A neighbourhood hospital

Micro-hospitals are primarily used to assess and treat less acute inpatients closer to a patient’s home

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By Dhanraj Chandriani

In the western world, the healthcare industry has seen the value that ‘micro hospitals’ offer. Healthcare system providers are establishing small, comprehensive hospitals in neighborhoods where people reside and also looking at such facilities to create a competitive edge by outspreading their brand to bridge gaps in the market. These facilities, as opposed to urgent care centres and stand alone emergency departments, provide similar services to the community as a traditional hospital, though on a smaller scale with quicker yet compassionate care.
Micro-hospitals are set up in smaller geographies and underserved areas, where the cost viability of a full-service hospital is absent. Yet they must be within a reasonable distant from a larger, multi-disciplinary hospital to ensure timely transportation of an acute patient. Most of all, micro-hospitals are simple, less expensive and faster to set up than conventional ones.
This concept is very much applicable to India, what with the categorisation of cities into metros, II and III tier. The last two are clear candidates for micro-hospitals. Despite its scale, it is essential that micro- hospitals maintain standards of healthcare delivery and comply with all applicable central and state licensing and regulatory requirements as traditional hospitals. This would also make their patients eligible for better health insurance reimbursement.
The west has adopted an approach that uses a retail-focused delivery model focusing on patients’ desire for convenience in the delivery of healthcare services. This service is available 24×7. Importantly, the planning and design norms cannot be much different from the acute care norms. Hospital planners would still have to adhere to best practices of the industry.
Micro-hospitals could be planned in approximately 16,000 to 20,0000 square feet facility with approximately two to three emergency bays and 15 to 20 in-patient beds. OPD and diagnostic facilities such as radiology and imaging could be on the ground floor in clear view of the patients entering the facilities, thus giving them the comfort of coming to a proper hospital and not just an urgent care facility. IPD rooms and an administration block could be built on the upper floor/s, height permitting.
Whilst micro-hospitals provide overnight stays, they are primarily used to assess and treat less acute inpatients closer to a patient’s home and in a more cost efficient manner than a full-service hospital.
Hospital architects could simplify the design and inpatient and allied room sizes would need efficient and a tighter design. Operating rooms could be approximately to 300/350 square feet, concentrating more on out-patient surgeries.
However, micro-hospitals must provide for basic mandates like hand-washing sinks and storage, or those features that patients have come to expect, including family areas. No doubt it’s a challenge to be at the bare minimum to reduce cost. Owing to limited space, these patient care centres may have reduced public spaces (and hence costs) such as waiting rooms; outsourcing dietary and laundry services, which not only consume large areas but also are also expensive to provide.
Whilst micro-hospitals have a lesser capex than traditional ones, economies of scale could differ where the cost per bed is often higher. To contain costs, these facilities could opt for modified design standards of a larger hospital and substitute materials and finishes that are similar in look and feel but are less expensive. This, no doubt, could be challenging at times, as patients would expect the classiness of a hospital environment with the accessibility of a neighborhood outpatient centre.
Yet, it is possible for a micro-hospital to get branding through its design as a key factor besides just the patient experience. There is also the possibility to create a uniform, branded look for multiple micro hospitals belonging to one single group just as retail goods franchise.

Dhanraj Chandriani is Managing Director with Technecon Healthcare Pvt. Ltd.

How does one differentiate a micro hospital in India from the already existing ‘nursing homes’ and small hospitals in the healthcare landscape? For example, micro-hospitals would have inpatient beds and would be fully licensed hospitals with an emergency department, pharmacy, lab, and imaging. Some micro-hospitals could also offer primary care, telemedicine, dietary services, women’s services, and surgery.
Then again, micro-hospitals are different from satellite hospitals/centres where the former may have 25-30 beds with sizes ranging from 20,000-25,000 square feet, whereas satellite hospitals typically would be larger.
It is clearly established that a micro-hospital is not a rural hospital. They would typically be established in more affording townships that are within 20-30 kms of a conventional hospital where patients could be transferred for advanced care.
In conclusion, a micro-hospital model is a concept to make access to a hospital more convenient for patients and closer to their homes. It is more appropriately sized for the neighbourhood population compared to larger, more complex facilities. All in all, it is `value based care’.

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