A PROJECT REPORT ON

DEMAND FORE CASTING OF ULTRA MODERN ALL FACILITY HOSPITAL IN LUCKNOW WITH ITS LOCATION PLANNING

SUBMITTED TO:
PROF. VINOD KUMAR CHIB

SUBMITTED BY: ANKIT KANNOJIA (JL13PGDM69) ANKIT PANDEY (JL13PGDM70) ANKITA CHANDRA (JL13PGDM71) ANKUR SHRIVASTAVA (JL13PGDM72) ANSHUL BAJPAI (JL13PGDM73) ANSHUMAN BHATTACHARYA (JL13PGDM74)
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ACKNOWLEDGEMENT
At the very outset we would like to express our deepest sense of gratitude to our faculty Dr. V.K.Chib Sir, for having given us this wonderful opportunity to work in such an exciting project in the domain of Operations Management. The Project which related to the various Inventory and Operational Issues being faced by Sahara Hospital, gave us valuable insights into how things actually work in the real world. It gave us this wonderful opportunity to relate the concepts we have studied with the practical world. And last but not the least our sincere regards to Dr. H.N. Tripathi & Dr. S.N. Gupta for giving us time and sharing valuable information.

Table of Contents
INTRODUCTION .......................................................................................................................... 4 Purpose & Back ground of the project ........................................................................................ 4 Literature review ............................................................................................................................. 4 Concept ....................................................................................................................................... 4 General .................................................................................................................................... 5 District..................................................................................................................................... 5 Teaching .................................................................................................................................. 5 Clinics ..................................................................................................................................... 5 Specialised .............................................................................................................................. 5 Ultra Modern All Specialty Hospitals..................................................................................... 6 Introduction of information and analysis sources ........................................................................... 6 Planning of Hospital: .................................................................................................................. 6 a. Need of the Hospital in a particular location ...................................................................... 7 b. Site conditions:.................................................................................................................... 7 c. Economy of the area where the hospital is going to be located .......................................... 7 d. The catchments of the area for the patients to utilize the services: .................................... 8 e. Availability of Manpower: .................................................................................................. 8 Planning & Co-ordination with other departments ..................................................................... 9 Background Research ............................................................................................................... 13 Functional & operations of hospital .............................................................................................. 13 Building Attributes................................................................................................................ 14 Efficiency and Cost-Effectiveness ........................................................................................ 14 Flexibility and Expandability................................................................................................ 15 Therapeutic Environment...................................................................................................... 15

Sustainability......................................................................................................................... 16 Conclusion: ................................................................................................................................... 16 LIMITATIONS & OPERATIONAL DIFFICULTIES OF HOSPIATLS: .............................. 16 LIMITATIONS OF THE PROJECT: ....................................................................................... 17

INTRODUCTION
Purpose & Back ground of the project
Increase in demand of hospitals because of increase in number of patients suffering from different ailments as in todays time few diseases like diabetes, migraine, blood pressure problem are very common . There are very less number of hospitals serving high technology in medical science in lucknow, so people usually rush to leelavati (delhi) ,apollo(new-delhi ) etc. to avoid this inconvenience we are in need of high technology, modern edged high expertise hospital to serve more and more people of Lucknow and nearby cities. Though there are some hospitals such as SAHARA Hospital, Medical college & PGI in lucknow but they are unable to fulfill the demand of lucknow. We have find that there is a huge demand and supply gap in this sector. If a person is in emergency, it is sometimes possible that a patient is unable to find a bed to get him treated. We have come up with this hospital with the most ultra modern super specialty hospital with 500 bed capacity and most sophisticated diagnostic & imaging equipment such as an intra-operative MRI scanner and high-speed, low-dose CT scanners & also latest life saving equipments, so that patients with high level problems have not to rush to big hospitals. Though we know that a unit of 500 bed will not suffice the demand but it may bring down & help more people in need.

