Hospital Planning (EDL 341)
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Module I : Guiding Principles
Case Study
SIMUL8 Studio is a simulation tool and a visual and interactive online platform, which imitates the processes of an existing or proposed system. Simulation can accurately represent the real processes by adding timings and rules around the tasks, resources, and constraints.
By using a virtual representation to test the impact of process changes and ‘what if’ scenarios, simulation helps get an overview of impact of change on the whole system. It has enabled organizations to improve processes rapidly, increase efficiency and reduce costs.
Benefits of Simulation
• It is less expensive than real life experimentation
• Possible to test diverse ideas under the same situations
• Establishes long-term impact of process changes
• Simulation provides impartial insight to assist process improvement
• Determines the potential results of random events
• Simulation allows thinking about every aspect of a process and this rethinking can sometimes result in improved operations
Isle of Wight NHS Trust, an integrated acute community mental health and ambulance health care provider in England, used BED. P.A.C. simulation software for bed management. Their primary objective was to deviate from the spreadsheets planning and be able to handle the variation that exists in reality. Answers for some other questions were also needed: effect of winter pressures on inpatient beds, the effect on inpatient bed utilization of reducing delayed discharge patients, the downstream capacity constraint of community nursing beds, how to use short-term predictions to show where inpatient bed capacity problems may arise over the next seven days.
Arrivals of elective and emergency patients across each specialty were analyzed and these forecasts along with 12 months of historical data of arrivals, length of stay and discharge times were uploaded to the software. The BED.P.A.C. automatically created daily patient arrival patterns and profiles of the typical length of stay depending on time and day of arrival and specialty. The results illustrated hourly capacity for emergency and elective beds separately, and also where patients would need to be shifted to avoid waiting times.
Bed.P.A.C.’s results were shared with the clinical staff and discussed to investigate “what if” scenarios. The detailed and highly sophisticated results increased enthusiasm of the clinical staff and encouraged effective and productive discussions towards improvement. The confidence intervals provided for each scenario were critical in showing the level of risk with the bed planning choices and the vulnerability to fluctuations in demand.
The simulation showed that the Isle of Wight required more beds to meet the present demand; these beds could be the hospital beds, or community or patients’ bed at home with appropriate support. BED. P.A.C. helped achieve the right balance between acute and community care. Other benefits included increased bed capacity for medical patients by approximately 17%, increase in community bed capacity through redesign of existing surplus capacity and increase in home-care packages
The Isle of Wight chose Bed.P.A.C. over alternative bed planning and management tools because it was rapid, engaging, as the ‘what if’ scenarios were visually compelling and easily comprehended by the clinical staff, and enhanced level of detail and accuracy. The Isle of Wight now has a full suite of detailed system performance metrics with confidence intervals provided for every result giving confidence in their analysis and ensuring buy-in from clinical staff. Also, it means they have substantial evidence to generate and have the difficult conversations that must happen to produce the right plan for optimal hospital performance.
Question 1: “The costs of permissions/approvals, architectural design falls under the category of “
Select one:
a. Hard costs
b. Soft Costs
c. Financing Costs
d. Other Costs
Question 2
A successful hospital is based on
Select one:
a. good planning
b. good design and construction
c. good administration
d. All of the Above
Question 3
Results of the simulation
Select one:
a. lead to productive solutions
b. motivated clinical staff
c. reduced uncertainity
d. All of the Above
Question 4
SIMUL8 has enabled organizations to:
Select one:
a. improve processes
b. increase efficiency
c. reduce costs
d. All of the Above
Question 5
Simulation can accurately represent the real processes by adding timings and rules around ___________.
Select one:
a. tasks
b. resources
c. constraints
d. All of the Above
Question 6
the BED.P.A.C. was used to meet what challenges?
Select one:
a. Bed Capacity Planning
b. Inadequate Staff
c. Increased Costs
d. None of the Above
Question 7
he first phase in planning for a hospital invovles
Select one:
a. Needs Assesment
b. Defining a plan
c. Both A and B
d. None of the Above
Question 8
What are the pressures of change
Select one:
a. To reduce cost and increase efficiency
b. extend care to remote areas
c. provide a Multi-disciplinary Approach
d. All of the Above
Question 9
What is SIMUL8?
Select one:
a. Simulation tool
b. Software program
c. Excel datasheeet
d. None of the Above
Question 10
Which program was used by the Isle of Wight NHS Trust?
