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Hospital Planning

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HOSPITALS
&
NURSING HOMES
Planning, Organisations & Management

The hospital is an integral part of social and medical


organization. The function of which is to provide for the
population complete healthcare, both curative and preventive,
and whose outpatient services reach out to the family and its
home environment; the hospital is also a centre for training
of health workers and for biosocial research.
HOSPITALS
&
NURSING HOMES
Planning, Organisations & Management

Syed Amin Tabish

JAYPEE BROTHERS
MEDICAL PUBLISHERS (P) LTD.
New Delhi
Published by

Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj
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Hospitals and Nursing Homes: Planning, Organisations & Management

© 2003, Syed Amin Tabish

All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or
transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or other-
wise, without the prior written permission of the author and the publisher.

This book has been published in good faith that the material provided by the author is original. Every
effort is made to ensure accuracy of material, but the publisher, printer and author will not be held
responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under
Delhi jurisdiction only.

First Edition: 2003

Publishing Director: RK Yadav


ISBN 81-8061-154-X

Typeset at JPBMP typesetting unit


Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida
To
my parents
(Syed Ghulamuddin and Syeda Zainab)
my wife (Farhat)
and my children
(Syed Abeer and Syed Nabil)
without whose inspiration and sacrifice
this work could not have materialised
Preface

This book has been developed so that those involved in planning, designing, building, and
operating healthcare facilities can understand and appreciate all the work required to produce
a facility that will be as reasonably safe and efficient as possible for staff to work in and for
patients to be treated and housed in. This book provides the step-by-step process of planning
and state-of-the-art design to achieve a viable facility to meet this objective. It covers the
planning and design problems of hospitals with a deep insight.
A hospital is a community in which the interaction of individuals is fundamental to the
successful working of the whole. The great depth of technical knowledge required for the
design, enables the complexities to be brought together into a whole concept which respects
the fundamental requirement, to build a community.
The process of planning, design and construction of hospitals involves the coordination
of many groups and agencies on many levels. A endeavour has been made to sort out the
many ingredients necessary to construct a hospital and presenting them in such a way that
the whole process can be comprehended and showing how the multitude of requirements
necessary in building a hospital can be satisfied (the order of topics).
Materials have been organised as much as possible in the order in which events occur.
Healthcare facility planning and construction could be the result of a growing population;
an aged building becoming too aged; or a desire of benefactors to help others by contributing
to the building of a hospital in memory of someone. The result is a decision by some group,
administration, or agency to build a particular type of hospital in a certain location.
Even after construction, the operation of a hospital requires more surveillance because
of the nature of its activities and its special occupants. Any modification, therefore, must be
viewed with more than normal concern.
The process of planning, design and construction of a hospital has become a complicated
one. These are building codes, fire codes, health codes, inspection agencies, certificates of
need, certifications, licensure, accreditation—all in order to build a healthcare facility.
Balancing needs, desires, costs, and regulations, in the planning, design and construction
of a hospital requires knowledge of a host of complicated and hospital care is a dynamic
process. Architecture for health has to strive for shells for living, continuously changing
organisms. Health facilities have, after being designed, built and commissioned, to be main-
tained, adapted to changing requirements and have also been modernised. This means
architecture for health leads into planning which is continuously escorting the life and the
operation of the facility.
Planning, organisation and management of healthcare facilities are more and more
influenced by the rapid developments of information and computerisation. Modern informatics
open up for us, new different possibilities in the functional and architectural composition of
healthcare facilities, respectively.
viii  Hospitals & Nursing Homes (Planning, Organisations & Management)

Dealing with hi-tech medicine on the one hand, and with conditions of limited resources
on the other, one has to become more conscious of the time factor. In planning under
limited resources, adaptability to changing (and usually increasing) demands is indispensable
if misinvestments are to be avoided.
We have to learn to think of setting limits and to design and organise for efficiency,
economy and humanity.
This book presents new planning concepts and recent trends in the hospital architecture
that ought to be thoroughly considered by hospital administrators and trustees in anticipation
of their arduous work with architects, consultants, and responsible staff members over the
problems involved in trying to make their buildings, as up-to-date as possible to accommodate
the current technology and as adjustable as possible for the new, revised, or expanded
functions that they will be expected to house in the future.
The aim of this book is to introduce the reader to some of the basic ideas and research
in hospital planning, design, construction, organisation and management. Each chapter of
the book deals with a particular topic beginning with a theoretical framework from which
the subject could be approached. I hope that the book will be particularly relevant for
administrators or chief executive officers of a facility and their staff; healthcare facility board
members; building committees; medical facility plant engineers; healthcare architects,
designers; and engineers; contractors; financial advisors; business, economics, architecture,
hospital administration students who plan to enter the healthcare field; and medical and
nursing personnel who are responsible for the planning, organising and management of a
healthcare facility.
This book is useful particularly for clinical directors/head of the clinical and paraclinical
departments; unit managers; in-charge of service departments, laboratories and patient
care areas. All therapeutic and diagnostic facilities have been discussed in detail with
extraordinary emphasis on nursing zone, clinical zone, support zone and utility services.
An endeavour has been made to place under one cover a lot of material that heretofore
was scattered throughout various books, articles, and documents to make it the most
comprehensive treatment of this subject to date.
I am extremely grateful to Mr RK Yadav, Director Publishing, M/s Jaypee Brothers Medical
Publishers, for his unswerving dedication, commitment and conviction of courage to advance
medical knowledge by encouraging promising authors to put their ideas into action.

