Q: So to enhance their effectiveness, should the healthcare facilities focus on what they do best (i.e.

clinical and medical care) and partner with hospitality firms to offer the services which are their core competence? Does the above idea seem far-fetched? "A functional design can promote skill, economy, conveniences, and comforts; a non-functional design can impede activities of all types, detract from quality of care, and raise costs to intolerable levels." ... Hardy and Lammers Hospitals are the most complex of all building types. In the olden days, hospitals are just meant as the places where diseases are treated, but the modern definition of the hospital has transformed. Hospitals are no more only for the sick and ill, it is also a place for healthy individuals too. Because of the Consumer Protection Act (COPRA), hospitals or the health care facilities treat the patients or the clients as the consumers of health care facilities. Therefore, health care facilities not only must focus on clinical and medical care, but has to adopt the modern hospitality measures. Hospitals require special attention and need to follow all the regulatory standards as they not only deal with the ill clients but also well human beings and also the attenders, visitors those who come for the clients and as well as for the other professionals. In this context, it is not only the clients and other related people are important, but even the health care providers. Each hospital is compromised of a wide range of services and functional units. These include: Diagnostic and treatment functions, such as clinical laboratories, imaging, emergency rooms, and surgery; Hospitality functions, such as food service and housekeeping; and The fundamental inpatient care or bed-related function.

The diversity of these services is reflected in the breadth and specificity of regulations, codes, and oversight that govern hospital construction and operations. Each of the wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical, and telecommunications systems, requires specialized knowledge and expertise. Why should hospital must provide services beyond clinical and medical care services? No one person can reasonably have complete knowledge, which is why specialized consultants play an important role in hospital planning and design. The functional units within the hospital can have Competing needs and priorities Idealized scenarios and strongly-held individual preferences must be balanced against mandatory requirements,

Actual functional needs (internal traffic and relationship to other departments), and The financial status of the organization.

In addition to the wide range of services that must be accommodated, hospitals must serve and support many different users and stakeholders. Ideally, the design process incorporates direct input from the owner and from key hospital staff early on in the process. The designer also has to be an advocate for the patients, visitors, support staff, volunteers, and suppliers who do not generally have direct input into the design. Good hospital design integrates functional requirements with the human needs of its varied users. .Churchill The basic hospital is, ideally based on the services it provides. The services are: Bed related in patient functions Outpatient related functions Diagnostic and treatment functions Administrative functions Service functions (food, supply) Research and teaching functions

These services are not functioned individually, but they are interdependent, like in the following diagram.

We shape our buildings and afterwards our buildings shape us... Winston Churchill Health care facilities encompass a wide range of types, from small and relatively simple medical clinics to large, complex, and costly, teaching and research hospitals. Large hospitals centers may include all the various subsidiary health care types that are often independent facilities. Core competent facilities to improve the hospitality services

Along with the clinical and medical care facilities, hospital provides other amenities for the patients, they all depend on the needs of the patients.The clues start At the approach to the facility, The drop-off area, The parking lots, and The street signs.

Importance of additional services provided by the hospital Ideally, one that conveys welcoming, caring, comfort, and compassion, commitment to patient well-being and safety, where stress is relieved, refuge is provided, respect is reciprocated, competence is symbolized, way-finding is facilitated, and families are accommodated. The facility also influences employee service attitudes and behaviors. Finishes, signage, and artwork must be carefully selected, well coordinated, and integrated. Security can be balanced with some features apparent to patients/visitors, while conveying a message of safety. Thoughtful design can help ensure the proper first impression is created and sustained. The design of health care facilities is governed by many regulations and technical requirements. It is also affected by many less defined needs and pressures. The most pressing of these are: Workforce shortages, Reimbursements, Malpractice insurance, Physician-hospital relations, Capacity, Care for the uninsured, Patient safety, Advances in technology, and Patient satisfaction per a recent american college of healthcare executives survey of hospital ceos.

Consumer decisions are based on Cost,

accessibility, Quality of service, and Quality of medical care.

EMERGING ISSUES There is an increasing emphasis on security, especially in large public facilities, and the need to balance this with the desired openness to patients and visitors. Evidence-based design. ARTICLE 1 According to the Center for Health Design, "Evidence-Based Design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. Evidence-based health-care architecture creates safe and therapeutic environments for patient care and encourages family involvement. It promotes efficient staff performance and is restorative for workers under stress. These designs ultimately should improve the organization's clinical, economic, productivity, satisfaction, and cultural measures." HEALTH CARE SERVICES OR HOSPITALITY SERVICES The requirement of the additional hospitality services also depend on the type of health care setting. A trend towards specialization has resulted in a growing number of health care types. Among them are hospitals, nursing homes, outpatient facilities, psychiatric facilities, rehabilitation facilities, hospices, assisted living facilities, congregate housing, adult day care facilities, and various specialized outpatient facilities. These health care facilities demand the following services Building attributes Regardless of their location, size, or budget, all hospitals should have certain common attributes. Efficiency and Cost-Effectiveness An efficient hospital layout should: Promote staff efficiency by minimizing distance of necessary travel between frequently used spaces Allow easy visual supervision of patients by limited staff Include all needed spaces, but no redundant ones. This requires careful pre-design programming.

