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Academy of Hospital
Administration, Kolkata Chapter
Hospital Architectural Planning
and Designing - Part 5
Prof (Col) Dr R N Basu
Adviser
Quality and Academics
Hospital Planning and Management
Medica Superspecialty Hospital
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Equipment Planning and Installation
• Most equipment have substantial utilities and
installation requirements
– These requirements impact the design and
engineering of healthcare facilities
– Some of these equipment such as for radiology
department or operation theatre has
considerable lead time
– In many instances the space and utilities are
driven by a specific manufacturer’s requirement.
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Equipment Planning and Installation
• Equipment has profound effect on architectural design
of hospital
• Space and functional requirement of equipment varies
with manufacturer and model
• It is, therefore, necessary to finalise the equipment list
and their make, model and vendor early
– It is preferable that the list is finalised and signed off by
the equipment planning team
– Typically, equipment planning should commence no later
than the project’s design development phase
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Equipment Planning and Installation
• Equipment has profound effect on architectural design
of hospital
• Space and functional requirement of equipment varies
with manufacturer and model
• It is, therefore, necessary to finalise the equipment list
and their make, model and vendor early
– It is preferable that the list is finalised and signed off by
the equipment planning team
– Typically, equipment planning should commence no later
than the project’s design development phase
Equipment Planning and Installation
• Equipment List
– An equipment list shall be included in the contract
documents to assist in overall coordination of:
• Acquisition
• Installation, and
• Relocation of equipment
– The equipment list shall show all items of equipment
necessary to operate the facility
– The list shall include classification of equipment
Equipment Planning and Installation
• Most equipment have substantial utilities and
installation requirements
– These requirements impact the design and
engineering of healthcare facilities
– Some of these equipment such as for radiology
department or operation theatre has
considerable lead time
– In many instances the space and utilities are
driven by a specific manufacturer’s requirement.
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Equipment Planning and Installation

• Drawing Requirement
– The drawings shall indicate provisions for installation of fixed or movable
equipment
– These equipment are those which require dedicated building services or
special structure
• Not in-contract Equipment
– Some equipment may not be included in the construction contract
– Out of these equipment some may require mechanical or electrical
service connection or construction modification
– These equipment should be identified on the design development
document
– These will also be shown on construction document

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Commissioning a Healthcare Facility

Commissioning a Healthcare Facility
• The commissioning of Healthcare facility embraces two
distinct tasks
• Upon completion of construction, the facility – The Technical Commissioning of the Facility
must be brought into use • This involves commissioning of the buildings, services, and
equipment
• Commissioning is a complex task • The commissioning is to ensure that it complies with the quality and
performance specifications and that all systems operate
• Commissioning should ensure a smooth satisfactorily
– The Operational Commissioning of the facility
transition to the new working arrangement • It covers the process of preparing to operate the completed facility

• It also should realize the anticipated benefits • To provide the healthcare services for which it was designed, and
• Maintain and operate the building services

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Technical Commissioning Technical Commissioning

• Its requirements will have been considered in the • The Project Manager will coordinate them with overall
design stage project programme
• The requirements shall have been included in the – It will be accepted if satisfactory else will be returned to
specifications for construction and equipment them for amendment
contracts – It will be ensured that the programme is coordinated with
• It is important that the performance of equipment and the operational commissioning
of M and E services are specified adequately • Inspection and Testing
• The Project Manager should require the contractors – Completeness and quality of building work should comply
and suppliers to provide commissioning programmes with specification
– This should include date, time and method of – Equipment and systems to be tested for satisfactory
commissioning operation and compliance with specified performance
criteria
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Technical Commissioning Technical Commissioning

– Important Element of the Process are:
• Testing Integrated Systems
– This may comprise components from several sources
– This is to ensure that the system as a whole performs
satisfactorily
• Maintaining Records of Inspections and of
commissioning test results
– This is to be maintained as a permanent record
• Listing minor defects which do not prevent the
facility from being used satisfactorily
– Completion certificate may be issued
– The list to be attached to the completion certificate
– These are to be rectified later
• Ensuring that only those items not conforming to
specifications are considered as unacceptable

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Technical Commissioning Operational Commissioning

• Organising the Commissioning Process
• Other Deliverables – This must flow from the organisation of the construction project
• A contract is complete when all the specified deliverables have – A commissioning manager is to be appointed
been supplied
• The manager can be from the existing resource of the construction
• Typically these are: organisation or can be a new person
– Equipment spare parts – Appointment of the commissioning team
– Operating and Maintenance Manuals, and • The team should operate under the commissioning manager
– As-built drawings • The members should be drawn from the users of the healthcare
facility on a representative basis
• Following should be observed:
• Should include members of medical, nursing, operational
– The above items should be included in the contract management, finance , personnel, equipping, estate and other staff
– Their receipt should be made a condition of a Certificate of Completion as necessary

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Operational Commissioning Operational Commissioning

– Role of the commissioning team
• The team should support the commissioning
manager in bringing the building into use
• The team to ensure that the business objectives
of the scheme are delivered
– The Commissioning Process Will include
• Drafting operational procedures
• Establishing base line and future staffing profiles
• Establishing baseline and future revenue budget
• Establishing equipping requirements
• Identifying staff training needs, and
• Establishing details of the occupation programme
for that user function, for incorporating into the
overall Commissioning Master Plan

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Operational Commissioning Operational Commissioning

