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DISSERTATION WORK DONE BY
Dr. Preet Matani
AT
HOSMAC (India) Pvt. Ltd
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ACKNOWLEDGEMENT
The dissertation period gave me an opportunity to explore the field which has
always intrigued me and where my interest was- that of facility planning.
I am indebted to Dr. Vivek Desai Director HOSMAC (India) Pvt. Ltd. for giving me an
opportunity to work in his organization as there are but a handful of such organizations where
I could have pursued such a study.
I am extremely grateful to Mr. Hussain Varawalla- Sr. Architect HOSMAC (India) Pvt. Ltd., my
guide who took a lot of efforts for my sake.
I am also extremely grateful for the support provided by my seniors Mr. Sameer Mehta and
Mr. Kapil Rawal who were a constant source of encouragement at HOSMAC.
I would like to thank Brig. S.K. Puri, my guide, for having faith in me and I hope that I would
be able to live up to his expectations.
I am also indebted to my teachers Dr. S.G. Kabra and Dr. Hari Singh for their guidance
throughout my academic career.
Lastly but not the least I would like to thank my friends - Shekhar, Rupesh, Gaurav Tripathi
and Benjamin for always being with me throughout my stay at IIHMR.
PREET MATANI
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TABLE OF CONTENTS
CHPT
NO
TOPIC PAGE
NO.
1 STUDY DESIGN
1.1 INTODUCTION AND BACKGROUND INFROMATION 1
1.2 RATIONALE FOR THE STUDY 3
1.3 OBJECTIVE 4
1.4 SPECIFIC OBJECTIVES 4
1.5 METHODOLOGY 4
1.6 LIMITATIONS OF THE STUDY 5
1.7 TIME PERIOD AND PLACE 5
2 ABOUT THE ORGANIZATION 6
3 LITERATURE REVIEW 15
4 SPACE PROGRAM 23
5 OPERATION THEATRE 38
6 INTENSIVE CARE UNITS 50
7 RADIOLOGY 61
8 LABORATORY 72
9 CENTRAL STERILE PROCESSING DEPARTMENT 80
10 PATIENT ROOM 87
BIBLIOGRAPHY 89
ANNEXURES
1 LIST OF LICENCES, REGISTRTIONS AND APPROVALS 90
2 AERB SPECIFICATIONS FOR MEDICAL DIAGNOSTIC
EQUIPMENT (X-Rays)
91
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EXECUTIVE SUMMARY
This study was carried out at HOSMAC (India) Pvt. Ltd, a consultancy firm of
repute. HOSMAC has experience of building several hospitals with many new
projects in the pipeline. This study is about a brief for a proposed 100-bed
hospital. It is both exploratory and descriptive in nature.
Once a decision has to build the hospital has been taken the next step is its
architectural design. A detailed architects brief has to be first prepared to enable
the architect in drawing up his plans. The landscape, facility mix, bed mix,
availability of utilities in the vicinity will have to be considered. Considerable
inputs from other agencies like air-conditioning, electrical, plumbing, etc. will be
required to finalize the working plan for the building. Inputs from the equipmentvendors especially in specialty areas like Cath-labs, CT-scanners, MRI, linear
accelerators, operation theatres etc. will be essential. In India a common thing is
lack of emphasis given to support services like kitchen, laundry, CSSD, back-up
electricity and so on. Not only are these services vital, but these also have high
capital cost and recurrent expense and hence should be properly planned. Just to
illustrate the standards for healthcare design in India, we are still designing
facilities where total area per bed is hardly 600 sq. ft. whereas western standards
are close to 1,400 2,000 sq.ft. per bed and WHO recommends an area of 800-
1200 sq. ft per bed. While it may not be prudent to follow the western concepts
blindly, one needs to pick up the good things from the modern methods. Some of
the issues that could be adapted from developed countries are flexibility for
future expansion, larger secondary areas for better patient comfort, proper
utilities for wait areas, nurse stations, storage, changing rooms, alcoves for
stretchers/ wheelchairs, adequate transport facilities, parking facilities, proper
light and ventilation etc.
In the case of hospitals functional complexities far outweigh physical complexities
and demand an addition to the planning and design team of persons who
understand not only the work process of individual departments but those of the
hospital operating system as a whole.
The study will help in formulating a functional brief or an architects brief that will
have an analysis of functional needs, interrelationship of departments, area
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requirements, major equipment, the grouping of accommodation and the main
outline of traffic flow.
This document would help the architect in understanding the complex needs of
hospital functioning and enable him to build a hospital that is functional, efficient
and yet economical without compromising on the design aspect.
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1.1 INTRODUCTION AND BACKGROUND INFORMATION:
Planning can be defined as ' The specification of the means necessary for the
accomplishment of goals and objectives before action towards these goals has
begun'
What are the various things that must be addressed to during healthcare
programming and design process?
1. Provide a functional design that ensures efficient, safe and appropriate work
spaces.
2. Accommodate technical requirements for highly sophisticated equipment.
3. Create clear, segregated paths for movement of people and material within
the building.
4. Create a humane environment for patients and staff.
5. Develop building systems that can accommodate rapid change.
6. Blend technical and functional requirements into a design that brings delight
to those who use the building and those who pass by it.
Architects and construction oriented professionals acting alone may provide a
building that operates efficiently as a physical structure, however, it is equally
possible that they may entirely miss the mark in terms of operationalfunctionality.
And Functionality as a prime determinant of operational efficiency is a major
factor in the total life cycle cost of all hospital structures. There is also little doubt
that quality of care and treatment is also affected by the degree to which design
accommodates both inter and intra-departmental functions. Hence a new
discipline called functional planning has emerged over the past few years, which
augurs well for the future of hospital design. Individuals possessing adequate
training and experience in this field have made and are making substantial
contributions to the planning and design process. Usually such planners have
backgrounds in hospital management. They could also be architects who have
specialized in hospital architecture or trained personnel of consulting firms.
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Responsibilities of a functional planner:
1. Physical evaluation of existing facilities (along with architect)
2. Functional evaluation of existing facilities.
3. Preparation of workload projections.
4. Functional programming.
5. Space programming (along with architect).
6. Master site planning (along with architect).
Although functional planning of hospitals has not reached its maturity and
indeed may never do so, concepts springing from its practice are burgeoning
yearly as intense study is made of alternative operational and building systems.There are even more innovative changes in operational methods and procedures
on the horizon as demands for greater employee productivity are considered. All
this will directly depend upon architectural design for implementation and few
can be brought into being without direct input to the design process by
functional planners.
Determination of the services to be provided in quantitative terms requires
consideration of the following:
Functions
Locations
Relationship
Utilization
Staffing pattern
Space requirements
Work flow.
Before an architect can develop a hospital design that will best serve its
functions he has to be provided a written programme explaining these
requirements. This is the architects brief from the interpretation of which he
prepares schematic drawings and sketch plans.
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The brief would contain the permission required from various regulatory bodies,
spatial needs of various departments, manpower required, special requirements
of various departments, inter and intra departmental relationships.
1.2 RATIONALE FOR THE STUDY:
The future will see a continued demand for the construction of healthcare
facilities including completely new or replacement facilities and projects involving
major additions and modernization. The annual value of healthcare construction
projects will see an uptrend in the immediate years ahead owing to various
factors like opening up of the insurance sector and privatization initiatives.
