Conference Paper

Facilities Planning Promoting Efficient Space Use at Hospital Buildings

To read the full-text of this research, you can request a copy directly from the authors.


Purpose-Due to an increasing demand for care delivery and emerging new health care technologies facility managers are frequently confronted with changing spatial demands of end-users. The purpose of this study is to explore if facilities planning at a diagnostic outpatient clinic can increase the level of space utilization and the speed of care delivery. Design / methodology/ approach-The current study was made in the context of discovery and exemplification. The influence of facilities planning, by means of resource allocation and patient categorization, on the actual use of facilities was investigated. A comparison was made between the planned and the actual space utilization level of a scanning room. In a time study the actual utilization times of 55 patient examinations were compared with the planned times. Moreover, the nature of activities was registered by a multidimensional work sampling method. Findings-This study showed that the actual space utilization level deviated from the planned utilization level. In this case the actual fluorodeoxyglucose (FDG) whole-body examinations on a positron emission tomography-computed tomography (PET-CT) scanner took less time than planned and, in addition, the weight of patients significantly influenced the actual examination times. Patients with a heavy body weight took more time than patients with low weight. Moreover, this study showed that employees only spend 47% of their activities on care-related activities. Practical implications-This current study has shown that facility management research (FMR) allows facility managers to improve their insight in the efficiency of space use, and, in addition,

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... The manual approach is always time-consuming and error-prone in terms of the expected results of space utilization, whereas the automatic method lacks details of user space demands, such as room area, indoor and outdoor environments. This method is more applied to the planning and design phases of a building instead of the operation and maintenance (O&M) phase (Zijlstra, Mobach, Van Der Schans, & Hagedoorn, 2014). However, the O&M phase is the longest period in the life cycle of a building, its space management is also critical. ...
Full-text available
Lists and floor plans have been widely adopted as space management tools for educational office buildings. However, the two-dimensional floor plans fail to present the indoor complexity, which hinders users from intuitively observing the indoor equipment arrangements and adapting to the indoor environment within a short time. Meanwhile, insufficient research has been conducted on space management tools regarding building indoor navigation. A Building Information Modeling Space Management (BIMSM) system was proposed in this study based on BIM. This system is comprised of two components, i.e. indoor space allocation management and indoor path navigation. The real-time space usage can be queried and user demands may be matched with available space by applying the Space Usage Analysis (SUA) theory. After the establishment of indoor maps, an improved A* algorithm is used to provide smooth navigation paths, and the visualization of such paths can be provided in mobile terminals. The BIMSM system was applied in an office building in a university in Shanghai, China. In this case study, the overall user satisfaction reached 91.6% by greatly reducing space arrangement failures. The time indoor navigation took outperformed that based on the traditional A* algorithm, with the search efficiency increasing 5.28%. First published online 17 December 2019
... Space is one of the most valuable and essential resources of any organization (Zijlstra, Mobach, van der Schans and Hagedoorn 2014). It has to be managed systematically and efficiently because is expensive to buy and costly to maintain (SMG, 2007;Wiggins 2014). ...
This paper deals with inefficient space management of public real estate resulting in discrepancy between the amount of space required for provision of public services and the amount of space that is available. This situation causes either waste of resources, in case of underused spaces, or affects quality of service if the space is overused. To address this issue, this paper compares different methods for space-use analysis and discusses their suitability for public facilities. It also proposes a novel, activity-centered method for defining space needs. The paper contributes to the state of the art in the following ways: It demonstrates that generally used methods for space-use analysis are not appropriate for public buildings due to their cost, complexity and building-centered approach. Moreover, it reveals that methods used in the private sector cannot be simply copied to the public one. However, its biggest contribution is proposal of a new, low-cost and activity-centered method for determining space needs that can be applied for multiple public buildings of different purposes.
