Text Book:

1. Principles of Hospital Administration & Planning by B M

Sakharkhar
2. Hospital Planning and Management by G D Kunders

Hospital Administration the

concept
Any institution, which has to achieve a goal
has to deliver services within a time
using certain infrastructure resources,
Through people
Specific quality
At minimal cost

needs administration or management.

Management
It is a set of interactive processes through which the utilization of

resources results in the accomplishment of organization objectives.

Elements of
Administration:

There are several elements for administration. In practice all these elements
are interrelated to one another.

Planning
Organization
Staffing
Directing
Coordinating
Reporting

Budgeting

Supervising
Evaluation
Newer modern techniques

such as operation research

and behavioral sciences

Optimum utilization of resources

Instill efficiency and effectiveness into the system.

New concept
Fast catching up
Phenomenal growth

prospects

How do you differentiate hospitals

from
any
other
industrial
organization

The responsibility- Distinction between a

Hospitals are havens of hope for people suffering from pain and illness.
hospital and an industrial organization
Management of a hospital entails a lot of responsibilities and is a round-the clock job.
It is not merely the treatment meted out to the patient but the overall atmosphere of a hospital that a patient remembers

after discharge.

Inefficiency or inadequacy either the quality of doctors, medical facilities or its administration area can mar the image of

an institution.

From ensuring that the corridors are sparkling clean to keeping life-saving machines in working order to attending to

patients' complaints and catering needs--the hospital administrators perform multifarious tasks.

An awesome infrastructure and gleaming machine doesn't help out in making a hospital successful.

A hospital deals daily with life, suffering, recovery and

death of human beings.

For direction and running of such an institution , its

administrative personnel need a particular combination of

knowledge, understanding, traits, abilities and skills.

Functions of a Hospitals
1.
2.
3.

Functions of a hospital
Intramural functions: confined to inside walls of

the hospital
1.Restorative
:
include
diagnostic,
curative,
rehabilitative, care of emergencies.
2.Preventive : control of communication diseases,
vaccination, health education, occupational health,
supervision of normal pregnancies, child birth and
growth of children.

3. Education : medical undergraduates, specialists, nurses,

technicians, paramedical staff
4. Research : Clinical medicine, hospital practices and
administration.
Extramural functions: which radiate outside the hospital

and to home environment and community.

1.Outpatient services
2.Home care services
3.Outreach services
4.Mobile clinics
5.Medical care camps

Essentials for running a Hospital

1.
2.
3.
4.

Business of running a Hospital

Facility management - Water , Electricity
Marketing of Hospitals

Business Development
Quality and patient safety practices Accreditation
Best Operations Practices for

maximum utilization of resources

And smooth functioning

Economics Costing of services - least cost and maximum

efficiency and effectiveness

Budgeting
Finance
Human Resource management
Patient Satisfaction Customer Satisfaction
Material Management to ensure availability of medicines and
consumables and prevent
stock outs.
Laws & legal requirement for running a Hospital

Hospital Acquired Infection Control

Communication skills handling sensitive issues in hospital
Public Relations
Health Insurance & Third Party Administrators ( TPA)
Legal Aspects Medico legal cases, Consumer Protection Act

Professional management
Past vs present.
Run by Senior doctors
Retired personnel from Army or medical services or religious

sisters of mission hospitals

Corporate Sector emergence application of management skills,
operational strategies and sense of ethics
Need to conform to international standards
Professional management qualified and trained personnel at
every level ----- deep impact on quality of care to patients.

Quality of care provided by its personnelbe it CEO, Medical

superintendent, receptionist or just a sweeper.

Work needs to properly planned and designed only then a

hospital is administered professionally.

What it really means is Doing everything at every level of
the hospital in a professional manner.

Hospital Ethics
Code of Ethics of hospitals go hand in hand with code of ethics

of physicians- Hippocratic oath.

Ethics deals with righteousness and wrongness of the actions.
Medical Ethics would include:
Physician will serve the patient by virtue of his medical
knowledge he possesses.
Physicians' primary commitment must be patients welfare
regardless of the financial arrangements.
A physician should not discriminate between a private and a
general ward patient.

Confidentiality is important. The physician must honor the confidentiality

of the patient and the personal information given by the patient and
observations made during examination except for academic discussions
and court of law.
No one including the treating physician and the nurse has the right to

expose the patient unnecessarily.

Physician cannot give advertisement to solicit patients, to become sexually

involved with their patients, enter into business agreement with them etc.