Literature review
Concept
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals are usually funded by the public sector, by health organizations (for profit 4

or nonprofit), health insurance companies, or charities, including direct charitable donations. Historically, hospitals were often founded and funded by religious orders or charitable individuals and leaders. Today, hospitals are largely staffed by professional physicians, surgeons, and nurses. Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others often are described as clinics. General The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and normally has an emergency department to deal with immediate and urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States, have their own ambulance service. District A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and long-term care. Teaching A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school, nursing school or university. Clinics The medical facility smaller than a hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practise is allowed). Clinics generally provide only outpatient services. Specialised Types of specialised hospitals include trauma centres, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth. In Germany specialised hospitals are called Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery). Specialised hospitals can help reduce health care costs compared to general hospitals. For example, Narayana Hrudayalaya's Bangalore cardiac unit, which is specialised in cardiac surgery, allows for significantly greater number of patients. It has 3000 beds and in pediatric heart surgery alone, it performs 3000 heart operations annually, making it by far the largest such 5

facility in the world. Surgeons are paid on a fixed salary instead of per operation, thus the costs to the hospital drops when the number of procedures increases, taking advantage of economies of scale. Additionally, it is argued that costs go down as all its specialists become efficient by working on one "production line" procedure. Ultra Modern All Specialty Hospitals An ultra modern hospital is a center for treatment of all kinds of diseases & is equipped with all types of medical, diagnostic & surgery through modern and latest high end equipments and technology. The no. of these hospitals are very limited in our countries and they are mostly concentrated towards the metro cities.

These all types of Hospitals have a same function i.e. treatment of patients but they majorly differ in their operations. A specialized & ultra modern all specialty hospitals deals with more critical cases where as the rest are more for a general purpose. The critical case handling capacity of a hospital is what makes it different from other hospitals and therefore it requires highly specialized doctors, nurses, technicians & highly advanced medical care systems such as ICU, ICCU, Trauma center and many more. Though these various types of hospitals are designed for their specific purposes but they are required to do many common jobs as well, such as emergency treatment, general medicine and active during drastic situations.

Introduction of information and analysis sources

Planning of Hospital:
The hospital planning can be divided into Two Categories: I. Feasibility study for the hospital to be located in a particular area II. Actual planning of the buildings, equipments etc., I. In the feasibility study, we have to analyze the following: a. The need of the hospital in that location b. Site conditions c. Economy of the area where the hospital is going to be located d. The catchment of the area for the patients to utilize the services 6

e. Availability of Manpower f. Financial Resources a. Need of the Hospital in a particular location: It is better to appoint a consulting firm, who is specialized in hospital planning to survey the locality for the feasibility of the hospital. It is better to appoint an outside expert so that we will not have preconceived opinion about the project. In the survey, they should examine whether the local community will be able to use the hospital and whether they can afford for the services given by the hospital. If the community is wealthy, the hospital should have luxury otherwise the hospital should have moderate facilities. Also we should see whether the hospital staff would have facilities for their people such as schools, good transport and easy accessibility to that area etc., b. Site conditions: The selected site should be large enough for future expansion. It should be suitable for building construction and it should not be water located area and should be easily accessible from any direction. It should have bus routes and should be on the main road. The availability of water supply should be considered and also the disposal of sewage should be taken care of. If the water table is very high then the disposal of sewage will be of a problem. Water also should be portable so that the equipment and pipeline will not be corroded due to salts. The soil condition of the site should be studied so that the foundation for the building can be designed economically. Some times, if the soil is clay then the foundation cost will be very high. In some places, we find that even if we put borewell upto 400 to 500 ft, there will not be any water, which will increase the recurring cost for supply of water. Also we should see whether the Corporation/Panchayat could supply enough quantity of water since consumability of water in the hospital per bed per day will be approximately 300 400ltr. So buying water from outside will be very expensive. Also we should see that electrical power supply (3 phase) of industrial supply would be available in that locality. Other facilities like telephone, roads, and central sewage should be considered before selecting the site. c. Economy of the area where the hospital is going to be located : we should study the earning capacity of the people in that area so that the hospital can be designed in a moderate way or luxuries way. Always we should see that services should be affordable by the local community. The facility should be available for all categories of people.

