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Business Accent
Modern Concepts in Hospital Planning
Hospitals have been changing in shape, size and functions
to adopt themselves to the advancements in the medical field and socio-economic
changes around them.
Col AK Dutta |
Hospitals are dynamic organisations. They have been changing
in shape, size and functions to adopt themselves to the advancements in the
medical field and socio economic changes around them. Advances in medical fields
like discovery of ether in 1846, Lister's use of carbolic spray for antiseptic
surgery, Roentengen's discovery of X-ray in 1895, introduction of CT scanners,
ultrasound and MRI and socio-economic changes like Public Health Act, national
health programmes, and healthcare financing all had profound impact on the structure
and functions of hospitals.
Hospitals originated as a result of sympathy for the sick and suffering and
were initially a part of religious institutions. Two ancient civilisations,
Indian and Egyptian, had well-developed hospitals in early Greek and roman civilisations.
Hospitals were not separate entities but formed part of big temples where more
of soul healing then physical healing was done.
An efficient hospital requires a well-balanced organisation for compassionate
care within an adequate technical and environmental framework. This basis has
remained vital throughout the centuries, although patterns of diagnostics, therapeutics
and care have changed. Healthcare 50 years hence cannot be visualised clearly
but it is certainly delivered also in facilities planned now. 'Tomorrow is born
out of today'.
Planning a Hospital
 More
often than not, the hospital planning process concentrate more on the designing
of buildings and their architectural appearance, and devotes inadequate attention
to the planning of organisation and equipment as well as accommodating them
and generating spaces to meet policies. The concern of hospital planning is
the quality of medical care and the improvement of its standards. There is no
place for perpetuation of the status quo as well as for astounding innovations.
Continuing advances in medicine and society impose great demands on the planning
team. A sound general design can always be modified in detail: a perfect detail
does not guarantee a perfect whole.
Innovate or Die
Innovation is not incremental, but it is radical. Innovation is disruptive to
the establishment, core competition and industry but not to its customers. There
are some principles for change that can be followed to bring in innovations.
Modular construction: There is a dire need for faster,
more efficient forms of construction to keep pace with the healthcare modernisation
process and for better quality outcomes in lesser time. The use of modular construction
is directly influenced by the client's requirements for speed of construction,
addition of new departments, least disturbance to existing facilities, quality,
and added benefits of economy of scale as well as single point procurement.
Flexibility in Design: Flexibility has always been
a source of aggravation in hospital design. Hospitals are facilities that are
heavily serviced and are built to last, and yet they have to constantly adapt
to changing needs coming mainly from technological development and new medical
practices. In regard to morphology and spatial organisation, over the last decade,
some major factors have been shaping the contemporary hospital; like the introduction
of public spaces within the hospital, and the importance accorded to natural
light and new medical practices. The introduction of interior streets and atria
has led to horizontal organisations. Services are distributed along a major
spine that brings in daylight and diversions are created for patients and staff.
These new horizontal hospitals create better functional relationships between
departments and allows contiguity between services which otherwise would have
been on different floors.
New diseases profile: The epidemiological transition
has been from a disease profile in which communicable diseases and nutrition-related
conditions predominated, to one where non- communicable and life style related
diseases, accidents and injuries are the major causes of morbidity and mortality.
Advances in Technology: Information technology: Electronic
health record, computerised physician order entry, biometric identification
of patient are some of the new trends emerging in IT. Computer workstations
will be replaced by wireless hand held tablets, voice recording devices and
multi-modal sensors. Technology will enable the revenue cycle management.
Imaging explosion, digital radiology, total body scan, brain suites or image
guided surgeries, PACS, all are being increasingly utilised. Also, advanced
biomedical tele collaboration, anatomical and surgery simulation for teaching
and training has replaced traditional training methods.
Nanotechnology: Small is good, small is smart and small
is powerful. In fact, things small in size seem to be ruling the world. Nano,
a Greek word meaning dwarf (one billionth of meter in length), is finding its
way into myriad applications. In addition, micro sensor monitoring healing process
decreases post-operative hospitalisation, and the waiting time for transplant
devices too.