Role of the Hospital

The role of a Hospital Administrator is critical in saving lives
Administrator
although the administrator does not himself provide medical
services.
Hospital administrators oversee operations in a variety of clinical

settings; hospitals, outpatient clinics (including ambulatory care

centers, surgery centers, imaging centers, and cancer centers),
hospices, and drug treatment centers.
Administrators have many responsibilities including acting as a

liaison between the governing board of trustees, the

administration team, the medical staff,
and department
heads.

They also organize and oversee the services of all departments so that they

operate as a cohesive unit.

Hospital administrators plan budgets, set the rates for health services that are
provided and ensure that federal and local regulatory reporting and
reimbursement requirements are met.
Other important tasks involve planning departmental activities, evaluating
doctors and other hospital employees, and creating and maintaining policies.
In addition, they set measures for quality assurance, patient services, and
public relations.
While a physicians goal is to optimize the health and well-being of his patient,
the administrators goal is to support that excellent medical care at a broader
level by coordinating all
physical, human and financial aspects of the
hospital towards achieving quality care.

Aptitude
Personal commitment

Astute business judgement,

Excellent communication skills and superior administrative capabilities.
Leadership initiative & decision making
Soft skill assets
Sense of empathy and self discipline
Clarity of thought
Time management skills,
Optimistic & proactive an approach

Challenges for a Hospital Administrator

Challenges of hospital
administrator
Within the health field
From Public

For eg:
a.Business and professional leaders -trustees of voluntary hospitals.
b.Large Number of Physicians -medical staff -concerned about the
facilities and services.
c.Accreditation Body/Certification Bodies .
d.Professor teaching faculty in teaching hospitals
e.Labor standards of employment and working conditions
f. Members of registered society, shareholders of corporate hospitals

Conditions peculiar to
administrative
work
in Hospitals
Consumers are physically /mentally
ill.
Needs of consumers have individual needs and require highly

personalized and custom made services.

Hospital/institution has to provide wide range of scientific and technical
services such as nursing, anesthesia, radiology etc. And that too round
the clock every day of the year.
All the services involve many individuals ill customer, his emotionally
charged relatives, friends, physicians, nurses, technicians.
Apprehension of exposure to diseases, hospital personnel are expected
to maintain a very high level of efficiency as it effects lives of people.

Problems of the hospital are very delicate and volatile.

Efficiency and quality of health care is dependent on use of

sophisticated technology like medical equipments for

diagnosis., treatment etc.
Consumer Protection Act 1986
Disposal of Hospital Waste Management is a peculiar condition
and is a burning issue.

The past

An individual afflicted by a wound or disease was condemned to suffer and fend for

himself the healthy never assisted or looked after the afflicted; an afflicted person
considered a spent-force no longer useful to society.
Belief illness was caused either by evil spirits or was a punishment for ones

misdeeds
Treated by the tribe with magic spell to appease/scare away the evil spirits with a

counter-curse
As civilization advanced from Individual family tribe organized community,

society acknowledged common responsibility towards the sick.

The middle of nineteenth century saw the arrival of Florence Nightingale

to
revolutionize nursing by supplementing good intentions and humane concern with
scientific approach to nursing through training.

 The institution that we know today as the hospital is a phenomenon of the

twentieth century. The early institutions from which it developed bore little
resemblance to that important part of community life, which we call the hospital.
In its earliest form the hospital was aimed at care of the poor and lodging was

the primary function of the early hospital. The record shows the earliest hospital
in
Paris to have been founded about 600 A.D., and St. Bartholomews in London
dates from the year 1123.
The first hospitals in the New World were built by the Spanish in Mexico City

(1524)
and the French in Canada. There was a general tendency to lump together the
Physically handicapped, the sick, the socially unwanted and the poor. Special
inoculation hospitals were built during the smallpox epidemics to care for persons
being so treated, but these died out when this form of treatment was superseded
by vaccination.

Indian Scenario:
The history of Indian medicine and surgery dates back to the earliest of ages. In

India,
hospitals have existed from ancient times.
Even in the 6th century B.C. during the time of Buddha, there were a number of
hospitals to look after the crippled and the poor. The outstanding hospitals in India
at that time were those built by King Ashoka. Charaka and Sushrutha of ancient
India were famous physicians.
The Mohammedans brought with them their hakims who followed the Greek
system of medicine Yunani.
The use of allopathic system of medicine commenced in the 16th century with the
arrival of European missionaries in South India. It was during the British rule- East
India company that there was once again progress in the building of hospitals.
Organized medical training was started in the 19th century. The first medical school

was started in Calcutta, followed by one in Madras. In the beginning both the
modern system and the Ayurvedic system were taught.

