Factor Influencing Hospital Utilization ( WHO Report: p31—p35)

• Availability of hospital Bed • Method of payment for hospital services

• Age of the Populations • Service coverage and Bed distribution
• Availability of extramural medical services
• Hospital Bottle neck
• Medical Customs and social Pattern
• Supply of physicians
• Research and Training
• Existence proprietary hospital
• Housing
• Morbility
• Internal Organization
Factor Influencing Hospital Utilization ( WHO Report: p31—p35)

1 Availability of hospital Bed

Availability of Hospital has been observed in the economically developed countries that the larger the number of
available hospital beds, the larger the volume of hospital utilisation; but it is unlikely that these two trends are really
correlated. They are the result of factors linked to the socio-economic development, such as better health education,
increased health consciousness, larger protection by social security, and higher standards of living, leading to an
increased number of demands for medical care. A saturation level is eventually reached, especially for maternity
services and some specialised departments. In some cases, there is a direct relationship between the bed/population
ratio and the utilisation indices, such as admission rates, bed occupancy rate, per person hospitalisation rate, and
others. If the bed complement is very great, high bed/population ratios may be accompanied by a low bed-occupancy
rate and/or a high turnover interval.

2 Methods of Payment for Hospital Services

As previously noted, there are two methods of payment for hospital services: direct and indirect. In the former,
payment is made directly by the utilisation of the hospital services; in the latter, services are paid for through prepaid
programmes, sickness insurance, general taxation and other indirect means. Hospital utilisation is greatly influenced
by the method of payment.

3 Age of the Population

A population with a high life-expectancy (and a consequently higher proportion of aged persons) tends to raise the
volume of hospitalisation. The effect of age on utilisation indices is reflected in an increase in the per person
hospitalisation rate and in the average length of stay per patient.

4 Service Coverage and Bed Distribution

A high bed/population index does not always indicate a full coverage of the population; this depends on the
geographic distribution of hospital beds rather than on the total number of beds, and even geographic distribution
increases hospital utilisation by making the hospitals more available to all the people. On the other hand, a large
number of beds concentrated in urban areas may still mean a low admission rate for the country as a whole, inasmuch
as large sectors of the rural population may not be able to take full advantage of the hospital because of the distances
involved. Similarly, the per person hospitalisation rate
may be low while the bed-occupancy rate may be high, indicating a very high utilisation rate by one segment of the
population and a low utilisation by another.

5 Availability of Extramural Medical Services

The type, extent, and quality of extramural medical services affect hospital utilisation in various ways. A well-organised
domiciliary medical service can, by caring for patients in their homes or clinics, reduce the load on the hospital.
However, in developing countries these services also tend to uncover hitherto undiscovered sickness in the
community, which can give rise to a completely new demand for hospital services. An important role is played by the
out-patient department of the hospital. A good consulting out-patient department with diagnostic facilities may greatly
reduce the number of admissions to the hospital. Similarly, hospitals provided with a casualty station or an observation
ward in the out-patient department may avoid many unnecessary admissions

6 Hospital “Bottlenecks”
Another important factor in hospital utilisation, connected with the hospital itself, is what might be termed hospital
bottlenecks, or, in other words, the efficiency of the hospital’s supporting services: X-ray department, laboratory
services, operating room services, and others. Shortage of personnel, space, or equipment in these departments
results in a prolonged average hospital stay and a lowering of the admission rate. Improved efficiency in these
departments increases the admission rate and thereby increases the cost per day. This results in decreased hospital
stay, however, and may lower the cost per case, i.e., per person treated. Similarly, the administrative services, such as
the admission and discharge procedures, may act as bottlenecks and adversely affect the efficiency of the hospital.

7 Medical Customs and Social Patterns

The customs or attitudes of the medical profession affect hospital utilization. Thus, early ambulation, which has been
adopted in many countries, has resulted in a lower average stay in hospital. With regard to obstetrics, customs differ
greatly from country to country. In some countries, the medical profession, or the women concerned, insists on
hospital deliveries for nearly all cases whereas, in other countries, hospital deliveries are confined to abnormal cases
and, possibly, primiparas. In addition, the length of hospitalization in normal obstetric cases varies from two to three
days in some countries to up to fourteen days in others. The demand on hospitals is also affected by social and
cultural patterns of the population, as previously suggested.

