AMERICAN INTERNATIONAL BANGLADESH Department of Public Health MPH Program Hospital Planning and Organization Guide for Mid

Term Examination Spring 2012-2013

UNIVERSITY-

Instructions: 1. There are TWO parts of the question paper: Part-A & Part-B. All Parts should be answered. Marks of each question are indicated.

Part A 13x2 = 26 marks 1. The word Hospital comes from the Latin word : Hospes

13 Questions

2. From the common root of Latin, besides Hospital what are two other English words emerged? Hostel and Hotel 3. Give examples of ancient Greece and Roman to demonstrate linking of religion and medicine in ancient culture. In ancient Greece, temples dedicated to the healer-god Asclepius . Under his Roman name sculapius 4.When the modern hospital began to appear and mention its distinctive features.

In the eighteenth century, the modern hospital began to appear, serving(helping) only medical needs and staffed with physicians and surgeons. 5.Name three early examples of modern hospitals The Charit, founded in Berlin in 1710 is an early example. Guy's Hospital was founded in London in 1724 from a bequest by the wealthy merchant, Thomas Guy. When the Vienna General Hospital opened in 1784. 6.What percent of bed occupancy is considered as optimum in hospital planning? About 85 percent bed occupancy is considered optimum. 7.which one of the following is advisable from functional efficiency standpoint in hospital planning (a) two separate hospitals of 400 beds, or (b) a single one of 800 beds? a) two separate hospitals of 400 beds 8.What are the WHO suggested admission per 1000 of direct and indirect population per year? Admission per 1000 direct population per year 165 (WHO) Admission per 1000 indirect population per year 55 (WHO) 9.Which term is used to measure degree of crowding on a site in hospital planning? However the degree of crowding on a site is considered in terms of floor area ratio (FAR) 10.How the water requirement of hospital is estimated in hospital planning? About 300 to 400 liters per bed per day

11.How much solid waste originates in a hospital per day? Solid waste from hospitals is approximately 1 kg per bed per day. 12.How much liquid effluents originate in a hospital in a day? Between 300 to 400 liters per bed per day. 13.How the requirement of electric power in a hospital is calculated? 1 kw on a per bed per day 14.Name the International HealthCare Accreditation groups of Great Britain, France, USA and Canada Accreditation Canada from Canada, The Joint Commission from the USA, The Trent Accreditation Scheme from Great Britain, and Haute Authorit de sant (HAS) from France. 15.Who are direct and indirect population for hospital planning? The population in the vicinity(distic) of the hospital are known the direct population and the outside people of the hospital area known as Indirect population. 16.How bed capacity of a hospital is calculated and which are included in such calculation? Beds capacity of a hospital is calculated on the basis of beds assigned(give) exclusively(fully) for inpatient care. For this purpose, beds in the following are included in the bed count: 1. Observation beds equipped and staffed for overnight use 2. Paediatric incubators in paediatric department

Direct population 6,00,000 Indirect population 8,00,000

Admission per 1000 direct population per year 165 (WHO) Admission per 1000 indirect population per year 55 (WHO) Average length of stay in days 10 Desired Bed occupancy 85% ) 17.Beds from which areas do not form a part of bed count in hospital? 1. Incubators in the maternity suite(set) 2.Labour room beds 3.Casualty/emergency department 4.Recovery room 5.Any other which are not equipped and staffed for overnight use 18.What is Floor Area Ratio (FAR) in hospital planning? ( It is the ratio of the total covered area on all floors of a building to the total area of the site,) 19.Briefly mention relevance of soil in hospital planning. Two very important factors that should be looked into

the level of

subsoil water and the structure of the soil.

20.Briefly mention about different LPCDs for different bed strengths of hospital. 455 liters of water per consumer day (LPCD) for hospitals up to 100 beds and 340 LPCD for hospitals of 100 beds and over. 21.Briefly provide historical uses of the facility now known as Hospital Almshouse care of the Poor and the Destitute An institution for Aged and Infirm(sick) An institution for the care of sick and wounded A place of hospitality", for example the Chelsea Royal Hospital (in England),. A place of rest Lodging(room) for the pilgrim and wayfarer

Part B 7x7=49 marks

7 Questions (out of 10)

1. State two definitions of Hospital A Hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete health care, both curative and preventive, and whose outpatient services reach out to the family and its home environment; the hospital is also a centre for the training of health workers and biosocial research An institution that provides medical,surgical,or psychiatric care and treatment for the sick or the injured 2.Briefly mention influents of Hospital Florence Nightingale revolutionize(DEVELOP) nursing by supplementing good intentions and humane concern with scientific approach in middle of nineteenth century Discovery of Anaesthesia Principles of Antisepsis Discovery of steam sterilization in 1886, rubber gloves in 1890 and Xray in 1895 Progress made in cellular pathology, clinical microscopy, bacteriology during 1850 to 1900 Antibiotics Radiation Blood transfusion Improvements in anaesthetic techniques Advances in surgical techniques Advances in medical electronics