d. The catchments of the area for the patients to utilize the services: In the preliminary survey, we should find out whether the people can use the services of the institution. We should see the availability of hospitals in that area so that we can assess the people who are going to utilize the facilities of the new hospital. Also we should see whether facilities are available such as quarters etc., for the patients who are coming from little far away. e. Availability of Manpower: We should ascertain whether enough paramedical staff and other personnel like sweepers, watchmen, office staff etc are available locally. Otherwise it will be very expensive to appoint people from outside. Also facilities like transport, education institution and other basic facilities should be available for the staff nearby the institution. f. Financial resources: Before starting up the project, we should study the financial resources available. Mostly the finances for the project to be done by either banks or other financial institutions such as HUDCO, LIC etc., we should plan in such a way that will be within our resources so that the project will not be stopped in the middle. In most of the organizations, the project will be started without proper planning of finances, which will delay the project or stop the project. We should budget in such a way that the pay back period within 7-10 years. Then only the project will be feasible. In hospitals, the medical equipments are very expensive and often new developments will be coming up. Unless the hospital is moderately equipped, it is very difficult to complete with the neighboring organization. More time to be spent on planning the preliminary things. In our country, we spend less time in planning and more time in executive. By this there will be lot of changes in planning and also more of remodeling etc., which will cost more money. III. Actual planning of the buildings, equipment etc :-,After preliminary studies and survey etc., the planning of the building may be done. We should appoint an architectural firm who is well versed in hospital designing. We have to prepare a master layout, so that the positioning of the various buildings can be located in that site. Before preparing the master plan, an advisory committee should be formed to get various, information from various department heads. With this information we can prepare the spaces needed for each department such as reception, waiting area, registration, examination rooms, treatment rooms, toilets, space for laboratories, X-ray, Scan etc., Every specialty has got different types of planning. Some specialties may have bigger examination room and lot of diagnostic equipment should be in the examination room. Before 8

planning we should study the equipments and furniture to be provided for the particular department so that we can plan the size of the room. Also we have to see what type of power plugs, computer connection, UPS needed for each department so that all the things can be planned for each type of room. According to the economic condition of the patient and demand from the community, the inpatients room should be designed. In some places, we should have more luxury rooms whereas in other places we may to need more common rooms. Facilities should be provided in the hospital for public such as toilets, wider veranda, cafeteria, medical stores, optical stores, gift stores etc., The nursing station should be in a central place, The inpatients area should be very quite. The reception area should have welcoming atmosphere for the people to come to the hospital. When we plan for specialty clinics, the requirements should be discussed with people who are going to use the department and the layout of the various facilities should be done according to the flow of patients. When we plan the buildings, we should use the right materials so that the maintenance cost will not be in increased.

Planning & Co-ordination with other departments

Land purchase Legal Opinion Encumbrance certificate 30 years Clearance for the Urban land Income Tax clearance appropriate Registration - Change of use of land (Revenue) - Name Transfer (Patta) - Highways permission for approach - Electricity Board Appointment of Architect Plan Approval Appointment of contractors (Civil, Electrical, Air-conditioning, Sanitary,Lift etc.,) Appointment of Engineers Chief Electrical Inspector Pollution Control Approval Furniture supplies 9

 Equipment supplies Bankers (Financial Institutions) Before we start the construction of the hospital, we have to purchase the required land for the construction. We have to get legal opinion through a lawyer regarding the documents of the land. Then the land is to be registered through Sub Registrars Office. We have to get clearance from the Urban Land Department for the Exemption of the land from the Urban land ceiling. We have to get Encumbrance certificate for atleast 30 years for the ownership of the land through Registrars Office. We have to get Income Tax clearance if the land value is more than 5 lakhs and clearance from Appropriate Authority if the value of the land is more than 20 lakhs in cities. After the land is registered, we have to apply to the Revenue Department to change the use of the land ie, from agricultural or industrial to hospital construction. After registration, the name of the owner should be changed through revenue department by getting a patta. If the land is on the highways, we have to get permission from the highways department for providing an approach from the road to the proposed hospital land. We have to apply to the electricity board for power supply permission for the construction. If the size of the project is big and consumes HT power supply, which is more than 110KVA, we have to apply for HT power supply, for which, the electrical inspector should certify and then only the Electricity Board will give the power supply. For HT power supply, we have to provide our own transformer. For specialized works, such as air-conditioning, sewage treatment plant etc., we need to have special consultants, so that the work can be done economically. If finance is to be arranged through banks or from any other financial institutions, we have to prepare the project report regarding the feasibility of the project. We have to study about various financial institutions to know the variations in the rate of interest and to minimize the interest rate for the loans. Water Supply. The sources for water supply are: 1. Borewell at the site 2. City supply 3. Private The need of water for the hospitals is very high. The requirements of water should be calculated considering the patient load, (inpatients and outpatients) and also the residential area. Normally the water consumption per bed will be around 300- 400ltrs per day and for residents is about 10

