88-Book Reviews - Hospitals, Facilities, Planning and Management

214 Book Reviews
Prof. B. Bhattacharyya in association with MVIRDC World Trade

Centre (Mumbai) has done an excellent work by bringing out this work by
presenting all related aspects on the theme. Subject coverage ideally fits the
common phrase ‘necessary and sufficient’ which is generally used while
proving mathematical theorems. However, as issues such as the theme of
this book ‘SAFTA: Catalyst for Growth, Trade and Peace’ are not static but
continuously expanding everyday, there is need for constantly revising such
books on regular basis, say, once every two years, just as the present book
is an extension of the Centre’s previous study of 2001. The book should
stimulate other professionals, taking cue from this book, to write more books
on related topics in fast expanding field of global trade, besides Prof.
Bhattachryya himself writing more and more on the advancing frontiers of
FTAs in particular and foreign trade at large.
Downloaded From IP - 115.248.73.67 on dated 30-Nov-2010
K.M.Mital, Professor of Strategic Management and Chairperson, General

Members Copy, Not for Commercial Sale
Management Area, IILM Institute for Higher Education.

www.IndianJournals.com
G.D.Kunders, Hospitals: Facilities Planning and Management, Tata

McGraw-Hill Publishing Company Limited (7 West Patel Nagar, New
Delhi 110008), 2005, xxvi + 507. Rs. 810 hardbound.
The book divided into of thirteen chapters is doubtless a pioneering work by
the author on an important subject like ‘Hospital Facilities Planning and
Management.’ A hospital is a place where every activity needs to be
performed fast and efficiently. Chapter 1 is titled as ‘Promoting and Building
a New Hospital.’ It covers principles in planning hospital facilities and services,
equipment planning, financial planning, hospital infrastructure planning, etc.
Any modern hospital focuses on high quality patient care, efficient healthcare
and nursing services, community orientation, affordable healthcare costs
consistent with its economic viability, sound architectural design, etc. In the
first instance hospital site should be chosen after ascertaining people’s
healthcare needs, services provided by other clinics in the area, and it should
be convenient to both patient and hospital staff. It should be at a place
where it can attract both full time and part-time staff, accessible to public
utilities, roads and transportation infrastructure, etc.
Nurses’ station should be situated at a place which can enable them to
exercise control over patients’ corridors and visitors’ movements. Bed is
very important resource in a hospital and the entire hospital planning in one
Management & Change, Volume 11 Number 1 (2007)
Book Reviews 215
or other way depends on this vital resource. More than number of beds it is
‘average bed occupancy’ and ‘mean length of stay’ that is used in hospital
resource planning. As per general thumb rule, total hospital area should be
roughly ten times area occupied by hospital beds.
In general hospitals should have four entrances, main entrance, outpatient
entrance, emergency entrance and service entrance, and entry points more
or less than four may depend on hospital size. Elevators should be located
where there is maximum concentration of traffic. Outpatients may be routed
from the registration and medical records side to sub-waiting areas and
from there to the laboratory, X-ray, pharmacy, special therapeutic and other
service areas. Service entrance should be adjacent to the kitchen and storage
areas which receive bulk of supplies, and wherever possible close to a
service elevator. A platform and scale are provided in that area. Garbage
and other solid wastes are removed from this point, including dead bodies
some hospitals.
Planning is an integral part of hospital architecture. Chapter 2 is titled

as ‘Planning and Designing a Hospital: The Correct Way,’ which is based
on a well-formulated business plan, facility master planning, and choice of
an appropriate architectural process. Hospital planners should keep in mind
that outpatient services are generally more profitable, and that a majority of
inpatients are outpatients first, and accordingly maximum comfort provided
for their arrival and brief stay. A hospital design should be flexibility driven.
In most hospital projects in India, architects plan for dialysis capability only
in the renal analysis unit, but in modern hospital design with built-in flexibility,
this facility is provided in ICUs and emergency departments as well for
promptly attending critical cases.
Chapter 3 titled as ‘Examples and Models: Profiles of Some Hospitals’
provides plot plans for three hospital projects but without any evaluation or
comments. This includes - (i) Dr. Singh’s Cardiac Hospital and Research
Centre; (ii) Proposed Superficiality Hospital in Maharashtra; and (iii) Narayna
Hrudayalaya, Bangalore. It is for the readers to see within the backdrop of
what readers have learnt in the book how different promoters or architectural
firms approach the subject and go about their task of planning and evaluation
about their respective merits or demerits.
Chapter 4 is titled as ‘Organization of the Hospital’, which presents
216 Book Reviews
‘organization structure,’ ‘management structure’ and ‘organizational charts.’

