OVERCOMING

HOSPITAL DESIGN
AND DEVELOPMENT
CHALLENGES:
INTERVIEW WITH
DALJIT SINGH, PRESIDENT
OF FORTIS HEALTHCARE

Hospital design and development is

fraught with complications such as
stakeholder collaboration, construction
quality and timely delivery. In this
exclusive interview, IQPC talks with
Daljit Singh, President of Fortis
Healthcare Limited to discover his
biggest challenges, his strategies to
overcome them and the key lessons
learnt from his years of experience in
the industry.

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IQPC: How long have you worked in the healthcare sector and what
kind of projects, pertaining to hospital design and development, have
you been involved in?
Singh: I’ve been involved in the healthcare sector for almost 12 years. During this time there
have been ten major hospital projects that I’ve been involved with in terms of design and or
construction. These have largely been super specialty hospitals focusing on cardiac sciences
oncology, orthopaedics, neurosciences, gynaecology and organ transplant; pretty much the entire
compendium of specialities required in a hospital offering comprehensive services.

IQPC: What is the biggest challenge you encounter in hospital design?

I think the biggest challenge is around firming up the requirements for the hospital project. Projects
are, by their very nature futuristic, because, from the time of conceptualization to commissioning,
there is usually a large time gap, that usually extends up to 3 years or more.

In order to determine these requirements, we usually engage the operational staff from our existing
hospitals and incorporate their inputs into the plan. However, firming up a hospital design has its
set of challenges – the operations experts have their priorities embedded in the ‘current reality’,
whereas the inputs required need to project a ‘futuristic’ requirement. An added challenge that we
are confronted with is that, by the time the hospital is completed, it is always a different group of
staff who are appointed to operationalize the hospital and these team members, rightly so, examine
the hospital from their perspective – leading to a list of changes that need to be incorporated in the
hospital nearing completion!

So the question we ask ourselves is, how can we accurately conceptualize the look and feel of a
facility that will be ‘fit for purpose’ for our clinicians, patients and the community 10 years after the
facility has been commissioned. Other key questions that need to be answered early on are, what
will be the positioning of the proposed hospital vis-à-vis the community and our clinicians? What
will be distinctive about this hospital? How will the new hospital facilitate the delivery of better
patient care and clinical work? The answers to these questions enable us to design a hospital that
will be relevant for the future.

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IQPC: Given that the process of foreseeing and incorporating near future
healthcare needs into hospital design is inherently difficult, could you
elaborate on the techniques you use to do this?
We start by assessing the current state of the location and take into account the pace of development.
Secondly, we look at the trends, technologies and practices being used elsewhere in the world. For
example, one trend we are seeing in developed countries like Australia, is the drive to shorten the
amount of time a patient will spend in a tertiary hospital before moving into a rehabilitation center. In
India we have not yet arrived at the stage of setting up rehabilitation centres. So another question we ask
ourselves is whether these models of care will benefit our patients and whether these can be integrated
into the existing healthcare system?

IQPC: What other challenges do you encounter in hospital design?

Based on my experience in India, another challenge we face is the issue of delivery timelines. Quite
often local architect firms have little experience and expertise in designing hospitals. They tend not to be
able to design hospitals with a high level of specificity and detail. This means that when a project nears
completion, often some important design considerations have not been provided for. Having to then
rework on design and execution often proves expensive and time consuming.

Due to this gap in understanding hospital functionality, a lot of the design related inputs are provided
by internal experienced healthcare administrators, medical directors and other professionals with
experience. These stakeholders all have a view about what the facility should be and what works best; so
we tend to guide the architects to come up with a design that meets their requirements. However, this is
perhaps not the best way to design hospitals!

Today we are increasingly turning to architectural firms that have deep expertise in the design of hospitals.
These firms have in-house hospital planners with a deep understanding of hospital spaces and work
flows and have the ability to provide vital inputs during design finalization. They also possess information
and knowledge of best practises across hospitals in other parts of the world. Their inputs contribute
significantly to deliver a hospital design that will be cater to future requirements. When you work with
such firms and combine your own vision for the project, then you get a product that you want.

Another challenge that we face in India is to do with the execution capability of local contractors. They
often rely on old and conventional methods of construction that are inherently labour intensive and slow;
coupled this with unskilled labour, project quality and execution time frames can be highly variable,
thereby impacting project viability.

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IQPC: What strategies and techniques are you using to overcome these
design and construction challenges?
Choosing to work with firms that are able to contribute valuable inputs at each stage of design
development is essential to good hospital design. One technique we have been using with great success
has been the use of 3D design software. By creating a realistic representation of the whole project, this
technology ensures that when you give the design to the construction team, there will be fewer problems
for you to deal with due to construction related conflicts that often arise during execution.

The second priority must be to engage with contractors who have an ability to use modern construction
technology and have trained workmen on their rolls, people who understand and adhere to construction
processes and construction safety. We are increasingly moving towards prefabricated construction -
once onsite the parts can simply be assembled, almost like in the game of Lego. This helps standardize
the hospital build in terms of quality and dimension and ultimately helps us achieve better outcomes.
Although these choices can raise the cost of a project by approximately 10 per cent, what you gain in
quality and timely delivery more than offsets the extra amount spent on the project.

IQPC: How common is the use of prefabricated building

components in the hospitals that Fortis Healthcare is designing?
It is increasingly becoming our construction method of choice.
In two projects, with a combined bed strength of approx. 300,
we have deployed the prefab methodology of construction.
The object is to minimise wet work on site. One of these projects
will be ready by year end.

The benefits of using prefabricated materials can vary, but

a rough estimate is that it can reduce the construction time
anywhere between 30 to 50 per cent. In regards to both build
quality and delivery timelines, using prefab materials greatly
increases the project’s predictability and it is this aspect which
can make or break a project’s viability.

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IQPC: Throughout your career in healthcare business leadership,
what are the key lessons you have learnt along the way?
Do not hurry to get to the construction stage. Spend a lot of time on planning and getting your thoughts down
in black and white. Get key stakeholders involved and incorporate their ideas before going live with the details.
If you are diligent during the design stage, then the number of changes needed later during execution will drop
dramatically; so thorough planning is a very critical aspect.

Secondly, focus on the technology strategy of your hospital project. During hospital design there is usually a
lot of focus on the hard stuff like the building/engineering services/medical equipment etc, but contemporary
hospitals need to be increasingly designed around the IT that will support patient care. This is particularly
important because it is this technology that will impact, most dramatically, patient care and experience over the
coming decades.

Finally, hospital designs need to be patient centric. Traditionally hospitals have been built largely around the
requirements of doctors. For example, does the patient need to travel a long way within a facility, or even
between departments within a facility? My learning is to keep the patient at the centre of what you do. First you
need to think about the patient, then the doctor and then everything else. This prioritisation of patient centricity
is something that we have emphasized over the last ten to twelve years and it is this aspect which has been
driving hospital design within our organization.

How Can You Create Cost Effective Design & Construction

to Improve Efficiency & Healthcare Outcomes?
Meet the regions leading healthcare professionals, construction contractors,
arhcitects and consulting engineers at Health Facilities Design and Development Asia
29 - 30th March 2016 in Singapore.

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