The Critical Elements for Hospital Success - Part 1

[Due to the nature of the topic, this post has been divided in two parts]

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The word hospital has been derived from the Latin word “hospice”; in fact, the words hospital, hotel, and hostel all are derived from the general Latin root “hospice,” which means a place or an establishment where the guest should be received, also known as hospitium or hospitale. Here guests are patients, their attendants and visitors, where hosts are hospital staff including management. Today, hospital means an institute in which sick or wounded persons are taken care of and treated. The WHO defines hospital as “A hospital is a combined or an integral part of social and medical organization, function of which should be to provide complete health care to the people in population, both curative and preventive, and whose outpatient services reach out to the family and to its home environment [1]

The hospital is also an institution where training of the health workers and biomedical-research is conducted. The quality and suitability of the hospital environment are key contributors to the patient experience. Early and consistent clinical engagement is an important aspect to enable true alignment of clinical services and facilities. It is necessary that the planning of hospital facilities must respond to changing models of care and is undertaken through an authentic “whole system” approach [2].

The unprecedented rate of social, technological, and medical change has led to the development of different healthcare architectural approaches to design for a specific medical program while planning for its future change [3]. Huge hospital building projects provide an ideal opportunity to implement change through the planning and design phases. This will require a planning team approach by doctors, nurses, allied health professionals and administrators, architects, and simulation engineers [4].

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The volatile environment for health care delivery worldwide, due to its multiple burden of communicable, non-communicable, perinatal and maternal, and injury-related disorders with generally poor health outcomes, compels health care managers to adopt contemporary management approaches in resource-constrained environments to make the available Heath Care Establishments (HCE) a success[5]. This requires a thinking and strategy  involving proven operations practices and techniques that improves the quality and efficiency of production and service delivery by enhancing operational flow and diminishing wasteful activity in an establishment whether small or big both in public and private sector[6]. However, the question of what critical success elements will predict the success remains unanswered and depends upon a no of factors.

Constructing a health care facility is a tedious and complicated job. Many Government agencies are involved because of safety and public protection concerns. Since these facilities have a diversity of functions going on in them, therefore, they are subject to many regulations. A Healthcare Manager must therefore keep abreast of these regulations as well as functional, technical and aesthetic aspects to be able to make a worthwhile contribution in making a good health care facility worth calling a success[7].

Planning A New Hospital

Since hospital construction is a capital-intensive venture so it has to be conceptualized and implemented in a very thoughtful manner. Well, it’s definitely not a cakewalk for it to be a successful venture. However, there’s a good chance of it, if one keeps a few essential parameters in mind. Multiple factors at various stages of planning need to be accounted for to make a hospital run smoothly and efficiently. Each and every department has to function in tandem with one another. Rigorous planning and subsequent implementation are the prerequisites of success when it comes to a hospital.

Methods Of Planning And Design: The complex process of planning and designing a hospital requires that it should be a multidisciplinary endeavor. In general, the people involved in this process are health planners, functional planners, financial planners, physical planners,  architects,  engineers (such as civil, mechanical, and sanitary),  quantity surveyors, staff responsible for procurement of supplies & staff members such as doctors/nurses and above all the clients/end users. The planning team and the process, include: the needs assessment team, planning team, briefing team, design team, construction team, and commissioning team. The close interaction of various groups of people involved in the process is a highly essential requirement for making the project a success. 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, scale of the hospital, the target population or catchment area, the financial feasibility of the project with cost-benefit analysis and etc[8].

The art and science of designing/constructing a hospital anywhere is a complex affair[9]. For hospital planners/managers, knowing how all the pieces fit together and how they fit into the picture is important. Under the umbrella of Health Care Establishments (HECs) are outpatient set-ups, nursing homes, and various types of hospitals (primary, secondary, and tertiary care establishments viz Basic Health Unit, Rural Health Canter, Tehsil, and District Level hospitals in the public sector), medical colleges with attached teaching hospitals,  health spas, diagnostic centers, hospices, old age homes and more. Most of these institutions will have varied needs, which will differ vastly in terms of their planning needs. Healthcare provision in developing countries is different in rural and semi-urban settings where it is more unorganized to today’s modern/super specialty centers where it is more institutionalized[9].