Provide an efficient logistics system, which might include elevators, pneumatic tubes, box conveyors, manual or automated carts, and gravity or pneumatic chutes, for the efficient handling of food and clean supplies and the removal of waste, recyclables, and soiled material Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi-purpose spaces Consolidate outpatient functions for more efficient operationon first floor, if possible for direct access by outpatients Group or combine functional areas with similar system requirements Provide optimal functional adjacencies, such as locating the surgical intensive care unit adjacent to the operating suite. These adjacencies should be based on a detailed functional program which describes the hospital's intended operations from the standpoint of patients, staff, and supplies.

Flexibility and Expandability Since medical needs and modes of treatment will continue to change, hospitals should: Follow modular concepts of space planning and layout Use generic room sizes and plans as much as possible, rather than highly specific ones Be served by modular, easily accessed, and easily modified mechanical and electrical systems Where size and program allow, be designed on a modular system basis, such as the VA Hospital Building System. This system also uses walk-through interstitial space between occupied floors for mechanical, electrical, and plumbing distribution. For large projects, this provides continuing adaptability to changing programs and needs, with no first-cost premium, if properly planned, designed, and bid. The VA Hospital Building System also allows vertical expansion without disruptions to floors below. Be open-ended, with well planned directions for future expansion; for instance positioning "soft spaces" such as administrative departments, adjacent to "hard spaces" such as clinical laboratories.

Therapeutic Environment Hospital patients are often fearful and confused and these feelings may impede recovery. Every effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as possible. The interior designer plays a major role in this effort to create a therapeutic environment. A hospital's interior design should be based on a comprehensive understanding of the facility's

mission and its patient profile. The characteristics of the patient profile will determine the degree to which the interior design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness. Some important aspects of creating a therapeutic interior are: Using familiar and culturally relevant materials wherever consistent with sanitation and other functional needs Using cheerful and varied colors and textures, keeping in mind that some colors are inappropriate and can interfere with provider assessments of patients' pallor and skin tones, disorient older or impaired patients, or agitate patients and staff, particularly some psychiatric patients . Admitting ample natural light wherever feasible and using color-corrected lighting in interior spaces which closely approximates natural daylight Providing views of the outdoors from every patient bed, and elsewhere wherever possible; Photo murals of nature scenes are helpful where outdoor views are not available Designing a "way-finding" process into every project. Patients, visitors, and staff all need to know where they are, what their destination is, and how to get there and return. A patient's sense of competence is encouraged by making spaces easy to find, identify, and use without asking for help. Building elements, color, texture, and pattern should all give cues, as well as artwork and signage. (As an example, see VA Signage Design Guide.

Cleanliness and Sanitation Hospitals must be easy to clean and maintain. This is facilitated by: Appropriate, durable finishes for each functional space Careful detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joints Adequate and appropriately located housekeeping spaces Special materials, finishes, and details for spaces which are to be kept sterile, such as integral cove base. The new antimicrobial surfaces might be considered for appropriate locations. Incorporating O&M practices that stress indoor environmental quality (IEQ)

Accessibility

All areas, both inside and out, should: Comply with the minimum requirements of the Americans with Disability Act (ADA) and, if federally funded or owned, the Uniform Federal Accessibility Standards (UFAS) In addition to meeting minimum requirements of ADA and/or UFAS, be designed so as to be easy to use by the many patients with temporary or permanent handicaps Ensuring grades are flat enough to allow easy movement and sidewalks and corridors are wide enough for two wheelchairs to pass easily Ensuring entrance areas are designed to accommodate patients with slower adaptation rates to dark and light; marking glass walls and doors to make their presence obvious

Controlled Circulation A hospital is a complex system of interrelated functions requiring constant movement of people and goods. Much of this circulation should be controlled. Outpatients visiting diagnostic and treatment areas should not travel through inpatient functional areas nor encounter severely ill inpatients Typical outpatient routes should be simple and clearly defined Visitors should have a simple and direct route to each patient nursing unit without penetrating other functional areas Separate patients and visitors from industrial/logistical areas or floors Outflow of trash, recyclables, and soiled materials should be separated from movement of food and clean supplies, and both should be separated from routes of patients and visitors Transfer of cadavers to and from the morgue should be out of the sight of patients and visitors Dedicated service elevators for deliveries, food and building maintenance services

