Transcript of Hm 2012 session-iii planning & developing a hospital
1. Hospital ManagementBuilding or extending a hospital
department Session III Tuesday, 14 February, 2012 Dr. Ashfaq Ahmed
Bhutto MBBS, MBA, MAS, DCPS, MRCGP, (PhD)
2. Feasibility Module 12
3. Promoters Objective The promoter needs to determine the
objectives of the project with clarity. These include the type of
services to be provided: Secondary care/tertiary care.
Sophistication in the building plan and equipments. The investments
and returns the promoter is looking for. To rationally determine
the above, a feasibility report based on a market survey is
essential.3
4. Feasibility report The study should clearly bring out the
following: The potential of the planned institution. The medical
facilities that are lacking and need to be made available. The
migration pattern of patients. Competition from existing hospitals
and new entrants. Based on observations and findings from the
market survey, a detailed project report should be prepared, with
the following objectives: To recommend medical facilities in terms
of departments and equipments. To determine manpower requirements.
To project financial performance for the first 10 years of
operation. To arrive at an implementation schedule for completing
the project. To study the scope for future expansion of facilities.
The report should realistically discuss operational feasibility,
financial viability and the medical departments in heavy demand in
thrust areas. It should also analyse the location of the site, the
hospital design, manpower4 planning, project cost, financial
analysis, sensitivity analysis and implementation.
5. Market Survey The first consideration in the survey is to
study the character, needs and possibilities of the community which
the hospital is going to serve. The existing medical facilities in
the region should be studied in terms of: Quality and number of
hospitals. The areas of
specialisationdoctors/specialists/paramedical staff. Level of
technology, latest medical equipment. Patient flow, disease
pattern. Costs of investigation and treatment. Public opinion
regarding the existing facilities, the need for more departments,
and the response from the medical community are vital to the study.
It is on the basis of this information that a decision can be taken
about where a hospital should be built and its type and size. Is
the community a wealthy one; or is it made up of moderate wage
earners; are the industrial workers indigentthese are the deciding
factors in determining the kind of hospital should be planned for.
For example, if the community largely constitutes wealthy
individuals, one can plan to build a luxurious hospital, with
deluxe rooms and sophisticated diagnostic and therapeutic
equipment; if it is largely meant for indigent patients, a
non-profit or charitable hospital is needed. Apart from levels of
income, characteristics such as5 occupation, age distribution, and
so on must be studied. These determine the amount and kind of
hospital.
6. MARKET Survey- Next Phase To study all the existing hospital
facilities on an area-wise basis. This study should be
comprehensive, covering both short and long-term needs. The most
important part of the study is an inventory of the facilities, beds
and services of every hospital. It should cover the following
areas: Bed capacity of the institution Physical condition of
facilities Hospital occupancy Bed ratio Volume and kind of hospital
services provided Quality of facilities and services6
7. BASIC QUALITY REQUIREMENTS Module 27
8. Factors considered in location of Hospital 1. It should be
within 15-30 min traveling time. In a place with good roads and
adequate means of transport, this would mean a service zone with a
radius of about 25 km. 2. It should be grouped with other
institutional facilities, such as religious, educational, cultural
and commercial centers. 3. It should be safe from physical dangers
e.g. low lying areas. 4. It should be in an area free of pollution
of any kind, including air, noise, water and land pollution. 5. It
must be serviced by public utilities: water, sewage, electricity,
gas and telephone.8
9. Reachability A general hospital should be easily reachable
by public transport, assessed on the basis of transport frequency
and the distance to the stop, and also by taxi, car or bicycle.
This requirement is complied with if a general hospital is situated
at one of the geographic/demographic concentration points in its
catchment area. A geographic/demographic concentration point is a
municipality where the population level and level of amenities
(schools, retail trade, recreation, public services) is such that a
substantial proportion of the population in the catchment area of
the hospital is more9 or less automatically orientated towards that
municipality.
10. Access The site needs to be easily accessible by patients,
visitors and staff. This apply to pavements/ footpaths (minimum
width, minimum free height, maximum slope, maximum height of
kerbs), ramps (minimum width, maximum slope and length, halfway and
end platforms), outside stairs (minimum width, maximum rise,
installation, height and design of handrails), material properties
of paving surfaces (flat, rough and jointless) and lighting.
