HOSPITAL DESIGNING

& PLANNING

DR. D .H. SUKHWAL

Aim

 To build a hospital that is

functional, efficient and yet
economical without
compromising on the design
aspect

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Objectives

• Provide a functional design that

ensures efficient, safe and
appropriate work space.
• Accommodate technical
requirements for highly sophisticated
equipment.
• Create clear, segregated paths for
movement of people and material
within the building.
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Objectives..

• Create a humane environment for

patients and staff.
• Develop building systems that can
accommodate rapid change.
• Blend technical and functional
requirements into a design that
brings delight to those who use the
building and those who pass by it.
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STEPS

Decision to build the hospital

A detailed architect’s brief
Architect drawing up his plans with
consideration of landscape, facility mix, bed
mix, availability of utilities in the vicinity
Inputs from other agencies like air-
conditioning, electrical, plumbing, etc.
required to finalize the working plan for the
building
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Inputs from the equipment vendors
especially in specialty areas like Cath-
labs, CT-scanners, MRI, linear
accelerators, operation theatres etc.
essential
Emphasis to be given to support services
like kitchen, laundry, CSSD, back-up
electricity
Should be properly planned: Vital
services with high capital costs &
recurrent expenses
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Planning & Design Team

• Functional complexities in hospitals

are more than physical complexities;
so we require persons who
understand not only the work process
of individual departments but those
of the hospital operating system as a
whole
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Planning & Design Team ..

Required: analysis of functional

needs, understand
interrelationship of departments,
area requirements, major
equipment, the grouping of
accommodation and the main
outline of traffic flow
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 Standards followed

 India: total area per bed is hardly

600 sq. ft.
 Western standards: 1,400 – 2,000 sq.
ft. per bed
 WHO recommends an area of 800-
1200 sq. ft per bed

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 FUNCTIONAL PLANNING

Functionality is a prime
determinant of operational
efficiency in the total life
cycle cost of all hospital
structures

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functional planner takes care of..

• Functions
•Staffing pattern
• Locations
•Space requirements
• Relationship
•Work flow
• Utilization
Functional planner is a trained
hospital administrator who is capable of
interpreting complex relationships,
internal traffic flows (personnel and
supplies)
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 Functional planner also takes
care of..
•Technological requirements
•Operational procedures
•Product of beauty
•Reasonable cost
•Optimal utility
A functional design: promotes skill, economy,
conveniences & comforts.
A nonfunctional design: impedes activities of
all types, detracts from quality of care &
raises costs
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 functional planner
• With Architect :
• Physical evaluation of existing facilities
• Space programming
• Master site planning
• Functional evaluation of existing
facilities
• Preparation of workload projections
• Functional programming
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Physical evaluation of existing
facilities
 This is a study to determine the
degree of physical obsolescence
of existing facilities and to identify
major code violations and physical
problems and to project future
usability.

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 Space programming
• Based on functional program amended &
approved by hospital a room by room
listing is made of all areas in proposed
project
• Net square footage is assigned to each
space, & totals accumulated for every
department or functional entity using net
figures
• Appropriate calculations are then made to
set gross totals for each department or
functional entity as well as the total for
entire project 15
 Functional evaluation of existing
facilities
• Here we define functional problems (that
detract from operational efficiency, quality of
patient care, and convenience of building
inhabitants);
• to evaluate traffic flows & physical relationships
• to determine space insufficiencies in terms of
current requirements
• to study need for modernization, alterations &
expansion, according to strategic plan findings
• to note possible alternative future uses of
structure as a whole as well as of various
departmental areas
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 Preparation of workload projections

 Functional planner determines &

formulates concepts of operation for
proposed project according to previous
study findings.
 These concepts are incorporated in
functional program
 These projections form the basis for
functional programming, revenue
projections & staffing estimates
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 Functional programming
• Formulating recommendations for operational
concepts
• Detailed room composition of project, required
phasing, alterations, internal & external traffic
flows, interdepartmental relationships &
operating systems
• Using approved recommendations & findings of
strategic plan, findings of physical & functional
evaluations & workload projections, functional
planner formulates the activity
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 Architect’s brief

• Written program explaining the

above requirements
• With this written program’s help,
architect prepares schematic
drawings and sketch plans
• Helps the architect to build a
functional, economical and efficient
hospital.
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 Architect’s brief contains ..

