FACTORS AFFECTING

LOCATION
OF

MULTI- SPECIALTY
HOSPITALS
FRANCIS JOSE
MBA (IB)
19TH FEB 2015

OUTLINE

Introduction

Building attributes

Issues in facility location

General process of facility location

Levels of decision

MULTI-SPECIALTY HOSPITAL
CARDIOLOGY

NEUROLOGY

RADIOLOGY

GYNAECOLOGY

DERMATOLOGY

MICROVASCULAR

BLOOD BANK

ENT

IMMUNISATION

CT SCAN

GASTROENTEROLOGY

PSYCHIATRY

SURGICAL
ONCOLOGY

TRAUMA CARE

UROLOGY

ORTHOPEDICS

PAEDIATRICS

PULMONOLOGY

BUILDING ATTRIBUTES
Regardless of their location, size, or budget, all hospitals should have certain common
attributes.
Efficiency and Cost-Effectiveness
Flexibility and Expandability
Therapeutic Environment
Cleanliness and Sanitation
Accessibility
Controlled Circulation
Aesthetics
Security and Safety
Sustainability

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
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.

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

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 GSA's ABA Accessibility Standards
In addition to meeting minimum requirements of ADA and/or GSA's ABA
Accessibility Standards, 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, colour, 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. Because
hospitals place such demands on community resources they are natural
candidates for sustainable design.
Section 1.2 of VA's HVAC Design Manual is a good example of health care
facility energy conservation standards that meet EPAct 2005 (PDF 1.3 MB, 550
pgs) and Executive Order 13423 requirements. The Energy Independence and
Security Act of 2007 (EISA) (PDF 740 KB, 310 pgs) provides additional
requirements for energy conservation. Also see LEED's (Leadership in Energy
and Environmental Design) USGBC LEED for Healthcare
Other issues

SCOPE OF MEDICAL
SERVICES
Increasing population

Health consciousness
Management practices

WHY LOCATION DECISION MATTERS?

Large investment

Competitive capacity

Strategic nature

Profit and effectiveness

Operating complexity(economic environment)

Meet future demand accurately

Expansion opportunities

Market shift of population

hanges in the economic

nvironment:
Transportation and IT development.

Changes in the economic

environment:

Helps in the internationalization of the

operations: higher geographical
diversity in location decisions.
Tendency to localize close to the
markets: emphasis in customer
service, direct customer contact, fast
development of new products, fast
delivery
Due to flexible technologies,
companies have the possibility of
starting up more plants at a smaller
size.

J.I.T. Systems.
Some industries are forcing their
suppliers and customers to locate their
facilities in a close area to reduce

International level competition among

companies.
Location in countries different than the
origin of the company are a common
situation for big companies.
Appearance of new markets and
unification of others.
Increase of competition pressure.
Logistics factors are more important and
complex.
Companies are reviewing their facility
locations in order not to loose
competitiveness.

ISSUES IN FACILITY LOCATION

Proximity to Customers

Business Climate

Total Costs

Infrastructure

Quality of Labour

Suppliers

Other Facilities

Political Risks

Government Barriers

Trading Blocks

Environmental Regulation

Host Community

Competitive Advantage

SITE OF HOSPITAL

Facilities available in the particular place.

The cost ,price and nature of the land.

Nature of other buildings around the hospital.

There should not be other hospitals around the particular place

that provide similar services.

The availability of labor.

Transport facilities should be accessible .

Supportive Units.

Other Facilities like; Water, Electricity, Gas...etc should be

considered.

LOCATION OF HOSPITAL

Have to see the convenience of the people.

Proximity through cheapest mode of transport.

Communication System: have to see if there is there are police

station, fuel station, fire service stationetc.

Hospitals should be free from all types of pollutions like noise, air,
wateretc. i.e. it should be eco friendly.

Consider the cross infection from the hospital.

Marketing facilities like medical shops ,stores, hotelsetc should be

available.

Locality participation should be ensured , i.e the locality supported

should be gained.

GENERAL PROCESS IN FACILITY

LOCATION

Creation of a multifunctional team to perform the study.

Preliminary analysis.
Study of the companys strategies and the policies of the company to translate
them into Facility Location requirements.
Due to the big quantity of factors affecting Facility Location, the company should
determine which is the criteria to evaluate the different alternatives
(transportation needs, land, supplies, labor, infrastructures, services,
environmental conditions).

Search of Location Alternatives.

Establishment of a group of location candidates.

Evaluation of Alternatives (detailed analysis).

The multifunctional team must distinguish between: Dominant factors (essential);

Secondary factors (desirable).

Information gathering from each location to be measured against each of the

factors considered.

Selection of Facility Location.

Through qualitative and quantitative analysis, the different alternatives will be
compared against each other, to determine several valid locations.
Objective: Look for several acceptable locations, to let senior management to
decide taking into account subjective factors.

Levels of Decisions.
Market Region

Market Potential
Market Share
Operating Cost

Subregion

Transport Cost (RM)

Taxes
Raw material costs
Labor Cost and Availability

Community

Access to market/materials
Material Cost
Labor Cost and Availability
Taxes
Availability of public services
Availabilty of sites
Community amenities

Sites

Access to transport Network

Site Characterics
Taxes
Availability of public services
Land and acquisition costs
Construction Costs

GOVERNMENT

MAPS
In this space, insert a political
and/or physical map of your state.
Point out the state capital.
Note: Check out Clip art and Media
on office Online at
http://office.microsoft.com/clipart
for maps and other graphics of
your state.

LOCATION
METHODS
Various quantitative methods are
available to aid location decisions,
depending upon the nature of the
problem.

ECONOMY

WEATHER

NATURAL RESOURCES

NATURAL RESOURCES, CONTINUED

PLACES TO
VISIT
Choose one place in your state that
would be interesting to visit. Tell
where it is located in the state and
why it would be interesting to visit.
Note: You can use Microsoft
Internet Explorer to find
information about your site.

FAMOUS PEOPLE

Choose three well known residents of your state. Tell what they
did to become famous.

STATE MOTTO

Tell about the state motto and what makes this state special.

WORKS CITED

List the resources you used for your research.