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In the past decades, public hospitals in Thailand have developed gradually and been characterized by an incremental development of hospital facilities. First, this study aims to investigate the factors that have caused the incremental development and how such development has affected the hospital’s architectural layout. Second, the paper assesses the functional quality of nonclinical areas in the Maharaj Hospital to identify space management problems.

The first part of the study is based on a literature review of the Thai health-care landscape. The second part includes the functional quality assessment of nonclinical areas, walk-through observations and documentation. Obtained data were synthesized using building quality method and measurement criteria and analytical drawing techniques for design assessment.

The first part identified three factors: the lack of local general practitioners, the limited number of public hospitals and the implementation of Thailand’s universal coverage scheme. These factors have resulted in a dramatically high number of patients in public hospitals. The second part identified problems regarding poor accessibility, a low level of spatial flexibility and poor spatial orientation. These problems are related to a lack of appropriate strategic space planning and lack of integration of the Thai culture into hospital design processes.

An identification of space management problems is a prerequisite to the improvement of hospital facilities.

This paper presents the first study of space management problems concerning nonclinical areas in Asian hospitals.

Since the publication of the report “To Err Is Human: Building a Safer Health System” by the US Institute of Medicine in 2000, much has changed with regard to patient safety. Many of the more recent initiatives to improve patient safety target the behavior of health care staff (e.g., training, double-checking procedures, and standard operating procedures). System-based interventions have so far received less attention, even though they produce more substantial improvements, being less dependent on individuals’ behavior. One type of system-based intervention that can benefit patient safety involves improvements to hospital design. Given that people’s working environments affect their behavior, good design at a systemic level not only enables staff to work more efficiently; it can also prevent errors and mishaps, which can have serious consequences for patients. While an increasing number of studies have demonstrated the effect of hospital design on patient safety, this knowledge is not easily accessible to clinicians, practitioners, risk managers, and other decision-makers, such as designers and architects of health care facilities. This is why the Swiss Patient Safety Foundation launched its project, “More Patient Safety by Design: Systemic Approaches for Hospitals,” which is presented in this chapter.

This exploratory study stems from research conducted between 2015–2018 focussing on dementia-friendly design (DFD) in hospitals (Grey T. et al. 2018). Specifically, this study focusses on facilities management (FM) staff in Irish hospitals to gain a preliminary understanding of the level of knowledge and engagement of FM in the implementation of dementia-friendly hospital (DFH) design.

A mixed-methods approach based on a series of ad hoc semi-structured interviews, and an online survey. The aims were, namely, assess the extent of FM engagement in hospital works; measure the level of awareness regarding DFD; and identify facilitators and barriers to DFD in hospital settings. Participants (74) comprised FM staff in 35 Irish acute care hospitals. The research findings are based on thematic analysis of ad hoc semi-structured interviews (participants, n = 4) and survey responses (participants, n = 13).

While FM staff reported to possess important knowledge for building DFH, they also mentioned a lack of engagement of FM in design processes and hospital works.

The research has gained insight into the role of FM in promoting a dementia-friendly approach. Lack of or poor engagement of FM in design processes and hospital works means not fully tapping into rich expertise that would be invaluable in the development, implementation and maintenance of DFH. Universal design is a key driver for facilitating their engagement in the design, implementation and maintenance of DFH environments.

This is the first study exploring the role of FM in supporting a DFD approach in acute care hospitals.

Modularity promises to relieve problems of complexity in service systems. However, limited evidence exists of its application in specialized hospital services. The purpose of this paper is to identify enablers, constraints, and outcomes of modularization in specialized hospital services.

A qualitative comparative study of a hematology unit with modular service architecture and an oncology unit with integral service architecture in a university hospital is performed to analyze the service architectures, enablers and constraints of modularization, and outcomes.

A framework and five propositions combining the characteristics of specialized hospital services, enabling activities, and outcomes of modularization were developed. Modular service architecture was developed through limiting the number of treatment components, reorganizing production of standardized components into a separate service unit, and standardizing communication and scheduling in interfaces. Modularization increased service efficiency but diluted ownership of services, decreased customization, and diminished informal communication. This is explained by the specific characteristics of the services: fragmented service delivery, professional autonomy, hierarchy, information asymmetry, and requirement to treat all.

Modularization can increase efficiency in specialized hospital services. However, specific characteristics of specialized care may challenge its application and limit its outcomes.

The study identifies enabling activities and constraints that hospital managers should take into account when developing modular service systems.