Syed Amin Tabish


Contents  ix

Contents

Part-one
Healthcare Facility Planning: Past, Present and Future

Growth
1. The Art and Science of Medicine .......................................................................................... 3
2. The Hospital .......................................................................................................................... 9
3. Hospital Organization and Structure ................................................................................... 20
4. Growth of the Modern Hospital ............................................................................................ 36
5. Changing System of Health Services Concepts .................................................................. 62
6. Changing Concepts in the Health Facility Planning ............................................................. 70

Planning
7. Regional Planning ............................................................................................................... 80
– The planning organization machinery 88
8. Planning Health Facilities .................................................................................................... 93
9. Renovation ........................................................................................................................ 101
10. The Process of Planning ................................................................................................... 104

Emerging Approaches
11. Towards Total Health Care ................................................................................................. 120
12. The Patient-Centred Approach .......................................................................................... 125
13. Patient Focused Hospital ................................................................................................... 127
14. Emerging Approaches in Hospital Design ......................................................................... 142
15. Nucleus Concept ............................................................................................................... 152
16. Modular Building Concept ................................................................................................. 156
17. Hospital Modernization ...................................................................................................... 158
18. Cutting Construction Costs ............................................................................................... 163

Recent Trends
19. Humanising Health Care Facilities ..................................................................................... 166
20. Autonomous Health Care Facilities ................................................................................... 168
21. Recent Trends in Hospital Architecture .............................................................................. 170
22. Furure Trends .................................................................................................................... 183
23. The Hospital of Tomorrow .................................................................................................. 188
x  Hospitals & Nursing Homes (Planning, Organisations & Management)

Part-two
Hospital: Design and Development

From “An” Idea to “The ” Idea


24. Hospital: From The Center of Excellence to Community Support ...................................... 215
25. Fundamentals of Design ................................................................................................... 236
26. Functional Design ............................................................................................................. 247
27. Profile of the Hospital Environment ................................................................................... 258
28. Environment ...................................................................................................................... 264
29. Influence of Climate on Buildings ...................................................................................... 280
30. Space Programming and Functional Systems ................................................................... 289
31. Hospital Patient ................................................................................................................. 308
32. Floors, Walls and Installations ........................................................................................... 317

Design and Construction


33. The Nursing Zone ............................................................................................................. 327
34. The Clinical Zone .............................................................................................................. 355
– Emergency Department 355
– Outpatient Department 365
– Operating Department 374
– Critical Care Units 406
– Multidisciplinary Intensive Care Units 430
– Emerging Trends in Intensive Therapy Unit 441
– Acute Nursing Care Units 445
– Medical Monitoring 449
– Isolation of Patients 455
– Obstetrics Department 458
– Day Care Facilities 474
– Ambulatory Surgery Facility 477
– Hospital Standards for the Care of HIV Infected Persons 489
– Healthcare Facilities for Elderly People 498
– Special Care Department 510
# Renal Dialysis Unit—510
# Cardiac Catherisation Laboratory—515
# Pulmonary Medicine—519
35. The Support Zone ............................................................................................................. 521
– Physical Medicine and Rehabilitation 521
– Laboratory Planning and Layout 536
– Planning a Medical Laser Programme 562
– Radiodiagnosis Department 568
– Medical Resonance Imaging 585
– Comparison of Various Imaging Techniques 592
Contents  xi

– Positron Emission Tomography 595


– Designing a CT Scan Room 601
– Extracorporeal Shockwave Lithotripsy 604
– Radiation Oncology Department 609
– The Brachytherapy 621
– Nuclear Medicine Department 625
– Blood Transfusion Centre 635
– Hospital Blood Bank 646
– Medical Informatics 651
– Medical Records Department 661
– Electronic Healthcare Record 670
– Central Sterile Service Department 674
– Dietary Services 689
– The Hospital Pharmacy 702
– Planning of Laundry Services 717
– Medical–Surgical Gases and Vacuum 725
– Libraries in Hospitals 729
36. Planning a District Hospital ............................................................................................... 753
37. Planning of Health Centers ............................................................................................... 773
38. Hospital Engineering Services .......................................................................................... 777
39. Fire Safety in Health Care Facility ..................................................................................... 795
40. Morgue/Mortuary .............................................................................................................. 804
41. Housing Facilities .............................................................................................................. 806
– Research Facilities 809
42. Landscaping ...................................................................................................................... 812
43. Parking .............................................................................................................................. 814

Part-three
Hospital Administration

44. Hospital Acquired Infection ................................................................................................ 817


45. Management: A Conceptual and Experiential Approach ................................................... 832
46. Staffing Pattern ................................................................................................................. 861
47. Waste Management and Ecohealth ................................................................................... 869
48. Telemedicine ..................................................................................................................... 875
49. Appendices ....................................................................................................................... 877
– Constitution of the Community Hospital 877
– General Evaluation and Checklist for any Existing Building 880
– Fire Safety in Hospitals 883

Index ................................................................................................................................ 887

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