NURSING

MANAGEMENT
PLANNING

Namgay Lham
M.Sc 2nd year
KCON
NURSING MANAGEMENT
 Is the process of working through staff
members to be able to provide
comprehensive care to the patient
 This includes planning, organizing,
directing and controlling
 The task of the nurse manager is to plan,
organize, direct and control available
financial, material, and human resources in
order to provide effective, economic care to
groups of patients
PLANNING
PLANNING
 Is deciding in advance what to do, how to
do a particular task, when to do it, and
who is to do it.
 Is predetermining a course of action in
order to arrive at a desired result. It is the
continuous process of assessing,
establishing goals and objectives and
implementing and evaluating them, which
is subject to change as new facts are
known
COMPONENTS OF PLANNING
 PREDETERMINED ACTION
 WHO IS TO DO IT: -professional, non-
professional
 HOW TO DO IT: -technique, principles
 WHAT TO DO: -nursing activities
PLANNING FOR HOSPITALS
 Hospitals are the most complex of building
types. Each hospital is comprised of a wide
range of services and functional units.
 These include diagnostic and treatment
functions, such as clinical laboratories,
imaging, emergency rooms, and surgery;
hospitality functions, such as food service
and housekeeping; and the fundamental
inpatient care or bed-related function.
CONT……
 Many of the medical equipments and modalities
have special physical requirements including
controlling environment, energy and other
engineering services.
 The functional units within the hospital can have
competing needs and priorities.
 Idealized scenarios and strongly-held individual
preferences must be balanced against mandatory
requirements, actual functional needs (internal
traffic and relationship to other departments),
and the financial status of the organization.
CONT……..
 The architect and planers have to keep pace with
the development in modern medicine, nursing
technique and general community expectations.
 Medical technology is developing very fast so
much so that often hospitals become outdated
even before they are put to use.
 There has been very rapid change in last five
decades in functioning of hospitals due to
medical advances which have direct bearing on
patient care.
 FACTORS WHICH HAS
DIRECT BEARING ON
HOSPITAL PLANNING
 Costly diagnostic services cannot be provided all
hospitals. Thus, there should be proper choice of
place and services to be rendered.
 Tertiary care cannot be provided in all places due
to high cost and lack of availability of trained
man power.
 Design should follow function, however, the
proper use of esthetic quality and humanized
surrounding must be kept in mind so that it looks
attractive.
CONT……
A study of activities in health facilities at
different levels is a prerequisite of planning as it
answers several important questions.
 For health centers of different sizes and with
different functions, what is the proportion of
working hours devoted to various broad activities
or define tasks:
 which different types of staff are needed and in
what proportions?
 what are the space requirements to discharge this
functions?
CONT…....
 What is the inter-relationship between these
functions and consequently, what layout will
be more convenient?
 As conditions vary from place to place, it is
necessary to undertake such a study for each
project.
BUILDING ATTRIBUTES
Regardless of their location, size, or budget,
all hospitals should have certain common
attributes.
Efficiency and Cost-Effectiveness

An efficient hospital layout should:

Promote staff efficiency by minimizing
distance of necessary travel between
frequently used spaces.
Allow easy visual supervision of patients by
limited staff.
CONT…..
 Include all needed spaces, but no redundant
ones. This requires careful pre-design
programming.
 Grouping of closely related activities should
be put together in one area.
 All areas should be located in relation to one
another to allow direct communication and
easy flow of patients, staff and services.
CONT……
 Provide optimal functional adjacencies, such
as locating the surgical intensive care unit
adjacent to the operating suite.
FLEXIBILITY AND EXPANDABILITY
 Since medical needs and modes of
treatment will continue to change,
hospitals should:
 Allow maximum flexibility and expandability
in design and the structural system.
 Physical planning must allow for future
expansions in all major functional areas of the
hospital and for internal adjustments in the
use of space to desired degree of changes
must be feasible.
FUNCTIONALLY HOSPITAL HAS SIX MAJOR
FACILITY ZONES:
 Accident and emergency.
 Ambulatory care (outpatients department).
 Diagnostic and therapeutic facility.
 In-patient (nursing care) units.
 Administration departments and business.
 Hospital engineering services.
 Each of the functionally components need to
be suitably placed depending on their inter-
relationship but with shortest possible travel
to achieve efficiency.
EMERGENCY DEPARTMENT
 An independent unit to function round the
clock like a mini hospital.
 Entry to this department has to be prominent
and self-guided so that a very minimum time
is lost in giving immediate treatment to
casualty and emergent cases arriving in the
hospital.
AMBULATORY CARE UNITS
 Has to perform three main functions:
 To diagnose and treat patients at an early stage.