Therefore planning and design will continue to merit prime emphasis amongst
other responsibilities of healthcare officials. In the case of hospitals functional
complexities far outweigh physical complexities and demand an addition to the
planning and design team of persons who understand not only the work process
of individual departments but those of the hospital operating as a single
functional system. Functional planning is the responsibility of a trained hospital
administrator who should be capable of interpreting complex relationships,
internal traffic flows (personnel and supplies),
Technological requirements and operational procedures to the extent a product of
beauty, reasonable cost and optimal utility will result. A functional design can
promote skill, economy, conveniences and comforts whereas a nonfunctional
design can impede activities of all types, detract from the quality of care and
raise costs. A non-functional building is the nemesis of any hospital striving to
compete in the current climate of competition and emphasis on productivity. Thus
this stage consisting of preparation of the architects brief is important as the
design of the hospital will become crystallized during this phase. Time and
trouble spent during this stage will be well repaid and will enable the whole
project to proceed smoothly with a minimum of subsequent revision.
In undertaking any complex activity it is well to examine the experiences of
others in similar situations if such information can easily be found and properly
interpreted.
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1.3 OBJECTIVE:
To prepare an architectural brief that would help the architect to build a
functional, economical and efficient hospital.
1.4 SPECIFIC OBJECTIVES:
1. To study/understand the issues involved in functional planning of a hospital.
2. To determine the recent trends and changes in the healthcare facility needs
and to evolve a document that can incorporate these changes so as to enable
the architects to build hospitals in tune with modern requirements.
3. To draw up a space plan for the proposed hospital.
4. To study certain departments in greater detail and to provide a brief that may
be used as a basis for detailed programming later on.
1.5 METHODOLOGY:
Both primary and secondary research was carried out with more emphasis on
the latter.
Primary research will involve in-depth interviews with hospital consultants and
architects experienced in building healthcare facilities.
Secondary research will involve descriptive studies of the functional planning
carried out while building hospitals in the recent past. This will also involve
literature review by going through different books and journals.
Thus the study design is both exploratory and descriptive in nature.
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1.6 LIMITATIONS OF THE STUDY:
Considering the time factor all the departments of the hospital were not
dealt with: only certain key departments were covered.
The study could provide only a preliminary brief for the architect. It would
be the basis for the development of a more detailed brief.
1.7 TIME PERIOD AND PLACE:
The study was carried out at HOSMAC (India) Pvt. Limited, Mumbai from 24th
January till 17th April 2003.
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Chpt. 2 ABOUT THE ORGANIZATION:
HOSMAC India Private Limited is a pioneering name in the field of Hospital
Planning & Management consultancy in India. Since its inception in 1996,
HOSMAC has grown rapidly to become a Unique hub of skill sets which cuts
across various facets of a health care facility be it architecture, engineering,
management, or information technology.
In a short span of 6 years, HOSMAC has notched up an impressive string of more
than 80 projects in India and abroad. HOSMAC provides the entire range of
services that any health care service provider, may require: undertaking market
research, feasibility studies, detailed architectural design, project co-ordination,
equipment procurement, commissioning assistance, conducting an operational
audit for existing hospitals.
To provide such wide ranging services HOSMAC has a motivated team of highly
qualified and experienced professionals (doctors, MBAs, architects, engineers andproject managers). On a cumulative basis these professionals have more than
245 man years of experience and have rendered more than 60,000 hours of
management consulting services, designed 1.4 million sq feet of hospital space,
and are coordinating hospital projects worth more than 3.34 billion INR.
Unlike other industries, the health care industry is extremely complex in terms of
the wide spectrum of specialties, technologies, and the skilled/unskilled
manpower. The smooth interplay of these factors only will lead to a successful
health care organization. The alarming rise in cost for providing quality healthcare will drive hospitals to cut costs rather than only enhancing revenue.
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Some of HOSMACs services
OSPITAL PLANNING & PROJECT MANAGEMENT
Market Research For Project Conceptualization
A comprehensive market research is undertaken to ascertain the needs in the
local health care market. HOSMAC's field workers are specifically trained to
conduct surveys and gather secondary data from various governmental and non-
governmental agencies.
The survey could include
households
medical professionals
diagnostic centres
nursing homes
hospitals.
relevant data from census report, demographic surveys,
government/media publications, and various other sources is also
searched
Such a market study is essential:
to primarily know the deficiencies in the health care market, thereby
assisting us arriving at a proper facility & bed mix.
to helps us finalizing the project size
for existing hospitals to undertake benchmarking in areas like tariff
rationalization, compensation policies, utilization reviews for various
services etc.
Feasibility Reports
Having decided on the facility mix, the next value added service provided by
HOSMAC includes a very detailed and comprehensive feasibility study of the
project. This has been our major strength and we have to credit more than 30
such studies. We are proud to mention here that many of our reports have been
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accepted by leading Financial Institutions in the country like IDBI, ICICI, IL&FS
and also multilateral agencies like the World Bank, Kfw etc.
The feasibility report would essentially contain the following vital information:
Brief description on the major findings of the market research
Proposed facilities plan
Detailed project cost inclusive of land & building, medical equipment, non-
medical equipment, furniture & fixtures, utilities, pr-operative costs,
contingencies, and working capital requirement, and the means of finance
Income and expenditure projections based on the feedback from themarket research and form HOSMAC's exhaustive database
Profit and Loss/ Balance sheet/Cash flow statements
Break even analysis
Sensitivity analysis
Architectural Designing
It is a known fact that Hospital Architecture in India is a neglected specialty.
HOSMAC's aim is to bridge this gap by providing modern yet practical cost-
effective solutions to the health care industry.
Healthcare architecture differs from that of other building types in the complexity
of the functional relationships between the various parts of the hospital. In the
residential and commercial building types the design brief is relatively easy to
understand and cater to. Healthcare architecture, however, requires specialized
knowledge on the part of the architect and the supporting engineering team. The
lack of such trained professionals results in many of the hospitals in India todaybeing ill conceived and costing their promoters much more in construction and in
inefficient operation than they need to. Eventually it is the patient who bears the
brunt of this incompetence through lack of quality in the medical care provided,
physical and mental discomfort and increased cost of hospitalization.
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Specialized healthcare architecture is a field that is still in its infancy in India. As
pioneers in the field, HOSMAC is uniquely positioned to advise its' clients. This
advice is based on the combination of the skills and knowledge of our varied
team of professionals, which consists of doctors, architects, engineers and
hospital management graduates and the resource of an extensive database ofinformation compiled over the years.
However, this specialized field is not only about satisfying the stringent functional
demands that the hospital makes on its designer. The emphasis of healthcare
architecture is also on improving the quality of the environment for patient and
caregivers alike. It must meet the needs of people who use such facilities in
times of uncertainty, stress, and dependency on doctors and nurses. It must
recognize and support patients' families and friends by providing pleasant spaces.
At the same time the building should project an underlying reassurance that the
patient is in the hands of competent medical staff and in a technically sound
healthcare facility.
In the future patients will be increasingly demanding of healthcare organizations.
Those facilities that are designed to be most responsive to patients in terms of
convenience, caring encounters, service orientation and the quality of care will do
best in meeting these new demands.
Architects are regarded as talented problem solvers. The problem here is to finda way to deliver a high quality of care and access in a setting that is also highly
supportive of human relationships during times of great anxiety and fear. The
particular skills of HOSMAC's design team are well suited to meeting this
challenge.
We invite you to proceed to learn more about how HOSMAC (India) can help you
design and construct your proposed healthcare facility.
Project Management
Apart from providing Architectural Designing solutions, HOSMAC also provides
the most vital project management services. An ardent need was felt for this as
most hospital projects in India suffer from lack of co-ordination between various
agencies like the promoters, architects, contractors, consulting agencies, doctors,
equipment vendors etc. HOSMAC thus identified this as a vital growth area and
has been rendering such services to help our clients in combating TIME/COST
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overrun apart from giving functionally sound infrastructure solutions.
