Designs to save

Designs for saving! In hospitals? Sounds strange! We believe the domain of economics of a hospital belongs to the hospital administrator. Then how does it relate to the architect’s role?

Let’s have a close look at the way hospital designs are generally done. Have you asked your architect if he has a comprehensive understanding of the complex functioning of a hospital? Or does he consider it similar to other creative work that he does for other clients who are into various other investments like shopping malls, software technology parks, multiplexes …… so on and so forth! You, as a doctor or an investor from a different field, may have spelt your requirement to an architect and he designed it. As a specialist doctor you may have checked the intra-departmental planning of the spaces in terms of your comfort and with respect to your way of functioning as a specialist working at micro level. You may be happy with the planning of your own department but have you thought about other specialities and support services and whether they function in an orchestrated way?

After the inauguration of your hospital, when the doctors/ specialists are on board, you may be hearing from the people who run the show that in many of the places things are not working? You introspect and get convinced that it’s really not working and you need changes. You are in the process of modifying the plan to make it conform to your specialists’ requirements. Finally you have compromised! You have compromised on the operational efficiency and investment. You made additional investments. You spent on the opportunity cost for the delay in functioning of the hospital.

Moreover, business models and SOPs consider a hospital sustainable first and then profitable. The design of the hospital acts as a catalyst to make business models succeed. The integrated design of the hospital helps to follow SOPs and improve efficiency of the workforce along with improved customer satisfaction. In the process you save on your investments and increase throughput to make it breakeven faster.

As a prelude to savings, the design and construction process covers the whole ‘life’ of a project, from recognition of a need to the operation of the finished facility. This approach ensures that all issues are considered from both, a business and a technical point of view. Furthermore, this approach recognises and emphasises the inter-dependency of activities throughout the duration of a project. It also focuses on the ‘front-end’ activities whereby attention is paid to the identification, definition and evaluation of the requirements in order to identify suitable solutions.

Factors that contribute to a hospital’s success story in the changing healthcare scenario are varied and myriad. Few basics of hospital design that result in savings are as follows:

Market analysis and business modelling

A business model based on identification of specialities and facilities coupled with the targeted socio-economic strata of the population that fits with the appetite of the investor is the key. The healthcare seeking behaviour of the target population and their expectation of the built environment leads the thought process of the architect. Involvement of the architect in the discussions on business models, especially on phases of development to achieve breakeven, sparks the idea for approach to design which is most effective in the given circumstances.

With the given parameters and guidance from the business model, the approach to design with due consideration to the functional zoning of a hospital marks the beginning point. Efficient hospital designs help to minimise the interweaving of various activities along with containment of activities in specific zones.

Outpatients’ department

A major segment of people seeking healthcare in a hospital comprise the OPD patients. And be it relatives or friends, each patient is escorted by three to four persons as attendants, on an average. Hence, the waiting areas should be designed to optimise the space requirements as well as accommodate the crowd. The space allocated for the waiting can be optimised by careful calculation of number of persons waiting in a particular period of time. If the waiting are is small, problems crop up, not immediately but after some time when the patient load picks up. The discomfort of people leads to loss of patients to other hospitals. However, bigger waiting areas may be good to look at but add to the capital investment. Hence, optimisation of spaces by understanding patient load helps you save. However, the architect must have the knowledge and experience to understand the methodology to calculate waiting time. Moreover, the fatigue due to waiting for long time in front of the consultation room may be relieved by giving them an extra exposure to natural light and greenery. This improves face value of the first interface of the patients with the hospital.

Diagnostic services

The clinical support services in a hospital are shared facilities. Doctors in their domain of super-specialities feel more comfortable to have all clinical support services nearby or within the department. Often it leads to duplication of spaces and equipment. To support those spaces a handsome investment is required to provide services like electrical, air-conditioning etc. More often location of these spaces at various places in the hospital leads to complexity of laying services and moreover, it leads to difficulty in servicing the same. This not only increases the capital investment but also increases operational costs since more manpower is engaged to run it. Hence integrated planning of clinical services saves the investment. There are many proximity-related diagnostics services like echo, TMT etc which can be planned in the same cluster so that the staff can do multitasking and the manpower is reduced. An understanding of diagnostic services helps an architect to plan spaces efficiently and save cost.

Emergency department

A place where within no time every facility in a hospital is required. In here, the caregivers literally run to save a life. A wrongly located emergency department (ER) can ruin a hospital’s activities in case of emergencies like accidents, effects of political vengeance etc. Activities in an ER may be perceived in two major parts. One relates to clinical procedures being done and the other is to manage the patients’ attendants, friends and relatives in grief. For the former, proximity of the imaging, ICU and operation theatres are essential and the route of travel to these facilities should not criss-cross other circulation patterns of a hospital. However for the later, managing emotions of the crowd becomes extremely difficult unless they are attended to frequently. Crowding in front of the emergency is common in majority of Indian hospitals. Such crowd affect the caregivers from performing their duties and even other emergencies at the same time face the brunt of it. Planning of exclusive waiting areas for the crowd in grief and counselling rooms make a lot of difference in managing the crowd. This helps all those who are involved in the emergency situation i.e. the patient, caregivers and the anxious relatives. This intangible portion of the planning principles of ER makes a major difference in functioning of a hospital.

Operation theatres and CSSD

As a standard practice, the OT and CSSD are located in close proximity with each other for ease of issuing sterile materials and instruments. During the space planning, many a times it happens that the outline of the floor plates could not be matched with the lower floors in a hospital as various activities in the other floors may not sum up to the total area. For such situations, it becomes effective to bring the CSSD at a different level and connect it with the OT complex through a pair of dumb waiters, thus saving lot of space and filling the empty spaces that may be left due to integrated planning of various departments. Judicious analysis of redundant or forced usage of spaces may justify the capital investment on dumb waiters in CSSD. Taking CSSD at a different level sometimes becomes an advantage to control the overall movement of materials including consumables, as the sterile supplies for OT are directly stored in the CSSD complex. In such a scenario, the OT works independently and issual of sterile materials for uses other than in the OT is taken care at a different level, thereby reducing the movement in the OT floor. With judicious planning of such activities a lot of floor space can be saved.

Modular in-patient areas

Market forces play a big role in the type and number of patient rooms in a hospital. With economic development and increase in spending capacity of the people, the choice in type of inpatient facilities vary. For the change in expectations of people over a period of time, the flexibility to adjust the size of rooms to accommodate specific requirements is the need of the hour. There are many instances where people are not interested to share rooms with other people. On the other hand, multi bed patient rooms are required, especially at the start of a hospital. So, modular approach to accommodate such variations is the answer. Using easily removable walls like gypsum board wall are a better choice over traditional brick mortar construction as it adds to the flexibility. In spite of a little more capital investment on partition walls, the savings achieved from not disturbing the infrastructure while making the transitions are evident.

Services

Design of services play a critical role as it is considered to be the backbone of a hospital. Improper layout of services leads to disruption of activities in departments when there is a blockage in the plumbing and sanitary lines. Planning of a hospital becomes easy when we close our eyes to the planning of services. It is been observed in many places that going by the requirements of the doctors/specialists, proper routing of services are not done and some “jugaad” kind of layout like taking drainage lines along the winding corridors as and when required is carried out, ignoring the serviceability factor completely. There are enough examples where doctors are insistent on their kind of planning and ignore the architect’s advice on serviceability. Integration of services with the planning ultimately saves the capital expenses and operating costs.

Thus, it is the in depth knowledge of the architect in healthcare planning and designing that makes the difference!