3 Hospital Planning

Senapati Bapat Road, Pune: 411004, (MS), India
Phone: 91-20-25655023, 8888892258

Email: pgdhhm@schcpune.org
Website: www.schcpune.org
Roll number: 17200077
Name of the program: PGDHHM -Post Graduate Diploma in Hospital & Health Care
Management
Assignment no. 6 (based on module 6): Hospital Planning

Total marks: 100
2nd Set of Assignments (Modules 6 to 11)

Module 6
Hospital Planning
Total: 100 Marks
Answer the following questions. Each question carries 20 marks.
1. One NRI is interested to start one super specialty hospital in India. He has invited project
proposals for the same. As a person interested in it prepare a proposal with the help of
following:
• Planning
• Designing
• Site selection
• Facilities & services
• Hospital engineering
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The following guiding steps will be used to construct the hospital proposal under the following
sequence of actions.
Importance of Planning:
Although to treat the patients, hospitals need to have a team of experienced and professional
doctors, but the other factor that plays a great role in treating the patients is the infrastructure
of the hospital. The infrastructure design of the hospitals plays a crucial role in the safety of the
patient. No matter how much money is spend on the infrastructure of the hospital because you
cannot renovate the hospital so frequently. Therefore, infrastructure must be kept in mind
before building a hospital. The infrastructure of the building should be designed in such a way
that it looks attractive, functional and safer for the patients. Therefore, hospital planning and
designing plays a crucial role.
Reasons why hospital planning and designing is important:
Planning is the forecasting and organizing the activities required to achieve the desired goals.
• All successful hospitals, without exception are built on a triad of good planning, good design
& construction and good administration.
• To be successful, a hospital requires a great deal of preliminary study and planning. • It must
be designed to serve people.
• It must be staffed with competent and adequate number of efficient doctors, nurses, and other
professionals.
• A strong management essential for the daily functioning of a facility; must be included in the
plans of a new hospital.
Hospital building differs from other building types in the complex functional relationship that
exist between the various parts of the hospital.
• Apart from providing right environment for patients and care providers, it should also be
sensitive to the needs of visitors.
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• It is thus imperative to examine the emerging issues, analyze the challenges, appreciate the
emerging trends and study the various strategic options available for planning, designing and
construction of a hospital.
Planning involves six questions:
• What we expect to do? • Why it will be done? • Where will it be done? • When we expect to
do it? • Who all are going to do it? • How will it be done?
To offer the better facilities to the patients, a team should be assigned, and responsibility should
be given to every member of the team. Various people might be required for facility planning
like engineers, interior designers, architects, medical planners, landscape designer.
Lots of things that might sound minor, but in actual plays a major role and all such things need
to be planned such as parking area for staff and patients, emergency entry gate, main entry,
clinical area, common hall, patient area, etc.
It should always be kept in mind during hospital facility planning that there are numerous people
who might have been suffering from different problems. So, arrangements should be done
according to every type of problem.
The industry standards must be followed when doing hospital planning for bed space, operation
theaters, consultation and investigation rooms, etc.
The environment of the hospital must be positive for the people present in the hospital. As
people usually feel stressed for their relative or friend who has been suffering from some
disease. Therefore, during the designing of the hospital, it should be kept in that mind that there
should be some worship area, positive quotes on the wall, positive wall hangings in the hospital
to keep people strengthened.
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A hospital should always have a canteen with adequate space fir sitting so that people who come
with patients could have something to eat,
The waiting area for the patient should be designed in such a way that a patient could relax
properly if he or she must wait for a long time for the treatment process.
Patients usually prefer to get treatment from the hospital that has a quality infrastructure in
terms of safety and management. So, if you are looking for hospital designing and planning
service provider, then you must choose a team of professional facility planner, architects,
engineers that is known for doing hospital planning and designing-in accordance with the
national and international accreditation standards.
Step 1: Analyzing Project Needs

Analyzing project needs is a logical first step in the planning phase. Information about needs
drives decisions during the planning phase and helps estimate the capital requirements of the
project. One way to get this information is to perform a needs analysis. A thorough needs
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analysis should involve a detailed assessment of each department or service, coupled with
projections for the future state of the service for volumes, relevant offerings, space
requirements, and so on. For example, as part of a needs assessment for a maternity unit, an
organization should examine population projections of women ages 15 to 44, including historical
and projected fertility rates by geographic area. Similarly, in assessing the needs of a surgical
service, an organization should examine the impact of payer-driven changes, such as from
inpatient to outpatient provision of services, and estimate what the population-based surgical
rate will be in the future for cases such as heart or orthopedic procedures.
Needs Analysis Topics

As part of a need’s analysis, an organization collects information from either the strategic plan
or an independent market study aimed at providing a detailed analysis of the project scope and
direction. This type of research can help the organization obtain information on a variety of
topics, including the following:
• Service area demographics and projections
• Payer mix of constituents
• Specialty service line expertise
• Community perceptions of the facility and any of its potential projects
• Appropriate location of a new facility or facilities
• Potential lost revenue due to a project or relocation of a facility
• Presence and impact of competition
Results from this research should be considered when determining whether to do a project at
all, as well as when determining the location, nature, timing, and financial impact of the project
when it goes forward.
Step 2: Assembling the Project Team
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A critical step in the planning phase is selecting the project team—the group of people who
influence and are involved in the planning, design, and construction phases of the project. Every
project team consists of two distinct groups: representatives of the organization and the
consultants, or project partners, who work on the project. To achieve a successful planning
phase, organizations should be aware of the needs, goals, and perspectives of both groups. The
consultants and project partners are selected at different times based on the contracting choice
and bidding process.
Organization Representatives
On any project team, an interdisciplinary group from various departments should represent the
organization. This group should provide information to project partners and react to a variety of
proposals made by the partners. Conversely, the project partners should work with organization
representatives to tailor design and layout ideas to fit the organization’s unique needs and
culture.
Executive Project Team

With large projects, there is usually a hierarchy of organizational involvement in teams. The
leadership team with the authority for final decision making is normally called the executive
project team. Following are those persons in an organization who will be included on this team:
• Representative of the executive administration, such as the CEO
• Physicians and other practitioners
• Nursing leaders, such as director of nursing
• Infection prevention and control specialist
• Facilities planning and/or engineering director
• Representative(s) of the established planning or building committee(s)
• Information technology supervisor
• Representative from the finance department
• Safety officer (the person who manages environmental risks)
• Representative(s) of the user groups
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The Project Leader

Empowering a leader on the executive project team is critical to ensure that the planning phase
moves forward on time and on budget. The project leader must be established as the primary
contact on the team and the conduit for decisions and exchange of information. This person
must therefore be a good manager of people, schedules, changes, surprises, and problems. To
know when and how to bring about timely decisions, this person must understand the
institution’s leaders and their interests or concerns, as well as those of the project team
members. A project leader must also have the respect of management and the board, and the
authority and responsibility to make the planning phase work
As project leader, this person develops the organizational structure for the project, which
includes subgroups such as other project teams, including user groups.
User Group Teams

As the project moves through the design development phases, it is important to involve multiple
internal stakeholders. This is often accomplished through user group teams (individuals
representing those who will be using parts of the building). These stakeholders should see not
only their own space but also its interdependence on other spaces and processes throughout
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the facility. The following are areas of the organization that should have user group teams
involved in the planning, both intradepartmental and interdepartmental:
• Facilities management
• Pharmacy
• Laboratory
• Radiology
• Surgery
• Clinical engineering
• Treatment areas such as the emergency department, renal dialysis, and outpatient care
areas
• Specialized clinical areas, such as oncology, magnetic resonance imaging (MRI), and
computed tomography (CT)
• Support services staff, such as food service, housekeeping, and materials management
• Representative(s) of the board of directors (these will be part of the executive project team)
• Emergency management groups
The following external groups could be considered for advisory members on appropriate user
group teams:
• Previous patients (particularly from focused specialties) and visitors to the campus
• Representatives from community organizations, such as senior care organizations and child
and family services
• Vendors in key areas, such as information technology, imaging, and surgical specialties
• Representatives from local regulatory or governmental organizations
• Donors
Project Partners
The project partners, professional consultants who design and execute the planning, design, and
construction phases, are essential to the executive project team and its subgroups.
The exact makeup of these consultants will vary according to the scope of the project, size of
the organization, and nature of services needed to develop and implement a sound plan. The
following list identifies a range of consultants that organizations should consider:
• Architects, including the principal, project manager, lead medical planner, and lead designer
• Engineers, including mechanical, civil, structural, electrical, and plumbing engineers
• Contractors, including the project manager, estimators, and schedulers

• Health care management consultants
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• Developers or development consultants

• Financial consultants
• Cost estimators
• Equipment and technology planners
• Specialized consultants, including those specializing in kitchens, furniture, information
technology, and security
• Landscape architects
• Interior designers
• Wayfinding experts
• Process flow experts
• Green (environmentally sustainable) construction experts (
• Experts in patient handling (for example, ceiling-installed lift systems)
Integrating the Contractor

Benefits of bringing the contractor or construction manager on board during the planning phase
include receiving their advice on project scheduling and their opinions on construction costs.
Contractors can also provide advice on the selection of building systems and constructability
issues. When a government facility or other organization requires a competitive bid process at
the completion of design, an organization should consider hiring a contractor for
preconstruction services to assist with these activities during the design process. Ideally, the
same contractor in preconstruction will be with the project through construction, but this is not
a requirement.
Criteria for Partner Selection

After determining which outside professional services are needed, criteria should be developed
for selecting the best firms and individuals for each specialty. One way to do this is to send a
request for qualifications (RFQ) to several qualified firms. The responses to the RFQ should be
reviewed, and the 5 to 10 most qualified firms should be invited to submit a request for proposal
(RFP). A short list of the firms submitting RFPs (3 to 4 at most) should be invited to participate
in an interview process with a selection committee. Make sure deadlines for submission allow
adequate time for firms to respond and prepare for RFQs, RFPs, and interviews. Also, the team
does not need to issue a separate RFP for each professional consultant required for the project.
The RFP should identify whether the RFP should include the
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architect’s team only or the full design team including consultants. If the former is chosen, then
the consultants will be selected by the architect with the owner’s consent. Otherwise, the full
design team submits and interviews jointly, under the architect’s leadership.
The following criteria are useful when selecting which firms to send an RFQ, reviewing the RFQs
to determine which firms to send an RFP, as well as during the interview process:
• Commitment: The firm and its principals should be able to demonstrate commitment,
interest, and an understanding of the client’s professional service needs.
• Location and availability: The location of the firm with respect to the site and/or client, and
its availability when needed, will be important factors in selecting a firm, particularly if the
firm will be involved through the construction of a project. This will make it easier to conduct
master facility planning or other predesign services on a more predictable schedule. After
construction begins, it is critical that the project leader from the firm be available on short
notice. In some cases, local firms may not have the expertise necessary for the project. In
these cases, a more geographically distant firm with appropriate expertise can team up with
a local firm to manage on-site issues. Cost and availability to travel to the site are also
important considerations.
• Skill and experience: It are essential that people assigned to the project have the relevant
skills, experience, and professional training. The firm must distinguish between its capabilities
and those of the specific staff that will be assigned. In addition, organizations choosing to
pursue certain types of design—such as sustainable, evidence-based, or safety-related
design—should choose consultants who are well versed in these areas. References from prior
projects should be checked closely to ensure that stated skills and expertise have been
demonstrated in the past and are specific to hospital or other health care construction.
• Track record: Prospective firms should be able to demonstrate professionalism, dependability,
and a proven record of delivering on time and within budget for comparable clients and types
of service. Occasionally, informal research can uncover negative experiences. In such cases,
consider that problems in a relationship can result from either client-created or consultant-
created situations.
• Creativity, ingenuity, and imagination: The proposed consultant team needs to have
demonstrated these attributes in solving complex problems of a similar nature and must be
able to apply them within given financial constraints.
• Firm size: The size of the firm should match the size and scope of the work. When the scope
is too large, smaller firms can be overwhelmed; large firms, on the other hand, carry higher
overhead costs that are difficult for a project to absorb when the scope of services is small.
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• Culture: There should be a positive relationship between organizational cultures and the
key personnel involved in the effort. Architects and engineers should have a positive
working relationship with each other and, if possible, have some history of working
together. A fit between the team and organization is paramount. The team members
must respect each other, understand the others’ needs, and interact positively.
• Fee: The fee structure and rates of compensation are a significant factor in selecting
consultants. However, it is not always the lowest bid that provides the best fit for the project.
All the factors identified here are important to weigh and evaluate against proposed fees. Also
note that fees are often negotiable, so a proposed fee need not always be an absolute cost. To
help with this, an organization should make sure a consistent breakdown of fees is included in
all proposals for each task and consider a specialized cost consultant to see if there is an anomaly
in the pricing that will be causing a significant discrepancy in the fees. In many cases the fee
negotiation is set separately from the selection process. The fee is negotiated with the top firm
selected. In the few occasions when there is failure to reach an agreement, the negotiation shifts
to the second selected firm.
Frequently, the best firms for consideration are those that have worked with administrative
colleagues of comparable organizations. Projects need to engage professional consultants that
have significant health care facility planning and architectural expertise to conduct and
coordinate the planning phase. The planning and design phases of the health care facility
construction process require a broad perspective and knowledge base, including an
understanding of health care delivery systems and services, the effect of planning and design on
these services, and the facility construction process. Professional consultants must consider the
values of the broad range of constituents involved in the process and communicate effectively
with each.
Team Decision Making

