A Study on Hospital Management-Setting up A new Hospital
Key criteria Introduction
There are different types of hospitals categorised under two types, based on the ownership (like Government & Private) and the treatment (specialists in eye care, cancer treatment, heart care and the likes). The hospital envisaged in this chapter is a multi-specialty hospital with all the major facilities for the treatment of major diseases like cardiovascular and cancer. The following sections will explain some of the key steps needed to be taken while setting up a new hospital.
Planning of a New Hospital
Setting up of any project is associated with many activities, which require a detailed prior planning. Many of these activities may be taken up simultaneously to ensure smooth workflow and attaining the scheduled deadline. The following are some of the major activities which will be required for setting up a hospital:
- Selection of the location is one of the most critical factors for a hospital. It is a fact that clients or patients visit a hospital because they are forced to come. Hence, the first thing that needs to be looked at before setting up an infrastructure is the location and accessibility of the location.
- Appoint a few key people with relevant experience in setting up hospitals. Getting permission for getting up of a hospital from Health Ministry.Prepare detailed architectural design for the hospital from a qualified and competent architect. Get the building approval from the municipal or metropolitan development corporation or any other competent authority.
- Finalise a civil construction contractor.
- Look for power and water connection. During construction activity, the department mayprovide temporary connection.
- Approach the State Pollution Control Department for pollution control clearance.
- Approach machinery & equipment suppliers, review prices of different suppliers, and then place an order.
- Planning for consultant physicians and initiating discussions.
- Getting permission from Bhaba Atomic Research Centre for radiology centre.
- Receipt and installation of machinery.
- Marketing the hospital through relevant channels.
- Recruitment of manpower.
- Starting of commercial operation.
Planning & Construction of Wards
Based on the treatments available in the hospital like cardio, cancer and other treatments it is assumed that the building will include a basement + 6 floor constructions. The details of different type of facilities available in each of the floors are as given below:
Basement - Parking Space, Office, Change Room, Store Room, Toilet, and some free space
Ground Floor - Reception with sitting arrangement, Medical Hall, OPD, Labour Room, Post Labour Room, Toilet and some free space
First Floor – Laboratory, Operation Theatre, Toilet and some free space
Second Floor - ICU + ICCU, Post Operative Recovery Room, Four Bedded Room, Toilet and some free space
Third Floor - Four Bedded room, Three Bedded Room, Toilet and some free space
Fourth Floor - Three Bedded Room, Double Bedded Room, Toilet and some free space
Fifth Floor - Double Bedded Room, Single Bedded Room, Suite, Canteen, Kitchen & Laundry, Toilet and some free space
Utility Room – Which would house Plumbing, Laundry and Electrical and other Equipments Approximately each floor would be of 14000sq ft in area and a utility room would be of around 2000sq ft. Thus, the total floor plan of a typical super specialty hospital would be 103000sq ft.
Infrastructure Requirements
Building up the infrastructure for a hospital is a key factor for its success. To build up the right kind of hospital infrastructure needs a proper planning of the available resources like land, equipments, and other. In these section key issues like land requirement and equipment requirements will be discussed.
Land Requirements
For understanding land requirements, let us take a hypothetical case of a super specialty hospital. It is estimated that a super speciality hospital will require a minimum floor space of 103010sq ft of constructed space to accommodate all the facilities. Considering a Floor Space Index (FSI) of 2.5 which is prevalent all over the country, the minimum size of the land should be 3.04 acres. To make the project suitable for some future expansion, one has to consider that the size of the land will be 3.5 acres. To maintain good amount of open space that ensures provision for gardening/landscaping, it is assumed that the covered area will be about 35% of the total land area. The details of the land utilisation are as given below:
- Basement of the Building: 14430sq ft
- Utility Shed: 2000sq ft
Equipment Requirements
Equipment is one of the key requirements of a hospital setup. The kind of equipment required for the hospital depends on the type of treatments provided in the hospital. Here since we are studying a multi-speciality hospital all the important machinery like MRI, CT scanner, mammography and LINAC has been considered. A brief explanation of each of this equipment is given below.
