1.

First Year Policy Direction (2019)

The policy direction to meet excellent service at the beginning of the year of the
Strategic Plan of Haji Medan Hospital that has been implemented includes:
1) Geriatry service is a special service for elderly people over 60 years old who are
vulnerable to health problems. This is directly proportional to the 2016 Indonesian
Health Profile from the Ministry of Health the number of elderly people reached a
population of about 22.5 million people.
2) Endocrine Services is a service for patients who experience health problems that can
occur in the endocrine glands and organs can affect the overall metabolic function of
the body (pancreatic glands, adrenal glands that are above the kidneys, pituitary
gland, thyroid gland, and some reproductive organs, such as the ovaries and testes).
3) Orthopedic Surgery services are services on joint and bone health problems. Various
orthopedic surgery performed include the installation of pen on the bone, surgery to
replace the ankle, knee shoulder and hip.
4) Plastic Surgery as well as Burns Treatment, which requires a Room in Wound Care.
5) Conducting a Master Plan Review in the framework of the preparation, planning and
development of the Hospital 5-10 years into Green Hospital.
6) Make repairs in the room al-Ikhlas, Shafa and Marwa with the available budget so
that it can be used.
7) Make improvements in the Al-Ihsan room for geriatry patient inpatient rooms as a
special service for the elderly.
8) Reorganize the park of Haji Medan General Hospital of North Sumatra Province.
9) Apply for the addition of sub-specialist/specialist/general health workers and nurses
to get the best service.
10)Establish a nurse committee to conduct credentials for all nurses of Haji Medan
General Hospital in order to create good clinical governance.

2. Second year of Policy Direction 2020, among others:

Service development plans in 2020 include:
1) Building office space is the front room of the hospital this is done to support services
2) Stroke Center services are health services that experience circulatory disorders in the
form of disruption of blood supply caused by reduced blood flow or stopped in some
areas in the brain, usually bleeding occurs because the walls of blood vessels are
torn. Development of Facilities and Facilities in the Stroke Center Room including
treatment rooms and tools that support and improve HR skills by planning special
education and training.
3) Pulmonary TB-MDR (Multi Drug Resistant Tuberculosis) Treatment Service is a
service in lung infection caused by Mycobacterium Tuberculosis germs. The high
percentage of deaths from lung infections (pulmonary tuberculosis) according to the
results of research from the Ministry of Health became a health priority issue.
4) For TB-MDR handling services require a Special Treatment Room, TB-MDR Special
Laboratory Room and adequate HUMAN RESOURCES in supporting the Service.
 5) In the 2020 budget, rehabilitation will be carried out rehabilitation of Arrijal Room of
Haji Medan General Hospital into MDR TB Room this is to support the national
program.
6) FESS Surgical Services and Digestive Surgery, as a support for the implementation of
FESS surgical services must previously prepare standard advice and infrastructure
and in accordance with FESS surgery.
7) Implement SNARS (National Standard of Hospital Accreditation). Accreditation of
Hospitals in Indonesia is carried out to assess the hospital's compliance with
accreditation standards, pada currently Haji Medan Hospital has received a UTAMA
rating assessment from KARS. So to improve the status of Accreditation, the
assessment of SNARS edition I by the Hospital Accreditation Commission (KARS)
needs to support this activity is the Accreditation Committee room with meeting
rooms, Medical Employees and Paramedics who must conduct education, training.
as well as technical guidance for the achievement of SNARS Accreditation edition I at
Haji Medan General Hospital of North Sumatra Province.
8) The development of SIM RS (Hospital Management Information System) is to
continue the module modules that have not been implemented and the preparation
of good human resources and advice needed in the development of rs sim
9) Rehabilitation of Hospital Building, Inpatient Building in accordance with the master
plan review stage is implemented, namely the Al_Iklhas Room room which is
currently a Switeroom / Super VIP / and VIP room at Haji Medan General Hospital
can not be said to be good by looking at the conditions that are not habitable then,
improvements are made to become a superior room and can compete with other
Hospital patients.
10)Rehabilitation of Shafa and Marwa Room, this room is a Class I and Class II room at
Haji Medan General Hospital, which is the same as al-Ikhlas room is not habitable,
although at this time the room is used, the rehabilitation plan of Shafa and marwa
room is to make improvements to the bathroom, paint and repair sills that can not
be used.
11)Rehabilitation Of Jabal Rahmah Room is a room in laintai II Of Haji Medan Hospital is
currently unusable because the room that leaks seepage into the first floor room,
this rehabilitation is carried out as a priority of Haji Medan General Hospital so that
the room can be used so as to increase the income of Haji Medan General Hospital
which is currently declining.
12)Environmental Impact Analysis (AMDAL) which is a condition of the completeness of
the establishment of Cedung and Building and operational permits, based on
Presidential Regulation No. 27 of 2012.

3. Third year of Policy Direction 2021:

1) The development of the Heart Surgery Building and Cardiac Center Services is a
service that prioritizes cardiac (cardiac) disease. The development of Facilities and
Facilities in the Cardiac Center Room includes the Patient Observation Room and
what needs to be needed is HR skills by planning special education and training. This
 is a priority of Haji Medan General Hospital in North Sumatra Province given the
large number of heart surgery patients in North Sumatra.
2) Acceleration of international hospital development . In accordance with the
implementation of the next phase I development carried out the construction of
phase II (in accordance with the ability of the North Sumetera Provincial Budget fund
and the Special Allocation Fund of the Ministry of Health)
3) Oncology Services, which are specialized health services serving cancer health
disorders.
4) The addition of Hospital Facilities and Infrastructure, to go to international hospitals,
it requires various completeness in accordance with the standards of Type B hospital
(Decree No. 56 of 2014 on Classification of Hospital Licensing).

4. Fourth year of Policy Direction in 2022.

1) Acceleration of Development, acceleration of Phase III development is the
construction of the final stage, which is expected to be carried out in realizing the
feasibility of becoming an International Standard Hospital
2) JCI preparation. JCI (Joint Commission International) is a division of Joint Commission
International, under The Joint Commission his organization has dedicated itself to
improving the quality and safety of health.
3) JCI's mission is to improve the quality of health.
4) continuously to the community, by working with stakeholders, evaluating health
care organizations, and providing inspiration in improving the provision of the
highest safe, effective, and quality services.
5) JCI preparation is carried out so that Haji Medan Hospital gets the title of
International Hospital with services in accordance with the Vision, Mission of the
Governor of North Sumatra.

5. Fifth year of Policy Direction 2023

 Become an International Hospital in accordance with the vision and Mission of the
Governor of North Sumatra "Providing Excellent Health Services." Namely excellent
health services or the best health services to the people of North Sumatra.

1.1. ANALYSIS OF TOTAL NEEDS OF THE ROOM

1.1.1. TOTAL NEED FOR SPACE
1) Usually the minimum need for space for one bed and access is approximately 10 m2.
The total floor area of the hospital is estimated to be 8 (eight) to 10 (ten) times the
need for bed area.
2) For example, a hospital with 200 beds, the floor area requirement is 10 ( m2/bed) x (8
to 10) x 200 beds = 16,000 m2 to 20,000 m2.
3) With the rapid development of technology, medical science and administration, the
need for spacious space increases. For example, laboratory test rooms have almost
doubled over the past 10 (ten) years.
 4) A few years ago, the need for hospital rooms was between 45 m2 to 55 m2 per bed.
5) The need for space for modern hospitals is approximately between 80 to 110 m2 per
bed.
Table 6. 1, showing important parts of a non-educational public hospital and the space
it needs.

Table 6.1. Minimum space requirement for non-educational public hospitals.

RUANG LUAS (m2) PER TEMPAT TIDUR
1 Administrasi 3 ~ 3,5
2 Unit Gawat Darurat 1 ~ 1,5
3 Poliklinik 1 ~ 1,5
4 Pelayanan sosial 0,1
5 Pendaftaran 0,2
6 Laboratorium Klinis, Patologi 2,5 ~ 3
7 Kebidanan dan kandungan 1,2 ~ 1,5
8 Diagnostik dan Radiologi 3~4
9 Dapur makanan 2,5 ~ 3,0
10 Fasilitas petugas 0,5 ~ 0,8
11 Ruang pertemuan, pelatihan 0,5 ~ 1
12 Terapi Wicara dan pendengaran 0,1
13 Rumah tangga/kebersihan 0,4 ~ 0,5
14 Manajemen material 0,4 ~ 0,5
15 Gudang pusat 2,5 ~ 3,5
16 Pembelian 0,2
17 Laundri 1 ~ 1,5
18 Rekam medis 0,5 ~ 0,8
19 Fasilitas staf medik 0,2 ~ 0,3
20 Teknik dan pemeliharaan 5~6
21 Pengobatan nuklir 0,4 ~ 0,5
22 Ruang anak 0,4 ~ 0,5
23 Petugas 0,3 ~ 0,4
24 Farmasi 0,4 ~ 0,6
25 Ruang publik 1 ~ 1,5
26 Ruang pengobatan kulit 0,1 ~ 0,2
27 Therapi radiasi 0,8 ~ 1
28 Therapi fisik 1 ~ 1,2
29 Therapi okupasi 0,3 ~ 0,5
30 Ruang bedah 3,5 ~ 5
31 Sirkulasi 10 ~ 15
32 Unit rawat inap 25 ~ 35

Source: G.D Kunders, Hospitals, Facilities, Planning and Management, McGraw-Hill, 2004

1.1.2. HOSPITAL PLANNING

1. General Principles
1) The first provision, the protection of patients is the main provision. Too much
traffic will disrupt patients, reduce the efficiency of patient care and increase the
risk of infection, especially for surgical patients where clean conditions are
essential. Guaranteed protection against infection is the main heart of service to
patients.
 2) The second provision is to plan as short as possible traffic lanes. This condition
helps maintain aseptic hygiene and secure the steps of everyone, nurses, patients
and other hospital staff. The hospital is a place where things go fast. The
patient's soul often depends on him. Time wasted due to unnecessary steps
wastes costs in addition to people's fatigue at the end of the workday.
3) The third provision, separation of different activities, separation between clean
work and dirty work, quiet and noisy activities, differences in patient type,
(examples of serious and outpatient pain) and different types of traffic inside
and outside the building.
4) The fourth provision, controlling a certain number that comes with the
separation of different activities, but not enough. The nursing post should be in
a situation assisting the nurse in training the patient in the patient corridor, and
visitors enter and outside the unit. Infants should be protected from possible
theft and from disease germs carried by visitors and hospital staff. Patients in
the ICU should be guarded against infection. Surgical rooms should be
protected in a similar way.
5) Two illustrations of the main traffic plan shown in Figure 2.7 and Figure 2.8.
Figure 2.9 also show the functional zoning plan .

2. Special Principles
1) Maximum lighting and wind for all parts of the building are important factors.
This is especially so for hospitals that don't use air conditioning.
2) Windows should be equipped with gauze wire to prevent mosquitoes and other
flying animals from being everywhere around the hospital.
3) The hospital has at least 3 access / entrance, consisting of the main entrance,
entrance to the Emergency Department and entrance to the Service area.

Figure 6.2. Examples of Location Plans

4) The entrance for service should be adjacent to the kitchen and storage area
(warehouse) that receives items in bulk form, and when possible adjacent to the
service elevator. Bordes and scales are available in the area. Access to the
morgue should be protected against the views of patients and visitors for
psychological reasons.
5) The entrance and lobby should be made attractive enough, so that patients and
patient delivery people easily recognize the main entrance.
6) The flow of patient traffic and hospital staff should be planned as efficiently as
possible.
7) Public corridors are separated by corridors for patients and medical personnel,
intended to reduce congestion time. Materials, materials and garbage disposal
should not cut through people's movements. Hospitals need to be designed so
that officers, patients and visitors are easy to orient if they are inside the
building.
8) The flow of outpatients who want to go to the laboratory, radiology, pharmacy,
specialized therapy and to other medical services, not through the inpatient
area.
9) The flow of inpatients if they want to go to the laboratory, radiology and other
parts, must follow a predetermined procedure.
Figure 6.3. Patient traffic flow inside public hospitals
 Figure 6.4. Traffic flow from traffic outside

10) The width of the corridor is 2.40 m with a ceiling height of at least 2.40 m. The
corridor should be straight. If the ramp is used, the slope should not exceed 1:
10 (making a maximum angle of 70).

