interventions.
Recording and maintenance of patient information.

18. ICU Equipments Monitoring Equipment Cardiovascular Therapy
Respiratory Therapy
Dialysis Equipment
Radiological Equipment
Laboratory Equipment
Others

19. Obstetrical Unit
The obstetrical unit should ideally be located close to the labor and delivery room as also to the nursery to avoid the exposing the bodies to infection.
A room for patient education and group discussions is essential with cheerful decoration is desirable.

20. Newborn Unit
An area of 30sq.ft/ infant with a space of at least three feet around is recommended
All partition should be made of clear glass to permit observation.
Furnishing in the full term nursery include a bed side cabinet, incubator, utility table, wash basin, waste receptacles, outlets for oxygen and suction, facilities for examination etc.

21. Pediatric Unit Equal space should be provided for beds.
If patients are allowed to stay with the parents, provision must be made for toilets, sleeping and storage of personal belongings
Separate provision for examination and treatment of infants.
Each pediatric unit have isolation room with other necessities like washing facilities and sterile gowns and masks.
Single room for critically ill and uncontrollable patients
Recreation or play room
Storage space for toys, linen, recreational materials
Walls between patient room and the corridor should have glass panels for viewing
Lighting decoration and equipment must create a cheerful atmosphere.

22. Psychiatric Unit
Consultation area containing staff offices for individual and family care sessions.
Conference therapy area for group therapy session.
Inpatient area for hospitalizing patients
Activities area for occupational recreational therapy.
The number of beds should be between I order to permit proper observation and treatment and private rooms are preferred.
One room for the management of violent patients are desirable.
There should be no object which can be used to hurt one self.

23. Radiology and Laboratory Services
Should be easily accessible to the OPD, casualty and the inpatient wards.
Preferably be sited on the ground floor.
Adequate reception and registration area
Convenient patient flow with minimization of criss cross traffic.
Adequate waiting area
Separate entrance for accident and emergency cases in busy hospital
Provision of room for technical functioning
Flexibility, expandability and upgradability need to be kept in mind while sitting the department.

24. Pharmacy
Out patient should have ready access to the hospital pharmacy to collect prescription.
Staff of wards and department can access it without having to travel a long distance thorough other crowded areas.
Collection of indents and dispensing of prescription for inpatients can be carried out in a central dispensing area which is accessible to hospital staff when they come to consult the pharmacist or to obtain stocks for ward use.
Suppliers have an access to it from out side
Space required for-
Dispensing counter
Cash counter
Drugs storage including dressings
Cool and cold storage
Administrative office
Circulation space
Space for compounding and bulk preparation

25. Hospital Store
It should be located centrally to the hospital
Approachable by supply vehicles and should have separate service entrance
Risk of fire and explosion in a medical supplies storehouse, storage of acids, inflammable materials and oxygen and other gas cylinders will require special attention
CSSD
CSSD mostly serves the operation theatre, emergency, casualty department, wards, maternity suit and should be so cited as to be central to all this
Hospital Dietary Service
Should be located taking into consideration the prevailing wind direction so that smoke and kitchen odours are not constantly wafted to patient care area
Should be sited at ground level and connected to store with lift

26. Hospital Work Shop / BME department
A large quantum of various types of mechanical and electrical equipment is installed in a hospital and requires repair and preventive maintenance.
Laundry
Used linen from wards, operation theatres and delivery suites maybe infected, and therefore needs careful handling at an area remote from all other clinical and supportive services areas
Space for washing, storing, drying shades and ironing rooms have to be catered for at an appropriate area with plentiful supply of water
MRD
Should be located immediate to the admission and registration area.
Enough space for keeping/storing of patient files
Adequate safety .

27. Space Requirements of some Basic Departments
Area
Sq .ft / bed
Nursing unit
Nursery
12-18
Delivery suite
15-20
Operation theatre
30-50
Physical medicine
Radiology
25-35
Laboratory
Pharmacy
4-6
CSSD
8-25
Dietary
Medical record
8-15

28. Space Requirements of some Basic Departments
Area
Sq .ft / bed
House keeping
4-5
Laundry
12-18
Mechanical installation
50-75
Maintenance work shop
4-6
Stores
25-35
Public areas
8-10
Staff facilities
10-15
Administration
40-50
Total
Circulation
Total net area

29. Project Costing
The most common method of estimating hospital construction costs has been the “ per bed” method, i.e., if the total cost of a 100 bedded hospital has been Rs.400 lacks, the cost/ bed is Rs.4,oo,ooo.
Break up of project cost-
Acquisition of site
Site survey, investigation
Landscaping
Construction contact-building with fixed equipment
Supervision and inspection
Equipping the hospital-diagnostic and therapeutic equipment
Movable equipment, furniture etc.
Architect's fee
Consultant’s fee
Site engineer’s fee

30. Phasing
The necessity to bring facilities into use as quickly as possible for operational reasons.
The necessity to split a major project into a smaller units as a contractual consideration
The necessity of having certain departments ready before others.
Limitation on availability of capital funds

31. Commissioning Formation of commissioning team Activities-
Hospital consultant
Hospital administrator
Chief of clinical services
Senior nurses
Supplies officer
Others
Activities-
Bring the hospital building, plant and equipment to a state of the operational readiness
Development operational system
Testing of equipments
Coordinate training of staff
Ensure good communication

32. Hospital Project Staging
Stage A
Functional content:
Outline brief:
Project team
Assessment of functional content
Submission of owners( Govt,private organization etc.)for approval
Site appraisal, gross floor areas
Building space. Draft master plan
Estimation of cost and phasing
Appraisal of work by owners
Stage B
Operational policies:
Developmental plan:
Operational policies
Departmental and inter related activities
Departmental and hospital policies
Development control plan
Budget cost
Continuous informal discussion with owners

33. Stage C
Schedules of accommodation, sketches,
Final cost estimate:
Schedules of accommodation
Sketch drawing
Equipment schedules component estimates
Cost revenue and staffing estimates
Final cost approval
Stage D
Detail design working drawings, tender action:
Working drawings
Engineering details
Bills of quantities
Calling tenders
Stage E
Contract and construction:
Assessments of tenders
Award of contract
Construction
Engineering commissioning
Stage F
Commissioning:
Staff assembly and training
Equipment and supplies assembly
Testing of installation

34. Conclusion Technology requirement must be met
Clinical needs must be considered
Safety is a major factor
Standards and Guidelines are essential
Importance of the role of Hospital Staff in construction and design.

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