Session III Planning and Building a Hospital

1. Hospital Management
Building or extending a hospital department
Session III
Tuesday, 14 February, 2012
Dr. Ashfaq Ahmed Bhutto
MBBS, MBA, MAS, DCPS, MRCGP, (PhD)

2. Feasibility
Module 1
2

3. Promoter‘s Objective
The promoter needs to determine the objectives of
the project with clarity. These include the type of
services to be provided:
 Secondary care/tertiary care.
 Sophistication in the building plan and
equipments.
 The investments and returns the promoter is
looking for.
To rationally determine the above, a feasibility
report based on a market survey is essential.
3

4. Feasibility report
The study should clearly bring out the following:
 The potential of the planned institution.
 The medical facilities that are lacking and need to be made available.
 The migration pattern of patients.
 Competition from existing hospitals and new entrants.
Based on observations and findings from the market survey, a detailed
project report should be prepared, with the following objectives:
 To recommend medical facilities in terms of departments and
equipments.
 To determine manpower requirements.
 To project financial performance for the first 10 years of operation.
 To arrive at an implementation schedule for completing the project.
 To study the scope for future expansion of facilities.
The report should realistically discuss ‗operational‘ feasibility, financial
viability and the medical departments in heavy demand in thrust areas. It
should also analyse the location of the site, the hospital design, manpower
4
planning, project cost, financial analysis, sensitivity analysis and
implementation.

5. Market Survey
The first consideration in the survey is to study the character, needs and
possibilities of the community which the hospital is going to serve. The
existing medical facilities in the region should be studied in terms of:
 Quality and number of hospitals.
 The areas of specialisation—doctors/specialists/paramedical staff.
 Level of technology, latest medical equipment.
 Patient flow, disease pattern.
 Costs of investigation and treatment.
Public opinion regarding the existing facilities, the need for more
departments, and the response from the medical community are vital to the
study. It is on the basis of this information that a decision can be taken about
where a hospital should be built and its type and size. Is the community a
wealthy one; or is it made up of moderate wage earners; are the industrial
workers indigent—these are the deciding factors in determining the kind of
hospital should be planned for. For example, if the community largely
constitutes wealthy individuals, one can plan to build a luxurious
hospital, with deluxe rooms and sophisticated diagnostic and therapeutic
equipment; if it is largely meant for indigent patients, a non-profit or charitable
hospital is needed. Apart from levels of income, characteristics such as
5 occupation, age distribution, and so on must be studied. These determine the
amount and kind of hospital.

6. MARKET Survey- Next Phase
To study all the existing hospital facilities on an
area-wise basis. This study should be
comprehensive, covering both short and long-term
needs. The most important part of the study is an
inventory of the facilities, beds and services of
every hospital. It should cover the following areas:
 Bed capacity of the institution
 Physical condition of facilities
 Hospital occupancy
 Bed ratio
 Volume and kind of hospital services provided
 Quality of facilities and services
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7. BASIC QUALITY REQUIREMENTS
Module 2
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8. Factors considered in location of Hospital
1. It should be within 15-30 min traveling time. In a place
with good roads and adequate means of transport, this
would mean a service zone with a radius of about 25 km.
2. It should be grouped with other institutional
facilities, such as religious, educational, cultural and
commercial centers.
3. It should be safe from physical dangers e.g. low lying
areas.
4. It should be in an area free of pollution of any
kind, including air, noise, water and land pollution.
5. It must be serviced by public utilities:
water, sewage, electricity, gas and telephone.
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9. Reachability
A general hospital should be easily reachable by public
transport, assessed on the basis of transport frequency
and the distance to the stop, and also by taxi, car or
bicycle.
This requirement is complied with if a general hospital is
situated at one of the geographic/demographic
concentration points in its catchment area. A
geographic/demographic concentration point is a
municipality where the population level and level of
amenities (schools, retail trade, recreation, public
services) is such that a substantial proportion of the
population in the catchment area of the hospital is more
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or less automatically orientated towards that municipality.