Health committee appointed by the

Government
After Independence, rapid industrialization in country and
continuous growth of population; increasing no. of medical and
health problems
Committees therefore set up from time to time
Reports of the Bhore Committee, Mudaliar Committee, jain

Committee, Kartar Singh Committee, Jaisukhlal Hathi Committee,

Srivastava Committee, Sidhu Committee and Bajaj Committee
continue to guide the makers of health policies in India

Definition of a Hospital
hospital derived from latin word hospitalis which comes from

hospes, meaning a host.

Hospital comes from French word hospitale (like hostel & hotel)

an establishment for temporary occupation by the sick and the

injured

A hospital is an institution which is operated for the medical,

surgical and/or obstetrical care of in-patients and which is treated

as a hospital by the Central/state government/local body/private
and licensed by the appropriate authority
- Directory of Hospitals in India, 1988

A hospital is an integral part of a social and medical

organization, the function of which is to provide for the
population complete health care, both curative and
preventive, and whose outpatient services reach out to the
family and its home environment, the hospital is also a centre
for the training of health workers and bio-social research.
-WHO definition of Hospital

Changing Role of Hospitals in the

Health
systems
Shift in emphasis in :
Acute to chronic illness
Curative to preventive medicine
Restorative to comprehensive medicine
Inpatient care to outpatient and home care
Individual orientation to community orientation
Isolated function to area wise or regional function.
Tertiary and secondary to primary health care
Episodic care to total care.

Hospital as a system
What is a system??
1.
2.
3.

Management science defines a system as

a collection of component subsystem which,

operating together, perform a set of operations in

accomplishment of defined objectives

Hospital as a system

Input

Process
( Transformation)

Feedback

Output

Input
People
A. Staff

Physician
Nurses
Paramedics
Supportive

B. Patient, their
attendants and
relatives
Material
Drug and
chemicals
Equipment
Diet
Money
To maintain staff,
facilities and procure
materials

Process- Transformation
Communication : Between
Physicians and patients
Physicians and nurses
Physicians/nurses and paramedical staff
Physicians and administrator
Administrator and community
Administrator and nursing/paramedical staff
Nursing/paramedical staff and patients
Decision making: For
Cure: Diagnosis, treatment
Care: Creature comforts of patients, diet
Procurement of materials in right place at the
right time.
Action
Putting decisions into practice
Balanced mix of communication, decision
making and action.

Output:
Efficient
Patient care

Peculiarities of a Hospital system

Open system- interacts with its environment.
Boundaries separating hospital system from other social system are

not clear.
Output of a hospital system are not clearly measurable.
Hospital system has to be in a dynamic equilibrium with its wider
social system.
A hospital system is not an end in itself. It must function as a part of
larger health care system.
A hospital like other open social systems tends towards elaboration
and differentiation- specialized departments, newer technology,
expansion of scope of services

Hospital as a social system

Dual lines of authority
1.Administrative /management
2.Professional/doctors
Importance of free communication and integration for better

patient care.

Classification of hospitals
Can be classified in many ways
According to their objectives :
1. Teaching Hospital
2. Charitable Hospital
According to the age group which get treated:
1.Children's Hospital,
2.Women Hospital ,
3.Geriatric Hospital

According to ownership and Control:

1. Central Govt : Under Ministry of Health RML, Safdarjung Hospital

Railways, CGHS, Ministry of Defence Army
Under Act of Legislation : Central Act AIIMS ,
State Act : PGI, NIMS
State Govt or Public Hospitals : run by State govt like LNJP, Gandhi
Hospital.
: Corporation Hospitals, Cantonment Hospitals.
Local Bodies
2. Non Government Hospitals Profit Oriented, non profit oriented/voluntary
hospitals.
Profit oriented : a. Private nursing Homes/maternity Homes : Corporate
Hospitals: Global Hospital, Yashoda

b. Public service : offering services to others on payment

basis- some CGHS/Railway/Army Hospitals.

Private Nursing homes

Generally owned by an individual doctor or a group of doctors
No uniform definition for nursing homes out-of-home care

facilities offering a range of services similar to many found in a

hospital
Run on a commercial basis
Becoming more popular due to shortage of govt. and voluntary

hospitals; long queues & man power shortage

Corporate hospitals
Latest concept run on commercial lines
Are public limited companies formed under the Companies Act
Can be either General or Specialized or both

Non Profit Oriented /Voluntary

hospitals

Those established and incorporated under the Societies Registration Act, 1860 or Public

Trust Act, 1882 or any other appropriate Act of the Central or State government.