Select one:
a. SIMUL8 Professional
b. BED. P.A.C.
c. Scenario Generator
d. None of the Above
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MODULE II
The global increase in demand for healthcare services raises the+B3:B8 need to minimize expenditures on “non-core” activities like maintenance and operations with a subsequent rise in the demand for high-level built-facilities. The increased competitiveness in the healthcare business puts considerable pressure on hospitals to enhance facility management. For efficient facility management, proper facility planning is the key. Over the last four decades, facilities management has witnessed significant development, owing to five global trends –
1. Increased construction costs
2. Studying effects of space on productivity
3. Increased performance requirements
4. Contemporary bureaucratic and statutory restrictions
5. Recognition that performance of facilities is highly proportional to maintenance
A facilities planning committee in a hospital should be responsible for developing strategic facilities plan to determine the best occupancy options while meeting the department’s changing needs. Financial impact is a major consideration for any facility planning. The impact of facility decisions, financial analysis and cost effectiveness should be long-term tasks for any health care set up.
Facility planning involves various tools of planning for successful outcomes. The three key outputs of facility planning involve strategic facility plan, master plan and annual facility plan. Of all, the strategic facility planning (SPF) plays a key role as it aims at developing a flexible and implementable plan based on the specific and unique considerations of the individual business. The four main aspects of SPF include understanding, analyzing, planning and acting. The SPF identifies the type, quantity and location of spaces required to fully support the organization’s business initiatives. The master plan provides a framework for the physical environments that incorporate the buildings. The master plan develops the natural conditions and constructed infrastructure and systems at the functional, aesthetic and temporal levels. The annual facility plan deals with developing a comprehensive plan each year to address the new or changing priorities and focus on departmental initiatives.
Building Performance Indicator (BPI) is also a key component of facility planning. This aims to compute the actual physical performance score for each system in a given building and the entire facility. This provides a physical performance indicator to be measured on a 100-point rating scale. This procedure acts as a physical assessment mechanism that monitors the building, its systems and components.
SWOT Analysis is another planning tool used to strategically evaluate the strengths, weaknesses, opportunities and threats in the facility. Strategic Creative Analysis (SCAN) is another process for strategic planning, decision making and analyzing case studies.
Besides having the right tools for facility planning, setting up the plan in the right manner plays a key role in paving the way for successful planning outcomes. Some major steps in planning are:
• Document the primary objectives to be addressed in the SFP
• Evaluate sites, zoning, costs, labor, competition and all factors critical for success
• Conduct financial and risk analysis to focus on finding the maximum value
• Develop alternatives with recommendations and priorities
• Develop a process for marketing the recommended SFP to gain management approval
• Obtain financial and other approvals needed to launch the action phase
Question 1: “In the case study, maintenance and operations are termed as _______ activities. “
Select one:
a. Non-core
b. Key
c. Crucial
d. Significant
Question 2
“____ acts as a physical assessment mechanism that monitors the building, its systems and components.”
Select one:
a. Strategic Facility Planning
b. Annual facility planning indicator
c. Core plan
d. Building Performance Indicator
Question 3
BPI in the case study stands for?
Select one:
a. Bill Price Index
b. Building Performance Indicator
c. Blood Pressure Increase
d. British Phonographic Industry
Question 4
How many global trends have influenced facilities management over the last four decades?
Select one:
a. 6
b. 5
c. 4
d. 10
Question 5
What does SCAN stand for?
Select one:
a. Simplified Computing Analysis Network
b. Strategic Creative Analysis
c. Sample Copy for Assessment and Negotiation
d. Sample for Clinical Assessment and Negotiation
Question 6
What does SWOT stand for?
Select one:
a. Strategic Wellbeing Of Towers
b. Seller s Write-Off Trust
c. “Strengths, Weaknesses, Opportunities and Threats”
d. Source Worked Organic Traffic
Question 7
Which of the following aims at developing a flexible and implementable plan based on the specific and unique considerations of the individual business?
Select one:
a. Strategic facility plan
b. Master plan
c. Annual facility plan
d. Core plan
Question 8
Which of the following aims to compute the actual physical performance score for each system?
Select one:
a. SWOT
b. SCAN
c. KPI
d. BPI
Question 9
Which of the following is NOT a part of the four aspects of strategic facility planning?
Select one:
a. Understanding
b. Analyzing
c. Constructing
d. Planning
Question 10
Which of these provides a framework for the physical environments that incorporate the buildings?