10. Access
The site needs to be easily accessible by
patients, visitors and staff.
This apply to pavements/ footpaths (minimum
width, minimum free height, maximum slope, maximum
height of kerbs), ramps (minimum width, maximum slope
and length, halfway and end platforms), outside stairs
(minimum width, maximum rise, installation, height and
design of handrails), material properties of paving
surfaces (flat, rough and jointless) and lighting.
Regulations also apply to the measurements and layout
of parking places.
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11. Access
 There are additional requirements for the less able, such as the size
of parking places. Obstacles should be indicated by warning
paving, continuous guiding lines must be present.
 Taxis should be able to come right up to the main entrance and the
entrance to the outpatient unit.
 The entrance to the emergency department and if necessary the
main entrance should be accessible by ambulance.
 Public entrances to a hospital building should comply with minimum
dimensions and also be accessible by people with a physical
handicap. These entrances should be covered over and provided
with good lighting.
 There are also specifications that apply to the entrance hall
(sheltered situation, minimum dimensions, location of the
doors, lighting), thresholds (maximum heights) and door handles. In
the case of revolving or carrousel doors, there must be an extra
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swing or sliding door provided.

12. Flexibility
 The flexibility refers to the degree to which a building is adaptable to
changing space needs.
 Flexibility is concerned with a structural process of change, thus
spatial adaptation of buildings is inevitable. With a high level of
flexibility, these adaptations can be kept to a minimum, as a result of
which the financial consequences and the hindrance to management
remain within acceptable levels.
 The main structural design of a hospital should possess a high degree
of flexibility. The building structure should be simple to extend at
different points and should be able to cope with internal displacement.
 A characteristic feature of today‘s hospital architecture is that account
was taken of future changes and innovations in science, technology
and policy when selecting the building structure.
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13. Flexibility
There are four types of flexibility.
1. Usage flexibility: Usage flexibility concerns the possibility of
changing the use made of a room/space without the need to
renovate that room/space.
2. Disposal flexibility: Disposal flexibility concerns the possibility of
removing building elements without a detrimental effect on the
cohesion of the building elements to be retained and with a
minimum of hindrance.
3. Internal flexibility: The term refers to the possibility of interchanging
hospital functions independent of the supporting structure. A
supporting structure with concrete columns makes this possible
because the internal fittings geared to the function can be removed
without constructional consequences and be reconstructed once
again.
4. External flexibility : The term refers to the possibility of expanding
13 the existing building structure. Expansion possibilities are mainly
programmed for functions where growth may be expected. In the

14. Finances
Module 3
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15. Average Costs
The cost computed per bed depends on various
factors, such as the cost of the land in a particular
place, the wage and salary rate, accessibility of
materials, and so on. Similarly, sophisticated
equipment and expensive construction material will
significantly enhance the investment. Average costs
for a typical hospital expressed as ‗per bed‘, can be
rise proportionally:
Tertiary
Secondar
y
Primar
y
15