Regulations also apply to the measurements and layout of parking
places.10
11. Access There are additional requirements for the less able,
such as the size of parking places. Obstacles should be indicated
by warning paving, continuous guiding lines must be present. Taxis
should be able to come right up to the main entrance and the
entrance to the outpatient unit. The entrance to the emergency
department and if necessary the main entrance should be accessible
by ambulance. Public entrances to a hospital building should comply
with minimum dimensions and also be accessible by people with a
physical handicap. These entrances should be covered over and
provided with good lighting. There are also specifications that
apply to the entrance hall (sheltered situation, minimum
dimensions, location of the doors, lighting), thresholds (maximum
heights) and door handles. In the case of revolving or carrousel
doors, there must be an extra11 swing or sliding door
provided.
12. Flexibility The flexibility refers to the degree to which a
building is adaptable to changing space needs. Flexibility is
concerned with a structural process of change, thus spatial
adaptation of buildings is inevitable. With a high level of
flexibility, these adaptations can be kept to a minimum, as a
result of which the financial consequences and the hindrance to
management remain within acceptable levels. The main structural
design of a hospital should possess a high degree of flexibility.
The building structure should be simple to extend at different
points and should be able to cope with internal displacement. A
characteristic feature of todays hospital architecture is that
account was taken of future changes and innovations in science,
technology and policy when selecting the building structure.12
13. Flexibility There are four types of flexibility. 1. Usage
flexibility: Usage flexibility concerns the possibility of changing
the use made of a room/space without the need to renovate that
room/space. 2. Disposal flexibility: Disposal flexibility concerns
the possibility of removing building elements without a detrimental
effect on the cohesion of the building elements to be retained and
with a minimum of hindrance. 3. Internal flexibility: The term
refers to the possibility of interchanging hospital functions
independent of the supporting structure. A supporting structure
with concrete columns makes this possible because the internal
fittings geared to the function can be removed without
constructional consequences and be reconstructed once again. 4.
External flexibility : The term refers to the possibility of
expanding13 the existing building structure. Expansion
possibilities are mainly programmed for functions where growth may
be expected. In the
14. Finances Module 314
15. Average Costs The cost computed per bed depends on various
factors, such as the cost of the land in a particular place, the
wage and salary rate, accessibility of materials, and so on.
Similarly, sophisticated equipment and expensive construction
material will significantly enhance the investment. Average costs
for a typical hospital expressed as per bed, can be rise
proportionally: Tertiary Secondar y Primar y15
16. How much money do you need? 1. People in the business. Not
the competitors, but entrepreneurs outside your geographic area. 2.
Sources of supplies. Theyre very forthcoming because theyre looking
for business [from you] but "Do some comparison shopping, 3. Trade
associations. 4. Business start-up guides. How-to start-up guides
are available from several independent publishing companies and
some trade associations.16
17. How much money do you need? 5. Franchise organizations. If
youre thinking about buying a franchise, the franchisor will give
you lots of data about start-up costs. 6. Business start-up
articles. Newspaper and magazine articles rarely give item-by-item
start-up-cost estimates but these write-ups can offer ballpark
estimates of overall start-up costs. 7. Business consultants. A
well-qualified business consultant can offer excellent advice about
start-up costs--and even do a lot of the research for you. A
consultant can also help you organize your own research into useful
financial projections and scenarios.17
18. Sources of funds Government grant- Bank loan Local
development corporation A relative Government How good is your case
Hurdles to cross-hard-headed administrators, planning officers and
financial experts Private - a prospective lender will review your
creditworthiness.18
19. The "Five Cs" of Credit Analysis Capacity to repay -most
critical. Primary source of repayment - cash. The prospective
lender will want to know exactly how you intend to repay the loan.