8 Supply of Physicians
The number of doctors in a country influences hospital utilisation in a number of ways. On the whole, the pattern of
hospital utilisation is less influenced by the number of doctors than by factors such as the attitude of the medical
profession toward hospitalisation and the organisational patterns of medical care. Other factors being equal, the
number of doctors influences the admission rate as follows: in areas with a very small supply of doctors, the admission
rate tends to be low, as large sectors of the population have no access to medical practitioners, and much illness
remains undetected. As the number of doctors increases, more cases of illness are detected and the hospital
admission rate rises. A point of maximum rise is reached when the physician/population ratio is such that there is
practically complete coverage of the population, but the number of patients per doctor is very high. Thus, the
overburdened practitioner tends to refer to the hospital cases that had he more time; he could deal with efficiently on
an out-patient basis or at home. A further rise in the number of doctors diminishes the patient load and allows for more
medical work outside the hospital. The admission rate therefore tends to fall, though not to the level of areas
undersupplied with doctors.

9 Research and Training

Hospitals with programmes of research or training, or both, tend to be more selective in their admission policy. On the
other hand, the average length of stay in these hospitals tends to be longer because there are many specialised
departments, such as neurosurgery, orthopaedics, and neuropsychiatry that select serious cases.

10 Existence of Proprietary Hospitals

The proprietary hospital is also selective in its admission policy, usually receiving minor or curable cases. Therefore,
complicated cases are mostly referred to general hospitals, which must keep them longer. Thus, in the proprietary
hospitals, the length of stay is generally shorter than that in other hospitals.

11 Housing
The current trend for families to live in smaller houses or apartments has a definite influence on hospital utilisation.
Many admissions to hospital are due not so much to the need for hospital care as to the inconveniences encountered
in caring for the sick person at home. Smaller housing units demand fewer home help. Therefore, the combination of
shortage of space and shortage of home help is an important factor in the demand for hospital admission. This is
particularly true with regard to the elderly, who often cannot be kept at home when sick.

12 Morbidity
Hospital utilisation is greatly influenced by the morbidity pattern of the community. The sporadic increased demand
due to an outbreak of disease and the day-to-day morbidity pattern both determine, to a large extent, the type and
volume of hospital admissions. Thus, the acute, communicable diseases result in a demand for more beds in
“short-stay” institutions, which raise the admission rates, whereas the degenerative or chronic infective and parasitic
diseases tend to prolong the average stay in hospital.

13 Internal Organization
The greater the amount of segmentation within a hospital, the less the degree of utilisation, as shown by the
bed-occupancy rate and the turnover interval. This points out the need to provide the greatest practicable flexibility in
planning a hospital and to avoid, so far as possible, earmarking beds for particular diseases or putting them at the sole
disposal of particular consultants. The length of stay in hospital and the interval between onset of disease and
resumption of work should be shortened by all possible means. The work and importance of a hospital ought not to be
measured in terms of beds; the average length of stay, occupancy rate, and admission rate are all part of the picture.
The hospital’s activity should also be related to the number of patients examined and treated as in-patients or
out-patients, in the rehabilitation service, or under home care. The hospital of the future should have fully developed
extramural services and a reduced number of beds. Consideration of the hospital bed as the sole yardstick of medical
care activity belongs to the past.

Hospital Planning Process

In general, the people involved in this process are:
• Health planners, functional planners, financial planners and physical planners.
• Architects • Engineers (such as civil, mechanical and sanitary) • Quantity surveyors • Finance managers • Staff
responsible for procurement of supplies • Staff members such as doctors/nurses, clients/end users
(a)Needs assessment team (b)Briefing team (c)Design team (d)Construction team
(a) Needs assessment team
At the earliest stage, a needs assessment team involving the planners, end users such as the hospital staff and the
community establishes an overall plan of the needs, range of services to be provided, the target population or
catchment area, the financial feasibility of the project with cost benefit analysis and the scale of the hospital, etc.