16. How much money do you need?
1. People in the business.
Not the competitors, but entrepreneurs outside your
geographic area.
2. Sources of supplies.
They're very forthcoming because they're looking for
business [from you] but "Do some comparison shopping,―
3. Trade associations.
4. Business start-up guides.
How-to start-up guides are available from several
independent publishing companies and some trade
associations.
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17. How much money do you need?
5. Franchise organizations.
If you're thinking about buying a franchise, the franchisor will
give you lots of data about start-up costs.
6. Business start-up articles.
Newspaper and magazine articles rarely give item-by-item
start-up-cost estimates but these write-ups can offer ballpark
estimates of overall start-up costs.
7. Business consultants.
A well-qualified business consultant can offer excellent
advice about start-up costs--and even do a lot of the
research for you. A consultant can also help you organize
your own research into useful financial projections and
scenarios.
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18. Sources of funds
 Government grant-
 Bank loan
 Local development corporation
 A relative
 Government – How good is your case
 Hurdles to cross-hard-headed
administrators, planning officers and financial
experts
 Private - a prospective lender will review your
creditworthiness.
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19. The "Five C's" of Credit Analysis
 Capacity to repay -most critical. Primary source of repayment - cash.
The prospective lender will want to know exactly how you intend to
repay the loan.
 Capital-money you personally have invested in the business and is an
indication of how much you have at risk should the business fail.
Interested lenders and investors will expect you to have contributed
from your own assets and to have undertaken personal financial risk.
 Collateral or guarantees are additional forms of security you can
provide the lender e.g. home.
 Conditions describe the intended purpose of the loan. Will the money
be used for working capital, additional equipment or inventory?
 Character is the general impression you make on the prospective
lender or investor. Are you trustworthy to repay the loan?
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20. Hospital size
Module 4
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21. Physical Scale of Hospital
Stage 1: Collect Data
Suppose data collected is:
 Population of serving area 150 000
 Average length of stay in hospital 5 days
 Annual rate of admissions 1 per 20 population
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22. Physical Scale of Hospital
Stage 2: Compute number of beds needed
(Bed occupancy 100%)
(1) Total number of admissions per year:
= district population x rate of admission per year
= 150000 x 1/20 = 7500
(2) Bed-days per year:
= total number of admissions per year x average length of stay in
hospital
= 7500 x 5 = 37500
(3) Total number of beds required when occupancy is 100%:
= bed-days per year 365 days
= 37500 365 = 102.74 Rounded to 105 beds.
22

23. Physical Scale of Hospital
Stage 2: Compute number of beds needed
(Bed occupancy 80%)
(1) Total number of admissions per year:
= district population x rate of admission per year
= 150000 x 1/20 = 7500
(2) Bed-days per year:
= total number of admissions per year x average length of stay in
hospital
= 7500 x 5 = 37500
(3) Total number of beds required when occupancy is 100%:
= bed-days per year (365 x 80%) days OR (365 x 80/100) days
= 37500 365 = 128.42 Rounded to 130 beds.
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24. Physical Scale of Hospital
Stage 3: Compute total area needed for hospital
Total area of hospital:
= total number of beds x 40 square meters per bed
= 105 beds x 40 = 4200 square meters (for 100% occupancy)
= 130 beds x 40 = 5200 square meters (for 80% occupancy)
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25. Design considerations
Module 5
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26. Design of the general hospital building
guidelines
 The guidelines were drawn up on the basis of the different
activities that take place in a hospital.
 These are activities that concern the primary process, i.e.
the direct interaction between the patient and the care
provider (nursing, diagnostics and treatment), these
different activities may be subdivided into three ‗blocks‘:
A. patient-related facilities where the patients themselves
are/may be present;
B. patient-related facilities where patients themselves are
not present;
C. general & technical support services.
This subdivision is not a blueprint for the way in which a hospital should be divided up, but merely
forms a plan based on the different activities within a hospital.
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27. A. Patient-related facilities where the
patients themselves are present
Three main function groups in this ‗block‘ are:
1. Nursing;
2. Diagnostics & treatment;
3. Special functions (if present).
The nursing main function group includes the spatial facilities for
special care, general nursing, paediatric nursing, maternity
nursing (including delivery rooms), geriatrics and day nursing.
The diagnostics & treatment main function group includes the
following spatial facilities: outpatient appointment
department, general organ function investigations, imaging
diagnostics, nuclear medicine, outpatient treatment, operation
unit, emergency unit and physiotherapy.
The special function main function group includes the spatial
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facilities for dialysis, a rehabilitation day treatment unit or a

28. B. Patient-related facilities where
patients themselves are not present
This ‗block‘ includes the spatial facilities for:
 Central Sterilising Services (CSSD),
 The pharmacy and
 The laboratories
 clinical chemistry,
 medical microbiology,
 clinical pathology
28

