Based procedures and allied matters. The draft

Based on these, the contract bidders prepare their proposals and estimates for the building and submit their tenders when invited to bid competitively.

The award of contract is made to the lowest bidder, considering also his standing and experience in the building trade.

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The architect supervises the construction to ensure that the work is carried out according to the contract, and that correct materials are used and specifications followed.

The agreement drawn between the owners and the contractor should lay down the time schedules, method and periodicity of payment to contractor, sureties to be furnished by the contractor, penalties in case of default, inspection procedures and allied matters.

The draft of this legal document is prepared with the help of the architect and consulting engineers and executed through a law firm.

The contractor usually subcontracts various parts of the work to other contractors, each a specialist in a particular line of work. Nevertheless, the overall responsibility for the construction lies with the main contractor as per the terms of the contract.

As clarified earlier once the work has started, any change in the construction plan is going to disrupt the project and cost a lot of money.

However, modifications may become necessary due to unforeseen circumstances during the construction stage.

In such a case, the drawings and specifications which have to be changed by the architect may call for redrawing of the contract with the contractor.

Because planning invariably takes a considerable time, it is clear that by the time design and construction are complete; more modern ideas are being developed.

The temptation to alter designs, because ideas encorporated in planning earlier are no longer the latest fashion must be avoided.

Some modifications in detail may be permissible if it can be contained within the cost limit, but it may be cheaper to build the mistake—often mistakes may not be so bad when seen in retrospect.

It is desirable to engage the services of a mechanical engineer to supervise the installation of mechanical equipment of complex nature, under the overall control of the architect.

Arrangements for safe storage of all equipment at the site must be made in advance, and adequate time should be earmarked to uncrate, check, inspect, assemble and install each item of equipment in its appointed place.

The hospital administrator-consultant should be available to guide the placement and installation of diagnostic and therapeutic equipment.

Phasing:

Few projects can be taken to the stage of completion without recourse to breaking it into phases. This is necessitated because of following factors.

1. The necessity to bring facilities into use as quickly as possible for operational reasons

2. The necessity to split a major project into smaller units of building work as a contractual consideration

3. The necessity of having certain departments ready before others

4. Local priorities for introducing services

5. Limitation on availability of capital funds.

Phasing requirements have a dominant effect on the future building shape depending on whether the phased development is on existing hospital site or a new site.

The phased hospital on a new site has to provide the necessary basic services in the first phase which takes a disproportional amount of capital, severely reducing the clinical content.

On the other hand, having to build basic supportive departments smaller than their ultimate capacity necessitates defining how they can provide the increased services required in the later phases whilst still maintaining operational efficiency and optimal departmental relationships.

The way in which the first phase departments will expand to serve later phases will have to be very carefully considered.

Commissioning:

The hospital is ready to be commissioned when its building is ready, all equipment has been installed, and the staff and manpower engaged.

The plant and machinery should have undergone many test runs before this, and the therapeutic and diagnostic equipment should have also been tested.

The medical staff and other paramedical personnel should have been positioned a few weeks in advance.

The commissioning team would have started meeting much before the completion of the buildings and will comprise of key members who will be connected with the new hospital.

It will have the hospital consultant, the hospital administrator and with him the chiefs of clinical services, senior nurses, personnel manager, supplies officer and a few others, in fact the chiefs or representatives of all the departments.

The role of the hospital administrator, who should have been selected in advance, becomes crucial now.

The team has the task to bring the hospital buildings, plant and equipment to a state of the operational readiness, develop operational systems, testing the equipment for use, coordinate training of staff, ensure good communication with the public, and communicate with outside organisations affected by the hospital.

Establishing a project room for this purpose will be advantageous. It acts as a communi­cation centre for the team where maps, charts, drawings, data sheets, systems manuals, equipment schedules, etc. are available.

Shake-down Period:

A well-planned hospital passes from the construction stage to the commissioning stage with a smooth transition if adequate thought has gone into aspect planning, equipment and staffing.

After commissioning, a hospital’s staff, patients, community, buildings, facilities and environment interact and adjust with one another until the hospital settles into its usual routine.

The period from the time of commissioning of the hospital till it settles down into a satisfactorily functioning entity is the “shake-down period”. It is the period during which it experiences its teething troubles.

In general, this period will be shorter if adequate time and thought have been devoted to planning and execution and can last from a few months to a year. Any necessity for additions, alterations and modifications will become apparent during this period, as also the necessity to readjust staffing schedules.

Epilogue:

“Talking about hospital planning is like talking about swimming. One can derive some principles and postulations, and give advice. But, in the final analysis, the only way to achieve proficiency is to jump in and do it”.