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Article
Publication date: 8 May 2018

Supuck Prugsiganont and Per Anker Jensen

In the past decades, public hospitals in Thailand have developed gradually and been characterized by an incremental development of hospital facilities. First, this study…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Practical implications

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

Originality/value

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

Details

Facilities, vol. 37 no. 7/8
Type: Research Article
ISSN: 0263-2772

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Book part
Publication date: 24 October 2019

Irene Kobler, Alfred Angerer and David Schwappach

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…

Abstract

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.

Details

Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

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Article
Publication date: 11 January 2021

Dimitra Xidous, Tom Grey, Sean P. Kennelly and Desmond O’Neill

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…

Abstract

Purpose

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.

Design/methodology/approach

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).

Findings

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.

Practical implications

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.

Originality/value

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

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Article
Publication date: 5 June 2017

Katariina Silander, Paulus Torkki, Paul Lillrank, Antti Peltokorpi, Saara A. Brax and Minna Kaila

Modularity promises to relieve problems of complexity in service systems. However, limited evidence exists of its application in specialized hospital services. The purpose…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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

Practical implications

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

Originality/value

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.

Details

International Journal of Operations & Production Management, vol. 37 no. 6
Type: Research Article
ISSN: 0144-3577

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Article
Publication date: 26 July 2011

Oscar Barros and Cristian Julio

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Business Process Management Journal, vol. 17 no. 4
Type: Research Article
ISSN: 1463-7154

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Article
Publication date: 22 February 2021

Ali Zabihi, Mina Safizadeh and Massoomeh Hedayati Marzbali

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Journal of Facilities Management , vol. 19 no. 3
Type: Research Article
ISSN: 1472-5967

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Article
Publication date: 23 September 2019

Oscar Barros

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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

Social implications

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

Originality/value

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.

Details

Business Process Management Journal, vol. 26 no. 2
Type: Research Article
ISSN: 1463-7154

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Article
Publication date: 21 February 2020

Davide Schaumann, Nirit Putievsky Pilosof, Michal Gath-Morad and Yehuda E. Kalay

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.

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Originality/value

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.

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Article
Publication date: 1 July 2018

Jennifer Loy and Natalie Haskell

Cutting-edge hospital and residential care architecture and interior design aim to address the emotional and practical needs of patients, staff and visitors. Yet, whilst…

Abstract

Purpose

Cutting-edge hospital and residential care architecture and interior design aim to address the emotional and practical needs of patients, staff and visitors. Yet, whilst improving on past practice, current approaches to design still rarely recognise or respond to individuals. The purpose of this paper is to provide a review of design-led research into digital technology across disciplines for the personalisation of healthcare environments and is informed by the authors’ ongoing hospital-based research.

Design/methodology/approach

This review is based on a design anthropology framework providing insight into designing for changing the experience for older patients in current healthcare contexts and future focused strategies, integrating digital technologies and human-centred design across scale and disciplines. It is informed by ongoing hospital studies based on design-led research methodology, drawing on design anthropology and ethnographical methods.

Findings

Technology enhanced, human-centred, assistive devices and environments implemented into healthcare across scale are developing but integration is needed for meaningful experiences.

Research limitations/implications

This review is a positioning paper for design-led research into digital technology across scale and medium.

Practical implications

This paper provides the basis for practical research including the ongoing hospital-based research of the authors.

Social implications

This approach potentially enhances emotional experiences of connected healthcare.

Originality/value

Future care scenarios are proposed, with technology and human experience as key drivers. Individualised and personalised solutions better cater for diversity. Within this context, it is strategic to question and test new ways of crafting the older persons care experience. This paper brings new direction to this discussion.

Details

Journal of Enabling Technologies, vol. 12 no. 2
Type: Research Article
ISSN: 2398-6263

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Article
Publication date: 5 June 2017

Saara A. Brax, Anu Bask, Juliana Hsuan and Chris Voss

Services are highly important in a world economy which has increasingly become service driven. There is a growing need to better understand the possibilities for, and

Abstract

Purpose

Services are highly important in a world economy which has increasingly become service driven. There is a growing need to better understand the possibilities for, and requirements of, designing modular service architectures. The purpose of this paper is to elaborate on the roots of the emerging research stream on service modularity, provide a concise overview of existing work on the subject, and outline an agenda for future research on service modularity and architecture. The articles in the special issue offer four diverse sets of research on service modularity and architecture.

Design/methodology/approach

The paper is built on a literature review mapping the current body of literature on the topic and developing future research directions in service modularity and architecture.

Findings

The growing focus on services has triggered needs to investigate the suitability and implementation of physical-product-focused modularity principles and theories in service contexts, and to search for principles/theories that enhance services. The expanding research stream has explored various aspects of service modularity in empirical contexts. Future research should focus on service-specific modularity theories and principles, platform-based and mass-customized service business models, comparative research designs, customer perspectives and service experience, performance in context of modular services, empirical evidence of benefits and challenges, architectural innovation in services, modularization in multi-provider contexts, and modularity in hybrid offerings combining service and tangible product modules.

Originality/value

Nine areas are recommended for further research on service modularity and architecture. The introductory piece also discusses the roots of service modularity and provides an overview of current contributions.

Details

International Journal of Operations & Production Management, vol. 37 no. 6
Type: Research Article
ISSN: 0144-3577

Keywords

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