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Surgical services are settings where resilient performance (RP) is necessary to cope with a wide range of variabilities. Although RP can benefit from a supportive built environment (BE), prior studies have focused on the operating room, giving scant attention to support areas. This study takes a broader perspective, aiming at developing BE design knowledge supportive of RP at the surgical service as a whole.

Seven BE design prescriptions developed in a previous work in the context of internal logistics of hospitals, and thus addressing interactions between workspaces, were used as a point of departure. The prescriptions were used as a data analysis framework in a case study of the surgical service of a medium-sized private hospital. The scope of the study included surgical and support areas, in addition to workflows involving patients and family members, staff, equipment, sterile instruments and materials, supplies, and waste. Data collection included document analysis, observations, interviews, and meetings with hospital staff.

Results identified 60 examples of using the prescriptions, 77% of which were related to areas other than the operating rooms. The developed design knowledge is framed as a set of prescriptions, examples, and their association to workflows and areas, indicating where it should be applied.

The design knowledge is new in surgical services and offers guidance to both BE and logistics designers.

The high variability in cardiac surgery length – is one of the main challenges for staff managing productivity. This study aims to evaluate the impact of six interventions on open‐heart surgery operating theatre productivity.

A discrete operating theatre event simulation model with empirical operation time input data from 2,603 patients is used to evaluate the effect that these process interventions have on the surgery output and overtime work. A linear regression model was used to get operation time forecasts for surgery scheduling while it also could be used to explain operation time.

A forecasting model based on the linear regression of variables available before the surgery explains 46 per cent operating time variance. The main factors influencing operation length were type of operation, redoing the operation and the head surgeon. Reduction of changeover time between surgeries by inducing anaesthesia outside an operating theatre and by reducing slack time at the end of day after a second surgery have the strongest effects on surgery output and productivity. A more accurate operation time forecast did not have any effect on output, although improved operation time forecast did decrease overtime work.

A reduction in the operation time itself is not studied in this article. However, the forecasting model can also be applied to discover which factors are most significant in explaining variation in the length of open‐heart surgery.

The challenge in scheduling two open‐heart surgeries in one day can be partly resolved by increasing the length of the day, decreasing the time between two surgeries or by improving patient scheduling procedures so that two short surgeries can be paired.

A linear regression model is created in the paper to increase the accuracy of operation time forecasting and to identify factors that have the most influence on operation time. A simulation model is used to analyse the impact of improved surgical length forecasting and five selected process interventions on productivity in cardiac surgery.

This empirical paper investigates the relationships between the amount of human capital that flows into a firm and two activities underlying a firm’s knowledge production, variation or change and knowledge retention. We track the flow of human capital within and across organizational and geographic space for all multi‐unit banks operating in the world foreign exchange trade industry from 1973 to 1993. The findings indicate that an increased reliance on past experience reduces how much human capital a firm imports in the future. This effect is moderated by a self‐reinforcing cycle of human capital inflow. Inflows of human capital also decline when a firm has recently adopted novel changes in its operations. The paper uses evolutionary thinking to define a model for intrafirm knowledge production.

The challenges arising from the reform of the social and healthcare sector call for efficient, effective and novel processes in both public and private health and medical care. Facilities need to be designed to suit the new processes and to offer usable workspaces at different levels of healthcare services. Along with traditional construction, modular facility innovations could be one solution to these pressures. The paper aims to discuss these issues.

This case study analyzed the different usability characteristics of the work environment in modular and non-modular healthcare facilities (HCFs). The qualitative research method was based on semi-structured interviews of employees and observations of the case buildings.

According to the results, the usability characteristics were divided into four main categories: functionality, healthiness, safety/security and comfort. The main differences between the modular and non-modular facilities appeared to be room size, soundproofing, safety issues and the utilization of colors and artwork, which were all perceived as better realized in the non-modular facilities. The staff highlighted functionality as the most important characteristic in their work environment. They even considered functionality as a feature of a comfortable work environment.

This paper presents new knowledge and a detailed description of the opinions and experiences of healthcare professionals concerning a user-centric, usable environment in the context of modular and non-modular HCFs.

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.

The purpose of this paper is to carry out the business process re‐engineering (BPR) of a surgical ward in a hospital in order to improve the efficiency of the ward.

This work was developed using a case study on a surgical ward. In this type of ward, in which scheduled and unscheduled operations often have to coexist and be managed, ways to minimise patient inconvenience need to be studied. A framework based on event‐driven process chains (EPCs) methodology, the entity‐relationship model and discrete event simulation is presented to define and analyse the current state of a surgical ward and design a future system. The modelling of the processes, activities and sub‐activities, which took up a great amount of ward resources, allowed a what‐if analysis to be developed which simulates various scenarios and assesses their performance.