3.Briefly mention the important factors which have led to roles and functions of the hospital

the changing

The important factors which have led to the changing role and functions of the hospital are as follows: 1. Expansion of the clientele(consumers) from the dying, the destitute, the poor and needy to all class of people 2. Improved economic and social status of the community 3.Control of communicable diseases and increase in chronic degenerative diseases. 4. Progress(development) in the means of communication and transportation 5. Political obligation(commitment) of the government to provide comprehensive health care 6. Increasing health awareness 7. Rising standard of living (especially in urban areas) and sociopolitical awareness (especially in semi-urban and rural areas) with the result that people expect better services and facilities in health care institutions 8. Control and promotion of quality of care )by statutory and professional associations 9. Increase in specialization where need for team approach to health and disease is now required 10. Rapid advances in medical sciences and technology 11. Increase in population requiring more number of hospital beds 12. Sophisticated instrumentation, equipment and better diagnostic and therapeutic tools 13. Advances in administrative procedures and management techniques 14. Reorientation of health care delivery system with emphasis on delivery of primary health care 15. Awareness of the community

4.Briefly describe Hospital as a system. ( A system is construed as having inputs which undergo certain processing and get transformed into output, the output itself in turn sending feedback to the input and the process, which can altered to achieve better output. A system is therefore a continuous and dynamic phenomenon. Input Man (People) Staff Physician Nurse Paramedical staff Supportive staff Patients, their attendants and relatives Materials Drugs and chemicals, Equipment, Diet Money Process Transformation Communication between Physician and Patient Physician and Nurse Physician/Nurse and paramedical staff Physician and Administrator Administrator and Community Administrator and Nursing/paramedical staff Nursing/paramedical staff and patients Decision making for Cure: Diagnosis, treatment Care: Creature comfort for patients, Diet Procurement of materials in right place at right time Action Putting decisions into practice Balanced mix of communication, decision-making and action Output Efficient Patient Care

5.Briefly mention peculiarities of hospital system 1.A hospital system is more than the sums of its parts 2,A hospital is an open system which interacts(related) with its environment 3.Although a system generally has boundary, the boundaries separating the hospital system from other social systems are not clear but rather fuzzy(unclear). 4. A system must produce enough outputs through use of inputs. But the output of a hospital system is not clearly measurable 5. A hospital system has to be in a dynamic equilibrium with the wider social system 6. A hospital system is not an end in itself. It must function, as a part of the larger health care system. 7.hospital system like other open social systems tends towards elaboration and differentiation, i.e. as it grows, the hospital system tends to become more specialized in its elements and elaborate in structure, manifesting in the creation of more and more specialized departments, acquisition of new technology, expansion of the product lines and scope of services

6.Briefly mention functions of hospital(Two distinct types: a. Intramural functions are confined within the walls of the hospital b. Extramural functions are the services which radiate outside the hospital and to the home environment and community

Intramural Functions of Hospital

1 Restorative a. Diagnostic b. Curative c. Rehabilitative d. Care of emergencies

2. Preventive a. Supervision of normal pregnancies and childbirth b. Supervision of normal growth and development of children c. Control of communicable diseases d. Prevention of prolonged illness e. Health education f. Occupationalhealth 3.education a. Medical undergraduates b. Specialists and postgraduates c. Nurses and midwives d. Medical social workers e. Paramedical staff f. Community (health education) 4. Research a. Physical, psychological and social aspect of health and disease b. Clinical medicine c. Hospital practice and administration

Extramural Functions of Hospital

a. b. c. d. e. f. g. Outreach services Mobile clinics Medical care camps Home care services Day care centers Night hospital (?)Outpatients services

7.Briefly mention different groups and their dynamics in hospital. The First Group is the providers of medical care, viz. the doctors, nurses, technicians and paramedical personnel The Second Group is management, administrative and support group comprising of personnel dealing with non-clinical functions of the hospitals, such as diet, supplies, maintenance, accounts, housekeeping, security etc.

 The Third Group and the most important one for whose benefit the first two groups exist in the first place, is that of the patients, who seek hospital service and their attendants, relatives and associates who, along with patient come in close contact of the hospital. This group is broadly termed as the Community. . The nature of relationship between the two groups influences community relationship, and on this relationship depends the image of the hospital. To better this image, hospitals have to re-orientate themselves to the expectations of the community

8.Briefly mention guiding principles of hospital planning (In fulfilling(satisfying) responsibility to render(make) essential service, hospital planning should be guided(direct) 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). 9.Briefly discuss dilemma of medical technology in hospital 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--vis shortage of resources constantly play on the minds of the planners. Even in western countries, rational planning for medical technology in 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 specialization, and by national review agencies which have strong links with similar agencies in other countries. Specialized 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.) 10.Briefly mention the requirement of a hospital consultant in hospital planning(Of utmost importance in planning a new hospital or addition of new facilities in an existing hospital, is the utilization of a competent hospital administrator-consultant. A professional trained as a hospital administrator with adequate experience can profitably combine the job of hospital consultant and administrator. Such a professional may be referred as hospital consultant. The hospital consultant is able to provide experienced guidance in areas which cover, (i) local and regional surveys of health care, (ii) analysis of the demand and need for hospital facilities, (iii) assessment of the extent and range of services required, (iv) equipment selection, and (v) administrative and organizational relationships ) 11.Briefly mention about the formation of hospital planning team 12.Briefly mention about the consultation/input during planning for a hospital Of utmost importance in planning a new hospital or addition of new facilities in an existing(obtained) hospital, is the utilization of a competent(capable) hospital administrator-consultant. A professional trained as a hospital administrator with adequate experience can profitably combine the job of hospital consultant and administrator. Such a professional may be referred as hospital consultant.

