HM 15: HOSPITAL PLANNING & PROJECTS Dr Kithsiri Edirisinghe MBBS, MSc, MD ( Medical Administration )

HM 15: HOSPITAL PLANNING

& PROJECTS

Dr Kithsiri Edirisinghe

MBBS, MSc, MD ( Medical Administration)

Modular Objectives

• Objective: The course gives a comprehensive idea of hospital projects from conception to its commissioning.

• Mode of Learning: Lectures & discussion

15.01 Introduction to Hospital Projects and its Components

• Learning outcomes: Basic knowledge on organizing

hospital projects

• Discussion topic: Introduction to project management, fundamental principles, scope, components and measurements

• Methodology: Lecture discussion

15.02 Introduction to Hospital Project Feasibility

• Learning outcomes: Competence in feasibility study of hospital projects

• Discussion topic: Feasibility study: Introduction to demographic, epidemiological, health sector, financial feasibility; Selecting geographical areas and business opportunities for patient groups and sizes and types of hospital facilities.


15.3 Introduction to Conceptualization of Hospital Projects and Proposals • • Learning outcomes: Competence in conceptualization

and organizing investment proposals

• Discussion topic: Conceptualization and the planning of medical services, organization of the project and investment proposals


15.04 Introduction to Organizing and Managing Hospital Planning and Projects • Learning outcomes: Basic knowledge on hospital

project planning and construction management • Discussion topic: Hospital planning : Designing the

civil, M & E, equipment, different hospital designs; consideration of energy; physical movements; preparing architect’s brief equipment planning and budgeting; Activity plan and the controls of construction, equipment establishments and standards.


15.05 Strategic Business Planning

• Learning outcomes: Competence in formulating a strategic business plan on hospital construction management

• Discussion topic: Strategies of activities of organizing a strategic direction, formulation of objective differentiation, pricing and promotional, attracting human resources giving examples of recently concluded hospital projects.


Readings

1. Project Management, Dennis Lock, 1996

2. Hospital Architecture, Christoper Schirmer , Phillip Meuser, 2007

3. Step by Step, Hospital Designing & Planning, Sangeet Sharma, Purnima Sharma, 2008

4. The Art of Medical Equipments & Furniture Planning, Universal Hospital services, 2007

15.01 Introduction to Hospital Projects and its Components

What is a hospital?

• Hospital is a place where :– “all patients and their loved one are received,

treated and released in a friendly, dignified , and ethical manner

– maintaining the professional and institutional policies and standards

– thus preventing, investigating, treating and rehabilitating patients

– Supports training and research – with a view to exceeding patients and

institutional expectations”

WHO Definition

• An integral part of the Medical & Social Organization

• Which produces complete healthcare for the community

• Both curative & preventive and outpatients services to

reach out to family in environment

• It is also a center for training of healthcare workers for

Bio- social research

06 key Functions of a Hospital

1. Preventive

2. Investigative

3. Curative

4. Rehabilitative

5. Training

6. Research

Uniqueness of hospital projects

• It is one on of the most complicated projects

• Many specialists needed

• Proper and precise coordination is needed

• Medical administrator has to take the responsibility of the total project

• All Stake-holder participation is essential

• High cost

Hospital projects

• Project phases

• Project functions

• Project activities

• Project Tasks

Hospital Project phases

A. Project development

B. Hospital design

C. Approvals

D. Site Management

E. Construction - Civil, Mechanical & Engineering

F. Equipment Management

G. HR planning , recruitment and training

H. Supplies Management

I. Establishing systems - Policies and Protocols

J. IT planning , commissioning and training

K. Commissioning and Hand over of the hospital

L. Operational Management

A. Project Development

1. Justification of Management idea to enter to hospital industry

2. Feasibility study

3. Conceptualization & strategy

4. Location

5. Medical Brief or the Medical Plan of Services

1. Justifications of XXX entry in to hospital sector

• Widening demand gap

• Government beds per 1000 population 5 ( Colombo)

• Private beds per 1000 population 3 ( Colombo)