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging is a method of getting pictures of various parts of the human body without using X-rays or CT scans. The machine consists of a large and very strong magnet in which the patient can lie down. A radio wave antenna built in the system is used to send signals to the body and then receive them back. These returning signals are then converted into pictures by a computer. MRIs can take pictures of almost any part of the body and in almost any particular angle.
CT (Computerised Tomography) Scanner
It is a special kind of X-ray machine that sends several beams of X-rays simultaneously from different angles into the body. Beams that have passed through less dense tissue such as the lungs will be stronger, whereas beams that have passed through denser tissue such as bone will be weaker. This difference in the intensity of beams is used to work out the relative density of the tissues, examined by a specially programmed computer.
Colour Doppler
Doppler ultrasound test uses reflected sound waves to evaluate blood circulation through blood vessel, which helps doctors in evaluating blood flow through the major arteries and veins of the arms, legs, and neck. The test can show blocked or reduced blood flow through major arteries of the neck that could cause a stroke. It can reveal blood clots in leg veins that could break loose and block blood flow to the lungs. Even during pregnancy, this test may be used to look at blood flow in a foetus to check the health of the foetus.
Mammography
Mamma is Latin for breast and mammography is a type of breast X-ray that uses only a limited amount of radiation. It can detect many breast cancers at an early stage. They can also give doctors important information about a breast.
Bone Densitometer
It measures bone density at various sites in the body by using a small amount of radiation. A bone densitometer can detect osteoporosis before fracture occurs, and can also predict the chances of fractures. It can also determine the rate of bone loss.
Haemodialysis
It is a method for removing waste products such as potassium and urea and free water from the blood when the kidneys are in renal failure mode. Haemodialysis is one of three renal replacement therapies (the other two are renal transplant; peritoneal dialysis).
Gamma Camera
It is a device used to image gamma radiation from emitting radioisotopes (scintigraphy). The applications of scintigraphy include early drug development and nuclear medical imaging to view and analyse images of the human body of the distribution of medically injected, inhaled, or ingested radionuclides emitting gamma rays into the body.
Linear Accelerator (LINAC)
It is one of the most frequently used methods for external beam radiation treatment of cancer patients. LINAC delivers a uniform dose of high-energy X-rays that destroy cancer cells at the target, sparing surrounding healthy tissue. LINAC can also be used in stereotactic radiosurgery. It can be used for Intensity-Modulated Radiation Therapy (IMRT), which is an advanced method of high-precision radiotherapy that uses computer-controlled X-ray accelerators to deliver precise radiation doses to a malignant tumour.
High-Dose Rate (HDR) Brachytherapy
It is an accurate form of internal radiotherapy used in treating cancer patients. It is a quicker, more effective way to give radiation treatments which places the radiation inside the tumour, tightly focused within the site of the cancer. This technique ensures the maximum radiation dose is given where it needs the most, while allowing little radiation to reach the healthy surrounding tissue. In many cases, brachytherapy is an effective alternative to surgical removal of a tumour and the affected organ.
List of Major Utilities
The utility division mainly consists of the HVAC, power and power back up equipment. The list of major utility considered is a transformer, a 750KVA generator, lifts to carry patients, doctors and other hospital staff and HVAC equipment. The mentioned utilities form an important part of setting up of a hospital. This division is the key requirement of the hospital since they help in running the hospital operation smoothly without any breakage.
Skill Requirements
Planning for manpower is a most crucial area for the hospital. The hospital is heavily dependent on external consultant physicians for all the departments. However, there will be about doctors who will be employed by the hospital. These doctors will be mostly heading the departments. In total the hospital will require more than 400 people which will include all support staffs working in three shifts in a day.
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