The hospital consultant is able to provide experienced guidance(supervision) in areas which cover, (i) local and regional surveys of health care, (ii) analysis of the demand and need for hospital facilities, (iii) assessment of the extent and range of services required, (iv) equipment selection, and (v) administrative and organizational relationships

13.Briefly mention about two methods used in assessing the extent of functional need of a hospital ( There are two methods of assessing the extent of functional need for a hospital. Those are (i) the empirical method, which applies the norms(standard) of the past and rules of the thumb to the problem, with appropriate modifications to suit local conditions, and the (ii) analytical method which makes a more fundamental, systematic approach to the problem. The empirical method hinders(HAMPER) evolution(DEVELOPMENT) of new solutions, whereas the analytical method lacks the controlling elements of the norms. Use of such norms and rules of thumb also tend to perpetuate(ACHIEVE) past faults. The analytical method overcomes some of these faults. In practice, therefore, a combination of the two methods, will usually be applied) 14.Briefly mention about demand and need for hospital (Demand for hospital services can be estimated by reviewing the statistical returns of current usage and morbidity statistics. Measurement of need for hospital services takes account of a more positive approach by aiming at a quantitative estimation of the amount of illness in the community which would require hospital services. The term demand is commonly used to denote effective demand (potential user manages to reach the facility, gets into it and demands services), and generally equated with utilization of services

However demand should not be equated with need. It is often found that many people who demand care hardly need it (in medical terms), while many people who need medical care do not demand it for various reasons. Coverage refers to the proportion of a target group which can utilize the facility or services. The three determinants of coverage are availability, accessibility and acceptability. Though in developing countries demand for care is reasonably close to the need due to high standards of medical care and the method of surveying the need, this assumption is not valid in developing countries, where medical services are in intermediate stage of development and in which the need is far greater than the demand. Therefore, there is no merit in trying to measure demand as it exits. Estimation of the need of medical care on the basis of experience and adhoc survey will serve the purpose.) 15.Briefly mention different levels of medical care with examples of facilities from Bangladesh 16.Briefly mention different levels of medical care with examples of service providers making decision 17.Briefly mention important factors to consider in hospital planning (Other Factors to consider in

Hospital Planning
1. Metrological information Temperatures Rainfall Humidity 2. Geographical information Existing road and rail communication Terrain: Riverine, Plain, Mountainous Surrounding district boundaries Susceptibility to earth quacks, flooding Ecology: atmospheric pollution from adjacent industry and other sources, proximity of sources of noise like air-field, rail tracks Building height restrictions due to proximity of airport 3. Availability of Electricity Water

 Sewerage disposal Trained Human Resources required 18.Briefly describe bed planning exercise considering admissions from direct and indirect population, average length of stay and percentage of bed occupancy( Direct
population 6,00,000 Indirect population 8,00,000 Admission per 1000 direct population per year 165 (WHO) Admission per 1000 indirect population per year 55 (WHO) Average length of stay in days 10 Desired(preferred) Bed occupancy 85% Calculation Admission per year from direct population 99,000 Admission per year from indirect population 44,000 Total admission per year 1,43,000 Total bed days per year @ 10 days average stay 14,30,000 Total beds per year with 100% occupancy 3918 (14,30,000/365) Total beds per year with 85% occupancy 4610 (3918x100)/85)

19.Briefly describe site selection considerations in hospital planning Site is a very important factors for, upon(winning) availability of it, will depend the hospitals fate and utility in future. With increasing demand on hospital beds, planning for expansion at a future date should always be kept in mind right at the outset while choosing the site. Therefore, the site should be large enough to enable future expansion and growth. However, strategic(planned) sites large enough for the project requirement may be hard to find in urban areas. In dense urban areas, a large site near the periphery of the present town is suitable that will, in due course become central to the major residential areas at a later date. Close collaboration with local town planners will pay dividends in choosing the site. The earlier idea that a hospital should always be established on an open site is open to question in large towns and cities. The idea was based on experiences obtained from the pavilion type of wards(area) of old where indeed a large plot was required. The social function of the hospital demands that a hospital should be

situated in the heart of society. Accessibility is the most striking need the location must be within easy reach of the users. This choice means that the hospital does not belong to an empty, uninhabited office area, but in a living and habitable city centre.