• Growth of private sector hospitals

• Average revenue growth 15%

• Sector vision to be the leader in health care business

• Platform to enter other areas in the Healthcare sector

• Favourable impression in the market & among professionals about XXX

entry to hospital sector

2. Feasibility study

1. Demography

2. Epidemiology

3. Health Services

4. Market

5. Financials

6. Environmental assessment

To identify the concept and type of the hospital

1. Demographic

Identify the market population

1. General population - 650,000

2. Feeding population - 250,000

3. Expected population – 900,000

Comment : Average market population for a private hospital in Jaffna –

360,000

Jaffna Province 1250 SqKm – Vadamarachi, Thanamarachi, Jaffna Islands,

Valakama

84% Hindus , 99% Tamils , 79% more than O/L, 70% Productive population, 16% elderly,

44% employed - 15% Govt employees & 29% private /self

2. Epidemiological

1. Communicable diseases

2. Non communicable diseases

“ Multispecialty services with special focused

specialties and high demand / revenue ”

3. Health Services

1. Available hospital beds

– Government - 1000 beds

• JGH – Occupancy rate 110 / Turnover rate – 81 / ALS – 4.9

– Private - 100 beds – Mainly nursing homes

2. Out patient services

“Main service provider are government hospitals & in the

private sector CNH along with many small out door care

services”

4. Market 1. Middle income group

– 44% employed : 15% Govt. employees & 29% private /self

2. Government servants , bankers , farmers

3. Elders and families with foreign support – 16 %

4. Foreigners , NGOs, construction company workers , new

businessman

5. High patient migration to Colombo ( 10 % Col. Beds)

“Most rapidly growing health market with no major player at the

moment “

5. Financial

1. Low capital infusion – Well planned medical services – Well controlled project management

2. High revenue services – Manageable model– High quality care – High asset utilization – Faster turnaround time

3. Project IRR - 25% / Equity IRR – 30% – Start as general services and expand on to focused areas most

feasible model in Sri Lanka

4. BOI concessions - 08 year tax holiday

6. Environmental analysis

• External environment

• Internal environment

External Environment Assessment

Opportunities Threats

Political 1. End of civil war – best time to invest 2. Government support 3 NGOs / Businessman

1. More opening in the market 2. Improved infra structure – easier to access Colombo Facilities 3. New health regulation

Economical 1. Improved income 2. Channeling of money

1. Culture of spending

Social 1. Willingness to spend for health 2 . People coming back to Jaffna

1. Perception regarding local hospitals

Technological 1. No technologically sound hospital 2. Travelling to Colombo even for basic investigations

1. New investors of Laboratory and Non invasive technologies

Health sector 1. Lack of private sector beds 2. 15% Colombo Beds occupied by Northern Patients

1. Many big players coming to the market 2. Improvement of exiting players – Govt. and private

Internal Environment Assessment

Strengths Weakness

Leadership 1. Owners willingness 2. Thinakural brand equity

1. Medical director’s mindset2. Social project 3. Medical Administrator

Personnel 1. Consultant specialists 2. GP practice 3. Accounts4. Out side consultants’ willingness

1. Nursing 2. Para medical3. Marketing

Service delivery

1. As the only pvt. hospital2. Brand name of 25 years

1. Existing facility

MIS 1. Accounts 2. Medical records

1. Lack of Hospital Specific MIS

Quality 1. Technical quality 1. Poor service Quality

Finance 1. Owners equity 2. Bank willingness 3. Cash & stable business

1. Long term returns

Cost 1. Low cost operations 1. Low fees charged

Development 1.Experinece & capability of Micro & GHC2. Closer to the Medical Faculty & Hospital

1. Lack of frontend 2. Big players of faster project

implementation

C. Conceptualization

Conceptualization

• Mode of entry

• Hospital model

• Project model

• Strategy – Vision – Mission – Objectives – Strategy

Objectives of the XXX hospital Project

• To established a Multi-specialty hospital in Colombo

district.

• To establish 2-3 satellite hospitals in selected

outstations.

• To support related special projects identified by

Hemas.

