Creating a Hospital that Fulfils the Expectations of the Community it Caters

Dr Karen Marlyn Sr Consultant, Hospital Planning & Management in Projects & Consultancy Division of MedicaSynergie Group

The concept of caregiving is chaging time to time. The past 50 years or so has seen hospitals transforming from a place of rest for the convalescent to an institution that is built, staffed, and equipped for the diagnosis and treatment of the sick and the injured and for accommodating them during the process. Refering to the ancient societies, the Romans, in time of war, did establish infirmaries, which were used to treat sick and injured soldiers. Later on, similar infirmaries were founded in the larger cities and were supported out of public funds. In a way, the Romans were the pioneers of what we call hospitals. As time went hospitals came to be known as almshouses for the poor, hostels for pilgrims, or hospital schools. Since living conditions during the middle ages were not very comfortable or hygienic, the hospitals of those days were far from being clean or orderly. In fact, many hospitals would put two or more patients in the same bed. During the 17th century, there was a general improvement in living conditions and people began to feel that it was the duty of the state to care for its ailing citizens. But it wasn’t until the 18th century that hospitals became more hygienic and better known as places where the sick can be healed. The modern hospitals came into being only in the 20th century with developments in medical science and technology and especially so with the development of anaesthesia and the concept of infection control. Today, investment in Indian hospitals has become one of the most promising business venture. Large superi-speciality hospitals as well as 50-100 bed hospitals are rapidly coming up. The metros and larger cities are seeing a flood of multi-speciality hospitals that have resulted in cut throat competition. On the other hand we see investors rushing into tier II and tier III cities with small size multi-speciality or single speciality hospitals ranging from 50-200 beds. One can ask are these hospitals required in the country—the answer will be a definite yes considering that India has just 0.7 beds per thousand population which is way below the world average of 2.6 beds per thousand population. The real question here would be are these hospitals really required where they are? The answer will depend on the location of the hospital.

Most investors, especially the first timers have very little idea on the type of hospitals they should establish and the best possible location they should do so. We have large chain hospitals more concerned in increasing the total hospital bed strength of the group and we have single or multiple doctor investors focussing more on increasing their clinical practise. This has lead to the unfortunate scenario where beautiful hospital buildings have come up equipped with high end equipment but not really fitting into the community or environment they are placed and having to aggressively push the services they have to offer onto the people. Today’s hospitals require to adapt to multiple situations surrounding our community. What is more challenging in India is the diversity that exist in terms of demographics, history, culture and political conditions. A clear understanding of the need through an assessment of the market and identification of possible ways to bridge the need is therefore of utmost importance.

A few questions one can start with are:

• What is my purpose for building a hospital?
• What is the type and capacity of hospital that I can build with the resources I have?
• Who can help me realise this by understanding the market and conceptualising the plan?

A geographical and demographic information of the area to be covered by the hospital like location, accessibility, population density, distribution of urban and rural population, annual population growth rate, migration pattern and percentage of migrant population require an analysis as these have an impact on deciding the size of the hospital. Cultural values, social characteristics and political aspects also need to be considered as these will have influences in the design as well as operations of the hospital. Appropriate knowledge of the economic scenario will help planners to evaluate the economic status of the population, their purchasing power with respect to health services, the occupational health hazards existing, economic resources available for developing hospital services, insurance mechanisms and economic crises which can influence hospital functions directly or indirectly. Decision on specialities and services to be offered will require an understanding of the health status of the population and its trends.

What is existing in the market? who are the leading practitioners? which are the leading hospitals in the area and what do they offer? how are these hospitals doing and what is the development potential they have? What are the expectations of the primary stakeholders? Answers to these questions will further contribute towards shaping up a hospital that fits into the community it belongs and at the same time makes business sense. Market knowledge will need to be clubbed with a scientific conceptualisation of how one can utilise resources available. The goal of promoters should be to create a hospital using evidence based design concepts at the lowest cost possible without compromising on quality. Reduced cost will translate into lesser burden on the patients.

One of the most safe, comfortable and private place is one’s own home. So the idea of making the clinical space as ‘homely’ as possible, without compromising the clinical aspects of the service delivery, is the best way to go about planning a hospital that will fulfil the expectations of the community it serves. On the other hand the planner has to also remember that people do not always stay within the confines of their home. People in metros and larger cities more often visit malls and large recreation areas whereas people in smaller towns are privileged with more open and more green areas for shopping, an outing or socialising. If budget permits larger hospitals in big cities could look at including a shopping mall kind of space with retail shops, food court and recreation areas. Green areas are definitely more possible in smaller towns but hospitals in larger cities should also try to create greenery through terrace gardens, balcony gardens etc this will only bring delight to every occupant. Besides the external community the hospital should also fulfil the expectations of the workforce as they form the internal community. Addressing their requirements is of vital importance as they spend a major portion of their time in it, if they are happy and comfortable in the place they work they will only reflect it to the people they interact with.

Hospitals will always continue to be an integral part of the community they cater to.

(The Author is Sr Consultant, Hospital Planning & Management in Projects & Consultancy Division of MedicaSynergie Group)