29. C. General & technical support services
This ‗block‘ includes general and staff facilities (such
as central kitchen, linen service, restaurant and
technical service), as well as facilities for
management and training.
There is a trend towards outsourcing some of the
facilities listed under B and C to third parties. This is
particularly the case with the laboratories and
pharmacy, administrative tasks, kitchen
facilities, linen service and technical service.
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30. Share as percentage of different blocks
what the share in percentage of the different blocks
of the floor area on the basis of the usual function
package of a general hospital.
Function group Share as percentage
Standard package
Block A: patient-related facilities (patient 65%
present)
Block B: patient-related facilities (patient not 10%
present)
Block C: general & technical (non-patient- 25%
related) services
Total 100%
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31. Planning
Module 6
31

32. Methods of planning and design
Planning team & process
In general, the people involved in this process are:
1. Health planners, functional planners, financial planners
and physical planners.
2. Architects
3. Engineers (such as civil, mechanical and sanitary)
4. Quantity surveyors
5. Finance managers
6. Staff responsible for procurement of supplies
7. Staff members such as doctors/nurses, clients/end
users
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33. Methods of planning and design
Planning team - Need assessment team
At the earliest stage, a needs
assessment team involving the
planners, end users such as the
hospital staff and the community
establishes an overall plan of the
needs, range of services to be
provided, the target population or
catchment area, the financial
feasibility of the project with
costbenefit analysis and the scale
of the hospital, etc.
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34. Methods of planning and design
Planning team – Briefing team
After the needs and the size of the
hospital have been determined, the
briefing team involving
architects, engineers, the staff and
the community sit together to
prepare the key document, i.e. "the
design brief" which translates the
requirements into
functions, activities, space
distribution and/or any other
information necessary for the
design.
34

35. Methods of planning and design
Planning team - Design team
This team consists of all the people
involved in designing the facility and
pools the expertise of its members to
produce the instruments for
implementing construction, starting
from preliminary investigation to the
final designs with technical
specification, tendering documents
and detailed working drawings and
estimates of cost. This team mainly
consists of
engineers, architects, quantity, surve
yors, hospital staff, the community
and the approving authority.
35

36. Methods of planning and design
Planning team - Construction team
This team consists of
engineers, architects and
builders. The construction
team implements the design
from the approved drawings
and technical specifications
within the prescribed time
and cost and produces tile
facility for commissioning
cause serious complications
when left untreated.
36

37. Methods of planning and design
Planning team - Commissioning team
The commissioning team
responsible to staff the
hospital, commissions
and procures the
equipment, furniture and
supplies and prepares it
for operation.
37

38. Methods of planning and design
Planning team - Planning team
By the end of the
project, multitude of
people would have
made their
contribution to the
project as part of a
whole working team
including the
community.
38

39. Planning process-contd.
 Project Team
 End users
 Staff
 Planners
 Architects
 Engineers
 Contractors
 Suppliers
39

40. Stages in planning & designing a hospital
Stag Task Input output Working Team
e Active Consultativ
e
One Establish Information Decisions to User/Client
demand for new Indicators construct, Planner
hospital or for Projections renovate,
hospital expand
expansion
Two Prepare design Services to be Design Brief User/Client Architect/
brief delivered Engineers
Function
requirement
Thre Design Design Brief Design of Architect/ User/Client
e Additional Data Hospital Engineers
from consultants Working
documents
Four Construct Design of Hospital Hospital in Architect User/Client
Working drawings physical form Builder
Engineers
Five Commissioning List of Staff Appointment User/Client
40 and training of
List of furniture Procurement
staff staff

41. Size of project
 Small
 Medium
 Large
 A formal Project Team will be set up.
 Everything will have to be in writing.
 To keep a record of decisions.
41

42. Planning process
Capricode
In NHS UK: When planning and building, the Regional
and District Health Authorities and their officers are
compelled to follow Capricode (Capital Projects
Procedures) and operate systems of
approval, monitoring and control which are compatible
with it. It is a logical sequence of events. It is only a
framework, the results depending on how the Appraisal
Project Teams use that framework.
42