In addition to a common understanding of health care facility needs, there must be a common
understanding of decision making on the project team. To operate effectively, a clear chain of
command should be established early on. Lack of a structured decision-making process is a
major cause of delays. Such delays are likely to make consultants, such as architects and
engineers, exceed both schedule and fee projections. Organizations may want to include a
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facilitator on the project team to assist with communication and ensure streamlined decision
making.
Team Collaboration and Partnering

Small or large, the best projects involve team relationships, shared successes, shared failures,
and tolerance for human error and project complexities. Adversarial or autocratic relationships
often lead to failure. Success is much more likely when an organization and project partners
engage in collaboration— working closely as a team, generating ideas, exploring solutions,
discarding bad ideas, and mutually reaching conclusions.
Planning should always be collaborative. Such collaboration has many advantages, including the
following:
• Market, infrastructure, and operation issues are defined early.
• Various kinds of expertise inform and identify issues and solutions.
• Approval processes are streamlined on every level.
• A fact-based case can be made for capital investment.
In large projects, however, collaboration can be challenging: With many constituencies and
finite resources, conflicting needs inevitably will surface at different points during the planning
phase. Causes of conflict include the relative importance of specific project elements, current
needs versus anticipated patient demands, and organizational concepts of the project. The
factors forcing these issues are the initial determination of a project budget, the sequencing of
construction, and the proposed physical location of services. The needs of the surgery service,
for example, should be balanced against the needs of other services, including those necessary
to support surgery. If these issues are not addressed during the planning phase, they will
reemerge during design, jeopardizing the project scope and timetable along with the entire
team’s morale.
Common Level of Understanding

For the planning phase to work, all participating team members must have a common level of
understanding. This includes some common base of knowledge, mutually understood goals, and
shared experiences. Relevant literature, research, and field trips to innovative facilities can
establish this common ground. Following are some areas in which there should be a common
understanding from planning onward:
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• Health care facilities projects: A shared language and understanding of health care facility
projects facilitates communication and decision making. This can be achieved through
thorough documentation of the guiding principles, design elements, and other features of the
master facility plan. It is important that anyone asked to sign off on plans has the information,
background, and time needed to make a thoughtful decision.2
• The health care organization: To facilitate collaboration, before beginning the planning
phase, all project team members should acquaint themselves with the organization’s mission,
strategic plan, planning assumptions, and objectives, so there are clear-cut agreements and a
mutual understanding of the goals and objectives of construction planning efforts. This is a
good place to begin identifying the organization’s existing operational and facility
infrastructure.
• The project goals: As teams begin the planning phase, they should specify all goals. Unstated
objectives can throw a process off track and result in miscommunication and
misunderstandings. This can lead to “project creep”— add-ons and other unscheduled
delays—that can derail a project. For example, an organization may have an unstated goal of
constructing a building that does not look overly expensive, so patients will not raise
questions regarding the cost of health care. At the same time, the architect(s) may aspire to
win a design award and consequently may focus on design visibility. These unspoken goals
need to be candidly shared before a line is put to paper. Architect and client can achieve a
shared understanding of building image by viewing notable works of architecture together or
by carefully studying slide images to determine client and community desires. A quality design
will result in firm balance between architectural features and infrastructure.
Mutual Respect
Trust and chemistry between the organization and the project partners are as important as the
partners’ skills. For a facility construction project to be successful, the team must be able to
work closely together, not only with mutual understanding but also with mutual respect, to
share successes and to work through failures. Team leaders must recognize and rely on the
strengths of participants, ensure open communication, and make timely decisions with respect
to project scope and budget. This approach will best position the project for success.
Partnering
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Many organizations approach larger projects with the concept of partnering in mind to
proactively coalesce complex teams of in-house staff and consultants. The key characteristics of
partnering in the project process include the following:
• Identifying individual goals and resolving conflicting goals
• Building lines of communication and mutual trust among project team members
• Setting common goals and project milestones relative to project scope, quality, and timing
• Establishing methods for later conflict resolution
Partnering can also occur between a hospital and the community itself.
Step 3: Gathering Project Data
The data collection process familiarizes the project team with the organization, its services, and
its facilities. The process should identify a wide range of goals, facts, and issues that will affect
or be affected by the planning, design, construction, and commissioning process. Data collection
activities usually involve detailed graphic and written documentation of the following:
• Type and volume of existing services
• Current and anticipated operational structures
• Anticipated health care market trends
• Property boundaries and features
• Current facility issues
• Desired facility elements
Organizations should also consider existing research on health care facility design to use as
evidence during the design phase. Research could focus on the specific needs of the building
type and patient population. For example, an organization planning construction or renovation
of a neonatal intensive care unit (NICU) might search for literature on NICU design and the
impact on patient outcomes and staff efficiency.
Existing Facility and Site Conditions

Documenting the layout, size, and function of existing facilities is necessary to understand
current use and condition, as well as the future needs of the facility. As part of this effort, the
project team may want to develop narrative and graphic histories of each facility, including
changes in the physical plant. The team should look at existing drawings and verify their
accuracy. In some cases, an on-site survey, with measurements of each department, floor,
building, and site, will be necessary.
Areas for Evaluation
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Organizations should evaluate the current physical condition of all existing facilities and review
their potential for continued use, whether in existing form or as renovated space. Three specific
areas should be evaluated:
1. Systems and infrastructure: Evaluating the condition of a building involves identifying, or
verifying, the types of materials and functional systems used in the original construction and
subsequent renovations of the building, as well as its general condition. Special features or
qualities and notable deficiencies should be documented. At this point, it will be appropriate to
have engineering
consultants evaluate the condition, life expectancy, and future capacity of existing buildings,
sites, and, perhaps, off-site systems.
2. Compliance with standards and codes: A code analysis should be conducted to verify each
building’s code classification, its allowable occupancy load, its allowable height and area
limitations, and its conformance to codes and standards related to seismic design, flood
issues, evacuation processes, life safety, accessibility, and so on. The results of this
assessment often play a significant role in determining the future use of facilities and their
need for renovation or replacement.
3. Functional and operational space needs: There should be a functional assessment to

determine how existing facilities accommodate the functional space needs of each
department or service. The process usually involves evaluating surveys conducted during
meetings with departmental staff or their representatives on the project team. Information
should be gathered about each department’s services and functional relationship with other
departments. The functional analysis should consider the location and accessibility of all
departments and determine how location affects the functionality of each. The bottom line is
that the functional assessment should analyze whether current departmental space can
accommodate existing and future needs.
Workload Analysis
As part of the data collection process, a project team should conduct a workload analysis. This
analysis can help determine the space needed for specific components of the project, such as
the size of operating rooms (ORs), patient beds, or examination rooms. If the project scope and
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size allow, team members may wish to create a five-year profile that details historical workload,
staffing, and other measures for each service, along with an analysis of operational policies,
functional requirements, patient care objectives, and growth assumptions. This picture will help
in understanding overall trends, seasons of peak demand, and the link to operational goals.
These must be tempered with an understanding of changing health care patterns.
It is important to exercise caution when using past data and workload factors to size and design
future spaces. Many facilities that undertake new construction are functioning in outdated,
inefficient built environments. Designing to fix those problems may not be the goal of the
organization. Process improvement or revision activities are strongly recommended at this stage
Guidelines and Requirements

As part of the data collection effort, organizations should research the local, state, and national
regulations that will affect the design, content, and layout of the facility. These regulations will
vary depending on where an organization is located, and the type of facility being built.
Step 4: Devising a Project Plan
Every specific project must have a plan that fits within the master facility plan. At this point in
the planning phase, this plan is known as the preliminary facility plan (or preliminary facility
program). The activities involved in creating the plan are often referred to as programming,
which is another term for predesign, the part of planning that deals with specific projects. A
preliminary facility plan is used to determine a project’s scope and anticipated facility care
needs, phasing and scheduling, and estimated project budgets for early phases. Preliminary
facility plans usually do not include a detailed space-by-space list of needs; instead they identify
general departmental or functional area needs. Development of a much more detailed facility
plan will result from the master facility plan after a project is initiated.
Preliminary Facility Plan Elements

In addition to a statement describing the overall intent of the project, the preliminary facility
plan typically includes the following elements:
• Phasing and scheduling
• Space needs (existing space measurements and the project’s general goal for spatial/physical
organization)
• Cost-benefit analysis (both long- and short-term) of the specific project and related projects
• Future growth projections A wide range of computer modeling tools and other guidelines is
available to help create a preliminary facility plan.
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Other Preliminary Facility Plan Considerations

Although examining different physical and functional relationships is important, other areas of
a facility or campus should be considered while creating the preliminary facility plan. The areas
of safety, equipment, and utilities are summarized here:
• Safety: Standards and regulations related to safety in health care facilities require
performing risk assessments to identify safety issues that can result in harm to patients, staff,
and visitors. Many also relate to built-environment remedies to address those risks. During
the planning phase, it is helpful to perform the required safety risk assessments if there is an
existing facility for baseline information. Safety risk assessments can be an iterative process
for design review as well.
• Major equipment: Large equipment planning is an essential and time-critical element of
health care facility planning and development. Existing and new equipment, such as an x-ray
machine, often affects the size and layout of a planned space in a project. As part of the
predesign process, a preliminary equipment list should be developed to determine the
equipment space and design needs for the preliminary facility plan. The list will not only
identify appropriate space considerations, but it can also be used as a preliminary pricing
guide for the budget.
• Utilities: The project team should ensure that the project’s utilities, including its mechanical,
electrical, and air-handling systems, are determined early in the process and coordinated with
existing systems. This is true regardless of whether the project is a new building, an addition, or
a renovation. If the organization has not considered the cost, location, and functionality of utility
systems early in the planning phase, unpleasant surprises can emerge as cost estimates are
developed. All too often, organizations order equipment without considering the utilities
required to run the equipment or keep it temperature controlled. This can result in utility costs
that surpass the cost of the equipment. Consulting engineers can determine a project’s utility
requirements.
Schedule
As noted above, part of the preliminary facility plan should include estimates of the length of
time necessary to complete each phase in the process: planning, design, construction, and
commissioning. Schedules should reflect a realistic time frame for completion of the entire
project.
To create a project time line, the team must identify and schedule the major milestones and the
stages of the project within each phase. Typical early milestones include points of organization
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input and key go/no-go decision points for the organization’s board of directors or governing
entity. Each stage within the phases of planning, design, construction, and commissioning
consists of a specific set of tasks or activities that should be defined and organized. This requires
identifying each activity and estimating its duration and interdependencies to establish an
accurate overall timetable. It is wise to allow for some float time in the schedule as a contingency
for unforeseen events, such as delays in obtaining geological surveys, weather delays,
negotiating contracts, securing financing, and obtaining necessary agency approvals.
Representing the Time Line

After time estimates and interrelationships for each activity have been defined, the schedule
needs to be formalized in a format for reference. Several effective tools are available to
represent the overall time line. The simplest employs a bar chart with a scale representing logical
units of time. This is typically represented in weeks for planning, but it may take months for large
projects. The anticipated start date and duration of an activity are represented by the location
and length of a bar extending across the graph. The bar chart has found wide acceptance,
primarily due to its simplicity and ability to illustrate an entire process in compact form. The
major weakness of a bar chart is that it fails to identify the activities whose completion or delay
will have an immediate effect on the duration of the project.
Detailed Space Plan

Again, part of the preliminary facility plan addresses existing and projected space needs.
Organizations should therefore create a detailed accounting of the space needed to meet the
project’s goals and objectives. Such an outline can use forecasted workloads and likely scenarios
to estimate key patient care spaces (patient beds, exam rooms, and ORs) and develop estimates
of the other space elements necessary to support these areas. This outline is often referred to
as a detailed space plan (or detailed architectural program). It can be generated through working
sessions with departmental representatives, tours of similar facilities, and examples from
previous projects. It typically includes the following:
• Summary list: A list that identifies department, building, and project area subtotals and
totals. The list should also include a room-by-room space list that is organized by department,
functional area, or physical component of the building or project. At a minimum, this list
should identify the name, number, and size of every room, space, area, and department that
will be included in the project.
• Narrative description: A narrative description for all key spaces identifying how the size and
character of each is determined. This detailed information should also be recorded on
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separate forms called room data sheets, which are developed for each room. For more
information on the detailed space plan and room data sheets.
Benchmarking for Estimating