Hospital utilisation trends: New medical technologies
allows many procedures previously performed only in the hospital to be performed
in ambulatory surgical or diagnostic centres.
Trends in demand for Hospital Services
Medical conditions associated with lifestyle: Overweight
and obesity are a growing problem among urban Indians. Automobile injuries and
death will only start declining if we adapt improved automobile and high way
design. Given the increasing availability of effective drugs, the demand for
hospital services associated with HIV/AIDS is likely to decrease. Disease and
conditions associated with ageing will increase with increase in geriatric population.
A spurt in cardiovascular diseases is expected which means more coronary care
unit capacity will be needed and more coronary artery bypass surgery will be
performed. Congestive heart failure will put more demands on emergency rooms
and ICUs. Cancer burden is expected to rise as the population ages. New evidence
signals the unfolding of a diabetes epidemic in India. Diabetes leads to strokes,
blindness, kidney failure, leg amputations, and myocardial infarctions. Musculo-skeletal
disorders, osteoarthritis, osteoporosis, and obesity-related problems are rising.
However, weight loss programmes, exercise programmes, better pharmacologic agents
to treat osteoporosis and arthritis may see a decreased need for hospital services.
Need for cataract surgery is sure to increase. Hospitals need to develop robust
capability for this common ambulatory procedure
Hospital infection: To maintain asepsis in a hospital,
due care in planning designing and detailing is required in terms of right location
and choosing the right materials and specifications. This acts as preventive
measure against infection to the patient. Transmission of infection to patients
occurs through air and contact. Hence, air quality has to be appropriately planned.
Design of hospital must support hand washing by way of placement of sinks and
auto disinfectant dispensers. Modern trend and evidence suggests that we must
switch over to single bedrooms for patients from multiple beds.
Patient safety: Patient being the main focus, protection
of the patient is the primary rule. Planning and designing must provide a safe,
comfortable and healthy environment to the patient. The consumers are increasingly
demanding convenient, reliable and timely services provided in a caring, safe
and high quality environment.
Social and political changes: Patient safety concerns
have both social as well as political overtones. Many Western countries have
passed legislations on same, and India will also follow the suit. Consumer Protection
Act is already in place. Computerised physician order entry (CPOE), automation
of pharmaceutical dispensing, and evidence-based hospital referral have emerged
as solutions to these concerns. Political influence has given rise to healthcare
accreditation in this country.
Patient empowerment: Patient assumes increasing responsibility
for his own care. General turmoil and disaffection of both doctors and patients
and a highly 'take charge' population has given rise to patient empowerment.
Patients have become tech savvy. They communicate with each other and also join
support group of concerned disease and are active in consumer movement. Today's
patient is aware and educated, demands information, wants to have a say in the
treatment, and interested in prevention of disease and promotion of health and
quality - not prolongation of life!
Assumptions
Some of the new assumptions, which have emerged, are:
- OPD- based assumptions.
- Day care: Number of surgeries, chemotherapy, transfusions.
- OPD- based number of procedures, number of scopies
and minor surgeries.
Inpatient assumptions: Focused surgeries and focused
therapy to reduce ALS, change from 20 sqm to 96 sqm per bed constructed space
which includes diagnostics, circulation and therapeutics space.
Impact of new Technologies on Future
Pharmaceuticals will replace some procedures and will decrease the need for
admission to hospital, and newer vaccines will treat as well as prevent disease.
Minimally invasive surgery will reduce hospital stay and promote outpatient
operations. Sensors will change central laboratories and intensive care units
of today.
Digitised images will be accessible to all clinicians, and there will be change
in configuration of operation theatre due to new techniques. Also, there will
be a slew of minimally invasive surgeries, image guided and computer-aided surgery,
advanced data and communication system, robot-assisted surgery, and voice-assisted
surgery.
Challenges
- Understanding likely future demand.
- Improved forecasting of length of stay and other
aspects of hospital performance.
- The benefits of sub-specialisation and methods to
reduce the impact of this on access to services.
- How hospitals can be staffed.
- How to manage change effectively.
- Development of flexible approaches to planning of
a hospital.
The writer is VSM Dir MS OPP Army Headquarters, New Delhi
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