Physical design and process design are inseparably connected in healthcare facilities. Modelling facility and operations aids in evaluating design alternatives and in familiarising an organisation and its staff to a new space during transition. This article explores simulations of various fidelity, their characteristics, and their uses in healthcare management.
All across the world, healthcare organisations face changes from their payers. Insurers and governments are changing reimbursement models while the healthcare consumer, the patient and their family, is increasingly informed and discerning. This pace of change is driving the need for improvement in healthcare management. While operational improvement projects can be nearly continuous, facility projects occur more intermittently.
Facilities projects represent an opportunity for great transformation in the management of a hospital or other healthcare organisation. The permanence of a built facility and the large investment required mean that incremental testing of various design options is both more important and more difficult. A full build of multiple facilities to “test” which results in the outcomes important in healthcare–improved health for the population, improved experience of care, and reduced costs–-is not reasonable financially. Instead, various models of facility and operations can allow for testing alternatives through other mediums.
Modelling and simulation allow for building and testing operations and facilities in a different medium than the medium of the finished project. Merriam-Webster defines the verb model as “to produce a representation or simulation of” and the noun simulation as “the imitative representation of the functioning of one system or process by means of the functioning of another.” Thus, the terms modelling and simulation can, and will within this article, be used interchangeably.
However, there are many different types of models. This article discusses various simulations popular in operational and facility improvement projects along their focus and their fidelity. Simulations can focus on operations or facility or integrate both operations and facility process and constraints.
Simulations can be of various degrees of accuracy and exactness in terms of how well they represent the final product. In modelling, this degree is usually referred to as fidelity; a low-fidelity model is designed in a system less representative of the final product, while a high-fidelity model more closely represents the final product. Models that take a more integrated systems approach and focus on both operations and facility tend to be of a higher fidelity than more-singularly-focused models.
There is no single best way to model or sequence of models that works for every project. While high-fidelity models more closely represent the final product, they tend to require a greater investment of resources: more time and more money. The progression of simulation is iterative and at times disordered throughout the lifetime of a project, but the fidelity of simulations generally increases as time passes. Overall, it is best to match your method of modelling to the phase of the project and the resources and goals of your organisation. It is also important to understand your stakeholders and what simulations will best communicate new operations designs and/or facility designs so that the users themselves can evaluate and learn the new healthcare space. Engaging the right simulations of your operation and your facility at the right times can lead to many improved outcomes.
A Sample of Simulations
Listed below are some simulations that range from those most established and common to those on the cutting edge of the industry. However, there are limitations. Different people and/or different organisations may call the same model by different names. Often, the distinguishing characteristics that categorise or name simulations are not black-or-white, making their naming tricky. Additionally, this is by no means an exhaustive list.
In the world of healthcare architecture, a floor plan is the most utilised and recognisable facility simulation. A floor plan is a scale diagram of the arrangement of rooms in a story of a building. The fidelity of a floor plan can range from an initial hand-drawn sketch to fully detailed computer drawings that act as construction documents.
Process Flow Mapping
Process mapping is a very common simulation that focuses on operations. The fidelity of process flow mapping can range from rudimentary to quite complex, while being constrained to a 2D representation. At its bare minimum, mapping generally involves rectangles representing processes and arrows representing direction and order of processes; often, diamonds serve to represent decision points.
Lean, a quality management methodology that views value from the customer’s perspective, tracks the processes a patient experiences in a “value stream map.” Further developments of this methodology have suggested mapping processes for patients and families, staff, medications, supplies, equipment, information, and process engineering. There are many different ways that process flow mapping can simulate the operations for a healthcare organisation. Visio is a common tool for process flow mapping.
A spaghetti diagram is a beneficial simulation that incorporates the facility modelling of floor plans and the operational modelling of flow mapping into one 2D simulation. Often, multiple flows are diagrammed on top of a floor plan in a hybrid simulation that address both facility and operations.
Mock-ups refer to full-scale representation of a facility ranging from a mocked floor plan to an entire room fitted with the materials determined for use in the actual healthcare building. Mock-ups are facility-focused, but their life-size scale empowers more operational testing and understanding than a floor plan. Tape or paint representing boundaries and fixtures create a mock-up floor plan. At the highest end of fidelity, a 3D mock-up room outfitted as the designed room fully represents the final product. While this is costly, healthcare organisations find this useful to make final decisions before building when the facility may contain hundreds of these standardised rooms. Other materials can be used to move into 3D while containing modelling cost; for example, cardboard mock-ups have represented entire floor layouts.