Capital-money you personally have invested in the business and is
an indication of how much you have at risk should the business
fail. Interested lenders and investors will expect you to have
contributed from your own assets and to have undertaken personal
financial risk. Collateral or guarantees are additional forms of
security you can provide the lender e.g. home. Conditions describe
the intended purpose of the loan. Will the money be used for
working capital, additional equipment or inventory? Character is
the general impression you make on the prospective lender or
investor. Are you trustworthy to repay the loan?19
20. Hospital size Module 420
21. Physical Scale of Hospital Stage 1: Collect Data Suppose
data collected is: Population of serving area 150 000 Average
length of stay in hospital 5 days Annual rate of admissions 1 per
20 population21
22. Physical Scale of Hospital Stage 2: Compute number of beds
needed (Bed occupancy 100%) (1) Total number of admissions per
year: = district population x rate of admission per year = 150000 x
1/20 = 7500 (2) Bed-days per year: = total number of admissions per
year x average length of stay in hospital = 7500 x 5 = 37500 (3)
Total number of beds required when occupancy is 100%: = bed-days
per year 365 days = 37500 365 = 102.74 Rounded to 105 beds.22
23. Physical Scale of Hospital Stage 2: Compute number of beds
needed (Bed occupancy 80%) (1) Total number of admissions per year:
= district population x rate of admission per year = 150000 x 1/20
= 7500 (2) Bed-days per year: = total number of admissions per year
x average length of stay in hospital = 7500 x 5 = 37500 (3) Total
number of beds required when occupancy is 100%: = bed-days per year
(365 x 80%) days OR (365 x 80/100) days = 37500 365 = 128.42
Rounded to 130 beds.23
24. Physical Scale of Hospital Stage 3: Compute total area
needed for hospital Total area of hospital: = total number of beds
x 40 square meters per bed = 105 beds x 40 = 4200 square meters
(for 100% occupancy) = 130 beds x 40 = 5200 square meters (for 80%
occupancy)24
25. Design considerations Module 525
26. Design of the general hospital building guidelines The
guidelines were drawn up on the basis of the different activities
that take place in a hospital. These are activities that concern
the primary process, i.e. the direct interaction between the
patient and the care provider (nursing, diagnostics and treatment),
these different activities may be subdivided into three blocks: A.
patient-related facilities where the patients themselves are/may be
present; B. patient-related facilities where patients themselves
are not present; C. general & technical support services. This
subdivision is not a blueprint for the way in which a hospital
should be divided up, but merely forms a plan based on the
different activities within a hospital.26
27. A. Patient-related facilities where the patients themselves
are present Three main function groups in this block are: 1.
Nursing; 2. Diagnostics & treatment; 3. Special functions (if
present). The nursing main function group includes the spatial
facilities for special care, general nursing, paediatric nursing,
maternity nursing (including delivery rooms), geriatrics and day
nursing. The diagnostics & treatment main function group
includes the following spatial facilities: outpatient appointment
department, general organ function investigations, imaging
diagnostics, nuclear medicine, outpatient treatment, operation
unit, emergency unit and physiotherapy. The special function main
function group includes the spatial27 facilities for dialysis, a
rehabilitation day treatment unit or a
28. B. Patient-related facilities where patients themselves are
not present This block includes the spatial facilities for: Central
Sterilising Services (CSSD), The pharmacy and The laboratories
clinical chemistry, medical microbiology, clinical pathology28
29. C. General & technical support services This block
includes general and staff facilities (such as central kitchen,
linen service, restaurant and technical service), as well as
facilities for management and training. There is a trend towards
outsourcing some of the facilities listed under B and C to third
parties. This is particularly the case with the laboratories and
pharmacy, administrative tasks, kitchen facilities, linen service
and technical service.29
30. Share as percentage of different blocks what the share in
percentage of the different blocks of the floor area on the basis
of the usual function package of a general hospital. Function group
Share as percentage Standard package Block A: patient-related
facilities (patient 65% present) Block B: patient-related
facilities (patient not 10% present) Block C: general &
technical (non-patient- 25% related) services Total 100%30
31. Planning Module 631
32. Methods of planning and design Planning team & process
In general, the people involved in this process are: 1. Health
planners, functional planners, financial planners and physical
planners. 2. Architects 3. Engineers (such as civil, mechanical and
sanitary) 4. Quantity surveyors 5. Finance managers 6. Staff
responsible for procurement of supplies 7. Staff members such as
doctors/nurses, clients/end users32
33. Methods of planning and design Planning team - Need
assessment teamAt the earliest stage, a needsassessment team
involving theplanners, end users such as thehospital staff and the
communityestablishes an overall plan of theneeds, range of services
to beprovided, the target population orcatchment area, the
financialfeasibility of the project withcostbenefit analysis and
the scaleof the hospital, etc.33
34. Methods of planning and design Planning team Briefing
teamAfter the needs and the size of thehospital have been
determined, thebriefing team involvingarchitects, engineers, the
staff andthe community sit together toprepare the key document,
i.e. "thedesign brief" which translates therequirements
intofunctions, activities, spacedistribution and/or any
otherinformation necessary for thedesign.34
