Stages of Hospital Development

HOSPITAL PLANNING & ARCHITECTURE

- NABH Compliant Layout, Space & Functional Planning- Detailed Architecture & Structural Design- MEP,
Engineering Services & HVAC Design & Planning-- OT, CSSD & ICU Layout Guidelines & Design,Patient
and Employee safty Guidelines
PROJECT MANAGEMENT SERVICES
- Work closely with the Planners, Designers, Equipment Specialists and Commissioning experts-
Ensure an integrated approach and timely completion from concept to commissioning stage
MARKET SURVEY & FEASIBILITY STUDIES
- Identication of patient catchment areas- Mix of services at Tertiary and Secondary care levels-
Competition analysis and Satisfaction with current providers- Challenges and drivers to a new facility
in the Area
EQUIPMENT PLANNING & FACILITATION
- Developing list with budget for all Equipments- Room Layout & Space Planning Requirements-
Equipment Selection & Procurement-- Equipment Installation & Commissioning
LICENSING SERVICES
Formulating License requirements , Segregating the requirements, Applying for licenses and Proceed
accordingly
 Feasibility Study
• I) Why a Feasibility Study? 1. To understand the Needs of the Community 2. Estimate the Patient Load the
Hospital can attract 3. Establish the Viability of the planned Hospital 4. Design the Services and their
Phase-wise Roll-Out 5. Prepare a Project Plan and Report for the Investors
• II) How Feasibility Study done 1. Through Field Study – Primary Data 1. Interviewing the Key Stakeholders
of your Project, the Doctors, Corporates in the Region, Patient Groups, Societies 2. Analysing the
Competition – other Hospitals Providing the Services 2. By Study of Secondary Data 1. Health Indicators,
Demographics, Disease Trends, and Incidences from Govt Publications
• III) The focus of the Feasibility Study 1. Evaluation of accessibility of the planned location 2. Demand and
Supply Gap in the Catchment 3. Clearly understanding the Risk & Challenges to the Project & mitigation
measures
• IV) Some extracts from a Typical Market Feasibility Report
• V) Key Survey Findings - 1. Specialties most needed in City 2 Major Procedures needed in City 3.
Competitor Analysis: Quality Ratings of other Hospitals in the City 4. Surveyed Doctor’s Expectations from
the New Facility 5. Top Specialties to focus on, ranked based on priority
• VII) Roll Out Plan - Based on Feasibility Study
Feasibility Study
• A Hospital Feasibility Study is the best way to find out the sources of patient flow to
the Hospital. The Feasibility Study comprises both a Market and Financial Analysis of
the Project and is an essential aspect to be considered either while establishing a new
hospital or a new facility in an existing hospital or expanding the existing hospital.
• Objective of carrying out a Market Feasibility Study for a Healthcare Facility
• Format suitability, whether if Tertiary - Single, Multispecialty or Multi-super Speciality
• Evaluating the suitability of the proposed facility location
• Identifying the right Specialities to be provided by the Healthcare Facility for the
location
• Understanding the Critical Gaps in the Private Healthcare provided in the planned
catchment by the key factors that Doctors in the area look for from such Facility
Feasibility Study
• Carrying out a Market Feasibility Study helps
• New investors looking at opportunities in Healthcare delivery space
• Completing a thorough competitive analysis given the healthcare service lines being explored.
• Carrying out a demand analysis for the space or medical services provided by the proposed facility
• Projecting the trends that are shaping what these markets will look like in the future
• Funding agencies in examining infrastructure investment in regions with less healthcare facilities
• Overseas players wanting to replicate a successful chain model in India
• Medical Suppliers looking to penetrate the Corporate Hospital market
• Preparing Detailed Project Report (DPR) based on Market Analysis
• Results that can be expected from our Hospital Feasibility Report
• Format recommendation: To begin as a Multi Specialty Hospital and then transform into a Multiple Super Speciality.
• Super Speciality recommendations like
• Secondary care speciality recommendations
• Supporting specialities to complement the specialities offered and cater to the general needs of the area.
• Business model recommendations : Corporate Image model, Speciality driven
Feasibility Study
Feasibility Study
• Methodology & Approach to a typical Hospital Feasibility Study
• Establish the Doctor Group to be surveyed depending on the preferred specialities. To include:
• General Practioners
• Consultant Physicians
• General Surgeons
• Specialist Doctors
• Use a combination of Qualitative Surveys & Quantitative Surveys. The Qualitative Surveys being free flowing interview taking about
45 minutes for each Doctor and Quantitative Surveys, based on a more structured approach taking about 30 minutes for each.
• Survey will be structured to evaluate the prospects for the new Hospital based on the following factors.