Full-text available
Purpose The “old” concept of productivity seems to be misleading in health care, because it does not involve the contribution of the patient in value creation. The purpose of this paper will therefore be to explore possibilities for developing service productivity in theory and practice. Design/methodology/approach The analysis is based on a discursive reading of authoritative texts, an understanding of how health care work is organised and of several examples illustrating value creation. A proposed theoretical frame draws on “value creation”, “match matching” and “agency”. Empirical material is used, as are an analysis of a service meeting in health care, official texts in a Swedish context and narratives written by “users” and professionals. Findings The concept of service productivity in the context of health care encompasses values such as experienced health, quality of life, accessibility, trust, communication, avoidable suffering and avoidable deaths, and not only reduced costs, activities and outcomes. Research limitation/implications There is a need for more research concerning matchmaking and support of the customer. An overall aim for the providers should be to match the value creation process of the customer (patient). Originality/value This is a conceptual paper concerning value creation and service productivity in health care.
Full-text available
This paper provides a comprehensive survey of research on appointment scheduling in outpatient services. Effective scheduling systems have the goal of matching demand with capacity so that resources are better utilized and patient waiting times are minimized. Our goal is to present general problem formulation and modeling considerations, and to provide taxonomy of methodologies used in previous literature. Current literature fails to develop generally applicable guidelines to design appointment systems, as most studies have suggested highly situation-specific solutions. We identify future research directions that provide opportunities to expand existing knowledge and close the gap between theory and practice.
Full-text available
Hospital diagnostic facilities, such as magnetic resonance imaging centers, typically provide service to several diverse patient groups: outpatients, who are scheduled in advance; inpatients, whose demands are generated randomly during the day; and emergency patients, who must be served as soon as possible. Our analysis focuses on two interrelated tasks: designing the outpatient appointment schedule, and establishing dynamic priority rules for admitting patients into service. We formulate the problem of managing patient demand for diagnostic service as a finite-horizon dynamic program and identify properties of the optimal policies. Using empirical data from a major urban hospital, we conduct numerical studies to develop insights into the sensitivity of the optimal policies to the various cost and probability parameters and to evaluate the performance of several heuristic rules for appointment acceptance and patient scheduling.
Full-text available
The aim of this guideline is to provide a minimum standard for the acquisition and interpretation of PET and PET/CT scans with [18F]-fluorodeoxyglucose (FDG). This guideline will therefore address general information about[18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and is provided to help the physician and physicist to assist to carrying out,interpret, and document quantitative FDG PET/CT examinations,but will concentrate on the optimisation of diagnostic quality and quantitative information.
Full-text available
Managed care companies contend there is still waste in the healthcare system that should be eliminated. Healthcare providers argue that further cuts will reduce quality. Which side is right? In order to answer this question it is necessary to determine the threshold implicit in the corollary question: How far can we go in reducing healthcare expense without diminishing quality? A new variability based methodology is proposed that has the potential to determine the threshold at which cost reduction will negatively impact quality. Illustrations of its specific application are provided.
Full-text available
The noise equivalent count (NEC) rate index is used to derive guidelines on the optimal injected dose to the patient for 2-dimensional (2D) and 3-dimensional (3D) whole-body PET acquisitions. We performed 2D and 3D whole-body acquisitions of an anthropomorphic phantom modeling the conditions for (18)F-FDG PET of the torso and measured the NEC rates for different activity levels for several organs of interest. The correlations between count rates measured from the phantom and those from a series of whole-body patient scans were then analyzed. This analysis allowed validation of our approach and estimation of the injected dose that maximizes NEC rate as a function of patient morphology for both acquisition modes. Variations of the phantom and patient prompt and random coincidence rates as a function of single-photon rates correlated well. On the basis of these correlations, we demonstrated that the patient NEC rate can be predicted for a given single-photon rate. Finally, we determined that patient single-photon rates correlated with the mean dose per weight at acquisition start when normalized by the body mass index. This correlation allows modifying the injected dose as a function of patient body mass index to reach the peak NEC rate in 3D mode. Conversely, we found that the peak NEC rates were never reached in 2D mode within an acceptable range of injected dose. The injected dose was adapted to patient morphology for 2D and 3D whole-body acquisitions using the NEC rate as a figure of merit of the statistical quality of the sinogram data. This study is a first step toward a more comprehensive comparison of the image quality obtained using both acquisition modes.
Full-text available
Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support.
