GROUP DISCUSSION

ON
Planning and Organizing Hospital Units and Ancillary Services

SUBJECT: NURSING MANAGEMENT

SUBMITTED TO: SUBMITTED BY:
Mrs. Rittika Priya Kumari
Assistant Professor M.Sc Nursing 2nd Year
Obstetric and Gynecological Nursing, Child Health Nursing
NSCN, Palampur Roll No. 08

SUBMITTED ON :
BACKGROUND OF INFORMATION

Title of course - M.Sc. Nursing 2nd Year

Unit - 4th Unit

Name of teacher - Priya Kumari

Topic - Planning and Organizing Hospital Units and Ancillary Services

Duration - 1hr& 20min.

Date and time

Place - Classroom

Methods of teaching - Lecture cum discussion

Total students - 15

AV-Aids - PPT , Pamphlets , Blackboard

Name of evaluator - Ms. Ruhi Gupta

Previous background of trainees - students has a little knowledge about the topic ( yes/ no)

By the end of this lecture students will gain knowledge, attitude, skills, practice about the “ Planning and Organizing Hospital Units and Ancillary
Services”.

At the end of lecture students will be able to:

Sr. Time Specific Content Matter Methods Teaching Evaluation
No Objective of teaching Learning
(AV-Aids) Methods
1. 20 To introduce Today’s topic for presentation is “ Planning and Organizing Hospital Units - - Topic is
sec. the topic and Ancillary Services”. introduced.

2. 30 To assess the Previous knowledge assessment: - - -

sec. previous Do you have an idea about Planning and Organizing Hospital Units and
knowledge of Ancillary Services.
students
3. 2min. To introduce
topic Introduction.
• A hospital is a human invention, and as such can be reinvented at any
time.
• Hospitals design has been subject to many changes over the past 100
years or so in both layout and size.
• In the early 20thcentury hospitals were basically places where the very - - -
sick spent their last days. But today, emerging concepts of a
hospital are calling for designs that promote wellness and
wellbeing rather than merely the treatment of diseases.
• Health care organization, medical and pharmaceutical
advances and medical technology developments and patient
expectations are continuously changing at a fast pace.
• The implications of these changes on the planning and design of
health care facilities are direct and evident and the design response
to them manifests itself in emerging planning concepts and ideas.

4. To explain
about planning PLANNING AND ORGANIZATION OF HOSPITAL UNITS
and A hospital is responsible to render an essential service.
organization of In fulfilling this responsibility, hospital planning should be guided by
hospital units certain universally acknowledged principles.
and its aims The principles are usually irrespective of the level of planning , i.e. whether
at national level , state level or individual hospital level.

Aims of Hospital Planning :

• Modernizationof the already existing facilities.
• To increase population coverage
• To increase productivity of hospital
• To reduce the cost of operations and maximize efficiency of services
• To increase utilization of hospital facilities
5. To explain Guiding Prnciples In Planning :
about guiding  Patient care of high quality : it can be achieved by the hospital
principles in through adopting following measures:
planning  Provision of appropriate technical equipments and supplies.
  An organizational sturucture that assigns responsibility and
requires accountability for various functions within the
organization.
 A continuous review of adequacy of care provided by
physicians, nursing staffs and paramedical personnel.
 Effective community orientation : this should be achieved by the
hospital by adopting following measures:-
 A govering board made up of persons who have demonstrated
concerns for community and leadership ability.
 Policies that assure availability of services to all people.
 Participation of the hospital in community programmes to
provide preventive care.
 Economic viability : this is achieved by adopting measures like:-
 A corporate organization that accepts responsibility for sound
financial management in keeping with desirable quality of
care.
 An annual budget plan that will permit the hospital to keep
pace with times.
 Orderely planning: it should be achieved by the hospital by
following:-
 Acceptance by the hospital administrator pf primary
responsibility for short and long-range planning with support
and assistance from competent financial, organizational and
functional advisors.
 Preparation of a functional programme that describes theshot
range objectives and facilities, eqipments and staffing
necessary to achieve them.
 Sound architectural plan: it is achieved by the following:-
 Selection of a site large enough to provide for future expansion
and accessibility of population.
 Recognition of the need of uncluttered traffic patterns within
for movement of staff, patients and visitors and efficient
transportation of supplies.
 Medical technology and planning:
 Development in medical technology is taking place so rapidly
that now the use of sophisticated technology is taking place so
 rapidly that now the use of sophisticated technology
determines the professional status.

7. To describe HOSPITAL PLANNING PROCESS

about hospital
planning Conceptualization of hospital:
process Here the imagination or idea of the originator takes into a practical shape, and
compares his dreams with the existing hospitals of country or outside world,
tries to fit dreams into any such project.

Support groups: Once the idea is developed, the entrepreneur, discuss

project,and then finds support groups to join hands and complete the project.
Temporary organization and securing funds:
A group should be formalized called as a hospital trust, which must be
registered under the society‟s act or companies act.
 The originator is the chairman and others are members who are assigned
different tasks.
 A detailed work out as to how much capital will be required for establishing
the hospital.
• Geographical, environmental and miscellaneous factors:
 Meteorological information:
o temperature, rainfall, humidityGeographical information: existing road and
rail communications, susceptibility to quakes/floods, building height
restrictions due to proximity of airports.
 Miscellaneous availability:
o trained manpower, water, sewage disposal.
Hospital Design:
Bed planning: it should be realized that the hospitals are not only
utilized by the population in the vicinity but also will constitute the
indirect population in the larger catchment area. About 85% bed occupancy is
considered optimum.
Hospital size: as a very large hospital of 1000 beds or more becomes
extremely unwidely to operate, and a small hospital of 50 or less are not
profitable. From functional efficiency point of view, it is advisable to plan two
separate hospitals of 400 beds, each with a scope of future expansion, rather
 than a single one of 800 beds.