Teams should be wary of using simple rule-of-thumb guidelines to estimate schedules, space
needs, budgets, and other aspects of the preliminary facility plan. For example, space estimates
based on inpatient beds or other simple statistics can easily overlook unique characteristics of
an institution and the enormous changes occurring in health care. Benchmarking is a good tool
to identify potential inefficiencies in use of space. The design team can use the benchmarking
information to find outliers and determine whether the variance can be justified. Benchmarking
may also be useful to test an early budget estimate. Comparing it against industry benchmarks
can show substantial variation based on facility type and geographic location. For example, in
the United States, health care projects usually include a total project cost-to-construction cost
multiplier of 1.25 to 1.4, depending on the engineering requirements. A specialty facility or
smaller project may require a significantly higher multiplier.3
Step 5: Determining a Budget
Underestimating, or failing to identify and predict, total project-related costs is one of the
biggest obstacles to successfully completing a project. Careful financial and data analysis is
therefore an integral part of the planning phase. Determining a budget is a core step, and it is
important to note that a project budget is more than just a construction budget. It includes all
other costs associated with planning, design, construction, and commissioning. A good budget
includes critical costs related to land, construction, professional fees, interest, start-up, moving,
equipment, furnishings and other finishes, and contingencies.
Anticipated Critical Costs

Following are some critical costs that make up the project budget. These must be considered
during planning and readjusted as necessary throughout the project process.
Construction Costs
The largest element of the budget, construction costs, may account for 60% to 80% of total
project costs. Construction estimates are typically based on an approximated cost per square
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foot. Factors applied to this estimate reflect the geographic location, building occupancy
classification (per life safety regulations), relative complexity of construction for each
component of the project, and type of construction (for example, new or remodeled; wood,
concrete, steel, or composite). It is also important to remember that major construction or
renovation requires several years between budget development and ground breaking, and costs
may rise due to demand or inflation.
Equipment Costs
Equipment is often the second most expensive item in the budget, but the cost of major medical
equipment can be among the most difficult to estimate in the early phases of a project. The
specific services included in the project and the potential reuse of existing equipment can cause
the estimate to range between 15% and 40% of the total cost. An inventory of existing
equipment, including an estimate of its remaining life expectancy, should be completed early in
project development. Special consultants for equipment planning are often available for large
projects, and there are several software programs that can be helpful in developing equipment
budget requirements.
Finishes Costs
Finishes in construction account for a large portion (32%) of the initial construction cost of a
health care facility.4 The cost of finishes will be part of the construction budget or it will be a
separate budget item. This is often determined by who is providing the finishes budget. Because
cost for finishing details (such as wall and flooring surfaces, furnishings, and window treatments)
varies greatly depending on design decisions, many firms separate out costs of finishes. This
allows project managers better control and oversight of the various cost drivers.
Professional Fees
This category covers professional services for all planning/ predesign, design, construction, and
commissioning services, including consultants not traditionally listed in the basic architectural
or engineering categories. For example, the fees for construction management or a materials
management consultant are not defined as basic architectural or engineering services.
Permit Fees
The local building department, the regional utilities, and the state’s department of health each
levy their own fees to review and approve the project plans and construction. These permit fees
are typically based on the construction cost and should be accounted for in the project budget.
Escalation Fees
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These fees come into play when there are unreasonable or unpredictable delays in the project,
or when the general time frame is long. To account for escalation, projects are often estimated
to the midpoint of completion, which means the schedule must be known in detail prior to
budgeting. When setting an escalation factor, the risk is shared by the organization and the
construction team. On a large project
extending across several years, even a modest escalation factor of 3% per year can result in a
significantly higher cost estimate for the project.
Budget Contingencies
Because of the complex nature of projects, as well as the impossibility of predicting exactly what
conditions will be encountered during a project, organizations must allow for contingencies
related to the budget. If an organization has an absolute limit on the amount of money it can
spend on a project, the initial allowance for all contingencies should be larger. If cost overruns
are of little consequence, more money can be budgeted for the project itself and less for
contingencies. Following are contingencies that should be considered during the budgeting step
of the planning phase.
Design Contingency
Generally, a design contingency is established early in the predesign stage of planning or in the
design phase to cover unforeseen conditions. This contingency should be largest during the
predesign stage, but it can be reduced as design and documentation progress. Design
contingencies for renovation projects vary considerably, depending on knowledge of such
conditions as the presence of asbestos, concealed mechanical and electrical systems, and
building code changes.
Construction Contingency
A construction contingency should be budgeted to cover field coordination and unanticipated
conditions during construction. For new construction, a rule of thumb is to initially budget
construction contingencies at 2% to 4% of construction cost; for remodeling, 4% to 10% is
typical.
Owner Contingency
In addition to construction and design contingencies, the organization as “owner” should carry
a contingency. Owner contingencies are often used for changes in project scope that occur after
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consultant bids are received. These can vary from 5% for new construction to 10% for smaller
remodeling projects. As the design moves forward, firm pricing on construction and equipment
serves to reduce risk, and the contingency should be reduced accordingly.
Step 6: Finalizing the Master Facility Plan

The goal of master facility planning is to develop a definitive master facility plan. The project
team develops a final conceptual plan that addresses all the planning goals and issues for all
projects. This plan, if developed properly, will be flexible enough to meet the evolving needs of
the organization for several years. A well-crafted master facility plan provides guidance and
information needed by the project team members as they work with organization leadership to
continue making critical facility-related decisions, many of which will have lasting consequences.
Because an organization’s master facility plan may embrace several projects, a project will be
the first one in that master facility plan or a later one. Regardless, any preliminary facility plan
and the more detailed project plans based on them must work within the master facility plan,
which is created first; the projects are part of the phasing in of the overall master facility plan.
Implementation in Phases
As the planning phase draws to a close, the organization needs to consider how the master
facility plan will be implemented. Implementation of most master facility plans must be
accomplished in several phases, due to limits on available resources as well as operational and
physical constraints. Phasing is a major planning factor and can have an immense impact on
timing, schedule, and cost. It can also have a major impact on the care and comfort of patients
and staff. Note that phasing of a master facility plan is of broader scope than the schedule
phasing of a project.
The first step in the master facility plan phasing process should be communication with staff and
the public that something major is about to happen. Subsequent steps will bring forward new
or revitalized services and spaces, as recommended in the master facility plan or in the predesign
part of the planning for a specific project.
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Step 7: Ensuring Regulatory Compliance
Regulatory process requirements vary from state to state and country to country. It is critical to
any project that the various regulatory requirements for approving and constructing a health
care facility be identified and all relevant stipulations met.
Most jurisdictions within the United States and internationally have several review steps that
span the project process. Often this includes preliminary approval of the project, intermediate
approval of plans and costs, final approval of plans, and occupancy permitting. Any partner
chosen for the project be knowledgeable about the associated regulatory requirements.
Regulatory review processes can add months or even years to the project schedule.
Certificate of Need
One activity to complete before proceeding to the next step is securing a certificate of need
(CON). This involves justifying to the state why a project is necessary. It allows states to provide
a balance of services across health care organizations and ensures that each one is adequately
serving its community. Some states require this; others don’t. If a state requires one,
organizations should have a preliminary review with CON hearing staff early in the planning
process and allow extra time in the schedule for the CON hearing process. Presenting a master
facility plan as part of the review will show the scope of the organization’s plans and may
facilitate CON hearings for all projects in the master facility plan.
Step 8: Documenting the Master Facility Plan
All project plans must be documented in a manner that is not only easy to understand but also
easy to use, share, and store. This documentation serves multiple purposes, such as providing
the historical perspective of selection decisions and rationales, and orienting new partners and
organizational team members.
Form and Format

A master facility plan will be documented into a book (physical or digital) that includes a text
narrative, tables, and drawings. This book should contain an executive summary that highlights
key goals, facts, issues, assumptions, facility needs, concepts, and master facility planning
proposals for specific projects. An executive summary should enable key decision makers to
digest the most important information and make informed decisions without reading the entire
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document. The body of the document should be organized to reflect the key steps in the
planning phase and the findings that resulted from each step. The body provides the
substantiating evidence for the master facility plan proposals. Documentation of the steps in the
planning phase will be in an appendix and include such information as the work plan and
schedule, meeting minutes, and background information.
2. Explain the feasibility study of hospital project.
A feasibility study in healthcare is part of a strategic plan designed to address a medical, acute,
or long-term care, in or outpatient service expansion or new development. The healthcare
feasibility study and strategic planning process encompasses several components. First,
the market study identifying where the customers are and how they get connected to your
service. Second, a financial feasibility analysis, typically encompassing three to five years of pro
forma financial statements. The final step in the completion of the healthcare strategic planning
process are the business plan components specifying the execution plan for making the project
a reality.
A feasibility study aids in transforming an idea into a viable reality
A feasibility study is the process of investigating the viability of a health service, whether it is an
expansion of an existing operation or a creation of a ground up project. This study is an essential
component of the strategic planning process. The feasibility study analyzes the viability of an
idea and answers a myriad of essential questions. Among them:
• What are the primary and secondary markets?

• What is the target audience?
• What are the potential referral sources?
• What competition exists in the primary and secondary market areas?
• How much working capital is required to cover start up losses?
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• At stabilization, what are the operating profits?
The above questions are just a few of the issues that are addressed by a feasibility study. If
you’re looking to raise financing for your project or perhaps seeking strategic partners, a well
conceived and detailed feasibility study is a must. Even if you are in the enviable position of not
needing financing or a strategic partner, a feasibility study provides you with an objective vetting
process and a road map for a successful venture. Alternatively, the study can also supply you
with enough warning signs that prevents you from undertaking a potentially unsuccessful
venture which can save you lots of money and heartaches.
Financial feasibility analyses demonstrate the ability to reach the desired level of return
The second component of a feasibility study, the financial feasibility analysis, focuses on the
development of detailed operating pro forma financial statements. These statements should
outline in detail, both revenue and expense items for your project. Since these are pro forma
statements, it is important to specify the myriad of assumptions that were utilized in identifying
the revenue and expense items in the pro forma. These pro forma statements can project
income/loss at the net operating line or can even take into consideration asset related expenses
and thus, project down to the net income line.
We tend to recommend that the financial feasibility analysis account for the financial
performance of the proposed project from the time of opening until 12 consecutive months of
stabilized operations. Doing so allows the analysis to cover the full start up period (which in turn
identifies the amount of working capital required to sustain the operations through the period
of financial loss) and identifies the amount of profit at the time of operational maturity.
A feasibility entails many aspects of a real estate development project. Whether one is
developing a hotel or many single-family homes, or a school, the report will outline anything
from the permit process to the land usage rights. Below are some, but not nearly all, features of
a real estate feasibility study report, all of which can be classified as undertaking due diligence
before construction begins.
• Civil Site and Public Infrastructure Improvements

• Land Use and Environmental Permitting
• Geotechnical Investigation
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• Structural Engineering
• Environmental Study and Report
• Survey (boundary, title research)
• Site Planning, Development Program, and Code Review/Compliance
• Traffic Plans, Neighborhood Impacts, Schools in the Area
• Water/Sewage
• Architect
The points are just a glimpse of the many features of a feasibility study.
There are numerous benefits to creating a feasibility study. First and foremost, you would want
to ensure that you can develop on the proposed land. The property zoning laws may permit or
prohibit certain features of the project, such as the height and size of the development. Here
are few main reasons for preparing a feasibility study for a real estate development project.
▪ Knowledge: As noted above, knowing whether you can develop and under what terms will
save needed time and capital. If a negative picture is portrayed, then you would stop
development. If positive news transpires from the feasibility report then you would continue.
Knowing the options is more than half the battle.
▪ Property Assessment: Before committing capital to any development you would ensure that
the concept itself is viable and therefore tested. Conducting a land assessment prior to
development can save the company money and time.
▪ Project Confidence: Like writing a business plan, a feasibility can give the principals the
needed confidence boost to move forward with the project. If the feasibility report shows
promising results, both financially and strategically, this can give convince the team that their
assessment for development is correct. This can help when capital is needed to be raised or
allocated from investors. A confident management team, with a factual feasibility document
in hand, can add great strength to the company’s mission.
▪ Funding and Capital Raising: As noted, a well written feasibility study, like a well written
business plan or prospectus, can aid in the strength of the business and alleviate fears from
investors
▪ and lenders. While the feasibility study is usually prepared for the management team to
decide if the given project is even feasible to develop, the document itself can be used as a
powerful tool when raising capital and approaching investors.
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Financial Feasibility Study for Property Development