• Permission required from various

regulatory bodies
• Spatial needs of various departments
• Manpower required
• Special requirements of various
departments
• Inter and intra departmental
relationships
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Issues that need to be addressed

 Flexibility for future expansion

 Larger secondary areas for better
patient comfort
 Proper utilities for waiting areas
 Nurse stations
 Storage
 Changing rooms
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 issues…

• Alcoves for stretchers/ wheelchairs

• Adequate transport facilities
• Parking facilities
• Proper light and ventilation
Time & trouble spent during this
stage will be well repaid & enable
whole project to proceed smoothly
with minimum subsequent revision
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 Market survey
 To primarily know the deficiencies in the
health care market, so that we can decide
proper facility & bed mix
 To help us finalize size of the project
 For existing hospitals to undertake
benchmarking in areas like tariff
rationalization, compensation policies,
utilization reviews for various services etc.
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 Market survey.. Of..
 Households
 Medical professionals
 Diagnostic centers
 Nursing homes
 Hospitals
 Relevant data from census report,
demographic surveys, government/
media publications etc.
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 Feasibility Reports
 Brief description on major findings of
market research
 Proposed facilities plan
 Detailed project cost: land & building,
medical & non-medical equipment,
furniture & fixtures, utilities, pr-operative
costs, contingencies, working capital
requirement, means of finance

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 Feasibility...

 Income and expenditure projections

based on the feedback from the
market research and available
database
 Profit and Loss/ Balance sheet/Cash
flow statements
 Break even analysis
 Sensitivity analysis
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 Specialized healthcare
architecture
Healthcare architecture requires
specialized knowledge on part of architect
& supporting engineering team
Stringent functional demands
Improves quality of environment for
patient & caregivers
Meets needs of people using such
facilities in times of uncertainty, stress, &
dependency on doctors & nurses
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Specialized healthcare
architecture..
 Recognize & support patients' families &
friends by providing pleasant spaces
 Project an underlying reassurance that
patient is in hands of competent medical
staff & in a technically sound healthcare
facility
 Convenience, caring encounters, service
orientation and quality of care
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Project Management

• Liaison with all Agencies -

Architects/contractors/equipment
vendors/utility service consultants and suppliers
• Monitoring Project with PERT/CPM
• Managing Change in Project Plans - most vital &
complicated component due to various fall outs
from change in project design
• Managing equipment planning schedule
including cost-feature analysis, procurement
process, installation etc.
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Project Management..
Architectural Operational Audits:
Designing o Improvement of the lab
services
Project o Operation theatre
Management utilization reviews
o Manpower audits
Turn Around o Medical audits
Strategies o Infection control programs
o Reorganization of profit
centers
o Support service audits etc.

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Project Management..
 Costing of Services
 Systems Study & Re-design
 Manpower Audit & Training
 Marketing Strategies
 Biomedical Equipment -
Planning & Procurement Norms
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Product Development
 Benchmarking regarding market expectation
from a hospital management system
 Hospital best practices
 Reviews of newer modules and upgrade
versions and provide recommendation of any
enhancements/modification
 Periodic comprehensive review and study of the
existing modules to update and upgrade
continuously
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Implementation
 Implementation plan with solution
 A comprehensive system study
 Gap analysis
 Preparing specification for customization
 Site monitoring
 Audits of the sites where software is already
installed to identify areas of problem
 Business development in terms of
identifying new leads, identify right business
partner
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Good planning is critical to
the hospitAl’s success
 If a hospital has to be successful it
must be built on bedrock of three
sound principles namely:
good planning,
good design & construction
good management

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 Efficient, Functional and
economical hospital
 real test of any hospital is: quality of
healthcare it provides
 minor defects in designing could make
operation of a hospital inefficient
 inefficient hospital costs significantly
more to operate staff & maintain:
patients within it get less health
services for money they pay
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Efficient, Functional and
economicAl hospitAl…
 The initial cost of building a hospital
is insignificant when compared to
the cost of running and maintaining
it over the years-
by one reckoning eighteen to
twenty times over a period of
twenty years
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Efficient, Functional and economical hospital..