Grading of City Hospitals: The size of a city hospital is a function of the hospital & bed requirement, which in turn is a function of the size of the population it serves. The disease prevalence in the catchment area varies widely in type and complexity. It is not possible to treat all of them at one hospital hospitals. Some may require the intervention of highly specialist services and use of sophisticated expensive medical equipment.  Patients with such diseases can be transferred to tertiary and other specialized hospitals[10].

In order to make the plan a success, here are some of the key factors to be implemented before starting a hospital.

Draft a mission, vision, and logo for the hospital: Each organization should prepare a vision and mission statement at the onset. A focused vision statement helps in projecting the principles of decision-makers, and vision points out to the path chosen. The success of the venture depends upon how the vision & mission are, followed, accomplished, and maintained.   

Infrastructure completion: The teams must not be impatient. Ensure infrastructure completion before inaugurating. For example, the mechanical, electrical, and plumbing requirements of the building should be completed; the necessary equipment should be installed. A suitable Hospital Management Information System (HMIS) should be purchased. The HMIS should be adaptable to future trends like minimum use of paper, adequate data storage, electronic access for remote devices, future-ready systems and digital screens, etc.

Manpower: A detailed plan of manpower required for the hospital should be tabled. Hiring the right manpower is one of the most important aspects as they form the backbone of the hospital. A Chief Executive Officer (CEO)/ Medical Director should be the first one to be hired, ideally before hiring any other manpower and before any critical decisions are taken. The CEO/ Medical Director should be involved in all the major decisions like the purchase of the equipment and hiring of other manpower. Against the manpower, the necessary education, skillset, and experience should be listed. The manpower of the hospital is to be selected with utmost importance. The selection should be carried out considering parameters like experience, required skillset, and the ability to communicate easily with the patients[11].

Processes for the hospital: Develop and implement standard operating procedures (SOPs) as per services offered and the role of each staff. SOPs are unique to each hospital. The very purpose of an SOP is to carry out operations in a correct and consistent manner, thus serving as a guiding tool for the staff.

Tariff/Fee for services offered: The hospital services and competitive fee structure should be listed as per the specialties/facilities and a team headed by the CEO/Managing Director should finalize it as per the hospital’s vision.

Preparing forms and formats: Forms and formats that are mandatory by law and are required by departments need to be prepared and printed beforehand as well.

Training: The necessary training as per the department and required skillset should be provided to the manpower to operate equipment and the HMIS. Further, department-wise training should be provided for SOPs. Adequate training for all procedures is required to handle adverse and unforeseen situations.

Branding and communication: Branding of a new hospital is a very important aspect which is often neglected. Branding and clear communication enable the hospital to convey to the patients the services offered. Seminars, conferences, and a tour of the facilities with the stakeholders are extremely educative in purpose[12].

Prepare a detailed checklist: A detailed checklist should be prepared for all departments. The checklist should cover infrastructure, manpower and processes

Dry run of the hospital: A dry run helps in establishing patient flow, clearing out any bottlenecks, and also in anticipating problems that can be solved before the opening. Many hospitals try to solve the issue once the hospital is running, which may lead to a negative patient experience. Most of the time the above parameters are neglected and result in a chaotic hospital, an unpleasant experience for both patients and the staff which can be avoided by paying attention to detail.

The planners/financers must consider the following factors before starting the projects as these will certainly help in making it sustainable:

Influencing  Factors: In order to determine various parameters of such a hospital, a selected survey (Market Intelligence Report) has to be conducted in an area where the future hospital is planned, about area profile, general perceptions of future clientele about hospital and clinics, consultants’ view, prevailing illnesses,  adjacent pathological and radiology labs and prevailing charges (to remain competitive). The findings of this survey will, will be helpful in “Project Design”

In order to ensure continued financial support for the building, maintenance, and operation of a hospital, certain additional important parameters are to be determined first.

(The article continues here)

References

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