A hospital CEO these days can be a physician or even a non-medical
professional administrator. As in business, governing board is supreme
authority in hospital administration. There should be some mechanism to
evaluate performance of the board members, both collectively and individually,
and study the differences that exist between the levels of individual and
group performance. There should be well-defined relationship between the
governing board that evolves hospital policies and the CEO who implements
them. A CEO should always be available, approachable for listening and
redressing public grievances with regard to community healthcare.
‘Management structure’ is different from clinical governance, which provides
the hierarchy through which instructions flow for execution. The chapter
includes ‘organizational charts’ of select representative hospitals but without
any specific evaluation or comments.

Chapter 5 is titled as ‘Management of the Hospital,’ which deals with

issues such as recruitment and selection, orientation, training and

development; and tips for hospital authorities who should be in state of
readiness to manage it professionally. In a complex hospital organization,
two lines of authority work side by side within the system. One is the
hierarchical line and the other professional line. First is well-defined
hierarchical authority vested in and exercised by the hospital management
and the other exercised by medical professionals. Position of medical staff
is outside line of authority, particularly in hospitals where the medical staff is
not full time salaried staff. Governing board, medical professionals and
management group (particularly when they are not medical professionals)
often enter into conflict, though final goal of everyone is the same - high
quality patient care. It is observed that medical professionals are often not
at ease with non-medical CEOs and un-easy relationship exists between
them.
Chapter 6 is titled as ‘Planning and Designing Administrative Services,’
which covers areas such as executive suite, professional service unit, financial
management unit, hospital information system, nursing service administrative
unit, human resource management, public relations department, and hospital
marketing strategy. ‘Executive suite’ is the main administrative block of the
hospital which houses ‘governing board’ and CEO’s office complex.
‘Professional service unit’ is an area from where a Chief Medical Officer

Book Reviews 217
or CEO directs and coordinates all medical, ancillary and related hospital
activities of the hospital. Performance of a hospital is no longer measured
by its response to community needs alone but by its ability to maintain a
strong, viable financial position that commands respect. Financial hospital
unit deals with patient accounts and accounts payable, budgeting and auditing.
A hospital generates lot of data and hence the need for hospital information
system (HIS), which apart from many applications is very useful for hospital
resource planning.
An HIS has a comprehensive clinical, administrative and financial
database and an advanced database technology. Designed to capture, edit
and store information online and in detail, it delivers maximum responsiveness
to online users. It has capabilities for extensive management reporting for
all departments without affecting simultaneous responsiveness of online users.

It can handle a wide spectrum of the hospital’s requirements from abstracting
of medical records and historical reporting to retroactive processing of a

patient’s complete financial data to producing patients’ bills.