Project model

• Multi-specialty hospital

• Group of hospitals

– Colombo (01) , initially

– Selected Outstations ( 03), later

• Partnership with existing hospitals

– Outsource unavailable facilities

– Reach outstations

Multi Specialty HospitalVs. Single Specialty hospital

• Disease pattern in Sri Lanka

• Direct patient care & Supportive care

• Capital investment

• Hospital utilization

• Attracting doctors & patients

Group of HospitalsVs. single hospital

• Feeding hospitals

• Demand in the Outstations

Hospital Model

• New concepts to attract doctors & patients

– Use of IT in patient care & administration

– Controlled infrastructure

– High quality of care with minimal waiting time & cost

– Comfortable environment for doctors & patients

– Focused on the largest (60%) middle income group

– Concentrate on the general specialties

– Combination of Medical management & Hotel management

Three basic models

– According to bed strength

A. Large

B. Medium

C. Small

Hospital Model A

• Bed strength

– 100

• Cost: Rs. 1000 million

• Multi-specialty General hospital

– Curative, preventive & rehabilitative care

• Services

– General specialties

– No high end,capital intensive services

• Facilities

– Inward & outdoor care

– Special care units

– Diagnostics ,up to CT scanner

Hospital Model B

• beds -75

• Project cost :Rs.750 million

• Tertiary care facilities

• Outdoor: all related specialties

• Diagnostics up to CT scanner

Hospital Model C

• Beds -25

• Project cost :Rs.250 million

• Inward: 04 General specialties

• Outdoor: all related specialties

• Diagnostics up to an US

Scanner

The Strategy

A.CORE STRATEGIES

• Integration - MERGE WITH A FOREIGN HOSPITAL

• Restructuring – NEW EFFECTIVE STRUCUTRE

B. GENERIC STRATEGIES

• Cost leadership – LOW COST & HIGH QUALITY

• Value chain – ADD VALUE to EXISTING BUSINESS

Selected Strategies

Vision

“To be the best

Patient Centric hospital in Sri Lanka “

Mission ………

Project model

• Build a hospital for 30 years • Multi- specialty hospital –

– Two stage development – 50 bed could upgraded to 100 beds

• Service level – Match Colombo Standards

• Services offered – Preventive / Investigative /Curative Rehabilitative care /

Training development • Tie up with foreign hospital

C. Location & Site

Location • People - Area economies, population

density • Demand gap - Government hospital &

competition • Access to doctors • Access to patients• Access to Staff• Availability of land • Supplies

C. Location & Site

Site • Site visibility • Access to patients – transport • Environmental assessment • Access to material • Disposal of waste water • Ventilation • Access to water • Light • Site soil and surface

D. Medical Plan /Brief

Medical plan

• Main responsibility of the hospital administrator / manager

• Medical services – 30 years – Areas of specialties for next 30 years – Number of Services delivery per unit with time

scales – Quality standards of the planned services

• Other related services • Out-sourcing • Linking of services

Medical plan

• Put up Initial plan • Discussion with the respective specialists • Discussion with equipments/ supplies managers • Identify new trends in treatment / investigation

methodologies

Project costing 01

• Conceptual costing of the hospital project

• Use market data

• Previous project cost data

• Validate with today's rates

• Sample 01

Operational Finances 01

• Revenue for the next 10 years

• IRR

• ROI

• NPV

• Dividend plan

Establishment of a company

• Company incorporation

• Appointment of the Board

• Regularity clearance for the company

Project finance

• Mode of financing

B. Site Management

• Confirm Feasibility • Survey plan • Title search • Soil, Water testing • Approvals

– Survey plan– UDA– BOI

• Assessment of the site – Water supply – Electrical supply – Effluent disposal – Road access – Weather pattern– Work force

• Agreements • Acquisition • Fencing• Security

C. Hospital Design

1. Confirmation of the Medical Plan

2. Master planning

3. Unit planning ( done later )

4. Process Analysis of the respective services – out put of services

– allocation Space, HR , equipments

– Confirmation of the policies and strategies

5. Architects Brief

4. Schematic design– Civil – M & E– Project Costing II

5. Detailed design – Civil – M & E– Project Costing III

6. Functional design– Process – Systems – Confirmation with AP

D. Approvals

• Project Approval – MOH

– Local Gov

– UDA

– BOI

• Site approval ( Survey Plan) – Local Gov

– UDA

• BOI Approval – Preparation and signing of agreement

– Submission and approval of the Equipment & the Building material and M & E List

– Submission of Detailed Plans and BOQs

• Building Plan Approvals– Local Government– UDA – Atomic Authority – Fire Department– Traffic Impact Assessment – Water, electricity & Telephone– CEA– MOH – RDA

• Operational Approvals – Certificate Of Conformity – MOH registration

E. Construction

• Preparation of B.O.Q.s of Civil & M& E contracts

• Preparation of agreements

• Bonds and guarantees & signing of agreements

• Initial payment

• Mobilization

• Initiation , monitoring of the construction

• Project financial and logistic management

• Commissioning and Hand over

• Insurance

• Civil – Piling – Structural – Masonry– Interior decoration– Crash bars– Landscape– Staff Quarters – Service building