They are run with public or private funds on a non-commercial basis; by a board of trustees

incl. prominent members of community & retd high officials of govt. and appoint
Administrator(s) and Medical director(s) to run such voluntary hospitals.
No part of the profit goes to the benefit of any member, trust or any other individual, nor is
any such individual entitled to a share in the distribution of any of the corporate assets on
dissolution of the registered society
These hospitals spend more on patient care than what they receive from the patients what is earned from rich patients of private wards are spent on the patients of general
wards

 The main sources of their revenue are public and private

donations, and grants-in-aid from the Central Government,

State government and both national and international
philanthropic organizations
These run on a no profit, no loss basis

According to the system of medicine

Allopathy, Homeopathy, Ayurveda, Naturopathy, Yoga
According to the number of beds Large, Medium,

Small
More

than 300 beds Large

Between 100-300 beds Medium
Less than 100 beds Small
According

to Clinical Basis : General Hospital,

Specialized Hospital
According to length of Stay of Patients : Long Term
Stay Hospitals, Short Term Stay Hospitals.

Classification according to the

Directory of Hospitals in India,
Types of Hospitals:
1988
1. General hospital all establishments permanently staffed by atleast

two or more medical officers, which can offer in-patient

accommodation and provide active medical and nursing care for more
than one category of medical discipline (eg., general medicine, general
surgery etc.)
2. Rural hospital hospitals located in the rural areas (classified by the

Registrar General of India) permanently staffed by atleast one or more

physicians, offering in-patient accommodation and provide active
medical and nursing care for more than one category of medical
discipline (eg., general medicine, general surgery etc.)

3. Specialized hospital hospitals providing medical and nursing care

primarily for only one discipline or specific diseases (eg., TB, ENT,
Paediatrics, Orthopaedics etc.)
4. Teaching hospital hospital to which a college is attached for
medical/dental education
5. Isolation hospital hospital for the care of persons suffering from infectious
diseases requiring isolation of the patients
6. Tertiary hospital hospitals set up by the Central/State governments in
their capitals, for treating referred patients (eg., AIIMS, New Delhi; PGI,
Chandigarh etc.)

Classification according to the

Directory of Hospitals in India,
1988

Types of Management:

1.Central Government/Govt. of India all hospitals administered by the GOI viz.,

hospitals run by railways, military/defence, mining/ESI, Post & Telegraph or public

sector undertakings of the Central Govt.
2.State Government all hospitals administered by the state/UT governments

authorities and public sector undertakings operated by states/Uts including the

police, jail, etc.
3.Local bodies all hospitals administered by the local bodies, viz., the municipal

corporation, zila parishad, panchayat

4. Private all private hospitals owned by an individual or a private organization

5. Autonomous body all hospitals established under a special Act of
Parliament/state legislation and funded by the central/state/UT government eg.,
AIIMS, New Delhi; PGI, Chandigarh
6. Voluntary organization all hospitals operated by a voluntary body/a
trust/charitable society registered by the appropriate authority under
Central/state government laws; includes hospitals run by missionary bodies and
co-operatives
7. Corporate body hospital run by a public limited company. Its shares can be
purchased by the public and dividend distributed among its shareholders

Clinical/Non clinical services in the

hospital:
CLINICAL

NON CLINICAL

Individual departments
Clinical Service
OPD

Clinical Support
Services

Emergency
ICU or Intensive Care
Medicine & Medicine Dept
Surgery and Surgical Departments
Pediatrics
OBG
Anesthesia
Dental
Physical Medicine and

rehabilitation

Radiology & Imaging

Services,
Laboratory Services,
Pharmacy & Medical
Stores
CSSD
Blood Bank
Operation Theatre

Clinico Administrative Services

Nursing Department
Admission office
Medical Records
Mortuary
Infection Control
Ambulance
Administrative Departments
Top Management
Hosp Administrator
Accounts Department
HR
Finance & Accounts Dept
PR
Security
Housekeeping
Communications- paging,
intercom, LAN
Purchase Dept
Engineering Services

Planning of a Hospital
The successful hospital is based upon a triad
good community planning,
good design and construction, and
good administration.

A well-planned hospital requires a great deal of preliminary study and

planning.
It must be designed to meet all the needs of the people it is to serve.
It must be a size, which the people can afford to build and operate.
It must be well staffed with a sufficient number of physicians, nurses and other

trained personnel to give adequate and efficient service.

A progressive hospital will build its services on certain knowledge of the
community it is to serve. and upon many groups, professional and nonprofessional;

Essentials for good Hospital

planning

High Quality Patient Care

Patient care of a high quality should be achieved by the hospital through:

Provision of appropriate technical equipment and facilities and competent
professional and technical staff to support the hospitals patient care objectives.
An organizational structure that assigns responsibility and requires accountability
for the various functions within the institution.
A continuous review of Adequacy of care provided by physicians, nursing staff, and
paramedical technicians and the adequacy with which patient care is supported by
other hospital activities.