(b) Briefing team

After the needs and the size of the hospital have been determined, the briefing team involving architects, engineers,
the staff and the community sit together to prepare the key document, i.e. "the design brief" which translates the
requirements into functions, activities, space distribution and/or any other information necessary for the design.
c) Design team
This team consists of all the people involved in designing the facility(ies) and pools the expertise of its members to
produce the instruments for implementing construction, starting from) preliminary investigation to the final designs with
technical specification, tendering documents and detailed working drawings and estimates of cost. This team mainly
consists of engineers, architects, quantity, surveyors, hospital staff, the community and the approving authority
(d) 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.

Hospital planning steps comprise of briefing stage, design stage, construction stage, testing, and
commissioning stage, operation, and post- occupancy evaluation.

1 Briefing Stage
➢ A feasibility study needs to be carried out in order to clarify the objectives of the project
➢ A feasibility study includes the type of services to be provided, sophistication in building plan and equipment, and
investment and returns that is targeted.
➢ Based on the information of feasibility study, Briefing team prepare a medical/ design brief document.
➢ This medical/design brief describes in detail the overall requirement of the hospital plan, which includes the plan of
needs, scope of services to be provided, the target population or catchment area, the financial feasibility of the project
with cost benefit analysis and the scale of the hospital, such as the bed numbers etc.
➢ At this stage, the users should play an active role to establish the demand for the new hospital by giving their
decision to construct the design briefs, such as the services to be delivered and required functions etc.

2 Design Stage
This is a very important step where the architect translates the clinical and administrative needs into architectural and
engineering realities. At this stage, the users should play their consultative role. At the designing stage, the design
team produces the hospital master plan, detailed design, and construction drawing. Designing team is also
responsible to prepare a detailed design including the structural, electrical, and plumbing specifications.

3 Construction and Installation Stage

➢ This is a stage where construction team implements the design from the approved drawings and technical
specifications within the prescribed time and cost.
➢ At this stage, several elements, such as quality, safety requirement, and rules set by various bodies and local
authorities need to be considered.
➢ Planners ,on the other hand ,should focus on the procurement of machinery and equipment and recruitment of the
man power, while the users should play their consultative role.

4 Testing and Commissioning Stage

➢ This stage takes place after the construction and installation are completed. Usually refers to the last few months
before the hospital operates.
➢ every aspects of the hospital should be tested during this phase to ensure that they are able to function when the
hospital operates.
➢ The commissioning team is responsible to staff the hospital, commissions and procures the equipment, furniture,
and supplies and prepares it for operation.
➢ The users should actively play their role at this stage by carrying out the testing and verification of the services,
processes (such as patient information system and communication system), equipment, structures, water and
electrical supply.
5 Operation stage
This step is the operation of the hospital once it is opened to the public and the implementation of the services and
activities planned .

Factors to be considered in locating a district hospital

●​ It should be within 15-30 min travelling time. In a district with good roads and adequate means of transport, this
would mean a service zone with a radius of about 25 km.
●​ It should be grouped with other institutional facilities, such as religious (church), educational (school), tribal
(cultural) and commercial (market) centres.
●​ It should be free from dangers of flooding; it must not, therefore, be sited at the lowest point of the district.
●​ It should be in an area free of pollution of any kind, including air, noise, water and land pollution.
●​ It must be serviced by public utilities: water, sewage and storm-water disposal, electricity, gas and telephone.
In areas where such utilities are not available, substitutes must be found, such as a deep well for water, generators for
electricity and radio communication for telephone.\

Hospital site selection criteria:

In the case of either site selection or evaluation of adaptability, the following items must be considered: size,
topography, drainage, soil conditions, utilities available, natural features and limitations.

1 Size of the site

The site must be large enough for all the planned functional requirements to be met and for any expansion envisioned
within the coming ten years.
the following minimum requirements have been proposed:
• 25-bed-capacity - 2 ha (800 m2 per bed)
• 100-bed capacity - 4 ha (400 m2 per bed)
• 200-bed capacity - 7 ha (350 m2 per bed)
• 300-bed capacity - 10 ha (333 m2 per bed)
These areas are for the hospital buildings only, excluding the area needed for staff housing. For smaller hospitals,
single-storey construction generally results in effective use of the building, less reliance on expensive mechanical
services and lower running and maintenance costs.

2 Topography
Topography is a determinant of the distribution of form and space. A flat terrain is the easiest and least expensive to
build on. A rolling or sloping terrain is more difficult and more expensive to build on, but the solutions can be
interesting and innovative; by using the natural slope of the ground, the drainage and sewage disposal systems can
be designed so as to result in lower construction and maintenance costs .

3 Drainage
The terrain must allow for easy movement of water away from the site. A high point in the community is ideal. If the
site is at a low point or in a depression, the following must be checked:
➢​ how the surrounding natural terrain and waterways can be used to move water away from the site;
➢​ whether the type of soil allows rapid absorption and disposal of water
➢​ the use of other technical means of ensuring drainage such as the building on a podium or on stilts, or digging
temporary reservoirs .
●​ A site with no apparent drainage problems when bare may be subject to serious flooding when developed, if
adequate provision is not made for disposal of rainwater.
●​ Wherever possible, a site should be provided with surface openings to storm-water drains, drainage channels
or waterways. Storm-water run-off from roads and buildings should be piped to such openings.
●​ the waterways themselves are not subject to flooding and that, in flood conditions, water will not back up on
the hospital site.
When deciding the ground floor level of the buildings, care should be taken to safeguard against temporary flooding of
the building in a heavy downpour. In areas prone to regular flooding, a raised ground floor, which allows for expected
peak floods, is essential. Local engineering advice on the possibilities of drainage from a site should be obtained
before proceeding with its purchase, when such advice is available (e.g., from records of the local authority or relevant
government department). It may also be necessary to perform percolation tests to determine .
4 Soil conditions
The soil conditions are a determinant of foundation schemes. Ideally, the subsoil should be such that conventional,
economical structural design and foundation schemes can be used. Waterlogged areas, swamps and former rice fields
should be avoided. If no other site is available, however, the following steps must be taken:

a) Check the bearing capacity of the soil.

●​ For foundation requirements , the subsurface soil and water conditions must be determined.
●​ •A sufficient number of test borings or pits must be made so that the engineer can best judge the true
subsurface conditions.
●​ If necessary, appropriate laboratory tests should be performed to determine the safe bearing capacity and the
compressibility of the various strata of soil, including alkali content, which might affect concrete foundations in the long
run.
(b) Scrap unstable top layers, if necessary, and fill with well compacted, suitable materials, like clean coarse sand. (c)
Seek engineering advice before finalizing the depth and size of the foundations, which should be designed to suit the
site conditions.

5 Natural features

➢​ Features such as natural lakes and ponds and lush vegetation are not necessarily a disadvantage and can
have great potential for enhancing the building design.
➢​ Building design should respond as much as possible to the site, so that the structure is in context with the
environment for example:
➢​ All attempts should be made to maintain the existing trees on the site in accordance with the profile of the
building.
➢​ Solutions can be numerous, involving creativity and innovation, but they should be based on two overriding
considerations:
(i) that the design respects and follows the laws of nature; and
(ii) that the limitations imposed by the natural features do not detract from the functional performance or
cost-effectiveness of the facility.
➢​ If the constraints of a site result in a building form that is too expensive, an alternative site should be found or
the restrictive feature removed. For example, a waterway that crosses a site might be diverted around the edge of the
site.

Organization policy in regard to:

(a) Patient movement. The manner in which patients are moved---on stretchers, their own beds or wheelchairs affects
decisions on circulation routes and spaces, corridor widths and door widths. It also affects decisions on types of
vertical routes to be used, whether stairs, lifts or ramps.

(b) Staff and staff movement.

The routes taken by the staff from the outside to their places of work, how they arrive and their distribution within the
hospital bears on the size and siting of staff areas and amenities, including areas for parking, changing, resting,
conference and study.

(c) Supply delivery.

A hospital may adopt a centralized system for storage and delivery of supplies. In case of centralized sullply , corridor
routes by which supplies are brought from the central store to departments must be of adequate dimensions to
accommodate the delivery of equipment used such as trolleys and mechanical pullers. In hospitals that opt for
decentralized systems, traffic routes are simpler but a number of sub-supply posts must be provided in different
departments or units.
(d) Disposal of used goods.
Used goods, especially contaminated ones, very often require design solutions that involve segregation of clean and
dirty streams of traffic. Segregation may also involve use of plastic bags or sealed containers, so that clean and dirty
streams can use the same corridor.