Select one:
a. Strategic Facility Planning
b. Master Plan
c. Annual facility plan
d. Core plan
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MODULE III: OPERATIONAL PLANNING
Besides having great doctors, it is the equipment in any hospital that helps provide high-quality patient care. The advancements in technology have paved a way to simplify complex procedures and minimize the associated risks. Procuring high-quality equipment and maintaining them within the facility is often a costly affair. Yet, proper planning can help minimize the cost and improve operational efficiency, while lack of planning could result not only in wastage of money, but also lower standards of patient care. Many healthcare leaders across the globe are searching for innovative care delivery models that ensure lowering of costs with a concurrent improvement in quality.With an increase in the incidence of heart disease in Indian lifestyle, many patients refrain from taking appropriate treatment owing to the costs associated with it. According to a study done in the early 2000s, around 2.4 million Indians required a heart surgery annually, but only 60,000 received it. Hospitals today should be focusing on minimizing costs and optimizing productivity. An example of one such hospital is Narayana Health, which combines innovative technology and a highly efficient delivery system across its 31 tertiary hospitals in 19 cities.With a tight focus on efficiency, Narayana Health has achieved savings through the smart use of equipment and telemedicine, connecting around 800 centers to be the world’s largest telemedicine network. Using technology with proper planning has paved the way for this system to treat more than 53,000 patients through telemedicine. In its new spread to the Caribbean, hospital leaders at Narayana Health are trying the use of solar power and importing of supplies from India to run their operations cost-effectively. With such measures being implemented, this health system has performed 12 percent of all cardiac surgeries in India, resulting in patient outcomes that rival those in the United States. Technology helps surgeons quickly develop expertise and work towards better patient outcomes. According to a report by Narayana Health, there have a 1.4 percent mortality rate in the first 30 days of coronary artery bypass graft surgery compared to 1.9 percent in the US.Going by its technology and equipment planning, Narayana Health has added the following as part of its new equipment during 2016-17:
• Da Vinci Surgical Robotic System at MSMC Hospital, Bengaluru. It is used to facilitate complex surgeries, using minimally invasive approach.
• Surgical Operating Microscope with vascular and tumor fluorescence, Model Pentero 900, Make Carl Zeiss for SRCCNH Hospital, Mumbai.
• Low radiation biplane Cath lab system at SRCC Hospital, Mumbai. This will greatly help safety and efficiency of pediatric catheterization.
• A new 128 Slice CT scanner at Jaipur Hospital and SRCC Mumbai each to upgrade the diagnostic services to the next level.
• Installed digital LINAC Accelerator at NSH Howrah to treat cancer patients with external beam radiation technology.With all the latest technology and equipment in place and costs of procedures being minimal, Narayana Health reports a total comprehensive income of rupees 830 million and an increase of 314.5% over the years 2015-16.
Question 1: About how many people in India required heart surgery in the early 2000s?
Select one:
a. 5 million
b. 2.4 million
c. 3.6 million
d. 1 million
Question 2
Advancements in technology have what benefits for hospitals?
Select one:
a. They simplify complex procedures and reduce risk
b. They speed up the treatment of diseases
c. They attract international patients
d. They reduce probability of humar errors in diagnosis
Question 3
How can technology help surgeons?
Select one:
a. Technology helps surgeons quickly develop expertise and work towards better patient outcomes
b. It helps minimize the cost of surgery
c. Sugeons can earn more per operation
d. None of the above
Question 4
How does telemedicine help to reduce cost of medical care?
Select one:
a. Medical experts are able to connect to patients virtually and help them
b. “Actual physical travel of patients and doctors is avoided, thus leading to cost savings”
c. Diagnosis can be done virtually by sharing of reports online
d. All of the above
Question 5
How has Narayana Health benefitted with the correct use of technology?
Select one:
a. It has seen an increase in the incidence of heart disease in India
b. “It has achieved savings through the smart use of equipment and telemedicine,”
c. It is able to treat more international patients
d. It is aiming for lower standards of patient care.
Question 6
What are some ways in which technology has become embedded into hospital structure?
Select one:
a. Telemedicine
b. Hospital Management Systems
c. Imaging equipment like MRIs
d. All of the above
Question 7
What are the challenges of implementing advanced technology is hospitals?