This service includes important activities
Liaison with all Agencies - Architects/contractors/equipment
vendors/utility service consultants and suppliers
Monitoring Project with PERT/CPM
Managing Change in Project Plans - most vital and complicated component
due to the various fall outs from the change in project design
Managing equipment planning schedule including cost-feature analysis,
procurement process, installation etc.
MANEMENT CONSULTANCY
Management Consultancy Services
Turn Around Strategies
Such assignments include studying the historical trends of the hospital in terms
of its income/expenditure patterns, identifying cost/profit centers, identifying the
key success criteria for improving the bottomline. Having done this we provide a
strategic business plan with definite milestones to implement our
recommendations and monitor the same.
Operational Audits
This is again a niche service provided by HOSMAC for health care institutions
requiring specific departments to be studied for improvement which may be
qualitative and/or efficiency related. An example of studies could include:
improvement of the lab services
operation theatre utilization reviews
manpower audits
medical audits
infection control programs
reorganization of profit centres
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support service audits etc.
Costing of Services
This is a highly specialized service which we provide. It is a well known fact that
hospitals in India set their tariffs in comparison to the market rates. This leads to
skewed rate setting and the customer is the looser. HOSMAC has conducted
several costing exercises for our clients to help them understand the real cost of
providing services by virtue of which our clients have an advantage over their
competitors. In many cases we found that hospitals were under pricing their
services hoping that volumes will cover up the cost, whilst they were actually
increasing their losses. We have developed an in-house format for costing of
various services on a department wise basis which enables us to conduct our
studies in a systematic manner within a short span of time.
Systems Study & Re-design
Though HOSMAC does not provide computerization solutions, we are thorough in
system analysis and provide vital interface solution with the agency providing the
computer solutions. Also such assignments are essential for hospitals which do
not have computerized systems for various activities. The activities involved
include 'walking through' the processes, identifying the stumbling blocks, finding
solutions, redesigning the systems/processes/forms/reports/records,
implementing the 'changed' processes and providing online correctional
interventions. Many of our clients have found our association to be invaluablewhilst implementing the computerization modules.
Manpower Audit & Training
Hospitals are labour intensive institutions and salary expenditure forms the major
head of expenditure. Therefore it is of paramount importance that a proper
manpower plan is formed and implemented. Also notable feature is that in
hospital setting the interaction between the highly skilled and unskilled workforce
is of a very high magnitude leading to IR problems. Whilst conducting such study,
we undertake an exhaustive manpower audit of all departments and benchmarkit with the industry standards to ascertain the deficiencies. Wherever required re-
distribution of manpower, job enlargement, and job enrichment solutions are
recommended. Customized training programs are conducted targeting specific
needs like attitudinal change, team building, grooming in etiquettes, etc.
Marketing Strategies
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This has been one of our most popular services and we have devised and
implemented successfully our marketing plans. We begin our assignment by
benchmarking the services against the best hospitals in the client's service
segment and conducting a customer satisfaction survey to understand the
drawbacks in our services and products to be marketed. This followed by aproper product development for marketing, which includes improvement in the
service delivery mechanisms, proper pricing, identification of target audience,
preparation of brochures/mailers, and setting milestones for productivity
enhancement. We help our clients in implementation of the strategy by making
visits to the corporates and monitoring the overall process of marketing.
L EQUIPMENT PLANNING
Biomedical Equipment - Planning & Procurement Norms
Advances in Engineering and Information Technology in the recent years havebrought about several changes in the field of Medical Science. Medical Equipment
play a very significant role in the field of medicine and healthcare delivery
system. Sophisticated biomedical equipment requires a host of utilities like the air
conditioning and refrigeration, stabilized power supply systems etc. The design
criteria of these support systems are of paramount importance.
Hospital equipment fall into an extremely wide spectrum ranging right from a hi-
tech MRI and CT scanner to a simple patient trolley. These all account for a major
part of any hospital project cost, which could go upto almost 60%. Of this,biomedical equipment could account for nearly 50% of the cost. Keeping this in
view it is essential to ensure maximum utilization of the equipment with
minimum downtime.
The health care industry is experiencing a new era in cost containment. In the
past, little attention was given to the financial impact of equipment related
decisions. Today, however, times have changed. In this new environment, "state-
of-the-art" is no longer sufficient as planning criteria for selecting new
technology. Today, for a technology to be appropriate, it must address the needs
for efficiency, cost-effectiveness, and productivity and at the same time, improve
or maintain the quality of patient care. In addition, hospitals are finding
themselves in an extremely competitive arena, which puts an additional emphasis
on a technology's marketability. The challenge faced by hospital executives today
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is to gain the management and control required to make effective equipment
planning decisions.
Whilst medical devices can be broadly categorized into diagnostic and therapeutic
equipment, the selection criteria for procurement would need to take into account
several factors viz. type of hospital & level of services provided; services
available in the neighbourhood and technology employed; background of the staff
that would operate the equipment; proposed tariff for the services employing
medical devoices; etc. Having addressed these issues one would need to carry
out a separate financial feasibility for the major and critical equipment and then
set out to prepare the specifications and features of the medical devices that
would be considered most appropriate for the hospital. After having undergone
this exercise too there are multiple products that one can choose from. For this
one would need to apply further criteria and do a detailed analysis of factors
related to the technology and design base of the equipment; the maintenance
convenience and available service support; forthcoming technology and
interchangeability with the current generation; presence of the manufacturer /
vendor in the existing market place; and once again the factors are several!
Product Development Assistance
Provide benchmarking data regarding market expectation from a hospital
management system
Details hospital best practices
Undertake detailed reviews of newer modules and upgrade versions and
provide recommendation of any enhancements/modification
Periodic comprehensive review and study of the existing modules to update
and upgrade continuously
Implementation Assistance
Jointly prepare implementation plan with solution provider
Undertake a comprehensive system study
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Gap analysis
Preparing specification for customization
Site monitoring assistance
Undertake audits of the sites where software is already installed to
identify areas of problem
Business Development Assistance
Provide business development assistance in terms of identifying
new leads, represent and recommend the business partner during
presentation to key clients as hospital consultants.
LITERATURE REVIEW:
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Since Henri Fayol's pioneering treatise on management in 1916, planning has
involved two considerations, i) Assessing the future and ii) making provisions for
it.
According to Robert M. Fuller "Planning is of course decision Making because it
involves selecting from among established alternatives" Certainly the adoption ofa systematic planning process is imperative in any hospital facility. Failure to
adopt and to adhere to a specific methodology almost invariably results in a
deterioration of the quality of planning. Architectural design represents the most
definitive act of planning any building project. Although representing a new
discipline, functional planning already has achieved recognition through its
contribution to operational functionality and has become a key factor in hospital
design. Future research in this area of planning and design process may further
enhance productivity in the healthcare field.
In terms of broad categories of activities the process of hospital project planning
can be a multistep process.
The steps are as follows:
1. Perception of need for a building program.
2. Strategic Planning and feasibility assessments.
3. Organizing for planning, design and construction.
4. Determining the planning, design and construction approach.
5. Scheduling planning, design and construction.
6. Opening the completed project.
The role of the Functional planner is most important in steps 3 and 4.
Selection of the professional planning team
A complete team should possess capabilities in
Financial Feasibility Consulting. Functional Planning.
Architectural and Engineering services
Construction Management.
Selection Timing:
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The Functional Planner, the architect and the construction manager can all
make valuable contributions in the early stages of a project and should be
contracted at approximately the same time. Because the functional planner has
the most intense involvement in the very first stages, he might be brought in
first, but the other two must closely follow.
