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 a centre for the training of health
workers and bio-social research.
-WHO definition of Hospital
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 longrange 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

Defining requirements- people involved in direct utilization & delivery of care- experts in
respective clinical fields
Hosp administrator/Medical administrator
Nursing administrator
Architect & Engineers with exp in hospitals
Hosp consultant
Financial expert
Hosp Project Staging

 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 and 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.
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 that 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 required : 8 to 10 times of min accepted space.
4 Following basic rules
1. Protection of the patient is the primary rule. Too much traffic, infection risk, efficiency of
patient care especially for surgical patients where asepsis is a must.
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 to keep a control over visitors entering and leaving the
ward, prevent infants from getting stolen and germs to patients in ICU.
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. Separate Entrance and exit for clarity &
security. Independent access for stores bulk and transport of heavy duty or bulky articles directly to
the point where it is required. This could be helpful in case of bringing fire fighting equipment in case
of a fire. 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.
Movement 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.
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) (also floor space ratio (FSR), floor space index (FSI), site
ratio and plot ratio) is the ratio of 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