1.1.3. HOSPITAL BUILDING PLANNING

1. Roof
The roof should be strong, leakless, durable and not be a place for insects, rats, and
other disruptive animals.
(1) Roof Cover
(a) The roof covering of concrete material overlaid with a waterproof coating, is the
main choice.
(b) Roof covering when using ceramic tile, or concrete tile, or clay tile (plentong), the
installation must be with a slope angle in accordance with applicable provisions.
(c) Given its difficult maintenance, especially in the event of a leak, the use of metal
tiles should be avoided.
(2) Roof Frame
(a) The roof frame should be strong shouldering the load of the roof cover.
(b) If the roof frame is of wood, it must be of good quality and dry, and coated with
anti-termite paint.
(c) If the roof frame is of metal material, it should be from metal that is not easily
 rusted, or painted with an anti-rust base paint.

2. Palate
The ceiling should be strong, light colored, not asbestos-made and easy to clean.
(a) The ceiling height in the room, at least 2.70 m, and the height in the ceiling
(corridor) is at least 2.40 m.
(b) The ceiling frame should be strong.
(c) The ceiling may have to be of soundproofed material.

3. Walls and Partitions

Walls should be hard, not porous, fireproof, waterproof, rust resistant, unsusable
(intact), and easy to clean. In addition, the walls should not be shiny.
(a) Coating walls with hard materials such as formika, easy to clean and maintain.
The connection between them can be "sealed" with plastic fillers. Laminated
polyester or plaster is smooth and painted, giving the wall no potent (no joint =
seamless).
(b) Walls are lined with ceramics/ porcelain, collecting dust and micro organisms
between the joints. Cement between ceramics / porcelain cannot be smooth, and
most of the connections that are supplied are porous enough to be easily inhabited
by micro organisms even though they have been cleaned.
(c) Ceramics/porcelain can be cracked and broken.
(d) Epoxy paints basically have a tendency to peel off or form flakes.
(e) Stainless steel sheet/elbow coating at the corners where the impact helps reduce
damage.

4. Floor
The floor should be made of a strong material, watertight, flat surface, not slippery,
bright color, and easy to clean.
(a) The floor that is always in contact with water should have a sufficient slope
towards the sewer.
(b) The meeting of the floor with the wall must be in the form of a conus / curve to be
easily cleaned.
(c) The floor should be conductive enough, so it is easy to remove static electrical
charges from equipment and officers, but not so conductive that it endangers the
officer from electric shock.
(d) To prevent the stockpiling of electrical charges at the site where flammable
anesthetic gases are used, conductive flooring must be installed.
(e) Conductive flooring can be obtained from various types of materials, including
anti-static vinyl, asphalt tiles, linolium, and teraso. Electrical resistance from
these materials can change with age and as a result of cleaning.
(f) Prisoners from the conductive floor are measured monthly, and must meet the
applicable requirements as in NFPA 56A.
(g) The surface of the floor must be able to make way for equipment that has
moderate electrical conductivity between the equipment and the officers
associated with the floor.
 (h) Floor dislocated anesthesia that is not flammable does not need to be conductive.
A kind of hard plastic (vinyl), and non-connection materials are used for non-
conductive flooring.
(i) The surface of all floors should not be porous, but hard enough for cleaning with
flooding, and wet vacuuming.

5. Ramps
Ramps are circulation pathways that have fields with a certain slope, as an alternative
to people who cannot use stairs.
(a) The slope of a ramp in the building should not exceed 70, the slope calculation
does not include the prefix and end of the ramp (curb ramps / landing).
(b) The horizontal length of one ramp (with a slope of 70) should not be more than 900
cm. The length of the ramp with a lower slope can be longer.
(c) The minimum width of the ramp is 120 cm with safety edges. For ramps that are
also used at once for pedestrians and freight services must be carefully considered
the width, so that it can be used for both functions, or carried out the separation of
ramps with their own functions.
(d) The flat face (bordes) at the prefix or suffrage of a ramp should be free and flat
allowing at least to rotate the wheelchair and stretcher, with a minimum size of
160 cm.
Figure 6.5. Typical Ramp
Figure 6.6. Ramp shapes

Figure 6.7. Ramp shapes

 Figure 6.8. Grip on the Ramp.

Figure 6.9. Grip on the Ramp.

Figure 6.10. The door at the end of the ramp

(e) The flat surface of the prefix or suffrage of a ramp must have a texture so that it is
not slippery either in the rain.
(f) The width of the ramp safety edge (low curb) is 10 cm, designed to block the
 wheels from the wheelchair or stretcher so as not to get mired or out of the ramp
path. If it is directly adjacent to public road traffic or intersections, it should be
made in such a way as not to disturb public roads.
(g) Ramps should be illuminated with enough lighting to help with ramp use at night.
Lighting is provided on the ramp that has a height to the surrounding ground face
and harmful parts.
(h) Ramps must be equipped with a handrail handle that is guaranteed strength with
the appropriate height.

6. Ladder
Stairs are facilities for vertical movement designed taking into account the size and
slope of the footing and incline with adequate width.
(a) Must have a footing dimension and climbs that are uniformly sized Each footing /
climb is 15 - 17 cm.
(b) It should have a slope of less than 600 stairs.
(c) The width of the stairs is at least 120 cm to carry the reservoir in an emergency, to
evacuate patients in case of a fire or bomb threat
(d) There are no hollow climbs that can harm the stair users.
(e) Must be equipped with a handrail.
(f) The handle of the vine should be easily held at a height of 65~80 cm from the
floor, free from distracting construction elements, and the tip should be round or
well deflected towards the floor, wall or pole.
(g) The handle of the vine should be increased in length at the ends (top and bottom)
by 30 cm.
(h) For stairs located outside the building, it should be designed so that no rainwater
pooling on the floor.
 Figure 6.11. Typical Stairs

Figure 6.12. Rambat Handle on the Stairs

 Figure 6.13. Ladder Profile Design

Figure 6.14. Rambat Grip Details on stairs

Figure 6.15. Rambat Grip Details on the Wall

7. Elevator
Elevator is a vertical traffic facility both for hospital officers and for patients.
 Therefore it should be planned to be able to accommodate the patient's bed.
(a) The size of the hospital elevator is at least 1.50 m x 2.30 m and the width of the
door is not less than 1.20 m to allow the passage of the bed and stretcher together
with the introduction.
(b) Passenger lifts and service lifts are separated whenever possible.
8. Door
A door is part of a tread, building or space that is a place to enter and exit and is
generally equipped with a cover (door leaf).
(a) The main exit / entrance has an opening width of at least 90 cm or can be passed
by the patient's gurney, and the doors that are not the patient's access have an
opening width of at least 80 cm.
(b) In the area around the entrance wherever possible avoided ramps or differences in
floor height.
(c) Emergency Door
 Every hospital building that is more than 3 stories high must be equipped
with emergency doors.
 The width of the emergency door is at least 100 cm open to the rescue
stairs room (emergency) except on the ground floor opening to the outside
(yard).
 The distance between emergency doors in one building block is a
maximum of 25 m from all directions.
(d) Special doors for inpatient bathrooms and toilet doors for accession, should be
open to the outside (see figure 3.7.1), and the width of the door leaves is at least
85 cm.
9. Tiolet/Restroom
Accessible sanitation facilities for all persons (without exception persons with
disabilities, the elderly and pregnant women) in buildings or other public facilities.
1) Public toilets
(a) Public restrooms or restrooms should have enough wiggle room to get in and
out by the user.
(b) The height of the toilet seat should correspond to the height of the user (36 ~
38 cm).
(c) The material and floor finish should not be slippery.
(d) Public restrooms or restrooms should have enough wiggle room to get in and
out by the user.
(e) The height of the toilet seat should correspond to the height of the user (36 ~
38 cm).
(f) The material and floor finish should not be slippery.
(g) The door should be easily opened and closed.
(h) Toilet locks or grendel are selected in such a way that they can be opened
from the outside in case of an emergency.
2) Toilets for accessibility
(a) Accessible public toilets or restrooms should be equipped with the display of
signs / symbols of "people with disabilities" on the outside.
(b) Public restrooms or restrooms should have enough wiggle room to enter and
 exit wheelchair users.
(c) The height of the toilet seat should correspond to the height of the wheelchair
user approximately (45 ~ 50 cm)
(d) Public toilets or restrooms should be equipped with a handrail that has a
position and height adapted to wheelchair users and other people with
disabilities. The handle is recommended to have the shape of the elbows
pointing upwards to help the movement of wheelchair users.
(e) The location of tissue paper, water, water faucets or showers and equipment
such as soap and hand dryers should be installed in such a way that it is easy
to use by people who have physical limitations and can be reached by
wheelchair users.
(f) The material and floor finish should not be slippery.
(g) Doors should be easy to open and close to make it easier for wheelchair users.
(h) Toilet locks or grendel are selected in such a way that they can be opened
from the outside in case of an emergency.
(i) In places that are easily reached, such as in the entrance area, it is
recommended to provide an emergency sound button if at any time something
unexpected happens.

Figure 6.16. Wiggle room in the toilet for accession

1.1.4. HOSPITAL BUILDING SAFETY REQUIREMENTS

Hospital building safety requirements include requirements for hospital building ability
to load load, requirements for hospital building capabilities against fire hazards, hospital
building capability requirements against lightning hazards and hospital building capability
requirements against electrical hazards.
1. Requirements for Hospital Building Loading Capabilities Against Load Load
(a) General
(1) Every hospital building, its structure must be planned and implemented to be
strong, sturdy, and stable in carrying the burden / combination of burdens and
meeting safety requirements , and meeting serviceability requirements during the
planned service life taking into account the function of the hospital building,
 location, durability, and possible implementation of its construction.
(2) The ability to carry a load is taken into account against the effects of action as a
result of the loads that may work during the service life of the structure, both fixed
load and temporary load load arising from earthquakes, wind, corrosion
influences, fungi, and destructive insects.
(3) In the planning of the structure of the hospital building against the influence of the
earthquake, all elements of the structure of the hospital building, both part of the
substructure and the structure of the building, must be taken into account
shouldering the effect of the earthquake plan in accordance with the earthquake
zone.
(4) The structure of the hospital building must be planned in detail so that in the
maximum loading conditions planned, in the event of a collapse, the condition of
the structure can still allow hospital building users to save themselves.
(5) To determine the reliability level of a building structure, a periodic inspection of
the reliability of the building must be carried out in accordance with the applicable
Technical Guidelines or standards.
(6) Repair or retrofitting of the structure of the building must be done immediately in
accordance with the recommendations of the results of the examination of the
reliability of the hospital building, so that the hospital building always meets the
safety requirements of the structure.
(7) Examination of the reliability of hospital buildings is carried out periodically in
accordance with applicable technical guidelines or technical standards, and must
be carried out or accompanied by experts who have appropriate certification.
(b) Technical Requirements
(1) Structural analysis should be performed to check the structure's response to loads
that may work during the service life of the structure, including fixed loads,
temporary loads (wind, earthquakes) and special loads.
(2) Determination regarding the type, intensity and how the load works must be in
accordance with applicable technical standards, such as:
 SNI 03–1726-1989 or recent edition; Procedures for earthquake resilience
planning for homes and buildings.
 SNI 03-1727-1989 or recent edition; Planning procedures for homes and
buildings.