• M & E– Electrical – Plumbing – AC– Medical gas– STP– Incinerator– Morgue – Ceiling – Flooring – Fire – PA– IT

E. Construction

F. Equipment Management

• Equipment Planning – Selection of the equipments

– Project Costing IV

– Layout & Process confirmation

– Should be Completed before detailed civil construction

• Tendering & Selection of Suppliers • Preparation of Agreements

– Supply & Installation

– Training

– Servicing

– Insurance

• Importation • Installation• Training • Protocols for management • Commissioning & Hand over

G. HR Management

1. Confirmation of the process activities relation to HR

2. Job Analysis - Planning of the Number , Profile and the Job descriptions

• Medical staff • Doctors, Nurses and Para Medical

and Medical assistants and Nurse Aides

• Technicians - Incinerator, CSSD, OT & ICU, Endoscopy, Radiology

• Facility staff • PR, Security ,, Kitchen, Laundry,

House Keeping• Maintenance Civil , M & E (STP,

electrical, Water supply, AC, Incinerator

• Administration • Medical Administration• Finance • Marketing • HR

3. Market Analysis & Preparation of packages

• Salary• Perks• Quarters• Meals 4. Advertising & Recruitment5. Training

• Basic organizational concepts , policies • Special –protocols

6. Continuous training & Development plan

H. Supplies Management

1. Confirming the Supplies aspect of the process analysis

2. organizing the supplies chain Management process

• the process and policies

• HR

• Space and special requirements

3. Initial estimation through AP

4. Formation of the Supplies Management board

• Drug regulatory committee

• general supplies management committee

5. Selection of Items, quantity of the products

6. Negotiations and selection of the suppliers

7. Agreements

8. Purchase and storage

I. Establishing Systems

• Systems , Policies & Protocols

• Medical Administration – Patient care services

– General Administration

– HR

– Marketing

– Financial Management

– Facility Management

– IT

K. Commissioning and Hand over

A. Civil

B. M & E

C. Equipments

D. IT

E. Promotions

Hospital Design

Where to Start?

Early Planning

• The Team – ICT + project team

• Patient care services

• Process of delivery

• Use Government reports and guidance

• WHO, international guidelines

• Decisions were made on the number of bays,

single rooms, bed spacing, utilities and toilet

The Planning Stage • Architects, builders, engineers and project

managers have little or no knowledge on infection control

• ICT - Infection Control Team• Participation of the ICT professionals in early

stages • Microbiologist, Medical director, Nursing director,

Unit heads (doctors, nurses, others) • Infection control risk assessment should be

done at the initial stages

Hospital Design

• Conceptual design – Master plan – Master functional design – Unit planning– Equipment planning

• Detailed design – Specifications – Roof – Floor – Walls

Hospital Design

1. Conceptual design

2. Detailed design

3. Final functional design

1. Conceptual design

A. Master plan

B. Unit planning

C. Primary functional design

A. Master plan• Type of the hospital – Special / General• Medical service plan • Building structure & size • Vertical transport & natural light • Placement of clinical units • Critical, High risk – OT, ICU, NICU, LR • Medium risk – wards, Investigation units, OPD,

blood bank • Low risk – General - Patient waiting, landscape

A. Master plan• Placement of Support services -

administration, facility services

• Facility engineering – Sewer treatment plant, water treatment, medical gas

• Waste management system – solid, liquid waste

• Stores – Medical and General

1. OT

2. BLOOD BANK & LAB

3. ROOMS

4. ETU

5. RADIOLOGY

6. RECEPTION

7. ADMIN & PUBLIC RELATION

8. OPD

9. CANTEEN

10. KITCHEN

11. SERVICE

1

2

2

3

3

3

4

5

6

7

89

10

11

1

1

B. Unit Planning • Layout of the units – Isolation rooms, ward to room ratio 80: 20 – Bay concept (wards) – MRSA , Meningococcal

• Ideal for developing counties due to issues in cost effectiveness

• 4- 5 beds per bay • Spacing of beds – Ideally 2.5 meters ( center to

center ) • Space for Bystander

– One way traffic ,natural light • Unit waste management• Dirty utility, Clean utility, linen store

B. Unit Planning

• Organize functional design - Unit patient

flow Identify potential areas of contact and

intervention

• General infection control polices

• Special infection control protocols

HDU

C. Primary Functional Design• Need to structure the guidelines chronologically,

so that the key action points are identified for each

stage of the developmental process.