43. Planning process-contd.
The Capricode sequence of stages is:
1. Approval in principle (AIP).
2. Budget cost.
3. Design - a long process when sketch plans are developed into
working/production drawings ready to go out to tender.
4. Tender and contract - normally the tender documents go to a chosen
group of contractors of proven ability:
5. Commissioning .
6. Evaluation -this should be a continuous process. At each stage, what has
been done should be assessed and consideration given to possible
effects on future progress of the scheme. Overall effectiveness can only
be assessed when the project is complete and working.
43

44. Planning process-contd.
CONCODE:
A guidance document on the procurement of
building and engineering work and the
commissioning of consultant architects and
engineers.
44

45. Planning process-contd.
CONCISE:
In NHS UK: A computer-based integrated health
building information system to help in the planning
and management of projects. It may be used for
any scheme, but it must be used for those over £1
million.
45

46. Critical path chart
46

47. Planning process-contd.
Approval in principle (AIP)
Once it has been decided that a project has sufficient merit to start an
appraisal, a Project Manager will be appointed and an Appraisal Team set
up, with membership limited to those making an essential contribution to the
relevant stage, changes in membership being considered at the end of each
stage. The members will be drawn from those managing and operating the
services (doctors, radiographers, nurses, etc.) and those administering
assets and resources.
Three early steps will heavily involve the doctors and paramedical:
1. Inception;
2. Defining objectives and criteria for development; and
3. Option appraisal.
47

48. Planning process-contd.
Budget cost
Once the decision has been taken that the solution
involves building, either new (considered during AIP) or
the extension of old, a Project Team will be set up.
The job of this team is to develop the scheme, drawing
up a brief which includes site, size and scope of the
development, subsequently moving to specific layouts of
individual rooms and spaces, detailing their contents and
arriving at cost implications - both capital and revenue.
48

49. Planning process-contd.
Design Brief
The design brief is a key document: it is the
written expression of the client's needs, as
expressed in consultation with various
professionals, including the architect and
engineers. It is important because a good
design brief is the sound base for a good
design.
49

50. Planning process-contd.
Information included in design brief
1. Functional content
2. Philosophy of service
3. Workload
4. Planning principles
5. Staffing
6. Functional relationships
7. Environmental factors and engineering
8. Schedule of accommodations
9. Financial aspects
1. Costs
2. Possible sources of funds
50

51. Planning process-contd.
Departments operational policy
Many decisions will require a very complete knowledge of the way in which the
department is intended to work; one department will not be exactly the same as
any other. This detailed picture will be formalized into the Departmental
Operational Policy. Not only will a carefully thought out policy be needed for
planning but also for commissioning.
The Operational Policy and the layout reciprocate. The layout will dictate the
patient and staff flow sequences and hence the Operational Policy, but the needs
shown by the Operational Policy will be the major factor in deciding layout-so
which comes first?
If there is no well worked out Operational Policy, a layout is likely to be imposed
because there is nothing to support or deny alternatives. It is not only patient/ staff
flows: for example, it may be policy that all equipment maintenance will be carried
out by outside contractors.
51

52. Planning process-contd.
Work flow list
A workflow comprises a series of tasks that are assigned to users
based on their roles. When the work containing the workflow is
instantiated, a user is assigned a task based on his or her role.
After the user completes a task the workflow progresses to the
next task in the predefined flow until the workflow is complete. The
workflow definition integrates all tasks in the flow by supporting
rule-based condition handlers for task sequence, routing, and
branching at specified decision points.
The Work Flow list is an internal departmental document,
exploring the viability of the policy.
52

53. Planning process-contd.
Work flow list-example
53

54. Planning process-contd.
Using the policies and WF lists
For example in a radiology department:
Operational policy : Reporting time-Immediate reporting will be
available.
Therefore: Procedure worked out in detail planning needs
determined from work flow lists.
This results in layout plans and required drawings.
54

