UNIT - 2

Construction Planning
Introduction
• Hospital building differs from other building types in the complexity of
functional relationships that must exist between the various parts of the
hospital.
• The goal of health service is to improve the health status of a given population
–The service must safeguard equity and fairness of access
–It should be responsive to the perceived health needs of the community
• It should achieve this goal through the provision of efficient and effective health
service
–The health service needs to take into account available resources and the available
means and methods of health care
Factors in hospital planning
• Socio Economic profile of a community
• Existing medical facilities
• Health profile of the region
• Vernacular architecture – Local traditional architecture.
• Local Regulations
• Source of Finance
• Choice of technology
• Climatic Zones- Design and space parameters
Emerging Issues and Strategic Essentials
some of the strategic issues that must be considered are –
• Regionalization
• Pre- planning consideration
• Need assessment
• Plot ratio
• Design for flexibility and expandability
• Fulfill the demand functions – Day care, Home Care and Transmural.
 • Emphasize on patient focused hospital
• Focus on energy conservation
• Intelligent buildings
• Create a healing architecture
• Aesthetic – an essential requisite
• Hospital architecture
• Go green
STEPS IN PLANNING

Need assessment

Feasibility report

Architects brief

Request for proposal - RPF

Appointment of consultant

Detailed project report

Notice inviting tender

Award of work

Construction of building, services and facilities,

equipment purchase and manpower selection and
recruitment

Stage of commissioning

Shake down process

Expression of Interest (E.O.I)

• Brief description of project
• Salient features
• Approx. Project cost and
• Conditions for prequalification.
Request for proposal – RPF
• Background of the project
• Architects brief
• Best practices in medical architecture
• Constraints/ Limitations
• Methodology and time frame for execution of project
• Contract Conditions
• Local Regulations
Architects Brief - MASTER PLAN
• Overall site
• Departmental boundaries
• Major entry and exit points
• Vertical transport – Stairs, Lifts and Escalators.
• Inter - departmental corridors
• Location of critical zones
• Energy conservation
• Future site development
• Appropriate way finding
Services master plan
• Project decision
• Outline brief
• Opportunities and constraints
• Options considered
• Evaluation criteria
• Recommended options
• Executive summary and recommendation
SPACE PROGRAMMING
• Process in which the specific requirements of a department are identified.
• Department’s space table is developed
 • Circulation/conversion factors
• Total building gross square footage (BGSF) is calculated
HOSPITAL PROJECT FEASIBILITY REPORT
• View of health scenario at national, regional, and local levels
• Vital statistics data
• Health needs assessment
• Site/location of proposed health care delivery
• Type of health care facility
• Approximate costs and source of funding
• SWOT analysis - Anticipated demand, competitors, revenue generation.
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
• Polices and procedure
• Schedule of accommodation
• Zoning
• Financial aspects
DETAILED PROJECT REPORT
• Background of the project
• Limitations
• Financial statement
• Labour deployment
• Detail estimate of the project
• PERT chart
• List of medical equipment and specification
• Man power requirement
• Running, maintenance and operational cost
Planning Grid
• A Planning Grid is an overlay of lines usually represented by a ‘long dash- dot-
long dash-dot’ (they need not necessarily be horizontal and vertical, but often
are) and is a design tool used by us architects to create some kind of order on
what is otherwise a (chaotic) blank white paper when they start to design a
building.
• Healthcare designers can derive their planning grids in one of the two following
ways:
1. In urban situations, where the hospital takes the form of a vertical building
comprising of a podium containing diagnostic / therapeutic and interventional services
and a tower housing the inpatient facilities, the planning grid is largely determined by
the layout of the inpatient tower.
 • The module(s) used to determine the shape and size of this grid is the module(s)
used to house the various kinds of inpatient facilities (rooms + toilets)
conceptualized by the designer.
In the example given below you can see how the planning grid modules (in red) of 3.90
M x 8.50 M is determined by the accommodation desired for a single bed patient
room, a double bed patient room and their toilets.