• Adequacy of Hospitals with these specialities in the Core Area
• Quality of these Hospitals based on
• Facilities & Infrastructure for handling advanced treatments
• Patient Satisfaction
• Treatment quality
• Doctor Recommendations on specialities and others.
• Location suitability
• Competition evaluation
• Format suitability – Primary, Secondary and Tertiary and if Tertiary
• Single Speciality
• Multispecialty
• Multi-super Speciality
Hospital Project Report and Business Plan
• Hospital Project Report Preparation
• Based on the Market Information gathered through the Study and decision taken
on the Services / Procedures to be offered, both clinical and diagnostic, we
prepare the Project Report cum Business Plan for the proposed Hospital, covering
the Phases of growth, over a 10-year period.
• Based on the study and if needed, we work out the Costs based on segments of
Patients using the Hospital's Services.
• For lower range patients, i.e., providing very affordable care
• For mid to higher range patients i.e., providing a For Profit, Private Hospital type
care.
• Capital Costs and Revenues will be worked accordingly to determine feasibility of
each option. This report will be the very basis for the decision on the mix of
Hospital Project Report and Business
Plan-2
• The Project Report cum Business Plan would include
• Details of the ProjectProject Description
• Locational Advantages
• Market Analysis
• Hospital USPs / Differentiating Factors
• Risk Analysis & Contingency Plan
• Demographics
• Service and Revenue Mix
• Stacking Plan
• Bed Distribution
• Market Plan
• Staffing Plan
Hospital Project Report and Business
Plan-3
•
Projected FinancialsEstimated Project costs including
• Construction Costs
• Equipment Costs
• Fixed Costs
• Variable Costs
• Operating Costs
• Estimated Income
• Projected Profitability Statement
• Projected Cash Flow Statement
• Projected Balance Sheet
Hospital Design
• Translating your vision into reality
The Concept Design is the first step by our Architect to translate your vision into reality. This is based on how well the
Architect interprets your brief creatively and engage with you until it is fully understood. At this stage we also carry
out extensive research, site visits and have regular conversations with you as the Client and various User Groups.
• Feasibility Study need
Prior to the Hospital Planning and Architecture Design process ideally there should be a Feasibility Study carried out,
the objective of which is to understand the healthcare requirements in the target area of the Hospital. This helps us
to finalise the services and even the specialities and get a fair idea of the expected patient load too. The Hospital
Concept Design should comprehensively address all these requirements.
• Conceptualisation
In the Concept Design we will provide the elevation of the Hospital Building, block relationships of the departments
showing area, shape and location within the building and of the vertical circulation elements such as elevators and
staircases and the layout of the horizontal circulation routes (corridors)
• Ensuring functionality and statutory /regulatory compliance
While Designing Hospitals we also ensure the efficient functionality of the Hospital within the built-up area & local
laws and planning guidelines as needed to ensure full compliance with the National and / or International Hospital
Quality Accreditations like the NABH & JCI.
 Hospital Design
• Design of Services (MEP) covering
• Electrification design including HT, LT & Gensets, Heating, Ventilation & Air Conditioning (HVAC) design
• Sanitary
• Plumbing
• Water Supply
• Fire fighting and Protection System Design
• Elevators specification
• Telecommunication System
• Public Address Systems / CCTV surveillance
• Medical Gas Pipe line (MGPS) Design
• Data and Voice Networking
• Building Management Systems
• Sewage treatment plant and disposal systems
• Rain water harvesting for the complex
• 
Hospital Design
• Critical Areas Designs  covering
• OT & CSSD Complex
• ICUs
• Emergency
• Accident & Trauma
• Radiology & Radiotherapy
• Nuclear Medicine designs

• Other Designs  
• Exteriors – Landscaping Design
• Laundry and Kitchen Layout & Design
Hospital Interiors
• 1. Efficiency: Principles of Lean Management are adhered to. To render health services efficiently, with optimal use of manpower and resources it is important for
the Hospital's Interiors to be designed for the same to promote staff efficiency and provide for easy staff supervision.
• 2. Sanitation: Cleanliness is an aspect that we pay particular attention to, while design the Interiors. Different areas of the Hospital, based on their use, have to be
easy to clean and keep sanitized.
• 3. Accessibility: As Hospitals are places where the maximum number of persons with various disabilities visit, our Interior Design ensures compliance with all
statutory and non-statutory requirements on accessibility. Persons with disabilities, permanent or temporary, should be able to reach and navigate the premises
smoothly.
• 4. Safety: As Hospitals are places in which people recuperate from major illnesses, treatments, including surgeries, it is very important that Interiors be planned and
designed in a way that ensures Patient Safety. Particular areas we note here are corridors, staircases, ramps, ensuring they are non-slippery, have sufficient railings
and permitted slopes, to avoid accidents.