Select one:
a. Patient data is likely to get compromised
b. healthcare workers are more focused on technology and less on patient care
c. Healthcare workers may resist the new processes and refuse to learn how to handle the new technology
d. “Patients face problems, as they have less faith on technology”
Question 8
What has Narayana Health used to connect about 800 hospitals globally?
Select one:
a. Branding
b. Web technology
c. Telemedicine
d. OTC treatment
Question 9
What was the percentage of increase in the comprehensive income of Narayana Health over the years 2015-16?
Select one:
a. 388%
b. 100%
c. 314.50%
d. 50%
Question 10
Why is operational efficiency of paramount importance for a hospital?
Select one:
a. So that all equipment is utilized to the maximum
b. It reduces expenses and helps provide better patient care
c. So that the time spent by healthcare workers is more productive
d. It helps in better planning for patients diagnosis and treatment
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MODULE IV : TECHNOLOGY PLANNING
Pharmacy is the health care service that comprises art, practice and profession of choosing, preparing, storing, compounding and dispensing medicine and medical devices, advising healthcare professional and patients on their safe, effective and efficient use.
The key components of physical planning of a hospital pharmacy include –
• Location
• Size
• Lighting
• Storage Area
• Prescription Area
Location of a hospital pharmacy is ideally on the ground floor of the hospital with storage preferably in the basement. The pharmacy should be readily accessible from the elevator and all areas of the hospital. Every hospital pharmacy should have a separate OPD unit to serve OPD patients. This can ideally be done by having a window access facing outwards for OPD patients and OTC prescription customers, while the main opening could be faced within the hospital facility.
The essential constituents of various areas in a pharmacy include – storage cabinets, standard counters, glass storage shelves, sectional drawer cabinets, cupboards, desk, computer, telephone, list of available drugs and information board.
WHO states that the doctor-population ratio in India is about 1:1218. People appear to rely on alternative health-care professionals, chemists, traditional medicine practitioners, faith healers, etc. to meet their health needs and reduce personal costs. Pharmacists play a crucial role in health care in the community.
With the physical requirements being on one side, a pharmacy can effectively run only in the presence of a qualified pharmacist. The pharmacist working within a hospital pharmacy should be responsible for effective dispensing of drugs. Thorough checking of prescription details should be done in order to avoid dispensing errors.
In a cross-sectional study conducted in Bengaluru in 2016, it was seen that about 19% of pharmacists check for all particulars on the prescription, like patient particulars, date of prescription, drug name, drug dose, frequency, signature of the doctor and registration number of the doctor, before dispensing drugs. The study also showed that the most commonly dispensed OTC drugs were analgesics, contributing to about 90% of all drugs being dispensed. Drugs like antipyretics, antihistamines, antacids follow with 68%, 49% and 46% respectively. Dispensing of drugs without prescription appeared to be common in residential areas compared to commercial areas.
Proper storage and timely discarding of drugs should be done in order to ensure patient safety and drug efficacy. In the study, it was seen that 97% of pharmacies had a refrigerator but 31% of these did not have a power back-up. With frequent power cuts in India, the drugs that are meant to be stored in cool temperatures will be exposed to temperature fluctuations without a power back-up, putting the efficacy of the drug and patient safety at risk. It was also revealed through the study that 62% pharmacies conducted a check for nearing expiry drugs on a monthly basis.
When functioning within a hospital, pharmacy is a major contributing factor towards patient health and safety. As most of the inmates of the hospital depend on the in-house pharmacy for medications, it becomes the responsibility of the pharmacist to dispense drugs with minimal or no errors at all.
Question 1: Does a hospital pharmacy serve only the admitted patients?
Select one:
a. “No, it serves OPD patients as well.”
b. “Yes, that is why a hospital pharmacy is set up”
c. “Yes, a hospital pharmacy serves only patients who undergo surgery”
d. Hospital pharmacy only provides the medicines as ordered by doctors in particular wards; it does not sell directly to patients.
Question 2
Effective dispersal of drugs can be done when:
Select one:
a. The pharmacist checks the expiry date on the drugs he is dispensing
b. The pharmacist checks the prescription thoroughly before dispersing
c. “Drugs are stored safely in the pharmacy, in dry and cool conditions”
d. All of the above
Question 3
The essential parts of a pharmacy are:
Select one:
a. storage cabinets
b. multiple dispersal counters
c. Information about available drugs
d. All of the above
Question 4
What kind of dispensing errors might occur in a pharmacy?
