Emerging Trends In Planning And Designing In Indian Hospitals - Part II

Dr K B Sood

Trends Affecting Hospital Engineering & Support Services

This process had started with Florence Nightingale when she studied in detail the way healthcare providers are delivering healthcare and methods of improving the outcome. She mainly focussed on the healing environments. Today, it is possible to control all environmental parameters to not only promote healing, but also to provide all kinds of support to the healthcare provider.

Web-enabled Hospitals

Deployment of new tools of IT shall create web-enabled hospitals, which will have seamless integration across all healthcare providers for managing patient data and administrative data. This shall especially benefit hospital chains to manage performance tracking, human resource, financial and purchasing functions. At the same time, the same technology shall enable the hospitals to provide a web-based audio-video communication between the patient and his family. The same technology will enable doctors to monitor their patients at their place of practice or rest within the hospital or at their residence, as appropriate.

The hospitals need to have a definite IT department to manage this capability. The department shall be tasked to manage tele-medicine, links for various virtual control rooms, access to third party payment plans online, patient interaction vide web and other such activities. An independent system administrator for this department will be responsible to maintain confidentiality of the information, its proper use, prevention of misuse and upgradation of the data at regular intervals. This trend is going to influence all hospitals, small or big in the next three to five years. Depending upon the resources available to hospitals, it will be implemented in a limited way in hospitals, while big hospitals will see implementation of full web abilities.

Wireless Monitoring Systems

Though wearable computers are still not available outside the defence research laboratory, its derivatives in the form of wireless monitors for such patients who do not need intensive care but still need close monitoring of their physiology are now freely available. This will enable such patients to regain their confidence immediately after an episode of critical illness. They are allowed to move within the confines of the hospital wearing such devices. So, they gain the confidence of being active and independent under close scrutiny.

The hospitals deploying such devices have to be planned and constructed by avoiding use of wire mesh as much as possible to allow free transmission of radio waves. The requirements are opposite of interference shielding that we generally provide in selected areas of hospitals now. This is a very specific application requirement that must be evaluated at an early stage of hospital planning to be really effective. When upgrading an existing hospital, this requires number of transmitters and boosters, which is not a very aesthetic solution. This trend will have its maximum impact on tertiary care hospitals.

Pre-engineered Workspaces

Pre-engineered workspaces are being deployed in most of the clean room areas of the hospital as well as in laboratory, blood bank, offices etc. These are modular units, which are pre-engineered and are built in factories to pre-defined specifications. They perform definitive functions and provide a defined controllable environment. The user has a choice for selecting some, out of a large number of modules, to meet the specific work conditions. On site, these are assembled quickly to provide defined workspaces. The modules by themselves provide partitions, walls ceilings, HVAC ducts, AHUs and other utility devices. The modules are generally steel-lined panels with built-in elements of piped medical gases, electrical distribution, data cables, X-ray viewers, automatic doors, HVAC fans etc.

They have proved to be highly reliable, have performed consistently well over years with minimal maintenance. First created for aero-bridges, they are very useful for making operating rooms, PCR laboratory, ICUs, recovery wards etc. Their main advantage is their ability to adapt to new technologies, new equipment systems and new work routines by changing some of the constituent modules. They have proved their usefulness in clean room and sterile room applications in pharmaceutical industry. Extensively used in last two decades in European hospitals, they shall be the new trend in designing the surgical suites in India in the coming decade. This is a trend that will have its maximum impact on tertiary care hospitals.

Bio-medical Waste Handling

It is now mandatory for hospitals to handle bio-medical waste in a defined manner. This warrants sterilisation of some wastes at the point of origin to make it safe for refuse handlers. So far, the existing hospitals found it difficult to meet this requirement for various reasons primarily because the planning had not catered for this. So, no definite spaces were provided for sterilisers or autoclaves to be placed strategically. The emerging trend in hospitals is to cater for the required spaces and areas for autoclaves, trolley sterilisers etc as appropriate. This is a trend that will have its maximum impact on secondary care and tertiary care hospitals.

