Hospital budgets, quality of care, and patient satisfaction will profit from this transformation, predicts Ines Arnolds. The researcher is part of Prof. Nickels’ team at the Karlsruhe Institute for Technology (KIT) / Institute for Operations Research in Germany.
Hospital designers and planners used to rely mostly on experience and existing campus outlays for inspiration. Tenders, too, would typically include requirements based more on legacy knowledge than on data derived from processes or expertise gained from daily routine. Legal requirements and architectural aspects added important influences, sums up Arnolds: “Obviously, legal requirements and utilization of experience are a must. However, processes should play a larger role in the design process.” This could help tap a variety of potentials, according to the KIT team. The group’s research has discovered numerous shortcomings in existing approaches.
Short-term aspects should not be neglected
Mostly, long-term perspectives regarding resource and capacity planning are in the focus of hospital design. However, the emerging building will also influence significantly short-term aspects, i.e. operational workflows.
Most architectural designers have assumed that the information they take into account is fixed and real (determinist); however, uncertainty can impact data, e.g. on future patient figures for certain diseases, as can processes – the flow of patients, materials, and staff, depending on outcomes and reconvalescence. This uncertainty should be reflected by the design process. “Processes should determine how buildings are designed, and not vice versa”, outlines Arnolds, “and planning should integrate methods for logistical analysis.”
Putting processes first
What would be a more suitable approach? Prior to entering the design phase for a new construction project, an analysis of processes needs to be carried out. In particular, clinical pathways for the patients to be cared for in the building should be investigated, providing information on the paths of movement of patients and staff.
The distances travelled can be reduced by adapting, in the layout, function rooms and departments to the processes which take place in the building, including patient, materials, and staff flow. “Reducing distances means savings in resources”, comments the expert. “Increased efficiency leaves more time to spend on care, which in turns leads to improved patient and staff satisfaction.”
Simulation leading to optimization
To accommodate uncertainties in data and processes, simulation and optimization from the area of Operations Research are combined. Multi-phase simulation scenarios help create of a robust layout which will show high performance even when patient, materials, and staff flows are uncertain. Potential key performance indicators are the time and distance travelled by patients and staff. – At a later point in time, the simulation model can be used to test new models for working hours, or building modifications, on workflows.
Embracement is still lagging behind
Despite increased orientation towards processes, knowledge and resource gaps about operations research still hamper acceptance for this new approach on the part of the decision makers, says Arnolds. This is why, according to the expert, the method has not been applied to any project as yet: “The challenge for researchers is now to work together with architects and hospital managers and to convince them that is the suitable path for the future.”