(e) Laundry services.

When laundry is to be undertaken within the hospital, a complete facility must be provided; if it is to be contracted
outside the hospital, laundry areas may be limited to a receiving counter for clean supplies and a temporary station for
soiled linen to be collected by the outside agency. Provision for washing "foul" linen may still be necessary.

(f) Food services.

A centralized kitchen from which food is brought directly to patients will be large, and centralized food management
will mean that the movement of large food trolleys must be considered in the design of the corridor system. A kitchen
that is decentralized to the departments and wards will be smaller at the central point but will involve satellite kitchens
for tray and plate preparation and washing and storage of utensils and equipment.

(g) Domestic service.

A centralized domestic service will require large storage areas for fresh linen and cleaning equipment. In a
decentralized system, these areas will be smaller units in different parts of the hospital. Organization policy in regard
to:

(h) Security.
The number of entrances and exits is often the concern of the security unit of the administrative office of the hospital.
The decision taken on the maximum number affects circulation and circulation routes both inside and outside the
hospital building.

(i) Engineering services.

The checklist for this aspect will include questions like:
• hot-water lines
• air-conditioned- centralized or serve only selected areas? ·
• medical gas lines -centralized or decentralized? Location of line outlet or in the form of portable tanks on carriers with
rollers?

(j) Fire safety.

Fire safety is not limited to the provision of fire exits and fire control; fire safety should start with the design of the
building. It can be improved by good planning and recognition of the specific problems of hospitals. A minimum of two
compartments should be provided per floor, with proper facilities to stop fire and smoke and fire doors of appropriate
standard. The larger the continuous floor area on any storey, the more fire compartments are required; this also
ensures greater opportunity for progressive evacuation. Maximum amounts of fire-resistant materials should be used
in constructing the buildings, in false ceilings and in partition walls, so that they have the requisite fire resistance and
flame-spread ratings as outlined in the code.

(k) Communication and call systems

The types of wired communication should be decided on, and whether all or only some of the following are required:
· internal telephones
· external telephones
· public (coin-operated) telephones
· intercoms
· patient-nurse call buttons
· emergency alarms
· public address system
· radio and television
· others

Master planning
The master plan of a hospital is the basis for present and future decisions on the layout of buildings and services,
changes in needs and phasing.
It indicates the phasing and grouping of individual buildings and the means of communication between them, the scale
and location of utilities necessary at various stages, and directions and limits of probable future expansion or
remodelling of the hospital.
During master planning ,any mistake in placing buildings, access roads, sewer systems, entry points and parking
facilities on the site can restrict possibilities of growth. The Master plan of a Hospital Project should be on the basis of:
●​ grouping main functions, like wards, medical services, admissions and central supplies;
●​ establishing appropriate access routes for easy orientation of patients and visitors, with special emphasis on
disabled people; and
●​ providing scope for future expansion to cope with an increased number of beds, supplementary functions and
medical specialization,
●​ ensuring maximum interaction between hospital units and support services.
The master plan consists of two elements:
(i) determination of circulation routes and corridor systems;
(ii) location of elements on the site in relation to one another.

(i) determination of circulation routes and corridor systems;

Circulation routes and corridor systems must be designed so that all users can find their way around with least
difficulty.
The main circulation loop must be noticeable from all part of the building , and the hierarchy of secondary routes must
correspond to the hierarchy of the hospital units they serve.
Simplicity should be the target of layout design; this reduces the requirements for signs and improves the quality of
service.
(ii) location of departments on the site in relation to one another. The placing of elements and departments on a site
should result in an optimal interrelationship among departments and provide room for expansion .

