Skip to main content
SpringerLink
Log in

Advancing evidence-based healthcare facility design: a systematic literature review

  • Published:
Health Care Management Science Aims and scope Submit manuscript

Abstract

Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig 1.
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Guenther R, Vernon W (2010) Global lessons in healthcare. Healthcare Design Magazine. www.healthcaredesignmagazine.com/architecture/global-lessons-healthcare. Accessed 3 Dec 2019

  2. Ed A, Morgan J (2019) Healthcare construction survey. Health Facility Management. www.hfmmagazine.com/articles/3590-hospital-construction-survey. Accessed 10 Dec 2019

  3. Michael V, Azeem T, Pirwani M, Sharma J, Allen S (2000) An epidemiological study of falls on integrated general medical wards. Int J Clin Pract 54:654–657

    Google Scholar 

  4. Wolf L, Costantinou E, Limbaugh C, Rensing K, Gabbart P, Matt P (2013) Fall prevention for inpatient oncology using lean and rapid improvement event techniques. Heal Environ Res Des J 7:85–101. https://doi.org/10.1177/193758671300700108

    Article  Google Scholar 

  5. Schreuder E, Lebesque L, Bottenheft C (2016) Healing environments: what design factors really matter according to patients? An exploratory analysis. Heal Environ Res Des J 10:87–105. https://doi.org/10.1177/1937586716643951

    Article  Google Scholar 

  6. Benedetti F, Colombo C, Barbini B, Campori E, Smeraldi E (2001) Morning sunlight reduces length of hospitalization in bipolar depression. J Affect Disord 62:221–223. https://doi.org/10.1016/S0165-0327(00)00149-X

    Article  Google Scholar 

  7. Choi J, Beltran L, Kim H (2012) Impacts of indoor daylight environments on patient average length of stay (ALOS) in a healthcare facility. Build Environ 50:65–75. https://doi.org/10.1016/j.buildenv.2011.10.010

    Article  Google Scholar 

  8. Ulrich R, Zimring C, Zhu X, DuBose J, Seo H, Choi Y, Quan X, Joseph A (2008) A review of the research literature on evidence-based healthcare design. Heal Environ Res Des J 1:61–125. https://doi.org/10.1177/193758670800100306

    Article  Google Scholar 

  9. Hicks C, McGovern T, Prior G, Smith I (2015) Applying lean principles to the design of healthcare facilities. Int J Prod Econ 170:677–686. https://doi.org/10.1016/j.ijpe.2015.05.029

    Article  Google Scholar 

  10. MacLeamy P (2004) Collaboration, integrated information and the project lifecycle in building design, construction and operation. Construction users roundtable. kcuc.org/wp- kcuc.org/wp- -content/uploads/2013/11/collaboration-integrated-information-and-the-project-lifecycle.Pdf. Accessed 1 Aug 2019

  11. Dickerman K, Barach P (2008) Designing the built environment for a culture and system of patient safety--a conceptual, new design process. Adv Patient Saf New Dir Altern Approaches 2

  12. Zimring C, Denham ME, Jacob JT, Cowan D, Do EY (2013) Evidence-based design of healthcare facilities: opportunities for research and practice in infection prevention. Infect Cont Hosp Ep 34:5514–5519. https://doi.org/10.1086/670220

    Article  Google Scholar 

  13. The Center of Health Design (2019) The Center of Health Design. www.healthdesign.org/certification-outreach/edac/about. Accessed 10 Mar 2020

  14. McCullough CS (2010) Evidence-based design for healthcare facilities. Sigma Theta Ta

  15. Burmahl B, Hoppszallern S, Morgan J (2017) ASHE hospital construction survey report. Health Facility Magazine. www.hfmmagazine.com/articles/2750-hospital-construction-survey. Accessed 1 Feb 2020

  16. Hosseini-Nasab H, Fereidouni S, Ghomi S, Fakhrzad M (2018) Classification of facility layout problems: a review study. Int J Adv Manuf Technol 94:957–977. DOI. https://doi.org/10.1007/s00170-017-0895-8

    Article  Google Scholar 

  17. Cama R (2009) Evidence-based healthcare design. Wiley & Sons, New Jersey

  18. Lu J, Price A (2011) Dealing with complexity through more robust approaches to the evidence-based design of healthcare facilities. Heal Environ Res Des J 4:3–7. https://doi.org/10.1177/193758671100400401

    Article  Google Scholar 

  19. Reijula J, Nevala N, Lahtinen M, Ruohomäki V, Reijula K (2014) Lean design improves both health-care facilities and processes: a literature review. Intell Build Int 6:170–185. https://doi.org/10.1080/17508975.2014.901904