Effective Community Orientation

A governing board made up primarily of persons who have demonstrated

concern for the community and leadership quality.

Policies that assure availability of services as needed to all the people in the hospital
service area.
Participation of the hospital in community programs to provide preventive,
emergency, and casualty care.
A public information system that keeps the community informed about and
identified with the hospitals goals, objectives, and plans.

Financial Viability
A corporate organization that accepts responsibility for sound financial

management with a view on optimum quality of care.

Patient care care objectives that are consistent with projected service demands,
availability of operating finances and adequate personnel and equipment.
A planned programme of expansion based solely in demonstrated community need.
A specific, planned program for capital financing that will assure appropriate
replacement, improvement, and expansion of facilities without putting burden on
patient charges.
An annual budget plan to keep pace with modern medical and hospital Practices.

Orderly Planning
Acceptance by the hospitals administrator of primary responsibility for both short and long-range planning, with

support and assistance from competent financial, organizational, functional, and architectural advice.
Identification of the hospitals service area and other healthcare resources.
Analysis of the hospitals medical staff and number of patients admitted in the last three years as the basis for

projecting admission trends of major clinical service.

Examination of use of major clinical service departments, and such supportive service departments for
making a future projection for each of these departments.
Establishment of short and long-range planning objectives with a table of priorities and target dates on which
such objectives may be achieved.
Preparation of a financial program that describes the short range objectives to be achieved and the facilities,
equipment and staffing necessary to achieve them.

A Sound Architectural Plan

Retention of an architect experienced in hospital design and construction
Selection of a site large enough to provide for parking and future expansion and

accessibility to people.
Determination of facility size appropriate to the projected service demands of the
hospitals service area and of departmental areas large enough to provide the
diagnostic and treatment services.
Importance of establishing convenient traffic patterns both in and out of the
hospital for movements of physicians, hospital staff, patients, and visitors and for
efficient transportation of food, laundry, drugs and other supplies.
An architectural design that will permit efficient use of hospital personnel,
interchange ability and flexibility in work areas.
Adequate attention to important hospital concepts such as infection control and
disaster planning.

Regionalization of Hospital
Service
Decentralization by establishing levels of care.
Three tier basis
Regional hospital hosp of entire geographical region, complete range of
service- radiotherapy, neurosurgery, thoracic surgery, oncosurgery etc,
associated with a medical college/post graduate teaching centre.
Intermediate or District Hospital several hundred beds, general hospital
providing medical, surgical obstetrical and specialized treatment.
Local or Rural Hospital 30 -100 beds, undifferentiated care- general,
medical, surgical and maternity care

Two way flow of referral system & sharing of senior medical

staff by consultant sessions and regular visits.

Quality of care & cost.

Levels of medical Care

Levels of care

Medical facility

Levels of decision maker

Primary

Dispensary, Primary Health

Centre or subcentre

GP, medical assistant,

multipurpose worker

Secondary

District
Hospital( intermediate) or
equivalent

GP, partly specialist

Tertiary

Provincial or similar
hospital( regional)

Specialists

Quaternary

Institute of Research and

higher training

Super specialists, researcher

Hosp Planning Team

1.
2.
3.

Hosp Planning Team

Defining requirements- people involved in direct utilization &

delivery of care- experts in resp clinical fields

Hosp administrator/Medical administrator
Nursing administrator
Architect & Engineers with exp in hospitals
Hosp consultant
Financial expert

Hosp Project Staging

Stage A: Functional Content, Outline
Brief

Inception
Project Team
Feasibility Studies
Outline Proposal
Submissions to Govt/Private
Organizations for approval
Site appraisals, Gross floor areas,
building space, draft master plan ,
estimate cost and phasing .
Appraisal of work by the owners.

Stage II: Operational Policies & Development

Plan

Operational Policies
Department & Interrelated Activities
Budget Cost

Stage III: Schedules of accommodation,

sketches, final cost estimate

Schedules of accommodation
Sketch Drawings
Equipment estimates
Cost revenue and staffing estimates

Stage D
Design detail working drawings, tender
action

Working drawings
Engineering detail
Calling tenders

Stage E
Contract & Construction

Assessment of tenders
Award of contract
Construction
Engineering Commissioning

Stage F
Commissioning

Staff assembly and Training

Equipment & supplies assembly
Testing of installations
Opening

Relationship between Demand

and Need

Factors influencing Hospital

Utilization
Hosp Bed Availability- dev vs develop countries
Population coverage and bed distribution
Age Profile of population
Availability of medical services other than hospitals
Customs & Attitudes of community & doctor- fear admission,

early ambulation.
Method of payment for hospital services
Availability of qualified medical manpower
Housing & Family Structure : Nuclear vs joint family

Morbidity Patterns: Acute vs Chronic

Hospital Bottlenecks: Poor admission & Discharge process,

poor lab & radio services.