 Follow up treatment after discharge from the

hospital and
 To institute health education programme to
educate the public in environment hygiene.
 A well organized and well equipped outpatient
department can play role in reducing the load
on the inpatient beds and save a lot of time and
expenditure.
DIAGNOSTIC AND
THERAPEUTIC FACILITY
 Includes the radio-diagnostic and imaging
department, clinical pathology as diagnostic
facilities whereas radiotherapy, operation
theaters, rehabilitation and physiotherapy as
therapeutic areas are to serve in common to
outpatient department and inpatient nursing units.
 These facilities are to be suitably placed at
different levels in consideration of their
functional use and degree of necessity to
dependent departments.
IN-PATIENT NURSING CARE
UNITS(WARDS)
 In-patient nursing care units (wards) occupy the
maximum share of hospital space.
 Nursing care is broadly classified into general
wards, specialty-wise wards and intensive care
units.
 Basic consideration in placing wards is to ensure
sufficient nursing care, segregating patients
according to three categories, locating them
according to the needs of the treatment in
respective medical discipline and controlling
cross infection.
CONT….
 Specialty-wise wards however, should be located
closer to their respective outpatient clinics to act as
self-contained centers.
 In planning a ward, the aim should be to minimize
the work of the nursing staff and provide basic
amenities to the patients within the unit.
 The units should be modified in such a way to
meet specific socio-medical requirements while
attempting to enhance the efficiency of nurse-
patients interaction, observability, lightning and
other physical requirements,
CONT….......
 Replenishment system for supply of diet
medical and surgical supplies, linen and other
materials at the door step of nursing activity
have further relieved the nursing staff on
non-nursing functions to attend patient
centered activities.
SITE SELECTION
 Itis important for hospital building. It must
have the following characteristics:
 Easy approach by people
 Enough land availability
 Sub-soil water must be deep
 Sufficient supply of water and electricity.
 While selecting the site, one must keep in
mind, any further expansion in future size of
land required.
CONT….
Water supply:
 The need of water for the hospitals is very
high. The requirements of water should be
calculated considering the patient load,
(inpatients and outpatients) and also the
residential area.
 About 300-500 liters of water per bed per
day (excluding water for gardening) is to be
catered for.
CONT…….
Electricity:
 Generator supply for certain essential areas
should be catered for.
 There should be provision for uninterrupted
electricity supply.
 Requirement for the hospital is One kv per

bed per day.

CONT……

"A functional design can promote

skill, economy, conveniences, and
comforts; a non-functional design
can impede activities of all types,
detract from quality of care, and
raise costs to intolerable levels."

... Hardy and Lammers.

CONCLUSION
 If hospital can be designed in proper fashion it can
combine science and wisdom to create holistic
approach to health care.
 Hospital design must be flexibility, to adopt
change and its concern should be the quality of
medical care and the improvement of its standards.
 The idea of planning is to prevent the haphazard
mushrooming up of structure, to prevent
fragmentation of function and to promote logical
flow of patient, staff and equipment and to attain a
fair degree of uniformity and standardization.
REFERENCE

 Basavanthappa B T. Nursing Administration.

2nd edition . New delhi ;Jaypee brothers
medical publications:2009

 Tabish S A. Hospitals and Nursing Homes

Planning, Organisations and Management. 1 st
edition. New Delhi; Jaypee brothers Medical
publishers(P) Ltd;2003.