    Article  Google Scholar 

  20. Beale C, Kittredge J (2014) Current trends in health facility planning, design, and construction. Front Health Serv Manag 31:3–17

    Article  Google Scholar 

  21. Benitez G, Silveira G, Fogliatto F (2019) Layout planning in healthcare facilities : a systematic review. Heal Environ Res Des J 12:31–14. https://doi.org/10.1177/1937586719855336

    Article  Google Scholar 

  22. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement free. Ann Intern Med 151:264–269

    Article  Google Scholar 

  23. Adkins E, Foran M, Gill M, Delatore L, Moseley M, Terndrup T, Walsh, J (2017) Aligning facility changes to modernize and improve emergency department care. Emerg Med Inves EMIG-157. https://doi.org/10.29011/2475-5605.000057

  24. Arnolds I, Gartner D (2018) Improving hospital layout planning through clinical pathway mining. Ann Oper Res 263:453–477. https://doi.org/10.1177/1937586716674471

    Article  Google Scholar 

  25. Arnolds I, Nickel S (2013) Multi-period layout planning for hospital wards. Socio Econ Plan Sci 47:220–237. https://doi.org/10.1016/j.seps.2013.02.001

    Article  Google Scholar 

  26. Bartley J, Streifel A (2010) Design of the environment of care for safety of patients and personnel: does form follow function or vice versa in the intensive care unit? Crit Care Med 38:388–398

    Article  Google Scholar 

  27. Bayramzadeh S, Alkazemi M (2014) Centralized vs. decentralized nursing stations: an evaluation of the implications of communication technologies in healthcare. Heal Environ Res Des J 7:62–80. https://doi.org/10.1177/193758671400700406

    Article  Google Scholar 

  28. Bayramzadeh S, Portillo M, Carmel-Gilfilen C (2018) Understanding design vulnerabilities in the physical environment relating to patient fall patterns in a psychiatric hospital: seven years of sentinel events. J Am Psychiatr Nurses Assoc 25:134–145. https://doi.org/10.1177/1078390318776086

    Article  Google Scholar 

  29. Bayramzadeh S, Joseph A, San D, Khoshkenar A, Taaffe K, Jafarifiroozabadi R, Neyens DM (2018) The impact of operating room layout on circulating nurse’s work patterns and flow disruptions: a behavioral mapping study. Heal Environ Res Des J 11:124–138. https://doi.org/10.1177/1937586717751124

    Article  Google Scholar 

  30. Benitez G, Fogliatto F, Cardoso R, Torres F, Faccin C, Dora J (2018) Systematic layout planning of a radiology reporting area to optimize radiologists’ performance. J Digit Imaging 31:193–200. https://doi.org/10.1007/s10278-017-0036-9

    Article  Google Scholar 

  31. Bowers J (2013) Balancing operating theatre and bed capacity in a cardiothoracic Centre. Health Care Manag Sci 16:236–244. https://doi.org/10.1007/s10729-013-9221-7

    Article  Google Scholar 

  32. Cheng M, Lien L (2012) Hybrid artificial intelligence-based PBA for benchmark functions and facility layout design optimization. J Comput Civ Eng 2:612–624. https://doi.org/10.1061/(ASCE)CP.1943-5487.0000163

    Article  Google Scholar 

  33. Chraibi A, Osman I, Kharraja S (2018) Adaptive layout for operating theatre in hospitals: different mathematical models for optimal layouts. Ann Oper Res 272:1–35. https://doi.org/10.1007/s10479-018-2799-x

    Article  Google Scholar 

  34. Copeland D, Chambers M (2017) Effects of unit design on acute care nurses’ walking distances, energy expenditure, and job satisfaction: a pre–post relocation study. Heal Environ Res Des J 10:22–36. https://doi.org/10.1177/1937586716673831

    Article  Google Scholar 

  35. Du G, Jiang Z, Yao Y, Diao X (2013) Clinical pathways scheduling using hybrid genetic algorithm. J Med Syst 37:9945. https://doi.org/10.1007/s10916-013-9945-4

    Article  Google Scholar 

  36. Feng Y, Wu I, Chen T (2017) Stochastic resource allocation in emergency departments with a multi-objective simulation optimization algorithm. Health Care Manag Sci 20:55–75. https://doi.org/10.1007/s10729-015-9335-1

    Article  Google Scholar 

  37. Freihoefer K, Kaiser L, Vonasek D, Bayramzadeh S (2018) Setting the stage: a comparative analysis of an onstage/offstage and a linear clinic modules. Heal Environ Res Des J 11:89–103. https://doi.org/10.1177/1937586717729348

    Article  Google Scholar 

  38. Gai L, Ji J (2017) An integrated method to solve the healthcare facility layout problem under area constraints. J comb Optim 1-19. https://doi.org/10.1007/s10878-017-0212-3

  39. Gharaveis A, Hamilton D, Pati D (2017) The impact of environmental design on teamwork and communication in healthcare facilities: a systematic literature review. Heal environ res des J 11:193758671773033. 11:1119-137. https://doi.org/10.1177/1937586717730333

  40. Gosavi A, Cudney EA, Murray SL, Masek CM (2016) Analysis of clinic layouts and patient-centered procedural innovations using discrete-event simulation. Eng Manag J 28:134–144. https://doi.org/10.1080/10429247.2016.1195664

    Article  Google Scholar 

  41. Gunn R, Davis M, Hall J, Heintzman J, Muench J, Smeds B, Miller BF, Miller WL, Gilchrist E, Brown Levey S, Brown J, Wise Romero P, Cohen D (2015) Designing clinical space for the delivery of integrated behavioral health and primary care. J Am Board Fam Med 28:52–62. https://doi.org/10.3122/jabfm.2015.S1.150053

    Article  Google Scholar 

  42. Hadi K, Zimring C (2016) Design to improve visibility: impact of corridor width and unit shape. Heal Environ Res Des J 9:35–49. https://doi.org/10.1177/1937586715621643

    Article  Google Scholar 

  43. Helber S, Böhme D, Oucherif F, Lagershausen S, Kasper S (2016) A hierarchical facility layout planning approach for large and complex hospitals. Flex Serv Manuf J 28:5–29. https://doi.org/10.1007/s10696-015-9214-6

    Article  Google Scholar 

  44. Hua Y, Becker F, Wurmser T, Bliss-Holtz J, Hedges C (2012) Effects of nursing unit spatial layout on nursing team communication patterns, quality of care, and patient safety. Heal Environ Res Des J 6:8–38

    Google Scholar 

  45. Johanes M, Atmodiwirjo P (2015) Visibility analysis of hospital inpatient ward. Int J Technol 6:400–409. https://doi.org/10.14716/ijtech.v6i3.1458

    Article  Google Scholar 

  46. Lavender S, Sommerich C, Patterson E, Sanders E, Evans K, Park S, Umar R, Li J (2015) Hospital patient room design: the issues facing 23 occupational groups who work in medical/surgical patient rooms. Heal Environ Res Des J 8:98–114. https://doi.org/10.1177/1937586715586391

    Article  Google Scholar 

  47. Ley-Chavez A, Hmar-Lagroun T, Douglas-Ntagha P, Cumbo C (2016) Layout improvement study to reduce staff walking distance in a large health care facility: how to not walk an extra 4740 miles. Qual Manag Health Care 25:134–140. https://doi.org/10.1097/QMH.0000000000000095

    Article  Google Scholar 

  48. Li X, Liu D, Geng N, Xie X (2018) Optimal ICU admission control with premature discharge. IEEE Trans Autom Sci Eng 61:1. https://doi.org/10.2139/ssrn.2062518

    Article  Google Scholar 

  49. Lin Q, Liu H, Wang D, Liu L (2015) Integrating systematic layout planning with fuzzy constraint theory to design and optimize the facility layout for operating theatre in hospitals. J Intell Manuf 26:87–95. https://doi.org/10.1007/s10845-013-0764-8

    Article  Google Scholar 

  50. Lopez K, Gerling G, Cary M, Kanak M (2010) Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting. J Am Med Informatics Assoc 17:313–321. https://doi.org/10.1136/jamia.2009.000422

    Article  Google Scholar 

  51. Mallor F, Azcárate C (2014) Combining optimization with simulation to obtain credible models for intensive care units. Ann Oper Res 221:255–271. https://doi.org/10.1007/s10479-011-1035-8

    Article  Google Scholar 

  52. Mazur L, Johnson K, Pooya P, Chadwick J, McCreery J (2017) Integrating lean exploration loops into healthcare facility design: programming phase. Heal Environ Res Des J 10:116–130. https://doi.org/10.1177/1937586716680063

    Article  Google Scholar 

  53. Morgareidge D, Cai H, Jia J (2014) Performance-driven design with the support of digital tools: applying discrete event simulation and space syntax on the design of the emergency department. Front Archit Res 3:250–264. https://doi.org/10.1016/j.foar.2014.04.006

    Article  Google Scholar 

  54. Moris MU (2010) Dealing with variability in the design, planning and evaluation of healthcare inpatient units: a modeling methodology for patient dependency variations. Dissertation, University of Skövde

  55. Neyens DM, Bayramzadeh S, Catchpole K, Joseph A, Taaffe K, Jurewicz K, Khoshkenar A, San D (2018) Using a systems approach to evaluate a circulating nurse’s work patterns and workflow disruptions. Appl Ergon 78:293–300. https://doi.org/10.1016/j.apergo.2018.03.017

    Article  Google Scholar 

  56. Nicholas J (2012) An integrated lean-methods approach to hospital facilities redesign. Hosp Top 90:47–45. https://doi.org/10.1080/00185868.2012.679911

    Article  Google Scholar 

  57. Novotná G, Urbanoski K, Rush B (2011) Client-centered design of residential addiction and mental health care facilities: staff perceptions of their work environment. Qual Health Res 21:1527–1538. https://doi.org/10.1177/1049732311413782

    Article  Google Scholar 

  58. O’Hara S (2014) Planning intensive care unit design using computer simulation modeling: optimizing integration of clinical, operational, and architectural requirements. Crit Care Nurs Q 37:67–82. https://doi.org/10.1097/CNQ.0000000000000006

    Article  Google Scholar 

  59. Ozcan Y, Tànfani E, Testi A (2017) Improving the performance of surgery-based clinical pathways: a simulation-optimization approach. Health Care Manag Sci 20:1–15. https://doi.org/10.1007/s10729-016-9371-5

    Article  Google Scholar 

  60. Pati D, Harvey J, Redden P, Summers B, Pati S (2015) An empirical examination of the impacts of decentralized nursing unit design. Heal Environ Res Des J 8:56–70. https://doi.org/10.1177/1937586715568986

    Article  Google Scholar 

  61. Pati D, Evans J, Harvey TE, Bazuin D (2012) Factors impeding flexible inpatient unit design. Heal Environ Res Des J 6:83–103. https://doi.org/10.1177/193758671200600105

    Article  Google Scholar 

  62. Pati D, Harvey T, Cason C (2008) Inpatient unit flexibility: design characteristics of a successful flexible unit. Environ Behav 40:205–232. https://doi.org/10.1177/0013916507311549

    Article  Google Scholar 

  63. Real K, Fay L, Isaacs K, Carll-White A, Schadler A (2018) Using systems theory to examine patient and nurse structures, processes, and outcomes in centralized and decentralized units. Heal Environ Res Des J 11:1937586718763794–1937586718763737. https://doi.org/10.1177/1937586718763794

    Article  Google Scholar 

  64. Reijula J, Kouri J, Aalto L, Miettunen R, Reijula K (2017) Healthcare facility design development in Kuopio University Hospital. Intell Build Int 9:137–147. https://doi.org/10.1080/17508975.2015.1120184

    Article  Google Scholar 

  65. Rismanchian F, Lee Y (2017) Process mining-based method of designing and optimizing the layouts of emergency departments in hospitals. Heal Environ Res Des J 10:105–120. https://doi.org/10.1177/1937586716674471

    Article  Google Scholar 

  66. Sabanci K, Akkaya M (2016) Improvement of facility layout by using data mining algorithms and an application. Intell Syst Appl Eng Classif Differ Wheat Var by Using Data Min Algorithms 4:2–6. https://doi.org/10.1039/b000000x

    Article  Google Scholar 

  67. Sands G (2012) Environmental factors associated with falls in hospitalised older people. Dissertation, Loughborough University

  68. Schaumann D, Pilosof N, Date K, Kalay Y (2016) A study of human behavior simulation in architectural design for healthcare facilities. Ann Ist Super Sanita 55:24–32. https://doi.org/10.4415/ANN_16_01_07

    Article  Google Scholar 

  69. Shariff S, Moin N, Omar M (2012) Location allocation modeling for healthcare facility planning in Malaysia. Comput Ind Eng 62:1000–1010. https://doi.org/10.1016/j.cie.2011.12.026

    Article  Google Scholar 

  70. Smith I (2016) Operationalising the lean principles in maternity service design using 3P methodology. BMJ Qual Improv Reports 5:1. https://doi.org/10.1136/bmjquality.u208920.w5761

    Article  Google Scholar 

  71. Su Z, Yan W (2015) A fast genetic algorithm for solving architectural design optimization problems. AI EDAM 29:457–469. https://doi.org/10.1017/S089006041500044X

