A Novel Uni-directional Flow Circular Facility Layout for Effective Social Distancing

Introduction

A hospital incorporates a wide range of services serving as many different patients and stakeholders demanding a facility design integrating functional requirements along with the varied requirements of patients. Planning and reconfiguring the hospital layout is required to reduce the anxiety and uncertainty of the patients in getting the medical care facility at the right time. The hospital facility requires a design that would make possible smooth inflow and outflow of patients, diverse interactions between the functional areas and bare minimum walking distance connecting the functional departments. The hospital layouts are designed by setting up units to optimally utilize the available area and trim down the total travelling distance (Arnolds & Gartner, 2018). Operations Research techniques aid in designing healthcare facilities to optimize hospital space planning, focusing on flow efficiency reducing problems of floor layouts. Machine learning is also being a recent technique to design building layouts (Jamali et al., 2020). Patient inflows into the hospital, the movements to various departments and other facilities and the outflows from various departments are making chaos and often result in vast delays and variations in providing effectual medical care and treatment. Unswerving information needs to be given to patients about the movement to make use of the required medical service devoid of confusion within the hospital. Placing the medical facilities in appropriate areas using meta-heuristic algorithms as a solution for optimization problems will boost operational efficiency with reduction in production costs, processing and delivery times (Shiguemoto et al., 2014).

The requisite to provide primary as well as specialty services in conjunction with quality of patient care in a cost-effective mode is a primary apprehension for all medical institutions. If in any case, the public finds difficulty to access a hospital due to its location or lack of infrastructure, it will adversely affect the proper functioning of the entire medical system as well as the hospital. Quality and competent care, availability of qualified physicians and allied health professionals are important (Price et al., 2005). Attributes for measuring quality care are average life spans and causes of illness and death, as per national or international standards. The productivity of a hospital is based on the performance of different healthcare delivery processes carried out there (Bhat et al., 2016). A good facility layout must consider the cost associated with patient movements and that of accompanying entities.

This article presents a new facility layout design for hospitals with unidirectional flow of patients avoiding zigzag or chaotic patient movement with provision for sufficient interaction between departments. The new layout design also takes into account social distancing, patient safety and health while optimizing cost associated with patient and medical resources, thereby improving overall productivity. The scope of the layout design is limited to overall positioning of common facilities and specialized departments without any further analysis on which departments are to be placed next to each other.

Layout Types and Designs

Theorists came up with some innovative ideas about hospital layouts. Various methods were developed to design facility layouts and systematic layout planning (SLP) by Muther (1973) is the widely used one and is continuing with the support of computer programs for generating additional designs. A relationship chart developed shows the relationship between each activity, rates the importance of the closeness between the activities supporting the rating with operating or producing departments planning the arrangement of service areas having little or no flow of materials. Langabeer (2008) suggested the Disney Model, which proposed separate passage for patients, staff and materials movement. Another idea initiated was the twenty-first century Airport Model propounded by Vos et al. (2007), proposes a central waiting area for patients until they get a call from the respective clinical unit. A patient will move from one room, for example, consultation room to examination room only when the latter is available. However, the advocates of this idea suggest that this type of system can be implemented only if patients’ punctuality is high and the hospital should have control of the flow of the patients with minimum variance, which, in turn, is a risk for the management. Computerized layout algorithms using Computerized Relative Allocation of Facilities Technique (CRAFT) can be applied for improvising the existing layouts. Further new plant layouts, using Automated Layout Design Program (ALDEP) technique, were developed as an improvisation over the CRAFT technique to reduce material handling costs supplemented by a travel chart (Deshpande, 2016).

A major concern with hospital facility layout is the difficulty faced in expansion or refurbishment due to lack of availability of space (Ahmad, 2014). Safety must be built into the hospital design by ensuring availability of assistive devices to prevent patient falls, appropriate ventilation to prevent the spread of infections and by using surfaces that can be easily decontaminated. The functional elements of the hospital include reception, lab, pharmacy, canteen, x-ray/scan facility, clinics, departments, observation room, operation theatre, supporting units such as ATM, etc. The patients have to move in a zigzag fashion because they have to visit different functional units that are not placed in the sequential fashion. All these arguments support the need of a coherent facility layout planning in hospitals to attain a flawless and efficient service quality. Layout design should address the sensitivities associated with the interdependencies of departments giving due importance to requirements of work processes and must position those departments next to each other that are having high interaction. All factors need further analysis that minimizes overall cost without compromising safety and health (Shojania et al., 2001). A survey conducted among people visiting the hospitals for medical attention shows that they face difficulty with traffic congestions (83%) in movements, difficulty in identifying the required departments (66%), dissatisfaction with the momentum of medical attention (71%), pressure of long waiting hours (78%), waiting time for elevator (66%) and fear of disease outbreaks (92%) from the current system of hospital layouts. The data shows evidence of complications relating to the design of existing layout of facilities.

