Planning and Designing a

Hospital

Parnab Roy
MHM(1st year)
SMU
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.
 Basic objectives which are to be
met by the hospital-

• Sound architectural plan

• Economic viability
• Effective community orientation
• Quality patient care
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 “– Emerson
Goble)
 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

 Type of hospital-

• Primary
• Secondary
• Tertiary
• Private
• Partnership
• Public charitable trust
• Cooperative society
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.
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.
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.
Operation programme-
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
 Planning of departments-
• In patient department-
 Patient room- These may be private/semi private
rooms or multibed 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.
• Economical
• High quality patient care
• Comfort to the patient
• Efficient operation of the unit
• Meeting the needs of the visitors
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
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,radioogy /,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
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.shoud 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,elivators and wards
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.
• Monitoring equipment
• Cardiovascular therapy
• Respiratory therapy
• Dialysis equipment
• Radiological equipment
• Laboratory equipment
• others
Obstetrical unit-
• The obstetrical unit should ideally be
located close to the labour 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
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.
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.
 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 20-24 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.
 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 siting the department.
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
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
Hospital work shop/BME A large quantum of various types of
department 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 .
Space requirements of some
basic departments-
Area Sq .ft / bed
Nursing unit 250-280
Nursery 12-18
Delivery suite 15-20
Operation theatre 30-50
Physical medicine 12-18
Radiology 25-35
Laboratory 25-35
Pharmacy 4-6
CSSD 8-25
Dietary 25-35
Medical record 8-15
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 567-751
Circulation 115-751
Total net area 682-891
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 beded hospital has been Rs.400
lakhs,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
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
 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
 Hospital project staging-
Stage A
Functional content:
Outline brief:
Stage B
Operational policies:
Developmental plan:
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
Operational policies
Departmental and inter related
activities
Departmental and hospital policies
Development control plan
Budget cost
Continuous informal discussion with
owners
Stage C
Schedules of accommodation, Schedules of accommodation
sketches, Sketch drawing
Final cost estimate: Equipment schedules component
estimates
Cost revenue and staffing estimates
Final cost approval
Stage D
Detail design working drawings, Working drawings
tender action: 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
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