55. Planning process-contd.
Individual rooms and areas
After decision-how many rooms are needed, where
and in what layout, planning comes to the individual
rooms and spaces. Each Project Team should
determine an area for any room or space on the basis
of activities that will be needed to meet local
circumstances and allocate enough space for those
activities to take place.
Illustrations of the 'critical dimensions' necessary for
general functions can be found in HBN Documents.
55

56. Planning process-contd.
Activity data sheets
This is an information system designed to help both sides of a
project and design team by defining the users' needs more
precisely. There are two principal types:
1. Activity Space Data Sheets (commonly known as 'A' Sheets)
and
2. Activity Unit Data Sheets ('B‗ Sheets).
These are meant to be used by design teams to ensure that the
necessary space, equipment and environment are provided to
enable the functions of the area to be carried out efficiently.
56

57. Sample ―A sheet‖
57

58. Planning process-contd.
The 'A' Sheets are in sections which cover:
1. Functional design requirements: a list of activities that will be undertaken in
the space.
2. Activity unit selection: items of equipment that will be needed to enable the
activities to be carried out.
3. Personnel: how many people will be occupying the space both
continuously and intermittently, staff and patients.
4. Additional equipment and engineering terminals: items not associated with
the equipment listed in (2), e.g. clock, curtain track.
5. Planning relationships: for example a barium enema WC will need to be
adjacent to the fluoroscopy room.
On the reverse side of the sheet are environmental parameters, design
character data, door and window details, etc.
58

59. Planning process-contd.
The ‘B' Sheets:
The 'B' Sheets can describe a single item such as a
chair, or a cluster of associated items such as wash
basin, paper towel dispenser, soap dispenser and paper
sack stand. Each 'B' Sheet includes a scale graphic
illustration together with a list of associated items in
Groups 1, 2, 3 and 4.
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60. Sample ―B Sheet‖
60

61. Planning process-contd.
Equipment groups
The equipment for any project is divided into groups which depend on the type
of contract under which the items will be provided:
Group 1: Items (including engineering terminal outlets) supplied and fixed
within the terms of the building contract.
Group 2: Items which have space and/or building construction and/or
engineering service requirements and are fixed within the terms of the
building contract but are supplied under arrangements separate from the
building contract.
Group 3: As in Group 2, but supplied and fixed (or placed in position) under
arrangements separate from the building contract.
Group 4: Items supplied under arrangements separate from the building
contract, possibly with storage implications but otherwise having no effect on
space, building construction or engineering service requirements.
61

62. Planning process-contd.
Equipment groups-examples
Group 1: Telephones, clocks, fixed cupboards, drug cupboards, wash
hand basins and taps, nurse/ staff call switches, departmental
intercom, protective screens, fire extinguishers.
Group 2: Soap & tissue dispensers, bench-mounted film markers (less
important with daylight systems), viewing boxes.
Group 3: All X-ray and imaging apparatus, processing apparatus, filing
cabinets, bookcases, movable cupboards, chairs, desks, typewriters,
dictating machines.
Group 4: Blankets and pillows, cups and saucers, curtains, protective
aprons and gloves, a wide range of desk-top accessories.
62

63. Planning process-contd.
Budgeting for equipment
The cost of all equipment, has to be assessed and money allowed
for it in the project budget. Equipment is always purchased a long
time after the overall budget is decided in the Agreement to
Proceed (stage 1 in Capricode) and worked out in more detail in
Budget Cost (stage 2). Prices will inevitably rise; there is updating
of the predicted cost every 6 months. The process of updating the
budget will see that money is available at the right moment for the
agreed equipment. There will not be the money for a change of
mind.
e.g. CT to MRI machine.
63

64. Planning process-contd.
Consultation over equipment
For most items, the hospital standard will be acceptable (e.g.
clocks and soap dispensers) but several items require special
consideration. Particularly in specialized services. Unless details
are specified in the building contract, supply of the these items will
be put out to tender by the builder and he will take the cheapest,
which may not be suitable. Adequate consultation to ensure that
the correct apparatus was specified and supplied is necessary.
64

