What It Actually Takes to Design a Hospital in India

We design spaces that heal. That is not a tagline. It is a constraint that governs every decision in hospital architecture — where the OT sits in relation to the CSSD, how natural light reaches a recovery ward, why a corridor width is what it is, and why the building envelope in Rajasthan's climate cannot be an afterthought.

A hospital that heals is not built by accident. It is planned that way from the first sketch.

And yet most hospitals in tier-2 and tier-3 Rajasthan cities are not planned that way. They are built to a budget and a floor plan, with NABH compliance discovered late, with the OT positioned wherever space was left, and with a building envelope designed for appearance rather than climate. The corrections come later — expensive, disruptive, sometimes impossible.

This article is about how to avoid that outcome.

Before the first drawing

The first question a doctor planning a hospital should ask is not how many floors or what the facade should look like. It is: what kind of hospital am I actually building, for whom, with which services, and at what scale?

That question produces a clinical brief — a document that specifies bed count and bed mix, OPD and IPD logic, which specialties will be present at opening and which will be added in year five, whether the hospital will have an OT from day one or phase it in, what diagnostic capability is needed, and how the hospital will grow. The brief also has to reflect the city. A 100-bed hospital makes sense in Bikaner. It may be too much hospital for a smaller city in year one.

Without this brief, the architect is designing a building. With it, the architect is designing a healthcare operation.

NABH accreditation — which most serious hospitals in Rajasthan now pursue — is not a checklist applied at the end of the project. It is a spatial logic that must be present from the first sketch. Corridor widths, handwashing station placement, clean and dirty separation, nursing visibility, storage, fire egress — these are NABH requirements, and they are also the difference between a hospital that works and one that does not.

Approvals shape the building

Before any zone is drawn, the approval framework must be understood. In Rajasthan, a hospital project requires fire NOC, lift clearance, local building plan approval, and — if radiation equipment is planned — AERB eLORA licensing. Collectively, these can take twelve to eighteen months. That timeline must be built into the project schedule from day one, not discovered after the structure is complete.

More immediately, approvals dictate the footprint. Local bylaws determine setbacks, ground coverage, and floor area ratio. A building planned without reference to these constraints will either be redesigned at cost or built in violation — neither of which is acceptable for a facility seeking NABH accreditation and statutory operating licences.

The approval framework is not an administrative hurdle at the end of the design process. It is a design constraint at the beginning of it.

Movement before rooms

The most consequential decisions in hospital design are not about rooms. They are about movement — how patients move through the building, how staff move, how sterile supplies move, how biomedical waste moves, and critically, how none of these paths cross each other unnecessarily.

In a well-designed hospital, a patient arriving at emergency does not share a corridor with a patient being wheeled to the OT. A nurse carrying medication does not pass through the same zone as a housekeeping trolley carrying soiled linen. These separations are not aesthetic choices — they are infection control decisions with direct consequences for clinical outcomes and NABH compliance.

At Dhaka Hospital in Deedwana, the site was constrained and the floor plate compact. The movement logic had to be resolved before a single room was positioned. Clean corridor, dirty corridor, visitor access, staff access, service entry — each defined first. The rooms followed.

In nearly twenty years of hospital design across Rajasthan, the projects that have worked best are the ones where the client was willing to spend the first month of the design process on brief and movement logic before touching a floor plan.

The critical care cluster

The OT, ICU, CSSD, and emergency department are not independent departments that happen to sit near each other. They are a cluster — and the relationship between them determines the clinical efficiency of the entire hospital.

The OT must be designed first. Not because it is the most important room in the building, but because its requirements — pressurisation, HVAC, sterile movement, medical gas routing, structural loading for ceiling-mounted equipment, clean and dirty corridor separation — affect every adjacent space and every building system. Once the structural grid is fixed around a poorly positioned OT, the problems compound through every floor above and below.

CSSD must be directly accessible from the OT without passing through public or semi-public zones. This adjacency is a NABH requirement. It is also common sense. Sterile instruments travelling long distances through mixed-use corridors are instruments at risk.