This is the first empirical study exploring the enablers, constraints, and outcomes of modularization in specialized hospital services. The study complements literature on service modularity with reference to specialized hospital services.

The purpose of this paper is to propose a method to support business process architecture and business process design, and present an application to the domain of public hospitals in Chile.

This method is based on the formalization of generic architectures and their internal process structure, proposed in this work as architecture and process patterns, which have been developed at the Master in Business Engineering of the University of Chile and validated empirically in hundreds of Chilean firms from different industries.

The authors have found that the use of architecture and process patterns accelerates the design of such structures until the last level of detail, providing a good and timely basis for information system design and, in particular, were able to develop comprehensive generic process architecture for public hospitals in two months.

The authors' approach considers explicitly the relationships among the architecture elements and process components, providing a systemic view of the business structure and ensuring the alignment between its elements.

The purpose of this paper is to present a process architecture pattern for designing particular components of a complex service. The proposal emphasizes the design of the service production flow component, following modularity ideas, which determines the sequence of actions needed to generate a high quality and efficient service. The authors report its applications to the design of the flow in a single emergency department (ED) case.

In complex services, production design is usually lacking because production activities are not clearly defined and, in many cases, they are dynamically determined as the service is produced according a client’s particular needs. In health services, for example ED, this generates a chaotic production flow that uses resources very inefficiently. The methodology uses a reference architecture, integrating it with disciplines – modularity, analytics and evaluation methods – that provide ideas for formally designing these complex services. This is mainly justified by the fact that, in many such services, no formal design exits and their production processes are the result of practice evolution.

Methodology was applied to the ED of a large public hospital. The authors first analyzed ED’s production and performance data. The authors found two patients’ groups that used more than 90 percent of resources. Therefore, design focused on these groups, defining specialized production lines for them and with physical space remodeled by an architecture project, resulting in well-defined separated workflows for each production line. Design also includes coordination with complementary shared services, including specialists consultations’ requests and execution, and request, processing and reception of laboratory and radiology examinations. The authors implemented new workflows producing a decrease of 26 percent in patients’ delays. More detailed results based on three months of observations also showed, for example, a reduction in examinations waiting times of 80 percent and an increase in the consultation resolution for cardiological patients from 24 to 80 percent in the same day, which means a significant quality increment.

Thus, the authors conclude the plausibility of the idea they proposed that an important design problem in health services, in terms of potential improvements in capacity utilization, is production design. This provides the opportunity to reduce investing large amounts of resources in new hospitals and to instead use the alternative to generate large amounts of capacity by production performance improvements.

The authors are replicating the approach in other hospitals with extensions to inpatient and ambulatory services.

Approach produces better service in public hospitals, which is a problem in emergencies in the world.

Formal design approach in health production services is proposed that provides great value by generating capacity, due to better use of resources, that reduces investment needs in new facilities.

Hospital landscape is not a useless space within hospital buildings anymore. It is considered as a supportive area providing mental and physical peace. However, the planting design of the hospital landscape and the way it should be in order to not disrupt wayfinding performance is neglected. This paper, which is a case study, aims at investigating the effects of planting design in Kerman hospitals’ landscapes on the users’ wayfinding using space syntax techniques.

This research focuses on the effects of planting design on the users’ wayfinding in hospitals. In so doing, library research, computer simulation and analysis with the University College London (UCL) Depthmap software, and comparison techniques are used. Based on axial maps, the measures of integration, connectivity and intelligibility are considered for analysing the wayfinding process of individuals.

The findings show that planting configurations in the hospital landscape can affect individuals’ wayfinding. Integrated and regular planting design in addition to combining planted areas with the hospital buildings can pave the way for intelligible space and easier wayfinding.

According to the authors’ knowledge, the current study is the first to use the space syntax techniques in the health-care landscape architecture in terms of planting design and wayfinding. As wayfinding is an important issue in health-care spaces, the study findings can greatly help the health-care building designers and the related organizations to pay attention to the hospital landscape as much as hospital indoors.