Some principles and guidelines for the Master Planning of a hospital are as follows:

●​ Departments that are most closely linked to the community should be closest to the main entrance: out-patient
department, emergency, administration (especially business sections), family planning clinic and other primary health
care support.
●​ Departments that support outpatient and emergency department should be next closest to the entrance: X-ray,
laboratories, dispensary.
●​ In-patient departments should be in the interior zones, or wards.
●​ Operating theatres, the delivery department should be on one side and the nursery should be on one side e.g.,
to provide easy access from the emergency and accident departments to X-ray and operating theatres. The delivery
department and nursery must be separated from the operating theatre.
●​ Housekeeping and domestic service areas should be grouped around a service yard: laundry, kitchen,
housekeeping, maintenance, storage and motor pool.
●​ Staff facilities should be located on the periphery near roads and public transport: staff dormitories, quarters or
housing.
●​ Teaching facilities, if any, should be close to both staff facilities and teaching areas and to roads and public
transport: student areas, educational and training components of primary health care.
●​ The mortuary should be in a special service yard, with a discreet entrance; it should be away from the
out-patient department, ward block and nursery

Hospital Building shape

The district hospital should reflect the local architecture.

Every country and every community has its own concept of form and of space and of their interrelationship, as well as
having its own feeling for scale and proportion.
The district hospital should reflect the rhythm of the local culture, civilization and historial heritage but at the same time
be flexible enough to accommodate mode of methods of health care and facilities.
The hospital should not be alien to its surroundings or stand out as an exception but should fit in with local life,
expressing its spirit and character. The hospital building should not be a huge, unfriendly, structure but should be a
human, welcoming part of the community.

According to American Institute of Architects:

There are no stock or standard plans for health care facilities. Each facility will be unique to the extent that
site constraints, local zoning, vehicular access and neighborhood requirements are taken into consideration
in the initial project.
The village form
The village form is organized like a small town, in which corridors correspond to streets and
departments correspond to the different land uses of a village.
This design is
• easy to phase, which is useful when the budget is limited.
• easy to expand, since the design is open-ended, and a wall can simply be broken down for
expansion into an open space.
• This form requires a large site; and if sufficient room is to be provided for ultimate growth,
the distances between departments will be great.
Modular village form
The modular village form is similar to the village concept except that the departments must
fit into a predetermined form.
• This form is useful when repeated modules are used.
• It results in forced planning of departments to fit within the same shape: some will fit just
right, others will be "bursting at the seams" and others will have waste
space.

The Finger Form

The finger plan consists of central corridor and side corridors, which link various
departments branching out in "fingers". It is a development of the train corridor form (Fig.
38), in which one must pass through one compartment to reach the next. Since the
corridors in the finger plan have single functions, this form lends itself to the provision of
abundant natural ventilation and lighting.
open-ended finger
An open-ended finger development plan can allow for the expansion of individual blocks at
different times. It also allows for staged development, by progressive extension of the main
corridor as further components are required.
 The Block Form
The block is a form for sites where the ground area is limited. As the hospital is developed
vertically, optimal relationships between departments may be difficult to achieve and one
department may be disposed on two levels. It is also a form that is difficult to expand later.

It is appropriate for designing wards, since wards have generally similar floor plans; however,
structural costs are likely to be higher than those for a similar number of wards in a single
story construction.

Tower and podium layout

In the tower and podium design, the fastest growing departments are located in the ground
floor podium and those that are slow-growing and departments that are typical and replicable
are located in the tower.
This form was developed with expansion and growth as the overriding criteria. The tower,
however, relies heavily on mechanical engineering services, and the structure of the tower
and the location of lifts and service ducts may severely limit the central area of the podium.
The roof of the podium must be constructed of fire-resistant materials so that fire will not
spread from the podium via external walls and windows to the tower block.

The courtyard plan

The courtyard plan closes on itself.
It has the same advantages of natural lighting and ventilation as the village and finger plans
but is easier to secure and more comfortable in humid tropical areas. This plan does impose
certain limitations; rooms at the corners of the court have no external light or ventilation;
facilities that face the court cannot be extended without displacing other rooms.

Compact Plan
The compact plan is a "deep“ form and its proper functioning relies heavily on engineering
services.
Artificial ventilation and lighting must be provided for inner areas; heat generated by people
and equipment must be removed by artificial cooling. This type of plan is therefore expensive
to construct, operate and maintain. Compactness can be of advantage in terms of proximity of
departments and of conservation of space, as in densely populated metropolitan areas. In
such cases, however, the building usually has several floors, and the proximity of
departments may be reduced by vertical separation.