• Land requirements: in rural and semi-urban areas, plentiful land may be

available permitting the hospital to grow horizontally, whereas in urban areas
there will always be great premium on land and only avenue will be a vertical
growth.

Public utilities: the national building code of ISI suggests 455 liters of
water per consumer per day (LPCD) for hospitals upto 100 beds and 340
LPCD for hospitals of 100 beds and over.

 Additional availability of water in case, staff quarters and nurse‟s

hostel are a part of hospital campus.

 The hospital sewage disposal is connected to the public sewage

disposal system, otherwise it needs to build and operate its own sewage
disposal plant.

 It is preferable that power supply should be available on a multi-grid

instead of uni-grid system in general use, to ensure a continuous supply
of electricity to hospital at all times. Electricity requirement is 1 KW
per bed per day2.
 Approval of plan by the local authorities: once the detailed plan has
been formulated, the local bodies are consulted and persuaded for
 approval of plans.
 Circulation routes: the utility and success of hospital plans depend on
the circulation routes on hospital site and within building.
There are two types of circulation in the hospital :-
 INTERNAL CIRCULATION .....the circulation space involves
corridors, stairways and lifts.Corridors with less than 8 ft. Width
are not desirable in hospitals and protective corner
beading is a necessity in hospital corridors.
 EXTERNAL CIRCULATION .....only one entrance to the hospital
for vehicular traffic from the main road is desirable.The entrance
and exit points should be wide enough to take two lanes of, one
traffic entry for clarity of all visiting traffic and one exit for security
from administrative view point.
 Distances, compactness, parking and landscaping:

 Distances must be minimized for all movements of patients,

medical, nursing and other staff, for supplies aiming at minimum of
time and motion.
 Functional efficiency depends on the compactness of the hospital
which is achieved by constructing multistoriedas they are
convenient due to compactness as compared to horizontal
development of hospital which demands more land involving extra
costs and installation of services, roads, water supply, sewage etc
 One car parking space per 2 beds is desirable in metropolitan
towns, lesser in smaller urban areas while much less in semi-
urban and rural areas.Separate parking for 3-5wheelers and
scooters, employees and staff parking areas separate from public
parking should be considered.
Zonal distribution and inter-relationship of departments:
 the departments which come in close contact with the public (e.g.
outpatient department, emergency and casualty) should be isolated
from the main in patient areas and allotted areas closer to the main
entrance.

 The supportive services like X-ray and laboratory services need

to be located near the OPD‟s.
  From the main entrance should be main inpatient zone consisting of
ICU, wards, OT and delivery suit.

 The other supportive and clinico-administrative department in the

hospital consists of hospital stores, kitchen and dietary
department, pharmacy etc.these departments should be preferably
grouped around a service core area.

 Gross space requirements: gross total area (building gross)-

 Distances must be minimized for all movements of patients,

medical, nursing and other staff, for supplies aiming at minimum of
time and motion.
 Functional efficiency depends on the compactness of the hospital
which is achieved by constructing multistoriedas they are convenient
due to compactness as compared to horizontal development of hospital
which demands more land involving extra costs and installation of
services, roads, water supply, sewage etc
 One car parking space per 2 beds is desirable in metropolitan
towns, lesser in smaller urban areas while much less in semi-
urban and rural areas.Separate parking for 3-5wheelers and scooters,
employees and staff parking areas separate from public parking should
be considered.
 Zonal distribution and inter-relationship of departments: the
departments which come in close contact with the public (e.g. outpatient
department, emergency and casualty) should be isolated from the main in
patient areas and allotted areas closer to the main entrance.

 The supportive services like X-ray and laboratory services need

to be located near the OPD‟s.

 From the main entrance should be main inpatient zone consisting of

ICU, wards, OT and delivery suit.
 The other supportive and clinico-administrative department in the
hospital consists of hospital stores, kitchen and dietary
department, pharmacy etc.these departments should be preferably
grouped around a service core area.
 Gross space requirements: gross total area (building gross)-
 Physical Plant .....It includes lifts, refrigeration and air-
conditioning, incinerators, boilers, kitchen equipments, mechanical
laundry, central oxygen etc.
 Hospital furniture and appliances..... Beds,stretchers,trolleys,
bedside lockers, movable screens, operation tables,instrument
trolleys etc.
 General purpose furnitures and appliances....... It includes office
machines (typewriters, calculators,filing system, and computers),
office furniture, crockery and cutlery.
 Therapeutic and diagnostic equipments.......... It includes
equipments for general use (BP instruments, suction machines,
glassware washers etc.) and equipment interacting with patients
during diagnostic and therapeutic procedures ( defibrillators, X-
ray machines etc.)