Designing a New Layout System

Hospitals with specialized departments need the interacting units to be placed closely within the limits to minimize chaotic and zigzag movement by making the patients follow uni-directional flow. The primary aim behind a hospital layout design is to ensure best quality service at the lowest cost, attaching high importance to safety and health (Hughes, 2008). Any person approaching a hospital usually goes through a lot of enquiry before reaching the actual destination. Usually, a patient has to approach the reception or an emergency section of the hospital when they first reach the hospital. Only after that do the others attend to their needs. There is a lot of waiting and delay in such a set-up (Bolster & Manias, 2010). Also, to get to a certain department, they unknowingly take roundabout routes. There is a risk that they might catch other diseases during this process of finding or reaching the destination department. Patients admire hospitals that minimize their movement inside the hospital and provide hassle-free treatment in minimum time (Saint et al., 2008). The placement of departments needs further analysis like Muther Grid and similar analysis (Deshpande et al., 2016). This also has direct bearing on the frequency of travel between the departments. The cost of renovation of an old building is only 1/10th of building a new one with the same plinth area (Charleson & Guisasola, 2016).

Suggested Annular Design for Hospital Layout

The design of an annular/circular uni-directional movement path for patients is presented as an ideal candidate for solution for an effective hospital layout reducing the chaos in handling volume and uncertainty in patient movement.

The conception of circular/ring structure was adopted from the traffic loop notion of the 1930s (Venkatachalam & Gnanavelu, 2009) that was initiated to curtail the population in the lanes and thereby maintaining effective inexorable transit. Taking into account the anatomy of the layout, Figure 1 represents a ring-shaped pure annular layout that is less commodious. Centre of the annular design will occupy the position for service lift. It will be surrounded by central facilities such as reception, pharmacy, ATM, billing, administration, MRI, scan, X-ray, clinical laboratories and so on. Being less airy, the scope of expansion is highly parochial. There will be an exit for each department and the common facility at appropriate lengths. Flow of patients will be strictly clockwise with no zigzag movements like in product layout to the extent possible. This concept would be more significant for getting adopted in infrastructures that amasses a high footfall diurnally. Taking into account the geography of the infirmary, the main block should be the central cynosure and the other departments as separate entities connected to the immediate vicinity. An outer chain road akin to the shape of a ring is constructed so as to connect the departments to facilitate more free movement of people, process and operations. The ring connects every department and opens separate sub-channel lanes in and out of every department, thus making the paradigm shift from the traditional functional layout which runs a congested, erratic move of people. Thus, the traffic intensity is highly controlled as flow is strictly uni-directional.

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Figure 1.

Source: The author.

The petal layout design (Figure 2) is more spacious with optimized walking distances and the implications for futuristic developments are highly promising depending on the intensity in patient inflows. Length of any petal can be increased to any length, independently. Hospitals can grow as per the requirement of any particular department. This structure opens a high viability to air and light, thus maintaining the entire system more dynamic for operations. This is the best suite for a new project.

OPEN IN VIEWER

Figure 2.

Source: The author.

The rectangular or square layout with unidirectional flow is more practicable looking into the hospital construction part (Muther, 1973). The rectangular layout, shown in Figure 3, is the best fit for an existing facility layout that tries to accumulate and adapt to the latest stigmas. Facilities such as X-ray, MRI, scanning and other facilities that are common for all the departments are accommodated at the central housing. The central housing also includes the causality with a service lift in the centre. After the initial observations under exigency, the patient is shifted to the respective department in furtherance of his/her condition.

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Figure 3.

Source: The author.

Leveraging the Features of the New Layout to Tackle COVID-19 Pandemic

The circular model facilitates easy access and nonoverlapping flow paths eliminating unnecessary interactions that help save time for various types of patients, medical employees and other supplies. Further, facilitates the flow of patients in a single direction only so that they can enter from one direction and leave through another instead of turning around all the way back to the entry point. The incoming patients do not obstruct the flow of outgoing patients and reduce the chances of infections too. Patients do not get a chance to see other suffering patients face to face, thereby increasing their psychological well-being. Doctors and paramedical staff find it easy to move around with ease and improve the speed of treatments. A patient entering a particular department goes out after treatment and online payment from the department itself, analogous to droplets of water exiting in a centrifuge. This reduces congestion in the mainstream flow. Traffic and congestions in hospitals can be avoided and is very much needed in the current situation where a pandemic like COVID-19 exists. This ring design will prove to be a highly recommended design to check pandemic or other infectious diseases spread.

