The potential savings that could be realized if improved planning concepts were applied to the reference hospital were also evaluated. The use of detailed demographic/demand analysis and projection would have indicated that the number of beds could have been reduced from 410 to 259 at a cost savings of $1,826,000 (see page 199). "Fast-track" scheduling of design and construction would have reduced the acute care portion of the improved hospital's design/construction time from 54 months to 39 months. Such a reduction would have permitted the hospital to begin operation one year sooner and reduce out-of-pocket costs by $240,000. The use of regional planning concepts might have changed the results of this study considerably. The reference hospital is a major referral center, with 41 percent of its patients coming from outside the county in which it is located, even though it is in the center of the county. Thus, the hospital relies heavily on the policies and plans of neighboring health care facilities. For example, the reference hospital is experiencing a low occupancy in extended care beds and has had difficulty in opening the rehabilitation floor due largely to factors beyond the hospital's direct control: a 394-bed nursing home was built near the reference hospital but never opened, indicating an excess of extended care beds in the area; and Hill-Burton applications for three rehabilitation centers (one at the reference hospital and two at other nearby facilities) were approved although local demand indicated the need for only one. Currently, despite excesses of inpatient beds in the area and a projected decline in population, another local hospital is planning to expand its bed capacity. Such duplication of resources can be largely eliminated through the use of currently available predictive tools which estimate regional demands for health care based on the age, sex, and socioeconomic characteristics of the population to be served and demographic projections of future population dynamics. However, these projected demands must be satisfied in concert by all health care providers in the area. The data requirements for such regional planning are discussed in Appendices B and C, but their 18-240 62E-98 application in this report is limited to the reference hospital in isolation and is not an adequate basis for truly comprehensive projection. Based on the systems analysis, detailed in subsequent sections of this report, the following summarizes the improvement alternatives recommended for use in the improved hospital: Dietary a total convenience food system should be implemented. - Laundry the existing in-house laundry system used by the reference hospital should be continued. Materiel Handling a semi-automated system with pneumatic linen and trash removal should be implemented. Floor Covering - a combination of vinyl sheet, vinyl asbestos, and carpeting should be used. Clinical Laboratories the same equipment currently in use at the reference hospital should be used with reduced staffing. rooms used in the reference hospital should be maintained. Construction a revised building configuration should be constructed using long-span interstitial space over the diagnostic/treatment zone. Computer-assisted layout should be used to help improve functional adjacencies. hospital planning and fast-track design/construction scheduling should be applied to the improved hospital. |