Cost evaluation of construction of hospital:

The most commom method of estimating the cost is on the basis of per
bedcost. It will also vary in type of facilities the hospital provides, like
teaching, training and research facilities.

8. To explain OUTPATIENT DEPARTMENT

about
outpatient Outpatient department is the one where all patients except those who require
department its emergency treatment, come for service in the hospital.
planning and
organization Planning and organization of the OPD...........

 Location: It should be easily accessible to those who come for outside, and
should be a separate wing for OPD attached to the hospital accessible from the
main entrance to the hospital with direct approach from the main road.
 Space: The space requirement will depend upon the land available and
location of the hospital.
• Generally 0.66-1 sq ft area per annual outpatient attendance should
be provided for OPD.
• If there are 3 lakhs visit in a year, the total space requirement for
 OPD will be 2-3 lakh sq ft or 4.5-6.8 acres.
 Size: The size of OPD depends upon the volume of attendance, clinics
provided and extent of facilities like bloodbank, emergency department.
9. To explain
about different ZONES OF OPD:-
zones of OPD
Functional Zone: This zone is mainly used by the patients attending the
OPD, attendants and relatives.This area includes parking area, entrance
hall, waiting space, enquiry and registration, and medical social services.

Administrative Zone: This zone is required in a large hospital to plan,

organize, supervise, evaluate and co-ordinate the facilities being provided.
The various functional units of this zone are:
 Office of the OPD in-charge
 Administrative control nurses station
 Cash counters
 Medical record room
Diagnostic And Supportive Zone: The various functional units in this area
are:
 Clinical laboratory
 Imaging section
Ambulatory Zone: This is a zone where the patients come in direct contact
with the doctors and paramedical staff for consultancies, advice and
treatment.
It includes units like:
 Clinics for various medical disciplines
 Pharmacy
 Treatment room
 Minor OT
Staff Zone: This zone is used exclusively by the staff members only. It includes
duty rooms, stores, housekeeping and conference room

10. To explain
functional Functional Management Of OPD...................
 management of
OPD o OPD timings: It is recommended that OPD shall work 6 days in a
week with facilities of morning and evening clinics.The morning
timings is usually from 8am- 12 pm, whereas the evening hours
shall be from 3pm to 5 pm, and specialty clinics from 2 pm to
4pm. overcrowding and waiting time of the patients and relatives must
be minimized.

o Records: A unit record system combining both in-patientsrecord and

continuousout patient record is recommended.

o Public relations: Public complaints can be minimized and defused

through public relations, the entire staff of OPD including public
relations persons should act as agents

12. To explain STAFFING OF OPD............ It includes

staffing of  Medical sta ff (consultant, professor, senior lecturers,
OPD medical officers, residents, junior and senior
should be available)
 Nursing staff (usually one nurse/OPD/clinic)
 Paramedical staff (for injection room, dressing room,
registration and MRD),
 Receptionists
 Medico Social Work

13. To explain
types of wards PLANNING AND ORANIZATION OF WARDS
and its
planning and A ward is the most important part of hospital where the sick persons are
organization kept for supervised treatment.
It is also a nodal point for research in medicine and nursing field,
training and teaching of medical, nursing and paramedical personnel.

TYPES OF WARDS:
A. General wards: In these wards, patients with non-specific ailments,
requiring no life saving care are admitted. The nurse patient ratio of 1:5
 in big wards, and catering to the patient‟s routine investigation,
treatment and care needs.
B. Specific wards: These include patients admitted for specific care
due to illness orsocial reasons. It includes:
 Emergency ward
 Intensive care unit
 Intensive coronary care unit
 Nursery
 Special septic nursery
 Burns ward
 Post operative ward
 Post natal ward
C. Units with specialist nursing, treatment and equipment:Wards
like burn ward, transplant ward functions at national or regional center
where particular service skills are concentrated.

14. To explain WARD PLANNING

about ward 1.. PHYSICAL FACILITIES: It includes
planning Size of the ward depends on-types of patient (an area of 100-120 sq
ft/bed is required and smaller rooms of 2-4 beds are preferable),

 Requirement of ward staff (a small ward will have same

requirement throughout the day, helped by a head nurse and a clerk for
administrative and clerical responsibilities).

Patient area
This is an area where patients are kept for treatment.

 The area per bed within the ward is 80sq ft/bed but in acute ward it is
100 sq ft/bed
 Space left between two rows of bed is 5ft.
1/2
 Distance between two bedsis 3 To 4 ft.
 Clearance between wall and side of bed is 2ft.
 Length of bed is 6’’, width of the bed is 3’’.
 Size of rooms
 Single bed room should have a size of 125 sq ft/bed
 2 bed room 160 sq ft/bed
 4 bed room 320 sq ft/bed
 6 bed room 400 sq ft/bed
 ICU 120-150 sq ft/bed
 Obstetrics and orthopedics 120 sq ft