The possibility to influence a project and its cost is reduced during the course of
its development after the client has decided to establish the requirements of the
user and started to investigate the problems. The largest reduction of possibilities
to influence the design occurs at point 1, which marks the clients decision
concerning implementation. The figure is based on a study by Stig Nordquist.
Responsibilities of a Functional Planner:
1. Physical evaluation of existing facilities (along with architect)
2. Functional evaluation of existing facilities.
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3. Preparation of workload projections.
4. Functional Programming.
5. Space programming (along with architect)
6. Master site planning (along with architect)
1. Physical evaluation of existing facilities:
This is a study to determine the degree of physical obsolescence of existing
facilities and to identify major code violations and physical problems and to
project future usability.
2. Functional evaluation of existing facilities:
This is a study to define functional problems that detract from operational
efficiency, quality of patient care, and convenience of building inhabitants to
evaluate traffic flows and physical relationships, to determine space
insufficiencies in terms of current requirements to study the need for
modernization, alterations and expansion, according to strategic plan findings
and to note possible alternative future uses of the structure as a whole as well
as of various departmental areas.
3. Preparation of workload projections:
The functional planner can determine and formulate concepts of operation for
the proposed project according to previous study findings. These concepts will
be incorporated in the functional program. These projections form the basis
for functional programming, revenue projections and staffing estimates.
4. Functional programming:
Using approved recommendations and findings of the strategic plan, findings
of physical and functional evaluations and workload projections, the functional
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planner formulates recommendations for operational concepts, the detailed
room composition of the project, required phasing, alterations, internal and
external traffic flows, interdepartmental relationships and operating systems.
5. Space programming:
Based on the functional program, as amended and approved by the hospital a
room by room listing is made of all areas in the proposed project. Net square
footage is assigned to each space, and totals accumulated for every
department or functional entity. using the net figures, appropriate calculations
are then made to set gross totals for each department or functional entity as
well as the total for the entire project.
Some pointers to successful hospital planning
Good planning is critical to the hospitals success:
If a hospital has to be successful it must be built on the bedrock of three sound
principle namely good planning, good design and construction and good
management. The absence of the first two of the equally important but closely
related triad, good planning and good design and construction means failure todesign the facilities for the optimum utilization of staff and services. This in turn
results in a mediocre hospital that fails to realize its economic goals.
Efficient, Functional and economical hospital:
The real test of any hospital is the quality of healthcare it provides. If the hospital
has to pass this test- a truly rugged test-planning and design must result in a
functional, efficient and economical hospital. It should be remembered that even
minor defects in designing could make the operation of a hospital inefficient. The
corollary of this is that an inefficient hospital costs significantly more to operate,
staff and maintain, not to mention the fact that the patients within it get less
health services for the money they pay.
It should be borne in mind that economy of operation and maintenance over the
life of the building as well as the quality care to patients depends in a large
measure on the proper planning and designing of the hospital and is more
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important than the economy of construction. The initial cost of building a hospital
is insignificant when compared to the cost of running and maintaining it over the
years- by one reckoning eighteen to twenty times over a period of say twenty
years. Another study says that the running cost of a hospital over 4 to 5 years
from the date of completion is about the same as the capital cost. and if thefacilities are not planned and designed properly this intangible cost can be
enormous. the efficiency with which the physicians and their assistants can
function has been greatly handicapped by obsolete design. Patient comfort and
provision for expansion have often been overlooked. Growing efficiency and
innovative ideas have revolutionized hospital building construction to meet
among other things, the special needs of patients. It is believed that a pleasant
environment that makes for an enthusiastic and more productive staff also
benefits the patients albeit indirectly.
Promoters and hospital planners often overlook to include in the facilities design
what helps to preserve the patients' dignity and status as a human being or
details that would make the hospital more livable. Many patients complain that
hospitals as institutions reduce privacy, individuality and more importantly
human dignity. Many of these details and facilities can be incorporated with little
or no extra cost.
While planning and designing a hospital the patients needs and expectations
should be kept uppermost in mind and any design should aim at his satisfaction
and comfort.
Today's healthcare facility is by its very nature a complicated entity and planning
and designing such a facility to serve the increasingly complex needs of its
patients, staff and management team is difficult and complicated. The problem is
compounded by rapid changes and advances that are taking place in the fields of
technology and medicine and the constant need to modernize, renovate, replace
and expand healthcare facilities.Process of planning:
A common understanding should be established between the architect and the
engineers on one hand and the promoters, doctors, administrators and planners
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on the other. A wide variety of professionals need to be integrated into a
planning team that is responsible for the implementation of this complex process.
Initial planning encompasses the general physical facilities that are being
considered, the space requirements, cost constraints, time schedules, standards
that must be included.In the next step details of the operational plan for each department should be
considered- location of each department, requirement of floor space,
intradepartmental and interdepartmental relationships, circulation, traffic flow
and requirements in relation to equipment, personnel and patients.
Operational and Functional planning first:
Before any plans can be drawn by the architect an understanding of the
requirements of the hospital in terms of services it is going to provide, number of
beds, departmental functions, departmental needs, major equipment, space
requirements, required personnel, relationships and adjacencies must be agreed
upon. All this must form a written document. This is called operational planning-
a written programme needed for any architectural project.
Operational planning establishes a dept-by dept description of needed space by
outlining for example, the no. and type of surgeries, X ray rooms, outpatient
services, laboratory services etc. the exercise thus determines current and
projected needs within the facility. A consultant or an administrator who is
knowledgeable and has experience in the operation of the hospital is by far the
best person to develop this document. Normally there is either no briefing of the
architect or the brief given to him is inadequate. The promoters must clearly tell
the architect the requirements of the hospital and not the other way round. The
architect should not dictate to them nor should he conjecture what the
requirements are or what he should design. More often than not there is no
written brief or operational program and to know what is needed the architecthas to fend for himself. Sometimes he is asked to prepare his building schedules
with the help of doctors, at other times he is asked to observe other hospitals
and take guidelines from them. Both these are unsatisfactory methods.
Key to Functional planning:
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The proper sequence is the development of operational planning that defines
the major requirements and needs first. The operational plan is then developed
into a functional plan. Planning of the hospital on a functional basis-that lists
every room and suggests net sizes for major functional rooms and the total sizeof the department. The key to functional planning is not just a room list but
understanding that travel and adjacencies will affect operational cost for the life
of the facility says David R. Porter the renowned hospital architect.
Mistakes in planning may prove costly:
Instances are aplenty of hospitals that were not planned with these critical
factors in mind-within five to ten years they found that the cost of construction
had been equalled or surpassed by operating expenses.
Functional grouping of high traffic areas such as X-ray, laboratories, surgical and
delivery suites, physical therapy and clinics on two floors is desirable. It permits
concentration of hospital activities in a manageable unit. When future expansion
or changes becomes necessary, they can be accomplished without disturbing the
nursing areas.
Operational Plan and Functional Plan must precede Architectural Plans:
Planning and Building a hospital to serve the increasingly complex needs of
modern healthcare is an intricate job. The architect though competent in his
profession may not be competent in the technical aspects of hospital architecture
and may lack knowledge of some of the specialized clinical and administrative
areas and matters. This document called the operational plan and functional plan
developed from it form the basis and are necessary prerequisites for the architect
to prepare the architectural plans.
Hospitals must be planned for the future:
A fundamental rule that promoters should remember is that the hospital should
be planned for at least 10 to 15 years ahead or else experts say plans will be
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obsolete when they come to the drawing board. With the rapid development and
advances in technological, medical and administrative sciences and innovative
techniques and therapies, space requirements of every department has increased
markedly. New departments come to be needed, and more space is required to
some specialties. In addition to space needs, technology is imposing a host ofphysical demands on our hospitals. Well planned systems must be built into them
to keep pace with the changes. Said one design expert ' We have got to design
`Smart hospitals that respond to present needs while anticipating future
change.