This study discusses that the necessary criteria and the solution approach taken to resolve the main spatial infection problems with a burn center design should be evaluated holistically to achieve spatial infection control in a burn center. The burn center design plays an important role in protecting severely burned patients from infection because the microbial flora of the hospital can affect the infection risk. In hospitals, sterilization and disinfection are the basic components of infection prevention; however, the prevention and control of infection for burn patients also requires the design of burn centers that adhere to a specific set of criteria that considers spatial infection control in addition to appropriate burn treatment methods and treatments. In this study, a burn facility converted from a burn unit into a burn center is introduced and the necessary design inputs for the transformation are discussed because there is no holistic study in the literature that delas with all the spaces that should be in a burn center and relations between spaces. This study aims to define the functional relations between each of the units and the spaces that change according to different sterilization demands in the burn center for ensuring spatial infection control. Furthermore, it aims to propose a method for ensuring continuity in the control of spatial infections.

The burn care and health facilities guidelines are examined within the framework of spatial standards, together with a comprehensive literature review. The design method was based on the spread of microorganisms and the effect of human movement on space and spatial transitions in the burn center, according to all relevant literature reviews. To determine the extent to which the differences in treatment protocols of burn care guidelines were reflected in the space, interviews were conducted with burn facility officials. The plan–do–check–act (PDCA) method is also modeled to ensure the continuity of infection control in the burn center.

The burn center design findings are classified under three main headings, namely, location of the burn center in the hospital, spatial organization and physical features of the burn center and the air flowing system. The importance of the interactions among the criteria for spatial infection control has been revealed. Due to the physical space characteristics and air flow characteristics that change according to human movement and the way microorganisms spread, it has been seen that designing the air flow and architectural aspects together has an effective role in providing spatial infection control. Accordingly, a functional relation scheme for the center has been suggested. It is also proposed as a model to ensure the continuity of infection control in the burn center.

This research presents spatial measures for infection control in burn centers for practitioners in health-care settings such as designers, engineers, doctors and nurses. The PDCA method also leads to continuity of infection control for hospital management.

This is the first study, to the best of the authors’ knowledge, to focus on developing the criteria for spatial infection control in burn center. Moreover, the aim is to create a function chart that encompasses the relationships between the units within the burn center design so that infection control can be coordinated spatially.

This study aims to use a narrative-based simulation approach to explore potential implications of including or excluding a dayroom in the design of an internal medicine ward.

The approach involved: collecting data in facilities using field observations and experts’ interviews; modeling representative behavior patterns in the form of rule-based narratives that direct collaborative behaviors of virtual occupants; simulating the behavior patterns in two alternative design options, one of which includes a dayroom; and analyzing the simulation results with respect to selected key performance indicators of day-to-day operations and spatial occupancy, including occupant density in corridors, number and locations of staff-visitor interactions and duration of a doctors’ round procedure.

Simulation results suggest that the presence of a dayroom reduces visitors’ density in corridors and diminishes the number of staff–visitor interactions that can delay the performing of scheduled medical procedures.

A high level of uncertainty is intrinsic to the simulation of future human behavior. Additional work is required to systematically collect large volumes of occupancy data in existing facilities, model additional narratives and develop validation protocols to assess the degree of uncertainty of the proposed model.

A limited number of studies explore how simulation can be used to study the impact of building design on operations. This study uses a narrative-based approach to address some of the limitations of existing methods, including discrete-event simulations. Preliminary results suggest that the lack of appropriate spaces for patients and visitors to socialize may cause potential disruptions to hospital operations.

Despite the undeniable need for innovation in hospital building design, the literature highlights the disconnect between research and practice as the primary knowledge gap hindering such innovation. This study shows this focus to be an oversimplification, for the complex processes that trigger design innovations and impact their ecosystems need to be examined from a systemic perspective. This paper aims to conceptualise the evolution of hospital building design and identify and explain the main factors triggering design and construction innovations over the past 100 years.

A novel hybrid research design to mixed grounded theory (MGT) methodology, with Charmaz constructivist paradigm, is developed as a new systematic way of constructing and interpreting the concepts and interconnections among them that triggered design innovation.

This study represents a taxonomy of concepts and an explanatory innovation framework, containing 617 interconnections between 146 factors classified across 14 categories. The complex innovation ecosystem comprises multi-faceted processes between heterogenous factors with both individual and collective impacts on design innovations.

This research highlights the main components of the innovation ecosystem and its overall behaviour in this field, and the most influential and interrelated contextual factors, as well as representing and mapping generative interactions that support innovation processes. This knowledge can help hospital researchers, designers, policymakers and stakeholders adopt a multidimensional outlook to analyse the strength of all influential factors, introduce potential novel ways of collaborating, conceptualise an organisational approach, re-formulate research questions through transdisciplinary methods and introduce interdisciplinary courses and programs in architecture schools, thereby contributing to timely design innovation.