35. Methods of planning and design Planning team - Design
teamThis team consists of all the peopleinvolved in designing the
facility andpools the expertise of its members toproduce the
instruments forimplementing construction, startingfrom preliminary
investigation to thefinal designs with technicalspecification,
tendering documentsand detailed working drawings andestimates of
cost. This team mainlyconsists ofengineers, architects, quantity,
surveyors, hospital staff, the communityand the approving
authority.35
36. Methods of planning and design Planning team - Construction
team This team consists of engineers, architects and builders. The
construction team implements the design from the approved drawings
and technical specifications within the prescribed time and cost
and produces tile facility for commissioning cause serious
complications when left untreated.36
37. Methods of planning and design Planning team -
Commissioning team The commissioning team responsible to staff the
hospital, commissions and procures the equipment, furniture and
supplies and prepares it for operation.37
38. Methods of planning and design Planning team - Planning
team By the end of the project, multitude of people would have made
their contribution to the project as part of a whole working team
including the community.38
39. Planning process-contd. Project Team End users Staff
Planners Architects Engineers Contractors Suppliers39
40. Stages in planning & designing a hospitalStag Task
Input output Working Teame Active Consultativ eOne Establish
Information Decisions to User/Client demand for new Indicators
construct, Planner hospital or for Projections renovate, hospital
expand expansionTwo Prepare design Services to be Design Brief
User/Client Architect/ brief delivered Engineers Function
requirementThre Design Design Brief Design of Architect/
User/Cliente Additional Data Hospital Engineers from consultants
Working documentsFour Construct Design of Hospital Hospital in
Architect User/Client Working drawings physical form Builder
EngineersFive Commissioning List of Staff Appointment User/Client40
and training of List of furniture Procurement staff staff
41. Size of project Small Medium Large A formal Project Team
will be set up. Everything will have to be in writing. To keep a
record of decisions.41
42. Planning process Capricode In NHS UK: When planning and
building, the Regional and District Health Authorities and their
officers are compelled to follow Capricode (Capital Projects
Procedures) and operate systems of approval, monitoring and control
which are compatible with it. It is a logical sequence of events.
It is only a framework, the results depending on how the Appraisal
Project Teams use that framework.42
43. Planning process-contd. The Capricode sequence of stages
is: 1. Approval in principle (AIP). 2. Budget cost. 3. Design - a
long process when sketch plans are developed into
working/production drawings ready to go out to tender. 4. Tender
and contract - normally the tender documents go to a chosen group
of contractors of proven ability: 5. Commissioning . 6. Evaluation
-this should be a continuous process. At each stage, what has been
done should be assessed and consideration given to possible effects
on future progress of the scheme. Overall effectiveness can only be
assessed when the project is complete and working.43
44. Planning process-contd. CONCODE: A guidance document on the
procurement of building and engineering work and the commissioning
of consultant architects and engineers.44
45. Planning process-contd. CONCISE: In NHS UK: A
computer-based integrated health building information system to
help in the planning and management of projects. It may be used for
any scheme, but it must be used for those over 1 million.45
46. Critical path chart46
47. Planning process-contd. Approval in principle (AIP) Once it
has been decided that a project has sufficient merit to start an
appraisal, a Project Manager will be appointed and an Appraisal
Team set up, with membership limited to those making an essential
contribution to the relevant stage, changes in membership being
considered at the end of each stage. The members will be drawn from
those managing and operating the services (doctors, radiographers,
nurses, etc.) and those administering assets and resources. Three
early steps will heavily involve the doctors and paramedical: 1.
Inception; 2. Defining objectives and criteria for development; and
3. Option appraisal.47
48. Planning process-contd. Budget cost Once the decision has
been taken that the solution involves building, either new
(considered during AIP) or the extension of old, a Project Team
will be set up. The job of this team is to develop the scheme,
drawing up a brief which includes site, size and scope of the
development, subsequently moving to specific layouts of individual
rooms and spaces, detailing their contents and arriving at cost
implications - both capital and revenue.48
49. Planning process-contd. Design Brief The design brief is a
key document: it is the written expression of the clients needs, as
expressed in consultation with various professionals, including the
architect and engineers. It is important because a good design
brief is the sound base for a good design.49
50. Planning process-contd. Information included in design
brief 1. Functional content 2. Philosophy of service 3. Workload 4.
Planning principles 5. Staffing 6. Functional relationships 7.
Environmental factors and engineering 8. Schedule of accommodations
9. Financial aspects 1. Costs 2. Possible sources of funds50
51. Planning process-contd. Departments operational policy Many
decisions will require a very complete knowledge of the way in
which the department is intended to work; one department will not
be exactly the same as any other. This detailed picture will be
formalized into the Departmental Operational Policy. Not only will
a carefully thought out policy be needed for planning but also for
commissioning. The Operational Policy and the layout reciprocate.
