Afree-standing Ophthalmic setup is an Ambulatory Surgery Centre (ASC). Designing and Building an ASC can increase your practice’s profitability, or it can become an attractive but underutilised money pit. Careful research, planning and financial analysis can pave the way for success.
When we start designing a facility, whether new or renovate an existing one, we need to focus on:
1. Outpatient Departments
2. Surgical spaces for cataract and other eye surgeries
3. Diagnostic and treatment spaces for Outpatient care
4. Indoor bed facilities for inpatient care
Moreover, we also need to plan for other spaces such as entrance & reception areas, administrative offices, conference halls, medical records, lounges, canteen, library, pharmacies and outlets for lenses and other optical devices and so on.
It must be remembered that patients using these facilities are visually impaired. The facility should be designed in such a way that these visually impaired patients find it easy to navigate through the facility. The design should pay special attention to reducing and/or eliminating obstacles that may hinder smooth mobility of these patients.
There are several design principles that need to be kept in mind when we begin designing a facility. The order of these may vary, but Hygiene must always be a priority in any healthcare facility.
Hygiene is a concept which has never been alien to the medical fraternity. We are probably more obsessed with cleanliness than anyone else, close to the point of being an obsessive-compulsivedisorder.
Yet we have probably never thought about incorporating the concept of hygiene in the design of a healthcare facility. The major thrust areas are:
a. Limit Dust & Mould
Countries with Tropical climate like ours, cannot eliminate dust completely. Air-conditioning helps to a great extent. But we need both extra filters to keep out dust and humidity control to prevent moulds.
The importance of handwashing in any healthcare set-up cannot be overemphasised. Design of hospitals have to make provisions for handwashing at all necessary point. These is overwhelming evidence that frequent hand hygiene has reduced SSI and VAPs. There cannot be a bigger proof than this.
Surgical spaces are our top priority when we design an Ophthalmic set up. Asepsis in the OTs and designing a unidirectional flow in the CSSD are an important and integral part of the design process.
The space allotted should be adequate and there should
be no segmentation. The design must include designated spaces for each of the
activity involved in CSSD while maintaining a unidirectional flow.
Appropriate & sustainable Technology
Technology is an ensemble of mechanical and scientific methods, products or systems invented for achieving human goals. Appropriate & sustainable technology reminds us to be aware of the consequences of our choices.
a. Flexibility & change
Use building systems that are simply built and can be altered or augmented. Provide modest component of excess capacity
b. Medical technology & technical support.
Facility design should support up-to-date technology with the needed space, structural support, electrical services, communication lines, piped medical gasses and other services.
The hospital building should meet good building
standards for structure, ventilation, HVAC, maintenance, ease of cleaning &
energy conservation. A reliable level of human comfort & air quality should
be provided. Incorporating natural lighting into the design is perhaps the most
important thing to do.
The hospital building must be designed to help staff work effectively and efficiently.
a. Form follows Function
The building should support good medical practices. It should not stand in the way of staff efficiency. The building should allow easy repairs and renovation.
b. Make Clear Functional Layout
It can either be Doctors hopping from one area to another or patients going from one point to another. One of these concepts should be followed in the design of the workplaces.
c. Functional requirements and design criteria
d. Waiting Areas
Combined waiting or De-centralised waiting? Both
have their positives. But locating waiting near the professional staff rather
than searching for patients in a general waiting area makes better sense as it
improves efficiency and reduces wastage of time in searching for the patient.
Response to Social Context and Community Design
a. Support local patterns of life.
Respect for and response to the local customs and the overall way of life goes a long way in building patient loyalty. A hospital design should incorporate all of this.
b. Community & Privacy
There are many intricate community practices on how they sleep, how they prefer ventilation etc. All of these small choices into the design helps to develop that extra bond with the community.
A very controversial point. But if the community
prefers that way the facility needs to be designed to educate the kin on
personal hygiene, eating habits, wound care etc. the facility needs to have a
dedicated area for such training activities.
a. Celebrate Eyesight
The eye should have something to celebrate in an eyecare facility. Local artists and craftsmen can be used to showcase local talent. Consider using textured surfaces, colours and shapes that can be appreciated in different ways by people with different visual acuity – they appreciate more vibrant colours with higher contrast.
b. Site Repair.
Builders often tend to select the most beautiful
spot on the site and replace them with a building there. The aim should be to
conserve that spot and build the new building around it on probably the worst
area on that plot.
a. Hotel Care & Medical Care
Very often we see lavish interiors in hospitals that compete with lobbies and rooms of a 5* or 7* hotel. What hospitals need are functional interiors that are high on their utility quotient, pleasing to the eye, yet, are easily amenable to HIC policies of the organisation. The LEAN concept of eschewing ornamentation is more important here than anywhere else.
b. Outpatient Care
Ophthalmology is one branch that has embraced outpatient care, positively. However, facilities located in remote areas need to factor in whether effective post-op care is possible at home after discharging patients immediately after surgery as is routinely done. Patients coming from remote areas may not be able to go and comeback for routine post-op visits; some may have co-morbidities that may need to be monitored. Inpatient facilities may have to be created for such patients.
Finances is a separate topic by itself and can
be discussed ad nauseum. But to sum up in short, in planning a budget for a
hospital it is critical to remember that the construction is not the whole
project cost. It is equally important to consider the life cycle cost
implications of building decisions.