Internal Organization: Tight compartmentalization of beds.
Public attitudes: Social & religious attitudes, local customs,
belief.

The Hospital Site- Selection of

Site

Accessibility to transportation and communication lines: The accessibility

of the site for ambulant as well as non ambulant
patients, visitors, staff members and personnel, and for the delivery of supplies
should
be considered. The location must be within the reach of the community and located
in an uncongested area.
Parking Areas. A car parking space per two beds is desirable in

metros, lesser in urban areas and less in semi urban areas. Taking into
account that for each inpatient there will be at least one visitor per day, for each
inpatient admission there will be 3 outpatients. Additional parking space for three
wheelers, scooters and motor cycles. Employees and staff parking areas are
preferably separated from public parking.

 Public Utilities. The hospitals should be situated

near adequate sewerage, water, electrical, telephone

facilities.
Nuisances. The site chosen for the hospital
should be free from undue noise
such as emanating from railway tracks, main traffic
areas, schools etc.
Distances : Routes which the patients must take on
stretchers, wheelchairs or on foot from their wards to
radiology department/lab/physiotherapy dept should be
carefully thought to minimise the length of the routes.

Topography. Ideally the building is best located on relatively high

ground in order to
take advantage of natural drainage.
Landscaping. The psychological effect of attractive grounds and

surroundings on patient welfare, public good will and staff morale cannot
be underestimated.
Future Expansion
Total Cost : emphasis on total cost rather only initial cost of the building.
Site Survey. After selection, provision should be made for a survey

and soil investigation. This will help determine the type of foundation,
possibility of constructing a basement, and effectiveness of sewage plant.
Map of the plan to be certified by appropriate authorities like City Corporation,
Municipality or Panchayat not disputed land or legal restrictions.

 Land Requirements. In rural and semi-urban areas,

large areas of land may be available permitting the

hospital to grow horizontally. In urban areas, the land area
will be available at higher costs and the hospital need to be
built on the available land and hence the urban hospitals
usually grow vertically in multi-storeyed buildings. The
other important points to be kept in mind while determining
the land requirements are the local municipal byelaws
which change from place to place

Floor Area Ratio ( FAR)

It is the ratio of covered area on all its floor of a building to the

total area of its site.

Example.
FAR of 2:1 is highest esp in cities, high density of buildings
Preferable range 0.5: 1 to 1.5: 1

Hospital Size Planning

Big Vs Small
Pros & Cons

There are three kinds of hospital beds:

1. Adult beds-those of standard length and shape for the
use of adults and older children.
2. Cribs-those equipped with sides or guards for the use of
young children and
3. Bassinets-for the regular use of infants other than
newborn infants.

Cribs

Bassinets

Bed Distribution
A hospital bed is one installed for regular 24-hour use by
inpatients during their period of hospitalization.
Total no. of beds : size of the hospital
Bed Capacity: max no. of beds that can be established in
the hospital at any given time.
Bed Complement: No. of beds normally set up and
available for inpatient use.

Bed Capacity of the hospital: following are included:

1.Observation Beds equipped and staffed for overnight stay
2.Pediatric bassinets & incubators in pediatric dept
Beds which are not included are :
1.Bassinets and incubators in maternity suite.
2.Labour room beds
3.Outpatient and Casualty /emergency dept
4.Beds in diagnostic depts like X ray or in Blood bank
5.Recovery room
6.Nursing hostel or staff residence.
7.Any other which are not equipped and staffed for overnight stay

Types of Bed Accommodation

Private
Semiprivate
General Wards
Grouped together : Departmentalization of services for better

utilization of common equipment and facilities.

Bed Distribution by service

The distribution of patients in a general hospital is expected in the range from:
medical- 30 to 40 per cent,
surgical 20 % ;
obstetrical 15-18 per cent;
paediatric 10-12 per cent;
miscellaneous and others (including eye, ear, nose, and throat) 10-15 per cent.