A ‘nursing service administration unit,’ which generates moderate to
heavy traffic, is headed by nursing superintendent who reports to the CEO.
Being a very vital hospital function, it should be fairly close to the ‘executive
suite.’ A nurse needs to be very computer savvy these days as she has to
feed patient’s admitting data, clinical update, doctors’ advice, patient
discharge details, etc. An HRD unit is generally situated close to the
‘executive suite.’ It is located within administrative block with convenient
access to payroll records of the financial service unit. Public relations
department needs to be situated close to the CEO’s office within
administrative block. In private hospitals particularly large ones marketing
department is a major function as revenue flows are generally outcome of
its efforts. Being a revenue generating function department also needs to
be located within the administration block.
Chapter 7 is titled as ‘Planning and Designing Medical and Ancillary
Services,’ which covers location, facility and space planning and design of
outpatient services, emergency services, clinical laboratories, radiological
services, diagnostic radiology, radiation therapy department, nuclear medicine,
surgical unit, labour and delivery suite, physical medicine and rehabilitation,
physical therapy, occupational therapy, recreational therapy, speech and
hearing therapy, pulmonary medicine, and cardiac catheterization laboratory,
218 Book Reviews
etc.
An OPD (outpatient department) should be conveniently located close
to registration and medical records, admission, laboratories, radiology,
pharmacy, physiotherapy, etc with adequate space for patient movements
including wheelchairs and stretchers. The OPD should have a separate
entrance possible with adjacent parking unless space is a constraint.
An ‘emergency department’ provides range of services from elementary
first aid and general outpatient services to surgical and medical emergencies
and full-scale trauma care. Not all hospitals can maintain a separate
emergency department that will offer full-scale trauma services but
emergency first aid part should be minimum available in all hospitals. An
emergency department should have built-in flexibility in design in terms of

space, equipment, personnel and supplies, to anyone who comes in distress
to the emergency department for treatment at very affordable and economic

costs. The emergency department should be located on the ground floor

with easy access to patients and ambulances.
There should be separate entrance to the department, which is away
from the main hospital and the outpatient entrances. It should be well marked
with proper lighting and signs, and should be easily visible and accessible
from the street. Radiology unit, laboratory services and blood bank should
be close to the emergency department as most emergency cases require
these services. The emergency department should be close to elevators so
that patients can be shifted to other departments quickly.
Although the emergency is a part of extended outpatient services, with
growing incidence of emergencies, the current trend is to have a full-fledged
independent emergency department under the supervision of a full-time
physician. Need for full time physician as head is important as many hospitals
are manned not by hospital-based salaried physicians but outsiders who
attend it on specified dates only.
The emergency department is often beset by legal hassles. Its staff
should have fairly good knowledge of medico-legal issues involved.
Emergency procedure manual should cover policies and procedures relating
to such cases which should be readily available in the department. There
are a number of reporting laws available aimed at detection and appropriate

Book Reviews 219
action by police and other governmental agencies in cases involving accident,

suicide, assault, public health and safety. It is mandatory for doctors to
comply with these laws and also testify in courts when needed to do so.
Chapter 8 is titled as ‘Planning and Designing Nursing Services’; which
covers location, facility and space planning and design of general nursing
unit, paediatric nursing unit, obstetrical nursing unit, psychiatric nursing unit,
isolation rooms, intensive care units (ICUs), coronary care units (CCUs),
and newborn nurseries. Patient care, space utilization, and speed are some
of the important objectives while designing a nursing unit. Nursing unit
basically comprises patient areas, nurse control station and the service areas.
The patient area covers private rooms and multi-bed general wards which
should be always environmentally pleasant with ample sunshine that may
lead to speedy recovery.

The nurse control station provides workplace for the nursing staff to
function centrally in the nursing unit. Nurses’ station should be centrally

located within a nursing unit to minimize their travel. As per some study
findings, nurses often spend one-sixth of their time in traveling within the
nursing unit. Service area covers space for ward store, ward infrastructure
such as ICT equipment, refrigerator, etc. Nursing units have close interface
with pharmacy, central stores, operating rooms, dietary services, laboratories,
etc. Nursing units operate round the clock in three shifts on 24x7x365 basis.
A pediatric nursing unit generally covers 12 to 5 per cent of the total
hospital beds. Children ward is generally noisy and thus it should be located
in quiet area, away from the main stream of hospital traffic, and if possible
adjacent to an enclosed terrace which may be used as a play area. Obstetrical
nursing unit is concerned with prenatal care, observation and comforting
women in pain, and mother and child care. A psychiatric unit should be
located on a floor that has a separate entrance from the rest of the hospital.
The unit should be designed as an open-type ward with a non-institutional
atmosphere for ambulatory patients who need minimum security. Its design
should avoid typical hospital look. Patients suffering from communicable
diseases have to be kept in isolation rooms. Isolation rooms may be located
within individual nursing units and placed at the end of the corridor.
Intensive care units are specialty nursing units designed, equipped and
staffed with especially skilled personnel for treating very critical patients or
220 Book Reviews
those requiring specialized care and equipment. ICUs use sophisticated