Within the building all departments must be planned in such a way that they can
stand individually. This can be done by freely locating each department with
space around for expansion. Further care should be taken that expensive
permanent fixtures and fixed equipment such as plants and elevators are not
located at the free ends of the departments as they would permanently block
expansion plans. Future expansion is rendered easy with free ended buildings
with extendable corridors.
Space Program:
The space plan is made on the basis of personal interviews with hospital
administrators experienced in building hospitals and also with the help of
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literature review and would help the architect in finalizing his plans. Hospitals are
a difficult planning subject as explained earlier. The maxim Design follows
function must be kept in mind while allocating space details. The area
specifications may be taken as indicative as suitable alterations would have to be
made by the architect to conform to the grid matrix.The total space area including the parking space, HVAC and water is 1,05,319 sq
ft which works out to be 1053.19 sq ft. This is in concurrence with modern
standards of constructing hospitals which provide for an area of 800-1200 sq ft
per bed.
Ground Floor:
Key Departments like OPD, Emergency, Radiology, Laboratory would be situated
on the ground floor. The Radiology dept. would be situated near the Emergency
dept.(According to a study nearly 40% of cases coming to Emergency require X
rays)
The administration department would be located on the 1st floor along with the
Blood bank and General and Paediatric wards.
The Labour room, Obstetric ward and NICU would be located on the 2nd floor
along with the semi-private ward.
The CSSD would also be located on the 2nd floor just below the operation theatre
with provision for dumb waiters between the CSSD and the OT.
The OTs will not be located on the top floor to avoid the excess heating nor will
they be located near the major traffic areas.
The ICUs and private wards will also be located on the 3rd floor.
The residential area will be located on the 4th floor just above the ICUs and the
OTs. So a doctor can easily attend to the patient when called.
30% of the area is kept for circulation.
Department wise area allocation
Department Area sq.ft
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General ward 3978
Semiprivate + deluxe 8437
Private+deluxe 8437
Obstetric Ward 3679
Paediatric Ward 2847
NICU 4921
ICU 7235
OT 5844
OPD 4940
Physiotherapy dept 975
Radiology 5005
Other diagnostic Facilities (ECG, 3380
EEG, Stress test, Endoscopy)
Laboratory 2425
Blood Bank 1840
Pharmacy Outlet 260
Pharmacy Store 520
MRD 1430
CSSD 1957
Laundry 1918
Kitchen 2300
Restaurant 2860
Housekeeping 325
Telecommunication 390
PR Department 260
Security 195
Auditorium 1950
Prayer Room 260Mortuary 975
Library 390
Manifold Room 390
Administration 2314
A/c Department 780
Stores 2405
EDP 780
Emergency Room 1937
Ambulance 325
Telephone Booth 260
Shoppe 130
Executive health checkup 1300Residents 15000
Total Space for 100 beds 105319
Area per bed 1053.19
(Current standards 800-1200 sq ft)
Parking Space 46875
Electrical+HVAC+Water 4550
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Distribution of floor space by wards and departments
Wards 45378 43%
Diagnostic Facilities 12650 12.01%
OPD+ Emergency+ Related Areas 10117 9.60%
Administrative Area 11349 10.78%
Service departments 10790 10.25%
Residential Areas 15000 14.25%
100%
Breakdown of Space Requirements of key departments
Area Sq ft per bed
Nursing Units 273.78
ICUs 121.56
Operation Theatres 58.44
Radiology 50.05
Laboratory 24.25
Pharmacy 7.8
CSSD 19.57
Dietary 23
MRD 14.3
Housekeeping Dept 3.25
Laundry 19.18
Mechanical Installations 49.4
Stores 24.05
Administration 30.94
Distribution of Beds
General 16
Semi- Private (two in one) 26Private 13
Deluxe 6
ICU 10
NICU 9
Obstetric Ward 10
Paediatric 10
Total 100
Other Beds
Pre -op 4
Post op 6
Emergency 4
Allocation of Departments floor wise
G+0
OPD 4940
Emergency 1937
Radiology 5005
Laundry 1918
Kitchen 2300
Physiotherapy 975
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Pharmacy outlet 260
PR Dept 260
Manifold room 390
Shoppe 130
Telecommunications 390
Prayer Hall 260
Ambulance 325
Telephone booth 260
Mortuary 975
Laboratory 2425
Total space 22750
G+1
Restaurant 2860
Housekeeping 250
Administration 2314
Security 195
Accounts Department 780
Executive Health Check Up 1300
Blood Bank 1840
MRD 1430
General Ward 3978
Paediatric 2847
Other Diagnostic Facilities 3380
Pharmacy Stores 520
EDP Dept 780
Total space 22474
G+2
CSSD 1957
Semiprivate ward + Deluxe beds 8437
Stores 2405
Obstetric ward 3679
NICU 4921
Total Space 21399
G+3
OT 5844
ICU 7235Private + Deluxe 8437
Total space 21516
G+4
Residential Area 15000
Library 390
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Auditorium 1950
Total space 17180
Department Wise Space Plan
General Ward
Beds 16 120 192
Nursing Station 1 200 20
Doctors room 1 100 10
Nurses room 1 100 10
Treatment room 1 100 10
Staff toilet 1 50 5
Store 1 60 6
Pantry 1 60 6
Clean utility room 1 60 6
Dirty utility room 1 60 6
Toilets General 3 50 15
Waiting Area 1 200 20
306
Add 30% circulation space 91
Total space 397
Semi private (2 in 1)
Beds 26 175 455Beds deluxe 3 350 105
Nursing station 1 200 20
Dr's room 1 100 10
Nurses rest room 1 100 10
Store 1 60 6
Pantry 1 60 6
Clean utility room 1 60 6
Dirty utility room 1 60 6
Toilet 1 50 5
Waiting area 1 200 20
649Add 30% circulation space 194
Total Space 843
Single Room\ Private
Beds 13 350 455
Beds deluxe 3 350 105
Nursing station 1 200 20
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Dr's room 1 100 10
Nurses rest room 1 100 10
Store 1 60 6
Pantry 1 60 6
Clean utility room 1 60 6
Dirty utility room 1 60 6
Toilet 1 50 5
Waiting area 1 200 20
649
add 30% circulation space 194
Total Space 843
ICU
Beds 8 225 180
Beds - Isolation room 2 250 50
Nursing Station 1 350 35
Equipment Room 1 250 25
Stat Lab 1 50 5
Doctors Room 1 100 10
Nurses Rest room 1 100 10
Toilet (staff) 1 50 5
Toilets -General 2 50 10
Store 1 60 6
Pantry 1 60 6
Clean Utility Room 1 60 6
Dirty utility Room 1 60 6
Waiting Area 1 300 30
Beds For Relatives 10 150 150
Toilets cum Bath 3 75 22556
Add 30% circulation space 167
Total space 723
NICU
Open Care units 9 125 112
Nursing Station 1 200 20
Equipment store room 1 200 20
Doctors room 1 100 10Nurses rest room 1 100 10
Toilets staff 2 50 10
Component milk formula room 1 50 5
Feeding room 1 60 6
Nursing room 1 100 10
Toilets - General 3 50 15
Waiting Room 1 250 25
Beds for relatives 9 150 135
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378
Add 30% circulation space 113
Total space 492
Obstetric Ward
Beds 10 120 120
Nursing Station 1 200 20
Doctors room 1 100 10
Nurses room 1 100 10
Clean utility 1 60 6
Dirty utility 1 60 6
Pantry 1 60 6
Staff toilet 1 50 5
General toilets 2 50 10
Store 1 100 10
Labour rooms 2 300 60
