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

The built environment (BE) influences the performance of health services, including patient outcomes, through a number of factors such as wayfinding, layout, and the flexibility of room configurations. These factors have been investigated mostly in the context of the evidence-based-design (EBD) literature. Although EBD literature is vast, its contribution to resilient performance (RP) - i.e., the systems property of coping with both expected and unexpected variabilities, maintaining the core system functionalities even under stress - has not been made explicit. Thus, the implications of this literature for the RP of specific hospital units and processes have not been explored. The aim of this research work is to develop a framework of BE design knowledge supportive of RP in the internal logistics of hospitals, a crucial process that spans large physical areas and involves activities of storage and transportation of patient and supplies. The framework is composed of different levels of abstraction ranging from principles relevant to any hospital unit to context-specific practical examples. Initially, a systematic literature review was carried out to develop generic BE design knowledge supportive of RP, based on concepts from resilience engineering and complex socio-technical systems. This knowledge is composed of meta-principles, principles, prescriptions, and practical examples of the influence of the BE on the RP across a broad set of health services. Next, this knowledge was refined based on two case studies, which also allowed for tailoring it to internal hospital logistics. The case studies were set in two teaching hospitals, focusing on activities of internal logistics that occurred in: (i) the common areas linking an intensive care unit (ICU) to other units of a large public hospital in Brazil; and (ii) the surgical service of a private hospital in Australia. Both case studies were based on multiple sources of evidence, including interviews with 48 healthcare professionals, 94 hours of non-participant observations, and consultation of a wide variety of documents, predominantly regulations. Findings from the first case study gave rise to seven prescriptions and 63 examples of the influence of the BE on the RP in the internal logistics to and from ICUs. In the second case study, those same seven prescriptions served as data analysis themes that allowed the identification of 60 examples relevant to internal logistics in surgical services. Results from both case studies also shed light on the importance of understanding the service flows within hospitals, as they highlight what happens intra and inter workspaces, providing a systems perspective for the BE design. Synthesising all data collected along the research process, a general framework of BE design knowledge supportive of RP in internal hospital logistics was derived. The framework is composed of four meta-principles, seven principles, seven prescriptions, and 181 practical examples. The results of this study are new in the context of health services, offering guidance to both BE and operations designers.<p></p>