Speaker 1: Good evening, everyone. I hope you understood a lot from the earlier presentation. So, we will be continuing in that same line of movement. So, this presentation is about hospital specific site selection, space planning and design. So, yes, so now, in this presentation, we go through. 4th stage of your planning in the 1st stage, we'll finalize based on what requirements you've thought of how big your hospital is going to be the next based on that size. We will decide what type of a site you need to look for, or if you're not looking for a site, what type of a building you would like to construct your hospital in. And once you've decided the site and building, we'll see what to go next as a hospital specific design. But now, from like, what explain after a feasibility study, you will have in your mind a plan of what type of facilities you want to provide in your hospital. How many of those facilities will be in house? How many will be outsourced diagnostic facilities? Will you provide, like, maybe just 1 and X ray and will you even go even further? Do you need cancer specialty? Do you need a bunker and access them all that you'll decide? And even you will have an idea of beds, like, either ranging from a 25 to 50 bed to even a 100 or 200 bed. Now, from experience, we've all worked out a small norm that we feel a hospital area that you need will range from a 600 to 1000 square feet per bed. Now, this is a wide range, so you will know ideally where your hospital will fall in by what services you provide. Now, for example, if you feel in your hospital, each of your patients need their own special, their own beds, their own rooms. It's not ward system. You just want private rooms. You want maybe a gym and a physiotherapy area. You need a large waiting space, the extra facilities, then you should ideally aim at a 1000 square feet per bed calculation. Otherwise, if you're going with a simple facility, a lot of wards, a lot of simple practical, just your consultation rooms, the basic X ray and CT alone, and that type, then you can go on a lower level of a 600 to a 700 square feet. And if you want an even mix of both, then you go maybe a neutral 800 per square feet. So, if you decide that you need a hospital, that is a 100 bed facility, then automatically you can assume around 80000 square feet will definitely be needed for a smooth running and for smooth space planning of your hospital. Knowing this area, keeping this area in mind, it's time to select your site. Now, the shape and size of your site are actually determined by three main factors, which you'll get information from the government itself. That is the FSI setback and coverage. Now, these are three values that you will know based on any site you go searching for, because from the local by your local construction area, your site information, you will know these values. Now, for example, FSI, which is flow space index, this will be a number. This will range like, let's say Tamil Nadu means you'll see a range from 1.5 to 2. If it's Kerala, you might see a range of 3 to 3.5. The larger the number, the better, because this will tell you how much you can build on your site. Now, for example, let's say you've got a site in Tamil Nadu, which is around 20000 square feet, and you've got an FSI of 2, which automatically means you can build a hospital of 40000 square feet on that site. So, that way you can even calculate back. You wanted that 100 bed for 800 per bed. So, 80000 square feet was your requirement. So, automatically have that at least the 40000 square feet site you will need to build that 100 bed facility. Then to determine the shape of your site, your setback and coverage plays a big role. Setback is the space you leave from the plot boundary to your building. Now, in a hospital, most of the bylaws recommend something like a 6 meter setback around. It's not compulsory everywhere, but in certain states like Tamil Nadu, Kerala, it is a compulsory norm. 6 to 7 meters have to be left. Which is around 20 feet. So, imagine you're looking at a site that is only around 50 feet wide. So, then you can't actually work with it. You leave 20 feet on either side. You're left with just the 10 feet wide building. So, that factor also has to be kept in mind, look for a good, maybe a square shaped plot, or maybe a reasonably rectangle plot. Don't go for 2 linear areas. Same way coverage also majority of the spaces cities actually say only around 50 to 60% of the site can be covered, which automatically means if you've got a 20000 square feet site, your ground flow can only be 10000 square feet area. It cannot be more than that. So, keep that in mind when you select your site. Similarly, you need to find out what your, what do you call your land use pattern is. Now, each of the sites you go look for, you find out what the land use of that site is. Like, if they say it's residential or mixed residential, commercial. In commercial institution, you don't have too much restrictions, but residential areas you have like Tamil Nadu, for example, in residential area, you cannot build a hospital. But if you get some special permission, you can build around 3000 square feet in it. If it's mixed residential, that can go to around 5000 square feet. In some places, like maybe Hyderabad, they say residential, you can't cross 20 bed facility. So, those things also have, you have to research on before you buy your site. Same way, the number of roads next to your site or the height of your building, the higher you go with your building, the more setback you have to give. So, automatically the larger the site you will need. Now, if it is not a site, if it is not a greenfield project you're thinking of, if it's a conversion project or a brownfield, what do you look for in that structure that you see on your site? You need to first check out your floor height. Now, in a hospital, you ideally need good head clearance. So, automatically around three and a half to four meters, at least you need to look for in all your floors, which is like 10 to 12 feet minimum. Now, you take your OT itself, for example, the HVAC system, your laminar airflow system itself takes up two feet of your false ceiling space, which means if you've got only 10 feet height in the OT and you've got two feet going up in that false ceiling, you're left only with eight feet and doctors are not satisfied with that. Their head can hit on the OT lights and all sorts of other problems can arise. So, always look for a good four meter height inside OTs and good lavish space. Same way for disabled friendly features, see if there's a ramp already there or if there's a facility for a bed lift. If not, you should be able to provide that facility in your structure. I mean, by, for example, if your structure has a grand, you feel it looks really