– Through Process analysis

– Look at the Patient flow & identify the critical

areas / high risk areas of infection transmission

C. Primary Functional Design• Develop, strategies, policies, protocols to

counter the threats posed

– General infection control polices

– Special infection control protocols

– Use Government reports and guidance

– WHO , international guidelines

2. Detailed Design

A. Demarcation of units

B. Environment - Air – Ventilation, Water,

Floor, Ceiling , walls & furniture, supporting

C. Hand washing

D. Equipment planning

A. Demarcation of Units

• Color coding of the units and areas according to the risk levels

• Maintain one way traffic

• Restriction of people

• Special procedures

B. Environment - Ventilation • Common HAI – Aspergilosis , TB, Legionellosis

• Fungi – Aspergillus – Aspergillosis -Lobar

Pneumonia - Spores

– Immuno-compromised patients, are at no

greater risk for infection within the hospital

than outside. Cancer/ HIV/AIDS

– Organ / bone marrow transplant

B. Environment - Ventilation • Filtered ventilation – Use of HEPA filters in all

Critical areas

• Use central Air conditioning

• Use of air conditioning & humidity

• Use positive air pressure – prevents corridor air,

coming in to clinical units

B. Environment-Ventilation • Preventing - TB

• Isolation rooms with an air lock room

• Use negative air pressure

• Sealed rooms – windows, self closing doors

B. Environment-Ventilation • Preventing Legionellosis

– Legionella is an important cause of community and

hospital-acquired lower respiratory tract infections

– Storage tanks, cooling towers of AC

– Clean water - Chlorination, Thermal eradication, UV light

B. Environment - Water

• Water born disease – Enteritis

• Disinfecting water sources

• Chlorination, Thermal eradication

• Water treatment plants

• Policies to supply safe water to patients

B. Environment- Floor

• Avoid Tiles and corrugated surfaces as much as

possible

• Use heavy duty floors in general areas – Granite

• Make it washable

• Keep the flow dry all the time

• Carpeting – Avoid in high risk areas, vacuum

daily and periodical steam cleaning

B. Environment- Floor • Bacteria on hospital floors predominantly consist of skin

organisms,- e.g., coagulase-negative staphylococci,

Bacillus spp.and diphtheroids , S. aureus and

Clostridium spp.

• Floors need to be dry and smooth with no gutters

• Use vinyl floors in patient areas - cleaning, maintenance

, sound, replacement, use of proper wheels

B. Environment - Ceiling & Walls

• Pathogenic microorganisms adhere walls or ceilings when the surface becomes moist, sticky, or damaged

• Walls and ceilings should have a smooth, impervious surface that is easy to clean , wall pictures

• Wall coverings should be fluid resistant and easily cleaned, especially in areas that contact with blood or body fluids

• False ceilings – Harbor dust and pests that may contaminate the

environment if disturbed.– Avoided in high-risk areas unless adequately sealed.

Daycare Centre

OPD Waiting area

B. Environment - Furniture and Fittings

• Furniture is thought to be a minor infection risk, but prolonged survival of VRE

• MRSA and VRE have also been recovered from privacy curtains, scrub suits, and plastic aprons

• Possibility of their being acquired by patients or health-care workers and spread from one person to another.

• Surface of future • Use of curtains – Vinyl and regular washing • Beds - Power coated, remote• Bed head panel

B. Environment -Furniture and Fittings

• Surface of furniture, should be easy to clean • Use of curtains – Vinyl and regular washing • Beds - Powder coated, remote• Bed head panel • Railing on corridors, door handles • Entertainment systems - key boards • Waste management system and the process

Typical room

C. Hand Washing • Hand washing is the single most important method to

prevent hospital infections. • Each patient room, examination room, and procedure

room needs at least one sink placed close to the entrance

• Large enough to prevent splashing. • Shallow sinks may cause contamination of hands by

bacteria residing in the drain- linked to a hospital outbreak of multidrug-resistant gram-negative bacilli

• Each sink should be equipped with a hands-free control, soap dispenser, and paper towel holder.