Advantages of the Circular Layout

Effective use of available space and resources is ensured. Equipment clearances, human ergonomics, sample requirements and walking distances are optimized. Also provides for future expansion depending on the intensity in patient inflows, especially, the petal layout design in Figure 2. Length of any petal can be increased to any length, independently. Hospitals can grow as per the requirement of any particular department without having to put up infrastructure of the same size to all departments reducing initial investment to a large extent. Productivity is high and time taken is low, enhancing the patient satisfaction. Lighting and cross ventilation can be ensured in all areas by avoiding congestion. Quality, speed and time, at reduced costs, attract more patients. Automation using the Internet of Medical Things (IoMT) helps manage smooth flow of patients (Venkatesh, 2019). Errors due to patients waiting in the wrong outpatient division rarely occur. This reduces the throughput time. Integration of lab, scan, MRI and pharmacy and billing over the hospital enterprise system simplifies the process and reduces human movement and errors. Arranging the position of departments and central facilities with Muther grid or Rel chart (Deshpande et al., 2016) in the circular ring layout further optimizes travel, cost and time.

Amalgamation of Technology

The circular concept in furtherance is to be empowered by the Internet of things (IoT) with radio frequency identification (RFID) tagged to each patient, which employs the principle of IoT to make the internal administration more flexible. This technology enables IoT to engage in hospital administration (da Costa et al., 2018). Whenever a patient arrives at the hospital, the administrative process begins by adding his personal information to the system by the hospital reception officer. Further the tag code with the identification of the registered patient will be offered as a device that can be a mobile bracelet containing the tag to identify the patient at the source so as to have all the operational facilities of respective domains to be carried out at those respective areas. Automation using IoT maintains seniority of patients and disposes them off in the order of seniority or emergency as the case may be. RFID tag can also help patients confirm whether he/she is sitting in the right outpatient division or not. Also helps the patients to easily access their medical records. The hospital personnel concerned can simply get the records virtually in no time. The sensors are calibrated with IoT chips and the reports are stored over an IoT cloud (Li et al., 2019). This virtual body scanning reduces time and uncertainty between the doctor and patient. The reports stored in the cloud can be easily deciphered by the doctor who mitigates the patients time engaged in the laboratory. A patient has to register only once on arriving at hospital and any additions to the patient specific data will be recorded as a single file. The system removes the requirement to carry every record of the patient while visiting a particular department for medical attention. The hospital personnel concerned can simply get their records virtually in no time with the support of technology to access the medical records. The new suggested functional layout with the support of IoT increases the effective diagnosis time between the doctor and patient, thus making the service more acceptable and satisfactory.

Implications and Drawbacks

An effective functional layout in hospitals is identified as the key factor in improving the productivity of health systems. The study provides a new perspective of hospital layout design using the circular concept, but there can be difficulty in implementing the uni-directional circular layout model. The infrastructure investment will be higher than the normal and the renovations and reconstructions may lead to huge expenses, although appropriate evidence of the costs is little. There might be a need to buy new land and abiding by land regulations makes it even more difficult to turn the new suggested concept of hospital layout design into reality. Over dependence on technology may not be acceptable by a particular sector. The patients may not be technologically updated and may find difficulty to cope up with IoT devices. When thinking from the hospital perspective, a sudden disruption and change in the traditional system can cause a lot of financial cost and maintenance cost associated and may also be high. Hardware must be replaced by software and needs regular updating to ensure smooth working. The advantages and benefits of the suggested circular design of layout will outweigh the few disadvantages to improve upon the productivity and quality of health services.

Conclusion

The overcrowding in hospitals due to long waiting hours for medical attention and the reduction and further control of disease outbreaks are the major highlighted benefits of the suggested new ring design of hospital layout. This suggested layout will benefit a smooth flow of facility operations, thereby generating greater ergonomics. This can refurbish the gusto of the doctors making them psychologically fit providing scrupulous diagnosis and medical attention for the patients that will reduce the stultification of patients, and it generates a greater satisfaction from the patient point. The irrelevant movements within the infirmary are allayed with the new circular layout and congruous interaction with the doctor is promised. In this paper, an attempt has been made to suggest a new facility layout design in hospitals for ensuring social distancing, especially during the current situation of COVID-19 spread, and further the advantages of the new facility concept of layout design are systematically explored. The new layout design considers social distancing, patient safety and health improving overall productivity, and future research works can be taken up in positioning the common facilities and specialized departments.