To explain Support service area. This section of ward includes

about ward
planning Nursing station/duty room: It should be located at such a place
that the time taken by a nurse for moving from one place to another
is limited.Centralizelocation is desirable.
Treatment room: The room is meant for examination of patients and
should be equipped with examination table, spotlight, dressing
material, hand washing facility etc.
Clean work room: It is a working room for staff nurses in
nursing unit, contains work benches for preparation of trays, care
of materials, equipments and supplies etc.
Pantry: It is a place where the dishes are cleaned, washed and stored.
Unit store: it is meant for storing the supplies and linens.
Sanitary area: it includes baths and toilets, dirty utility room,
store for sweepers etc.
Auxillary areas:
this section includes duty room for doctors, clinical side room, seminar
room, attendant room, locker room for staff.
To explain
about ward 2. .WARD DESIGN:
planning and
The primary objective of a ward design is to facilitate the nurse to hear and see
ward
everything in the ward and to enable the patients to easily call the nurse
management
when need help.
a.) Open Ward:- beds are placed in rows facing each other and nursing
station in the center of the hall.
b) Rigg’s Ward :- 3-4 beds are placed parallel to the windows in open bays
separated from each other by low partition.
c) Rigg’s Unilateral Ward:- side beds are placed in each side bay separated
from nurse‟s station with its standby services by a common corridor.
d) Bilateral Rigg’s Ward:- workable conditions, two unilateral rigg’s wards
are on either side of a central nursing station.
e) T- Shaped Ward:- bed bays are placed in front of nursing station and
critical patients bays are in front of nursing station.Isolation bays are at both
sides and ancillary and other service areas are behind the nursing station.
WARD MANAGEMENT It is the optimal utilization of the ward resources
to produce maximum output, namely care and comfort of patients. It includes:
1. Strategic Management........Responsibility of giving a strategic direction to
a ward lies within the nursing unit set up in each ward.Strategy formulation for
ward has to be done in the context and parameters defined by the strategy,
direction, resources and constraints of hospital.
2.Operational Management........Where as strategic management gives an
anchor and direction, operational management works towards the strategy.The
responsibility of
operational management of a ward rests with the ward head nurse/ nursing unit
with the help of other ward personnel like ward clerk.It includes
objectives of providing comfort and good care to the patients and long term
objective of improvement and establishment of systems in functioning of the
ward.
18. To explain
about CSSD its CENTRAL S UPPLY SERVICE
planning and DEPARTMENT (CSSD)
organization
 A CSSD is a department that furnishes all supplies required for the
nursing units and departments of a hospital-theatres, wards, out-
patient and casualty departments with complete, sterile equipment
ready and available for immediate treatment of patients.
 These supplies include sterile linens, sterile kits, operating room
packs, needles, syringes and other medical surgical supplies. In
addition, the personnelin this department clean, inspect, repair,
assemble, wrap and sterilize special treatment trays for various
nursing units.
Planning and Organizational Consideration of CSSD .
The CSSD should be planned all hospital above 100 beds.
 Theatre sterile supply unit(TSSU)is to meet emergent and large requirement of
OT and is established inside OT complex.
 In large hospitals like 500beds and above, TSSU is established in addition to
the CSSD in service area.

The following areas are to be provided in CSSD:

Equipment storage room
Receiving counter and clean up room
Needles and syringes processing room
Gloves assembling room with rubber goods processing room
gauze and dressing assembly area
Clean work area including sterilizers
Sterile storage area and issue counter

Percentage distribution of the space is as follows:

Clean area including sterilization-40%
 Sterile storage area-15%
Equipment storage-14%
Fluids, needles and syringes-14%
Receiving and clean up area-12%
Glove processing area-5 to 7%
Additional 25% space located for future expansion
LAYOUT:
 Location should be where the most rapid means of transportation of
supplies and equipment is possible.
 There should be avoidance of back tracking of sterile goods.
 There should be a continuous flow of equipment from the relieving
counter to the dispensing counter.
 The contamination of sterile goods should be avoided.
 Sterilizing area should be the last area before the sterile
storage and dispensing counter.

 The receipt and issue counters are separated by a corridor

to avoid contamination.
Area Requirements

It is recommended that the area of 1.64 sq.m/bed for a CSSD would be

appropriate up to 400 bedded hospitals, and for more than 400 beds an
area of 1 sq.m/bed would be sufficient.

The Manual of IGNOU has recommended following functional area for a 100
bedded hospitals
19. To explain Staffing Pattern
about staffing One CSSD worker per 30beds plus one supervisor is
pattern of recommended. In 200-300 bedded
CSSD hospital, need 10-15 persons.

Staff for 1000 bedded hospitals is:

 Supervisor –1(senior most and trained technician)
 Asst. Supervisor-one of the senior technician
 Technicians –6 (promoted attendants)
 Sweepers-15
 Clerk-1
Equipments and Materials Required
 Hot and cold running water
 Cleaning brushes and jet water gadgets
  Ultrasonic washers
 Hot air oven for drying instruments and sterilization
 Globe processing unit
 Instrument sharpener like needle sharpening machines
 Stem sterilizers and boiler for steam
 Autoclaves of various sizes including gas autoclave
 Testing equipment
 Chemicals to clean materials
 Wall fixtures like sinks, taps
 Trolleys for supply of sterilized items and
separate trolleys for collection of used items are
needed

20. Explain about

methods of METHODS OF STERILIZATION
sterlization and Sterilization is a process of freeing an article from all living
inventory organisms including bacteria, fungus, using dry or wet heat ,
management chemicals or irradiation.
1. Steam sterilization: autoclaving is the commonest method
2. Hot air sterilization:Vaseline and oils cannot be sterilized with
steam.These items are exposed to hot air to 160-1800c for 40 minutes.
3. Gas sterilization with ethylene oxide
4. Sub atmospheric pressure sterilization with formalin: it is meant to
disinfect instruments like endoscopes. The temperature required is
900c for 10-30 minutes.
5. Chemical sterilization with activated glutaraldehyde
6. Gamma irradiation sterilization: it is used for disposable goods but is a
costly method.
7. Formaldehyde steam sterilization
Inventory Management
Stock... To ensure the availability of sterilized items to the hospital units,
five times the average daily requirements. The replacement and procurement
of condemned items should be laid out so that situation of „stock out‟ can be
avoided.
Issue of materials.... The principle of „first in-first out‟ ensures proper
rotation of supplies in CSSD and prevents any item from being kept for
longer time so that its sterilization date expires.

Distribution of sterile items.........

Grocery system: in case CSSD is open 24 hrs, wards and
departments can send requisition to CSSD and stock is supplied
accordingly.
CSSD is open for limited hours:

 Clean for dirty exchange system: one clean item is provided for each item
in the ward used.

 Milk round system: it includes daily topping up of each ward/

department stock level to a pre determined level decided by users.

 Basket system: a basket with daily requirement of ward is changed

everyday irrespective sterile items used or not, and the items of the
whole basket is sterilized every day.
 In case the items are to be stocked in wards, the date of sterilization is
written on each item so that the unused items are returned to CSSD for
re-sterilization after 72 hrs.

Quality Control Methods

• Routine temperature/pressure and holding time testing of each autoclave.
• Steam clox is also very handy and reliable. Changes color from brown
to green

• Heat/time, moisture sensitive tapes may be used in same way as that

of steam clox
 • Random samplings of sterilized items are also tested in laboratory
• Culture of wall/floor and scrapings.

21. To explain
laundry its LAUNDRY SERVICES
functions and
types Functions of Laundry

• Control of cross infection: it reduces the chances of cross infection.

• Patient satisfaction: the patient likes to have clean linen which is

changed and washed frequently and has a psychological effect on
patient.
• Public relation: the image of hospital also depends on clean look
of linen as it instills confidence in patients and relatives

Types of Laundry

1. In plant or in house system.... the hospital has its own linen and laundry
and all activities of the hospital laundry services are done in hospital
premises. A hospital with more than 100 beds can run this type of laundry
services.
2. Rental sytem........ is used in advanced western countries. The owner of the
linen is also the supplier of linens to the hospitals and is also responsible
for the replacement as well as the laundering of patients and staff linen.
3. Contract system....... India, all hospitals have their own linen, majority
of the hospitals get the laundering done by contract dhobis. In some
cases, a subsidized contract type is prevalent and in some cases, the
hospitals provide water and washing area within the hospital premises.
4. Co-operative system..... is most beneficial to the smaller hospitals than the
large hospitals as the share the service of highly qualified laundry services

23. To explain
planning and Planning And Organization of Laundry Services
organization of
 Laundry Location :-If possible the laundry should be in the same building as the
services hospital, and should have separate entrance and exit areas. It is
recommended to have a mechanized laundry in the basement, with proper
drainage arrangements.

Space requirements:- requirement for any laundry services has been

worked out to be approx. 10-15 sq.ft./bed.

Laundry is divided into two distinct areas:

 Dirty area: It comprises of
 Reception of solid linen
 Sorting of soiled linen into suitable quantities for processing

 Clean area: It comprises of

o drying
o Finishing
o Discharge
o a barrier wall between the clean and dirty area is desirable

24. To explain LAUNDRY MANAGEMENT

about
management of The management of laundry contributes to morale of the staff and
laundry patients with fresh laundered linen
1. Sequence of Operation:

 Collection of laundry by laundry staffs in trolley with clean and

dirty linen separatelyand is sortedout as soiled, infected and foul
linen to avoid nosocomial infection.
 Disinfection is done using disinfectants for infected linens.
 Sluicing and washing: sluicing is done for foul linen in sluice
machine and then the linen along with those that are disinfected
are put in washer for cleaning.
 Hydro-extractor: it is then put in extractor for removing extra
water.
 Mending: the torn linen is sent for repair or condemnation and
replacement.
 Repaired linen is again
washed in washer and
washing cycle after that is to
be completed. Distribution to
ward is done by laundry staff
after it is ready for use.
 Dried tumbler : the linens are put for drying.
 Pressing: the linens are pressed .

2. Linen Distribution System:

 Topping up: In this, the ward is given certain number of stock
of linen based on 24 hours requirement and shortfall of linen due to
use is topped up by the laundry staff everyday and used ones are
collected.
 Clean for dirty‟ exchange: the issue of clean linen to exchange number
of pieces of dirty linen.
 Exchange trolley system: this is expensive and not used in
India. In this, total trolley is supplied which has 24 hours
requirement and next day fresh trolley is supplied with
 same number of pieces and old trolley istaken back to
laundry irrespective as how many pieces have been used and
linen is brought and washed.