Full-text available
This paper describes an evaluation method for the assessment of hospital building design from the viewpoint of operations management to assure that the building design supports the efficient and effective operating of care processes now and in the future. The different steps of the method are illustrated by a case study. In the case study an experimental design is applied to assess the effect of used logistical concepts, patient mix and technologies. The study shows that the evaluation method provides a valuable tool for the assessment of both functionality and the ability to meet future developments in operational control of a building design.
The number of books, training seminars and missives on the subject of change management continues to grow unabated. Yet few of these consider the importance of the physical change which inevitably accompanies the change of 'minds'. It is the physical change in the form of workplace redesigns, procurement of new buildings or perhaps the reengineering of a facilities service, which present the tangible evidence of change. People often discard the wise words which appear in the mission statement or the new process hardwired into the corporate intranet. If change is going to succeed, evidence suggests that a transformation in what we see, touch and experience is the only kind of change that people within an organisation are likely to understand and internalise. How does the facilities manager achieve such transformations? A starting point in this journey is the process of 'sense making' or understanding the nature of change. This chapter describes the changing landscape in which facilities management teams operate. In so doing, it seeks to contextualise facilities management. This chapter explains how each of the elements of the change management process is addressed in each of the book's chapters. This is achieved by (1) an analysis of current thinking on change management; (2) an exposition of how facilities management needs to be redefined to accommodate contemporary approaches and (3) an explanation of a framework (described as the REACTT model) which identifies the key stages of facilities change management which in turn correspond with each of the chapters of this book.
The primary issue addressed in this research is how to schedule clients as they call for appointments, without knowing which "types" of clients will call at a later time. The main goal is to compare various scheduling rules in order to minimize the waiting time of the clients as well as the idle time of the service provider. Interviews with receptionists verified that they have knowledge regarding differences between clients' service time characteristics. This information is used both to differentiate between clients and to develop various scheduling rules for those clients. A simulation model of a dynamic medical outpatient environment is developed based on insight gained from the interviews and from prior research. Two decision variables are analyzed ("scheduling rule" and "position of appointment slots left unscheduled for potential urgent calls") while two environmental factors are varied ("expected mean of the clients' service time", and "expected percentage of clients with low service time standard deviation compared to those with high service time standard deviation"). This resulted in 30 combinations of decision variables, each tested within 15 combinations of environmental factors. By using multiple performance measures, it is possible to improve considerably on some of the "best" rules found in the current literature. The "best" decisions depend on the goals of the particular clinic as well as the environment it encounters. However, good or best results can be obtained in all cases if clients with large service time standard deviations are scheduled toward the end of the appointment session. The best positioning of slots left open for urgent clients is less clear cut, but options are identified for each of a number of possible clinic goals.
Purpose The purpose of this conceptual paper is to examine key operational tradeoffs and challenges that call center managers face. Design/methodology/approach To support the concepts advanced in this paper, an embedded case study is used from an inbound call center for a regional wireless phone company that operates in the USA. The research involved: a review of available service quality and call center management literature; development of a resource‐based framework to understand key operational tradeoffs; use of a case study approach with structured interviews of key managers and employees; and synthesis of this data in order to understand why and how these managers made key operational tradeoff decisions. The case study was done on an inbound customer service call center for a regional wireless phone company that operates in the Southeastern USA. Findings This research suggests that there are four key resource management decisions that must be addressed in order to improve service quality and effectively manage call center operations: the efficient deployment and use of labor, effective leveraging of technology, capacity management, and demand management. Research limitations/implications The use of a single case approach limits the generalizability of results; however, this methodology is effective in providing rich data and a research framework to both build theory and advance future research in this arena. Practical implications It is noteworthy that while technology, capacity management, and demand management systems are essential, labor remains a key differentiator in achieving high service quality. A call center must provide dependable service with knowledgeable, honest, polite and empathetic employees who can efficiently answer customers' questions while also promoting more products and services to improve profitability. Originality/value While this research is primarily conceptual, it also uses a case study to explain why and how managers make key tradeoffs in order to compete effectively on service quality in the call center industry.
