HOSPITAL DESIGN & BUILD

Design of Single Specialty Hospitals: A co-ordinated approach
Monika Kejriwal, Director – Healthcare, RSP Design Consultants (India) Pvt Ltd; and
Dr. Jagadish Prasad, Interventional Neuro-Radiologist & Managing Director, Femiint Health 

​Date: 16 April 2022
Single specialty hospitals offer great opportunity to enhance patient experience while also improving patient outcomes. Brainstorming on design innovations is not only key to achieve these but it is also undoubtedly the most exciting phase of any healthcare project.
 
A coordinated approach of using design to add to a hospital’s competitive edge can be a powerful strategy with significant benefits for all stakeholders. Just as architects need to understand how healthcare facilities are run and keep abreast of the ongoing evolution in the healthcare industry; healthcare providers need to understand that design can be an extremely effective therapeutic tool.
 
Hospitals are a highly specialized building typology, most often purpose-built, to suit a specific function and yet with a need to plan for uncertainty and to accommodate unknown future functional and technology changes. A typical multi-specialty hospital by definition has many clinical specialties and complexities, further challenging planners and operators. Single specialty hospitals mitigate this conflict to some extent.
 
There is a recent trend of a rise in single specialty hospitals, with certain types of health care services, where clinically feasible, being offered in settings that are independent of large format multi-specialty hospitals. This shift in care delivery model also needs a thoughtful re-evaluation of the design of such healthcare facilities.
 
Patients are more aware and savvy healthcare consumers. They expect personalized, top-notch clinical care with seamless coordination at a reasonable cost, and in a convenient location. Increasingly, patients are embracing the free-standing specialty centres as their healthcare destination of choice if it provides the same quality and level of care as a traditional hospital setting.
 
More stable brief/clearer requirements
The clinical offering/services being focused on a single specialty, the design brief is relatively more stable and requirements more focused and clearer from the outset as compared to multi-specialty hospitals. The design program is rooted in highly specific operational premises. Various parameters such as average length of stay, are also more defined and predictable.
 
In some instances, the clinical program has defining implications on all aspects of the project design such as building architecture and site planning. For example, for a comprehensive Oncology Hospital, planning of a basement becomes a prerequisite for accommodating Radiation Oncology services. Similarly, for an Orthopedic facility, providing trauma care is important and good Emergency access becomes critical.
 
Medical Planning
There are numerous functional units within a hospital, and these different units invariably have requirements and priorities that compete with one another. Consequently, in multi-specialty hospitals, it is inevitable that trade-offs are there. As a result, sometimes a true understanding of functional relationships and requirement gets diluted.
 
In contrast, in a single specialty hospital, the flow diagrams/relationships are more straightforward, and lead to greater insight and more robust understanding of clinical operations, and functional & spatial flows in a hospital.
 
Armed with that knowledge, medical planners and health care architects are in a better position to help streamline workflows, right-size spaces and eliminate redundancies.
 
Patient Experience
While patient experience and patient centricity have always been the cornerstone of clinical work, the importance of these aspects is increasingly going beyond the clinical realm.
 
In any single specialty hospital, the patient group is more homogeneous and better known, as opposed to multi-specialty hospitals where the demographics is more varied and unpredictable.
 
Consequently, patient experience can also be better designed with a more personalized and appropriate approach. For example, delivery being a predominantly physiological event and not a pathological one, in a women’s hospital with a maternity focus, a less visibly clinical environment can be designed to the extent possible without compromising on clinical requirements. At a more micro level for example, devices / elements incorporating braille can be designed in an Ophthalmology center, or walking aids provided in an Orthopedics facility.
 
Level of technology
Technology has enabled more services to move out of the large format multi-specialty hospital to a setting that’s more convenient for patients.
 
In addition, the level of technology or technology enablers, such as use of Pneumatic Tube Stations, Robotics and/or incorporation of remote monitoring can also be more appropriately and optimally planned in a specialty focused hospital based on the acuity levels, and service line requirements.
 
Branding Opportunity
In recent times, there has been a spurt in the growth of single specialty hospitals which are part of a network. As a result, elements like branding assume an important role. In such single specialty hospital projects, there is an opportunity to integrate interiors and signage/branding more fully as opposed to signage/branding being an after-thought.
 
Execution Timeframe
Because they’re invariably smaller in scale, the construction timeframe for single specialty hospitals is shorter. Given the continually soaring construction costs, this in turn helps contain costs and control budgets better.
 
Also, with less variables to contend with and greater clarity from the start, there are invariably less changes during design and construction stages, further resulting in more streamlined and quicker execution schedule for the project.
 
The whole cycle of opportunity identification to commissioning plays an important role in business viability of small and medium sized single specialty hospitals.
 
Real estate capex is a very high burden on hospitals in general causing a very low ROCE. The fact that single specialty hospital requirements can more easily be templatised and executed with relative efficiency may certainly help in reducing capex.
 
Add to it the fact that these efficiencies could be achieved in existing buildings without the need for a complete greenfield project in certain cases may also decrease capex and time requirements.
 
Single specialty hospitals have great potential to use design as a differentiator, enable delivery of the project with a greater degree of cost-control, allow better and tighter operational planning – resulting in quicker execution, while enhancing patient experience and improving patient outcomes. These directly translate into capital cost savings as well savings in operating costs during the lifetime of the facility. Some of these factors may partially be contributing factors for the proliferation of single specialty hospitals.
 
The imperatives of a single specialty model when understood and brought to the project well from both a business and the design & planning perspective can contribute to the establishment of a successful enterprise that is efficient, convenient, pleasant, and cost-effective all at once.
 
About the authors:
Monika Kejriwal is a healthcare design professional with extensive experience in healthcare design industry working with leading international and Indian healthcare organizations for more than two decades. She serves as Director - Healthcare at RSP Design Consultants (India) Pvt Ltd.
 
Dr. Jagadish Prasad is a passionate clinician and a doc-preneur in both traditional healthcare delivery as well as the new age health tech space. In addition to performing complex neuro-interventional procedures, he has setup and runs Femiint Health, a single specialty hospital in the women and child space and has also been a founding member of mfine.   
 

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