HospiArch Bangalore: Voices from the Conference

The latest edition of AMEN’s series of conferences on Hospital Planning, Design and Architecture, aptly named as HospiArch, was organized on August 18^th and 19^th at API Bhavan, Bangalore. The event saw participation from over 100 delegates from different hospitals, architectural firms, consulting companies, engineering professionals and healthcare management students. The conference, supported by Hospaccx India Systems, is one of its kind event in India which attracts such a diverse set of audience. HospiArch is a 2-day conference which involves talks, panel discussion and Q&A sessions which are a rich source of knowledge to understand planning and design related issues for hospitals.

The Day 1 of the conference started with the Keynote address, delivered by Dr. (Wg Cdr) M.D. Marker, Medical Director - Bhagwan Mahaveer Jain Hospital Bangalore. In his speech, he addressed issues pertaining to architectural challenges involved in building a new hospital. He stressed the need for a hospital planner while designing a hospital and advocated a functional design approach.

His talk was followed by a presentation on “Planning & Designing a new hospital” by Dr. Alexander Kuruvilla, CEO - Medica Synergie Pvt. Ltd. Bangalore. He shared his vast experience in the field and the general steps for building a hospital such as feasibility study, market survey and project cost estimation & management. The highlights of his talk were his suggestions on having greenery, pipe music, aquarium & pleasant colours to keep the patients and relatives calm with in the hospital.

Dr. P. Satyanarayana, Retd. Professor of NIMS Hyderabad & Director of SVIMS Tirupati, took a session on “Factors that influence the bed utilization”. According to him, high cost of constructing physical infrastructure & facilities, high costs of running the hospital, high customer expectations and high cost of hospital expansion, modernization and modification bring sharp focus on bed utilization. He shared a few bed utilization indices, like Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), Bed Turnover Interval (BTI) and Bed Turnover Ratio (BTR) as performance indicators. He advised to hospitals that while deciding to create more beds, they should consider factors like current availability of beds in an area, prevalent payment methods in the area (like cash or cashless), age of population (a higher life expectancy tends to raise general bed utilization), bed distribution (no. of ICU, PICU, ER and ward beds), availability of extramural medical services and medical customers & social patterns.

His presentation was followed by another talk by Mr. Radhakrishna, CEO - Narayana Hrudayalaya Hyderabad, on the topic of “Budgeting & financial planning for a new hospital project”. He gave elaborate prescription on planning of hospital project involving multiple steps. He suggested going for a market research, which would cover statistics on demographics, performance analysis of top 4-5 leading hospitals in the vicinity, identification of specialties and specialists, financial feasibility and project report. Next factor was the Land, its location and cost, legal formalities and statutory requirements for use of land for hospital purpose. When it comes to hospital building, he discussed factors such as cost of construction, various approvals, Floor Area ratio and determining built-up area per bed. Next thing he covered was medical equipment, its purchase costs and technology-relevance. He also touched various means of financing the project, such as equity or unsecured loans and debt/external funding. He finished his discussion by sharing some key ratios, such as debt-equity ratio, debt service coverage, bed occupancy rate, EBITDA margins and ALOS for measuring project performance.

Mr. Naresh Duble, DGM - Business Development at Armstrong World Industries (India) Pvt Ltd. Mumbai, presented on “Hospitals are for people - Design Solutions” and touched various facets of Acoustic comfort, green building and thermal comforts. Another presentation on “Designing a CSSD - Techniques and Trends” was given by Ms. Anuradha Desai, Manager - Getinge India Pvt. Ltd. Mumbai. She used elaborate layouts to explain her points. An interesting topic she discussed was about Super-CSSD which is out sourced CSSD for various hospital in countries like France, U.K, Singapore in which linen is sent for sterilization in super CSSD and dispatched back to hospital.

The last presentation of the first day was given by Dr. Marker on “Planning & designing lab & other diagnostics areas of the hospital”. His advice for planning and designing a lab was to focus on three areas: Strategic Planning, Structure Planning (scope of services & future expansion) and Operational Planning (functional lab Area). He also discussed about location and space requirements for a lab.