2. Structural Capability Requirements over Hospital Buildings Against Load Load

Construction of hospital buildings can be made of concrete construction, steel
construction, wood construction or construction with specialized materials and
technology.
(a) Concrete Construction
Concrete construction planning must meet applicable technical standards, such as:
(1) SNI 03–2847-1992 or recent edition; Procedures for calculating concrete
structures for buildings.
(2) SNI 03–3430-1994 or recent edition; The procedure of planning the walls of the
structure of the hollow hollow block pairs of bony for the building of houses and
buildings.
 (3) SNI 03-1734-1989 or recent edition; Concrete planning procedures and reinforced
wall structures for homes and buildings.
(4) SNI 03–2834 -1992 or recent edition; Procedures for making a normal concrete
mix plan.
(5) SNI 03–3976-1995 or recent edition; Procedures for stirring and casting concrete.
(6) SNI 03–3449-1994 or recent edition; The procedure of the plan of making a
mixture of light concrete with light aggregates.
(b) Steel Construction
Steel construction planning must meet applicable standards such as:
(1) SNI 03-1729-1989 or recent edition; Procedures for planning steel buildings for
buildings.
(2) Procedures and/or other guidelines that are still related in the planning of steel
construction.
(3) Procedures for The Manufacture or Assembly of Steel Construction.
(4) Steel Construction Maintenance Procedures during Construction Implementation.
(c) Wood Construction
Wood construction planning must meet applicable technical standards, such as:
(1) Procedures for Planning Wood Construction for Buildings.
(2) Other procedures / guidelines that are still related in the planning of wood
construction.
(3) How to Make and Assemble Wood Construction
(4) SNI 03 – 2407 – 1991 or the latest edition; Wood painting procedures for homes
and buildings.
(d) Construction with Special Materials and Technology
(1) Construction planning with specialized materials and technologies must be carried
out by structural experts related to the field of materials and special technologies.
(2) Construction planning with due regard to the technical standards of the equivalent
for the technical specifications, procedures, and methods of testing such specific
materials and technologies.
(e) Specific Guidelines for Each Type of Construction
In addition to specific guidelines for each type of construction, other technical
standards related to the planning of a building must be met, among others:
(1) SNI 03-1735-2000 or recent edition; Building and environmental planning
procedures for the prevention of fire hazards in house and building buildings.
(2) SNI 03-1736-1989 or recent edition; Procedures for planning building structures
for the prevention of fire hazards in house and building buildings.
(3) SNI 03-1963-1990 or recent edition; Basic procedures of modular coordination
for the design of house and building buildings.
(4) SNI 03–2395-1991 or recent edition; Procedures for planning and designing
radiological buildings in hospitals.
(5) SNI 03–2394-1991 or recent edition; Procedures for planning and designing
nuclear medicine buildings in hospitals.
(6) SNI 03–2404-1991 or recent edition; Procedures for termite prevention in the
manufacture of house buildings and buildings.
(7) SNI 03–2405-1991 or recent edition; Procedures for handling termites in house
buildings and buildings with thermosideds.
3. Hospital Capability Requirements Against Fire Hazards
(a) Passive Protection System
Every hospital building must have a passive protection system against fire hazards
based on the design or arrangement of the architectural components and structure of
the hospital so as to protect residents and objects from physical damage in the event
of a fire.
The application of passive protection systems is based on the function / classification
of fire risk, geometry of space, installed building materials, and / or the number and
condition of residents in the hospital.
(1) Hospitals should be able to be structurally stable during fires.
(2) Compartmentalization and separation construction to limit potential blazes,
fire propagation and smoke, in order to:
 Protect residents who are in one part of the building against the impact
of fires that occur elsewhere in the building.
 Control the blaze so as not to spread to other nearby buildings.
 Providing an entrance for firefighters
(3) Open Protection. All openings must be protected, and utility pits must be
given a fire stop to prevent the spread of the fire and ensure the separation and
compartmentalization of the building.

(b) Passive Protection System

Active protection systems are fixed or non-fixed, water-based, chemical or gas-based
detection and extinguishing equipment used to detect and extinguish fires in hospital
buildings.
(1) Upright pipes and fire slang
Upright plumbing system is determined by the height of the building, area per
floor, classification of occupancy, system of road facilities to the outside, the
amount of required flow and the remaining pressure, as well as the distance of
the hose connection from the source of the water supply.
(2) Page Hydrant
Yard hydrants are required for firefighting from outside the building. The
slang connection to the yard hydrant must meet the requirements specified by
the local fire agency.
(3) Automatic Sprinkler System
An automatic sprinkler system should be designed to extinguish a fire or at
least be able to sustain a fire to remain, not developed, for at least 30 minutes
from the time the sprinkler ruptures.
(4) Light Fire Extinguisher (PAR)
Chemical light fire extinguishers (APAR) should be intended to provide a
means for firefighting at an early stage. APAR construction can be of
portable type (tote) or wheeled,
(5) Special Fire System
The special outage system in question is a non-portable (portable) outage
 system and operates automatically for protection in spaces and/or special uses.
Special fire systems include gas systems and foam systems.
(6) Fire Detection System & Alarm
Fire detection and alarm systems serve to detect early the occurrence of fires,
both automatically and manually.
(7) Emergency Lighting System
Emergency lighting in the hospital is needed especially in emergencies, such
as the malfunction of normal lighting from PLN or not being able to operate
immediately standby power from the generator.
(8) Directional Mark
If the emergency exit instructions cannot be clearly seen by visitors or users of
the building, it must be installed a sign with an arrow indicating direction, and
installed in corridors, roads to large spaces (halls), lobbies and the like that
give an indication of directions to the required emergency exit.
(9) Hazard Warning System
A hazard warning system can also serve as a public address, necessary to
provide guidance to residents and guests as an evacuation or rescue measure in
an emergency. This is intended so that the occupants of the building get
proper and clear guidance information.

4. Telephone Communication Requirements in a Hospital

Communication requirements in hospitals are intended as the provision of
communication systems both for internal building purposes and for external relations,
in the event of a fire and/or other emergency. These include: telephone system, sound
system, voice evacuation system, and nurse call system.
The use of sound installations in times of emergency is possible as long as they meet
applicable technical guidelines and standards.
(a) Telephone communication installation system and building comunication system,
its placement must be easily observed, operated, maintained, not harmful,
disturbing and detrimental to the environment and other building parts and
installation systems, and planned and implemented based on standards,
normalization of applicable techniques and regulations.
(b) Communication system equipment and installations should have no impact, and
should be secured against interference such as electro-magnetic wave
interference, etc.
(c) Regular measurements /tests are carried out on EMC (Electro Magnetic
Campatibility). If the measurement results against EMC exceed the specified
threshold, then rare countermeasures and safeguards must be made.
(d) In case there are still other requirements that do not have an SNI, can be used
standard standards and technical guidelines imposed by the competent authorities.
(e) The cable end stop must be bright, there is no standing water, safe and easy to
work with.
(f) The size of the manhole that serves the entrance to the building for telephone
installation is at least 1.50 m x 0.80 m and must be secured so as not to become a
water passage into the hospital in the rain etc.
 (g) It is attempted close to the wires from the telephone office and close to the big
road.
(h) The placement of telephone cables that are parallel to the power cable, at least
0.10 m or in accordance with applicable provisions.
(i) The PABX/TRO room of the telephone system must meet the requirements:
(j) The space is clean, bright, dustproof, the air circulation is sufficient and should
not be exposed to direct sunlight, and meets the requirements for equipment.
(k) No wall paint should be used that easily peels off.
(l) Room is available for central officers and telephone operators.
(m) The battery room of the telephone system must be clean, bright, have walls and
floors resistant to acid, adequate air circulation and waste air must be discharged
into the open air and not into public spaces, and should not be exposed to direct
sunlight.

5. In-Hospital Sound system Requirements

(a) Each hospital building with a height of 4 floors or 14 m and above, must be
installed a sound system that can be used to deliver announcements and
instructions in the event of a fire or other emergency.
(b) The emergency communication equipment system as referred to in item a) above
must use a special system, so that if the general sound system is damaged, then
the emergency telephone system can still work.
(c) Emergency communication installation cables must be separate from other
installations, and protected against fire hazards, or consist of fire retardant cables.
(d) Must be equipped with a source / supply of electrical power for normal conditions
and in the main electrical power conditions are impaired, with capacity and can
serve in sufficient time in accordance with applicable provisions.
(e) Communication system requirements in a building must meet:
 Law No. 32 of 1999, on Telecommunications.
 PP No. 52/2000, on Telecommunications Indonesia.
6. Nurse Call Installation
(a) Nurse call system equipment is intended to provide services to patients who need
the help of nurses, either in routine or emergency conditions.
(b) The nurse call system aims to be a means of communication between nurses and
patients in the form of visuals and audibles (sound), and provide signals in the
event of a patient's emergency.

7. Protection Requirements Against Lightning Hazards

A lightning protection installation can protect all parts of a hospital building,
including the humans inside, and other installations and equipment against the danger
of lightning strikes.

8. Electrical System
(a) The low voltage system (TR) in a building is 3 phases 220/380 Volts, with a
frequency of 50 Hertz. The medium voltage system (TM) in a building is 20 KV
or less, with a frequency of 50 Hertz, following the applicable provisions.
For hospitals that have a connected electrical power capacity from PLN of at least
 200 KVA it is recommended that they already have a Medium Voltage power
grid system of 20 KV (TM 20 KV power grid), according to the guidelines that
the Hospital has an electric power capacity of 300 KVA to 600 KVA, with a
calculation of 3 KVA per Bed (TT). 
(b) The medium voltage electrical installations include:
 Provision of hospital electricity substation building (size according to PLN
substation standards).
 Transformer equipment ( capacity according to installed power).
 TM 20 KV panel equipment and accessories.
 Assist equipment and grounding systems.
(c) UPS (Uninterruptable Power Supply) equipment must be available to serve the
Operating Room (Central Operating Theater), Intensive Care Unit, Cardiac
Special Intensive Care Unit ( Intensive Cardiac Care Unit ).
 There must be a UPS Room of at least 2 X 3 m2 (as needed) located in the
COT Building, ICU, ICCU and given air conditioning.
 UPS capacity is at least 30 KVA.
(d) Emergency lighting systems should be available in certain spaces.
(e) There must be a backup power source in the form of a diesel generator
(Generator). Generator sets must be provided 2 (two) units with a capacity of at
least 60% of the amount of power installed on each unit. Generator sets are
equipped with AMF and ATS systems.
(f) Class A hospital electrical system must be equipped with an insulator
transformer and complete monitoring of group 2E IT system at least 5 KVA
capacity for outlet points that supply important medical equipment (life support
medical equipment).
(g) The grounding system must be separated between the grounding panel of the
building and the tool panel. The grounding value of the equipment should not be
less than 0.2 Ohm.

1.1.5. Hospital Building Health Requirements

Hospital health requirements include the requirements of the hospital's air conditioning
system, lighting, sanitation, and use of hospital building materials.
1. Ventilation System Requirements
(a) Every hospital building must have natural ventilation and/or mechanical/artificial
ventilation in accordance with its function.
(b) Hospital buildings must have permanent openings, grilles on doors and windows
and/or permanent openings that can be opened for natural ventilation purposes.
(c) Technical requirements of ventilation systems, ventilation needs, follow the
following Technical Requirements:
 SNI 03 - 6572 - 2000 or recent edition; Procedures for the design of
ventilation and air conditioning systems in buildings.
 SNI 03 - 6390 - 2000 or recent edition; Conservation of energy system air
system in buildings
2. Lighting System Requirements
Each hospital to meet the requirements of the lighting system must have natural
lighting and/or artificial/mechanical lighting, including emergency lighting in
accordance with its function.
(a) Residential hospitals, health services, education, and public service buildings
should have openings for natural lighting.
(b) Natural lighting should be optimal, adjusted to the function of the hospital and the
function of each room inside the hospital.
(c) Lighting in Rumah Sakit must meet health standards in carrying out its work in
accordance with light intensity standards as follows:

Table 6.1. Exposure Index of Room Or Unit Type

INTENSITY OF LIGHT
NO. SPACE OR UNIT KKETERANGAN
(lux)
Patient room
1 - when not sleeping 100 – 200 Medium light color
- during sleep max. 50
2 R. General operations 300 – 500
Cool or medium
3 Operating table 10.000 – 20.000 light color without
shadows
4 Anaesthetic, recovery 300 – 500
5 Endoscopy, lab 75 – 100
6 X-ray Minimum of 60
7 Corridor Minimum of 100
8 Ladder Minimum of 100 Night
9 Administration/office Minimum of 100
10 Tool room/warehouse Minimum of 200
11 Pharmacy Minimum of 200
12 Kitchen Minimum of 200
13 Laundry room Minimum of 100
14 Toilet Minimum of 100
Isolation room of Tetanus
15 0,1 – 0,5 Blue light color
disease
16 Burn room 100 – 200

3. Sanitary Requirements
Hospital Sanitation Requirements can be seen in the Decree of the Minister of Health
no. 1204 / MENKES / SK / X / 2004, on the Hospital Environmental Health
Requirements.
A. Clean Water Requirements
a) There must be sufficient clean water and health requirements, or be able to
 hold treatment in accordance with applicable provisions.
b) Clean water is available at least 500 lt/bed/day.
c) Drinking water and clean water are available at every place of continuous
need.
d) There is a water reservoir (reservoir) below or above.
e) The distribution of drinking water and clean water in each room / room must
use piping networks that flow with positive pressure.
f) Provision of hot water and steam facilities consists of Boiler Units, piping
systems and their completeness for distribution to service areas.
g) In order to monitor water quality, the hospital must conduct inspections of
drinking water and clean water facilities at least once every (one) year.
h) Chemical examination of drinking water and/or clean water is carried out at
least 2 (twice) times a year (once in the dry season and once in the rainy
season), the sample point is in the water reservoir (reservoir) and the furthest
tap from the reservoir.
i) Water quality is used in special rooms, such as operating rooms.
j) Hospitals that have used treated water such as from PDAM, drill wells and
other sources for operating purposes can perform additional treatment with
filter cartridges and are equipped with disinfection using ultra violet.
k) Pharmacy and Hemodialysis Room: it consists of purified water for drug
preparation, injection preparation and dilution in Hemodialysis.
l) Clean water is available for firefighting purposes by following the applicable
provisions.
m) Clean water/drinking and waste/dirty water plambing system follows technical
requirements in accordance with SNI 03-6481-2000 or the latest edition,
Plambing System 2000.