Factors influence Bed Distribution:

1.New Hospital- phasing by floor by floor , wing by wing
2.Fluctuating census- allow interchangeability
3.Evaluation of needs, services, hospital policies, staffing

Space Requirements and

Relationships
A master plan takes into consideration the future developments of the
hospital, however, a major mistake in forward planning is to attempt to meet
pressure for beds, which is usually dominant, by adding them without giving
equal consideration to supporting facilities. The master plan should take into
Account the circulation routes, areas to be allotted to different departments,
zones, compactness, and also considering light, wind, hospital engineering,
and hospital hygiene aspects.
Min accepted space by 1 bed : 100 sq ft.
Total hosp area reqd : 8 to 10 times of min accepted space.

 Separate all departments yet keep them all close

together; separate types of traffic, yet save steps for
everybody; that is all there is to hospital planning .
By Emerson Goble.

4 Following basic rules

1. Protection of the patient is the primary rule. Too much

traffic
2. Plan for shortest traffic route : time is essence in hosp.
3. Separation of dissimilar activities : separation of clean from

dirty operations, quite and noisy activities, different types of

patients ( seriously ill and ambulatory)
4. Control: placement of nursing station

Distribution of Floor Space

Wards : 37 45 %
OPD : 12- 18 %
Diagnostic : 18 22 %
Administrative : 8-12 %
Service Department : 15 20 %

Circulation Routes
The utility and success of hospital plans depends on the circulation routes on
hospital site and within buildings.- Way finding is a major problem.

Develop flowcharts depicting movements of patients, personnel and visitors for

predicted movements between departments and within departments.

Internal Circulation:
Traffic of patients, staff, employees and visitors, as well as service deliveries, the
emergency entrance.
Movt of supplies and materials and removal of garbage should interfere with movt
of people.
Corridors, stairways and lifts
Ramps, steps, stairs: essential handrails and non skid hard level surfaces for steps
and stairs.
Avoid undue criss crossing of patients, staff, supplies and visitors.

Separate patient corridors and staff corridors to reduce

transit time.
Visitors route should be controlled by visitors pass- colour

coded
Outpatients routed from registration to sub waiting areas to
lab and radiology dept. They should not routed through
inpatient.
Staff should pass from entrance to locker rooms to place of
punching time/swipe cards

External circulation
4 separate entrances
Separate Entrance adjacent to kitchen and storage areas
receiving bulk supplies.
Main entrance and lobby should be attractive.
May create administrative problem, particularly theft
through unsupervised passages.

4 entrances in a hospital
Main Hospital entrance
Outpatient entrance
Emergency and ambulance entrance
Service entrance.

Interrelationships of
Departments

Each major department, clinical area supportive services and administrative

services have to be distributed over the site in appropriate zones to group them in a
manner that they are related to each other in context and proximity.
The departments which come in close contact with the public should be isolated
from the main inpatient areas and allotted areas closer to the main entrance to the
site. Such departments are outpatient and accident and emergency or casualty
department. The supportive service department, e.g. the x-ray and laboratory
services are extensively used by outpatients and need to be located as near as
possible, at the same time integrated with the main inpatient wards.
Beyond this, from the main entrance should be the main inpatient zone, consisting
of ICU, wards, operation theaters and delivery suite. This zone is as far away, from
the main traffic that takes place in areas close to the main entrance to hospital site.

Central services, especially service departments are better located on

the ground floor-they include laundry, CSSD hospital stores, pharmacy,
kitchen and cafeteria. These departments should be preferably
grouped around a service core area, the entrance of this being
independent of the main hospital entrance.
Floors should be constructed of materials by their future use and
maintenance. Hard floor, marble vs mosaic.
Corridors of size 8 feet by 8 feet.
Walls to be smooth and not attract dust and dirt.
Staircase at least 2 in different areas of hosp- fire exits, broad
enough for handling stretchers in emergency.
Elevators- max concentration of traffic. Separate pt and separate
service elevators

Gas Manifold System

Medical Gases used in a Hospital:
Medical Air /Compressed Air: used to operate surgical instruments like
pneumatic drills, saws in operating area etc.
CO 2: for laparoscopy, endoscopy, arthroscopy etc.
Vacuum for suction
N O for ventilators in NICU for babies.
When large continuous supply of various gases is needed, two or more

cylinders of the gas are connected to each other and their common
outlet is connected to a central piping system through a control panel:
Manifold

Pumps + compressors + pressure regulators + cylinder manifold +

maze of pipes: manifold system

Location should be on ground floor away from kitchen/open flames,

location storing combustible materials, power transformers, areas of

critical patient care.
Handling of compressed air and gases covered under Explosives Act.

Sanctions from Dept of Explosives, GOI essential.