• Expanding on this with the addition of the access corridor and stringing the
rooms out in a line, as in the plan below, we see how the planning grid starts taking
form.
• Looking more closely at this plan we can see something important has been
determined, namely, the positions of the columns that will support the
building.
• We can thus see how the structural grid (in blue), the network of lines defining
the location of columns, has been derived from the planning grid.
• The structural grid need not necessarily be the same as the planning grid, but is
usually derived from it.
• Next example, we can see that the designer has decided to twist the entire
inpatient tower block at an angle to the horizontal / vertical one. This is just
one example of how the planning grid could take almost any conceivable
shape depending on what the designer wants to do with it
2. In semi-urban or rural situations, where the land available is very likely to be
larger with respect to the built-up area desired, determining the planning grid is
another ballgame, one with much greater flexibility in the rules.
• In this situation, the planning grid will be determined by what
designers call as their ‘concept’ for the hospital.
• This ‘concept’ is also an ordering tool, and will have been used to determine
the form of the hospital in even the previous example of the urban site, but
with less freedom.
BED DISTRIBUTION
• The functions of the hospital revolve around the total no. of beds & their
distribution within various depart. & services.
 • The no. of beds in a hospital is the yardstick applied when referring to the size
of the hospital, its various services, occupancy rate,etc.
• Types of bed accomodations
• Bed distribution by services
• Space requirements
• Bed planning:
Population = A x S x 100
365 x PO
A = number of patients admissions/1000 populations/year
S = average length of stay PO = percentage occupancy
SPACE REQUIREMENT OF SOME BASIC DEPARTMENT
SITE SELECTION
1. Accessibility to transportation & communication lines
2. Parking facilities
3. Availability of public utilities
4. Proper elevation for drainage & general sanitary measures
5. Freedom from smoke,noise,vapours & other annoyances
6. Future expansion
7. Total cost
Stack diagram
This shows the distribution of the facilities in the various floors
and their vertical distribution with each other.
• OPD located vertically above the main entrance.
• CSSD is located vertically below the OT.
 • Emergency department is located vertically below the OT complex and
birthing centre.
EQUIPMENT PLANNING
• The term ‘equipment’ means all items necessary functioning of
all services of the hospital.
• It is necessary to consult with the architect designing the building early so that
the facilities planned will be of sufficient size to accommodate the equipment
& render the necessary services.
• A room by room equipment list is then complied & reviewed by the adm,
medical & depart. staff.
Equipment Planning
• Equipment has profound effect on architectural design of hospital

• Space and functional requirement of equipment varies

with manufacturer and model
• It is, therefore, necessary to finalize the equipment list and their
make, model and vendor early
–It is preferable that the list is finalized and signed off by the equipment planning team
–Typically, equipment planning should commence no later than the project’s
design development phase
• Most equipment have substantial utilities and installation requirements

–These requirements impact the design and engineering of

healthcare facilities
–Some of these equipment such as for radiology department or operation
theatre has considerable lead time
–In many instances the space and utilities are
driven by a specific
manufacturer’s requirement.
• Equipment List
–An equipment list shall be included in the contract documents to assist in
overall coordination of:
•Acquisition
•Installation, and
 •Relocation of equipment
–The equipment list shall show all items of equipment necessary to operate the
facility
–The list shall include classification of equipment
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.