During the initial phases of the feasibility study’s development, the writing of the financial
projections and budgets needed to implement the feasibility study would be undertaken.
Creating the financials at the onset of operations will also benefit the company in terms of
making the correct decisions moving forward. If the numbers do not make sense, then the
project would end. If the numbers work, then the project would continue. More reason why this
feature of the property feasibility report is conducted at the beginning of the process and not
the end.
Since the outcome of any business – real estate related or not – is to make a solid return on
investment, knowing the ins and outs of the financial feasibility study of the development
project makes it imperative to create such a report.
Land and Project Evaluation
Analysis of the overall land and site, including:
▪ Zoning law
▪ Land and physical restrictions
▪ Traffic and access points
▪ Buildings in the surrounding environment
▪ Sewage and water
▪ Competitive summary of new projects and similar existing developments
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Description of the Development and Industry Insights
A thorough description of the usage of the land along with the overall industry would be
discussed.
Market Analysis
A comprehensive market analysis would be undertaken as well. The market analysis section will
detail needed information about the market opportunity’s strengths and weaknesses, including:
▪ Population of the surrounding area and trends, including projected growth

▪ Age of the demographic and target market
▪ Income statistics
For tourist developments, additional market characteristics would be detailed, such as:
▪ Existing market size

▪ Historical numbers and market growth
Market Comparison
In addition to the demographics, a feasibility study would examine existing structures or

buildings in the near vicinity of the projected land development. Information would include:
▪ The location of a similar project

▪ Development similarities and project description
▪ Historical financials and pro formas, if available
▪ Proposed construction costs
Yearly Project Usage Analysis
A detailed summary of the proposed project, usually over a 5-year period. The yearly analysis
will include:
▪ Market size, demographics, etc.

▪ Competitive analysis
▪ Analysis of existing similar projects and their positioning
▪ Project location and parts needed to complete project
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▪ Concept Development and Planning for the Project

An engineering group should create the necessary plans to market and supply the target market
and its future growth. Do master planning, as well as the architectural and design plans,
including suggesting:
▪ The types of services offered

▪ The overall size and functions of the space
▪ Land and property need
▪ Architect plans, diagrams, graphics, videos, pictures, power point presentation or investor
deck
Financial Analysis
A comprehensive real estate financial analysis of the proposed project would be undertaken at
this point. The projections would normally consider the consecutive 5 years; however,
projections for 10 years out are also common. The financials would include:
▪ Revenue projections, proforma statements

▪ Budget expenses, operating projections
▪ Profit and loss
▪ ROI
Project Expenses – Development Recommendations
Allocate an expense analysis for the entire project and formulate the feasibility of the overall
project.
Preliminary Property Development Feasibility

Often, prior to a comprehensive feasibility study being written or prepared, a preliminary
property development feasibility study is written. For those who do not want to spend capital
on a more thorough feasibility study, the preliminary report can serve an important function.
While it is not as thorough as a feasibility study, the preliminary report will note the costs
associated with preparing a full feasibility study.
The following are five best practices for organizations and businesses to pursue:
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1. Conduct a debt capacity study.

The first step, before commencing with a financial feasibility study, is to conduct a debt capacity
analysis for the organization or business. Much more limited in scope than a full financial
feasibility study, a debt capacity analysis will pinpoint financial benchmarks necessary for an
organization’s success.
Will an organization’s or company’s balance sheet provide enough liquidity — cash and
investment reserves? New projects often require significant working capital, whether to fund
initial training or to fund operations during lease-up. These project funding needs generally can't
be borrowed, and ample alternative sources must be available. A debt capacity analysis won’t
answer all the necessary project questions but will help establish a framework for more detailed
analysis.
2. Identify key service lines.

While a project often represents new opportunities, it is just as important to identify those
service lines that an organization may need to discontinue. Service line goals are critical because
whether adding or subtracting, the result will be organizational change. The question for
providers is if patients and their families, staff and the community are prepared for the
necessary adjustments.
For example, many community hospitals would like to expand their offerings of surgery and
orthopedic services. But are staff members prepared for the necessary training and outside
assistance to make the goal achievable? Furthermore, is a community prepared to make a
necessary trade-off, such as divesting a costly nursing home to provide the cash flow necessary
for an emergency room modernization?
Projects are exciting but managing change can be complicated and time consuming due to the
sheer number of people and processes that may be affected. Smart providers recognize this
early in the financial feasibility process and make the necessary accommodations in the change
management process.
3. Establish a coordinated timeline.

With project parameters and goals determined, an organization should have its financial
feasibility advisor, project manager and lender at the table to help outline the time frames and
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deadline dates for different steps in the project. The project timeline will involve several parallel
project tasks, some of which are completely independent and some of which may not begin until
a previous task is complete.
Often with new construction, for example, a first step is to identify how long it will take to secure
the necessary land. Once that is done, the length of the architectural and construction contract
process must be determined, ideally with reasonable expectations for design iterations and, as
necessary, value engineering. Overlaying the whole project is securing funding, the timing of
which will be determined by the desired financing structure. To avoid delays and additional
expense, a financial feasibility study should be pursued in conjunction with the overall project
timeline.
4. Build realistic revenue projections.

Successful projects are built around a careful examination of the demographics and utilization
information that will support the financial feasibility study's revenue projections. With limited
budgets, it’s important that providers concentrate on projects with the greatest revenue
potential.
Hospital organizations are facing more moving targets than ever. With the changing health care
industry, including more insured people, how will overall utilization change and what will be the
desired services? How will the shift in payor mix to more Medicaid eligible and less private pay
affect net revenue? With continued medical advancement, will the inpatient and outpatient mix
change length of stay? A financial feasibility study may not be a crystal ball, but it should offer
careful analysis of these and many more questions.
3. Describe the planning of department of oncology in a multispecialty hospital.
Planning of department of oncology in a multispecialty hospital.

The same complexity that defines cancer at a molecular level is reflected in the array of
specialists and healthcare providers required to treat patients, as well as the business models
required to bring these disparate providers together to function as a cohesive unit. Typically,
oncology providers belong to multiple, independently operating entities, each with their own,
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often competing, clinical, financial, and political concerns. This disparity among providers results
in complicated relationships between individual providers and organizations, making
coordination of care especially difficult.
Given the nature of the disease (or, more appropriately, diseases) and the challenges associated
with bringing together a diverse group of providers, it is not surprising that the market for
oncology services is, more often than not, characterized by inconsistent access to care, limited
coordination among providers, frequent variability in treatment, and redundancy/waste in the
system due to the provision of duplicative services. At the same time, payers, most notably
Medicare, struggle with how to cover the rising costs of cancer care. In recent years, Medicare
has adopted strategies to both provide immediate savings (e.g., cutting payments to providers)
and longer-term systematic change through several innovative payment mechanisms (e.g.,
accountable care organizations, bundled payments, pay for performance).
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The oncology treatment team: Key characteristics
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Oncology service lines typically share the following characteristics:
• Facility and identity: The service line has a facility or center where all cancer services can be
presented to patients in a coordinated manner. The service line also has a brand name and
image that is identifiable by patients and physicians in the community.
• Coordination: Clinical services are delivered seamlessly throughout the continuum of cancer
care. As patients progress through each phase of treatment, providers share information to
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better inform the course of treatment, prevent unnecessary duplication of services, and ensure
adherence to evidence-based oncology practice guidelines across different specialties and sites
of service.
• Clinical programs: Differentiation occurs through the development of multidisciplinary tumor-

site–specific programs, typically focusing on one, or all, of the most common cancer tumor sites
(i.e., breast or lung).
A fully developed clinical program operates with dedicated staff and support resources and is
often marketed as a featured component of the oncology program. In order to provide tumor-
specific expertise, successful programs attract providers who are highly qualified and
experienced in
treating tumor-specific cancer sites.
• Clinical trials: Clinical trials enable patients to have access to treatment options that may be
beneficial but are still in experimental phases.
A robust research program may be a key asset to recruiting both patients and clinicians to the
program.
• Support services: A full range of psychosocial support services (e.g., patient avigation,
mental health and social work, financial counseling) are offered to complement diagnostic and
treatment services. These services are integral to the provision of high-quality patient care,
and leading programs are those able to proactively identify and match patients to the services
offered.
• Technology: State-of-the-art technology is used in the diagnosis and treatment of patients.

This includes the implementation of electronic medical records and health information
exchanges, which facilitate the flow of clinical information and enhance decision-making
among providers.
• Access: Services are easily accessible and provided in a patient-centric setting. Co-locating a
range of diagnostic, treatment, and support services improves access and provides physical
and psychological benefits to patients.
• Physician governance: Well-performing oncology programs have a well-defined physician

governance organization that incorporates physicians into policy and strategy setting activities,
enabling the physicians to have a meaningful role in charting the direction for the program.
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Having completed the initial physician alignment planning, hospital and physician leadership are
ready to begin defining the details of the arrangement. While the parties may agree on an overall
approach, the negotiation of transaction details can reveal challenges and disagreements that
will need resolution. Taking the time to systematically work through the various deal points is
critical to long-term success however, it is not unusual for hospitals to rush the transaction
process to meet a perceived crisis or artificial deadline. It is in these situations that obstacles
can emerge that may disrupt negotiations and ultimately stall or derail the transaction process.
Ultimately, the details of the alignment model must reflect the unique needs of the players and
the market. Despite their range in design and complexity, transactions that are successfully
completed typically utilize a standard method to work through the various issues and deal
points.
Definition of the Transaction Goals
Cancer programs and physicians should focus on defining critical success factors for the
transaction. Most importantly, the oncology program and the physicians will need to establish
how physicians will be rewarded for their contributions.
The transaction goals and objectives, in combination with the affiliation objectives, will serve as
the evaluation criteria to determine an appropriate model and can also help guide the first
discussions. However, it is important to expand on these initial objectives when evaluating what
each party hopes to
achieve through the actual transaction negotiation. For example, physicians may have disparate
opinions about the level of risk or types of incentives they want in their compensation plan,
while the hospital has limitations on the types of compensation models that can be used legally.
Regardless, it is important to determine which terms are most important to each party before
engaging in detailed discussions.
Depending on the group’s dynamics, this process could be initiated through individual
stakeholder interviews or focus groups and then shared with a broader steering committee of
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hospital and physician representatives; alternatively, the committee could jointly evaluate its
goals for alignment. Thinking through the various issues early on will help frame the discussion
and ensure that there is consensus on an overall shared direction. If consensus cannot be
reached on vision and priorities for the relationship, it makes sense to explore alternatives to
affiliation discussions.
Evaluate Business Implications
Once the objectives of the transaction are agreed to, organizations tend to rush through
negotiations to quickly finalize an agreement. Even in the most urgent circumstances, it is
important to utilize a structured process that will facilitate informed and shared decision-making
while avoiding impulsive decisions that can ultimately stall discussions. Determining the basic
feasibility of the relationship from a business perspective should be completed very early in
discussions.
The conclusions and recommendations resulting from determining the business needs of the
parties will provide a common understanding of the imperatives for alignment and help steer
negotiations, particularly as the key deal points for an arrangement become finalized. Some
consideration should be given to the following aspects of alignment:
• How does this arrangement assist the aligned organization’s overall vision for the future of
how oncology care is delivered in its market?
• Does this arrangement support the hospital’s broader physician alignment strategy?
• Will the arrangement facilitate greater clinical coordination and improve efficiency?
• Are provider needs for competitive compensation and stability addressed?
• Will this arrangement support the community need for oncology services
and subspecialty care?
• What should a true partnership involve?
• Are physicians willing and ready to help lead the oncology service line?
• What are “deal breakers” from each party’s perspective?
Understand key drivers