B. Waste Treatment and Disposal System

The requirements of Processing and Disposal of Hospital Waste in solid, liquid
and gaseous form, both medical and non-medical waste can be seen in the Decree
of the Minister of Health no. 1204 / MENKES / SK / X / 2004, on the
Environmental Health Requirements of the Hospital.

C. Medical Gas Installation Requirements

a) Medical gas systems and medical vacuums should be planned and installed
taking into account their type and level of danger.
b) This requirement applies mandatory to health care facilities in hospitals,
hospices, hyperbaric facilities, maternity clinics and other health care
facilities.
c) When there is a medical or vacuum gas term, the provision applies mandatory
to all piping systems for oxygen, nitrous oxide, medical compressed air,
carbon dioxide, helium, nitrogen, medical vacuum for surgery, disposal of
anesthetic gas waste, and mixtures of these gases. If there is a special gas
service name or vacuum, then the provision only applies to the gas.
d) Existing systems that do not fully comply with these provisions may remain in
use as long as the authorities have ensured that their use does not endanger
 lives.
e) The potential fire and explosion hazards associated with medical gas central
piping systems and medical vacuum systems should be considered in the
design, installation, testing, operation and maintenance of these systems.
f) The identification and labeling of a centralized (central) supply system should
be clear.
g) Cylinders/tubes and containers that may be used must be made, tested, and
maintained in accordance with the specifications and provisions of the
authorities.
h) The contents of the cylinder /tube must be identified with a label or mold
affixed that mentions the contents or coloring on the cylinder / tube in
accordance with applicable provisions.
i) Before use must be ascertained the contents of the cylinder / tube or container
by paying attention to the color of the tube, the description of the contents of
the tube that is pressed on the body of the tube, label (if any).
j) Labels should not be tampered with, altered or removed, and splicing fitrs
should not be modified.
k) Operation of a central supply system.
 It should be prohibited to use adapters or conversion fiting to adjust the
special fit of one gas to another gas fit.
 Only medical gas cylinders and their equipment may be stored in a room
where the central supply system or medical gas cylinders are stored.
 It should be prohibited to store materials easily lit, cylinders containing
gases easily lit or those containing liquids easily lit, in the room with
medical gas cylinders.
 It is permissible to install wooden shelves to store medical gas cylinders.
 When the cylinder is encased at the time it is received, the wrapper must
be discarded before it is stored.
 The valve protective lid should be tightly installed in place when the
cylinder is not in use.
 It should be prohibited the use of cylinders without proper marking, or that
marks and fiting for specific gases are not appropriate.
 Cryogenic fluid storage units intended to supply gases into the facility
should be prohibited from being used to refill other vessels of liquid
storage.

l) Planning and implementation

Locations for central supply systems and storage of medical gases must meet
the following requirements:
 Built with access to the outside and entrance locations to move cylinders,
equipment, and so on.
 Be kept safe with doors or gates that can be locked, or secured by other
means.
 If outdoors / building, it must be protected with walls or fences from
 materials that cannot burn.
 If indoors / buildings, must be built using interior materials that can not
burn or difficult to burn, so that all walls, floors, ceilings and doors have at
least a level of fire resistance of 1 hour.
 Equipped with racks, chains, or other binders to secure each cylinder,
whether connected or unconnected, full or empty, so as not to collapse.
 Supplied with electrical power that meets the requirements of the essential
electrical system.
 If provided shelves, cabinets, and supports, must be made of materials that
cannot burn or materials that are difficult to burn.
m) Technical standards and guidelines.
 For medical gas systems in buildings, it must be fulfilled SNI 03-7011-
2004, about safety in health care facilities, or the last edition.
 In the case of the above requirements there is no SNI, standard standards
and technical provisions are used.

D. RainWater Distribution Requirements

Rainwater distribution systems should be planned and installed taking into
account the height of groundwater surfaces, soil permeability, and the availability
of environmental/city drainage networks.
a) Every building and yard must be equipped with a rainwater distribution
system.
b) Except for certain areas, rainwater must be deposited into the yard soil and/or
flowed into the catchment well before it is channeled to the environmental/city
drainage network in accordance with applicable provisions.
c) The use of rainwater is allowed by following the applicable provisions.
d) If there is no city drainage network or other acceptable reasons, then the
distribution of rainwater must be done in other ways that are justified by the
competent authorities.
e) Rainwater distribution system must be maintained to prevent the occurrence of
deposits and blockages in the channel.
f) Rainwater processing and distribution follows the following technical
requirements:
 SNI 03-2453-2002 or recent edition; Procedures for planning rainwater
catchment wells for yard land.
 SNI 03-2459-2002 or recent edition; Specifications of rainwater catchment
wells for yard land.
 Procedures for planning, installing, and maintaining rainwater distribution
systems in buildings.

1.1.6. HOSPITAL BUILDING COMFORT REQUIREMENTS

Hospital building comfort requirements include the comfort of the wiggle room and
the relationship between rooms, thermal comfort in the room, comfort of view (visual), as
well as comfort to the level of vibration and noise.
1. Wiggle Room Comfort Requirements in Hospital Buildings
A. Common
Wiggle Room Comfort Requirements and Inter-Space Relationships
a) To get the comfort of wiggle room in a hospital building, you should consider:
 function of space, number of users, furniture / equipment, accessibility of
space, in hospital buildings; and
 safety and health requirements.
b) To get the comfort of relationships between people should consider:
 space function, accessibility of space, and number of users and
furniture/equipment in hospital buildings;
 circulation between horizontal and vertical squares; and
 safety and health requirements.
B. Technical Requirements
In the case of the comfort requirements of wiggle room in hospital buildings do
not have SNI, standard standards and technical guidelines can be used by the
competent authorities.

2. Thermal Comfort Requirements in Space

A. Common
a) For thermal comfort in the space inside the hospital building should consider
the temperature and humidity of the air.
b) To get the level of temperature and humidity of the air in the room can be
done with an air conditioning tool that considers:
 the function of the hospital / space building, the number of users,
geographical location, orientation of the building, the volume of space, the
type of equipment, and the use of building materials;
 ease of maintenance and maintenance; and
 principles of energy saving and environmentally friendly
B. Technical Requirements
For thermal comfort in buildings must meet SNI 03-6572-2001 or the latest
edition; Procedures for the design of ventilation and air conditioning systems in
buildings.

3. Comfort View Requirements (Visual)

a) To get a comfortable view (visual) must consider the comfort of the view from
inside the building to the outside of the building to certain spaces within the
hospital building.
b) The comfort of the view (visual) from the inside of the building to the outside
should consider:
 building mass composition, opening plans, inner and outer layout of
buildings, and design of the exterior shape of the building;
 utilization of the potential outdoor space of the hospital building.
c) The comfort of the view (visual) from the outside into the building should
consider:
  opening design, indoor and outer layout of the building, and the design of
the exterior shape of the hospital building;
 the existence of existing hospital buildings and/or that will be around
them.
 prevention against glare disturbances and reflection of light.

4. Comfort Requirements Against Vibration Levels

Comfort to vibration is a state with a level of vibration that does not cause
interference to a person's health and comfort in carrying out his activities.
Vibrations can be shock vibrations, mechanical or seismic vibrations either derived
from the use of equipment or other vibrating sources both from inside the building
and from outside the building.

5. Comfort Requirements Against Noise

a) Comfort to noise is a state with noise levels that do not cause hearing loss, health,
and comfort for a person in carrying out activities.
b) Noise disturbances in buildings can be at risk of hearing loss. To protect the
disturbance, it is necessary to design an acoustic environment in place of activities
in existing buildings and new buildings.
c) To get a level of comfort to noise in hospital buildings must consider the type of
activities, use of equipment, and / or other sources of noise both in buildings and
outside hospital buildings.
d) Any hospital building and/or activity that, due to its function, has a noise impact
on its environment and/or on existing hospital buildings, should minimize noise
generated to the permissible extent.
e) For comfort to noise in hospital buildings must be met standards of comfort
planning procedures against noise in buildings.
f) The noise requirements for each room/unit in the hospital are as follows:
Table 6.2. Noise Indeks of Room Or Unit Type
MAXIMUM NOISE
NO. SPACE OR UNIT (EXPOSURE TIME 8
HOURS AND DBA UNITS)
Patient room
45
1 - when not sleeping
40
- during sleep
2 General operations room 45
3 Anaesthetic, recovery 45
4 Endoscopy, lab 65
5 X-ray 40
6 Corridor 40
7 Ladder 45
8 Office/Lobby 45
9 Tool Room/ Warehouse 45
10 Pharmacy 45
 11 Kitchen 78
12 Laundry Room 78
13 Isolation Room 40
14 Dental Poly Room 80

1.1.7. HOSPITAL BUILDING FACILITIES REQUIREMENTS

Ease requirements include the ease of horizontal relationships in the hospital, as well as
completing infrastructure facilities in the utilization of hospital buildings.
1. Horizontal Relationship Requirements
A. Common
a) Ease of connection to, from, and within hospital buildings includes easy, safe,
and convenient facilities and accessibility for people with special needs,
including people with disabilities.
b) The provision of facilities and accessibility should take into account the
availability of horizontal relationships between room in hospital buildings,
access to evacuation, including for people with special needs, including people
with disabilities.
c) The completeness of infrastructure is adjusted to the function of the hospital
building.

B. Technical Requirements
a) Each hospital building must meet the requirements of ease of horizontal
relationship in the form of the availability of doors and / or adequate corridors
for the implementation of the function of the hospital building.
b) The number, size, and type of door, in a room is considered based on the size
of the space, the function of the space, and the number of users of space.
c) The direction of the opening of the door leaves in a room is considered based
on the function of the space and safety aspects.
d) The size of the corridor as horizontal access between rooms is considered
based on the function of the corridor, the function of the space, and the
number of users.

2. Vertical Relationship Ease Requirements in Hospital Buildings

A. Common
Each multi-storey hospital building must provide a vertical connection between
floors that is adequate for the implementation of the function of the hospital
building in the form of the availability of stairs, ramps, elevators, walking stairs /
escalators, and / or floor runs / travelators.

B. Technical Requirements
a) The number, size, and construction of vertical relationship facilities must be
based on the function of the hospital building, the area of the building, and the
number of space users, as well as the safety of building users.
b) Each hospital building with a height above five floors must provide a vertical
 connection in the form of an elevator.
c) Public hospital buildings whose functions are in the public interest, both in the
form of religious functions, business functions, and social and cultural
functions must provide facilities and completeness of vertical relationship
facilities for people with special needs, including people with disabilities.
d) The number, capacity, and specifications of elevators as a means of vertical
relationship in buildings must be able to perform optimal service for vertical
circulation in the building, in accordance with the function and number of
hospital building users.
e) Every hospital building that uses an elevator must be available fire elevator
that starts from the ground floor of the building (ground floor).
f) Fire elevators can be fire-specific lifts or regular passenger lifts or freight
elevators that can be regulated, so that in an emergency they can be used
specifically by firefighters.