Select one:
a. Fake prescriptions may be fil;led up if the pharmacist does not check the prescription details carefully
b. “Wrong medicine with a similar name, or a wrong dosage may be dispersed”
c. Medicines that are beyond the expiry date may be issued to patients
d. All of the above
Question 5
What percent of antacids were dispensed by pharmacists without a prescription?
Select one:
a. 68%
b. 46%
c. 49%
d. 74%
Question 6
What role do pharmacists play in the Indian healthcare sector?
Select one:
a. They do not play any part in healthcare sector other than dispensing medicines at the pharmacy
b. “They are informal prescribers of medicines for small ailments, as healthcare is expensive in India”
c. They provide regular medical advice in the absence of a doctor
d. People repy more on pharmacists than on a MBBS doctor
Question 7
Where does dispensing of drugs without prescription appear to be common?
Select one:
a. Residential areas
b. Commercial areas
c. Medical camps
d. Hospitals
Question 8
Which of the following is NOT a key component of the physical planning of a hospital pharmacy?
Select one:
a. Location
b. HVAC
c. Lighting
d. Size
Question 9
Which of these are most commonly dispensed without a prescription?
Select one:
a. Antacids
b. Antipyretics
c. Analgesics
d. Antihistamines
Question 10
Which of these is an ideal location of a hospital pharmacy?
Select one:
a. First floor
b. Ground floor
c. Cellar
d. Outside the building
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MODULE V : STRATEGIC PLANNING
Knowledge management, established as a discipline in 1991, is defined as the process of capturing, developing, sharing, and effectively using knowledge. Knowledge management efforts typically concentrate on strategic objectives such as improved performance, competitive advantage, innovation, the sharing of lessons learned, integration, and continuous improvement. Knowledge management it facilitates decision making, stimulates innovation and helps learn from past experiences. A proficient integrated healthcare knowledge management information system (HKMIS) is used in many countries to manage this information. A perfect HKMIS is a triad of three disciplines — Medicine, ICT, and Management.
National Health Management Information Systems (HMIS) was developed by Ministry of Health, Government of Pakistan, in collaboration with the provincial healthcare departments and international agencies during 1990-93 and HMIS was institutionalized in all the provincial healthcare headquarters of the country. Despite all the efforts, this system was not working to its full potential and some of the challenges faced were:
• Reports generated by the facility based HMIS received low priority
• Poor monitoring
• Facility staff looked upon HMIS as an additional workload
Additionally, the scope was limited to the Primary Level healthcare facilities and no data from inpatient/hospital, private care facilities or from the health facilities other than Provincial Health Departments were captured.
A SWOT analysis was done on HKMIS deployed in two public sector healthcare organizations of Pakistan. Hospital A had 1025 healthcare professionals with a total count of 1800 employees in 36 departments. Hospital B had 1225 healthcare professionals with a total count of 2100 employees in 32 departments, with in-patients (A>30000, B>25000 per year) and out-patients (A>1000000, B>900000 per year). Data was collected through various methods, including interviews. Some of the questions revolved around understanding among staff regarding terminologies like knowledge management, HKMIS, and the role, importance and benefits of technology in hospitals, weaknesses of existing HKMIS, opportunities and strategies to improve existing HKMIS and salient threats faced by HKIMS.
Strengths included betterment in:
• Provision of health care services
• Data maintenance and medical errors
• Data storage
• Confidentiality of sensitive information
• Fast communication between stakeholders
• Cost savings
• Access to accurate and relative information
• Productivity of end users
• Availability of timely data and reduced possibility of data loss
• Paperless environment
• Quality and originality of documentation and reporting
Weaknesses included a lack of
• Top management commitment and seriousness
• Competent staff
• Specific and professional training programs
• Professional reporting structure
• E-health services
• Access to internet and collaborative tools/applications
• Interest and professional ethics in learning new systems
• Proper recording of healthcare data
• Accountability and transparency
• Sufficient hardware and software maintenance staff
• Motivation or reward criteria
• Interoperability between service providers and increased costs of IT adoption
Opportunities included improvements in:
• Reporting and data presentation capabilities
• Quality of healthcare services
• Effective and efficient resources utilization procedures
• Support for knowledge management and decision making
• Patients trust and satisfaction
• Human resource management
• Proactive healthcare practices
• Costing and budget analysis for enhanced funds utilization
• Allocation of resources for supporting IT infrastructure
• Unification and integration of Public and Private sector health records
• Training programs and facilities, public awareness and community support programs.