The ICU requires nursing visibility across all beds, controlled access, proximity to emergency, and its own HVAC zone. Getting this cluster right at the schematic stage is the single highest-value investment in the design process. Getting it wrong is the single most expensive mistake to correct.

The invisible building

A hospital is a machine before it is a building. The systems that make it function — HVAC, medical gases, electrical load, backup power, plumbing, water storage, sewage, lifts, and service shafts — consume a significant portion of the construction budget and determine whether the building actually works when it opens.

Most hospital projects in tier-2 and tier-3 Rajasthan cities underestimate this. The architect designs the rooms. The MEP consultant is appointed after the structural drawings are substantially complete. By that point, the shaft locations are fixed, the floor-to-floor heights are set, and the plant room is wherever space was left over.

The consequence is a hospital where ducts are routed around columns, medical gas pipes travel unnecessary distances, and the lift shaft was positioned without reference to stretcher movement. None of these problems are fatal. All of them are expensive and permanent.

Medical gas infrastructure — oxygen, nitrous oxide, vacuum, medical air — must be planned from the structural stage. Pipe routing, manifold room location, cylinder storage, and zone valve placement are architectural decisions, not afterthoughts.

Climate, envelope, and what it costs to run

In Rajasthan, the building envelope is a financial decision as much as a design one.

A fully air-conditioned sealed hospital in Churu or Bikaner — glass facade, no shading, single large floor plate — will carry an electricity load that consumes a disproportionate share of monthly revenue before a single clinical cost is counted. The AC load on a poorly oriented, unshaded building in 46-degree heat is not a minor operational expense. For a 50-bed hospital running on thin insurance margins, it can be the difference between viability and distress.

The floor plate obsession deserves particular attention. Many doctors want everything on one floor — it feels simple, controllable. What a single large floor plate actually produces is the maximum possible roof area, which is the hottest surface in a Rajasthan summer, the longest possible service runs, and the highest HVAC load per bed. A compact multi-floor building with a smaller footprint costs less to cool, less to maintain, and less to expand.

Natural light is not a luxury. A ward oriented to receive morning light and shaded from afternoon sun reduces artificial lighting load, demonstrably improves patient recovery, and reduces the institutional confinement that makes patients anxious. Rajasthan's vernacular architecture understood this — thick walls, deep-set openings, courtyards, jaali screens. These are not nostalgic choices. They are climate-intelligent ones that were abandoned when glass and AC became available and before their operating cost was fully understood.

Build for year 7

The most common question in hospital briefing is: how many beds? The more important question is: how many beds in year 7?

A hospital built for today's patient volume without reference to future growth will either operate below capacity for years — paying for space it cannot fill — or will reach capacity and find that expansion requires demolishing something built five years earlier. Both outcomes are expensive. Both are avoidable.

Phased expansion requires that the structural grid, the vertical shafts, the utility loads, and the circulation logic are all designed to accommodate a building that does not yet exist. A structural column placed without reference to a future floor above it, a lift shaft sized for today's traffic, a plant room that cannot accommodate additional load — these are the details that make expansion expensive rather than straightforward.

At Jeevan Raksha Hospital Pilani, currently under design, the brief included a 200-bed target on a campus that will be built in phases. The structural grid, the service strategy, and the circulation hierarchy were all resolved for the full 200 beds before the first phase drawings were begun. The doctor builds 80 beds today. The building already knows it will be 200.

What this means in practice

Designing a hospital in India is not a variant of designing any other building. It is a discipline with its own logic, its own regulatory framework, and its own consequences when the logic is not followed.

Studio Athenos has been designing hospitals across Rajasthan since 2007. Completed and NABH-accredited projects include Balaji Cure & Care Hospital in Jaipur, Jeevan Raksha Hospital in Bikaner, and Jeevan Raksha Hospital in Shridungargarh. Projects currently under design include Jeevan Raksha Hospital Pilani — a 200-bed facility on an adaptive reuse campus — and hospitals in Deedwana, Sadulpur, Kotputli, and Luharu.

If you are planning a hospital in Rajasthan and want to understand what the design process should look like before you begin, contact Ar. Rahul Saxena directly.

WhatsApp: +91 94601 44678
rahul@studioathenos.in