A hospital is responsible to render an essential service. In fulfilling this responsibility, hospital planning should be guided by certain universally acknowledged principles. The principles are useful irrespective of the level of planning, i.e. whether at the national level, state level or individual hospital level.
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These principles were developed in the context of the American system of hospitals but have relevance and usefulness to hospital planning in India, and they are as relevant today as they were over five decades ago.
(i) Patient Care of a High Quality:
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Patient care of a high quality should be achieved by the hospital through adopting following measures.
1. Provision of appropriate technical equipment and facilities necessary to support the hospital’s objectives.
2. An organisational structure that assigns responsibility appropriately and requires accountability for the various functions within the institution.
3. A continuous review of the adequacy of care provided by physicians, nursing staff and paramedical personnel and of the adequacy with which it is supported by other hospital activities.
(ii) Effective Community Orientation:
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Effective community orientation should be achieved by the hospital through adopting following measures:
1. A governing board made up of persons who have demonstrated concern for the community and leadership ability.
2. Policies that assure availability of services to all the people in the hospital’s service area.
3. Participation of the hospital in community programmes to provide preventive care.
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4. A public information programme that keeps the community identified with the hospital’s goals, objectives and plans.
(iii) Economic Viability:
Economic viability should be achieved by the hospital through taking these measures:
1. A corporate organisation that accepts responsibility for sound financial management in keeping with desirable quality of care.
2. Patient care objectives those are consistent with projected service demands, availability of operating finances and adequate personnel and equipment.
3. A planned programme of expansion based solely on demonstrated community need.
4. A specific programme of funding that will assure replacement, improvement and expansion of facilities and equipment without imposing too much cost burden on patient charges.
5. An annual budget plan that will permit the hospital to keep pace with times.
(iv) Orderly Planning:
Orderly planning should be achieved by the hospital through the following.
1. Acceptance by the hospital administrator of prim responsibility for short and long-range planning, with support and assistance from competent financial organisational, functional and architectural advisors.
2. Establishment of short and long-range planning objectives with a list of priorities and target dates on which such objectives may be achieved.
3. Preparation of a functional programme that describe the short-range objectives and the facilities, equipment and staffing necessary to achieve them.
(v) Sound Architectural Plan:
A sound architectural plan should be achieved by the hospital through the following:
1. Engaging an architect experienced in hospital design and construction.
2. Selection of a site large enough to provide for future expansion and accessibility of population.
3. Recognition of the need of uncluttered traffic patterns within and without the hospital for movement of hospital staff, patients, and visitors and for efficient transportation of supplies.
4. An architectural design that will permit efficient use of personnel, interchangeability of rooms and provide for flexibility.
5. Adequate attention to important concepts such as infection control and disaster planning.
(vi) Medical Technology and Planning:
Developments in medical technology are taking place so rapidly that now the use of sophisticated technology determines professional status.
The diffusion of medical technology vis-a-vis shortage of resources constantly plays on the minds of the planners.
Even in western countries, “rational” planning for medical technology is an evasive subject. The workshop on problems of planning of health services in urban areas in Europe felt that rational planning is aided by a hospital hierarchy of specialisation, and by national review agencies which have strong links with similar agencies in other countries.
Specialised coronary care units (CCUs) were introduced on the basis of clinicians’ opinions about the effectiveness of such units.
The evidence is suggestive that the innovation had serious flaws but once CCUs were established, there was great resistance to formal controlled trials. Some studies suggest that admission to a CCU is no better than treatment at home.
However, the professional as well as popular view of these units is so entrenched that it is often difficult to plan for the proper use of these expensive facilities.