INTERIOR & FURNISHING

In a patient cantered environment, design solutions will respond to the needs of the
patients profile both architecturally and through material selections.
Should consider the following-
1. Infection control standards
2. Design story
3. Healing environment
4. Physical environment
5. Organizational planning understanding
6. Cost analysis
HOSPITAL BUILDING
• After completing all preparations for building a hospital the governing board
issues instructions for the development of final plans & specification.
• Principle-
# Protection
# Short traffic routes
# Separation of dissimilar activities
# Control
GENERAL FEATURES
• Environment
• Screened windows
• 4 separate entrance
• Exit point
• Attractive entrance
• Traffic flow
• Corridors
• Visitors control
• Running physical part
• Fire escape
COMMISSIONING
• Once the construction is completed Installation of air conditions, lifts
Equipments and Machinery Recruitment of Staff
• The hospital is commissioned Advertisement is made in paper Publicity
in local area Date of inauguration is finalized.
• The commissioning of Healthcare facility embraces two distinct tasks
–The Technical Commissioning of the Facility
• This involves commissioning of the buildings, services, and equipment
• The commissioning is to ensure that it complies with the quality and
performance specifications and that all systems operate satisfactorily
–The Operational Commissioning of the facility
 • It covers the process of preparing to operate the completed facility
• To provide the healthcare services for which it was designed, and
• Maintain and operate the building services
Technical Commissioning
• Its requirements will have been considered in the design stage
• The requirements shall have been included in the specifications for construction
and equipment contracts
• It is important that the performance of equipment and of M and E services are
specified adequately
• The Project Manager should require the contractors and suppliers to provide
commissioning programmes
–This should include date, time and method of commissioning
• The Project Manager will coordinate them with overall project programme
–It will be accepted if satisfactory else will be returned to them for amendment
–It will be ensured that the programme is coordinated with the operational
commissioning.
• Inspection and Testing
–Completeness and quality of building work should comply
with specification
Important Element of the Process are:
•Testing Integrated Systems
–This may comprise components from several sources
–This is to ensure that the system as a whole performs satisfactorily
•Maintaining Records of Inspections and of commissioning test results
–This is to be maintained as a permanent record
•Listing minor defects which do not prevent the facility from being used satisfactorily
–Completion certificate may be issued
–The list to be attached to the completion certificate
–These are to be rectified later
•Ensuring that only those items not conforming to specifications are considered as
unacceptable
Operational Commissioning
• Organizing the Commissioning Process
–This must flow from the organization of the construction project
–A commissioning manager is to be appointed
• The manager can be from the existing resource of the construction organization
or can be a new person
–Appointment of the commissioning team
• The team should operate under the commissioning manager
• The members should be drawn from the users of the healthcare
facility on a representative basis
• Should include members of medical, nursing, operational management,
finance , personnel, equipping, estate and other staff as necessary
Role of the commissioning team
• The team should support the commissioning manager
bringing the building into use
• The team to ensure that the business objectives of the scheme are delivered
The Commissioning Process Will include
• Drafting operational procedures
• Establishing base line and future staffing profiles
• Establishing baseline and future revenue budget
• Establishing equipping requirements
• Identifying staff training needs, and
• Establishing details of the occupation programme for that user function, for
incorporating into the overall Commissioning Master Plan
The Commissioning Master plan
The master plan shall
•Obtaining various licences, NOCs from concerned departments
•Selecting vendors for outsourced services
•Identify key dates for occupying or bringing the facility into use
- This may be undertaken in a phased manner
•Identify key tasks in the occupation and transfer process and
assign responsibility
•Identify critical path for an integrated transfer of functions
-This should address clinical needs and functional interdependencies
–Identify key dates for selecting and ordering equipment
–Identify any closures and arrangements for security and disposal of sites, if relevant
–Ensure that there is no disruption to patient services, and
–Identify a staff recruitment, transfer and counseling programme
Handover to Operation Management
–The Commissioning Team should be in place for at least three months after the facility
is brought into use
• The team and the commissioning manager should be available to deal with issues
which arise from occupation and use of the new facility
Official Opening
–Should be undertaken about 3 to 6 months after full occupation has been achieved
–This provides an opportunity for staff to become used to their new working
environment
SHAKE DOWN PERIOD
• After the commissioning of hospital Some time is taken for functional
integration of different units, services, staff, patient and community.
- This period is called shake–down period .
• This period can be shorter if adequate time and thought have gone into planning
and execution
–The period may last from a few months to a year
• This period will identify the necessity of additions, alterations and
modifications
–Staffing schedule may need readjustment
• Machine are tested Staff recruited and trained Standard operating procedures
are made Maintenance service is put in place Materials, linen and stationary
procured
• Then starts the routine and regular functioning of the hospital.