3. Evacuation Facilities Requirements

A. Common
Each hospital building should provide evacuation facilities for people with special
needs including people with disabilities which include:
a) a hazard warning system for users,
b) Emergency exit, and
c) Evacuation routes that can guarantee hospital building users to evacuate from
inside the hospital building safely in the event of a disaster or emergency.
B. Technical Requirements
a) For the requirements of evacuation facilities in hospital buildings must be
met with standards of planning procedures for evacuation facilities in
buildings.
b) In case there are still other requirements that do not have an SNI, can be used
standard standards and technical guidelines imposed by the competent
authorities.

4. Infrastructure/Public Facilities Requirements

A. Common
a) In order to provide convenience for hospital building users to move in it, every
hospital building for the public interest must provide completeness of
infrastructure and facilities for the utilization of hospital buildings, including:
worship rooms, toilets, parking lots, trash cans, and communication and
information facilities.
b) Provision of infrastructure and facilities adapted to the function and area of
hospital buildings, as well as the number of users of hospital buildings
B. Technical Requirements
Planning of facilities and infrastructure in hospital buildings follows:
a) SNI 03-1735-2000 or recent edition; Procedures for planning building access
and environmental access for the prevention of fire hazards in buildings.
b) SNI 03-1746-2000 or recent edition; Procedures for planning and installation
of exit facilities for rescue against fire hazards in buildings.
 c) SNI 03-6573-2001 or recent edition; Procedures for the design of vertical
transportation systems in the building (elevator).
d) Technical provisions of infrastructure and facilities of hospital buildings.
e) Technical provisions of Infrastructure and Facilities for the utilization of
hospital buildings and their completeness.
f) Technical Provisions Size, Construction, Number of Facilities and
Accessibility for Persons with Disabilities.
g) In the event that the above requirements do not have an SNI, standard
standards and technical guidelines can be used imposed by the competent
authorities.

1.1.8. DESCRIPTION OF THE HOSPITAL BUILDING

1. Outpatient Installation
The function of Outpatient Installation is as a place of consultation,
investigation, examination and treatment of patients in their respective fields provided
to patients who need a short time for their healing or do not require treatment services.
Polyclinics also serve as a place for the discovery of early diagnosis, which is the
place of examination of the first patient in the framework of further examination in
the stage of treatment of the disease.
The basic concept of polyclinics is in principle defined as follows:
a) The location of the Polyclinic is adjacent to the main road, easily reached from the
administration section, especially by the medical record section, closely related to
the pharmacy, radiology section and laboratory.
b) The waiting room in the polyclinic, should be quite spacious. There is a
separation of patient waiting rooms for infectious and non-infectious diseases.
c) The patient's circulatory system is carried out with one door (the patient's entry
and exit circulation at the same door).
d) Crowded poly-poly should not be close to each other.
e) Poly children are not placed close to The Pulmonary Poly, preferably Poly Anak
close to The Midwifery Poly.
f) The circulation of the attendant and the circulation of the patient are separated.
g) In each room there must be a sink (running water).
h) The poly is far from the incenerator room, IPAL and ME workshop.
i) If the concept of Hospital with Central Sterilization, there is no need for
sterilization room, but in some Polyclinics such as Dental Poli / ENT / Surgery
there must still be a sterilization room, because the tools used must be directly
sterilized for reuse (if patients are many).

The flow of activities on outpatient installations can be seen on the following flow
chart:
 Figure 6.17. Flow of Activities on Outpatient Installations

2. Emergency Department Installation

Every hospital must have an emergency service that has the ability to:
 Perform an initial examination of emergency cases
 Resuscitation and stabilization
Services in the emergency department of the hospital should be able to provide 24-
hour services continuously 7 days a week.
Have a top four specialist who is ready to call (on-call), a general practitioner who is
on-site (on-site) in 24 hours who has the qualification of GELS (General Emergency
Life Support) and or ATLS + ACLS services and is able to provide resuscitation and
stabilization of ABC (Airway, Breathing, Circulation) and has transportation tools for
referral and communication that are on standby 24 hours.
A. Service Program in the ER:
True Emergency (Emergency)
a) False Emergency (Emergency not emergency)
b) Cito Operation.
c) Cito/ Emergency High Care Unit (HCU).
d) Cito Lab.
e) Cito Radiodiagnostic.
f) Cito Blood.
g) Cito Depo Pharmacy.
B. Emergency Services in the ER:
a) Surgical Emergency Services
b) Obgyn Emergency Services
c) Child Emergency Services
d) Internal Medicine Emergency Services
 e) Cardiovascular Emergency Services

The basic concept of emergency care is in principle set out as follows:

a) The IGD area should be located in the front or face area of the RS site.
b) The IGD area should be easy to see and easily reached from outside the hospital
site (highway) with very clear and easy to understand signs of the general
public.
c) The IGD area is recommended to have a different vehicle entrance with a
vehicle entrance to the Outpatient/Polyclinic Installation area, Inpatient
Installation and Service Zone Area of the hospital.
d) For the rs site that is elongated following the length of the highway, the entrance
to the IGD area must be located at the entrance that was first encountered by
vehicle users to enter the RS area.
e) For hospital buildings in the form of multi-storey buildings (Super Block Multi
Storey Hospital Building) that has or does not have a basement floor (Basement
Floor), igd must be on the ground floor (Ground Floor) or an area that has
direct access.
f) IGD is advised to have an Area that can be used for the handling of victims of
mass disasters (Mass Disasster Cassualities Preparedness Area).
g) It is recommended on the area to lower or raise the patient (Ambulance Drop-In
Area) has a circulation system that allows the ambulance to move in one
direction (One Way Drive / Pass Thru Patient System).
h) The location of the IGD building is recommended close to the Inst. Central
Surgery.
i) The location of the IGD building is recommended adjacent to the Intensive
Care Unit (ICU (Intensive Care Unit)/ ICCU (Intensive Cardiac Care Unit)/
HCU (High Care Unit)).
j) The location of the IGD building is recommended close to the Midwifery Unit.
k) The location of the IGD building is recommended close to the Inst. Laboratory.
l) The location of the IGD building is recommended adjacent to the Radiology
Installation.

3. Inpatient Installation
The scope of activities in the hospital's Inpatient Room includes nursing care
and services, medical services, nutrition, patient administration, medical records,
patient family needs services (praying, waiting for patients, bathing, chapters,
kitchenettes/pantries, medical consultations).
Health services at the Inpatient Installation include: among others:
a) Nursing services.
b) Medical services (Pre and Post-Piercing Medical).
c) Medical support services:
 Radiological Consultation.
 Laboratory sampling.
 Consulting Anesthesia.
 Nutrition (Diet and Consultation).
  Pharmacy (Depot and Clinic).
 Medical Rehab (Physiotherapy and Consulting Services).
The basic concept of hospitalization is in principle defined as follows:
a) The overall room needs a relationship between spaces with the priority scale
that is required to be close and very related / in need.
b) Moving speed is one of the keys to the success of the design, so the unit block
should be made linearly / straight (elongated).
c) The recommended Inpatient Concept "Integrated Care" to improve the
efficiency of space utilization.
d) If the Inpatient Room is not on the ground floor, then there must be a ramp
ladder or a Special Elevator to reach the room.
e) The Inpatient Room building should be located in a quiet place (not noisy),
safe and comfortable but still have the ease of accessibility of inpatient support
facilities.
f) Morning sunlight as much as possible enters the room.
g) The flow of officers and visitors is separated.
h) Each of the 4 basic specialists has an isolation room.
i) The children's Inpatient Room is prepared 1 neonate room.
j) The floor should be strong and flat not hollow, the floor covering material can
consist of flat vinyl material or ceramic patio with flat grout so that ash from
dirt is not piled up, easy to clean, the material is not flammable.
k) The meeting of the wall with the floor is recommended in the form of a curve
to facilitate cleaning and not become a nest of dust / dirt.
l) The ceiling should be tight and strong, not fall out and not produce any other
dust/ dirt.
m) Type R. Hospitalization is VIP, Class I (2 beds), Class II (4 beds) and Class III
(6 beds)
n) Specific to certain patients should be separated such as:
 Patients suffering from infectious diseases.
 Patients with odor-causing treatment (such as tumor disease, ganggrein,
diabetes, etc.).
 Rowdy patients agitated (making noises in the room)
o) Nurse Station must be located at the center of the block served, in order for the
nurse to effectively supervise the service, serving a maximum of 25 beds.

4. Intensive Care Unit (ICU) Installation

It is an installation for the treatment of patients who are in severe pain after
severe surgery that requires intensive close monitoring and immediate action. ICU
(Intensive Care Unit) installation is a special service unit in the hospital that provides
comprehensive and continuous services for 24 hours.
a) The location of the ICU installation building should be adjacent to emergency
department installations, laboratories, radiology installations and central
surgical installations.
b) It must be free from electromagnetic waves and resistant to vibration.
c) The building should be located in a quiet area.
 d) The room temperature should be kept cool.
e) Electricity should not be cut off.
f) Air humidity regulators should be available.
g) It is recommended that air circulation is conditioned entirely fresh air (fresh
water).
h) It is necessary to prepare grounding points for electrostatic equipment.
i) Medical Gas flow (O2, pressurized air and suction) are available.
j) Smokeproof door &not flammable, there is a smoke cleaner in the event of a
fire.
k) There is a spacious evacuation door with ramp facilities if the ICU installation
is not on the ground floor.
l) The ICU/ICCU room should be fireproof (not flammable either from the
inside/ from the outside).
m) The meeting of the wall with the floor and the meeting of the wall with the
wall should not be in the form of an angle / must be curved to facilitate
cleaning and not become a nest of dust and dirt.

5. Obstetrics and Gynecology Installation

Services available at the Obstetrics and Obstetrics Facilities of Haji Medan
General Hospital:
a) Maternity services. Maternity services include: examination of new patients,
maternity care when I, maternity care when II (labor assistance), and the care
of newborns.
b) Nifas service. Nifas services include: normal nifas service and problematic
nifas service (post sectio caesaria, infection, pre-eklampsi/ eklampsi).
c) Reproductive health services / obstetric diseases. Reproductive health services
include miscarriage services, obstetric diseases and pregnancy disorders.
d) Obstetrics action/operation services. Obstetrics services are to provide actions,
such as vaginal polyp exerpasition, sectio caesaria surgery, uterine myoma
surgery, etc. This activity is carried out in the operating room located in the
Central Surgical Installation and can only be carried out at the Midwifery
Installation if it already has adequate operating equipment (e.g., anaesthetic
equipment, operating table, patient monitor and operating lamp).
e) Kb (Family Planning) Services. In order to improve the health of mothers and
children it has been established that the District / City Health Service Facilities
that 75% of hospitals in Kab / Kota organize PONEK (addition of rooms for
Emergency Mother & Child).
Services available at the Obstetrics and Obstetrics Facilities of Haji Medan General
Hospital include:
a) The basic concept of obstetrics and content installation is in principle set out
as follows:
b) The location of the obstetrics and obstetric installation buildings should be
easily reached, it is recommended to be close to emergency departments, ICU
and Central Surgical Installations, if they do not have an adequate operating
room or action room.
c) Bagunan should be located in a quiet / no noise area.
 d) The baby room and the mother's recovery room are recommended to be close
together to make it easier for the mother to see the baby, but it should be done
with a joining care system.
e) It has an adequate air circulation system and air humidity regulators are
available for thermal comfort.
f) There is a spacious evacuation door with ramp facilities if the location of
obstetric installations and obstetric diseases is not on the ground floor.
g) There should be a separate exit for corpses and dirty materials that are not
visible to patients and visitors.