Automatic Bedpan Washers

Today hospitals have few bedpan washers. Generally, the normal toilet is used. Over the years, it has conclusively been proved that bedpans and urine bottles played a major role in nosocomial infections and cross infections in hospitals. Deployment of automatic bedpan washers which clean and sterilise bedpans and urine bottles are most cost-effective and environment-friendly solution to contain this menace of cross infection.

The emerging trend in Indian hospitals is to provide one automatic bedpan washer per floor. However, I believe it shall soon be same as the NBC requirement for toilets, ie one automatic bedpan washer for every five to eight patients who shall need it regularly. It is not needed for patients who are ambulatory. The hospitals shall need to plan well in advance to make extensive use of automatic bedpan washer, as their deployment needs same services as a toilet.

Non-technology Trends Directly Affecting Healthcare Delivery

The changing socio-economical parameters of Indian society in this millennium are also impacting the planning and designing of Indian hospitals. Some of these trends, which have already started to influence the planning and designing of Indian hospitals are as under:

The Nuclear Family

Earlier, when somebody fell sick, the whole family used to come to hospital and test the hospital resources in terms of its ability to provide comforts to patient’s visitors. The concept of nucleus family, especially in metros and in most of the urbane cities, coupled with the fact that both husband and wife are working have started impacting the number of hospital visitors and the manner in which they visit the patient in the hospital.

Earlier, they came and cared for the patient, including performing some of the nursing jobs. Now, they come for limited time and expect the hospital to perform all its duties well. Only if the patient happens to be a child, or if the patient is very critical, the whole family is there. Earlier the whole family meant three to nine members, now it is generally two to three persons.

This requires that hospitals must have well-planned patient relations services so that patient information, and if possible, online communication ability is put on hospital server for the relatives to access this facility anytime. This has also reinforced the emerging trend of day care surgery, annual check ups and scheduled appointments. This trend will affect all medium size hospitals that provide secondary level care.

Third Party Payment For Healthcare

The emerging trend of non-price competition is the direct result of third party payment for healthcare. Since third party payment provisions are based on diagnosis, the hospitals compete to attract patients by providing better patient-comfort facilities. This trend has lead to provisions of well appointed rooms, better catering service, and like airlines, upgrading the accommodation entitlement without charge etc.

The hospitals have to gear up by making provisions for this ability to offer better accommodation, more comforts, matching the life style of the community it serves. It shall affect all hospitals, small or big in next three to five years.

The Ageing Population

The ageing population utilises the hospital services more than any other segment. This warrants that hospitals must be planned and designed to be user-friendly to this segment. Hospitals need to have floors distinctly marked with contrasting colour bands to indicate where it ends. Similarly, the stairs also need to be suitably designed to indicate where the steps end to facilitate visually handicapped to use them. Hospitals have to make an informed choice about the type of seat that future hospitals shall have, because the European type of seat is more comfortable to elderly patients. This trend is going to affect all medium size hospitals that provide secondary level care.

The Educated Patient

The educated patients have brought in another interesting trend of discussing in detail — the diagnosis, the treatment plan, the choice of healthcare provider, the prognosis and the outcome of the treatment. This warrants that hospitals must provide adequate number of well-appointed rooms for this personal discussion in most of its departments. It shall especially be seen in all secondary care and tertiary care hospitals.

Leland Kaiser, American healthcare futurist, has said: “The hospital is a human invention and as such can be reinvented at any time.” Over the centuries, they have proved to be best at absorbing all changes, adapting to all applied technologies, and hospitals do it with great wisdom. It must be said that if one hospital embraces any new technology, others are very quick to take a call on this change.

As hospital consultants, we must keep track of the emerging trends applicable for foreseeable future or distant future. When planning any hospital, we must evaluate and make a forecast of what is going to come in the next 5-10 years and plan the hospital to be able to adapt to the changes when required. This is the key to prevent obsolescence in hospital planning and designing.

The writer is New Delhi-based hospital consultant.
Email: nousdoc@vsnl.com