Threats:
• Ineffective and inefficient governance
• High staff turnover rate due to political interventions
• Undue transfers and postings of professional staff
• Patients perceptions on privacy and confidentiality of health data
• Load shedding and electrical surges
• Rapid changes in technology and IT systems
• Unreliable and unrealistic system and reporting requirements
• Data under security and hacking threats
• End users resistance to systems change and implementation
The SWOT analysis brought many external and internal factors to light. Definite steps can be taken to use HKMIS to its full potential and reap its benefits by exploring the opportunities and mitigating the effects of recognized weaknesses and threats, leading to improved quality of care.
Question 1: ” .. is an excellent tool to use in order to identify a performance goal for improvement, identify partners who have accomplished these goals and identify applicable practices to incorporate into a redesign effort.”
Select one:
a. Benchmarking
b. SWOT analysis
c. Balance Scorecard
d. Gap/Capability Analysis
Question 2
A perfect HKMIS is a mix of
Select one:
a. Medicine and ICT
b. ICT and Management
c. “Medicine, ICT and Management”
d. Medicine and Management
Question 3
How did the case study help in the use of HKMIS?
Select one:
a. It gave a list of areas of improvement and the strengths of the HKMIS program
b. It helped build a willingness to implement HKMIS
c. The threats to HKMIS imlementation showed the futility of implementing it
d. None of the above
Question 4
It’sessential for a hospital to take into account the existing organizational structure as well as external factors to determine where it needs to improve its performance or where it needs to focus.
Select one:
a. Sometimes
b. Always
c. Depends on circumstances
d. No
Question 5
Knowledge management efforts typically concentrate on
Select one:
a. improved performance
b. Competitive advantage
c. innovation
d. All of the Above
Question 6
Strategic planning enables an organization to
Select one:
a. Plan its future in an orderly and systematic way
b. ensures that a hospital remains relevant and responsive to patient and community needs
c. Maintain the salaries of its employees at good levels
d. All of the Above
Question 7
What was the outcome of the SWOT analysis?
Select one:
a. Recognised Gaps
b. Discovered Opportunities
c. List Strengths
d. All of the Above
Question 8
Which methods help identify weaknesses in the system
Select one:
a. SWOT Analysis
b. Gap Analysis
c. Both of the above
d. Benchmarking
Question 9
Which tool gives direction to an organization’s future?
Select one:
a. SWOT Analysis
b. Benchmarking
c. Market Analysis
d. All of the above
Question 10
Why was the SWOT analysis done at the public sector hospitals?
Select one:
a. Poor monitoring
b. No data from patner hospitals
c. facility staff looked upon HMIS as an additional workload
d. All of the Above
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ASSIGNMENT 2
In January 2001, a great many hospital buildings across Gujarat were affected during a catastrophic earthquake. Hospital facilities were housed in seismically vulnerable structures and were badly damaged or destroyed. About 167,000 persons were injured and needed immediate medical attention. Emergency medical response was seriously affected and the existing healthcare system in most of the affected regions failed when it was needed most. The widespread damage to hospital buildings and other structures also resulted in significant loss of medicines, supplies, and other medical equipment.
Among the buildings destroyed was the 281-bed Civil Hospital of Bhuj, the largest hospital of the Kachchh district, designated as referral hospital to treat the medical needs of about 1 million people. Collapse of the hospital building killed 172 people (including doctors and para-medical staff) and disrupted all medical services.
One of the lessons learned were that the infrastructure of health care facilities must be earthquake resistant. The new 300-bed hospital, designed with assistance from New Zealand earthquake engineering and completed in 2003, was fitted with a lead-rubber base-isolation system. The 280 lead-rubber bearings were part of the building’s foundations, allowing the structure to remain virtually stationary during an earthquake. The new 30,000m²-hospital was the first building in India to be fitted with the technology and is reputed to be able to withstand a force 10 tremor on the Richter scale.
In the aftermath, the National Disaster Management Authority (NDMA), the Government has formulated comprehensive National Disaster Management Guidelines: Hospital Safety (February 2016). A key objective is to ensure structural safety of hospitals (especially of critical facilities). The provisions laid down are the minimum required standards that shall be adhered to by all healthcare facilities and address both internal and external disasters that are likely to affect hospitals.