• The Commissioning Master plan
– The master plan shall
• Obtaining various licences, NOCs from concerned departments
• Selecting vendors for outsourced services
• Identify key dates for occupying or bringing the facility into use
– This may be undertaken in a phased manner
• Identify key tasks in the occupation and transfer process and
assign responsibility
• Identify critical path for an integrated transfer of functions
– This should address clinical needs and functional interdependencies
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– Identify key dates for selecting and ordering
equipment
– Identify any closures and arrangements for
security and disposal of sites, if relevant
– Ensure that there is no disruption to patient
services, and
– Identify a staff recruitment, transfer and
counseling programme
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Operational Commissioning
• Handover to Operation Management
– The Commissioning Team should be in place for at least
three months after the facility is brought into use
• The team and the commissioning manager should be available
to deal with issues which arise from occupation and use of the
new facility
• Official Opening
– Should be undertaken about 3 to 6 months after full
occupation has been achieved
– This provides an opportunity for staff to become used to
their new working environment

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Shakedown Period Shakedown Period

• A well planned hospital passes from the construction
stage to commissioning stage
– The transition may be smooth
• Provided adequate thought has gone into aspects of planning,
equipment, development of systems and processes and
training
– After commissioning, hospital’s staff, patients, community,
building, facilities and environment interact and adjust
with each other
– This continues until the hospital settles into its usual
routine
• There is a period from the time of commissioning till it
settles down into a satisfactorily functioning entity
– This period is called “ Shake-down period”
• This period can be shorter if adequate time and
thought have gone into planning and execution
– The period may last from a few months to a year
• This period will identify the necessity of additions,
alterations and modifications
– Staffing schedule may need readjustment

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Flexibility in Hospital Infrastructure

• Hospital infrastructure is typically designed for a life span of more
than 30 years
• During this time, demands on the infrastructure will change
significantly and unpredictably
Bottleneck- • This demand on infrastructure is due to

scope for future expansions – Demographic changes

– Changing epidemiological patterns
– Unforeseeable advances in medical technology, and
– Rapid regulatory changes
• As a result, scale and scope of demand on any individual hospital
over its lifetime becomes highly uncertain
• A hospital infrastructure, therefore, needs to be flexible
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Flexibility in Hospital Infrastructure Flexibility in Hospital Infrastructure

• Examples of design features that make hospital building • Some building components need
flexible are:
consideration for flexibility in hospital design
– Shell space
• These spaces are built but not yet medically equipped
– Column Grid
– Suitable structural foundations • In general, wider column spacing allows for more
• This is for allowing additional floors later
flexibility in the future
– It comes with wider and deeper columns and beams
• Such flexibilities can be used to expand capacity in future in
response to increased demand, if any – Floor-to-Floor Height
• If demand is lower than anticipated • In most cases, mechanical duct size, imaging
– It is important to be able to downsize equipment, manufacturers requirements and special
• E.g., by sub-letting or selling part of the infrastructure for other shielding details require higher floor-to-floor height
purposes
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Flexibility in Hospital Infrastructure Flexibility in Hospital Infrastructure

– Ceiling Space • These elements are costly and difficult to relocate in
the future
• Besides increased floor-to-floor height , extra ceiling
space on a few additional floors is helpful. – Their location affects the flexibility in future

– This shall allow rooms to be easily converted into • It is preferable to locate them in such a way that they
departments such as ORs. Imaging or special treatment make up larger more continuous space and do not
floors, fragment floor space
– This will obviate need for costly structural modifications
– Extra Mechanical and Electrical Capacity
– Core Location • The following shall allow for easier future expansion
• Typically, elevators, stairs, electrical rooms, – Increased electrical and mechanical capacity
telephone/data rooms and mechanical shafts – Flexible structural design with capability for additional
compose the core of building floor penetrations and weights

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Flexibility and Expandability

• For expandability the hospital should:
– Follow modular concepts of space planning and
layout
– Use generic room sizes and plans as much as possible
– Be served by modular, easily accessed and easily
modified mechanical and electrical systems
– Be open ended, with well planned directions of future
expansion
– Placing soft spaces such as administrative
departments, adjacent to hard spaces such as clinical
laboratories
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Bibliography Bibliography
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%20Alan%20Bachban%20RFP%20Request%20example%203.pdf
2. JCAHO. Guiding Principles for the Development of the Hospital
of the Future 6. AIA. Design Development. http://www.ncarb.org/Experience-Through-
Internships/IDP2-Experience-Categories-Areas/2-Design-Development.aspx
3. Concept Architectural Design. 7. Wiki. Working Drawing.
https://www.designingbuildings.co.uk/wiki/Concept_architect http://www.designingbuildings.co.uk/wiki/Working_drawing
ural_design 8. IS 7973 (1976): Code of practice for architectural and building working drawings
[CED 51
4. AIA Best Practices. Defining the Architect’s Basic Services. : Planning, Housing and pre-fabricated construction]
http://www.aia.org/aiaucmp/groups/secure/documents/pdf/ai
9. Wiki. Contract documents for construction.
ap026834.pdf https://www.designingbuildings.co.uk/wiki/Contract_documents_for_construction

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10. Wiki. Tender Process for

construction. http://www.designingbuildings.co.uk/wiki/Tender_process
es_for_construction_contracts
11. Bureau of Indian Standards. National Building Code 2005
12. Larry Lord, AIA. Commissioning. Excerpt from The Architect’s Handbook of
professional Practice, 13th edition ©2000

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