3. Quality Control Of Laundry Services:

Quality assurance of laundry should be developed since laundry is
important from where infection can be transmitted to other
patients, which should be seen by the hospital infection control
committee.
4. Policies And Procedure:
 Collection and distribution system of linens with periodicity
to each ward and department.
 Detailed instruction about handling infected andfoul linen.
 Charter of duty of each person handling laundry and training
schedule of staffs.
 Sluicing and disinfection procedures.
 Operation of laundry machines.
 Maintenance and service contracts of machines.
 Provision of detergents.
 Procedure for condemnation of linen and procurement of new linen
 Fire safety drills and fire extinguishing measures
 Record of distribution, collection, inventory of
detergents and linen procured/condemned.
 Security arrangements for laundry.
 Regular physical verification of linen and fixing
responsibility of any typeof loss.

26. To explain Ancillaries

about Laundry manager‟s office
ancillaries
services Stores
Tailoring bay
 Worker‟s rest room
Toilet
Boiler room

27. To explain
about kitchen KITCHEN SERVICES
services its
functions and
 A hospital dietary service includes most importantly a production unit
staffing
that converts raw material into palatable food.

 The prepration and distribution of food from store to spoon has many
challenges for the administration such as proper preparation, cost
accounting, pilferage and wastage.
Functions of Kitchen Services :
 therapeutic diet
 in-patient catering
 diet counseling
 education and training

Staff Requirements:
28. To explain Location And Space Requirement:
about
locationand Location ........ the dietary department should be located on the ground
 space floor near wards where the diets need to be taken and also accessible to road
requirements as supplies are to be carried to storage area.
of hospital Space Requirements.....
kitchen Hospital kitchen is divided into number of divisions which have a
particular activity.The broad areas are supplies receiving area,
storage area, cooking area, pots and pan wash, garbage disposal,
LPG stove and refrigeration facilities, housekeeping, dietician,
steward offices and circulation area.
Following space requirements are recommended for different size of
hospitals:
 200 beds or less: 20 sq ft per bed
 200-400 beds: 16 sq ft per bed or 18 sq ft per bed
 500 beds and above: 15 sq ft per bed

29. To explain
about Functional Areas In Department:
functional
areas in  Recipient Areas: this is the place where all provisions are off loaded.
kitchen these are checked for right quality and quantity, hence area should have
department unloading points, ramps, trolleys and weighing scales.
 Storage Areas: this is the area where the provisions are categorized
and stored in separate areas. the areas should have enough shelves and
bins:
 Dry provisions like flour, dal, sugar, oil etc.
 Fresh provisions like vegetables, milk, butter, meat etc
 Day Store : It is an area where provisions for one days
cooking issued to the cooks are stored.
 Preparation Areas: is an area where provisions are cleaned, washed,
soaked; meat is chopped, cut and sliced etc. the items like
kneader, weighing scale, slicer etc has to be provided.
 Cooking Areas: it should have pressure cooker, cooking range oven
etc.

 Service Areas: The food is put in service pots in trolleys and if it is a

 centralized distribution system, it is put in service trays, with
specifying the name of patients.

 Washing Areas : this is meant for washing cooking and service pots,
hence should have liberal hot and cold water.
 Disposal Areas: area where all garbage and left over food is collected
for disposal.
 Disposal Area: The are where all garbage and left over food is
collected for disposal.

Distribution Of Diet.......
 Central Service : The food is set in individual tray centrally at
dietary department including therapeutic diet of patients and are
transferred to wards in trolleys and served to the patients.
  Decentralized Service :The food is sent to wards and served as per
the need of the patient.
Dietary Store Management :
Storage of Food Items:
For dry storage, the temperature should be 700c, with adequate
ventilation has to be insured. The storing shelves, bins should be
placed 10” above the floor.
Purchasing of Food Products:
The items can be purchased from open market or through calling
tenders. The items to be purchased should have AG MARK OR
IDI. For this, an internal purchase committee may be constituted
by the hospital administration.
Equipment Planning : equipment purchase depends on the objectives
and basic functions of the department, workload and availability of the
personnel, and quality standards. Modern gadgets like mixer
grinders, pressure cookers, dish washers etc. Shouldbe a part of
hospital kitchen.

30. To explain
about LABORATORY SERVICES
laboratory
services, The basic function of laboratory services is:
functional
planning  To assist doctors in arriving at or confirm a diagnosis and
to assist in the treatment and follow-up of patients.

 The laboratory not only generates prompt and reliable

reports, and also functions as store house of reports for
future references.

 It also assists in teaching programmes for doctors, nurses

and laboratory technologists.
 It carries out urgent tests at any part of day or night.
 Functional Planning :
It covers the following activities:
 Determining approximate section wise workload.
 Determining the services to be provided.
 Determining the area and space requirement to
accommodate equipment, furniture and personnel in
technical, administrative and auxiliary functions.

 Dividing the areas into functional units i.e.Hematology,

biochemistry, microbiology etc.

 Determining the number of work stations

 Determining the major equipments and appliances in each
unit.
 Determining the functional location of each section in
relation to one another, from the point of view of flow
of work and technical work considerations.

 Identifying the electrical and plumbing requirements for

each area/ work station.

 Considering utilities i.e. lighting, ventilation, isolation of

equipments or work stations.

 Working out the most suitable laboratory space unit, which

is a standard module for work areas.

31. To explain
about Organization:
organization of Location......
laboratory
o It is preferable to have hospital laboratory planned on the ground floor
and so located that it is accessible to the wards.
 o In large hospitals, the entry of outpatients to the laboratory can be
obviated by opening a sample collection counter in the outpatient
service area itself.
1.