C. Hand Washing • Get more natural light near the sink • Wash Basins were stand alone so any splashes

fell on the floor rather than a work top. • Long handle taps• Hands free taps for the Critical Care• Alcohol hand gel mounted on the ends of beds.• Access to examination gloves and a trash

receptacle should be readily available

D. Equipment Planning

• Use equipment with smooth surfaces which are easy to clean

• Plan the layout for minimal spills and contamination

• Protocols for effective use of equipments – Do’s– Don’ts

• CSSD

3. Final Functional Design

• Finalize Hospital infection control policies• Train staff & Place controlling mechanism• Quality standards & Reporting systems • Quality audits • Organizational culture for infection control• Align infection control polices to performance evaluation

system of the human resource department • Educate visitors • Output specifications

Output Specification

• Output specifications for support services – Cleaning– Catering– Laundry– Waste disposal– Pest control – Utilities management.

• Model output specifications available on - www. dh.gov.uk

Hospital Unit Planning

Planning a hospital

1. Project Scope

2. Plan services

3. Space and Physical Requirements

4. Constructional Details

5. Service requirements

Mechanical Service Requirement

a. Air-conditioning

b. Refrigeration

c. Illumination

d. Lightning Protection

e. Ventilation

f. Gas Supply

g. Telephone and Intercom

h. Fire Protection

i. Waste Management System

j. Water Supply

k. Drainage and Sanitation

l. Power supply

1. Project scope

• Specialty – Uni / multi • Number of beds• Quality Standards • Place • Tentative budget • Master plan

“ To build a multi Specialty hospital of 100 beds according to the WHO standards in Colombo South for Rs. 1 billion”

2. Functions of the hospital

I. Functions of the hospital

II. Number of patients for services bed distribution

among specialties

Main functions of the hospital

• Receiving & Discharge

• Ambulatory care

• Investigation care

• In - Patient care

• Critical care

• Administrative & support Services

• Education & Research

• Green Services

A Patient care services

a. OPD

b. Inward

c. Critical care

d. Investigative care

e. Rehabilitative care

a. OPD Care (Capacity >1000)

• Consultation Channeling 15

rooms– General specialties - 400

– Supra specialties - 200

• GP Practice - 200

• General clinics - 50

• Special Clinics - 50

• Dental clinic - 100

• Eye clinic - 100

• Wound care clinic - 25

• Vaccine clinics - 50

• Wellness clinics - 25

• Fertility clinics - 25• Out reached services -25

– Home nursing care– Home investigations– Patient transport – Disability care

b. Inward care units

• Day Care/ transient care - 7 beds / 15 patients

• Wards ( twin beds ) - 04 rooms/ 08 patients

• Rooms ( single ) -30 rooms / 30 patients

c. Critical care Units

• Emergency treatment – 03 beds / 02 couches – 40 patients a day

• Intensive care - 03 beds – 3 patients

• Neonatal Intensive care – 03 cots / 03 babies

• Operation theater – 02 general beds – 8 major & 20 minor surgeries – 01 day bed – 20 day surgeries

d. Investigation Units

• Medical Laboratory- Haematology, Histo-pathology,

Clinical Pathology, Biochemistry, Microbiology -1000

tests

• Radiology - X-rays, US Scanning, CT Scanning -

• Cardiology- ECG, Stress ECG, Echo - 25 tests

• Neurology - EEG ,EMG - 20 tests

• Endoscopy- Colonoscopy, Gastro copy - 20 tests

• Ophthalmology - 50 tests

e. Rehabilitative Units

• Physiotherapy - 25 patients

• Speech therapy - 15 patients

• Drugs and Alcohol abuse – 10 patients

• Psychotherapy - Counseling- 15 patients

• Wound care - 20 patients

B. Support services

1. Administrative

2. Financial

3. Facility

1. Administrative Services

• Management of

Clinical services

• General

Administration

• Marketing / Promotion

• Medical records

• Legal

• Media

• CSSD

• Blood Bank

• Infection control

• Quality management

2. Financial Services

• Accounts department

– Cashiering

– Banking

– Audit

– IT

– Out sourced services

• Supply chain

– Medical

– Surgical consumable

– Non Medical /general

3. Facility Services

• Public relations

– Reception

– Telephone

• Facility management

– Room service

– Kitchen / canteen

– Laundry

– Janitorial

• Security

• Transport

• Staff rest / quarters

• Engineering services

– Civil

– M & E

OPD

OPD Care

• Consultation Channeling – General specialties

– Supra specialties

• GP Practice

• General clinics

• Vaccine clinics

• Wellness clinics

• Fertility clinics

OPD • Consultation rooms

– 15 X 15 – Hand washing

• Pt waiting • Reception • Registration & Payments • Medical records• Health information • Car park , canteen, book/ flower shop• It centre / Jim