Waiting Area 1 200 20
283
Add 30% circulation space 84
Total space 367
Paediatric Ward
Beds 10 120 120
Nursing Station 1 200 20
Doctors room 1 200 20
Nurses room 1 100 10
Clean utility 1 60 6
Dirty utility 1 60 6
Pantry 1 60 6
Store 1 60 6
Toilet- Staff 1 50 5
Toilet- General 2 50 10
Waiting Area 1 200 20
219
Add 30% circulation Space 65
Total space 284
Operation Theatre
OT roomsGeneral OT Room 2 450 90
Specialty OT Room 1 625 62
Scrub room 2 100 20
Instrument room 2 100 20
Wash room/ Dirty utility 2 60 12
Store room 1 200 20
Chief anaesthetist room 1 100 10
Dr's room 1 150 15
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OT incharge room 1 60 6
Nurse room 1 60 6
Dumbwaiters 2 20 4
Pantry 1 40 4
Equipment room 1 200 20
Trolley bay 1 150 15
Toilet 2 40 8
Change rooms 3 50 15
Reception 1 60 6
Waiting room 1 100 10
Pre operation room 4 beds 35
Post operation room 6 beds 60
449
Add 30% circulation space 134
Total 584
OPD
May I help you desk 1 50 5
Registration/billing 1 200 20
Waiting area-- Reception 1 500 50
Toilets (M&F) 8 25 20
Reception and Records room 1 250 25
OPD waiting area 1 400 40
Consultants rooms (Medicine, 5 150 75
Surgery, Gyn obs, Paed & Ortho)
Sub Waiting Areas 5 50 25
Staff toilets 2 50 10
Doctors toilets 1 75 7
Trolley/ Wheelchair bay 1 200 20
Collection room 1 50 5
Minor OT 1 300 30
OPD Store 1 75 7
Staff room 1 250 25
Administrators office 1 150 15
380
Add 30% circulation space 114
Total 494
Other Diagnostic Facilities
ECG Room 1 300 30
EEG Room 1 350 352 D echo room 1 500 50
Stress Test Room 1 750 75
Endoscopy Dept
Reception 1 50 5
Waiting 1 200 20
Consultation 1 100 10
Endoscopy room 1 350 35
260
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Add 30% circulation Space 78
Total 338
Physiotherapy Department 1 750 75
add 30% circulation space 22
total 97
Radiology
MRI 1 750 75
Ultrasound 1 350 35
Ultrasound Room
Change room
Sub Waiting
X ray- General 1 650 65
Radiography room
Control room
Change room
Sub waiting
Special X ray 1 900 90
Radiography room
Control room
Change room
Toilet
Barium Preparation
Sub- Waiting
Staff room 1 100 10
Radiologist room 1 100 10
Waiting room 1 300 30
Reception 1 100 10
Technicians room 1 100 10
Staff toilets 2 50 10
Records room 1 150 15
Film Store 1 150 15
Reporting room 1 100 10
385
Add 30% circulation space 115
500
Laboratory Reception 1 75 7
Biochemistry 1 300 30
Haematology & clinical pathology 1 200 20
Histopathology 1 200 20
Microbiology 1 200 20
Serology 1 200 20
Sample collection 1 150 15
Toilet 1 40 4
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Toilets (staff) 2 50 10
Waiting 1 100 10
Report dispatch area 1 100 10
Staff room 1 100 10
Technicians 1 100 10
186
Add 30% circulation space 56
Total 242
Blood Bank
Waiting area 1 200 20
Examination room 1 75 7
Recovery& refreshment room 1 150 15
Bleeding room 1 150 15
Staff room 1 60 6
Blood bank in charge room 1 100 10
Component separation room 1 400 40
Toilet (staff/visitors) 2 40 8
Issue counter 1 50 5
Store room 1 150 15
141
Add 30% circulation space 42
Total 184
Pharmacy
Store area 1 400 40
Retail area 1 200 20
60
Add 30% circulation space 18
Total 78
MRD
Process room 1 500 50
Office room 1 100 10
Record cum store room 1 500 50
110
Add 30% circulation space 33
Total 143
CSSD Receipt area 1 100 10
Wash room 1 200 20
Gloves sterilizing room 1 75 7
Change room 1 50 5
CSSD Supervisor room 1 100 10
Clean area for packing 1 100 10
Actual sterilizing room 1 450 45
Sterile store room 1 200 20
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Staff toilets 2 40 8
Trolley Park 1 150 15
Dumb Waiters 2 20 4
150
Add 30% circulation space 45
Total 195
Laundry
Receipt area 1 100 10
Dirty area 1 150 15
Ironing/ wash area 1 400 40
Laundry incharge room 1 150 15
Toilet 1 50 5
Store room 1 200 20
Mending room 1 100 10
Delivery/ Distribution 1 100 10
Trolley Park 1 100 10
135
Add 30% circulation space 44
Total 191
Kitchen
Receipt area 1 80 8
Dietician room 1 100 10
Store room 1 100 10
Utensils area for storage 1 100 10
Dry area 1 150 15
Cold area 1 100 10
Preparation area 1 150 15
Cooking Area 1 350 35
Washing area 1 150 15
Trolley park 1 150 15
Change area 1 50 5
Toilet 1 40 4
Dining room 1 200 20
Garbage room 1 50 5
177
Add 30% circulation space 53
Total 230
Restaurant Sitting area 1 1500 150
Preparation 1 500 50
Store 1 200 20
220
Add 30% circulation space 66
Total 286
Housekeeping
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Office 1 50 5
Store 1 200 20
25
Add 30% circulation space 7
Total 32
Telecommunication
Office 1 50 5
Cable area 1 250 25
30
Add 30% circulation space 9
Total 39
Personnel Relation department
Office 1 200 20
Add 30% circulation space 6
Total 26
Security
Office 1 150 15
Add 30% circulation space 4
Total 19
Mortuary 1 750 75
Add 30% circulation space 22
Total Space 97
Auditorium 1 1500 150
Add 30% circulation space 45
Total 195
Prayer room 1 200 20
Add 30% circulation space 6
Total 26
Library 1 300 30
Add 30% circulation space 9
Total 39
Electrical HVAC +Water+Boiler 1 3500 350 Compressor air & Vacuum
Add 30% circulation space 105
Total 455
Manifold room
Area 1 250 25
Office 1 50 5
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30
Add 30% circulation space 9
Total 39
Administration
MD/CEOs office 1 250 25
MS office 1 200 20
Office (secretary) 2 50 10
Waiting room 1 200 20
Manager administration 1 150 15
Clerical office 1 350 35
Nursing superintendent 1 200 20
Staff for nursing superintendent 1 200 20
Toilets
MD/CEO/MS 1 50 5
Clerical staff 2 40 8
178
Add 30% circulation space 53
Total 231
A/C department
Office 1 200 20
Process area 2 200 40
60
Add 30% circulation space 18
Total 78
Stores
Receipt area 1 100 10
Storage area 1 1500 150
Office 1 250 25
185
Add 30% circulation space 55
Total 240
EDP
Office 1 100 10
Server room 1 500 50
60Add 30% circulation space 18
Total 78
Emergency room
Triage 4 beds 500 50
Med. Officer 1 100 10
Nursing station 1 100 10
Dr change room 1 75 7
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Nurse change room 1 75 7
Toilet 1 40 4
Minor OT 1 250 25
Waiting area 1 250 25
Reception 1 100 10
149
Add 30% circulation space 44
Total 193
Ambulance
Control room 1 250 25
Telephone Booth 2 50 10
Shoppe 1 100 10
45
Add 30% circulation space 13
Total 58
Residential Area 1500
Executive Health Check Up
Reception 1 100 10
Waiting area 1 300 30
Doctors rooms 3 150 45
Collection room 1 50 5
Records & Storage 1 100 10
Toilets 2 50 10
100
Add 30% circulation space 30
Total 130
Parking space
Area for 1 car = 275 sq.ft
Area for parking 150 cars 4125
30 staff, 120 general
Area for I scooter = 75
Area for 75 scooters 562
25 staff, 50 general
Total 4687
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Operation Theatre
Function:
The function of this department is to receive patients after diagnosis, to
anaesthetize them, to operate upon them and to supervise their post-operative
condition before returning them to their wards. The surgical patients account for
30% to 40% of the in-patient admissions.