Regionalized Health System

Regionalized Health System means administrative control of all hospitals and health services of a wide area ,
containing a population of up to several million people.
Main objectives is
●​ To serve all kind of medical services in a reasonable number of populations;
●​ To avoid gaps and overlapping of medical services;
 ●​ Placed hospitals at a suitable positions considering population density and means of communication.
• In regional planning , the broad direction will be laid down by regional authority, day to day administration of
individual hospital is left to local initiatives.
• In developed country, regional authority is the proper body to administer and organize a blood fusion service for the
entire region. This would include setting up mobile team , laboratory for blood typing, refrigerated storage facilities, a
distribution system, arrangement for the preparation and distribution of publicity material.
• Regional planning of hospital on regional basis provides a better and fairer distribution of services in less developing
region.
• Regional planning ensure a reasonably uniform standard of medical services through out the regions.
• Regional systems promotes economy by making possible centralization of functions such as accounting, laundry
service, waste management, bulk purchasing of s drug supplies.
• Certain expert advisory services can also be organized to take advantage on a regional and sub-regional basis.
• Principal factors to define the hospital boundary are
❖ Major center of the populations
❖ Existing Major Hospitals
❖ Line of Communications
• When communication are adequate, the geographical size of a region is not of great importance, but population size
should be in between one to three million.
• To ensure standard medical care , in regional planning give option to share or interchange of medical opinion and
services.

According to the first report of the WHO expert committee on the organization of medical care,
there are three type of hospital--
1. The regional hospital provide complete type of treatment including such specialties as Radiography,
Neurosurgery, Thoracic Surgery and Plastic Surgery. Where possible it associate with undergraduate teaching
hospital .
2. The intermediate ( or District ) Hospital of several Hundred beds providing a high standard of medical , surgical,
obstetrical and specialized treatment.
3. The small, local, rural Hospital of 20 to 100 beds proving general medical surgical and maternity care.

Hospital may be divided into two classes:

(1) Special Hospital ( 2) General Hospital Special Hospital:

Special hospital:
Special hospital deals exclusively with specific organs or systems of the body ( ear, eye, nose, and throat); Central
nervous system, orthopedics or certain group of the populations ( tuberculosis , accidents , infectious diseases,
cancer).----
➔​ Special hospital is isolated from the general body of medicine.
➔​ Special trained staff focusing on their specialty.
➔​ Special hospital have played an important part in the development of medicine.
➔​ Due to more concentration on the clinical material in them, they have been natural centers of
research and of post graduate medical educations.

General hospital : General hospital contain a range of specialist services aim to provide treatment for men, women
and children suffering from any form of illness, except highly infectious and dangerous conditions.

Hospital may be divided into two classes:

(1) Public Hospital :
• the public hospital is an establishment and group of establishments. In some cases, this authority is local and
corresponds to a municipality.
• In other cases public hospital may be created and managed by a wider community such as department, province, or
region, containing a large and smaller number of communes. In this case, it is administered by departmental and
regional services.
• Public hospital may also created and managed by state itself and be administered directly by a minister. • In some
countries, the term public hospital cover hospitals that area managed by government services or public municipal,
departmental or national bodies and that are financed as a part of the overall budget for public services.

( 2) Private Hospital:
• Private hospital run by philanthropic institution, which make no profit and do not operate on a commercial basis.
These are created by different group of people: religious communities or groups, Lay philanthropic institutions,
sickness insurance , mutual aid society etc.
• Private hospital can run on commercial basis founded and managed by commercial group or by individuals as
commercial enterprises

District hospital

Definition
The term "district hospital" is used here to mean a hospital at the first referral level that
• is responsible for a district of a defined geographical area
• containing a defined population and
• governed by a politico-administrative organization such as a district health management team.

It is possible that the "district hospital" may vary from country to country but will remain distinct with its functions. In
some countries, where the population is small, the role and functions of district hospital may be enlarged to suit the
needs of the population.
Role:
District hospitals at the first referral level as the component of district health systems supports the health activities of
the district or community, and especially primary health care activities.
Such hospitals can provide wide-ranging support for patient referral as well as support for various technical,
administrative and educational/training activities in the district.
Functions:
The district hospital has the following functions:
(1) it is an important support for other health services and for health care in general in the district;
(2) it provides wide-ranging technical and administrative support and education and training for primary health
care;
(3) it provides an effective, affordable health care service for a defined population, with their full participation, in
cooperation with agencies in the district that have similar concerns.