The layout will dictate the patient and staff flow sequences and
hence the Operational Policy, but the needs shown by the
Operational Policy will be the major factor in deciding layout-so
which comes first? If there is no well worked out Operational
Policy, a layout is likely to be imposed because there is nothing
to support or deny alternatives. It is not only patient/ staff
flows: for example, it may be policy that all equipment maintenance
will be carried out by outside contractors.51
52. Planning process-contd. Work flow list A workflow comprises
a series of tasks that are assigned to users based on their roles.
When the work containing the workflow is instantiated, a user is
assigned a task based on his or her role. After the user completes
a task the workflow progresses to the next task in the predefined
flow until the workflow is complete. The workflow definition
integrates all tasks in the flow by supporting rule-based condition
handlers for task sequence, routing, and branching at specified
decision points. The Work Flow list is an internal departmental
document, exploring the viability of the policy.52
53. Planning process-contd. Work flow list-example53
54. Planning process-contd. Using the policies and WF lists For
example in a radiology department: Operational policy : Reporting
time-Immediate reporting will be available. Therefore: Procedure
worked out in detail planning needs determined from work flow
lists. This results in layout plans and required drawings.54
55. Planning process-contd. Individual rooms and areas After
decision-how many rooms are needed, where and in what layout,
planning comes to the individual rooms and spaces. Each Project
Team should determine an area for any room or space on the basis of
activities that will be needed to meet local circumstances and
allocate enough space for those activities to take place.
Illustrations of the critical dimensions necessary for general
functions can be found in HBN Documents.55
56. Planning process-contd. Activity data sheets This is an
information system designed to help both sides of a project and
design team by defining the users needs more precisely. There are
two principal types: 1. Activity Space Data Sheets (commonly known
as A Sheets) and 2. Activity Unit Data Sheets (B Sheets). These are
meant to be used by design teams to ensure that the necessary
space, equipment and environment are provided to enable the
functions of the area to be carried out efficiently.56
57. Sample A sheet57
58. Planning process-contd. The A Sheets are in sections which
cover: 1. Functional design requirements: a list of activities that
will be undertaken in the space. 2. Activity unit selection: items
of equipment that will be needed to enable the activities to be
carried out. 3. Personnel: how many people will be occupying the
space both continuously and intermittently, staff and patients. 4.
Additional equipment and engineering terminals: items not
associated with the equipment listed in (2), e.g. clock, curtain
track. 5. Planning relationships: for example a barium enema WC
will need to be adjacent to the fluoroscopy room. On the reverse
side of the sheet are environmental parameters, design character
data, door and window details, etc.58
59. Planning process-contd. The B Sheets: The B Sheets can
describe a single item such as a chair, or a cluster of associated
items such as wash basin, paper towel dispenser, soap dispenser and
paper sack stand. Each B Sheet includes a scale graphic
illustration together with a list of associated items in Groups 1,
2, 3 and 4.59
60. Sample B Sheet60
61. Planning process-contd. Equipment groups The equipment for
any project is divided into groups which depend on the type of
contract under which the items will be provided: Group 1: Items
(including engineering terminal outlets) supplied and fixed within
the terms of the building contract. Group 2: Items which have space
and/or building construction and/or engineering service
requirements and are fixed within the terms of the building
contract but are supplied under arrangements separate from the
building contract. Group 3: As in Group 2, but supplied and fixed
(or placed in position) under arrangements separate from the
building contract. Group 4: Items supplied under arrangements
separate from the building contract, possibly with storage
implications but otherwise having no effect on space, building
construction or engineering service requirements.61
62. Planning process-contd. Equipment groups-examples Group 1:
Telephones, clocks, fixed cupboards, drug cupboards, wash hand
basins and taps, nurse/ staff call switches, departmental intercom,
protective screens, fire extinguishers. Group 2: Soap & tissue
dispensers, bench-mounted film markers (less important with
daylight systems), viewing boxes. Group 3: All X-ray and imaging
apparatus, processing apparatus, filing cabinets, bookcases,
movable cupboards, chairs, desks, typewriters, dictating machines.