6. Central Surgical Installation (COT/Central Operation Theatre)

A surgical installation is a special unit in a hospital that serves as a place to
perform surgery effectively and acutely, which requires sterile conditions and other
special conditions.
a) The entrance of sterile items should be separate from the exit of dirty items &
clothes.
b) Division of the area around the surgical chamber:
 Public Area, meaning an area that can be entered by everyone without
special conditions. This area for example: waiting rooms, corridors,
surgery rooms.
 Semi-Public Area, meaning that this area should only be entered by certain
people, namely officers, and there are already restrictions on the type of
clothing worn by these officers (special clothing or loose-sandals / shoes,
and so on).
 The ASEPTIK area, which is the area of the surgical room itself, which
should only be entered by people who directly have something to do with
surgical activities at that time, is generally considered an area that must be
maintained sacredness. In this area there is often still an additional term:
namely the so-called 'HIGH-ASEPTIC' area, which is meant by the area
where the surgery was performed and its surroundings (surgical field).

c) Every 2 operating rooms should be served by at least 1 scrub up room.

d) There should be a separate exit for corpses and dirty materials that are not
visible to patients and visitors.
e) Operating room requirements:
 The door of the ideal operating room should always be closed during
operation.
 The recommended air change is about 18-25 times/ hour.
 Positive air pressure in the surgical room, thus will prevent the occurrence
of 'airborne' infection.
 Central air conditioning system, the ideal operating room temperature of
26 - 280C that must be maintained stability and must use absolute filters to
net microorganisms.
 Recommended space humidity is 70% (if using flammable anaestesi
material, then maximum humidity is 50%).
  Natural lighting uses dead windows, which are placed with a height above
2 m.
 The floor should be strong and flat or covered with flat vinyl or patio so
that dust from dirt is not piled up, easy to clean, materials are not
flammable.
 The meeting of walls with floors and walls with walls should be curved so
that they are easy to clean and not become a nest of ash and dirt.
 The ceiling should be tight and strong, not fall out and not produce any
other dust/ dirt.
 The door should be easily opened with elbows, to prevent nosocomial
occurrence.
 There should be see-through glass on the operating room wall facing the
side of the wall where the surgeon washes his hands.

7. Pharmaceutical Installation
The Pharmacy Unit at the Hospital is planned to be able to perform services:
a) Planning, procuring and storing drugs, medical devices reagents,
pharmaceutical radios, medical gases according to rs formulary.
b) Carrying out drug compounding activities according to the request of doctors
both for inpatients and outpatients.
c) Distribution of drugs, medical devices, pharmaceutical radio regensia &
medical gases.
d) Provide drug information services and serve drug consultations.
e) Able to support the activities of other health unit services for 24 hours.
The basic concept of pharmacy is in principle set out as follows:
 The location of the pharmaceutical installation must be integrated with the
hospital service system.
 Between facilities for the implementation of direct services to patients, the
distribution of drugs and medical devices and management are separated.
 Treatment should be provided regarding the management of cytotoxic
waste and hazardous drugs to ensure the safety of officers, patients and
visitors.
 There must be a storage area for special drugs such as the Administrative
Room for thermopolable drugs, narcotics and psychotropic drugs and
drugs / dangerous substances.
 The hospital's medical gas tube storage warehouse (Oxygen and Nitrogen)
is placed in its own warehouse (outside the pharmaceutical installation
building).
 Adequate and secure dedicated space is available to store documents and
recipe archives.

8. Radiology Installation
Radiology is a medical science that uses imaging technologies to diagnose and
treat diseases. It is a branch of medical science related to the use of X-rays emitted by
 X-ray aircraft or other radiation equipment in order to obtain visual information as
part of medical imaging.
Radiology Installation performs services as needed and requested by other
health units in the Hospital . Radiology units can also serve outside requests.
Radiology Services at Haji Medan General Hospital is to provide noninvasive
radiodiagnostic services with and without contrast, namely:
1. Radiodiagnostic (noninvasive)
a. Non Contrast
 Bones
 Thoracic
 Soft tissue
 Abdominal
b. With contrast
 IVP
 Cholecistography
 Fistulography
 Ceptography
 Hytero Salfingography
 Esophagography
 Duodenography ulcer
 Colon inloop (barium enema)
 Cor anaupe
2. Ultrasound examination for abdominal abnormalities, obstetrics and obstetric
diseases.
3. Able to support other unit activities for 24 hours a day and 7 days a week.

The basic concept of radiology is in principle set out as follows:

1. The location of the radiology room is easily accessible, adjacent to emergency
department installations, laboratories, ICU, and central surgical installations.
2. Circulation for patients and patient introduction are advised separately from staff
circulation.
3. The consultation room is equipped with facilities for reading movies.
4. Walls/doors follow the specific requirements of the radiation protection maze
system.
5. The dark room is equipped with an exhauster.
6. Air conditioning requirements:
a. The cool and comfortable temperature of the environment is at 22~26 OC with
a balanced pressure.
b. Air humidity in the radiation/inspection/irradiation chamber is between
45~60%.
7. Special radiological waste management is available.

9. Central Sterilization Installation (CSSD/Central Supply Sterilization

Department)
Central Sterilization Installation (CSSD) has the activity of washing and
 sterilizing (removing all microorganisms both by physical and chemical means) goods
/ materials such as medical instruments, gloves, gauze / sanitary pads / linen.
This system is one of the infection control programs in hospitals, which is a
must to protect patients from infection.
Activities included in the scope of CSSD installation are as follows:
1. Receiving materials, consisting of
a. New goods/linens/supplies from pharmaceutical installations that need
sterilization.
b. Instruments and linens to be reused.
2. Sort, calculate and record the volume and type of materials, goods and instruments
submitted by the General Hospital Installation room/unit.
3. Carry out the sterilization process.
a. Decontamination. Physical or chemical processes to reduce and/or eliminate
contamination in people, equipment, materials, and spaces by microbes
harmful to life, making them safe for later processes.
b. Packaging. Wrap, package and accommodate the tools used for sterilization,
storage and use. The purpose of packaging is to maintain the safety of the
material to remain in sterile conditions.
4. Submit and record the collection of sterile goods by the room / unit / General
Hospital Installation in need.

10. Laboratory Installation

The laboratory is planned to be able to serve three areas of expertise namely
clinical pathology, anatomical pathology and forensics to some extent from inpatients,
outpatients as well as referrals from other public hospitals, health centers or doctors of
private practice.
Laboratory examinations at Haji Medan General Hospital are:
1. Clinical pathology (Hematology, urine and stool analysis, clinical chemistry,
serologic/ immunology, Microbiology (on a limited basis)).
2. Diagnostic pathology, perform a complete examination for histopathology, frozen
cut, cytopathology and cytology.
3. Forensics can perform corpse treatment and cadaver surgery.
The laboratory service is also equipped by the following facilities:
 Blood Sampling and blood banks
 Administration of specimen receipts
 Regensia warehouses & chemicals
 Waste disposal facility
 Libraries, or at least bookshelves
The basic concept of the laboratory is in principle set out as follows:
 The walls are coated by materials that are easy to clean, not slippery and
watertight as high as 1.5 m from the floor (e.g. from ceramic or porcelain
materials).
 Laboratory floors and work desks are coated with materials that are resistant to
chemicals and vibrations and do not crack easily.
 Access to officers with patients/visitors is advised separately.
  On each pole the laboratory room is equipped with a sink (sink) for hand
washing and washing tools.
 Must have a special waste treatment plant.

11. Medical Rehabilitation Installation

Medical Rehabilitation Services aims to provide the maximum possible rate of
return of bodily functions to the patient after loss / reduction of functions and abilities
that include, prevention / countermeasures, return of function and mental patients.
The scope of medical rehabilitation installation services at Haji General Hospital
includes:
a) Physical rehabilitation
 Rehabilitation of the cardiovascular system
 Rehabilitation of the respiratory system
 Rehabilitation of neuromuscular and locomotor systems
b) Mental Rehabilitation
c) Social Rehabilitation
Basically the layout of the Medical Rehabilitation Unit is set on the basis of:
a) The location is easily reached by the patient, it is recommended that it is located
close to outpatient / polyclinic installations and hospitalizations.
b) Waiting rooms can be reached from the general corridor and close by the
registration, payment and administration counters.
c) It is recommended that entry for patients is separate from staff entry.
d) It is recommended to use a natural air circulation/air ventilation system.
e) For patients who use wheelchairs are provided a special toilet that has enough area
to move the wheelchair.

12. Hospital Administration and Secretarial Chart

A part of the hospital where the hospital management is carried out. It consists
of:
a) Board of Directors of rs
b) Medical Committee
c) Nursing Section
d) Service Section
e) Finance and Program Section
f) Secretarial and Medical Records. A sub-section of the Secretarial that records and
stores files of identity, history of disease, examination results and treatment of
patients. Medical record system applied in public hospitals is centralization, so:
- Each patient will have only one number.
- The storage of medical records of outpatients and inpatients becomes one.
g) Internal Surveillance Unit (SPI) Administrative placement wherever possible is
easy to achieve and can be directly related to polyclinics.

13. Body Repatriation

The function of the mortuary is:
a) Place to temporarily place the body before being taken by his family.
 b) Where to bathe/decontaminate jenazah.
c) Where to dry the body after being bathed
d) Autopsy of the body.
e) Funeral and retirement room.
The basic concept of body retirement is in principle set out as follows:
1. The capacity of the mortuary has a minimum number of refrigerators 1% of the
number of beds (in general 1 refrigerator can accommodate 4 bodies) or
depending on needs.
2. The mortuary is recommended to have direct access to several other installations,
namely emergency department installations, Obstetrics and Obstetric Diseases
Installations, Inpatient Installations, Central Surgical Installations, and ICU /
ICCU Installations.
3. The area is enclosed, inaccessible to unauthorised persons.
4. The area that is the path of the corpse is recommended to be tiled, watertight, not
porous, easy to clean.
5. Access in and out of the body using double door leaves / double fold.
6. It has a special sewage system.

14. Kitchen Nutrition Installation

The kitchen service system applied in the hospital is centralization except for
the processing of infant formula. Nutrition / Kitchen installation has a function to
process, organize patient food every day, and nutritional consultation. The basic
concept of nutritional installation is in principle set out as follows:
a) Easily reached, close to the Inpatient Installation so that the time of distribution of
food can be evenly distributed for all patients, especially inpatients.
b) The location of the kitchen is arranged in such a way that the noise (sound) of the
kitchen does not disturb the room around it.
c) Not close to landfills and morgues.
d) It has its own street and entrance.

15. Laundry installation

Laundry is a linen wash that is equipped with supporting facilities in the form
of washing machines, tools and disinfectants, steam boilers, dryers, tables, and ironing
machines.
Linen washing activities consist of:
a) Collection
 Sorting between infectious and non-infectious linen starts from the source and
puts the linen in a plastic bag according to its type and is labeled.
 Counting and recording linen in the room.
b) Acceptance
 Record linens that are accepted and have been split between infectious and
non-infectious.
 Linen is sorted based on its level of defilement.
c) Laundering
 Weigh the weight of linen to adjust to the capacity of the washing machine
 and the needs of detergents and disinfectants.
 Clean dirty linen from feces, urine, blood, and vomit then soak it using a
disinfectant.
 Washing is grouped based on its level of defilement.
d) Drying
e) Ironing
f) Storage
 Linens should be separated according to their type.
 The new linen received is placed in the bottom closet.
 The closet door is always closed.
g) Distribution is done based on the receipt card from the receiving officer, then the
officer hands clean linen to the room officer according to the receipt card.
h) Transportation
 Bags for wrapping clean linen should be distinguished from bags for wrapping
dirty linen.
 Use strollers of different colors and cover between clean linen and dirty linen.
Strollers should be washed with disinfectant after use transporting dirty linen.
 The time of transport of clean and dirty linen should not be done
simultaneously.
 Clean linen is transported in strollers of different colors.
 Hospitals that do not have their own laundry, transportation to and from the
laundry place must use a special car.
The basic concept of laundry is in principle set out as follows:
a) There are clean water taps with adequate quality and flow pressure, hot water for
disinfection with environmentally friendly disinfectants. Hot water temperatures
reach 700C within 25 minutes (or 950C within 10 minutes) for washing the washing
machine.
b) Washing equipment is permanently installed and placed close to the sewerage and
there is a washing machine that can wash different types of linen.
c) Closed wastewater channels are available equipped with initial treatment (; pre-
treatment) special laundry before being streamed to IPAL HOSPITAL.
d) For non-infectious linens (e.g. from office administration rooms) access to the
washing room without going through the decontamination room.
e) It is not recommended to have a dirty linen storage area.
f) The standard germ for clean linen after exiting the process does not contain 6 x 103
bacillus species spores per square inch.