electronic instruments for observation, signaling, recording and measuring
physiological functions besides monitoring temperature, blood pressure and
respiration rates. More nurses are needed in ICU units, sometimes on a one
to one ratio for each shift – 3:1 ratio for three shifts of the day is considered
ideal - to give close attention to the critically ill or post-operative patients.
Creating and maintaining an ICU unit is expensive as it needs added space,
equipment and staff. Not every hospital can provide all types of intensive
care. An ICU room should provide maximum visibility of the patients, not
only the monitor. The patient room should be close enough to permit
observation of respiration, facial colour and other revealing symptoms.
Chapter 9 is titled as ‘Planning and Designing Supportive Services,’
which deals with function, location, facility and space planning, and design
of admission department, medical records department, central sterilization
and supply department (CSSD), pharmacy, materials management, food

service department, laundry and linen service, housekeeping and volunteer

department.
There should be minimum delay in patient’s arrival in the hospital and
his being established in the room following admission. IT is most extensively
used in hospital admission. Admission as well as discharge requires
coordination among several departments. Inpatients are generally former
outpatients, patients admitted on emergency basis, and cases of elective
surgeries, etc. admitted on the basis of prior schedules. In many hospitals,
emergency services and obstetric department, admit patients directly in their
own departments, using common database. Patients are pre-instructed to
proceed to those departments directly.
Medical records department is crucial for providing service to the
patients which is frequently used by medical and paramedical staff. Accuracy
and timely availability of information determine quality of patient care. Medical
records should be well-documented, properly filed and quickly retrievable.
In medico-legal cases, when hospitals and physicians are often charged for
medical negligence, properly maintained medical records often come to
rescue. Medical records are also commonly used for teaching and research
purposes.
Data generated at the front desk is starting point of medical records.
Book Reviews 221
Front office, which registers all patients, assigns each patient a unique number,
collects patient demographics and other necessary data, assigns/ directs
patients to physicians, and creates records. In case of outgoing patients, it
retrieves their records and updates them. It maintains a master patient
index for all patients. Registration is the starting point for outpatient visits
and all patient-related activities.
Computers are widely used for patient registration, admission and record
keeping. Authorized hospital staff can have access to all current and historical
data. On-line abstracting can be done using screens and conditional editing.
All editing is done in real time. An on-line master patient index gives immediate
access to essential and episodic patient information. Medical records provide
access to requisite information on a specified format, which can be used to
generate information in several ways. Reports can be generated in any

manner, daily, weekly, monthly or annually.
In CSSD (central sterilization and supply department), instruments,

needles, syringes, etc.; rubber items such as gloves, tubing, catheters;
operating packs, trays, instruments, etc.; sterile linen packs, etc. are sterilized
by heating them with pressurized steam or by gas sterilization. Steam
sterilization is called autoclaving. As some rubber or plastic made items
cannot be autoclaved, they need to be sterilized by using ethylene oxide or
similar gases. Gas sterilization requires certain safety precautions such as
aeration prior to use and special exhaust ventilation. Under both systems,
sterilization is done on cleaned instruments wrapped in special linen. In a
decentralized CSSD, sterilization is carried out close an area where items
have to be used. In this set-up the facility is called theatre sterile supply unit
(TSSU).
CSSD also determines whether the item should be reused or discarded.
CSSD activities include packing all materials for sterilizing, sterilizing, labeling
and dating materials, storing and controlling inventory, and issuing and
distributing. In a well planned CSSD, there are three areas, soiled area,
clean area and sterile area. In the clean area, clean disinfected materials
are sorted, inspected and packed. After sterilization, the autoclaves are
unloaded in the sterile area and the materials stored there.
In hospitals, pharmacy is engaged in traditional activities such as drug
ordering, preparation, distribution and dispensing. Among them dispensing
222 Book Reviews
on doctor prescription is considered to be pharmacy activity. As in business,