Responses to demand uncertainty in the field of health-care services is a very timely research issue because of ongoing changes in demand patterns that are driven by demographics and recent changes in the delivery of these services. Despite its importance to researchers, the literature on demand management, capacity management and performance in health care has not been extensively reviewed. The present paper addresses this need by analyzing and synthesizing 463 articles published between 1986 and 2006. The key contributions of this work are the analysis and synthesis of research on demand management, capacity management and performance, along with an agenda to guide future research in this important area.
For many medical procedures, patients face substantial risk of complication or death when treatment is delayed. When a queue is formed in such a situation, it is imperative to assess the suffering and risk faced by patients in queue and plan adequate medical capabilities in advance to address the concerns. We develop in this paper a patient queue model that considers the condition and its changes over time for a patient in a queue. The risk faced by a patient is characterized under this model as a function of the arrival rate, the service capacity and the hazard rate of the disease. This characterization provides an approach to the planning and management of medical services based on the risk faced by patients. When the condition of patients is heterogeneous, a priority patient queue model is developed to minimize the overall risk for all patients. The operational characteristics of the priority queue, particularly the risk faced by different groups of patients, are derived. Managerial issues induced by prioritization are also addressed. In general, patients of heterogeneous condition should be prioritized in as many urgency classes as possible to maximize survival.
Allocation of a limited capacity of resources among several customer types is a critical decision encountered by many manufacturing and service firms. We tackle this problem by focusing on a hospital setting and formulate a general model that is applicable to various resource allocation problems of a hospital. To this end, we consider a system with multiple customer classes that display different reactions to the delays in service. By adopting a dynamic-programming approach, we show that the optimal policy for a system involving both lost sales and backorders is not simple but exhibits desirable monotonicity properties. Furthermore, we propose a simple threshold heuristic policy that performs well in our experiments.
To assess whether delays to outpatient specialty care can be solved by improving the way supply and demand are matched, without adding capacity. A systematic review of the interventions applied by 18 clinics using the model of 'advanced access' and a statistical analysis of the effects of the interventions on their delays. The clinics applied different combinations of interventions aimed at improving the way they match supply and demand, improving the efficiency of the way supply is organised and at reducing unnecessary demand. Fourteen clinics show statistically significant improvements. Two probably significantly improved and two clinics did not. Their access reduced on average 55%, from 47 to 21 days. It seems that delays in outpatient specialty care can be solved to a large extend by improving the way supply and demand are matched. Policy makers should analyse whether delays are caused by capacity problems or matching problems. For the latter, it appears more effective to invest in the ability to react then the ability to plan. Policy makers should create incentives for clinics to keep access short and remove incentives that stimulate delays.
Efficient scheduling of patient appointments on expensive resources is a complex and dynamic task. A resource is typically used by several patient groups. To service these groups, resource capacity is often allocated per group, explicitly or implicitly. Importantly, due to fluctuations in demand, for the most efficient use of resources this allocation must be flexible. We present an adaptive approach to automatic optimization of resource calendars. In our approach, the allocation of capacity to different patient groups is flexible and adaptive to the current and expected future situation. We additionally present an approach to determine optimal resource openings hours on a larger time frame. Our model and its parameter values are based on extensive case analysis at the Academic Medical Hospital Amsterdam. We have implemented a comprehensive computer simulation of the application case. Simulation experiments show that our approach of adaptive capacity allocation improves the performance of scheduling patients groups with different attributes and makes efficient use of resource capacity.
Every health care system, regardless of how rich the country in which it operates, rations medical services, because no nation has the resources to match the insatiable demand for services. In the variety of approaches to rationing that nations employ, as David Naylor points out in this paper, the United Kingdom and the United States represent the extremes. Britain's National Health Service (NHS), which offers patients medical care that is free at the point of service, practices queue-based rationing. People face time delays before medical problems are addressed. In the United States, those with health insurance rarely have to wait long for treatment. But those without insurance have no ready access to care and must fend for themselves in public hospitals and other institutions prepared to accept charity cases. Canada prides itself on developing a health care system that strikes a middle ground. It is publicly funded and universally available, but care is privately provided. Administration and delivery of care are decentralized. But as demands for service have increased, Canada has resorted to rationing by queue for some procedures, such as cardiac surgery, for which demand exceeds supply. Naylor, an assistant professor on the faculty of medicine, University of Toronto (UT), holds a medical degree from UT and a doctoral degree in social and administrative sciences from Oxford Univeristy, where he was a Rhodes Scholar (1979-1983). In this paper, Naylor describes the rationing of coronary care in Ontario, Canada's richest and most populous province. He recounts the evolution of Ontario's crisis over growing waiting lists and how the system has addressed the problem. One fascinating dimension of rationing, Canadian style, is the interface between the media, who publicize the fate of patients who fall victim to the queues, and politicians, who respond to the resulting hue and cry in a way that underscores their accountability to the electorate.