Internationally accepted Gas manifold color coded system:
Oxygen- Yellow
NO: Dark Blue
Compressed Air Sky Blue
Vacuum : Sky Blue.

Residential campus
Nursing Hostels

Orientation of Buildings
Natural cooling and ventilation by orientation and design.
Very large glass- overheating
Air conditioning and air ventilation Air Hygiene is imp.
Basic principle that contaminated air from one part of the

hospital is not transmitted to another.

Energy conversation & solar energy- Green Hospitals
Bifurcation of areas - Duration of air-conditioning

Building contract and Contract

Documents
Bids for construction.
Legally scrutinized before advertising
and opened in person by the owner.
Contract is normally given to the lowest bidder unless strong

justifiable reasons.

Furnishing & Equipping the

Hospital
3 types of equipment :
1. Built in Equipment : fixed kitchen equipment, elevators,

boilers, walk in coolers, deep freezers, surgical lighting etc.

2. Depreciable equipment : Equipment have a life of 5 years or
more is not purchased through construction contracts. eg:
diagnostic and lab equipment, Pharmacy equipment.
3. Non Depreciable Equipment: less than 5 years span: eg;
surgical instruments, linen, kitchen ware, table ware,
chinaware, lamps, waste baskets etc.

Actual user involved in laying specifications- Multidisciplinary

team.
Protection against weather , theft and damage, should not
interfere with construction work.
Role of Engineering ( Biomedical equipment)

Ready to operate Stage

Written documents like policies, manual, procedures, rules and

regulations for smooth start.

Before Opening the Hospital

Taking Over and after
Go on Stream in a Phased Manner
Skeletal Staff at outset
Phasing over a pre determined period of time
Synchronize with increasing patient census, occupancy and workload.
Time of appointment of staff is crucial.
Each staff selection meticulously done.
Proper orientation to staff.
Training to staff.
CEO to work closely with Dept Heads on details and functioning of the hospital.
Detailed plan of action.
Shake Down Period- Trial Run and appropriate evaluation and corrective measures.

Phasing
The necessity to bring facilities into use as quickly as possible

for operational reasons.

The necessity to split a major project into smaller units of
building work as a contractual consideration.
The necessity of having certain departments ready before
others
Local priorities for introducing services.
Limitation on availability of capital funds.

Commissioning and Inauguration

Need not synchronize.
Inauguration to include
Press

tour & Press conference

Elaborate Programme
Elaborate tour to public by expert guides
Attractive Brochure
Security for VVIP
Pooja Ceremony.

Hospitals globally have been tasked by federal funding mandates and accreditation (The
Joint Commission to the numbers of patients) to increase their in-house bed surge capacity,
identify and establish plans for additional alternate care sites and facilities

Major Challenges
Large scale disasters as Tsunami and Floods like in

Uttarakhand have drawn attention to the need for Prudent

hospital planning that must include internal mechanisms for
increasing capacity and maintaining capability
Within a hospital environment there are multiple departments
with staff that are capable and competent to provide cross
coverage to other areas of the hospital where their expertise
may be utilized during a large scale surge incident
External assistance is unlikely to be available to hospitals in
such national catastrophes

Floor area ratio(FAR) (alsofloor space ratio(FSR),floor

space index(FSI),site ratioandplot ratio) is theratioof a

building's total floor area (gross floor area) to the size of the piece
of land upon which it is built. The terms can also refer to limits
imposed on such a ratio.
As a formula:
Floor area ratio = (total covered area on all floors of all buildings
on a certain plot, gross floor area) / (area of the plot) Thus, an FSI
of 2.0 indicates that the total floor area of a building is two times
the gross area of the plot on which it is constructed, as would be
found in a multiple-story building.

F.A.R= Total floor area on the floors/Plot area

Govt of kerala

Sept 2013: In a bid to boost healthcare sector in the national capital, theDelhi

Development Authority decided to enhance floor area ratio of hospitals from 2.00
to 3.75.
FAR 2.50 is now allowed for plots located on roads less than 24 mt width, FAR
3.00 for plots located on roads having width between 24 mt and 30 mt and FAR
3.75 for plots on 30 mt and above width roads, officials said.
To meet out parking requirements, additional space would be available in the
form of podium parking, they said.
DDA has now also permitted activities like staff changing room, staff dining
facility, kitchen, laundry, radiology labs in the basement without counting into the
FAR

HUDA

Area of Plot
Maximum permissible
Maximum
permissible F.A.R
coverage on ground floor

upto 10,000Sq. mtrs.

33% of the area of the plot

150%
Above 10,000 Sq. mtrs.
150%

25% of such additional plot