A knowledge framework for the design of built environment supportive of resilient internal logistics in hospitals.

Internal logistics is crucial for hospitals, occurring within facilities that pose constraints and opportunities, demanding resilient performance (RP) to adapt to dynamic conditions and balance safety and efficiency pressures. However, the role of the built environment (BE) to support RP is not explicitly analysed in the hospital logistics literature, which is usually limited to discuss BE in terms of layout and routing issues. To address this gap, this study presents a knowledge framework of BE supportive of RP in internal hospital logistics. The framework was developed based on a study in a large teaching hospital, encompassing 11 service flows of people and supplies between an intensive care unit and other units. Data collection was based on 38 interviews, documents such as floor plans, and observations of logistics activities. Seven BE design principles developed in a previous study, concerned with RP in general but not focused on logistics, were adopted as initial themes for data analysis. Results of the thematic analysis gave rise to a knowledge framework composed of seven design prescriptions and 63 practical examples of BE supportive of RP in hospital internal logistics. The paper discusses how these prescriptions and examples are connected to resilience management. The framework is new in the context of internal hospital logistics and offers guidance to both BE and logistics designers.

The Built Environment Influence on Resilient Healthcare: A Systematic Literature Review of Design Knowledge.

OBJECTIVE: The aim of this study was to develop built environment (BE) design knowledge to support resilient healthcare by systematically reviewing the evidence-based design (EBD) literature. BACKGROUND: Although the EBD literature is vast, it has not made explicit its contribution to resilient healthcare, which is a key component of the highly complex health service. METHOD: This review followed the steps recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses method. After applying the inclusion and exclusion criteria, 43 journal papers were selected. The papers were analyzed in light of five guidelines for coping with complexity, allowing for the development of BE design knowledge that supports resilient healthcare. RESULTS: The design knowledge compiled by the review was structured according to four levels of abstraction: five design-meta principles, corresponding to the five complexity guidelines, seven design principles, 21 design prescriptions, and 58 practical examples. The design knowledge emphasizes the interactions between the BE as physical infrastructure and the functions that it supports. CONCLUSIONS: The design knowledge is expected to be useful not only to architects but also to those involved in the functional design of health services as they interact with the BE. Furthermore, our proposal provides a knowledge template that can be continuously updated based on the experience of practitioners and academic research.

Integrated modelling of built environment and functional requirements: Implications for resilience.

The built environment is a core part of most healthcare systems, involving a number of requirements such as those related to space and patients' well-being. However, these are usually addressed separately from other functional requirements, resulting in designs that do not support resilient performance. This study proposes a framework for the integrated modelling of built environment and other functional requirements, relying on two approaches: Functional Resonance Analysis Method (FRAM), and Building Information Modelling (BIM). Requirements are defined as equivalent to the precondition aspect of FRAM functions. BIM allows the creation of a database of requirements and functions, linked to an object-oriented model of the built environment. The proposed framework was devised and tested in an intensive care unit. Findings shed light on the necessary resilience to cope with the gap between built environment-as-imagined in design and built environment-as-done due to performance adjustments. This type of resilience may have a long-lasting nature, as many built environment attributes cannot be easily changed.

Monitoring complexity and resilience in construction projects: The contribution of safety performance measurement systems.

Although complexity and resilience are key inter-related characteristics of construction projects, little is known on how to monitor these characteristics and their implications for safety management. This study investigates the contribution of Safety Performance Measurement Systems (SPMS) as a means for monitoring and understanding of sources of complexity and resilience in construction. It is based in three empirical studies carried out in construction projects, two in Chile and one in Brazil. Two main tools were applied in these studies: (i) the Technical, Organizational and Environmental (TOE) framework, focused on complexity; and (ii) the Resilience Assessment Grid (RAG), focused on resilience. Improvement opportunities were identified for existing SPMS. Also, a set of guidelines for the design of SPMS emerged from these studies as well as a model that explains the connections between the main constructs encompassed by the guidelines.