100-200ltrs per head per day. Hence we have to calculate the total requirements of water per head per day to find out the total quantity of water requirements. The water to be used should be tested for finding out the quality of water and the salts and other chemical ingredients in the water. This water can be tested to get the percentage of impurities so that we can have equipments to treat the water to make it soft. Some times if the water has got salts, which will form scales in the pipelines and the pipelines will be blocked. We have to provide watersoftening plants to reduce the salts so that the pipelines can be maintained. For operation theatres, sterilization rooms and laboratories, we have to use good water so that we can avoid the scaling of the instruments, autoclave etc., When the total quantity of water is calculated, we have to design the water tanks overhead tanks and underground reservoir etc., In one cubic meter we can store 100ltr of water. Normally we should have atleast 2-3 days stock of water should be stored. For providing water to various places, we have to use pipelines to different diameters according to the requirements of water in that area. We use galvanized iron (G.I) pipelines of different pressure capacities ie. A, B, C types of pipes, which represents the thickness of the pipes. In some places, they use PVC pipes of Grade 4 KG pressure per sq.cm or 6 KG pressure per sq.cms. For underground supplies, we can use PVC pipes of higher diameter. In some of the buildings, the entire interior as well as exterior pipes, are used by PVC pipes. In some area, when there is difference of temperature for interior and exterior lines, there may be expansion due to heat. The joints in PVC lines may leak. When we use G.I pipes in the below ground level, we have to paint with corrosion resistant paints and some times we use tar coated gunny to avoid corrosion. Care should be taken to have proper joints to avoid leakages. The pipes also should be designed according to the discharge of water. In PVC pipes proper adhesive should used for joining the pipes. The water lines has to be designed depending upon the horizontal distances of the pipelines and the vertical heights. Necessary valves should be provided at different distances so that the maintenance can be done without dismantling all the pipes. Too many bends and joints should be avoided to reduce the friction. When we get water supply through city lines, they will provide water meters. If the water contains sand particles and salt content, the meter does not work properly. Always it is better to put a filter media before the water meter to avoid the breakages of the meter. If there is a scarcity of water and if its expensive then it is better to provide some way of water treatment plant for recycling the water. The waster water can be treated either by chemical, mechanical or natural flow 11

system. In some area, the treated water are used for flushing cisterns, gardens, road cleaning works and other areas where we dont touch the water. If possible the rain water can be collected and stored. In operation theatre and sterilization areas we need soft water for the safety of the equipments and surgical instruments. In some area, if we have central airconditioning plants, the condensed water can be collected from the air handling units, which is equal to distilled water, which can be collected and used for the O.T. and sterilization rooms Sanitary Arrangements In sewage disposal, we have got two types of disposal system. One for the grey water, which comes from toilets, kitchen area and other one water from washbasin, bathrooms etc., Depending upon the volume of sewage, we have to design the pipes. Usually for toilets outlets, we use stoneware pipes. Nowadays PVC pipes also used for sewage disposal. The sewage can be disposed in 3 ways. 1. Leachpit If its a small quantity 2. Septic Tanks 3. Mechanical treatment plant or with the modern developments of central flow ie., baffled tanks with arobic and anirobic filters. The capcity of the sewage disposal should be designed according to the quantity of the sewage. Necessary manholes, gully traps and nahini traps should be used for avoiding the bad smell in the atmosphere. The manholes are useful to remove the blocks in the pipelines. Proper filter should be provided so that the plastic or solid materials can be avoided. In hospitals we find there are lots of bio-medical waste, tissues, blood, cotton and other bio-medical waste. As per the government rules, we have to collect all these materials separately in different colour bins so that this can be disposed according to the rules. In big hospitals they have to provide their own incinerators to dispose the bio medical waste. Now as per the government rules to avoid pollution inside the city area, the government insists to have common incinerators outside the city livings. Care should be taken in both water supply and sanitary installation at the construction time itself to avoid maintenance problems. The location of the pipelines for both water supply and sanity should be provided in such a way that the maintenance people have easy way to attend the repairs. Necessary air vents should be provided to avoid air blocks in the pipelines, which may sometimes blow of the pipelines.

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Background Research
For our study we have visited Sahara hospital, Gomti nagar and Ford hospital, Gomti nagar. We choose these two hospital for our studies because Sahara being a modern all facility hospital and ford being a specialty and general hospital. These two can be served as our base for planning a new hospital in lucknow and will also serve us to differentiate between the flaws in the two system and to accumulate the goods and minimize the constraints of the project. The criteria for location planning for Sahara in ideal w.r.t. ford because of more space and free roads as it is established in less crowded area.