Group 4: Blankets and pillows, cups and saucers, curtains,
protective aprons and gloves, a wide range of desk-top
accessories.62
63. Planning process-contd. Budgeting for equipment The cost of
all equipment, has to be assessed and money allowed for it in the
project budget. Equipment is always purchased a long time after the
overall budget is decided in the Agreement to Proceed (stage 1 in
Capricode) and worked out in more detail in Budget Cost (stage 2).
Prices will inevitably rise; there is updating of the predicted
cost every 6 months. The process of updating the budget will see
that money is available at the right moment for the agreed
equipment. There will not be the money for a change of mind. e.g.
CT to MRI machine.63
64. Planning process-contd. Consultation over equipment For
most items, the hospital standard will be acceptable (e.g. clocks
and soap dispensers) but several items require special
consideration. Particularly in specialized services. Unless details
are specified in the building contract, supply of the these items
will be put out to tender by the builder and he will take the
cheapest, which may not be suitable. Adequate consultation to
ensure that the correct apparatus was specified and supplied is
necessary.64
65. Planning process-contd. Instruction to architects The
important principle at this stage of planning is that a suitable A
Sheet or group of A Sheets is chosen for the activity under
consideration and the listed B Sheets are checked for suitability,
notes being made of any points requiring special attention. As
necessary, amendments are made in the A and B Sheets until the
desired result is achieved. The groups of A and B Sheets for all
the activities and spaces will be collected together and will
constitute the foundation of the design of the department and its
contents. These, together with the final layout drawings, are the
basis on which the architect will proceed with the detailed design
of a department or an extension, and will thereby constitute his
instructions.65
66. Planning process-contd. Architectural drawings Block
drawings: Once the selection of A and B Sheets, including any
necessary amendments or modifications, has been completed,
preliminary drawings are prepared and submitted to the Project Team
for comment. They will show room shapes but little else.66
67. Planning process-contd. Agreement of layout With the many
conflicting requirements to be resolved by the architect, it will
be rare for this first block drawing to be completely satisfactory.
If previous briefing was accurate and complete, the work done
earlier is repaid at this stage. As the block drawing stage
proceeds, requests for substantial changes will taken with smile;
but if the basic concept is acceptable, minor alterations are taken
willingly. It may be possible to propose suitable solutions, but
take care not to tell the other professionals how to do their job.
If the architect does not get it right, it is probably because your
briefing and explanations are inadequate or not understood. The
more accurate and the more comprehensive the briefing, the more
likely it is that your needs will be translated into satisfactory
plans. Finally there will be agreed outline drawings: any future
change of layout will be67 resisted.
68. Planning process-contd. Sketch plans When the final layout
has been agreed, the process of refining the outline starts; the
loaded drawings will start to appear - in other words the fixtures
and fittings will be drawn in. As with all the other drawings,
these need to be looked at with care; look not only at the location
of obvious things, but also the smaller but no less significant
items. Now is the chance to ensure that the niggles over the
positioning of socket outlets in your office or the sitting of a
clock are not repeated; go through every room and space positively,
checking all the details.68
69. Planning process-contd. Freezing drawings By the end of
this stage of the planning process, the final layout and the
functional requirements will have been agreed. The drawings are
then frozen. It is from these that the detailed design work starts,
with structure, ventilation, electrical and water supply, etc., to
be added - a tremendous amount of work with numerous drawings for
every part of the building, each devoted to one aspect of the
structure or services. These are the Working/Production Drawings.
Any change from now on is not just a line on a piece of paper, but
will have wide-ranging significance, and it will only be allowed if
there is very strong representation backed up by cast- iron
reasons. Changes may delay the whole project, which can have
implications for costs as well as time.69
70. Planning process-contd. The fallow period From the time of
freezing the drawings, there is a long period during which
working/production drawings are prepared, tenders invited, contract
awarded and building starts. It may appear fallow (empty) for the
staff, but there is work to do and it is not nearly as fallow as it
looked at first sight. There should be detailed review of the
Departmental Operational Policy, deriving from it things like
staffing levels and job descriptions for various members of
staff.70
71. Planning process-contd. Ordering equipment The specialized
Engineer will be involved in the selection and ordering of
equipment and a Supplies Officer in the others. Their brief will be
to help in the selection process, but they will inevitably be
conditioned by what is available on contract, by Policy and by
other constraints. We may study equipment care later on.71
72. Commissioning Ready for service. Before being awarded this
title, however, a hospital must pass several milestones. Equipment
is installed and tested, problems are identified and corrected, and
the prospective crew is extensively trained. A commissioned
hospital is one whose materials, systems, and staff have
successfully completed a thorough quality assurance process.72