Introduction Individual hospital should be a part of larger health care system Must consider other hospitals No two plans will be the same Who is planning the hospital

Terms used Systemic planning

Planning on the basis of the analysis of the structures and evaluation of systems contained in institutions.

Statistics on internal activities Morbidity and mortality studies Opinion of regional and local auth on the need

Physical planning Concerned with architecture / architectural plans Engineering aspects of establishments Functional programme of the project

Area wide planning Planning for medical care facilities that aims at the most effective distribution of

facilities to provide complex medical care Est of medical care facilities network designed for a particular geographical area -

follows the principle of RegionalizationRegionalization

Coordinated or integrated medical care and all facilities required for a given geographical area in accordance with the health service system adopted

Preplanned referral services - secondary or tertiary care centers Ambulatory services Emergency services Rational allocation of resources Duplications avoided

Steps of planning Perception of need Organization for planning

Planning teamPerception of needOwner Board of trusteesGoverning body

Inadequacies or lack of hospitals

Overt need Hospital planning agencies – Studies to find out need

Questions to be answered: Philosophy of the Governing board Size Types of services Site

Plan Analysis

Time line Agencies for planning and designing

Organization for planning team Planning team is org after the decision of the construction No and type of members depends on stage of project and type of org

Organization for planning team Architects

Architect for design Landscape architect

Engineers Civil Electrical Structural

Organization for planning team Project director / manager Quantity surveyors Interior designer Landscaping Architect Miscellaneous Consultants

HVAC Plumbing Water Fire fighting

Activities of planning team Need survey Feasibility evaluation Site evaluation Acceptance of feasibility evaluation by Governing Board Work load estimation

Activities of planning team Architect’s brief – Hospital administrator Master site planning Space programming Conceptual drawings / block diagram Detailed line plan or schematic drawings Costing of the project Specifications – part of Architect’s brief Costing with specification Determination of approach Systems and fixed equipment planning

and design development Human resource planning Tender drawings Contract procedure / award of contract Construction Commissioning Shake down period

Need surveyIndicates :

Construction programme is essential Feasible Independent agency Hospital administrator Architect Planning Team (User and hosp planner )

What is the need of local community / regional needs Community survey / regional survey

Population characteristics Morbidity statistics

Prevalence and incidence of communicable and other major diseases Socioeconomic data

Education level Economic status Social habits Living conditions

Life style of people Geographical data

Details of rail, road heads, air port Climate Existing hospitals and health service facilities – adequacy Basic amenities Resources available Adequacy of existing beds Requirement of beds for community for agreed period Adequacy of existing centers / Dept Requirement of additional centers / dept

Feasibility evaluation Financial feasibility Technical feasibility Availability of proper land Legal requirement Financial

Rough financial feasibility Detailed financial evaluation not possible at this stage Further Planning to proceed if financial feasibility is there

Financial feasibility Funding requirements Availability of funds Return on investment Any reimbursement potential Financial options Financial plan

Financial plan Statement of financial feasibility Underlying assumptions

Market demand Market share Capital requirement Manner in which financial resources will be used

Technical feasibility Availability of appropriate technology Construction agency Availability of Materials / resources Availability of human resource

Determination of approach for planning and construction

Traditional approach Standard agreement Construction starts only when all documents are ready Single contractor

Turnkey projects Single agency Predetermined all inclusive price is fixed for the completed project

Design construct Two phases Option to change agency after completion of first phase

Buy documents from agency Work load estimation and functional programme

Hospital beds Depts/ Centers Operating suites Clinical services Supportive services Adm services Equipment details

Master site planning Architects Engineers In consultation with hospital administrator

Site selection Site evaluation Design drawing – finer details not shown

Location of different types of facilitiesArchitect’s brief

Prepared by Hospital administrator / user/ agency hired by user Vision of Governing board translated into written document by person qualified in the

field of hospital planning Space programming

Hosp administrator Architects Engineers

A room by room listing is made for all areas Total area for construction is calculated

Schematic / detailed drawings

Detailed line plan Reflects all rooms Circulation spaces level by level Corridors