The incremental costs associated with hospital/physician alignment often require that parties
identify additional revenue streams, either through increased volume or better
reimbursement. Financial challenges are particularly significant in oncology- related services
because many independent physicians rely on ancillary services for a substantial percentage of
their income.
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In addition, many of
these alignment arrangements require large up-front capital expenditures, whether it be to
assume the drug inventory of a medical oncology business or to purchase a radiation oncology
group’s linear accelerators and other related equipment.
To generate new revenue, many hospitals are seeking to convert all or portions of physician
practices to provider-based designation. Under provider-based status, physicians receive a
reduced Medicare professional fee for selected services, while the employing hospital can bill
for overhead expenses. The hospital bills a facility fee to cover the practice costs, which
typically exceeds the reduction in professional fees and can result in a reimbursement
advantage, particularly for select oncology services.
Ensure proper due diligence
The due diligence process is critical for every transaction and is typically conducted in an
iterative fashion, wherein increasingly detailed information is requested from the group.
Questions about compensation typically are initiated early in the process. It is critical for the
hospital to conduct a thorough assessment of the oncologists’ current practice, understanding
all revenue streams and expense drivers, before presenting a financial offer to the physicians.
This process is important for any specialty acquisition; however, it is particularly important for
oncology practices due to the complexities of the practices (e.g., large reliance on ancillary
income).
Issues that are commonly identified as a result of the practice assessment include:
• Lack of alignment between compensation and productivity
• Declining compensation and/or productivity over time
• A high level of midlevel services (e.g., infusion management) and/or other services that do
not support a work relative value unit (WRVU) compensation model
• High level of outside physician compensation
• Varying compensation plans between employed and shareholder physicians
• Antiquated or poorly maintained capital equipment
• Practices with a large debt load
• Abnormal supply costs relative to production levels
The initial financial review is a critical first step in transaction discussions, but the due diligence
process should be ongoing. Due diligence efforts related to implementation planning will begin
once a term sheet and/or letter of intent has been finalized. This could include a third-party
evaluation of the group’s practice (if applicable) and potentially a fair market value (FMV)
review of the proposed
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compensation plan. In addition, there will be several other considerations if integrating the
group into the hospital (e.g., space planning requirements for provider- based billing
compliance). Many of these considerations are outlined in the following sections. To facilitate
this process, though, it will be important to share the implementation timeline with the
physicians, so they understand the process as
well as the rationale behind what may seem like excessive data requests. Involving one or
more of the physicians in the implementation will help ensure that the physician group
continues to be educated about the key issues being evaluated.
Development of the Organizational Structure
To ensure successful alignment, the hospital and physicians should jointly develop the
governance, management, and operating structures for the new arrangement. Clearly defined
organizational structures that delineate the reporting relationships among the physicians and
hospital executives are a key element to successfully implementing the intended alignment
structure.
Group governance
Governance defines the structure under which the integrated entity sets its strategic direction,
manages fiduciary responsibilities, and oversees organizational performance.
Specifying organizational authority and accountability is a critical element in the development
of a group’s culture.
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Many top oncology programs elect to establish a governance structure that includes joint
representation from physicians and hospital leadership. The balance of membership of these
groups will vary depending on the ownership structure and the mix of clinical services and array
of physician specialties under the aligned structure. Typically, the governance body will provide
oversight for the operations,
finances, and planning of the oncology group. Depending on the evolution of the service line,
group governance may also be integrated with service line governance structures/functions.
During the planning process, key governance terms should be negotiated and agreed upon, such
as:
• Number and selection of governing body members
• Decision-making scope and list of responsibilities
• Role of governing body for the oncology group and (if applicable) within
the broader oncology service line
• Voting rights details
• Reserve powers
Management structure
Management of the group should entail experienced administrative leaders to ensure efficient
operations but should also incorporate physicians to ensure that they are continuing to monitor
operations and are invested in the group’s success.
In addition, specific management structures should aim to leverage the hospital’s employed
physician practice capabilities. Defining the management structure in any detail can be a
somewhat lengthy process; however, at a minimum, the initial term sheet should outline the
following:
• Leadership structure with management relationships noted for
key positions
• Job description of key leadership positions
• Appointment of leaders
Operational and clinical integration

It is also important to develop plans that operationally and clinically integrate the group with
the service line in order to meet shared objectives. The decisions that will be required in this
design phase include definitions of the following areas:
• Operational and clinical integration across subspecialties
• Branding and marketing activities
• Physician recruiting
• Utilization management
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• Information exchange, including use of electronic medical records

• Performance reporting
• Staff employment
Developing a Compensation Plan
Developing a physician compensation methodology that aligns physician incentives with

hospital oncology programmatic priorities is critical to ensuring that organizational objectives
are achieved. Effective compensation methodologies incorporate variables that encourage
clinical productivity, quality and coordination of care, financial stability, and other variables
identified by hospital leadership.
Compensation goals and objectives

In designing a compensation plan, it is important to incorporate provisions that support the
hospital’s broader service line and organizational objectives. Consequently, the first step when
designing a compensation plan should be the development of its desired goals and objectives.
Ultimately, the goals that are established at the onset of this planning process are used as the
evaluation criteria for alternative arrangements.
Service incentives
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Hospitals generally recognize that production-driven plans will need to evolve to reflect
changing practice patterns and economics, but there is a reluctance to get too far ahead of
reimbursement changes. Production-based compensation plans (typically measured in WRVUs)
continue to be the favored methodology for hospitals, and they often utilize productivity tiers
that disproportionately reward high producers and provide strong incentives at the margin.
These plans reflect the current economics of physician payment, which is still based almost
entirely on clinical work measures. Although hospitals typically incorporate some type of
performance or quality bonus into their compensation models, the measures are often not
based on stretch goals because defining, valuing, tracking, and measuring outcomes can prove
difficult.
They can provide a huge boon to executing service line strategies, though, and more institutions
are starting to incorporate these incentives and make them a larger portion of total
compensation. Key questions to address when evaluating service incentives include:
• Picking stretch targets: Are the metrics attainable? How much effort will be required to reach
targets? How should targets be adjusted year over year?
• Physician control: Are the metrics related to initiatives under the control of the oncologists?
Is there a balance of metrics related to each subspecialty?
• Areas of emphasis: How should each metric be weighted (e.g., equally, by importance, by level
of difficulty, by time commitment)?
• Performance measurement: How easily can the proposed service incentives be tracked and/or
measured? Who will be responsible for managing this program?
• Alignment of goals of hospital and group: Are the metrics encouraging both the desired group
behavior and meeting service line goals?
• Process-related metrics: How can we balance metrics aimed at developing processes versus
attaining specific measurable levels of achievement?
• Periodic review: How often should the planning objectives be reviewed by the hospital and
the physicians? Use of service incentives in physician compensation models is an emerging trend
that will continue to grow, particularly considering ongoing healthcare reform efforts that
emphasize patient outcomes and episode-based care.
Surgical oncology call coverage restrictions

With increasing sub specialization of surgical oncologists, many physicians are no longer
clinically able or personally willing to cover general surgery call. If the hospital’s current
emergency department (ED) call coverage arrangement or medical staff bylaws require the
physicians to take call, the transaction may require additional funding to compensate surgeons
to take general calls.
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Other nonclinical duties

Depending on the scope of an agreement, other nonclinical duties may need to be considered,
including but not limited to the following:
• Practice management responsibilities
• Outreach staffing
• Medical directorships and other hospital responsibilities
• Clinical research
Frequently, these types of services are incorporated into the compensation.
Agreement through various performance-related bonuses; some activities (e.g., medical
directorships) may reflect separate agreements.
Practice acquisition
If applicable to the arrangement, practice acquisition details should be defined early in the
planning process. Hospitals typically purchase a practice’s hard assets at FMV. When engaging
in the acquisition
process, parties should consider the following:
Timing: One of the most common causes for delay in transaction discussions, particularly for
large group acquisitions, is the valuation. Consequently, it is helpful to initiate a practice
valuation early in the planning process, potentially once a term sheet has been finalized and/or
a letter of
intent has been signed.
• Valuation firm selection: The most successful valuation process usually relies on one third-
party valuation firm to conduct the analysis. To ensure trust in the analysis, it is important to
have buy-in from each party in valuation firm selection. Some organizations opt to each hire its
respective valuation firm to conduct separate analyses; however, this process can often be
cumbersome and has the potential to significantly delay the transaction process as the parties
reconcile the two reports.
• Tangible versus intangible assets: In recent years, most transactions have excluded goodwill
and focused solely on tangible/hard assets. Increasingly, some hospitals do value select
intangibles (e.g., medical records, workforce in place), but the inclusion of intangibles often only
applies to large
group acquisitions.
• Stock versus asset sale: When acquiring a practice, parties have the option of utilizing two
different types of sales—an asset sale and a stock sale. In an asset sale, the hospital is purchasing
a defined list of assets and assumes a defined list of liabilities; consequently, the liability of
unknown future claims against the corporation is retained by the physicians. This is the most
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common method used in practice acquisitions. In contrast, under a stock sale, the hospital
assumes the liability for all unknown future claims.
Physicians are increasingly requesting the latter option; however, it is important to note that,
with the addition of these liabilities, the physician stock is worth less to the hospital than the
known quantities of assets and liabilities in an asset sale. In addition, if a stock sale is ultimately
considered, there are several steps that should be taken to limit future liabilities.
• Equipment leases: The disposition of the oncology office often depends on whether it is
owned by the practice or the office is in leased space.
In addition, oncologists may have engaged in various other lease arrangements that could
impact the valuation price. Because the assignment of the various assets to the hospital is
usually a condition of closing, any last minute, unforeseen expenses typically result in
incremental costs to the hospital that were previously not budgeted. Consequently, it is
important to engage in a due diligence process early on that identifies all relevant agreements
and associated costs for the practice.
Implementation
The key to a long-term successful transaction is effective alignment and integration into a
coordinated service line that can achieve the parties’ intended goals. It is at the implementation
phase immediately following closing that many well-conceived transactions fail. Although often
overlooked in the haste of events that typically precede the closing, it is critical that the hospital
and physicians
carefully plan and execute the implementation steps, which is frequently a two-phase process.
Phase I: Plan development

Following the signing of a term sheet, the parties should develop detailed plans for
implementation and integration, including:
• Identifying key stakeholders and knowledge experts from the respective organizations. This
typically includes practice administrators and staff from the physician groups.
• Creating an implementation plan.
• Communicating the implementation plan to work groups and seeking input on potential plan
changes.
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Phase II: Plan implementation

Upon closing, hospital leadership will need to implement this proposed plan by engaging in the
following:
• Creating a project manager or project management team to oversee implementation
–– This may encompass several work groups depending on the size and complexity of the
implementation
–– In certain circumstances, using independent, external resources to advise or lead
implementation through a project management office may better serve the combined entity
because it can overcome
institutional biases on either side to make decisions that are in its best interests
• Reporting results, progress, and risks to leadership to expedite decision-making and the
implementation of risk-mitigation plans
• Continuing to identify cross-functional dependencies
• Monitoring key issues to ensure resolution

• Providing interim management where necessary until permanent candidates can be hired
A well thought out, detailed implementation plan is required to transition responsibilities to the
new structure without impairing business performance, employee morale, or patient service. In
particular, the hospital needs to take special steps to ensure it makes sound operational
decisions and proactively communicates with the physicians. Issues will arise and maintaining
open communication through regularly scheduled leadership meetings and weekly
implementation updates is critical to managing the change.
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Summary:
Properly structured, economic oncology alignment arrangements can be mutually beneficial to

both parties. The most successful transactions typically apply the following approach:
• Using a rigorous, disciplined, and timely process when negotiating term sheet decisions
–– Initiating key tasks (e.g., practice valuation process) early in transaction discussions to set
parameters
–– Understanding market risks and trends before engaging in detailed compensation discussions
• Proactively establishing a shared vision and set of goals that define success
• Determining an appropriate vehicle to meet current and future service line needs
–– Incorporating terms that are tailored to the group by leveraging their strengths and
addressing their weaknesses
–– Creating incentives within the compensation plan to align physicians with the hospital’s
organizational priorities
–– Developing a structure that encourages and allows for strong physician
leadership in service line planning and management
• Creating a long-term, financially viable relationship
–– Determining an appropriate billing designation to maximize reimbursement opportunities
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–– Assessing cost-savings opportunities