OPD Waiting area

OPD & Investigation

Canteen

Inward care services

b. Inward care units

• Day Care

• Preliminary care units (PCU)

• Wards

• Rooms

Planning a General ward

• Entrance • Reception • Registration • Examination • Beds – General ,HD• Procedures• Treatment area• Bleeding • Nurse station

• Hand washing • Wash rooms • Staff officers • Communication• Utility

– CU, DU, Linen

• Equipment bay • Ventilation

Special requirements

• Medical – isolation rooms – Access to isolation room

• Surgical – Wound cleaning & dressing – Access to OT

• Obstetric – Feeding areas , special requirements for patients, labor room – Ante natal , post natal units

• Surgical – special requirements– Access to OT, ETU , ICU

• Pediatric– Space for Mother , play areas– Near neonatal unit – Isolation

Inward care

• Ideal number of beds for a ward – 24

• Bed – Size – width 3.3 – Gap – 6 ft

• Toilet – single , including the bath – 6 X 6

• Single room size – Including toilet – 13 X 24

• All corridors – Min of 07 feet – Well ventilated / well lit – Wall Height 10 feet / 12 feet with ceiling

• All toilets – ventilation fan / fan light

Typical Room

Typical room

Daycare Centre

c. High Dependency Units

• A & E

• E & R

• ICU

• NICU

• OT

• MICU

• SICU

A & E / ETU

• Easy access to– entrance , OT , ICU, to ward and OPD– Investigations – Radiology

• Less crowded area • Trolley bay • Security • Washing area• Waiting area • Utility & procedure rooms

OT

OT

• Pt transfer zone • Staff entrance • Pre operative area • Operation theaters

– Size 25 X 25

• Post operative area• Instrument supply • Equipment bay • Dirty corridor

• Staff changing • Patient changing • Reception & discussion • Sterile zone • CSSD• Rest rooms • Utility rooms

– CU

– DU

– Linen

HDU

• Transfer

• Examination

• Enema

• Stage units

• Delivery rooms – size - 20 X 16

• Recovery unit

• CU/DU/ Linen

Baby Delivery room

Support services

• Administrative Services

• Laundry services

• Diet services

• Water & Sanitation

• Electricity

• Cleaning - Janitorial

• Landscape

• Security

• Medical & Consumable

stores

• Transport

• Medical records

• Infection control

• CSSD

• Blood Bank

• Morgue

d. Investigation Units

• Laboratory

• Radiology

• Cardiology

• Audimetry

• Ophthalmology

Thank you!

Copyright Course Technology 1999

148

Introduction to Project Management


149

What Is a Project?• A project is a temporary endeavor

undertaken to accomplish a unique purpose• Attributes of projects

– unique purpose– temporary– require resources, often from various areas– should have a primary sponsor and/or customer– involve uncertainty


150

The Triple Constraint

• Every project is constrained in different ways by its– Scope goals– Time goals– Cost goals

• It is the project manager’s duty to balance these three often competing goals


151

Figure 1-1. The Triple Constraint of Project

Management


152

What is Project Management?

Project management is “the application of knowledge, skills, tools, and techniques to project activities in order to meet or exceed stakeholder needs and expectations from a project”

(PMI*, Project Management Body of Knowledge (PMBOK Guide), 1996, p. 6)

*The Project Management Institute (PMI) is an international professional society. Their web site is www.pmi.org. Over 315,000 copies of the PMBOK Guide were in circulation by June 1999.