Outpatient Sample Collection..........

o It should be located in the outpatient department itself.

o The design of this area should include waiting room for

patients, venipuncture area and specimen toilets separately for
male and female patients, along with provision of containers
with appropriate preservatives and keeping record of each
patient.

Area Space ..........

In a small hospital, the laboratory facility consists of a room in
which all the routine urinalysis, hematology and clinical
chemistry investigations are carried out. As the hospital size
increases, the requirement of technical and administrative
services also increases with the necessity for departmentalization
of the laboratory.

The requirement of space for the laboratory consists of:-

1. Primary space: This space is utilized by technical staf for the primary
task of carrying professional work.
2. Secondary space: it is utilized for all supportive activities.

3. Administrative space, i.e. Offers for the pathologists and others, staff
toilets etc. .
4. Circulation space: It is the space required for uncluttered movement of
personnel and materials within the department between various
technical work stations, rooms, stores and other auxiliary and
administrative areas.
 5. Laboratory space unit (LSU): It is a module of space and all
calculations for technical work areas and some auxiliary area are based
on LSU. For allocation of primary space, one of the most suitable
sizesof a LSU is one measuring 10‟ x 20‟ giving a LSU module of
200 sq. ft. a rectangular module is functionally more efficient because
in the same overall space, it can accommodate longer runs of benching
due to its longer perimeter.
Layout :Structural flexibility should be achieved by use of movable or
adjustable benching systems in association with an installation of service
mains that has been designed to permit the repositioning of outlets.
Administrative and Auxiliary Areas: The administrative area(the area is
the central collection point for receiving specimens and is the reception
and interaction area for patients and hospital staffs) is separated from the
technical work area so that the non-laboratory personnel need not enter the
technical areas.
Reception and Sample Collection : This is the area should be well
ventilated and lighted, should have a chair where the patient can sit in
comfort and where his arm can be stretched for the phlebotomy, a bed where
the patient can lie down for pediatric collection or aspiration cytology.
Bar System For Sample: This system is used to trace the samples.The
sample is received and then bar coded, and then sent to processing area.
This protects patient identity.
Specimen Toilet : It is provided for the the collection of urine and
stool specimens.
o Pathologist office: it is so placed that the pathologist can have an
easy access to the technical areas particularly histopathology unit.
Glass Washing And Sterile Unit: Small labs collect blood in bottles that
are washed and reused. This is partitioned into washing and
sterilizing area, containing sterilizer, pipette washer and sinks.
Report Issue : The reports should be issued in printed format. The
hospital lab software can be made as per the requirement of the
hospitals.
Utility Services : It includes water, gas and compressed air systems.Piping
systems should be easily accessible for maintenance and repairs with minimum
disruption of work. For safety purpose and to facilitate repairs, each
individual piping system should be identified by color, coding or labeling.
Internal Design And Fitments :
o Work benches: The height of the work bench on which the
technicians sit while working (revolving stools) vary from 75-90 cm
depending upon the height of the workers.

o Lighting: Natural light should be used to the fullest. Each work bench
should be provided with adequate electric points especially
fluorescentfixtures that give uniform illumination and minimize heat

o Storage: Each laboratory bench length should have storage space for
reagents,chemicals, glass wares and other items, provided in the
form of under benchdrawers, cupboards etc.
o Partitions: it may be required between some laboratory spaces.
o Air conditioning: Whole or at least histopathology section of the
laboratory should be air conditioned due to accumulation of
formalin vapors or else a powerful exhaust system should be
installed.
o Working surface/ flooring: the surface of work benches should
be resistant to heat, chemicals, stain proof and easy to clean. Floor
should be easy to clean, and not slippery. Flexible vinyl flooring is
preferred for laboratory floor coverings.
o Staffing: The hospital laboratory services should be under the control
and direction of a doctor with qualifications in pathology or a PG
degree in the new discipline of “laboratory medicine”.
o Number of personnel: Staff requirement of laboratory technicians can
be worked out empirically on the basis of generally accepted norm
which is about 30 tests per day per technician.

Equipments: Some of the core instruments that are needed are:

 Colorimeters/ spectrophotometers: They were used in old days, are now

replaced by new auto-analyzers these days.
 Auto analyzers: It is used maximum in biochemistry works.
 Cell counter: It gives a more complete blood picture. The principle of
the instrument is to pass the cells through a thin capillary.
  Centrifuge
 Refrigerators
 Pressure sterilizers
 Pipette washers
 Analytical balance
 Semi auto analyzer
 ELISA reader
 Blood gas analyzer
 PCR instrument
 Flow cytometer

32. To explain
Policies and Policies And Procedures :
procedures of
laboratory Laboratory Samples : Samples to be examined falls in two
categories:
o Samples collected by nursing staffs in nursing units
o Samples obtained by lab. personnel.
o All requests for lab. Examinations must be in writing.
Sample Recieving : The reception area, all samples of blood, urine,
body fluids etc should be received at the reception counter. Sufficient
racks and hand washing facility should be provided in this area.
Request Form : Request forms should be uniform in size and contain
only pertinent
information.

Container: specimens sent should be in proper containers.

Instructions on the timeof taking specimens, minimum volume
required, type of container etc. Should be posted at the nurse‟s station
 in wards.