• Preparing and executing a thorough, detailed implementation plan to ensure effective
physician integration upon the transaction’s close.
4. Elaborate disaster management & hospital disaster plan.
Definitions:
A DISASTER is defined as: “……. a serious disruption of the functioning of the society, causing
wide spread human, material, or environmental losses which exceed the ability of the affected
society to cope using its own resources.” A disaster occurs when a hazard (natural or manmade)
strikes a vulnerable society. Vulnerability is defined as “the extent to which a community,
structure, service, or geographical area is likely to be damaged or disrupted by the impact of a
particular hazard, on account of their nature, construction, or proximity to a hazard prone area”.
RISK is a measure of the expected losses (deaths, injuries, property, economic losses etc.) due
to a hazard of a magnitude striking in each area. The Fig. 1 illustrates the four factors that
contributes to risk. They are: Hazards (natural such as earthquake, floods, landslides, cyclones
etc. or manmade such as exposure to hazardous material, explosion etc.) Location of hazard
relative to the community at risk. Exposure (the effect of hazard on infrastructure and lifeline
systems serving the population such as water supply, communication, transportation network
etc.) Vulnerability of the exposed society, structure and systems to the hazard
Disasters have an uncanny ability to bring to the forefront vulnerabilities of systems, structures,
processes and people which in turn cause large scale damages; and hospitals are no exception
in this matter. In the last two decades, countries across the world have suffered a huge loss of
confidence, as well as economic losses on account of damages incurred by hospitals from
disaster
Inadequate or complete non-compliance of structural elements of hospitals to building codes

and other safety norms which result in the failure of hospital structures and their component
non-structural elements;
• Absence of a documented Hospital Disaster Management Plan;
• Lack of planning and preparedness to respond to disasters;
• Inadequate or complete lack of internal and external communication; and
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• Lack of networking amongst hospitals. As a result, when hospitals are affected by disasters the
repercussions are three dimensional – health, social and economic. The health impact of
hospitals being affected by disasters include, other than the obvious lapses in medical care that
hospitals provide to victims of a disaster, lapses in preventive medicine and public health
response. This is because hospitals host laboratories and can contribute to the diagnoses and
issuance of warnings of imminent communicable diseases that may spread post a disaster. The
social impact of hospitals being affected by disasters include a loss of confidence/morale in the
affected community which can affect the long-term recovery and sense of well-being of the
community. It can also lead to social and political instability, as hospitals are expected not only
to provide good medical care but also ensure the safety of their patients from disasters. The
economic impact of hospitals being affected by disasters is a little more obvious, given the
enormous investments required to be made to construct hospitals and the expensive equipment
that is lost when disasters strike hospitals. Even the use of temporary field hospitals as a
contingency measure is economically unviable. It is an attested fact that the costs involved to
mitigate and prepare hospitals for disasters are far less than those required for re-building
hospitals after they have been damaged by disasters.
Overview:
• The hospital should have a documented plan and procedure for handling the situations
like sudden rush of victims of i. earthquake, ii. flood, iii. train accident, iv. civil unrest
outside the organization’s premises, v. major fire, and vi. invasion by the enemy, etc.
These plans and procedures cover ensuring adequacy of medical supplies, equipment,
materials, identified-trained personnel, transportation aids, communication aids and
mock-drill methodology.
• The disaster plan must incorporate essential elements of alert code, information and
communication, action cards for each of the staff, availability and earmarking of
resources, establishment of command nucleus, training and mock drills, managing
clinical activities during the event based on National Disaster Management Authority
(NDMA) guidelines. Emergency room could follow triage policy according to NDMA
guidelines.
• Provision is made for availability of medical supplies, equipment and materials during
such emergencies. Resource availability should be according to threat perception. The
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quantity of resources, i.e. medical stores, etc. to be cross-checked with expected

workload.
• Staff are trained in the hospital‘s disaster management plan. The training shall include
the various elements of the disaster plan. e. The plan is tested at least twice a year.
Interpretation: This shall test all the components of the plan and not just awareness.
Simulated patients (not real) shall be used. This is only the minimum frequency, and this
may be increased. At the conclusion of every mock drill, the variations are identified,
reason for the same is analyzed, debriefing of the drill conducted and where appropriate
the necessary corrective and/or preventive actions are taken.
Aim of Hospital Disaster/Emergency Management Plan:

The aim of a hospital disaster plan is to provide prompt and effective medical care to the
maximum possible, in order to minimize morbidity and mortality resulting from any MCI.
Objectives and goals of a Hospital Emergency Plan:

The main objective of a hospital emergency/disaster plan is to optimally prepare the staff and
institutional resources of the hospital for effective performance in different disaster situations.
The hospital disaster plans should address not only the mass casualties which may result from
MCI that has occurred away from the hospital but should also address the situation where the
hospital itself has been affected by a disaster – fire, explosion, flooding or earthquake.
In case of MCI away from the hospital and not affecting the hospital, the further goals are:
• To control many patients and manage the resulting problems in an organized manner,
• By enhancing the capacities of admission and treatment.
• By treating the patients based on the rules of individual management, despite there
being a greater number of patients.
• By ensuring proper ongoing treatment for all patients who were already present in the
hospital.
• By smooth handling of all additional tasks caused by such an incident.
• To provide medications, medical consultation, infusions, dressing material and any other
necessary medical equipment.
In case of incidents affecting the hospital itself the further goals of the plan would be:
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• To protect life, environment and property inside the hospital from any further damage
• By putting into effect, the preparedness measures.
• By appropriate actions of the staff who must know their tasks in such a situation.
• By soliciting help from outside in an optimal way.
• by re-establishing as quickly as possible an orderly situation in the hospital, enabling a
return to normal work conditions.
Principles of a Hospital Disaster Plan

• Predictable: hospital disaster plan should have a predictable chain of management.
• Simple: plan should be simple and operationally functional.
• Flexible: (Plan should have organizational charts) Flexible:
• The plan should be executable for various forms and dimensions of different disasters.
• Concise: The plan should specify various roles, responsibilities, work relationships of
administrative and technical groups.
• Comprehensive: It should be comprehensive enough to look at the network of various
other health care facilities along with formulation of an inter-hospital transfer policy in
the event of a disaster.
• Adaptable: Although the disaster plan is intended to provide standard procedures which
may be followed with little thought, it is not complete if there is no space for adaptability.
• Anticipatory: All hospital plans should be made considering the worst-case scenarios.
A Part of a Regional Health Plan in Disasters: hospital cannot be a lone entity making its plans in
isolation. The hospital plans must be integrated with the regional (district/taluka/block) plan for
proper implementation.
To make the proceedings easier it is recommended that the hospital administrators embark
upon disaster planning using a phase plan. The hospital emergency planning can be divided into
three phases:
1) Pre-disaster phase
a) Planning: Most of the assessment and planning is done in the pre-disaster phase, the hospital
plans are formulated and then discussed in a suitable forum for approval.
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b) The disaster manual: The hospital disaster plan should be written down in a document form
and
copies of the same should be available in all the areas of the hospital.
c) Staff education and training: It is very important for the staff to know about and get trained
in using the hospital disaster/emergency manual. Regular staff training by suitable drills should
be undertaken in this phase.
2) Disaster Phase
a) Phase of activation: Alter and notification of emergency.
b) Activation of the chain of command in the hospital.
c) Operational phase: This is the phase in which the actual tackling of mass casualties is
performed
according to the disaster/emergency plan.
d) Phase of deactivation: An important phase of the hospital emergency plan when the
administration/
command of the hospital is satisfied that the influx of mass casualty victims is not continuing to
overwhelm the hospital facilities.
3) Post Disaster Phase
This an important phase of disaster planning were the activities of the disaster/ emergency
phase are discussed and the inadequacies are noted for future improvements.
Pre-Disaster Planning
Most of the planning of hospital emergency plans is done in pre-disaster phase. It is
recommended that all hospitals providing emergency care to patients start planning for the
worst at the earliest. It is always good to have a ready working plan before next emergency
strikes.
Hospital Disaster Management Committee

Formation of a disaster/emergency committee is the first step for making a disaster plan for the
hospital. The members of the disaster management committee should be from following basic
facilities of the hospital.
The hospital administration: -

• The director/principal/dean/head of institution/medical superintendent.
• Member/members from hospital management board.
• The chiefs/heads of various clinical departments supporting the emergency services;
e.g., casualty
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• and emergency services, orthopedics, general surgery, medicine, neurosurgery (if

present), cardiothoracic surgery (if present), anesthesia.
• The chiefs/heads of various ancillary departments e.g., radio-diagnosis, transfusion
medicine/
• blood bank, laboratory services/pathology, forensic medicine.
• The chief nursing superintendent/matron.
• The finance department.
• The stores and supplies department.
• The hospital engineering department.
• The public relation and liaison office.
• The chief of security of the hospital.
• The sanitation department.
• Hospital kitchen/dietary services.
• The social welfare department (if present).
• Hospital unions.
Central Command structure (Incident command system)
In order to ensure effective control and avoid duplication of action there should be a unified
command system which should be based on the individual hospital hierarchical chain. The
advantages of ICS are many. It has predictable chain of management; flexible organization charts
allowing flexible response to specific emergencies; prioritized response checklists;
accountability of position function; improved documentation; a common language to promote
communications and facilitate outside assistance; cost effective emergency planning within the
hospital.
Although this sort of chain of command is ideal to avoid chaos in emergency situations, it is seen
that there is a strong opposition to formation of any such hierarchical command system by the
physicians and hospital personnel.
Nevertheless, all doctors including the administrator should emphasis that such a command
system would come into effect only at the time of mass casualty incident and would close on
withdrawal of disaster alert. Therefore, all hospital personnel including doctors should respect
the command hierarchy during emergencies and disasters.
Any command system may be used by the hospital, but the most important rule is to make
organizational chart. Each position on the chart should be function based and not position or
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individual based. An individual can be assigned more than one position on the chart, so a person
might have to perform multiple tasks until additional support comes.
Delineate the jobs according to your command system the disaster/emergency management
plan describes many jobs which may need to be performed in an emergency, but how people
are assigned to jobs or the jobs to people depend on different circumstances existing in different
hospitals. Therefore, the jobs delineated according to the command systems depend on the
administrator or leaders of that hospital.
The titles used in a disaster/emergency plan are carried by functions and not individual
people/designation.
Job Cards
Action sheets or job cards are basis of a successful disaster/emergency management plan. These
sheets should be made for each position in the organizational chart of the command system.
The job cards should be detailed; Stored safely (in disaster manual); Color coded and laminated.
Some sample jobs cards are attached
Plan activation of different areas of hospital Plan activation of different areas of hospital the
areas which should find a mention in a hospital emergency plan are:
• Command center.
• Communications office/paging/hotline area/telephone exchange.
• Security office/police picket (chowki).
• Reception and triage area.
• Decontamination area (if needed).
• Minor treatment areas.
• Acute care area (emergency department).
• Definitive care areas (OTs, wards).
• Intensive treatment area and activation of High Dependency Units (HDUs)
• Mortuary.
• Holding area for relatives/non-injured.
• Area for holding media briefings (separate media/PRO/spokesperson room).
• Area for holding patients in case a part of the hospital is evacuated.
• All these areas should be mapped on the outlay map of the hospital. The normal
capacities of the existing areas should be mentioned on these maps. Enhanced admission
of patients requires an enlargement of suitable spots, if necessary, even by changing
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their function.
Disaster beds/ how to increase bed capacity in emergencies?

• The newly arriving patients would require admission for definitive treatment therefore
plans should be
• there to increase the bed capacity when needed. This can be achieved by the following
actions:
• Discharge elective cases.
• Discharge stable recovering patients.
• Stop admitting non-emergency patients.
• Convert waiting/non-patient care areas into makeshift wards.
Planning of public information and liaison

We live in the age of mass and multimedia. Every news and information source will seek access
to the latest and most up to date information. In most cases there is absence of clear and
credible information. This leads to media speculations and increases the stress and pressure of
the incident, especially on hospital and its staffs. The disaster committee should designate one
person from the hospital for regular media/ press briefing.
One of the areas in the hospital should be designated as media room where media persons can
be accommodated for controlled access to information. Media always gets its information – the
better way is controlled one.
Planning for security of hospitals in emergency

• During emergency the hospital is the focus of not only the patients being brought in but
a lot of other persons including relatives, by-standers, media etc. They often block the
entrance and other areas hampering the smooth functioning of the hospital. It is
therefore recommended that all hospitals should have some security arrangements even
in non-disaster phases. The hospital security should be operational at a very early stage
of disaster. Some of the duties recommended are.
• Work in close coordination with local police
• Maintain order within and outside the hospital
• Direct traffic so as not block the free access of patient carrying vehicles to and outside
the hospital
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• Protect key installation of the hospital (Emergency Department, Hospital Working areas,
Power
• Station/ Generators, Water Tanks/Water Supply etc.)
• Restrict and strictly control access to the hospital
• Direct the entry for authorized persons to appropriate areas (ambulances to emergency,
relatives to waiting area, media to media room etc.)
• Protect hospital personnel and patients,
• All hospital personnel should carry Identity cards
Logistics planning
i) Planning for communications (within and outside the hospital) Planning for communications
(within and outside the hospital)
Communications is one of the main problems in major emergencies and disasters. Information
transfer must be reduced to most important facts only. Multiple means of communications
should be planned to communicate with hospital staffs and administrator. The currently
available communication networks which should be investigated for availability in the hospital
are;
• internal telephone exchange (for the hospital)
• landline phones
• private mobile/cellular phones
• mobile/cellular phones in closed user group (CUG) for hospital staffs only provided by
the hospital
• Loudspeakers/ public address system
• Wireless sets for security and ambulance personnel
The communications room

