Patient logistics drive hospital construction

Until recently, hospitals were constructed the way they had been built through centuries. Today, however, hospital design is shifting towards patient logistics, opening up very new perspectives.


Hospital budgets, quality of care, and patient satisfaction will profit from this transformation, predicts Ines Arnolds, a researcher in Professor Stefan Nickel’s team in the Institute for Operations Research at Karlsruhe Institute for Technology (KIT), Germany.

Hospital designers and planners had relied 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, Ines Arnolds points out. ‘Obviously, legal requirements and utilisation 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.

Mostly, long-term perspectives regarding resource and capacity planning are a focus for 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 on data, e.g. on future patient figures for certain diseases, as can processes – the flow of patients, materials and staff, depending on outcomes and re-convalescence. The design process should reflect those uncertainties. ‘Processes should determine how buildings are designed, and not vice versa,’ he advises. ‘Planning should integrate methods for logistical analysis.’ (Michael Reiter)

Processes come first
What would be a more suitable approach? Before entering the design phase of a new construction, an analysis of processes is necessary. In particular, clinical pathways for in- and out-patients in the building should be investigated, providing information on the movement routes of patients as well as staff.

In the layout, by adapting function rooms and departments to the processes that occur in the building, including patients, materials and staff flow, distances travelled can be reduced, ‘Reducing distances means savings in resources,’ Ines Arnolds points out. ‘Increased efficiency leaves more time to spend on care, which in turns leads to improved patient and staff satisfaction.’

To accommodate uncertainties in data and processes, simulation and optimisation 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 flows of patients, materials and staff are uncertain. The potential key performance indicators are the time and distance travelled by patients and staff. At a later time the simulation model can be used to test new models based on workflows in working hours, or for building modifications.

Despite increased orientation towards processes, knowledge and resource gaps about operations research still hamper acceptance among decision makers of this new approach, he says, pointing to the reason why the method has not yet been applied to any project. ‘The challenge for researchers is to work together with architects and hospital managers and convince them that this is the suitable path for the future.’


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