Location:
The OTs can be grouped together in a centralized form to have an entire OT
complex or they can be decentralized. However for having decentralized OTs eg
like those for gynaecology, ophthalmology and ENT the quantum of work should
justify the need for them. Centralized OTs are preferred normally as there is
greater economy of staff and equipment, better professional supervision and
greater efficiency.
There will be 3 OTs- 2 General and 1 Specialty OT. They will be located on the 3rd
floor. The location will be such that they will be away from major traffic areas and
also not on the top floor. This will avoid overheating. They will be located close tothe ICUs for the easy transport of patients. They will also be located close to
vertical transport and above the CSSD. There will be 2 dumbwaiters- one for
clean linen and one for soiled linen.
Key Factors influencing OT complex Planning:
The total volume of expected operations alongwith the anticipated work period is
used to calculate the no. of operating rooms needed. Around 1 operating suite is
recommended for every 50 beds. The number of operating rooms has also been
indicated to be 5 per cent of the total number of surgical beds. OR in larger
hospitals a thumb rule 0.1 operations per bed per day has been used. For Indian
theatres conducting general surgeries it is estimated that the average time taken
for each surgery will be around 75 minutes per operation. Hence one OT can
perform around 5 general surgeries daily. A separate emergency OT would be
justified when 50 or more cases are reported in the casualty. The other factors
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that would influence the planning are the case mix and the type of operations to
be performed and also the ALOS of surgical patients.
The no. of operating rooms forms the basis for determining the number of pre-
op beds and the post-op beds.
Number of operations per day = No. of surgical bedsALOS of surgical patients
Number of OT rooms = Total no. of operations in hospitals
Capacity of 1 OT
Basic Functions:
Reception and identification of the patient.
Pre- op supervision of the patient.
Depilation of the patient if not done in the ward. Transfer of patient to the operating table.
Induction/ Intubation/ Positioning
Preparation of the operative area and surrounding skin.
Draping of patient
SURGERY
Sewing up/ Removing drapes/ Extubation
Transfer of patient to post- anaesthetic recovery area.
Post- operative supervision of the patient/ Step down.
Layout :The OT will be independent of the general traffic and movements of the rest of
the hospital. The rooms should be arranged in a manner that allows continuous
progression from the entrance through the various zones that become
increasingly clean. The various zones in the OT are
Protective Zone
Restricted Zone
Clean zone
Super clean Zone
Ultra clean Zone.
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The protective zone is the area where the entry is restricted to the patients, the
staff and their relatives. It is till the waiting areas for the relatives.
The entry to the restricted zone is limited to the patients and the staff. This
area includes the patient reception area, the staff changing rooms.
The clean zone, which is the next zone, consists of the pre and post op areas,the administrative areas, the stores, laboratory, space for equipment storage.
The superclean zone consists of the operating theatre and its ancillary rooms
like the scrub room, the instrument room and wash room.
The ultraclean zone consists of an area of 1 metre on either side of the
operating table.
An operating room for general surgery will have an area of 450 sq ft. However
operating room for specialty surgeries like orthopaedic and Neurosurgery will be
around 625 sq ft. The operation suite will consist of an operating room, a scrub
room, a waste disposal room and an exit room. The waste disposal room will lead
into the dirty corridor so that waste can be disposed off without it being allowed
to renter the clean zones. There will be a service lift to carry away the waste and
also a dumb-waiter to carry the soiled linen to the CSSD.
In older times it was believed that it was desirable to have a separate induction
room. However while such a room reduces the operating rooms occupancy time
as the patients can receive pre-operative anaesthesia while other patients are on
the operating table. The disadvantages however outweigh the benefits. The main
disadvantage may be the huge increase in capital as well as running costs
incurred in such a room. Also there will be the cost of additional equipment and
the utilization of the room will be low.
The preop holding area and post op recovery room should have piped and
medical gas outlets.
Provisions should also be made for flash sterilizers.
If the operating room has windows this will increase the heat load inside and
provision should be made for it. Windows provide for visual relaxation butwhether operating rooms should have them or not is a debatable question as
they may cause distraction if provided.
The temperature inside the OTs will be maintained at 21 degrees. The
airflow is laminar airflow i.e. positive pressure is created such that air
flows from the clean zones to the dirty zones. The laminar airflow is
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created through a plenum in the ceiling. The velocity of air flowing
through this plenum is 60 ft/min. The size of the plenum will be around 6
by 6 feet. This will be enough to cover the patient on the operating table
and also the entire operating team. The air moves outwards through
outlets, piped gas, suction and nitrous oxide are provided throughpendants in the OT.
HEPA filters which can filter air upto 0.3 microns will be used.
Between 20- 100% fresh air is used. The rest is recycled.
Humidity levels will be 55% plus or minus 5%
The floor of the OT will be granite with brass strips. This helps in earthing
purposes for the electrostatic current. The walls can be of stainless steel ormarble whereas the ceiling can be of stainless steel or Plaster of Paris. The
theatre corridors will preferably be 3.2 metres and not less than 2.85
metres wide.
Circulation within the department:
Patient flow:
In-patient nursing units Holding area Operating room
Pt rooms Post op recovery
Staff:
Entrance Changing rooms Working area Restroom/changing
room
Exit
Equipment & supplies:
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Clean Entrance Supply area Theatre area User Area
Sterile:
CSSD Theatre Preparation area User Area
Dirty linen and instruments:
Theatre Disposal room CSSD
Laundry
Relationships with other departments:
- Patient areas
- Support areas
The surgery dept will be related to patient areas like the emergency dept, the
ICU, patient rooms. They should have direct horizontal or vertical access to
surgery. Support areas such as pharmacy, laboratory, CSSD and housekeeping
services should have access to surgery through nonpublic and non-sterile
corridors.
CSSD will have vertical adjacency to surgery and will be connected by
dumbwaiters with the Operation Theatre.
Equipment required:
Movable Equipment
Surgical tables
C arm machines
Anaesthesia machines
Heart lung Machines
Flash sterilizers
Fixed Equipment:
Medical gas
Surgery lights
Laminar flow
Functional Areas:
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Control Station: The control station is primarily a clerical area located in a
position to control traffic into the surgery department. A control station differs
from a nurse station in that less people work out of this area. Surgeries are
scheduled; records and administrative functions are maintained. Space is
provided for requisite items to be delivered or picked up by other departments.Casework and furniture required:
Computer support components
File drawers
Form trays to organize the large volume of paper and forms.
Marker board for posting daily surgery schedule.
Pre-Operative Holding:
Patients arriving for surgical operations will be held in this area until the
operating room is ready. Here patients may be given medications or intravenous
fluids under close observation of the nursing staff.
Casework and furniture required:
A small workstation for filling out forms and paperwork.
Locker to hold patient care supplies.
Sink unit.
Medicine prep/ Storage
Specialty procedure carts.
Scrub Area:
They are placed with access to the operating rooms. Surgical scrub sinks are
generally ceramic or stainless steel with foot or knee controls. Shelves will be
placed above the sink to hold scrub brushes and masks.
