W henever an existing facility is renovated or a new facility designed, the chance exists to develop a layout that will improve process flow and minimize wasted space. When a new facility is designed, the facility layout should be integrated into the architectural design. Limitations on building lot size and shape, however, may heavily in? uence the layout con? gurations available. In other situations, a new layout is achieved simply by renovating an existing area, in which case the size and shape of the area are set, and the limitations relate to the funds available.

Planning facility layout is important for many reasons. The amount of capital invested in new construction or renovation is usually substantial. The results are long-term: while minor modi? cations may be possible, the overall layout will last well into the future. Furthermore, layout has an enormous effect on daily operations. Not only does layout dictate the distance a patient must travel from one department to another; it also in? uences which staff members are likely to interact and communicate. The basic goals in developing a facility layout should be functionality and cost savings find out.

Functionality includes placing the necessary departments, such as the operating and recovery rooms, close together. Functionality also includes keeping apart those departments which should not be together. Overall, functionality includes aspects of a layout which may not be immediately quanti? able, such as facilitating communication and improving staff morale. 102 Facility Layout 103 Cost savings include reduction in travel times between areas, reduced construction costs by minimizing the space required, and allowing for reduced staf? ng by placing similar job functions close together.

Two key elements of these goals are saving space and reducing the travel distance and time between departments. The amount of space allocated to a given department often is set by factors beyond the control of the facility planner, whose job it then is to make the most of that space. A poorly designed workspace harms both productivity and quality. Another aspect, the travel distance between departments, is a cost that can reach enormous proportions long-term. What may seem a short walk to a designer may add up, over the life of a facility, to days lost to travel. That not only adds to costs, but also weakens staff morale.

Facility layout is a complex process with many variables. Given unlimited time, space, and funding, it would be possible to develop and create the optimal layout. Given the constraints on any project, though, layout planning should still provide the best layout possible in any situation—one that can save money, improve the quality of care, and/or improve staff morale. A good layout will draw on the experiences of the planner, the technical knowledge of the staff who will be using the facility, a strong understanding of how to minimize wasted space and movement, and the forecasts of future needs.

Although a planner usually acquires most of these skills, certain technical knowledge of a ? eld is something the facility layout planner may never acquire. A strong understanding of the tools to minimize wasted space and movement, however, is readily taught and provides a good background from which to begin a facility layout (Stevenson, 2002; p. 232). The three basic types of layouts are the product layout, the process layout, and the ? xed-position layout. These layouts may be applied to either a single department or an entire facility (group of departments).

Therefore the elements of the layout may be either whole departments or individual pieces of equipment (hospital beds, cafeteria equipment). An actual facility layout is almost always a mixture of the three basic types. A hospital may have an overall process layout as all the departments are grouped (intensive care, nursing units, administration). At the department level, there may be some product layouts (cafeteria, labs), and ? xed-position layouts (an operating room). Product Layout The product layout arranges equipment (departments) in the order of product process ?ow.

This type of layout is generally used in a production setting, where services (processes) are standardized and there is little variation, such as an assembly line. A product layout is generally less ? exible and requires higher initial 104 Quantitative Methods in Health Care Management equipment cost, but minimizes process cycle time and increases equipment utilization. The product layout might be used for a hospital cafeteria. The speci? cs of a product layout are generally determined by the product or service itself.

Most of the decisions involve balancing the line so that each station has approximately the same cycle time, the time for one item to pass through that workstation. If one workstation takes much longer than the next, then the second workstation is likely to spend much time waiting for parts from the ? rst. Conversely, if the second workstation takes longer than the ? rst, then the ? rst is likely to spend much time waiting to move parts to the second (Stevenson, 2002; pp. 232–235). Since variability is inherent in patient care, the product layout is rarely useful in health care other than for supporting activities.

Although the processes involved in patient care may be common among a group of patients with a similar diagnosis, the amounts of time that patients spend in each process must of necessity vary greatly. A cafeteria line is a common example of a health service industry product layout. Process Layout The process layout groups types of processes (departments, equipment, and so on) together to provide the most ? exibility. Examples of a process layout can be found in physician of? ces (group practice), clinics, or hospitals.

The hospital groups together functions such as intensive care, surgery, emergency medicine, and radiology as separate departments. This arrangement allows one patient entering through the emergency room to be seen in radiology, possibly surgery, and then intensive care, and another to be admitted directly for elective surgery and then to intensive care. The variability among patients makes such ? exibility necessary. Another complicating factor is that it is often not clear when a speci? c bed will become open, so that scheduling a particular patient for a particular bed may not be possible.

The downside of a process layout is high material handling costs. While it is necessary to have the ? exibility to move patients from one department to any other department, it saves time to move the patient through adjacent departments along a common path. Process Layout Tools The many tools for designing a process layout generally weigh both quantitative and qualitative factors in deciding which departments should be placed closer together.

The number of trips that employees make between two departments is a quantitative measure that can approximate the cost of having the two departments Facility Layout 105 far apart. Hazards such as supplemental oxygen and open ? ames (as in a kitchen) are qualitative factors to consider.