Aesthetics Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It is important in enhancing the hospital's public image and is thus an important marketing tool. A better environment also contributes to better staff morale and patient care. Aesthetic considerations include: Increased use of natural light, natural materials, and textures Use of artwork

Attention to proportions, color, scale, and detail Bright, open, generously-scaled public spaces Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices Compatibility of exterior design with its physical surroundings

Security and Safety In addition to the general safety concerns of all buildings, hospitals have several particular security concerns: Protection of hospital property and assets, including drugs Protection of patients, including incapacitated patients, and staff Safe control of violent or unstable patients Vulnerability to damage from terrorism because of proximity to high-vulnerability targets, or because they may be highly visible public buildings with an important role in the public health system.

Sustainability Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. They are heavy users of energy and water and produce large amounts of waste. Continuous supply of energy and water has to be provided, even the alternative such as the arrangement of an external source such as generator in case of power failure and contract for water supply in case of interruption in water supply. Arrangement for proper waste disposal E.g: Bio Medical Waste management, has to be arranged for the massive waste generated in the hospital, as most of it is harmful, if not disposed properly. Related Issues The HIPAA (Health Insurance Portability and Accessibility Act of 1996) regulations address security and privacy of "protected health information" (PHI). These regulations put emphasis on acoustic and visual privacy, and may affect location and layout of workstations that handle medical records and other patient information, paper and electronic, as well as patient accommodations." EMERGING ISSUES Among the many new developments and trends influencing hospital design are:

The decreasing numbers of general practitioners along with the increased use of emergency facilities for primary care The increasing introduction of highly sophisticated diagnostic and treatment technology Requirements to remain operational during and after disasterssee, for example, VA's Physical Security Manuals State laws requiring earthquake resistance, both in designing new buildings and retrofitting existing structures Preventative care versus sickness care; designing hospitals as all-inclusive "wellness centers" Use of hand-held computers and portable diagnostic equipment to allow more mobile, decentralized patient care, and a general shift to computerized patient information of all kinds. This might require computer alcoves and data ports in corridors outside patient bedrooms. For more information, see WBDG Integrate Technological Tools Need to balance increasing attention to building security with openness to patients and visitors Emergence of palliative care as a specialty in many major medical centers A growing interest in more holistic, patient-centered treatment and environments such as promoted by Planetree. This might include providing mini-medical libraries and computer terminals so patients can research their conditions and treatments, and locating kitchens and dining areas on inpatient units so family members can prepare food for patients and families to eat together.

ARTICLE 2 Recently, a modern concept of BALANCED SCORE CARD SYSTEM is being implemented, inorder to improve the hospital performance and productivity. Improving hospital performance and productivity with the balanced scorecard. The purpose is to provide an overview of the usefulness of the Balanced Scorecard in improving a hospital's management and delivery of health care at reduced cost without loss of quality. This describes an approach to designing and implementing a balanced scorecard system for measuring performance and productivity in a hospital setting. Specific measures of performance criteria are suggested as well as interpreted. Guidelines for measuring productivity are also suggested and interpreted. How these measures may be used by a hospital to improve its administration of health care while reducing costs and maintaining quality are described. This paper is a useful resource for hospital managers looking to improve their performance and productivity. The balanced scorecard is a management tool that is widely used in the manufacturing industry. This fulfills a need by healthcare providers to obtain information on implementing a balanced

scorecard system that specifically addresses issues unique to hospitals. This also addresses how to measure productivity within a balanced scorecard system. PERFORMANCE MEASUREMENT AND THE BALANCED SCORECARD IN HEALTHCARE Emphasis on financial measures of performance in response to cost pressures may be a dangerous impediment to creating future economic value (Weber 2001). Hospitals can benefit by using a balanced scorecard (BSC) to measure performance and productivity. The BSC consists of an integrated set of performance measures that are derived from the hospital's management strategy. The BSC is designed to translate management's strategy into performance measures that employees can understand and implement. Using a balanced scorecard can provide a hospital with the following benefits: It aligns the hospital around a more patient-focused strategy, It facilitates, monitors, and assesses the implementation of the overall strategy, It provides a communication and collaboration mechanism, It assigns accountability for performance at all levels of the hospital, and It provides continual feedback on the strategy and promotes adjustments to changing market and regulatory factors.

The BSC was originally developed by Kaplan and Norton (1992; 1993) from the notion that reliance on financial measures of performance alone is insufficient for managing complex organizations, especially as those organizations become more customer focused and want to benefit from their knowledge-based human capital. The BSC has evolved into a strategic management system that uses a framework and core principles to translate an organization's mission.

************