Identification of Specimen : Lab. personnel should be responsible for

proper disposition of all specimens and requests within the lab. to
identify the specimen received, the specimen and request form should
be numbered with same numberand is also entered in the request
register.

Reports and Records : Lab. personnel should give reports only to

authorized ward/ OPD personnel and never directly to patients. A
daily record register should be kept of all examinations performed in
the lab. In order to maintain a monthly and yearly account of the work
done.
Blood Bank Services : It should be controlled by the officer in
chargeand the technical supervisor, to ensure that all are aware of
the establishment of written procedures for identification of blood
samples, storage facility etc.
Motivation and Cross Training : The in charge should discuss
professional, technical and administrative matters concerning the
laboratory during periodical meetings with staff. The lab. policy must
lie down that all staff is cross-trained to work in all the different
sections of the laboratory.

33. To explain EMERGENCY SERVICES

about
emergency An emergency department must be developed as a mini hospital within
services its a hospital i.e. Independent and self sufficient in day to day working.
planning and
organization

PLANNING AND ORGANIZATIONAL CONSIDERATIONS :

1. LOCATION .......
There are two essential location requirements:
 It must be on ground floor and easily accessible to both ambulatory
and ambulance patients, and there should be minimal separation
 between it and radiology department.
 Secondly, the emergency department should have ready access to
the acute patient care areas, eg. Operation theatre, ICU, blood bank
etc.
Emergency department must be designed usually 1000 sq.ft is
required for daily patient load of 100 patients.

2. STRETCHER, TROLLEY AND WHEEL CHAIR STORE.........

A store for stretcher, trolley and wheelchairs should be located

adjacent to the entrance.

3. AMBULANCE, ATTENDANTS, POLICE MASSMEDIA

ROOM.................

An equipped room of about 10 m2 near the entrance hall with

attached toilet serves the needs of above personnel.

4. WORK AREA............
It should be spacious with enough room for personnel and patients.

5. WAITING AREA FOR EMERGENCY DEPARTMENT....................

The main function of this is to be the passage way to patient
examination and treatment area.
 Waiting area for relatives........ patients relatives should not be allowed
in the work areas of emergency department. Waiting room with
recreational facilities may be provided.
 Visitor’s Toilet ................. should be provide near the main waiting
space.
 Nurses station and administrative office.............. should be next to the
entrance and manned on 24 hr. basis. It should be provided with
multiple telephones, bulletin board with duty roster of doctors on call
and directive pertaining to the emergency department should be
displayed.Nurses work room should be well stocked with drugs, IV
fluids.
 Examination and treatment room.......... area should always be in
readiness to receive patients at all times, and should consist of a large
room and number of separate smaller rooms for examination and
treatment.It should be well illuminated space with oxygen supply,
resuscitation equipment, suction, portable X-ray,
electrocardiographs, and Boyle‟s apparatus.

6. EQUIPMENTS............
• Stretchers
• On-the wall oxygen unit
• On-the wall suction unit
• BP apparatus, otoscope, stethoscope, opthalmoscope etc.
• Spot lights
• Utility table
• Airways and resuscitation bag

7. RESUSCITATION ROOM................
The patient is to be stabilized in this room before shifting to treatment or
recovery room, or to ICU or nursing unit.It should be well equipped with
resuscitation equipment, ECG machine and X-ray viewing screening with
facility for performing minor operative procedures.

8. OPERATION ROOM...................
A self sufficient operation room to serve patients who need minor
surgery and no admission or who are critically ill etc. in emergency
department.
9. FRACTURE ROOM..................
A separate fracture room equipped similar to OT and additional
facilities for reduction of closed fractures under local anesthesia
can be planned with hospitals with turnover of emergency patientsin
excess of 15,000 per annum.
10. CARE OF BURN..........
2
A separate room with 20 m area should be reserved for immediate care of
 burn patients. An observation ward of about 6-8 beds for patients to be
kept under observation overnight or 24 hrs.
11. ISOLATION ROOM................... For obstetric patients, pediatric
patients.

12. OTHER ROOMS ....................

It should be planned based on the local needs:
 Room for dead bodies
2
 Pantry-7 m
 Storage space
2
 Utility and soiled linen room-7 m
2
 Cleaners room-house keepers room 4m
 Change room duty rooms 9m2
 Conference room and reference library 8m2
34. To explain
staffing pattern Staffing Pattern
of emergency  Full time emergency physicians, especially trained in emergency
medicine

 A well staffed emergency department needs 8 nurse shiftsof 8 hours

each per 100 daily patients‟visits. Additional staff nurses is
required if there is observation ward attached.

 For registration and records, usually 3 clerks work in day and afternoon
shift, and one during night
 Security should be available round the clock
 Public relations and social worker should be available to take care of
the anxious and disturbed patients and their relatives.
35.

36.

BIBLIOGRAPHY

 A.G Chandorkar. Hospital administration and planning. 2nd edition. Paras medical publisher. New Delhi. 2009.pg no. 67-72,153-166,167-
179,181-195.
 B.M.Sakharkar. principles of hospital administration and planning. 2nd edition. jaypee brothers medical publishers ltd. 2009. pg.no-195-
207.
 D C Joshi, Mamta Joshi. Hopsital administration. Jaypee brothers medical publishers pvt ltd. New Delhi. 1stedition. 2009. pg. no.
186- 208.
 The nightingale times. volume II. pg. 32