grand because you've got these huge steps leading up to your ground floor. Then you should also plan out a small ramp that will lead to your ground floor too. You can't keep steps as your only mode of access. Same way your fire safety requirements. Is there enough space around your site? Are your staircases wide enough? And then column beam arrangement. This I'm not going to technical. I'm just saying that you look, make sure that your column to column space is a lot wider so that you've got a lot more flexibility to work with. Then we go into a lot more hospital specific design. Every single bylaw from national building code, your local bylaws, everything has a whole segment dedicated to hospitals. So, you've got practically your entire planning rules from staircase with ramp with corridor with door with all that is also specified in these guidelines. You just need to know correctly where to look and what information together. Same way ARB guidelines goes to such a specification of telling you what the shape and size of your X ray room should be. How thick the wall of your X ray room should be. What should your staff wear? What should they follow in such spaces? Then things like parking facilities, like, like what I've shown here. Also, this is a Tamil Nadu guideline, which says if your floor area is around 3000 square meters, then you need one car and one bike for every 50 square meter or of that built up area. So, these are all regulations that are available to us. So, this can easily ignite fire is something that can very easily happen. And that's why government is actually cracking down very hard on hospitals to make sure that they've got even now with this whole corporate pandemic. Also, they're very particular. Any hospital handling corporate patients must have an active fire. If not, they have to take steps and they're given a short period of time to fix all the necessary meet all the necessary requirements. Then comes other standards, which are from experience. We develop and which are then standards. Also, as in, why do you keep your certain corridors wide and where we have the flexibility of going narrow? What is the height that you need to keep inside your OT? What are the sizes of your bed lifts that are needed? Your ramp ratios now? Ramp ratio is actually a very important factor because a ramp needs to be, you need to be able to push something up or down around, push your structure with the patient on it. So, around cannot be too steep. Otherwise, you risk the patient falling over. So, for example, if your floor or one floor of a building is four meters, it automatically means your ramp needs to be 40 meters long, at least for it to be a proper, comfortable use space. So, since ramp is such an important aspect in a hospital, you have to immediately plan out for a ramp facility. And it's very important in some states, it's compulsory. Tamil Nadu, Kerala have to have ramps in their hospital facilities. Government will soon make it compulsory also. Then, of course, we've got certain critical spaces, how you plan your infection control in hospital because that is the key feature in most of the hospitals. So, in these cases, you've got main things to keep in mind are your critical and non-critical areas being properly segregated so that people don't mix your OT and CSSD planning, unidirectional movement. Like, if your staff is entering your OT, they enter through a change room. So, that means you enter into the change, change and get out into the sterile corridor. You don't come back into the same corridor through which you entered. It has to be unidirectional. Then, sanitization stations. This ranges from maybe a hand wash in a consultation room to a scrub station in an OT. Now, the position you keep it itself matters. Now, in an OT, once your doctor changes and comes out, they need to reach the scrub station before they reach the OT. That is the main factor to keep in mind. And one major problem we've seen here is the CSSD and how it is not given much importance. Nowadays, people know, they're aware that OT needs to be planned very well, but they ignore the CSSD. Why is that? Now, OT, yes, it's a critical area. Operations happen over there. That's why it's so serious. But what about CSSD? All the instruments you use, your scalpel, your forceps, everything gets sterilized and cleaned in your CSSD. Then why not follow the same zone? CSSD also has dirty area, clean area, sterile area. The movement between them is very important. The movement of materials, the movement of staff, unidirectional movement over there, all that needs to be really paid attention to and really handled very smoothly. So, after you have satisfied all those requirements, all your standards, the bylaws, your height standards, and your these clinical facilities, then it's time to go a little extra, take the extra step, go the extra mile to make your patients and visitors comfortable. Make your designs patient and visitor-centric. Give good, comfortable waiting areas with large windows. Give some positive distractions, either in the form of murals or arts or child-friendly areas. A small playpen in a pediatric hospital will help engage a child. Disabled-friendly facilities, you need your handrails on either side of your ramp and staircase, your guard bars and guard rails on corridors, grab bars and toilets, your handicap-friendly toilets. Give a small prayer room near your OT complex so that the family members of the patient can actually wait there to hear news about their loved ones. And a good view of your outside and natural ventilation. Now, with the lack of space, we have seen many hospitals with their IP rooms not having windows. That is not an ideal design. You need to have good windows, good view outside because your patients should not feel trapped in your hospital. This COVID pandemic, this fear in patients are a lot more than they were before also. With the masks and the gloves and all that, it's a difficult time actually for all of them to visit a hospital. So, let's make them feel comfortable. Let's make them welcomed in the space and not actually fear the space that you plan and design just for them. So, let's hope that they start coming a little more freely and not fear and leave their diseases untreated due to all these things. So, then hopefully all these points, just the basic, it's only a basic covering of all these points, but all these categories will give you a rough idea of what you need to keep in mind from your site selection to your design. And hopefully this has helped you in getting at least an idea of where to go. There's still a lot more in a design that is involved, rules, regulations, bylaws, everything. Hopefully this one has given you a slight better understanding. So, thank you very much for the opportunity. Thanks.