65. Planning process-contd.
Instruction to architects
The important principle at this stage of planning is that a suitable 'A'
Sheet or group of 'A' Sheets is chosen for the activity under consideration
and the listed 'B' Sheets are checked for suitability, notes being made of
any points requiring special attention. As necessary, amendments are
made in the 'A' and 'B' Sheets until the desired result is achieved.
The groups of 'A' and 'B' Sheets for all the activities and spaces will be
collected together and will constitute the foundation of the design of the
department and its contents. These, together with the final layout
drawings, are the basis on which the architect will proceed with the
detailed design of a department or an extension, and will thereby
constitute his instructions.
65

66. Planning process-contd.
Architectural drawings
Block drawings: Once the selection of 'A' and 'B‗
Sheets, including any necessary amendments or
modifications, has been completed, preliminary
drawings are prepared and submitted to the Project
Team for comment. They will show room shapes but
little else.
66

67. Planning process-contd.
Agreement of layout
With the many conflicting requirements to be resolved by the
architect, it will be rare for this first block drawing to be
completely satisfactory. If previous briefing was accurate and
complete, the work done earlier is repaid at this stage. As the
block drawing stage proceeds, requests for substantial changes
will taken with smile; but if the basic concept is acceptable, minor
alterations are taken willingly. It may be possible to propose
suitable solutions, but take care not to tell the other professionals
how to do their job. If the architect does not get it right, it is
probably because your briefing and explanations are inadequate
or not understood. The more accurate and the more
comprehensive the briefing, the more likely it is that your needs
will be translated into satisfactory plans. Finally there will be
agreed outline drawings: any future change of layout will be
67 resisted.

68. Planning process-contd.
Sketch plans
When the final layout has been agreed, the process of refining the
outline starts; the 'loaded' drawings will start to appear - in other
words the fixtures and fittings will be drawn in. As with all the other
drawings, these need to be looked at with care; look not only at
the location of obvious things, but also the smaller but no less
significant items. Now is the chance to ensure that the niggles
over the positioning of socket outlets in your office or the sitting of
a clock are not repeated; go through every room and space
positively, checking all the details.
68

69. Planning process-contd.
Freezing drawings
By the end of this stage of the planning process, the final layout and the
functional requirements will have been agreed. The drawings are then
'frozen'. It is from these that the detailed design work starts, with
structure, ventilation, electrical and water supply, etc., to be added - a
tremendous amount of work with numerous drawings for every part of the
building, each devoted to one aspect of the structure or services.
These are the Working/Production Drawings. Any change from now on is not
just a line on a piece of paper, but will have wide-ranging significance, and it
will only be allowed if there is very strong representation backed up by cast-
iron reasons. Changes may delay the whole project, which can have
implications for costs as well as time.
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70. Planning process-contd.
The fallow period
From the time of freezing the drawings, there is a long period
during which working/production drawings are prepared, tenders
invited, contract awarded and building starts. It may appear fallow
(empty) for the staff, but there is work to do and it is not nearly as
fallow as it looked at first sight.
There should be detailed review of the Departmental Operational
Policy, deriving from it things like staffing levels and job
descriptions for various members of staff.
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71. Planning process-contd.
Ordering equipment
The specialized Engineer will be involved in the
selection and ordering of equipment and a Supplies
Officer in the others. Their brief will be to help in the
selection process, but they will inevitably be
conditioned by what is available on contract, by ‗Policy'
and by other constraints.
We may study equipment care later on.
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72. Commissioning
Ready for service. Before being awarded this
title, however, a hospital must pass several milestones.
Equipment is installed and tested, problems are identified
and corrected, and the prospective crew is extensively
trained. A commissioned hospital is one whose
materials, systems, and staff have successfully
completed a thorough quality assurance process.
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73. 73