The guidelines observe that it is not simply the structural resilience but also operational resilience of hospitals that needs to be addressed. The February 2016 guidelines on Hospital Safety were therefore developed with the vision that all hospitals in India will be structurally and functionally safer from disasters. The usual reason for hospitals being put out of service during emergencies is functional collapse wherein elements that allow a hospital to operate on a day-to-day basis are unable to perform during emergency. These include labs, operating theatres, medical records, medical services, and the administrative process, etc.
The structural components of a healthcare facility comprise the design of buildings, resilience of material used etc. are. The guidelines on structural safety have noted that the Base Isolation System is an expensive technology option, though it is effective to counter the ill-effects of a strong earthquake. The guidelines provide that it may be adopted in important hospitals in seismic zones IV and V, and shall be adopted only when the safety of the hospital building is established by 1) Analytical methods (recommended in the guidelines) and 2) Full scale experimental testing of the base-isolation devices demonstrating that they are capable of resisting expected strong earthquake shaking.
It has also been found that making new hospitals and health facilities safer from disasters is not costly and incorporating mitigation measures into the design and construction of new hospitals accounts for less than 4 percent of the total investment. On the other hand, retrofitting hospital structures is a time-consuming and lengthy process.
The following structural systems have been prohibited for use in new hospitals: 1) Flat-slab buildings, with or without structural walls 2) Pre-stressed floor systems 3) Precast constructions (with natural or man-made materials), in part or whole of the structure 4) Pre-engineered structures in part of the whole of the structure 5) Large cantilever structures and long span structures and 6) Unreinforced masonry buildings.
Structural Elements of all new hospital structures shall be made of Reinforced Concrete and/or Structural Steel, except for structures in seismic zone II, where Reinforced Masonry may be used. Structural Walls shall be made of Reinforced Concrete (RC) and provided in select bays running through the full height of the building, irrespective of choice of material of the basic structural system adopted for the hospital, namely RC or Structural Steel. Structural walls made of steel plates or timber may be allowed in the construction of hospitals only in Seismic Zone II. Even then, safety of such hospital buildings with steel plate or timber structural walls shall be established by a) analytical methods and b) full-scale experimental testing of structural walls.
The provisions are applicable to all healthcare facilities in the government sector and their equivalent counterparts in the private sector. Smaller facilities may choose to adapt relevant sections of the guidelines as per their context and local conditions.
Question 1: Precast constructions
Select one:
a. may be adopted only in new buildings
b. are prohibited in new buildings
c. may be adopted is seismic zone II
d. may be adopted only after full-scale experimental testing
Question 2
Reinforced masonry
Select one:
a. may be used only in new buildings
b. is prohibited in new buildings
c. may be used in seismic zone II
d. may be adopted only after full-scale experimental testing
Question 3
Retrofitting hospital structures to make them safe during a disaster
Select one:
a. is a less expensive option than building a new hospital based on the new structural recommendations
b. accounts for less than 4 percent of the total investment of a new hospital
c. is costlier and time-consuming
d. is prohibited
Question 4
Structural walls in hospitals shall be made of
Select one:
a. reinforced concrete (RC) and/or structural steel
b. steel plates or timber if safety has been established
c. “unreinforced masonry, if safety has been established by full-scale experimental testing “
d. none of these
Question 5
Structural walls made of steel plates or timber may be allowed in
Select one:
a. the construction of hospitals only in Seismic Zone II
b. Retrofitting of existing hospitals
c. Government hospitals
d. Private hospitals
Question 6
The following structural systems are recommended in new hospitals
Select one:
a. pre-stressed floor systems
b. pre-engineered structures in part of the whole of the structure
c. flat-slab buildings
d. reinforced concrete
Question 7
The NDMA guidelines (2016) provide that lead-rubber base isolation systems:
Select one:
a. Are prohibited in new buildings
b. May be adopted in seismic zones IV and V
c. May be adopted only in seismic zone II
d. Are permissible only where existing buildings require structural changes
Question 8
The NDMA guidelines address
Select one:
a. earthquake-resistance only
b. fire-resistance and non-structural vulnerabilities only
c. external disasters only
d. both external and internal disasters
Question 9
The NDMA guidelines are not applicable to hospitals in:
Select one:
a. the government sector
b. the private sector
c. smaller facilities
d. hospitals not in seismic zones
Question 10
The overall safety of a health facility is determined by:
Select one:
a. “structural elements, eg. building design, etc”
b. “non-structural elements, eg, architectural finishes inside, equipment, etc”
c. both structural and non-structural elements
d. earthquake-resistance and fire resistance
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