Growth and change

Provision for growth is often ignored or treated as an afterthought, but it should form part of the initial planning and
design process. If it is left to the time when an urgency is recognized for more beds, laboratory services or X-ray
services, it may be difficult to accommodate these needs. It is therefore of utmost importance that, when preparing the
master plan for the hospital, imaginative foresight be used to identify the areas in which there will probably be fast
growth.
Growth is inevitable and is generated mainly by:
1. Growth of the community. A community may urbanize or may change drastically as the result of an event or a
catalysing situation that requires the equivalent growth of health care services.
2. Accumulated needs and requirements. Necessary expansion may not be undertaken immediately because of
lack of resources; needs are deferred and accumulate to the bursting point.
 3. Physical effects on the building with time. Buildings deteriorate and become obsolete and even irrelevant over
the years.
4. Changing standards and codes. Regulations for health and safety change to meet advances in construction
techniques and materials. A building may be declared unsafe and unfit for human use if it is not updated, upgraded
and properly maintained.
5. Changing methods in medicine. Development of new equipment, miniaturization, computerization and other new
technologies in the medical field translate into new requirements for architectural design to provide better and
more modern clinical services.

Growth and change

(1) Physical growth of hospitals

(a) Outward growth:

This is the recommended form of expansion (Fig. 27). Thus, those areas in which growth
is most probable should adjoin an outside wall; areas that are non- or slow growing
should be in the central part of the building complex.
Outward growth requires that departments be placed where they can expand into open
space without disturbing the operation of other parts of the hospital and infrastructure,
including the road network and sewer lines. Obviously, the greatest scope for
independent expansion of separate components is available in single-storey complexes
with separate buildings, each of which is extendable independently of the others (Fig. 28)

(b) Upward (vertical) growth

This direction of growth is the option for block forms on very limited sites (Fig. 29). It
disrupts operations, particularly on the top floor of the hospital; construction materials are
difficult to transport, requiring an elaborate system of scaffoldings and hoists.
Excess material, although initially expensive, must be installed ahead of time, in: ·
foundations that will accommodate the future load of additional floors;
●​ sanitary, electrical and mechanical systems that will accommodate future requirements;
●​ a strong roof slab on the top floor that can be converted to a future floor slab that will
support the projected load of patients and equipment;
●​ special and sometimes costly provisions to ensure that the building remains waterproof
throughout the period of extension,
 (c) Downward (vertical) growth
This direction of growth utilizes the basement volumes, when they are not part of the
original design (Fig.30), This can cause enormous problems of adequate headroom and in
clearing the existing system of foundations and columns, Furthermore, there are problems
of waterproofing and damp-proofing the new retaining walls. As windows will be limited or
impossible to install, there will be problems in providing natural ventilation and light. It is
always desirable to avoid this type of growth, owing to technical and cost considerations.
(d) Inward growth
This direction of growth pushes adjoining departments out of their location to make way
for a growing department (Fig. 31). It usually occurs in concentrated types of
development. This type of growth disrupts the operation of the growing Fig. 31. Inward
growth departments and the adjoining department.

(e) Growth by fragmentation

This is the division of a single department into several sub-units in different locations (Fig.
32). Departments and other units that can be fragmented are: administration, dining,
laboratories, storage, lockers and records. Fragmentations should be avoided, however, as
they pose problems of management and control and the hospital ultimately becomes less
efficient and productive owing to duplication of necessary support services.

(2) Increments of growth

It is most advisable to expand not in spurts with needs but by deliberate increments, thus: • by number of beds, but in
terms of ward units with their complementary manpower and supporting services (Fig. 33a); • by functional units, in
the case of a new hospital department (Fig. 33b ); • by specialist rooms and their supporting units and services (Fig.

33c)
Data Collected:
Population of district 150 000
Average length of stay in hospital 5 days
Annual rate of admissions 1 per 20 population
Computations: (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 ) x 100%
= 102.74 Say 103 beds.
(4) Total number of beds required when occupancy is 80%:
= bed-days per year + (365 x 80% )
= (37 500 /365) x 80%
= 82 beds