The Day 1 also witnessed a power-packed panel discussion on the topic of “Hospital Planning, Design & Architecture - Issues, Current Trends and Challenges”. The panel of 5 included Dr. P. Mohanakrishnan, CEO – Malabar Institute of Medical Sciences Calicut & Kottakal, Dr. Narendranath V., Chief Administrator – MS Ramaiah Hospitals, Mr. Tarun Katiyar, Principal Consultant – Hospaccx India Systems, Mr. Ramanand Prabhu, Director for Sourcing & Marketing – Global Healthcare Solutions and Dr. (Wg Cdr) M.D. Marker, Medical Director - Bhagwan Mahaveer Jain Hospital Bangalore. The panel discussion was moderated by Mr. Anuj Jindal, Senior Consultant – Hospaccx India Systems.

The discussion started with Mr. Jindal asking the hospital administrators on the panel to share their insights on common mistakes that they have come across that administrators have made while designing their hospitals. Dr. Mohan highlighted that administrators make a mistake when they do not create people-centric hospital designs. The structures are not built keeping in mind the needs of the employees and of the patients and their attenders.

Dr. Narendranath shared his experience with respect to the balance which needs to be maintained between academic and patient care requirements in the teaching hospital.

Dr. Marker gave an example from his professional experience wherein the statutory compliances and regulations were not completed understood before taking up the hospital project, thereby leading to considerable escalation of project cost and delay of the project by a couple of years. Mr. Tarun Katiyar took the example of small hospitals and their owners, wherein the doctors pump in their hard earned savings in building the hospital, but by the time the structure is built, either they lack enough funds to buy the medical equipments or they do not have enough working capital to run the hospital during the initial years of the hospital before it achieves profitability. This leads to the unfortunate situation in which the doctor either has to dump the hospital project or he starts looking out for buyers for his dream project.

Mr. Ramanand Prabhu highlighted the fact that hospital infrastructure and equipment is an important project cost and it has to be budgeted at the very beginning of the project and sourcing of same has to be identified well in advance. The panel also discussed innovative contemporary models of outsourcing certain departments to other specialized agencies who can co-invest in the projects, thus reducing the burden on the hospital administrators.

Day 2 of the conference witnessed 6 more speakers share their valuable experiences with the audience. The day began with Dr. Vinod Singh, Senior Consultant – Hospaccx India Systems, discussing the experience of their company in the field of hospital architecture. He stressed the fact that hospital architecture is very different from conventional architecture given the complex nature of hospital buildings and various loads requirements for the floors owing to heavy medical equipments and their power requirements.

This was followed by Prof. Dr. Usha Manjunath, Associate Professor – IHMR Bangalore, speaking on the topic of “Manpower planning for a new hospital”. She identified the importance of manpower planning as part of a new hospital project because of changing healthcare business paradigm, issues with availability of skilled manpower, vision of hospital promoters and the impact of policy issues on manpower requirements. Dr. Joy Bannerjee, Managing Director – Wiesermanner, discussed quality standards applicable to hospital planning, while Mr. Joseph Alexander, CTO - dWise Solutions & Services, discussed challenges in Hospital IT & Networking Design. Dr. Rajesh Kumar, Managing Director - Vijay Hospital Hosur, made a presentation on “Challenges in building hospitals in 2 tier towns” like the cost involved in the projects and the comparison of taking up a Brownfield project and a Greenfield project.

Lastly, Mr. Tarun Katiyar, Principal Consultant – Hospaccx India Systems, spoke on the topic “Re-planning & Re-designing an existing hospital”. His talk focused on the need for hospital renovation and how to go about it systematically. He gave elaborate examples of common mistakes hospital owners make while deciding to go for renovation of their buildings and suggested ways and means to avoid these mistakes.

In the end, HospiArch lived upto its expectation of being a source of great amount of learning for the participants and a good networking opportunity with the leaders in the hospital planning, designing and architecture services.

The next edition of HospiArch will be in Kochi next month. With the kind of conferences that happened earlier in Chennai, Hyderabad and Mumbai and now in Bangalore, HospiArch seems to be getting bigger and better. Let’s see what is in store for the audiences at Kochi in September. The last conference in the series in 2012 will be held in Delhi in December.