GENERATING THE MASTER PLAN FOR HOSPITALS

We must recognise, that HOSPITAL is not a mere building, but a complex social institution, composed of many groups representing a wide variety of interests and diverse needs. It utilises the services of various Medical, Paramedical and Support personnel to render all needed HEALTHCARE to the patients in its custody and through outreach programs to all on its medical charge. It employs a wide variety of modern technologies and engineering services to support the process of Healthcare. It utilises numerous Biological, Pharmaceutical, Chemical and Bio-chemical substances -- some of which can produce abnormal and unexpected reactions. It handles the dynamics of Life and Death situations during the process of rendering Healthcare. Therefore planning of Hospitals is tailored to meet the immediate and long term objectives of the Health Care Plan, it has to serve while incorporating the safety of the Patients, Visitors as well as Hospital staff. It specially addresses the issue of Healing Environment where Hospital Infections have been minimised and the Healing process is accelerated.

The members of the Medical Staff in the Hospital are qualified Consultants who, along with paramedical and support staff, form a team to render requisite Healthcare, yet individually exercise adequate charisma to establish their own following. The patients come to the Hospital seeking a varied variety of services like Consultations, Treatments and submit themselves to a plethora of Diagnostic and Therapeutic Procedures -- sometimes just to help another individual. The Visitors to a Hospital comprise of Relatives, Friends and Acquaintances of the Patients and staff who visit socially. Others are the Business Visitors who represent the visiting Faculty, Officials from Statutory and non Statutory Departments and Hospital Suppliers.

Thus there is a fusion of a wide spectrum of organisational skills, professional expertise and diverse interests. This needs a coherent, organised structure where each one has adequate freedom to practise his skill and at the same time, his work compliments the work of others and leads into effective Healthcare.

The Hospital Master Plan is an embodiment of all the varied Objectives providing a statement of its immediate requirements of the Hospital and Long term plans for providing Healthcare to its Medical Charge. It provides for, blending of multi disciplinary technological and human resources; operations within constraints of life & death situations; governance by various economic, social and organisational pressures; and measurement of quality by non providers. It provides for Phasing of activities to match the resource plan and lists all needed spaces, areas and their inter-relations. It states Hospital's requirements for various Engineering services providing it with Energy, Water, Steam, Piped Medical Gases, etc. It has come to consist of two distinct components - Functional and Architectural. The Architectural Master Plan is derived from the Functional Master Plan. The Functional Master Plan is derived from the Health Care Plan.

The Generation of Master Plan for a Hospital begins with the formulation of its underlying Health Care Plan.

The Health Care Plan establishes

1. The Immediate Objectives for proposed Healthcare Service Plan
2. The Long Term Objectives for proposed Healthcare Service Plan
3. The Medical Charge for the hospital which is all the populace living within the defined geographical limits.
4. The Healthcare Services to be provided.
5. The Level of Sophistication of the Healthcare Services
6. The Process of Providing the Healthcare Services

Functional Plan - is the plan of physical facility based on functional objectives and is one, that best meets the performance objectives identified. Where Health Care Plan can be grandiose, the Functional Plan has to be within the Hospital's limits of financial capability. The Functional Plan proposes to deploy the available capital in the most effective manner to realise the stated Objectives.

The Functional Plan details all requirements in terms of

1. Physical Facility which comprise of various Buildings and Building Blocks, Engineering Services, Hospital Utility Services and Support Services.
2. Departmentation Plan delineating various activities into comprehensive groups
3. Equipment Plan providing for all needed Medical and Allied Equipment
4. Manpower Plan providing for Medical Staff, Technical & Nursing Staff, Administrative and Support Staff
5. Hospital Supply Systems providing for all needed Medical & Surgical supplies, Sterile Supplies and other needed supplies for Housekeeping, Catering and maintenance.
6. Hospital Administrative Structure and Basic Hospital Administration Plan
7. Hospital Medical Administrative Structure and Plan as related to Hospital's Revenue budget.
8. Phasing Plan where creation of all above listed facilities, services, etc. are linked to a time frame.

The Architectural Master Plan is then established to develop Master Facility Plans that focus on the "Bricks and Mortar" resources needed to implement the Hospital's Functional Plan. This work involves a thorough evaluation of the existing facilities (which includes evaluation of present buildings, its structural characteristics, age, and condition, etc.); site analysis (which includes evaluation of; land area, soil investigation, available utilities, parking, vehicular and pedestrian circulation, etc.); evaluation of departmental adjacencies and Traffic (internal circulation-way finding and flow); and adequacy of mechanical and electrical systems.

The Architectural Master Plan then undertakes a Functional Architectural Analysis and establishes a space and area programme to provide high quality, cost effective patient care. This analysis leads to generation of a Building Form for the given site. This Building Form is divided into Building blocks and these blocks are related to the phasing plan.

The Architectural Master Plan details all requirements in terms of

1. Area Statement - detailed listing of all needed spaces and their area, location and relations.
2. Magnitude and Pattern of Traffic - detailing requirements for access, corridors, lifts, ramps, inter building connections, etc.
3. Service Systems Plan - detailing department wise requirements of engineering and Bio-medical engineering services.
4. Hospital Utilities Plan - detailing requirements of Catering, Laundry, CSSD, Piped Medical Gases, Waste Management including Incinerator and Housekeeping.
5. Interiors Plan - detailing department wise specific requirements for Finishes, Fixtures, Fittings, Lay-out of Furniture, Sign Posting.
6. Exteriors & Landscaping Plan- detailing specific requirements of External Finishes, Layout of Roads and Parking, Perimeter Fencing and Lightening, Landscaping of Open areas, courtyards, etc and external sign posting.
7. Commissioning Plans - detailing department wise requirements for integration of various services and utilities to deliver Patient Care, testing the various utilities with and without functional loads and rectification plans and maintenance plans

Hospital Planning has been compared to the process of creating a Painting where one starts with preliminary reference marks and progresses through a series of increasingly more defined refinements in line and shading. In a similar mode, the Master Facility Plan provides those reference marks that are subsequently refined in the planning steps that follow at detailed design level. It is a dynamic process which provides stability to planning from phase to phase.

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