Qualitative factors are easily analyzed in a closeness rating chart, developed by Richard Muther (1962), named systematic layout planning (SLP). The closeness rating chart is essentially a grid that qualitatively assesses the desired closeness between departments. For some departments, closeness may be undesirable. The grid of a closeness rating chart resembles the mileage chart on a map; the rating for department A relative to B is the same as the rating for B relative to A.

Codes denote the desired closeness, according to the relative strength of the closeness: A—absolutely necessary, E—very important, I—important, O—ordinary importance, U—unimportant, and X—undesirable. The codes take these factors into consideration: a) whether similar equipment or facilities are used, or similar work performed; b) sharing the same personnel, records, and communication; c) sequence of work? ow; and d) unsafe or unpleasant conditions (Muther and Wheeler, 1962). Different colors for the codes may make the chart more visually effective, but are not necessary to the tool.

The closeness rating chart may be used to create a block diagram for an effective layout. The chart may also be used to check the effectiveness of a layout that was created using another method or computer tool. Using a heuristic rule, the ? rst step in assigning departments to available spaces according to desired closeness relationships is to identify the absolutely necessary and the undesirable relationships. That is, all departments with A and X coded relationships would be identi? ed and their workplaces laid out on the available space. Then other departments with E, I, and O ratings would ?

t in. Let us develop a layout to illustrate this method. EXAMPLE 5. 1 A long-term care facility will be constructed with total available area of 200 400 ft. , as shown in Figure 5. 1. The dimensions of each department and the desired relationships among the departments are depicted in Figure 5. 2. A functional layout with the given parameters is desired. As can be observed from Figure 5. 2, it is important that the patient room area and the ambulance entrance be close to each other. On the other hand, the main entrance is not desired to be close to the laundry facilities or to the ambulance entry.

The next parameter is the size of each department (also shown in Figure 5. 2), so an algorithm can be applied to provide solution to the layout, using the closeness rating method. It should be noted that the patient room area will be the space left after other departments are logically laid out according to the closeness ratings algorithm. Following the heuristic algorithm suggested above, the following A and X relationships are identi? ed: namely, in A relationships, the nurses’ station and the 106 Quantitative Methods in Health Care Management FIGURE 5. 1.

Laundry 3. Patient Room Area 2. Amb. Entrance 1. Nurses’ Station 6. Dietary Dept. 5. Main Entrance Method of Minimizing Distances and Costs If the objective of the layout is to create ef? ciencies in functional areas where repetitive processes (nurses walking in hallways to fetch supplies or delivering care for patients) occur, then minimizing the costs or repetitive distances traveled becomes a goal. Data representing such traf? c can be summarized in a from-to chart.

A from-to chart is generally a table listing the departments to be considered and the number of trips (or ?ow) between them in a given period. Once such traf? c information is identi? ed, those areas with the most frequent interaction may be assigned adjacent to each other, and an initial layout can be generated. However, there may be many possible assignments. If three departments are to be assigned three spaces, there are six possible layouts.

This is calculated by factorial formulation, n! , where n represents departments. Increasing the number of departments dramatically increases the number of possible solutions. For example, for four departments, 4! , there are 24 possible assignments.

More formally, Dij , Wij , and Cij represent the distance, interdepartmental traf? c, and cost, respectively, between departments i and j. The objective of the layout is to minimize total cost (TC) function, and the problem can be speci? ed as: Minimize TC ij Dij * Wij * Cij [5. 1] As with any quantitative tool, however, the layout developed is only as good as the quantitative data used. Care should be taken to make sure that current Facility Layout 109 data are used, though without incurring data acquisition costs greater than the savings to be generated by the design effort.

The time period chosen should be long enough to account for ? uctuations over time, so that the data represent long-term travel between the departments. This method rarely, if ever, develops an optimal layout, so that may be implemented as the lowest cost that can be obtained by trying different assignments of the departments to the available spaces according to the frequency of interactions (? ow), Wij. Almost always, the initial layout will require modi? cation to accommodate qualitative factors that do not show up using the from-to chart.

Exhibit 5. 1 illustrates a EXHIBIT 5. 1. FROM-TO CHART FOR A SMALL HOSPITAL. 110 Quantitative Methods in Health Care Management from-to chart for a small hospital, displaying daily interactions, Wi j, among six departments. As noted earlier, for this particular problem there may be 6! , or 720 possible solutions. If we obtain the distances between departments and assume equal costs (Cij) of ? ow (for example, nurses’ travel times can be converted to cost by using wage information), which layout solution provides the minimal total cost? Let us illustrate this with a simple example. EXAMPLE 5.

2 Consider the departments A, B, and C of a small hospital. Assume the distance between the locations 1 and 2 to be 100 feet, between 1 and 3 to be 200 feet, and between 2 and 3 to be 100 feet. Assign these departments to locations 1, 2, and 3 in a rectangular space. Assuming that on average a nurse can walk 100 feet in 30 seconds and earns $48. 00 per hour including fringe bene? ts, what is the total initial cost of the initial layout? A summary of the information for this problem is shown in Table 5. 1. Since there are three departments to be assigned three locations, there are 3!

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