in hospitals also fairly very large amount of money is spent on hospital
purchases on a recurring basis. Pharmacy activities involve cash collection,
checking of re-order level, stock monitoring, review of expiry dates, etc. A
central pharmacy supplies drugs to all nursing units and satellite pharmacies
where these are administered to patients and then billed. In many hospitals,
patients buy drugs on cash down basis. Pharmacy is also involved in new
drug development activity (clinical pharmacy) by maintaining record of drug
effectiveness, etc. and then contributing in drug selection process also. A
pharmacy also maintains a suitable formulary of selected drugs. A formulary
is a listing of select drugs, which are selected and approved for use within
the hospital, along with particular drug specifications.
Inventory management involves acquisition, shipping, receiving,

evaluation, warehousing and distribution of goods, supplies and equipment
for an organization. Acquisition involves purchase, lease or rent; warehousing

is storage of drugs, supplies and equipment, and inventory control; and

distribution is delivery of drugs and supplies. While in many hospitals entire
inventory management is central for all functions, but in many hospitals for
certain departments such as dietary services, laundry and linen service it is
entirely independent. Meal planning is the main work of dietary services.
An adequate supply of clean linen is very much required for comfort and
safety of patients. In today’s healthcare, patients expect daily linen changes
and in some cases even more than once. This requires complete planning
and scheduling.
Chapter 10 is titled ‘Planning and Designing Public Areas and Staff
Facilities’ covering entrance and lobby area, main waiting area, gift shop,
bookshop and florist’s shop, coffee shop-cum-snack bar, meditation/quiet
room and staff facilities. Chapter 11 is titled as ‘Planning and Designing
Hospital Services’ covering engineering department, maintenance
management, clinical (biomedical engineering), electric system, air-
conditioning system, water supply and sanitation system, centralized medical
gas system, communication systems, environmental control, solid waste
management and transportation. Chapter 12 is titled as ‘Safety and Security
in the Hospital,’ which covers hospital safety rules, security and loss-
prevention programme, fire safety, alarm system, disaster and disaster
preparedness plan.

Book Reviews 223
Chapter 13 is titled as ‘Facilities Planning for Management of SARS,’ a

scourge which has ravaged many countries in recent times. It deals with
symptoms and signs of SARS (Severe Acute Respiratory Syndrome), how
SARS spreads, strategies for SARS treatment, SARS treatment settings,
internal and staff settings, triage, general public settings and design of future
hospitals. The book also includes a CD that gives demo of proposed hospital
information system based on the Siemens Model.
The book serves need of several groups of readers - students, practicing
architects and other professionals. The book has several distinctive features
which makes it unique. It brings out at one source very diverse nature of
information. It provides plethora of information in planning a hospital which
by its very nature is a complex entity. Despite its being a mammoth task,
author has largely succeeded in making a fairly comprehensive coverage of

many aspects of facilities planning and management in a complete and up-
to-date form. In fact, the book is so comprehensive work that it could have
as well been titled as ‘Handbook of Hospital Facilities Planning and

Management’ with some minor modifications.
The book is profusely illustrated with drawings and pictures, based on
author’s perception that illustrations make quicker and lasting impact on
human mind than words, and are more effective aid in learning process than
simple narrations. No single text could possibly include all facets such as
complex subject as planning and management of hospitals. Hospitals which
are better planned, equipped and where staff is adequately compensated
financially, can only provide requisite motivation to medical and paramedical
staff to deliver. A motivated workforce can only provide healthcare service
delivery which is critical for high quality patient care and hospital
management. Given this context, author needs to be complimented for his
stupendous efforts and the chosen strategy.
The book derives considerable information from experiences of ‘Asian
Health Services,’ an erstwhile consulting firm in India, which provided health
facility planning, design and development services of a high professional
standard in the country particularly South India. This source is mentioned in
the preface to the book. However, apart from this source, there is mention
of sources of information on some site plans of some hospitals, but not
everywhere, a necessary corollary of which is that these rest were developed
by the author himself and we presume it that way. In the book text, if
224 Book Reviews
articles, papers, and books on hospital management were consulted and