Functional & operations of hospital

The hospital is, ideally, based on its functions: bed-related inpatient functions outpatient-related functions diagnostic and treatment functions administrative functions service functions (food, supply) research and teaching functions

Physical relationships between these functions determine the configuration of the hospital. Certain relationships between the various functions are requiredas in the following flow diagrams.

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Building Attributes Regardless of their location, size, or budget, all hospitals should have certain common attributes. Efficiency and Cost-Effectiveness An efficient hospital layout should:Promote staff efficiency by minimizing distance of necessary travel between frequently used spaces Allow easy visual supervision of patients by limited staff Include all needed spaces, but no redundant ones. This requires careful pre-design programming. Provide an efficient logistics system, which might include elevators, pneumatic tubes, box conveyors, manual or automated carts, and gravity or pneumatic chutes, for the efficient handling of food and clean supplies and the removal of waste, recyclables, and soiled material Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi-purpose spaces Consolidate outpatient functions for more efficient operationon first floor, if possiblefor direct access by outpatients Group or combine functional areas with similar system requirements Provide optimal functional adjacencies, such as locating the surgical intensive care unit adjacent to the operating suite. 14

These adjacencies should be based on a detailed functional program which describes the hospital's intended operations from the standpoint of patients, staff, and supplies.

Flexibility and Expandability Since medical needs and modes of treatment will continue to change, hospitals should:

Follow modular concepts of space planning and layout Use generic room sizes and plans as much as possible, rather than highly specific ones Be served by modular, easily accessed, and easily modified mechanical and electrical systems Where size and program allow, be designed on a modular system basis, such as the VA Hospital Building System. This system also uses walk-through interstitial space between occupied floors for mechanical, electrical, and plumbing distribution. For large projects, this provides continuing adaptability to changing programs and needs, with no first-cost premium, if properly planned, designed, and bid. The VA Hospital Building System also allows vertical expansion without disruptions to floors below. Be open-ended, with well planned directions for future expansion; for instance positioning "soft spaces" such as administrative departments, adjacent to "hard spaces" such as clinical laboratories.

Therapeutic Environment Hospital patients are often fearful and confused and these feelings may impede recovery. Every effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as possible. The interior designer plays a major role in this effort to create a therapeutic environment. A hospital's interior design should be based on a comprehensive understanding of the facility's mission and its patient profile. The characteristics of the patient profile will determine the degree to which the interior design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness. Some important aspects of creating a therapeutic interior are: Using familiar and culturally relevant materials wherever consistent with sanitation and other functional needs Using cheerful and varied colors and textures, keeping in mind that some colors are inappropriate and can interfere with provider assessments of patients' pallor and skin tones, disorient older or impaired patients, or agitate patients and staff, particularly some psychiatric patients . 15

Admitting ample natural light wherever feasible and using color-corrected lighting in interior spaces which closely approximates natural daylight Providing views of the outdoors from every patient bed, and elsewhere wherever possible; photo murals of nature scenes are helpful where outdoor views are not available Designing a "way-finding" process into every project. Patients, visitors, and staff all need to know where they are, what their destination is, and how to get there and return. A patient's sense of competence is encouraged by making spaces easy to find, identify, and use without asking for help. Building elements, color, texture, and pattern should all give cues, as well as artwork and signage.

Sustainability Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. They are heavy users of energy and water and produce large amounts of waste. Because hospitals place such demands on community resources they are natural candidates for sustainable design.

Conclusion:
We got to know how operations is managed in a hospital and also various technical and uncertain difficulties faced by hospitals. We learned that operations is the key in running any process oriented industry. Operations is not only restricted to manufacturing industry but has a more complex structure for service industry. During our course we found out many limitations to the industry as well as our project.

LIMITATIONS & OPERATIONAL DIFFICULTIES OF HOSPIATLS:

Uncertain demand. Excess reserves and buffer stock. Managing staff. Unexpected approximations for outbound inventory. Inventory management. Maintaining cleanliness & hygiene norms. 24 x 7 operations 16

 High degree of rules and norms

LIMITATIONS OF THE PROJECT:

Unavailability of proper data. Unavailability of proper informative staff to provide relevant information. Dependency on observational skill over factual documents. Non disclosure policy of Hospital.

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