Using Delphi methodology, it was possible to identify a number of areas for improvement: number of operating sessions, preparation of the operating rooms for each operation, availability of specific surgical instruments. Moreover, the discrete event simulation approach led to an understanding of the most efficient management choices.

The decision to use Delphi methodology for the information collection stage before starting the BPR process is not found in other studies in the literature. Moreover, the use of models based on EPCs methodology allowed the panel of experts to develop models to examine and understand the resource requirements of medical assessment units and to provide a framework or develop standards that hospital developers and clinical managers can consult.

The present paper aims to analyze how the performance of hotels located on the Spanish Mediterranean coast (peninsular and Balearic) and Canary coast is affected by the degree of business agglomeration in tourist districts. If agglomeration affects hotels positively, then the externalities generated in tourist districts will be relevant when locating an establishment. Otherwise, the reason why hotels group together geographically would be more related to the suitability of beaches as a tourist destination. The study also analyzes the impact that regions or autonomous communities have on hotel performance.

The hypotheses are tested by multiple linear regression in which hotel profitability acts as the dependent variable which can be explained by independent variables such as the greater or lesser agglomeration of tourist companies at the destination and the autonomous region where the hotel is located.

The results show that hotels situated at destinations with a higher degree of agglomeration are less profitable, probably due to the greater rivalry that exists among nearby competitors. However, in accordance with the theory of tourist districts, one could expect hotels located at destinations with a higher degree of agglomeration to be more profitable because of the greater externalities generated within the district. In this sense, it is possible that hotel location decisions were based more on the natural advantage model, where firms look for specialized inputs like beach or climate, than on production externalities models.

It was necessary to work with secondary information sources which contain no data about RevPar (revenue per available room) or GopPar (gross operating profit per available room), the hotel profitability measures most often used in research studies.

The paper could be useful for hotel companies, when they are deciding on a location, and for public administrations.

The present paper is original for several reasons. First, it is one of the first studies which applies the theory of industrial districts to the tourism sector, a line of research which is still in its early stages of development. Furthermore, the ISTAT methodology is applied for the first time to the identification of Spanish tourist districts. Also, various studies relate the degree of agglomeration to hotel profitability, but none so far have used the degree of company agglomeration within a tourist district, linking it to profitability.

The purpose of this paper is to develop a business model to generate quantitative evidence of the benefits of implementing radio frequency identification (RFID) technology, limiting the scope to outpatient surgical processes in hospitals.

The study primarily uses the define‐measure‐analyze‐improve‐control (DMAIC) approach, and draws on various analytical tools such as work flow diagrams, value stream mapping, and discrete event simulation to examine the effect of implementing RFID technology on improving effectiveness (quality and timeliness) and efficiency (cost reduction) of outpatient surgical processes.

The analysis showed significant estimated annual cost and time savings in carrying out patients' surgical procedures with RFID technology implementation for the outpatient surgery processes in a hospital. This is largely due to the elimination of both non‐value added activities of locating supplies and equipment and also the elimination of the “return” loop created by preventable post operative infections. Several poka‐yokes developed using RFID technology were identified to eliminate those two issues.

Several poka‐yokes developed using RFID technology were identified for improving the safety of the patient and cost effectiveness of the operation to ensure the success of the outpatient surgical process.

Many stakeholders in the hospital environment will be impacted including patients, physicians, nurses, technicians, administrators and other hospital personnel. Different levels of training of hospital personnel will be required, based on the degree of interaction with the RFID system. Computations of costs and savings will help decision makers understand the benefits and implications of the technology in the hospital environment.

The purpose of this paper is to develop a model for physician staffing requirements that could be generally applied to any hospital department, taking into account factors such as occupancy level, professional absences, allowances, physician work duties and patient service levels.

The ability to generalize the model was tested via its implementation in five hospital departments considered to represent a cross‐section of all hospital requirements: internal medicine, surgery, orthopedics children's (pediatrics), and gynecology. The work is based on a combination of a survey, work sampling and direct time study, conducted by professional observers with a high degree of frequency and over a relatively long period of time.

The model is based on the concept of “required work capacity” of physicians. The model makes it possible to account for such factors as yearly capacity, level of desired service, increments for work conditions, roster duties and necessary absences.

The findings indicate that the departments studied required a significant increase in their physician staffing. In these departments the present manpower situation stands at 80–90 percent of the necessary staffing based on the average annual occupancy. The new staffing requirements model can be implemented in various departments.

This paper is an original effort to develop a model for physician staffing requirements at hospitals based on a survey, work‐study and direct time study. This contributes to past research that focused on the development of staffing requirements models, e.g. for nurse or family physicians. The paper presents an original model for physician staffing requirements at hospitals.