An area should be identified as communication room within the hospital and all internal and
external communications must be made from here. This communication room should be in
continuous contact with the command center/control room.
All-important numbers of hospital personnel, police, district functions of administration other
nearby hospitals etc. should be clearly mentioned in the disaster manual and a copy of this
manual should also be present in the communication room/ telephone exchange.
On getting the go ahead from the control room the disaster message should be flashed/
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communicated to all the numbers.
ii) Transportation
Transportation is necessary in emergency mainly to bring the patients from the site of mass
casualty incident to the hospital. Transport is also required to transfer patients to other hospitals
if the facilities at the hospital in question are overwhelmed or is unable to perform its functions
due to internal damage.
The transport room/driver room should also have a telephone or any other means of
communication like wireless to remain in touch with the control room.
iii) Stores planning

It is recommended that adequate stores of linen, medical items, surgical items should be kept
separately in the Emergency/Casualty and should be marked the “Disaster Store”. The activation
of this store is done only after the Disaster has been notified by the appropriate authorities.
As immediate measures the buffer stocks earmarked for the Casualty/Emergency Services
should be utilized till the fresh stocks are replenished from main Hospital stores/ disaster stores.
Close liaison is kept between the Stores In – Charge and the Hospital administration (Central
command).
Any requirements to the Operational Areas/Treatment areas are conveyed to the Command
Center.
iv) Personnel Planning
Medical Staffs:
In addition to the members of clinical staff, Para and preclinical disciplines (if present in the
facility) should render their services in managing the casualties. Duty roster for standby staffs
should be available in the control room/Command center, Nursing Staffs:
The Nursing Superintendent should be able to prepare a list of nursing staffs who may be made
available at a short notice. The nursing personnel officer should be also able to mobilize
additional nursing staffs from non-critical areas.
Other Staffs:
Duty roster (including those on standby duty) of all ancillary medical services (e.g. Radiology,
Laboratory, Blood Bank) and other hospital services (e.g. housekeeping, sanitation, stores,
pharmacy, kitchen etc.) should be available with the duty officer/ hospital administrator.
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Volunteers:
The role which volunteers will assume in the course of a disaster should be predetermined,
rehearsed, coordinated and supervised by the regular senior staff of the health facility.
Reserved Staff:
In cases of large-scale disasters, the recommendations are made for community participation
and reserve staff concept.
Preparedness will be enhanced by development of a community-wide concept of “reserve staff”
Identifying physicians, nurses and hospital workers who are (1) retired, (2) have changed careers
to work outside of healthcare services, or (3) now work in areas other than direct patient care
(e.g., risk management, utilization review). While developing the list of candidates for a
community-wide “reserve staff” will require limited resources, the reserve staff concept will
only be viable if adequate funds are available to regularly train and update the reserves so that
they can immediately step into roles in the hospital which allow regular hospital staffs to focus
on incident casualties.
Hospital preparedness can be increased if state medical councils, working through the State
Medical Services, develop procedures allowing physicians licensed in one system of medicine to
practice in another under defined emergency conditions.
Financial Planning
An important aspect of any management plan is the financial management. It is recommended
that the disaster plans are made in close association with the financial advisors of the
hospital/institution. This will make them more cost effective and avoid unnecessary and
repeated expenditure.
Operations Planning
The incident commander after notification of the hospital disaster activates and alerts the in-
charges of different important areas of the hospital. The in-charges of various facilities in turn
notify and alert the staff (other staff) working in these areas to immediately reach the area and
carry out their functions. The in-charges also call up the reserved staff which is not on duty to
be ready in case they are needed.
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Essential Medical/Non-Medical Staff Activation (In different Areas) Essential Medical/Non-

Medical Staff Activation (In different Areas)
1) Reception and Triage Area
This area is the first area of contact between hospital personnel and the incoming patients. This
area should be manned by Registration officer on the registration desk
• Triage Doctors/ Nurses
• Adequate number of doctors in the emergency room/ casualty
• Adequate no. of stretchers/trolley bearers
• Hospital attendants
Initial registration and Triage should be done in this area.
Triage criteria for disasters and the patients will be color coded according to the kind of
treatment they deserve e.g.
ONE - Immediate Resuscitation (RED)
TWO - Potentially Life-Threatening Injuries (YELLOW)
THREE - Walking Wounded (GREEN)
FOUR - Dead (BLACK/WHITE)
(2) Decontamination Area (If needed in NBC Disasters) Decontamination Area (If needed in NBC
Disasters)
(3) Acute Care Area (Emergency Department) Responsible person – casualty medical officer/
doctor Acute Care Area (Emergency Department) Responsible person – casualty medical officer/
doctor in-charge emergency services
(4) Definitive Care areas (Operation Theaters, Wards)
Responsible person – zcy services
(5) Intensive Treatment Area Activation (HDU/ICU’S)
Responsible person – Head of Anesthesiology/ Critical Care/ Medicine.
(6) Minor Treatment Areas
The Staffs mainly nursing staffs and hospital attendants who are familiar with first aid, splinting
and dressings can be sent to the Minor treatment areas and thus saving the Medical staffs for
more intensive and resuscitation areas
(7) Holding Area for Relatives/Non-Injured
A hospital staff member will stay with the family members. (Social Services will be assigned here
after reporting to the Command Center and other personnel assigned as needed) A list of the
visitor's names in association with the patient they are inquiring about should be kept.
Volunteers may be needed to escort visitors within the facility.
Essential Nursing Staff Activation
To be done by the Matron / Chief Nursing Superintendent of the hospital in association with
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Deputy Nursing
Superintendents and other nursing administrators.
Essential Ancillary Services (Lab, Radiology, Pharmacy)
(1) Laboratory Services
Department Head or designee will call in their own personnel as needed after reporting to
Command Center.
Call personnel from nearby hospitals and clinics as necessary. Have arrangements made to
obtain additional blood, equipment and supplies from area agencies.
(2) Radiology Services
Department Head or designee will: Call any or all personnel needed. Arrange for extra supplies
to be brought in if needed. Coordinate flow of work and delegation of work areas. Other
members of the Radiology staff will: Perform all x-ray exams/ CT scans/ Ultrasounds etc. as
needed and assigned.
(3) Blood Bank:
(4) Mortuary Services (Care for the dead)
Mortuary should be situated away from the main entrance of the hospital. It should be
adequately staffed with Senior Forensic Specialist/any designee appointed for that purpose.
Patients pronounced DEAD ON
ARRIVAL (DOA) should be tagged with a Disaster Tag and body should be sent to mortuary. The
Emergency department should also notify about all deaths to the Command Control room.
Bodies should be stored in the alternate morgue area if the capacity of mortuary to store bodies
is overwhelmed.
Mortuary Personnel will remain with bodies until removed by Mortuary In-Charger. After bodies
have been identified, the information will be filed on the Disaster Tag and Medical Records
notified as to the identification of the patient. The bodies may be removed via a separate gate
of the hospital with the knowledge of the Mortuary in-Charge. A complete record of all bodies
must be maintained along with the name of the agency removing them, e.g., police, fire
department, hearse, etc.
Be sure appropriate paperwork is filled out.
Other Ancillary Services
(1) Hospital Dietary Services (Kitchen)
Department head or designee will call in their own personnel as needed after reporting to
Command Center.
Prepare to serve nourishments to ambulatory patients, in-house patients and personnel as need
arise.
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Utilize additional areas for extra eating space. Be responsible for setting up menus in disaster
situation and maintain adequate supplies.
(2) Sanitation Services
Adequate sanitation services within and around the hospital should be ensured by the hospital
administration.
(3) Hospital Laundry and Sterile Supply
The hospital administration should ensure adequate supply of clean hospital linen, sterile
dressing and sterile supply of instruments to the essential areas of the hospital.
(4) Essential Services
Water: Adequate provision should be made to meet the additional requirement of water.
Planning should also be done for alternative sources of water such as storage tanks or tube well
which can provide water in case of possible breakdown in the normal system of supply.
Light and Power: Provision should be made for standby generators to provide light and power
to essential areas of the hospital like Emergency Department, Operation Theatres, ICUs etc.
Phase of Staff Education and Training

Once the Disaster Plan is ready the next phase would be the education and training of the staff
of the hospital about the plan and specific roles of each staff member in case of a disaster.
Concept of Common Language in Disaster Situation

The initial chaos of any disaster scenario in a hospital can be minimized by proper training of the
hospital staff about their roles and responsibilities in case of an MCI/Disaster so that, everyone
knows his/her job and work continues in an orderly fashion without confusion
Introduction of Disaster Management Training to Hospital Leadership

A presentation made to all administrators, department heads and managers regarding the
implementation of the Hospital Disaster Plan into the facility's emergency response plan will
help solidify support in all areas of the hospital. This program should be a combination of
education and public relations. Managers should be made to feel that they are all an integral
part of the new system. Interested managers can be recruited to become part of a train the-
trainer class.
Introductory Lessons for all Hospital Staff

An orientation and education program are required for personnel who participate in
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implementing the emergency preparedness plan. Education should address the following
1. Specific roles and responsibilities during emergencies,
2. The information and skills required to perform duties during emergencies
3. The backup communication system used during disasters and emergencies, and
4. How supplies and equipment are obtained during disasters or emergencies;
Disaster Drills
As a part of the emergency management plan, every hospital is required to have a structure in
place to respond to emergencies. This structure is routinely tested during drills. The evaluation
modules for hospital disaster drills are designed to be a part of that testing. Viewed in this way,
hospital disaster drill evaluations can provide a learning opportunity for all who participate in a
planned drill. The disaster drill evaluation modules present topics for valuation in a systematic
manner. They should be used to identify strengths and weaknesses in hospital disaster rills, and
the results gained from evaluation should be applied to further training and drill planning.
Although the evaluation modules can be used to identify improvement in repeated drills, they
are not intended to be used to make final or complete judgments about whether a hospital
passes or fails in its planning and training endeavors. The value of this approach is to identify
specific weaknesses that can be targeted for improvement and to promote continuing efforts to
strengthen hospital disaster preparedness.
Table Top drills

Table Top Exercise is a paper drill intended to demonstrate the working and communication
relationships of functions found within the disaster organizational plan. The exercise is intended
primarily for the administrators, managers and personnel who could conceivably be placed into
an officer's position upon activation of the disaster plan.
Partial evacuation/Non-evacuation Drills

Hospital evacuation may become a necessity if the hospital itself becomes a victim of any
disaster. Such situations need to be foreseen and proper planning must go into how to evacuate
and which areas of the hospitals need to be evacuated first in case of an internal disaster.
(Appendix: I) gives an idea about the evacuation plans of the hospital.
Revision of Hospitals Disaster/Emergency Plan

Continuous revisions should be made in the Hospital Disaster Management Plan taking leads
from the regular disaster drills in the hospital. This would refine the plan and cover up the
deficiencies faced in the Drill Phase.
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Continuing Staff Education

Phase of Disaster Phase of Disaster
Disaster Activation Disaster Activation – Disaster Activation Alert and Mobilization Phase (plans
for alerting the disaster committee, staff, other facilities via phones/paging and mobilizing
resources to appropriate activated areas) Several critical events must occur in this phase:
The Hospital Administration must appoint an Incident Commander.
a. The Incident Commander must not be expected to carry out any patient care, logistical,
security, or other activities, but must be free to command and coordinate the overall disaster
response.
b. The Hospital Administration must choose the most competent person to be Incident
Commander. (Competence in the context of coordinating a hospital during a disaster.) An
emergency Department physician with Emergency Medical Services and disaster experience
would be ideal, but the Incident Commander need not be a physician, nurse, or administrator.
(For example, if a security chief from another hospital just happens to be visiting, and has
managed many hospital disasters before, the Hospital Administration could appoint him as
Incident Commander.) The Incident Commander inherits authority directly from the Hospital
Administration.
c. The hospital Incident Commander's job is to direct all aspects of the hospital's participation
in the disaster operation. The effectiveness of the hospital is his responsibility.
Incident Staff Incident Staff