their contents influenced author’s writing anywhere in the text, this may be
done with proper referencing in the next issue, as and when it comes. In a
comprehensive book inclusion of bibliography is absolutely essential.
Book also needs to have a ‘glossary of terms’ on ‘hospitals facilities
planning and management’ at the end , which author may consider inserting
in the next edition. Book also needs some copy editing for tightening the
language which can again be taken care in the new edition. On the whole
authors efforts are remarkable for which he needs to congratulated in the
right earnest for his creativity and stupendous efforts. This book shows
what determination and hard work can achieve.
K.M.Mital, Professor of Strategic Management and Chairperson, General

Management Area, IILM Institute for Higher Education.
ECO- TOURISM
The experienced mountain climber is not intimidated by a mountain – he is

inspired by it. The persistent winner is not discouraged by a problem – he is
challenged by it.
- William Ward
Thousands of tired, nerve-shaken, over-civilized people are beginning to find

out that going to the mountain is going home; that wilderness is necessity;
that mountain peaks and reservoirs are useful not only as fountains of timber
and irrigating rivers, but as fountains of life.
- John Muir
The highest of the world’s mountains (Mt Everest), it seems has to make but
a single gesture of magnificence to be Lord of all, vast in unchallenged and
isolated supremacy.
- George Mallory
Why is that it is among the most glacial mountain peaks that I find the greatest
warmth?
- Ivan Granger
The natural environment sustains the life of all beings universally. Today
more than ever before life must be characterized by a sense of universal
responsibility.
- The Dalai Lama
Plans to protect air and water, wilderness and wildlife are in fact plans to
protect man.
- Stewart Udall


Book Reviews 225

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214 Book Reviews

Prof. B. Bhattacharyya in association with MVIRDC World Trade

K.M.Mital, Professor of Strategic Management and Chairperson, General

Management Area, IILM Institute for Higher Education.

G.D.Kunders, Hospitals: Facilities Planning and Management, Tata

Planning is an integral part of hospital architecture. Chapter 2 is titled

‘organization structure,’ ‘management structure’ and ‘organizational charts.’

any specific evaluation or comments.

Chapter 5 is titled as ‘Management of the Hospital,’ which deals with

issues such as recruitment and selection, orientation, training and

Management & Change, Volume 11 Number 1 (2007)

all departments without affecting simultaneous responsiveness of online users.

of medical records and historical reporting to retroactive processing of a

patient’s complete financial data to producing patients’ bills.

emergency department should have built-in flexibility in design in terms of

to the emergency department for treatment at very affordable and economic

costs. The emergency department should be located on the ground floor

Management & Change, Volume 11 Number 1 (2007)

action by police and other governmental agencies in cases involving accident,

lead to speedy recovery.

function centrally in the nursing unit. Nurses’ station should be centrally

those requiring specialized care and equipment. ICUs use sophisticated

and supply department (CSSD), pharmacy, materials management, food

service department, laundry and linen service, housekeeping and volunteer

generate information in several ways. Reports can be generated in any

In CSSD (central sterilization and supply department), instruments,

on doctor prescription is considered to be pharmacy activity. As in business,

Inventory management involves acquisition, shipping, receiving,

for an organization. Acquisition involves purchase, lease or rent; warehousing

is storage of drugs, supplies and equipment, and inventory control; and

Management & Change, Volume 11 Number 1 (2007)

Chapter 13 is titled as ‘Facilities Planning for Management of SARS,’ a

author has largely succeeded in making a fairly comprehensive coverage of

as well been titled as ‘Handbook of Hospital Facilities Planning and

articles, papers, and books on hospital management were consulted and

K.M.Mital, Professor of Strategic Management and Chairperson, General

The experienced mountain climber is not intimidated by a mountain – he is

Thousands of tired, nerve-shaken, over-civilized people are beginning to find

Management & Change, Volume 11 Number 1 (2007)

Downloaded From IP - 115.248.73.67 on dated 30-Nov-2010

Management & Change, Volume 11 Number 1 (2007)

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