Commissioning Documentation Policies / procedures Organizing & staffing Orientation & training Systems testing Equipment testing Operational shakedown period Opening & follow up

Medical architecture and principles of designPrinciple 1 – Inter bed distances

Centre of one bed to centre of the next bed - 2.25 to 3.4 meters Each bed size 2 x 1 meter

– Distance > 2.1 meters prevents HAI transmitted by droplets

Distance of centre of bed from adjacent wall – 1.3 to 2.9 metersPrinciple 2 – Turning radius within hospitals

For wheel chair (1065 x 630 mm) – 90 degree side turn 1215 mm – 180 degree U turn in open space 1325 mm

For patient stretcher (2120 x 800 mm) – 90 degree side turn 1600 mm

1 M

3.4 M2 M

For patient bed (2120 x 1000 mm) – 90 degree side turn 1600 mm

Principle 3 – Clear door openings Clear opening of door - Patient room, patient examination room and therapy room –

not less than1200mm– Required to move patient on hospital beds

Civil opening 1350 – 1500 mm– Accommodate door frame and thickness of door shutter in open position

Door shutter - one or two equal or un-equal leaves Civil opening more if double swing, floor mounted, door springs used Wash room for patients

– Clear opening not < 900 mm (wheelchair)– Civil opening 1050 mm – Door to open outwards (away from wash room)

Rooms with large plant and machinery or equipment– X-ray, CT MRI, Radiotherapy equipment, Operating rooms with CT or MRI,

Laboratories (large automatic analysers) Service block rooms – Clear door opening not < 2100 mm

Principle 4 – Slab to slab height Operating rooms - minimal slab to finished ceiling height = 3.25 m (total up to 4 m)

– Required to place Surgical light Operating table clearance below the light

– In accordance with various parameters Walk able service floors slab to slab height of 2.1 M or more( if provided between

functional floors)– Facilitate provisioning of modular units– Provide interstitial area for service lines

All levels not required to be planned in this manner– Required in the Clinical Support Service Areas– OPD, IPD and Offices

Slab to Slab Height (3.6 M)

Principle 5 – Provision of engineering service rooms Engineering Service Room

– Air handling unit(s) (AHUs) and associated risers, fans, pumps, etc– Electrical and communications equipment and associated risers– Other main equipment and risers serving functional areas in its Zone

Avoid routing utility feeders through areas they do not serve – Hampers future facility modifications

Locate service , balancing devices, and terminal equipment above corridors– Require periodic inspection or maintenance

Evaluate all statues, especially Fire Safety Code when sharing of engineering service room across more than one level or floor intended

Light, ventilation, sprinklers provision as per National Building Code of IndiaPrincipal 6 – Structural load for medical equipment

Building structures and shells designed to– Withstand the structural loads, environmental forces generated from within and

without Regular use conditions / extremes of climate / natural disaster

Different types of loads applicable Dead Loads (Gravity Loads)

– Weight of walls, partitions, floors, roofs, permanent structures in building, fixed plant and machinery

Live loads – Superimposed gravity and wind loads of varying magnitude and/or duration– Imposed loads and Environmental loads

Loads are transferred through envelope or components to ground via rigid elements Imposed Loads

– Loads as produced by intended use of building – Weight of moveable partitions, etc.– Excludes loads due to environmental factors

Environmental Loads : Load stress due to – Wind and Seismic Loads – Expansion and contraction of materials due to variation in internal temperature

of building envelop Loads generally act together Proper structural design provides adequate structural safety

– Architecture and Science of Structural Design Structural Load for Medical Equipment is overlooked

– Very heavy, dead and imposed loads– Architect’s briefs must list medical equipment– Probable locations must be identified and marked at time of concept design– Point loads of plant and machinery must be known at time of structural design

for safety Loads on building terrace / facade (Signboards) Heavy Lights

Structural safety assessment essential – Loads ( Medical equipment) added in a built structure – Floors in hospitals affected by* – Uniformly Distributed Loads (UDL)– Corresponding concentrated loads

* National Building Code of India, 2005 (NBC); Part 6, Section 1