• 5. Ambience: Hospitals are places of stress. Everyone who visits a Hospital is dealing with illness or injury from an accident, and needs to be calmed down and
made to feel at ease and comfortable. The Hospitals thus need to ensure that the ambience within the Hospital is pleasant, soothing and conducive to an early
recovery of the Patients. The ambient temperature kept at various parts of the Hospital plays a very important part. The temperature is regulated and
supplemented with adequate ventilation.
We make maximum use of Natural Light in our designs as this aspects is very important for health and well-being. Research shows that it reduces stress levels,
blood pressure, heart rate and promotes healing. So we give patients good access to nature and natural light, through maximum use of windows, skylights and
outdoor spaces.
• 6. Controlling Infections: Hospital acquired Infection is a serious issue and can be controlled at the design stage itself, right from selecting the right materials, the
wall and surface finishes, and furniture. Hard surfaces like in flooring are easier to clean than carpeted ones and smooth surfaces are not conducive to harbouring
bacteria. Sometimes we recommend antimicrobial coatings to be applied additionally to reduce spread of infection. Other design features we include are
automated doors, touchless taps and soap dispensers, seamless flooring with no cracks or crevices etc.
• 7. Reducing Noise: Noise is a problem to be controlled in areas like Emergency Departments and intensive care units. A great deal of research has been in the area
of acoustics to come up with solutions in hospital design to reduce noise and establish a quiet and peaceful environment. Some measures we adopt are noise
reducing curtains, sound-absorbing ceiling tiles, carpeting of floors etc., to reduce sound etc
• 8. Signage: Our golden rule here is that visitors to a Hospital need to be able to reach the place they want to go to, without asking anyone. Those that are new and
not familiar with the Hospital layout can find wayfinding quite frustrating and stressful. Usually a combination of color-coding with signage, and other visual
indicators are used. Our Patient friendly Interior Designs develop clear sightlines and traffic flows that are logical and help people to find their way easily around.
Regulations
• 1. LOCAL REGULATIONS TO BE COMPLIED WITH AT HOSPITAL DESIGN / LAYOUT STAGE
• 2. Successful Hospital, Green, Lean, Digital and Affordable Care
• 3. Hospital Accreditation
• 4. Why Statutory Compliance at the Design Stage
• 5. Hospital Infrastructure Regulations
• 6. Local Planning Authority / Building Regulations
• 7. Basic Requirements for Hospital Planning, General Hospitals and Nursing Homes in India
• 8. Clinical Establishment Act.
• 9. State PCB Clearances
• 10. National Building Code - Fire & Life Safety
• 11. Atomic Energy Regulatory Board – Xray, C-arm, CT, Mammogram, MRI, Cathlab, PET CT, Radio therapy
( Layout Approval, Buy approval, Installation, Inspection, Registration/License, Commissioning)- Punishable Offense
• 12. Reference Data on Shielding of X-Ray Installation Room
• 13. NABH Guidelines
Operational Due Diligence Study
• Operational Due Diligence Study of the entire Hospital to examine in detail the
existing Infrastructure, Facilities, Equipment, Licenses and Approvals, Staff, and
other Resources. The coverage primarily under each of these heads would be:
• Infrastructure:Building Location and outside layout, covering Access points,
Setback, other Patient Safety Provisions, Legal and Statutory Approvals /
Compliances met like on Fire, Environment Management, Disaster Management,
Pollution Control, Waste Management etc.
• Building Inside layout. Space Planning covering Lobby, other Patient Waiting Areas,
locations of Emergency / Casualty, Utility points, Critical Care Areas including
Operation Theatre, ICU & CCU Complexes, In Patient Areas – Rooms and Wards
etc.
• IT Network
Operational Due Diligence Study-2
• Equipment & Facilities (including Diagnostics):Adequacy – sufficient for load projected and to be handled
• Technology – in keeping with the best currently available
• Safety – for Staff and Patients, like AERB provisions being met in Radiation areas etc
• Maintenance / Calibration provisions including monitoring systems in place
• Availability of the trained and skilled Staff for operating the Equipment
•
Systems and Processes:Clinical Areas including Patient Admission, Assessment, Treatment, Medications, Emergency Care & Discharge
and Infection Control Protocols
• Non-Clinical Areas incl. Administration, IT, Marketing, HR, Purchase & Stores, BMW Management
•
Staffing – Clinical and Administrative:Organogram review of existing staff for determining adequacy, for level of Operations
• Qualifications & Experience of Key Staff
• Training needs, identification and provision
•
Market Study – Primary Data (Doctor Surveys):Identifying gap between demand and supply for advanced healthcare in the Region
• Assess the extent being met by this Hospital
• Understand the strength of the competition based on Quality, Infrastructure & Facilities