Layout Planning in Healthcare Facilities: A Systematic Review

Operating Room Performance Optimization Metrics: a Systematic Review

Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of 'optimization' has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.

The Impact of Quality of Work Organization on Distress and Absenteeism among Healthcare Workers

The quality of work organization may be responsible not only for reduced productivity but also for an increased risk of mental and physical disorders. This study was aimed at testing this hypothesis. Workers of a local health unit in Italy were asked to fill out the Work Organization Assessment Questionnaire (WOAQ) during their periodic medical examinations in the second half of 2018. On the same occasion, they also completed the Demand/Control/Support (DCS) measure of job strain, the Effort/Reward Imbalance (ERI) questionnaire, and the General Health Questionnaire (GHQ12) to assess psychological health. A total of 345 workers (85.8%) completed the survey. Linear regression analysis showed that the quality of work organization was inversely proportional to psychological health problems (p < 0.001). Occupational stress, measured both by job strain and ERI, was a moderating factor in this relationship. The relationship between the WOAQ and psychological health, moderated by job strain or ERI, remained highly significant even after adjustment for sex, age, social support, and overcommitment. Regression models explained over 40% of the shared variance of the association between quality of work organization and psychological health. The quality of work organization significantly predicted the risk of sickness absence for musculoskeletal disorders (OR = 0.984, CI95% 0.972-0.996) and for other health problems (OR = 0.977, CI95% 0.967-0.988). A continuous improvement of work organization must consider not only the clients' or production needs but also the well-being of workers.

A new approach for layout design of an emergency department in hospitals: a case from Jordan

Purpose

The design of the emergency department (ED) requires high precision in the process of distributing spaces. An increase in population and continuous development during the past years caused the addition of new services, changes in patients’ numbers, movement flow and treatment procedures which makes the existing layout plan of the ED no longer appropriate for its current needs. Therefore, the purpose of this paper is to generate a process of finding better alternatives for ED’s spatial planning.

Design/methodology/approach

The genetic algorithm method as a part of the systematic layout planning strategy was adopted for decision-making in redesigning the ED layout and finding the most appropriate alternative. This methodology was applied to a teaching hospital in Jordan to create layout alternatives with better functional dimensions.

Findings

The design that is based on the study of the movement of users and the relationship of spaces increases the layout performance.

Research limitations/implications

The structural method of this study can be adopted for different hospital designs, but the results are limited only to the study case itself because of the different factors and data for each building.

Originality/value

This study demonstrates the process of making the most appropriate decision to redesign the ED in the hospital; therefore, the method can be adopted in restructuring the scheme of different hospitals and evaluated, especially before implementation.

Generating Plan Layouts: A Case Study on Visualization of Implicit Knowledge by "Doctor Architects"

AIM

This article presents an opportunistic case with particular focus on instances from an extended procurement operation in which medical professionals run a proactive process involving the generation of layouts through distinct modes of representational practices without any actual collaboration with designers. The questions of inquiry involve an analysis on how the visualizations came into being and a discussion into the content of drawings that was shaped by individuals without any formal design education.

BACKGROUND

Although the literature introduces examples of genuine participation, particularly in healthcare design practices, the instances in which nondesigners demonstrate accomplished skills in spatial reasoning and representation are limited.

METHOD

The research was formulated as a qualitative case study including a series of observations of the activities of the participants followed by interviews recorded at different locations. The investigation also focuses on the features of these authentic graphics which illustrate the intentions of the medical professionals concerning the function of spaces.

RESULTS

In this research, the participants went through a labor intensive and elaborate effort to produce "architectural representations" with the intention to convey their implicit professional expertise in the domain. The layouts were introduced to be the vital elements to visualize the implicit knowledge regarding the functioning of space.

CONCLUSIONS

The productive and creative engagement of clinicians within this research makes the case for a multidisciplinary approach that reframes the limits and potential contributions of participants alongside drawings, which are exclusively claimed by and strategically employed by architects as negotiation devices within participatory design processes.

DEVELOPING A STRATEGIC SUSTAINABLE FACILITY PLAN FOR A HOSPITAL LAYOUT USING ELECTRE AND APPLES PROCEDURE

Today healthcare globally is growing at a rapid pace and despite the huge technological advancement, healthcare still faces primitive challenges and hence results in the poor service and facility to the needy. Layout planning acts as one major reason which requires improvements for the effective and efficient working of the healthcare facilities. This research aims at optimizing several quantitative criteria related to economic, technology and society which are taken into consideration for the decision-making during the evaluation, analysing and selection of the best layout for an existing healthcare facility. Critical areas for the improvement were found out using statistical analysis based on a survey questionnaire and Apple’s layout procedure is utilised to design the different possible layouts for an efficient facility. The seven criteria namely inter-departmental satisfactory level, the average distance travelled and the average time required for staff flow, the average distance travelled and the average time required for patient flow, the average distance travelled and the average time required for material flow were taken into consideration. The ELECTRE methodology was used as multi-criteria decision making based on decided seven criteria for comparing the different layout by methodical and orderly thinking.

Advancing evidence-based healthcare facility design: a systematic literature review

Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.