 Another study says that running cost of a

hospital over 4 to 5 years from the date of
completion is about the same as the capital
cost
 if the facilities are not planned & designed
properly the intangible cost can be enormous
 efficiency with which physicians & their
assistants can function is greatly
handicapped by obsolete design
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 efficient, functionAl And economicAl hospitAl…

• Patient comfort & provision for expansion is often

overlooked.
• Growing efficiency & innovative ideas have
revolutionized hospital building construction to
meet special needs of patients
A pleasant environment that makes for
enthusiastic & more productive staff also
benefits patients indirectly

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efficient, functionAl And economicAl hospitAl…

• Many patients complain that hospitals

reduce privacy, individuality & more
importantly human dignity. Many of
these details & facilities can be
incorporated with little or no extra cost.
• So, patient’s needs & expectations
should be kept uppermost in mind & any
design should aim at his satisfaction &
comfort
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efficient, functionAl And economicAl hospitAl…

These factors are again influenced

by rapid changes and advances
that are taking place in fields of
technology & medicine &
constant need to modernize,
renovate, replace & expand
healthcare facilities
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 Process of planning
• A common understanding is required between;
• ON ONE HAND: ARCHITECT & ENGINEERS
• ON OTHER HAND: PROMOTERS, DOCTORS,
ADMINISTRATORS & PLANNERS
• Next step is operational plan for each department
to decide;
• LOCATION of each department, requirement of
FLOOR SPACE, intradepartmental &
interdepartmental RELATIONSHIPS, CIRCULATION,
TRAFFIC FLOW and requirements IN RELATION TO
equipment, personnel & patients

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 Operational & Functional planning
first
 Operational planning is a written document
for any architectural project:- Services,
number of beds, departmental functions,
departmental needs, major equipment, space
requirements, required personnel,
relationships and adjacencies are included
here.
 Dept-by dept description of needed space
 current and projected needs within the
facility
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 Operational & Functional planning first

 Normally there is either no briefing of the

architects or the brief given to him is inadequate
 They are asked to prepare building schedules with
the help of doctors OR
 Observe other hospitals & take guidelines from
them. Both these are unsatisfactory methods.
Promoters must clearly tell architect the
requirements of hospital & not the other way
round

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 Key to Functional planning
 The proper sequence is;
First: Develop operational planning that
defines major requirements & needs.
Next: Operational plan is developed into a
functional plan i.e. planning of the
hospital on a functional basis-that lists
every room & suggests net sizes for major
functional rooms &total size of the
department.
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Mistakes in planning may prove
costly
 Functional grouping of high traffic areas
such as X-ray, laboratories, surgical & delivery
suites, physical therapy & clinics on two floors is
desirable
 It permits concentration of hospital activities in a
manageable unit.
 When future expansion or change becomes
necessary, they can be accomplished without
disturbing other areas

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 Operational Plan & Functional Plan
must precede Architectural Plans
Otherwise;
 Within 5–10 years, it is found that cost
of construction equaled or surpassed
by operating expenses

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Hospitals must be planned for
future

 A fundamental rule is; hospital should be

planned for at least 10 to 15 years ahead or
else plans will be obsolete
 Well planned systems must be built to
keep pace with the changes
 `Smart` hospitals that respond to present
needs while anticipating future change;
should be built

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hospitAls must be plAnned for future…

 All departments are planned in such a way that

they stand out individually
 Each department with space around for
expansion.
 Future expansion is rendered easy with free
ended buildings with extendable corridors
 Expensive permanent fixtures & fixed
equipment such as plants & elevators are not
located at free ends of the departments as they
would permanently block expansion plans
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Space Plan

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 ‘design follows function’
 Architect finalizes his plans, with help of;
 personal interviews with hospital administrators
experienced in building hospitals
 literature review
 For a 100 bedded hospital, total space area
including the parking space, HVAC & water
is 1,05,319 sq ft which works out to be
9784.45 sq meter.
 Modern standards of constructing hospitals
requires; 800-1200 sq ft per bed.
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 Ground Floor

 Key Departments like OPD,

Emergency, Radiology, Laboratory
should be on the ground floor.
 Radiology dept. should be near
Emergency dept. 40% of cases
coming to Emergency require X rays

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First floor

 Administration department
 Blood bank
 General and Pediatric wards

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Second floor

 Labour room
 Obstetric ward
 NICU
 Semi-private ward
 CSSD just below the operation
theatre with provision for dumb
waiters between the CSSD and the OT
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3rd floor

 ICU
 Private wards
 OT

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4th floor

 Residential area just above ICU &

OT. So a doctor can easily attend
the patient when called

 30% of the area is kept for

circulation

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