16. Mechanical and Electrical Facilities Maintenance Installation (Workshop)

The main tasks and functions that must be summarized by the workshop unit are, as
follows:
a) Maintenance and minor repairs on:
 Medical peralatan (Optical, electromedic, mechanical etc.)
 Medical support equipment
 Metal/metal household appliances (including bedding)
 Wooden household appliances
  Channels and piping
 Electricity and electronics
b) Repair activities are carried out with the following procedures:
 Reports of any units that have suffered tool damage
 The equipment is examined the extent of the damage to find out the level of
repair required technical practicality of the implementation of the repair
(whether sufficiently repaired in its place, or must be taken to the workshop
room)
 Damage analysis
 Process of procuring components / parts
 Implementation of component repair/installation
 Light building repairs
 Electricity/ Electronics
 Phone/Audio Visual.
Located far from the treatment area and medical support buildings, it should
be placed in the service area because it causes a lot of noise.

1.2. NEEDS AND FULFILLMENT OF FACILITIES AND INFRASTRUCTURE

Based on the Regulation of the Minister of Health of the Republic of Indonesia
Number 3 of 2020 on Hospital Classification, it is mentioned in article 24 paragraph (4)
regarding the classification of general and special hospitals:

Figure 4.1.The Law on Hospitals

 Figure 6.18. Classification of General and Special Hospitals

The calculation of human resources needs of Haji Medan General Hospital is based
on various methods with more emphasis on the calculation of needs based on the
estimation of the number of patients with some adjustments to suit the needs of a hospital.

1.2.1. Human Resources Needs of Medical Services

The calculation of health human resources needs in hospitals refers to Decree
No.262 / Menkes / Per / VII / 1979 on the calculation of health needs based on the
comparison between the number of beds with certain types / categories of energy. In the
decree, health human resources are divided into 4 categories, consisting of medical
personnel, paramedics, care, non-care paramedics, and non-medical personnel.

Table 6.3. Health Human Resource Standards in Hospitals

RATIO OF Bed to Human Resources
NO. CLASS
CE TPP TPNP TNM

1 A and B (4 - 7) :1 (3-4) :2 3:1 1:1

2 C 9:1 1:1 5:1 4:3
3 D 15:1 2:1 6:1 3:2
Description: TT=Bed; TM = Medical Personnel; TPP = Medical Care Personnel
TPNP = Non-Care Medical Personnel; TNM = Non-Medical Personnel

To facilitate the calculation, for hospitals class A and B used the ratio of bed to
medical personnel = 4: 1 and the ratio of bed to paramedic care = 3: 1 (minimum standard)
The standard used to calculate the needs of specialist doctors in hospitals refers to
the manual for the implementation of hospital services of the Directorate General of
Medical Services Ministry, 2008 as follows:

Table 6.4. Hospital Specialist Staff Standards

CLASS SpOG Spa SpPD SpB Span Spr SpPK Total
B 3 3 3 3 2 3 3 20
B pend 5 5 5 5 5 4 4 33
C 2 2 2 2 1 1 1 11
D 1 1 2

The need for human resources for medical services should be the main concern,
because medical services are core bussines in hospitals. An overview of the human
resources needs of medical services of Haji Medan General Hospital, up to the next 10 years
simulated by the calculation-based ratio method above is presented in the following table
4.3
The number of personnel ranging from medical personnel, pamedis, other health,
non-medical and administrative at Haji Medan General Hospital showed an increase since
2011. In 2015 there were a total of 2,358 permanent and contract employees.
The number is quite high in nurses and midwives who number 1,502 people. When
coupled with nurses and midwives who have a bachelor's degree or equivalent, then the
number increases to 104 people. So that the total number of nurses and midwives reached
1,606 people or reaching 68% of the total employees.

Table 6.5. Number and type of employment at Haji General Hospital 2011-2015
NO TENAGA KESEHATAN 2011 2012 2013 2014 2015
1 MEDIS
a Dokter Umum 87 75 101 99 121
b Dokter Gigi 26 22 35 31 25
c Dokter Spesialis 54 10 13 12 85
2 PARAMEDIS
a Perawat 618 325 466 492 752
b Bidan 372 617 636 655 750
3 PARAMEDIS NON PERAWATAN
a Gizi 23 19 22 24 44
b Sanitarian 60 43 54 7 45
c SMF 11 17 14 20 48
d Analis Kesehatan 30 21 28 26 56
e Rontgen 11 4 7 8 24
f Anastesi 10 3 2 2 -
g Teknik Medik 2 1 1 1 2
h Rekam Medik - - 1 1 6
i Fisiotherapy 9 5 5 5 7
j Perawatan Gigi 26 23 24 21 23
k Teknik Gigi 19 2 1 1 -
4 APOTEKER 20 9 10 10 17
5 SARJANA KESEHATAN
a S2 Kesmas 7 5 8 12 13
b S1 Kesmas 64 70 76 54 54
c S1 Keperawatan 63 52 64 63 64
d S2 Keperawatan - - 1 1 1
e S1 Farmasi 5 3 1 1 1
f D4 Kebidanan - - 5 3 3
6 NON MEDIS 38 32 39 39 39
7 TENAGA LAINNYA
a S1 lain 17 14 22 25 24
b S2 lain - - 1 1 1
c S1 Teknik 4 5 3 3 3
d SLTA 216 84 134 137 106
e SLTP 39 16 31 25 18
f SD 23 6 13 15 13
g D1 dan D3 lainnya - - 17 16 13
JUMLAH 1.854 1.483 1.835 1.810 2.358
Source:
Primary data, Haji Prov HOSPITAL staff. SUMUT

1.2.2. Analysis of Medical Personnel Needs

To support the needs of medical personnel and paramedics in the Building of
Dr Pringadi Hospital of North Sumatra Province, especially Medan City, in this case
the guidelines / standards for the needs of medical personnel and paramedics of a
hospital refer to the Regulation of the Minister of Health (Permenkes) No. 3 of 2020
concerning the classification and licensing of hospitals.
 Article 11 of the regulation states that the Human Resources of Class B
General Hospitals consists (in accordance with the accreditation of Haji Medan
General Hospital) consisting of:
a) Medical personnel.
b) clinical psychologists;
c) nursing personnel;
d) obstetric energy;
e) pharmaceutical energy;
f) public health workers;
g) environmental health workers;
h) nutritional energy;
i) physical energy;
j) medical technical personnel;
k) biomedical engineering personnel;
l) other health workers; and
m) non-health energy.
The number and qualification of human resources above in the form of permanent
workers who work on a full-time basis are appointed and determined by the Hospital
Leadership adjusted to the results of analysis of workload, needs, and service capabilities of
the Hospital. In addition to permanent personnel, the Hospital can employ irregular personnel
and / or hospital consultants in accordance with the provisions of the laws and regulations.

1.2.3. Nursing Needs

With the update of data conducted by THE INITIAL Review 2017, the study
estimates the number of nursing workers based on government hospital employment
standards. Determination of the number of nursing personnel follows the Government
Hospital Military Standards stipulated in the Regulation of the Minister of Health no. 262 /
MEN. KES/Per/VII/1979, with a ratio of the number of beds.
For Type A Hospitals, it is in accordance with Decree No. 3 of 2020 on Classification and
Licensing of Hospitals mentioned the number and qualifications of human resources above in
the form of permanent workers who work on a full-time basis appointed and determined by
the Hospital Leadership adjusted to the results of analysis of workload, needs, and service
capabilities of the Hospital. In addition to permanent personnel, the Hospital can employ
irregular personnel and / or hospital consultants in accordance with the provisions of the laws
and regulations.

1.2.4. Needs in the Hospital Development Program.

According to the calculation of labor standards in hospitals, cakan will be at
the forefront if it already has the addition of beds in the VIP and SVIP classes which
are estimated to amount to 400 beds. The estimated needs of employment are:
 Table 6.6. Needs in the Development Program Haji Medan General Hospital
Number of bed = 400

Medical personnel =1:4 = (400 bed /4) x 1 = 100

Nursing personnel =1:1 = (400/1) = 400 + 20 midwives
Non-care personnel =1:3 = (400 bed /3) x 1 = 133.3
Non-medical personnel = (400 bed /5) = 80
Administration =(400bed/5)/need = 80
Total     = 813 people
Source: Analyst Consultant

The details of employment at Haji Medan General Hospital in the future are:

Table 6.7. Details of Employment at Haji Medan General Hospital in the future
NO SDM JUMLAH
1 TENAGA MEDIS
a. Dokter 125
b. Dokter Gigi 25
2 TENAGA KEPERAWATAN
a. Perawat 600
b. Bidan 20
TENAGA NON KEPERAWATAN/TENAGA
3 200
KESEHATAN LAIN
4 TENAGA NON MEDIS
a. Apoteker 36
b. Tenaga Kefarmasian 28
c. Radiografer 20
d. Analis Kesehatan 18
e. Tenaga Gizi 18
5 ADMINISTRASI DAN MENEJEMEN 120
JUMLAH 1210
As an overview and comparison of health human resources needs can be seen from
the table below;

Table 6.8. Minimum Standards of Health Human Resources

General Hospitals Class A, B, C, and D (PMK No. 56/2014)
Source: Analisis Consultant

1.3. ANALYSIS OF HUMAN RESOURCES NEEDS OF HAJI MEDAN GENERAL HOSPITAL

The hospital is a capital-intensive, technologist and labor-intensive organization. This
condition requires proper planning of human resources that are at the core of the
organization. Human resources in hospital health services are a representation of technology
and health services. Human resource investments must be appropriately allocated and
developed optimally.
Health services by hospitals consist of medical and supporting services, administrative
services and hotel services. In the eyes of patients, the three components are accepted as a
unit that affects patient satisfaction. So that the hr development strategy in the hospital must
be balanced and pay attention to all components of the profession. For example, the
cleanliness and comfort of the room is often a patient complaint, although the assessment of
medical services is good. Administrative complexity is also often a source of patient
dissatisfaction.
The study of human resource capabilities is assessed by comparison of the condition of
Haji Medan General Hospital and human resource needs in accordance with class B hospital
service standards. Another consideration is the type of profession resources needed in
accordance with the nature of hospital services. Hospital medical services require specialist
doctors, general practitioners, nurses and midwives.
Medical support services require nutritional, pharmaceutical, laboratory and radiology
personnel as well as sterilization. Non-medical support services needed are sterilization and
laundry services, maintenance of facilities and environmental management. Another
component that also contributes is cleanliness and safety which also requires professionals.
In addition to functional aspects, administrative and management functions must also be
considered in the development of human resources. Support services and management
administration — although it does not contribute direct income, but it is a necessity to be
able to run the function of income-generating units in this case medical services.
Schematically the system of services and human resources in hospitals is described in the
following scheme.