A. The purpose of the Incident Staff (comprised of Command and General Staff) is to provide the
hospital IC with enough manpower to meet all his or her responsibilities in conducting the
disaster relief operation. This frees him or her to carry out the IC's primary functions of overall
supervision, development and implementation of strategic decisions, approving the requesting
and releasing of resources, and liaison with the Hospital Administration and any other
participating agencies. For a small disaster operation, the hospital IC may discharge some or all
the Incident Staff duties himself or herself, but a large disaster operation might have an Incident
Staff numbers of which can vary.
B. A Staff consisting of the seven positions most appropriate for a medium-sized disaster by
grouping all hospital-related ICS functions into these seven positions. The seven positions in
an ideal incident command system as are follows:
The operation chief: The operations chief is overall in-charge of all patient care activities and
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supervises:
the following areas:
a. Medical Care
Emergency Department
In patient areas
Surgical services
Critical care units
b. Ancillary Services Ancillary Services
Laboratory Services
Radiology Services
Pharmacy Services
Mortuary Services
c. Human Services
Psychological Support
Social Work Support
The Logistics chief: The logistics chief is overall in-charge of all support services of the hospital
and:
supervises the following areas:
a. Communication systems
b. Transportation
c. Dietary Services
d. Stores
e. Sanitation, Water and Power Supply
The planning chief he is planning chief: The planning chief is over: all in-charge of the manpower
planning and is
responsible for making immediate as well as extended rosters of the following staff:
a. Medical Staff
b. Nursing Staff
c. Group ‘C’ and ‘D’ Staff
The public inf he public information officer/ Public Relations Officer: The public information
officer is:
responsible for dissemination of all the information, medical or otherwise, to the relatives
coming
to the hospital as well as to the media.
The Liaison Officer: The liaison officer is responsible for maintaining a close liaison with the
other:
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agencies providing rescue and relief to the victims of MCI/ Disaster. His work is liaison with the
following agencies:
a. The Police
b. The Ambulance Services
c. The Defence Medical Services
d. Railways or other agencies providing medical relief
e. Other hospitals in the network/ Area
f. Blood Banks or other ancillary medical services in the area
The Security and Fire Officer: The security and fire officer are responsible for activating and
alerting:
all the security staff within the hospital and mobilizing them to areas like hospital gate,
emergency department etc. where they are needed most.
The Finance Officer: The Finance Officer is responsible for allocation of emergency funds and:
facilitating emergency purchases when needed in the course of the disaster.
An important concept embodied in the Incident Command System is that of span of control. The
ideal maximum span of control is five; this means that each member in the command structure
should supervise no more than five others. (The functional imperative of this principle, for any
management problem, is: when things get too complex, delegate.) It is not essential to unfold
the whole incidence command structure of the hospital in all disaster. Depending upon the time
of the day and the level of disaster the positions mentioned in the incidence command structure
can be taken over by the staffs working in the hospital that time. Multiple roles can be
performed by a single person till the time other people arrive to support the existing staff.
Different types of hospital Responses

a) In-Hospital Response Phase (small multi-casualty incident, using only main Em. Dept. patient
Care)
During this phase, extra resources are brought to areas such as the ICU's, OT, and Emergency
Department, and some elective operations may be postponed, but otherwise hospital
operations proceed much as normal.
Even if the situation presents with many patients, it is advisable to start in the Small Multi-
Casualty Incident Phase, because it is only a slight extension of normal operations and can be
started without difficulty.
Later, the incident commander can order more staff to reach the hospital and help in both
direct patient care activities as well as support activities.
b) Additional Area/Out of Hospital Support Phase (Large multi casualty incident using additional
areas of the hospital as overflow zones. Also utilizing other definitive care areas of the hospital
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like the OT’s, ICU, HDU’s, Pediatric/ Maternal facilities)

During this Phase, the number of patients disrupts normal functioning; the Emergency
Department is no longer able to handle the patient load, even with extra resources. Other
emergency patient are areas must be opened. This requires assigning extra nurses, physicians,
and support personnel to the area, and establishing command and communication links to the
area for adequate coordination.
The Emergency Department may be able to decongest by postponing care for trivial problems
(sore throats, children with fever etc.) and take more serious patients.
c) Damage to Hospital Phase (Structural Assessment Plans, Damage Control Plans and
Evacuation Plans
are activated)
d) Catastrophic Disaster in City Phase (e.g. Earth quake/ Serial Bombings, hundreds of patients
coming to hospital – Inter-hospital Transfer Protocol Plans come into force) If a particular
Hospital is tasked with caring for hundreds of patients, hospital must be able to extend the
hospital's resources out to nearby areas that can handle large numbers of patients During such
an extended operation, we would have to some degree, merge our Incident Staff with that of
the city, in order to form a Unified Command and to allow proper coordination.
Disaster Deactivation (Demobilization phase) Disaster Deactivation (Demobilization phase)
Disaster Deactivation or declaring the disaster to be over is also a very important step in the
hospital emergency plan. The decision to deactivate the hospital emergency plan should be
taken after proper assessment of the situation by the incident commander and other hospital
administrator. The deactivation should not be too early (premature) or too late. It is very difficult
to reactivate the emergency plan once it has been declared over because staff fatigue sets in
which is difficult to overcome.
Post Disaster Debriefing –

Importance of debriefing exercises as a part of Planning cannot be stressed
further. Debriefing is a process in which the Disaster Committee sits down after the Disaster has
been deactivated and tries to figure out how things went. It can be best described as a critical
self-review of one hospital’s own performance during a disaster. What went right is taken
cognizance of and what went wrong is further incorporated into the disaster plans.
5. Write short notes on:

a. Green hospital
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Green Hospital is one of the four initiatives of the Hospital 2020 movement. Aiming to
accelerate the development, use, and diffusion of environmentally preferable products,
practices and construction of green buildings in hospitals and medical practices worldwide. The
alliance includes all interested parties in the green hospital movement from hospitals,
healthcare leaders, hospital suppliers, green building vendors, universities and governmental
entities who can bring valuable resources in how to build or even convert existing hospitals to
become more sustainable, at the same notion provides first hand insight on the many benefits
of becoming green hospitals of the future.
The seven elements of the initiative:
• Food at the hospital

• Water use at the hospital
• Waste at the hospital
• Alternate Energy at the hospital
• Green Building Design at the hospital
• Energy Efficiency at the hospital
• Transportation in and around the hospital
The green hospital movement began years ago following the U.S. Green Building Council
(USGBC)’s release of their Leadership in Energy and Environmental Design (LEED) standards for
building construction. Although initial cost to adopt green practices might be higher but they
are the best investment in your facility. Green hospitals have been shown to reduce long-term
energy costs. In addition, there is a growing consensus among the health care profession that
pollutants generated by medical facilities must be reduced. Moreover, green hospital design
has been linked to better patient outcomes and staff retention. In the past few years, a number
of newly constructed and renovated hospital buildings have strived for and received LEED
certification.
The Green Hospital is defined as a hospital that has taken the initiative to do the one or more
of the following: choose an environmentally friendly site, utilizes sustainable and efficient
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designs, uses green building materials and products, thinks green during construction and keeps
the greening process going. A Green Hospital is constructed around a facility that recycles,
reuses materials, reduces waste, and produces cleaner air.
Program Services and Deliverables:
The Green Hospital initiative provide participants with the following:
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• TOOLS: A checklist by our trained members to assess the sustainability of the workplace at
hospitals and medical centers. Our workbooks assist participants in learning about
environmental issues in their facilities and the best sustainable practices to adopt, and in
deepening their understanding of their values and purpose in being a green hospital
professional. Our action plans help identify and institute immediate and longer-term changes
for all program components.
• RESOURCES: A rich variety of printed and online educational materials are distributed to
increase the health care professional’s knowledge about environmental issues in the community
that impact human health. Resources include: Green Purchasing Resources List,
Guide to Environmental Impact in Hospitals.
• COACHING: Ongoing coaching is provided to support participants as they navigate through

each aspect of the green hospital practices process and design longer-term sustainability efforts.
• PEER NETWORKING: Face-to-face and online discussion groups are offered to foster a learning
community among participants, and to share emerging sustainable best practices.
• LECTURES AND COURSES: we offer an ongoing series of events, lectures and courses focused
on sustainable practices, insight on operational efficiency, strategies to reduce costs and create
a better environment for patients and employees.
• GREEN HOSPITAL CERTIFICATION: under the standards developed by the Green Hospital
Initiative, in conjunction with other organizations and Green Councils. These hospitals have not
only achieved regulatory compliance but have gone above and beyond in the areas of waste
management, energy and water use reduction, pollution prevention and other sustainable
practices.
Green Hospital promotes the following:
• Sustainable building materials

• Products free of mercury, latex, PVC, and DEHP
• Energy and water conservation
• Tools and resources for environmentally preferable purchasing
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• Greener cleaners
• Integrated pest management
• Waste Reduction and Recycling
• Green Electronics
• Managing pharmaceuticals
• Environmentally Preferable Medical Waste Treatment and Disposal
• Safer alternatives to PBDEs: products in health care settings
• Nutritious, Sustainable Foods and Food Systems
b. Bidding requirements & procedures
Bidding is a procurement method by which you can select the vendor for purchasing the
required goods or for completing subcontracted work within the estimated budget and time.
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To initiate the purchasing process, you send a bid, a request for proposal, or a request for
quotation.
Bidding for a vendor

Bidding is a procurement method by which you can select the vendor for purchasing the
required goods or for completing subcontracted work within the estimated budget and time.
Requesting a proposal
If you have a standard contract with a vendor, you can request a proposal.
Requesting a quote
You can request a quote to purchase products or services from any external vendor.
Sending bids and requests to vendors

When the bid, request for proposal (RFP), or request for quote (RFQ) is approved and issued,
you send this record to the vendors. The vendors can then respond to the bid or request and
you can access their responses.
Awarding contracts from bids

When the vendors respond to your bid, you can analyze their responses and decide who to
award the contract to.
Awarding purchase orders from requests

When the vendors respond to your request for proposal (RFP) or request for quote (RFQ), you
can analyze their responses and award a purchase order.
Bidding process
The bidding process is used to select a vendor for subcontracting a project, or for purchasing
products and services that are required for a project. Bid records contain the specifications of
the project or details of the products and services to be purchased.
Creating bids
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The bid document describes the specifications and estimated costs of the project. The bid
document also contains a list of potential vendors.
Clarifying bids
Clarification during the bidding process is through a bid clarification record sent to the relevant
vendor.
The bidding process is used to select a vendor for subcontracting a project, or for purchasing
products and services that are required for a project. Bid records contain the specifications of
the project or details of the products and services to be purchased.
A typical bidding process consists of the following stages:
The project manager or contract/purchasing manager creates a bid that describes the
specifications and estimated cost of the project.
The manager issues the bid.
(Optional) The reviewers approve the bid.
The manager sends the bid to a group of vendors for response.
The vendors analyze the bid and calculate the cost at which they can complete the project. Each
vendor responds to the bid with details about the products and services that are needed and
the overall cost.
The manager manages and analyzes the bid responses.
The manager awards the bid to the vendor that best meets the requirements of the project.
A standard contract is automatically created by using the bid details and response information.
During the process, the manager or vendor can request clarification about the bid.
******************************************
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Senapati Bapat Road, Pune: 411004, (MS), India

Phone: 91-20-25655023, 8888892258

Roll number: 17200077

Assignment no. 6 (based on module 6): Hospital Planning

2nd Set of Assignments (Modules 6 to 11)

Total: 100 Marks

Answer the following questions. Each question carries 20 marks.

Reasons why hospital planning and designing is important:

Planning involves six questions:

Step 1: Analyzing Project Needs

Needs Analysis Topics

Step 2: Assembling the Project Team

Executive Project Team

The Project Leader

User Group Teams

• Contractors, including the project manager, estimators, and schedulers

• Developers or development consultants

Integrating the Contractor

Criteria for Partner Selection

Team Decision Making

Team Collaboration and Partnering

Common Level of Understanding

Step 3: Gathering Project Data

Existing Facility and Site Conditions

Areas for Evaluation

3. Functional and operational space needs: There should be a functional assessment to

Guidelines and Requirements

Step 4: Devising a Project Plan

Preliminary Facility Plan Elements

Other Preliminary Facility Plan Considerations

Representing the Time Line

Detailed Space Plan

Benchmarking for Estimating

Step 5: Determining a Budget

Anticipated Critical Costs

Step 6: Finalizing the Master Facility Plan

Step 7: Ensuring Regulatory Compliance

Step 8: Documenting the Master Facility Plan

Form and Format

2. Explain the feasibility study of hospital project.

A feasibility study aids in transforming an idea into a viable reality

• What are the primary and secondary markets?

• At stabilization, what are the operating profits?

• Civil Site and Public Infrastructure Improvements

Financial Feasibility Study for Property Development

Land and Project Evaluation

Analysis of the overall land and site, including:

Description of the Development and Industry Insights

▪ Population of the surrounding area and trends, including projected growth

▪ Existing market size

In addition to the demographics, a feasibility study would examine existing structures or

▪ The location of a similar project

▪ Market size, demographics, etc.

▪ Concept Development and Planning for the Project

▪ The types of services offered

▪ Revenue projections, proforma statements

Preliminary Property Development Feasibility

1. Conduct a debt capacity study.

2. Identify key service lines.

3. Establish a coordinated timeline.

4. Build realistic revenue projections.

3. Describe the planning of department of oncology in a multispecialty hospital.

Planning of department of oncology in a multispecialty hospital.

The oncology treatment team: Key characteristics