Health care facility construction projects are one of the most demanding of all construction projects. Every such facility consists of areas and a variety of functional units where a spectrum of services is provided. For example, a health care facility may accommodate: hospitalized patients, specialized outpatient surgeries, diagnostic facilities (laboratories, X-ray examination rooms) and other spaces that support catering, accommodation and cleaning.

This diversity is naturally reflected in the broad range of legislative regulations and standards that must be borne in mind whenever a health care facility is constructed or run. Each of the extensive and ever developing functions of such a facility—including the extremely complicated equipment and telecommunications—requires dedicated knowledge and experience. No one individual can have such comprehensive knowledge which is why a large number of specialists are involved in the construction of such a health care facility. Particular functional units within the facility may also have competing needs and priorities that can only be realized subject to compliance with rigorous mandatory requirements, actual functional needs (such as those regarding operational linkage and inter-departmental relationships), financial limitations on the employer’s side, and so on.

The phase of planning prior to commencement of design preparation is frequently required at the preliminary stage but is often neglected. This is an intermediate stage between strategic decision-making and designing and is an ideal platform for managers and other staff involved in such a health care facility to express their visions, influence design (such as floor space), locations and financing of the project. This phase can also have an impact on the cost and efficiency of the facility as a whole for many decades of its expected useful life. The people involved in the pre-design planning phase must sometimes make difficult and unpopular decisions. These may include stoppages of planning and postponement of the commencement date so that the priorities and other factors can be reassessed in the meantime. The following, for example, will have to be taken into account in this phase:

• Inpatient to outpatient ratio related trends. Despite pressure to restrict the length of hospitalisation, expenses and new equipment and services that facilitate broader outpatient care are ever growing. This is due to an ageing population and better diagnostic techniques and equipment which result in more hospitalized patients.
  
• Use of intensive care. In the US, for example, there is a ‘safety net’ for 45 million uninsured patients for whom health care is not available elsewhere.
  
• Personnel shortages. Outflow of those in charge for better conditions, power of trade unions, legal minimum number of personnel required to be present depending on numbers of patients, and so on.
  
• Trends in development and technological innovation. Better technology leads to longer life expectancy of patients, better quality of life, productivity increases, reduced costs, and so on.
  
• Increasing expenses. Not only for labour, but also for insurance premiums, better contingency planning (for example, against terrorism and natural disasters), research and development costs, adjustments for changes in costs over time.

This prior-to-design planning can be defined as a process that pre-determines proper selection of:

• services which will be in compliance with the facility’s strategic purposes, business plan and forecast market development trends;
  
• size as based on demand expectations, available personnel and equipment and level of comfort;
  
• locality as based on access routes, operational efficiency and suitability of building(s);
  
• structure of financing such as from own funds, credit, leasing, shared private and public resources.

Cooperation with a designer should commence as soon as possible. However, it is mainly the employer who will have to thoroughly consider all priorities at the planning phase. With respect to priorities and limits on the employer’s side, the level of detail into which the tender design should go into must also be considered. Sometimes it is up to the designer to come up with alternative solutions while respecting the limitations imposed by the employer. Usually, the employer and their consultants should offer alternatives in respect of their intentions, strategies and objectives.

Apart from the wide range of services to be provided, a health care facility must serve many diverse users and other concerned parties. Ideally, the owner’s or user’s key employees or representatives should take part in the design preparation phase. The designer, however, must also guarantee efficiency gains and benefits from the standpoint of patients, visitors, auxiliary personnel, volunteers and service providers who do not usually take part in these design preparation efforts.

A well-designed health care facility, such as a hospital, will have to efficiently harmonize the functional requirements with the needs of its various users. The following sections will focus on the most significant health care facilities, i.e. hospitals.

The basic structure of a hospital tends to be as follows:

• Inpatient section/hospitalized patients
  
• Outpatient section
  
• Diagnostics department (complementary)
  
• Customer care facility
  
• Office areas
  
• Areas for support services and maintenance
  
• Areas for research, education and training
  
• Relaxation and entertainment areas
  
• Parking, traffic and access routes.

The individual parts are functionally interconnected to form various configurations. This allows for efficient logistics and for effective movement and communication to take place there. Possible configurations then depend on limitations due to on-site and climatic conditions, neighbouring buildings, budget constraints and so on.

Regardless of location, size or budget, all hospitals have some common characteristics. In particular, those dealing with efficiency and cost effectiveness, flexibility, expandability, therapeutic requirements, cleanliness and hygiene, access requirements, internal circulation and logistics, aesthetics, safety and use of information technologies.

Efficient configuration of a hospital should:

• allow efficient work of employees by minimizing distances between frequented areas;
  
• allow easy monitoring of patients, given the limited number of health care personnel;
  
• include all necessary areas, but avoid unnecessary ones. Making use of adjacent areas and multipurpose areas;
  
• provide an efficient system of logistics;
  
• consolidate outpatient functions on the ground floor for immediate access;
  
• put together groups or combinations of active areas meeting similar requirements due to their functional neighbourhood (such as placing the intensive surgical care unit next to the operating theatres).

Health care will face ever-growing demands on facilities and treatment methods. In order to sustain steady development, hospitals should: