QUERI – Quality Enhancement Research Initiative

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Quality Improvement Methods

13. Facility Layout

a. Definition: The physical arrangement of a workspace, such as a healthcare clinic or a hospital, has a significant impact on productivity and quality. Methods exist for arranging workspaces to minimize distances the staff and patients must move, and to optimize visibility, sound, safety and other aspects of a facility's layout. These considerations may be ignored by architects or plant operations but considering the needs of the clinician or operations management can have a long term beneficial impact. When a new process or intervention is planned, the facility layout often should be studied as well because it can influence the effectiveness of such a change. Also, similar to layout decisions, the subject of facility location can also be addressed in an analytic manner.

In terms of the arrangement of a work place, generally the cost of staff movement is the most important element. The total time taken can be determined as the product of the number of trips, distance and speed of movement. The cost of various types of staff can also be factored in. Alternative layouts can be compared by the total cost of movement time and the least costly arrangement selected.

Another approach to selecting the best layout would be to compare what areas are adjacent to each other and evaluate what areas should be close by, such as the need to travel between them and what areas should be as far apart as possible due to factors such as noise and appearance. Alternate layouts can be compared based on how they meet closeness ratings.

b. Literature:

  • Tompkins, James A. Facilities planning. Wiley, 2010.
  • Muther, Richard. "Systematic layout planning." (1973). (contains many practical and easy to use tools but may be difficult to find)
  • Miller, Richard Lyle, and Earl S. Swensson. Hospital and healthcare facility design. WW Norton & Company, 2002.
  • Joseph, Thomas P. "Design a lean laboratory layout." Medical Laboratory Observer 38.2 (2006): 24. The principles of Lean and efficiency apply to facility layout as well.

c. Example: In the initial planning of changes to a clinic, changes to various functions were needed: reception, business office, phone system, exam rooms, doctor's offices, medication storage, and others. The organization knew how big a space it could afford and had a site which required a certain exterior configuration. As a first step, the organization had to determine how much space was required for each function and then where each function should be located within the building walls. Through an analysis of various adjacency factors, an optimum basic configuration was developed. This reduced future operating costs, and assured patient satisfaction and clinical quality.

d. Steps: There is a wide range of issues which might be involved in facility layout; what area should be near what (adjacency), size of workspace, configuration/shape of a workspace, layout of workstations for safety and convenience, etc. Depending on the objective, different steps will be required. If a basic block plan is needed, the following are the basic steps:

1) Identify areas requiring space, factors affecting their size, and determine total area required for each.

2) Determine size of building space to be occupied.

3) Move about blocks with relative size to determine what spaces are best near (or far from) others. Also determine the travel costs between areas for alternate arrangements and decide what areas should be closer to each other.

4) Adjust blocks to fit into available building space and shape.

5) Finalize block plan, resulting in a basic configuration, such as below, and then continue to add details within it.

Clinic Block Plan