153

Project Management Framework

TT


154

Project Stakeholders• Stakeholders are the people involved in or

affected by project activities

• Stakeholders include– the project sponsor and project team– support staff– customers– users– suppliers– opponents to the project


155

Project Management Knowledge Areas

• Knowledge areas describe the key competencies that project managers must develop– 4 core knowledge areas lead to specific project

objectives (scope, time, cost, and quality)– 4 facilitating knowledge areas are the means through

which the project objectives are achieved (human resources, communication, risk, and procurement management)

– 1 knowledge area (project integration management) affects and is affected by all of the other knowledge areas


156

Project Management Tools and Techniques

• Project management tools and techniques assist project managers and their teams in various aspects of project management

• Some specific ones include– Project Charter and WBS (Scope)– Gantt charts, PERT charts, critical path

analysis (Time)– Cost estimates and Earned Value Analysis

( cost )


157

Sample WBS for Intranet Project in Chart Form

C oncept

D esign U ser Interfa ce

D esign Server Setup

D evelop ServerSupport Infra structure

W eb S iteD esign

D evelop Pa gesa nd L inks

D evelopFunctiona lity

C ontentMigra tion/Integra tion

T esting

W eb S iteD evelopm ent

R oll O ut Support

Intra net Project


158

Sample Gantt Chart

*This template file comes with Project 98

WBS Gantt Chart


159

Sample PERT Chart

Each box is a project task from the WBS. Arrows show dependenciesbetween tasks. The tasks in red are on the critical path. If any tasks on thecritical path take longer than planned, the whole project will slip unless something is done.

B

2 2 days

Mon 8/3/98 Tue 8/4/98

C

3 3 days

Mon 8/3/98 Wed 8/5/98

D

4 4 days

Tue 8/4/98 Fri 8/7/98

E

5 5 days

Wed 8/5/98 Tue 8/11/98

G

7 6 days

Thu 8/6/98 Thu 8/13/98

H

8 6 days

Wed 8/12/98 Wed 8/19/98

I

9 2 days

Fri 8/14/98 Mon 8/17/98

F

6 4 days

Wed 8/5/98 Mon 8/10/98

A

1 1 day

Mon 8/3/98 Mon 8/3/98

J

10 3 days

Thu 8/20/98 Mon 8/24/98


160

0

50

100

150

200

250

300

1 2 3 4 5 6 7 8 9 10 11 12

Month

$

BCWS or Cumulative Plan

ACWP or Cumulative Actual

BCWP or Cumulative EVBCWS

ACWP

BWCPSchedule Variance

Cost Variance

EAC

BAC

Sample Earned Value Chart


161

Advantages of Project Management*• Bosses, customers, and other stakeholders do not like

surprises• Good project management (PM) provides assurance and

reduces risk• PM provides the tools and environment to plan, monitor,

track, and manage schedules, resources, costs, and quality • PM provides a history or metrics base for future planning as

well as good documentation• Project members learn and grow by working in a cross-

functional team environment*Source: Knutson, Joan, PM Network, December 1997, p. 13


162

How Project Management (PM) Relates to Other Disciplines

• Much of the knowledge needed to manage projects is unique to PM

• However, project managers must also have knowledge and experience in– general management– the application area of the project

• Project managers must focus on meeting specific project objectives


163

Project Management and Other Disciplines


164

History of Project Management*• Modern project management began with the

Manhattan Project, which the U.S. military led to develop the atomic bomb

• In 1917 Henry Gantt developed the Gantt chart as a tool for scheduling work in job shops

• In 1958, the Navy developed PERT charts• In the 1970s, the military began using project

management software, as did the construction industry

• By the 1990s, virtually every industry was using some form of project management

* August 1999 PM Network has good articles on history of PM


165

The Project Management Profession

• A 1996 Fortune article called project management the “number one career choice”

• Other authors like Tom Peters and Thomas Stewart stress that projects are what add value to organizations

• Professional societies like the Project Management Institute have grown tremendously


166

Project Management Certification

• PMI provides certification as a Project Management Professional (PMP)

• A PMP has documented sufficient project experience, agreed to follow a code of ethics, and passed the PMP exam

• The number of people earning PMP certification is increasing quickly

• Other groups, like the Gartner Group and the Singapore Computer Society, have their own IT PM Certification programs


167

Figure 1-6. Growth in PMP Certification, 1993-1998Over 12,500

by May 1999


168

Code of Ethics

• PMI developed a project management code of ethics that all PMPs must agree to abide by

• Conducting work in an ethical manner helps the profession earn confidence

• Ethics are on the web at www.pmi.org/certification/code.htm

http://www.pmi.org/certification/code.htm

Thank you!

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HM 15: HOSPITAL PLANNING & PROJECTS Dr Kithsiri Edirisinghe MBBS, MSc, MD ( Medical Administration )

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