Hospitals want speed. Infrastructure doesn’t work that way.
By Arunima Rajan
Faster isn’t always cheaper. Poor planning can cost hospitals much more, says Pranay Kumar, Executive Director of Rudrabhishek Enterprises Limited (REPL), a publicly listed consultancy firm that works on large-scale urban development and infrastructure projects, including Smart Cities and AMRUT.
DPRs often read well on paper. What makes them execution-ready?
The quality of DPR depends upon the basis of input factors taken for making forecast. Management, Market, Technical and Financial all are equally important for the same. Market assessment of target demand, level of competition, technical detailing of various hospital components, their interlinkages, execution timelines, project capex and profitability assumptions all play a significant role in developing a quality DPR which can be used for execution as well. However, even well-prepared DPRs faces challenges during execution due to due to shift in market requirement, regulatory changes or, or incomplete stakeholder alignment. Execution-ready DPRs, therefore, must include flexible designs and contingency provisions. This needs to be backed up by close monitoring to take the required timely decisions. Successful DPRs are those that combine rigorous upfront analysis with adaptive mechanisms and supported by active risk management and managing evolving challenges during implementation.
In an age of AI and digital-first care, what should hospital design solve for?
AI-assisted design approach enables capturing real-time data and insights which allows for patient -centric efficient and effective hospital layout. In today’s AI-driven and digital-first healthcare environment, hospital design should focus on creating adaptable, patient-centred spaces that improve both care delivery and operational efficiency. AI-assisted design enables real-time data collection and analysis, which helps optimise patient flow, reduce wait times, and improve resource management. For example, AI can identify patterns in patient movement to redesign layouts that minimise staff fatigue and enhance workflow. Additionally, AI-driven simulations support better infection control by optimising ventilation and isolation areas. These improvements translate into measurable benefits, such as shorter patient stays, increased staff productivity, and overall enhanced patient experiences. Ultimately, AI empowers hospital design to be more responsive, efficient, and aligned with modern healthcare demands.
When design slows operations: where are hospitals going wrong?
Architectural design missteps in new hospitals include design flaws leading to inefficiencies in workflow, poor space planning, and lack of flexibility and adaptability to future technology. These may result in increased operational costs later due to suboptimal use of space, higher energy consumption, and difficulty in adapting to evolving medical needs. The cost of correcting these issues can range from lakhs to crores of rupees, depending on the severity and scope of the problem.
These costs often arise from the need for structural modifications, reconfiguration of spaces, and upgrades to systems such as HVAC and electrical layouts to better align with operational demands. While exact figures vary depending on project specifics, hospitals frequently face significant financial burdens when retrofitting or redesigning foundational architectural elements.
Experts emphasise that many of these costs can be avoided through thorough planning and designing for adaptability from the start. Flexible, forward-thinking hospital designs help reduce unexpected expenses and ensure more efficient operations. Hospitals falter when initial designs neglect operational efficiency and future readiness, causing costly delays and hampering healthcare delivery.
NABH, fire safety, and zoning: Can compliance be built into the blueprint?
NABH standards cover various aspects of hospital management and patient care, including facility management and safety. Inter alia, they include fire safety norms, zoning requirement. This includes integrating fire exits, fire-resistant materials, and automated systems into the plans, while zoning laws guide aspects such as site selection, building height, and land use. By addressing compliance at the planning stage, hospitals avoid costly retrofits and delays post-construction. Proactive design ensures smoother approvals, operational efficiency, and long-term legal and safety adherence.
NABH standards are integral to Greenfield hospital design and architectural blueprints are developed accordingly. This approach ultimately results in safer, compliant, and operationally efficient healthcare facilities. Regular coordination with statutory bodies during design development helps anticipate revisions in fire safety and other norms, enabling timely adjustments.
The Brownfield Hospital expansion project may need some retrofitting as well as the compliance requirement particularly for the fire safety undergoes revision by statutory authorities from time to time.
Structural supervision is rarely a boardroom issue. Should it be?