Casework and furniture required: Overhead storage of 2 feet per sink is required.
Operating room:
It is the area where surgical procedures are performed under sterile techniques.
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Operating room will have positive pressure ventilation systems, with controlled
temperature and humidity, to prevent corridor air from entering.
The work surface for the circulating nurse will be placed near the entrance door
and the movable modular casework on the wall at the foot end of the table
depending on the head orientation of the patient.Modular casework applications:
Procedure/supply carts used for
Anaesthesia supplies and equipment
Suction and cautery equipment
Monitoring equipment
Prep and dressing
Anaesthesia carts.
Lockers used for
General supply storage
Backup supplies
Specialty procedure carts.
Dirty utility:
Used linens, instrument sets and equipment are placed in soiled utility
immediately after surgery. This room may hold soiled linen and instruments until
they are returned to central supply.
This opens outside to the dirty corridor from where the things are removed via
the dumbwaiter to the CSSD or to the laundry via the service lift.
Movable modular caseworks:
Process tables or work surfaces for receiving soiled items.
Sink unit.
Staffs lounge:
A staff lounge is used primarily for coffee breaks, snacks and as a place for staff
to rest from the pressures of patient care. Space should be provided for a
refrigerator, microwave oven and large coffee maker.
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Staff change rooms usually adjacent to staff lounge are provided for male and
female staff to change from street clothing to surgery attire. Clothing lockers,
toilet facilities and showers are provided.
Movable modular caseworks and furniture: Tables and seating
Base cabinets for storage
Overhead storage for coffee maker and supplies.
Administrative office:
The following positions will require an administrative office
Director/ Head of Anaesthesiology
OT in charge
Operating room materials manager/ Store room
Movable Modular Casework and furniture systems:
Cantilevered work surfaces
Work surfaces for keyboard drawers or trays to accommodate computers and
printers
Overhead storage and marker boards for displaying information.
Task lights and personal lights.
Lighting:
Intensity:
At the plane of the incision it would be desirable to achieve an all round intensity
of about 40,000 lux.
Luminance:
Normal luminance brightness for the central field during an operation should be
2,000 to 3,000 cd/sq.m The floor around the surgical table should have a
luminance of 200 to 300 cd/sq m, the walls 300 to 500 cd/sq m and the ceiling
lights 1,000 cd/sq m at most.Operation lamp characteristics:
The intensity of light be variable, but generally at least 40,000 lux at the
working plane, and at least 8,000 lux at the bottom of a 13 cm deep and
5 cm wide incision.
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The operation lamp should with no part hang lower than 2.0 m above the
floor.
General Lighting in operation room:
General lighting in the operation room should attain a minimum of 400 lux. In the
U.S. general illumination capability of 2,000 lux uniformly distributed throughout
the room with provision for reducing this level has been recommended.
Lighting in Operation room:
A reasonable level of illumination at washbasins is 300 to 500 lux. In the U.S. for
scrub rooms the illumination level of 2000 lux has been recommended as
members of the surgical team will encounter in the operating room.
Lighting in post anaesthetic recovery room:
Patients are disoriented and aware of bright lights during the awakening period.
Therefore light fittings must be placed where they will not disturb the patient.
A lighting intensity of about 300 lux is recommended. A mounted wall or ceiling
source of higher intensity spot illumination about 10,000 lux must be available
for performing procedures if required.
Colour in surgical department:
Generally in the UK pale blue, grey and green have found to be most suitable.
Blues and yellows should be avoided. A light grey colour for the operating room
floor has been recommended.
For the scrub up room yellowish or red shades may be used.
For the anaesthetic room the reflections on the patients face would not obstruct
the anaesthesiologists judgement of the patients condition. The colour scheme in
the anaesthetic room may be the same as that for the operating room, possiblysofter and warmer.
Noise levels
In operating room:
The noise level in operation rooms should be below 50 decibels.
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In anaesthetic rooms as well as in the labour and delivery rooms the noise levels
should be below 45 decibels.
In recovery room:
A special sensitivity to noise and need for protection from it is found in newly
operated persons whose autonomic nervous system is in disorder. One of thepatients greatest irritations in the recovery area is the laughter and other noises
of the staff.
In recovery rooms sound absorbent ceiling materials and wall finishes with a
reflection factor of about 50 per cent should be used.
Temperature in the operating room:
The temperature in the operating room will be maintained between 21 to 23
degrees.
Humidity:
The acceptable limits for relative humidity as regards static electricity and
comfort are 45 to 60 per cent. Low relative humidity has been reported to be an
optimal condition for Kleibsiella pneumoniae Type A while high humidity in the
hospital enhances the danger of growth of Ps. Aeruginosa.
Humidity in the operation room is believed to contribute to the prevention of
dehydration of exposed tissues.
At a relative humidity of about 50 per cent a very thin invisible film of moisture
forms on operation equipment and other surfaces. The film of moisture conducts
static to earth before a spark producing potential is built up.
A standard of relative humidity between 40 to 65 per cent has been fixed for
operating rooms. (55 % + or 5%)
Flooring in operation room and anaesthetic room:
The rooms flooring in the operation rooms and the anaesthetic rooms should be
Non slippery when wet.
Withstand intensive application of water and disinfectantsNot absorb physically foreign molecules
Be elastic and recover after the removal of heavy objects.
Have a high resistance to breakdown.
Be fire resistant.
Be colourfast.
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PVC flooring is the floor finishing that satisfies the majority of the requirement
of the operating room flooring.
Walls:
Suitable surface materials include laminated polyesters with an epoxy finish
and hard vinyl coverings which can be heat sealed.
Semi matt wall surfaces reflect less light than high gloss finishes and are less
tiring to the staff.
The corners in the operating room should be rounded with the wall surfaces to
make cleaning routines easier.
Doors:
Door hardware should be designed with single lever action and should require
no more than 4 kg of pressure to open the door.
In the operation department, staff dressed in sterilized garments require a
minimum door opening width of 90 cm. A clearance of about 10 cm on either
side of the bed including special equipment is required to move it through an
opening.
A width of 150 cm for two leaf door openings can be recommended.
A device that holds the door open must be provided to simplify equipment
moving.
The sound insulation properties of the doors should be good.
Operating rooms and anaesthetic rooms should be provided with safety
glazed openings with blinds to save unnecessary opening.
In the post- operative recovery area the doorways should pass beds easily. A
door width of about 145 cm is recommended.
Electrical outlets and switches:Electrical outlets should not be placed so that the power cords between the
wall outlets and the junction boxes and apparatus hinder the staff.
In operating rooms about 20 outlets are needed for advanced operations.
Electrical outlets in the vicinity of the operating table should be combined in a
control panel comprising switches, fuses and plug outlets for main voltage
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and low voltage for electronic appliances. It is preferred to have the control
panel hanging from the ceiling from the pendant.
In post anaesthetic units upto 8 electrical points are necessary for each bed.
Medical gases, piped air, vacuum.
Oxygen, compressed air, nitrous oxide and vacuum are supplied via gas pipes
identified by colours according to international standards.
To maintain homeostasis the inspired gases should be warm and humidified.
Heated humidifiers which supply gases at 35 degrees centigrade and at 100
per cent relative humidity. The temperature of gases should be monitored to
prevent tracheobronchial burn.
Gas outlet points shall be at least 20 cm from electrical components to avoid
generation of sparks.
For preoperative areas oxygen, suction and compressed air are required.
For the operation theatre and postoperative areas oxygen, compressed air,
nitrous oxide and suction are required.
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v
Intensive Care Units:
Function:
ICUs are specialty nursing units designed, equipped and staffed with specially
skilled personnel for