Relative to other stochastic systems seen in hospitals, the patient queueing process of a radiology department is difficult to describe theoretically because of its wide variety of work sources, and in particular because of the mixing of patients who arrive with an without appointments. Using empirical data on X ray completion times, a computer simulation model was built and used to predict the effects of administrative changes on efficiency, as measured by the average patient queueing time and doctor idle time during a clinic session. Efficiency always improves when the proportion of patients with appointments is increased, but whether it is the staff or patients who benefit depends on the clinic size; the behavior of the system depends critically on the number of patients called at the beginning of the session, particularly in smaller clinics. In most circumstances, patients should be given coincident appointment times only for reasons of practicality. The completion time of a patient is shown to depend strongly on his age, mobility, and origin; this is exploited to demonstrate the efficiency increases to be expected when clinic sessions consist of groups of patients from the same origins.
Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.
Doelmatige zorg: management voor leidinggevenden in de gezondheidszorg
  • P A Buijnsters
Buijnsters, P. A. (2008), Doelmatige zorg: management voor leidinggevenden in de gezondheidszorg, Kayanah, Dwingeloo.
Service management: operations, strategy, and information technology
  • J A Fitzsimmons
  • M J Fitzsimmons
Fitzsimmons, J. A., Fitzsimmons, M. J. (2006), Service management: operations, strategy, and information technology, McGraw-Hill / Irwin, Boston.
Facilitating user driven innovation -a study of methods and tools at Herlev Hospital" in: Facilities management research in the Nordic countries: Past, present and future
  • A Fronczek-Munter
Fronczek-Munter, A. (2012), "Facilitating user driven innovation -a study of methods and tools at Herlev Hospital" in: Facilities management research in the Nordic countries: Past, present and future. Jensen, P.A., Nielsen, S.B. Ed., Polyteknisk Forlag, Lyngby, p. 199-214.
Work systems and the methods, measurement, and management of work
  • M P Groover
Groover, M. P. (2007), Work systems and the methods, measurement, and management of work, Pearson Prentice Hall, Upper Saddle River.
Bouw in de gezondheidszorg
  • S P M Heumen
  • P J A Brouwers
Heumen, S.P.M., Brouwers, P.J.A.M. "Bouw in de gezondheidszorg", available at: 5&laag3=106&item_id=855&Taal=1 (accessed 23 january 2014).
Kanker nu doodsoorzaak nummer één
  • J Hoogenboezem
  • J Garssen
Hoogenboezem, J., Garssen, J. (2009). "Kanker nu doodsoorzaak nummer één", available at: (accessed 14 november 2013).
Usability, ISO 9241-11, Internation organization for standardization
ISO (1998), Usability, ISO 9241-11, Internation organization for standardization.
Strategies and methods to improve spatial management within companies
  • A Kovacs
  • S Emrich
  • D Wiegand
Kovacs, A., Emrich, S., Wiegand, D. (2013), "Strategies and methods to improve spatial management within companies", International Journal of Facilities Management, 86-97.
Strategic Facility Planning: A white paper
  • K O Roper
  • J H Kim
  • S H Lee
Roper, K.O., Kim, J.H., Lee, S.H. (2009). "Strategic Facility Planning: A white paper", available at: (accessed 27 january 2014).
Operations management
  • N Slack
  • S Chambers
  • R Johnston
Slack, N., Chambers, S., Johnston, R. (2004), Operations management, Prentice Hall/ Financial Times, Harlow.
Health operations management: Patient flow logistics in health care
  • J M Vissers
  • R Beech
Vissers, J. M., Beech, R. (2005), Health operations management: Patient flow logistics in health care, Routledge, London.