Hospital construction is a complex project wherein the design development is spread out due to incoming vendor data on medical/radiological equipment, Medical Gas Piping system, Nurse calling system, pneumatic chute transfer system, operation theatres. The hospital CEO shall participate in the monthly design development and compliance review meeting apart from the project progress updates on time and cost. Their involvement facilitates quicker decision-making, smoother vendor coordination, and improved alignment between infrastructure and functional requirements.
When structural decisions are treated not merely as technical concerns but as strategic leadership inputs, hospitals are better positioned to prevent misalignments that can otherwise lead to operational inefficiencies post-construction.
What changes when you’re building onto an existing site?
A brownfield expansion project is necessarily more complex for handling bio medical waste, construction of new adjacent block creates a safety hazard for patients/ their visitors, patient discomfort due to noise/dust. Apart from it the integration of building faces water proofing issues, integration issues of utilities (water, electricity, and gas), firefighting etc. These may also result in additional retrofitting requirements. All these have an impact on the project time and cost as well as its subsequent efficient usage.
In practice, brownfield projects often encounter unexpected structural constraints, relocation of underground services, and service disruptions, especially when integrating new systems with older infrastructure. Delays can occur due to phased construction to avoid disturbing critical hospital functions, and coordination becomes more demanding with operational departments in place.
Costs also tend to rise when existing layouts need modification mid-project to meet compliance or integration challenges. Careful sequencing, stakeholder coordination, and contingency planning are essential to navigate these complexities effectively
Every CEO wants to cut time-to-launch. Where’s the risk in rushing?
Hospital is a complex construction project with a number of interlinkages. Faster go-live is normally attempted by every CEO at Hospitals to quickly catch the market, reducing overheads. However, inadequate project formulation and design development, unreasonable haste in construction will result in inefficient design, sub-optimal usage, quality deficiencies, and higher operational cost.
Hospitals that rush their launches frequently face costly reworks, delays caused by unresolved infrastructure issues, and challenges in meeting safety and compliance standards. Such setbacks inflate expenses and disrupt both patient care and staff efficiency.
When all is said and done, balancing speed with thorough planning, design validation, and alignment with clinical priorities is essential. Avoiding undue haste ensures optimal facility utilization, safeguards quality, and supports sustainable operations, significantly reducing the risk of expensive corrective actions post-launch.
Your firm has worked with government health infrastructure. What can private operators learn from that playbook?
Government has very detailed guidelines for hospital infrastructure creation. These include the space utilization to prudent budgeting and staffing for hospital operations. The new multi-specialty hospitals set up by the government and their experience are invaluable. However, private operators face relatively more constraints in the size of land parcels and hence need greater innovation in area utilization.
Private operators, however, often face tighter constraints such as limited land availability and stricter budget ceilings. Learning from government projects, they can adopt innovative space optimization techniques, modular design approaches, and phased development strategies to maximize utility without compromising on care quality.
For instance, successful government hospital projects have demonstrated how integrating multifunctional spaces and leveraging standardized design elements can help overcome space and financial limitations. By applying these proven strategies, private hospitals can enhance operational efficiency, maintain budget discipline, and deliver high-quality healthcare within constrained environments.
Green hospitals: talking point or operational imperative?
Green Hospital Buildings go Beyond certifications. Apart from utilizing natural resources in an efficient manner, it attempts to achieve patient well-being, aids the curative process. There is an increasing need from the patients for the quality of indoor air which aids in faster recovery. Green certification allows access to cheaper finance. Goodwill generates better patient footfall and also results in better revenue realizations. This aided with lower operational costs predominantly due to higher energy efficiency makes the viable business proposition.
CEOs often prioritise aesthetics until the bills come in. What’s the smarter way to think about hospital design ROI?
While aesthetics significantly impacts patient wellbeing, staff morale, and overall hospital experience, functionality provides efficient workflows, equipment accessibility, energy efficiency. A balanced approach of aesthetics and functionality is required. To optimize Hospital design ROI one needs to consider financial / non-financial parameters like patient outcome, staff efficiency and operational efficiency.
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