Process of Planning, Designing and Financing a Hospital Daniel Kelly, CEO

Overview Hospitals differ from other building types in the complexity of functional relationships that must exist between the various parts of the hospital. Apart from providing the right environment for patients and care providers, it should also be sensitive to the needs of visitors. It is thus imperative to examine the emerging issues, analyze the challenges, appreciate the emerging trends and study the various strategic options available for planning, designing and constructing a hospital.

EMERGING ISSUES Epidemiological and demographic changes Enhanced expectations of patients Emphasis on ambulatory/ day care Regulatory standards Ever changing function of a hospital Advancement in medical sciences Trend toward outsourcing

Schema of Building a Hospital

STRATEGIC ESSENTIALS Issues that must be considered: Regionalization Needs assessment Design for flexibility and expandability Fulfill the demand functions Emphasis on patient focused hospital Focus on energy conservation

IMPACTING FACTORS Community Profile Socio – economic Health Age Local regulations Source of finance Climatic zones

STEPS IN PLANNING Need Assessment Feasibility Report Architects Brief Request for Proposal Appointment of Consultant Detailed Project Report

STEPS IN PLANNING-cont. Award of Work Construction of Building Equipment Purchase Stage of Commissioning Occupancy

Feasibility Study

PLANNING A HOSPITAL Planning is the forecasting and organizing the activities required to achieve the desired goals. All successful hospitals, without exception, are built on a triad of good planning, good design & construction & good administration. To be successful, a hospital requires a great deal of preliminary study and planning. It must be designed to serve people and for promoters to build in the first place & sustain later.

Planning Team Make-up Hospital administrator Specialists from various clinical branches Nursing Personnel Civil and electrical engineers Representative of local board Senior architect

HOSPITAL DESIGN The main guideline while designing the hospital is ‘FORM FOLLOWS FUNCTION’. All architectural and aesthetic design should be secondary in nature The design of the department should be according to the function of the department

REQUEST FOR PROPOSAL Background of the project Architects brief Best practices in medical architecture Limitations Methodology and time frame Contract conditions Local regulations

ARCHITECTS BRIEF It is written document which explains the operational policies, types of services provided, inter relationships and interdependency of each facility. It includes: Site information Functional content Workload Staffing Equipment

ARCHITECTS BRIEF cont… Polices and procedure Schedule of accommodation Zoning Financial aspects

Bed planning- Bed: Population=A S 100 365 PO A= number of inpatient admissions/1000 population/year S= average length of stay PO= percentage occupancy

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.

Project costing- The most common method of estimating hospital construction costs has been the “ per bed” method. With a transition toward outpatient procedures the current methodology is the cost per square foot. 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

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

Commissioning- Formation of commissioning team Activities- Hospital consultant Hospital administrator Clinical Department Managers 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 equipment Coordinate training of staff Ensure good communication

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.

THANK YOU A hospital is a living organism, made up of many different parts, having different functions, but all these must be in due proportion and relation to each other and to the environment to produce desired result. – Dr. S. Billings