    Article  Google Scholar 

  72. Taylor E, Hignett S (2016) The SCOPE of hospital falls: a systematic mixed studies review. Heal Environ Res Des J 9:86–109. https://doi.org/10.1177/1937586716645918

    Article  Google Scholar 

  73. Trzpuc S, Martin C (2010) Application of space syntax theory in the study of medical-surgical nursing units in urban hospitals. Heal Environ Res Des J 4:34–55. https://doi.org/10.1177/193758671000400104

    Article  Google Scholar 

  74. Ulrich R, Zimring C, Zhu X, DuBose J, Seo H-B, Choi Y-S, Quan X, Joseph A (2008) A review of the research literature on evidence-based design. Heal Environ Res Des J 1:61–125. https://doi.org/10.1177/193758670800100306

    Article  Google Scholar 

  75. Villa S, Barbieri M, Lega F (2009) Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases. Health Care Manag Sci 12:155–165. https://doi.org/10.1007/s10729-008-9091-6

    Article  Google Scholar 

  76. Virtue A (2013) A healthcare space planning simulation model for accident and emergency (a&e). Dissertation, University of Westminster

  77. Wang T-K, Yang T, Yang C-Y, Chan FTS (2015) Lean principles and simulation optimization for emergency department layout design. Ind Manag Data Syst 115:678–699. https://doi.org/10.1108/IMDS-10-2014-0296

    Article  Google Scholar 

  78. Yi L, Seo H (2012) The effect of hospital unit layout on nurse walking behavior. Heal Environ Res Des J 6:66–82. https://doi.org/10.1177/193758671200600104

    Article  Google Scholar 

  79. Zamani Z (2018) Effects of emergency department physical design elements on security, wayfinding, visibility, privacy, and efficiency and its implications on staff satisfaction and performance. Heal Environ Res Des J 12:372–388. https://doi.org/10.1177/1937586718800482

    Article  Google Scholar 

  80. Zborowsky T, Bunker-Hellmich L, Morelli A, O’Neill M (2010) Centralized vs. decentralized nursing stations: effects on nurses’ functional use of space and work environment. Heal Environ Res Des J 3:19–42. https://doi.org/10.1177/193758671000300404

    Article  Google Scholar 

  81. Zhao Y (2013) Evidence based design in healthcare: integrating user perception in automated space layout planning. Dissertation, Loughborough University

  82. Zimring C (2011) The impact of nurse station typology on nurses’ informal communication and learning. World Health 61:19–42. https://doi.org/10.1177/193758671000300404

    Article  Google Scholar 

  83. Bai J, Fügener A, Schoenfelder J, Brunner J (2018) Operations research in intensive care unit management: a literature review. Health Care Manag Sci 21:1–24. https://doi.org/10.1007/s10729-016-9375-1

    Article  Google Scholar 

  84. Erekat A, Servis G, Madathil C, Khasawneh M (2019) Efficient operating room planning using an ensemble learning approach to predict surgery cancellations. IISE Trans Healthc Syst Eng 10:0:1–0:015. https://doi.org/10.1080/24725579.2019.1641576

  85. Gittler A, Halawa F, Madathil C, Khasawneh M (2019) Process-led ICU design: Applying discrete-event simulation and process improvement to measure ICU design performance. www.edra.org/resource/resmgr/2019edra50/core_2019/7731_-_process_led_icu.pdf. Accessed 1 Sep 2019

  86. Pati D, Harvey T, Cason C (2008) Inpatient unit flexibility. Environ Behav 40:205–232. https://doi.org/10.1177/0013916507311549

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Systems Science and Industrial Engineering, Binghamton University, Binghamton, NY, 13902, USA

    Farouq Halawa & Mohammad T. Khasawneh

  2. Department of Industrial, Manufacturing & Systems Engineering, The University of Texas at El Paso, El Paso, TX, 79968, USA

    Sreenath Chalil Madathil

  3. EwingCole, 14 Penn Plaza, New York, NY, 10122, USA

    Alice Gittler

Authors
  1. Farouq Halawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sreenath Chalil Madathil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alice Gittler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad T. Khasawneh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Farouq Halawa.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Halawa, F., Madathil, S.C., Gittler, A. et al. Advancing evidence-based healthcare facility design: a systematic literature review. Health Care Manag Sci 23, 453–480 (2020). https://doi.org/10.1007/s10729-020-09506-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10729-020-09506-4

Keywords

Search

Navigation