Figure 6.19. Hospital service scheme

To illustrate the condition of human resources presented a table of human resource
composition based on professional groups and installations with educational qualifications in
conditions in 2004-2009. As a comparison presented the needs of human resource standards
that are taken into account with regard to service capacity, work intensity, and
professionalism. The needs of nurses and midwives are taken into account using
Department of Health standards that take into account workload, number of patients,
services, shifts and qualifications according to the level of professionalism of the work.
Nutritional needs are taken into account based on service organization, volume of activities
(number of patients and menu). The needs of cleaning service personnel are taken into
account by considering the area and type of facilities that must be cleaned while security
personnel consider the number of building blocks and doors. Standards for other supporting
personnel are calculated by considering the function, capacity of work and service.
Medical and non-medical support services also play an important role to create the
quality of medical services. Overall, there is a shortage both in terms of quantity and
quality. In laboratory installation required high school equivalent qualifications, being a
Diploma health analyst and still required additional staff with Diploma qualifications health
analysts. When referring to the standards and development of services required clinical
pathology specialists who can be fulfilled with the task of learning one from the staff of
general practitioners with civil servant status.
Nutrition services are usually patient complaints and are part of a therapy management
program, so they must also be managed professionally. At least one Head of Installation
with a Nutrition Bachelor qualification as well as the addition of 6 people as a cook with a
high school equivalent qualification with a Boga major or Boga course.
Administrative personnel in each part / installation play an important role that does
not always have to be summarized by functional personnel in line with the growing service.
The accuracy of service data recordings will support planning and development. Proper
administrative processes also support the overall speed of service.
 Facility maintenance installations play an important role that is often overlooked given the
large number of medical equipment and technologies that require specialized maintenance.
To manage this, requires one expert with an electromedic Bachelor qualification as well as a
head supported by technical staff who are able to manage workshops and meetings
consisting of four types, namely woodworking, metal, electromedicy and other medical
support.
Non-medical support functions that still have to be developed are sterilization
services, laundry and linen. In line with the development of trauma services, Surgery room
and intensive care needs to be supported by sterility of tools, in addition to adequate
environmental sanitation. According to the process and function required the power of the
Head of Installation and administrative parts, reception, sterilization processing, packaging
and distribution. Similar organizations and functions are also found in laundry services that
can be added to the function of independent linen development by the hospital.
Other supporting functions needed are driver, safety and cleanliness that also need to
be considered. Driver power, especially ambulance and hearse drivers, provides direct
services to the community with a rapid response. Security provides a sense of comfort to
service users who are twenty-four hours. Likewise with cleaning services and parks that not
only support beauty but play a role in preventing infections in hospitals. Quantitatively,
security personnel are needed of 3-4 people with placement at the entrance of the building,
and in each building. Security guards in addition to functioning for security also regulate
service order as well as the first source of information for customers. Professionalism and
supervision are required to ensure the condition of all rooms and service facilities in the
house in a clean state for 24 hours.
The fulfillment of management and administrative personnel in general has met the
minimum needs. In line with improving the quality of service, training is still needed in the
field of strategic and planning and leadership. Management and administration services need
to be supported by a computer-based information system that is adequate so that it can
support management functions.
Tiered and sustainable education and training programs are a must for Haji Medan
General Hospital which must be supported by restructuring. Inequality is found in
paramedics whose qualifications are still many below the standard even though the numbers
have been met.
The human resources condition of Haji Medan General Hospital at this time is very
much more than enough to perform both medical and non-medical services, this can be
seen from the comparison of existing ratios for Type B hospitals, as in the Medical Personnel
group (1:4) with the number of beds available at the present time 248 bed should be
medical personnel required with enough 62 people, However, in practice the management
wants service satisfaction in the selection of doctors (medical personnel), so that in 1 poly
there are several 5-6 different doctor choices, this certainly depends on how the strategy of
the hospital marketing party in performing services to the community, so that the number
of medical personnel at this time becomes greater there are 121 people the number of
medical personnel. For projections up to 5 years ahead of the needs of Medical Personnel
with the needs of 400 bed. Therefor, for this we simulate the needs with the addition to 133
people, and for up to 10 years the addition to 146 people.
 For Paramedic Care Personnel with the current condition of Haji Hospital already has
1502 medical personnel, this number is theoretically very overloaded with the number of
beds available now (248 bed) with a ratio of 1: 1 then the number that should be 248
people, and if you want to multiply 3x to get good service (3 shif) then this number is also
still excessive, So that with the increase in the number of beds in the future to 400 bed,
then according to our analysis the number of Paramedics Perwatan does not need to be
added anymore., still with 1502 people now.
For Non-Care Paramedics, with the current condition of Haji Hospital already has 255
people, this number has also exceeded the standard requirement for Non-Care Paramedics
which should be 1:3 with the number of beds available, the number should be 82 people,
with the increase in the number of beds in the future to 400 bed, then according to our
analysis the number of Non-Care Paramedics does not need to be added anymore. It's still
with 255 people now.
For Non-Medical Personnel, with the current condition of Hajj Hospital already has
39 people, for Non-Medical Personnel power the comparison is 1:5 to bed, then the
appropriate number is 50 people, so that the needs of Non-Medical Personnel is still less for
the number of bed now, for the next stage with the need of 400 bed then the needs of Non-
Medical Personnel can be calculated with a ratio approach of 1:5 so that the number of
Non-Medical Personnel is 80 people.

1.4. STAKEHOLDER ANALYSIS

The parties involved in the Haji Medan General Hospital Project are:
a. Owner / Equity Investor (Project Owner)
b. Government
c. Lender/Bank
d. Insurance Company
e. Hospital management
f. Costumer / Patient
g. Prime Contractor
h. Consultant
i. Medical Supplier
j. Guest Doctor
k. Pharmaceutical Supplier

Each party in the Haji Medan General Hospital project has duties, rights and
obligations for its role in the project.

1.4.1. Owner / Equity Investor (Project Owner)

The owner of the project at Haji Medan General Hospital is the Haji Medan
Foundation and acts as the initiator of the project (idea owner), where basically the taskor
as a lay party conveys his intention and will to build to those who are trusted and known to
have expertise in the field of construction. The trusted construction expert is assigned to
pour the task force initiative into the form of design ideas (designs) and then simultaneously
build it (realized physically).
Based on the principle of trust in a professional way (trust worthy) they form an
agreement. Construction experts provide services through their expertise while the taskor
provides certain rewards for the services provided.

The duties and authority of the owner / equity investor include:

1. take care of the administration and permit of the implementation of the project to the
appropriate parties, both to the government and to other relevant parties.
2. select a project development team responsible for project funding in accordance with
the contract agreement
3. Provide the required data to the consultant
4. preparing auction documents and other auction completeness determines the winner
of the auction
5. Make decisions on changes in implementation time
6. Agree or disagree with job changes
While the right of the owner is to receive a report of accountability from other
parties related to this project.

1.4.2. Government
The government in this case is the party that serves as a regulator, the party that
issues regulations on land use, taxation and licensing. All project activities must be in
accordance with applicable regulations.
In the construction project of Haji Medan General Hospital, the relevant
government is the Medan City Administrative Office which issued regulations on the
Intensity of Space for Building Utilization that lead the planner to be able to plan the
building in accordance with its purpose. In addition, it is also involved the Health Service
that issued permits about the construction of this hospital. At the time of operation of the
hospital also involved the Cleanliness Office which is obliged to carry out transportation of
hospital waste (not dangerous) or hazardous waste that has undergone previous
processing and also the Medan City Environment Agency which issued recommendations
for environmental management documents.

The obligations of the government are:

1. Issuing permits that guarantee that the building is in accordance with the spatial plan
2. Ensuring that established buildings have facilities that are in accordance with the needs
of the building itself (e.g., hospitals have sewage treatment facilities, etc.)

The rights of the government are:

 1. Receive tax payments on taxable objects
2.Issue a sealing letter on the building if it is found that the building is not in accordance
with the original plan and applicable regulations in accordance with applicable law.

1.4.3. Lenders
Is a body or institution that can lend funds to the project in the development
process in addition to funds other than the equity of the project owner. These lenders are
usually in the form of banks, insurance, leasing companies or other financial institutions.

The obligations of the lender are:

1. Give a certain amount of money in accordance with the existing contract
2. Make a letter of agreement on stamp duty about the loan agreement so as not to
cause problems in the future

The rights of the lender are:

1. Get payment for the money borrowed in accordance with the agreement at the
beginning
2. Earn interest or profit on money lent in accordance with the agreement
3. Get a guarantee that the borrowed money will return in accordance with the
agreement
4. Projects that borrow funds from lenders are obliged to pay.

1.4.4. Insurance Company

The insurance company here is the party that is given confidence by the owner in
the investment he has, namely buildings and medical devices.
The obligations of this insurance company are:

1. Providing guarantees on buildings and medical devices

2. Provide reimbursement for losses if the building or medical devices experience
impaired function / damage in accordance with the agreement that has been
established.

The rights of the insurance company are:

1. Get a premium payment on the protection provided to assets owned by the hospital
2. Refuse to pay a replacement for losses if it is not in accordance with the agreement.

1.4.5. Hospital Management

Hospital Management is the party that conducts management and operational
activities on the project of Haji Medan General Hospital. To support hospital management
activities required organizational devices consisting of departments responsible for their
respective parts.

The obligations of hospital management are:

1. Managing, operating performing actions that can provide benefits to the Haji Medan
General Hospital Project.
2. Make regulations that must be obeyed by all parties in Haji Medan General Hospital
during the operational period.
3. Create a monthly report that can be accounted for to the owner / owner of capital.
4. Maintaining the quality, quality and good name of Haji Medan General Hospital
5. Create programs to improve the quality of services and programs
6. Create educational and training programs for doctors and other medical workers to
increase knowledge and improve medical quality
7. Providing satisfactory health care for patients
8. Provide health care information for the whole community to increase the number of
patients

The rights of the Hospital Management are:

1. Receive payment for medical services received from patients
2. Conduct the management and operation of Haji Medan General Hospital in full
3. Receive payment from the guest doctor in accordance with the agreement that has
been established.

1.4.6. Customer / Patient

In a hospital, the patient is the primary consumer. These patients can refer for
inpatient, outpatient, polyclinic, or just redeeming the drug in the pharmacy. With varying
financial conditions, patients are given the freedom to choose inpatient classes according
to their abilities.
The obligations of the patient are:
1. Comply with all regulations set by rs management
2. Resolving all administrative (financial) affairs
3. Getting adequate medical services in accordance with hospital service standards
4. Get information about existing medical services
5. Get easy payment with insurance (if you have).

1.4.7. Main Contractor

After the planning documents arranged which is consist of architectural drawings
and drawings of technical details, technical and administrative specifications then carried
out physical development. So that the main role of the contractor is as a resource
manager who is tasked with converting planning documents into outputs in the form of
physical buildings.
 By the contractor the planning drawings as part of the planning document are then
clarified and translated into work drawings for the purposes of operation and
implementation. Through the work image, the contractor must direct the foreman and his
workers to be able to install the components as well and precisely as possible.

1.4.8. Consultant
Consultant planner is the appointed owner to plan and design the building. The job
of a consultant is to give and pour thoughts, ideas, or ideas that are more software(
software). The consultant is assigned a direct appointment by the owner and related in the
agreement that has been made between the two.

The duties and authority of architectural planner consultants include:

1. Carry out the complete project architecture design along with the required images,
based on the wishes of the owner
2. Providing advice or consulting on the field of architecture to the owner

The duties and authority of consultant planners in the field of structure include:
1. Conduct the necessary investigations in the planning of the structure
2. Responsible for the complete structure planning with the required material details
including structural calculations
3. Perform additional calculations of design changes at the request of the owner (as
agreed both)
The duties and authorities of consultants in the field of Mechanical and Electrical (M / E)
are: planning and installing mechanical and electrical installations.
The right of the consultant is to get payment in accordance with the consulting services
provided.
1.4.9. Supplier of medical devices
Suppliers of medical devices are suppliers appointed to procure medical devices
such as operating tables, electric beds, etc. The obligation of the supplier is to provide
goods in accordance with the specifications that have been determined in a timely and
appropriate budget. While the right of the supplier is to get payment for the results of
procurement of goods.

1.4.10. Health Insurance Company

This insurance company is a party related to funding needs related to patient
health where the patient as a costumer of Haji Medan General Hospital The obligation of
the insurance company is to provide adequate health insurance to patients in accordance
with the premiums paid. The right of the health insurance company is to get the payment
of insurance premiums by the customer (patient).
1.4.11. Guest Doctor
Guest doctor is the party that provides health services to patients related to their
profession as a doctor who is bound by the code of ethics of medicine.

The obligations of the guest doctor are:

1. Providing health services in accordance with the field of knowledge that he pursued to
the maximum to improve hospital services.
2. Providing payment for each patient served in accordance with an agreement with the
Hospital Management.

The rights of the guest doctor are:

1. Can take advantage of available health care facilities.
2. Accept payments for the patients they serve.

1.4.12. Pharmaceutical Supplier.

Pharmacy supplier is a supplier that cooperates with the management of hospitals
related to the procurement of pharmaceuticals or drugs and medical equipment for
operations such as autoclave, etc. The obligation of the supplier is to provide goods in
accordance with the specifications that have been determined in a timely and appropriate
budget. While the right of the supplier is to get payment for the results of procurement of
goods.
From the interrelationships that occur between stakeholders, a hospital project is
said to be feasible if all stakeholders are willing to fulfill their obligations so as to get rights
in accordance with the initial agreement that has been agreed. Therefore, there is a
mutualism relationship that is mutually beneficial either between the parties involved or in
other words all stakeholder expectations have been fulfilled.