The quality of healthcare delivery in American hospitals is under constant and continued scrutiny by payers and the public alike. Two national studies released by the New England Journal of Medicine last year indicated that many hospitals do not meet even the basic standards for treating heart attacks, congestive heart failure, and pneumonia. With crowded waiting rooms, stressed-out staff, and strained budgets, hospital administrators—all the while being mindful of patient safety, physician satisfaction, and staff retention—rarely have the luxury of time to reflect on all the implications and ramifications of meeting tomorrow's healthcare needs.

Consider the following scenario: A hospital hired an architect to design a new patient holding area within its diagnostic imaging department. Because the requested square footage exceeded generally accepted space planning benchmarks, the architect asked why such a large area was needed. The answer: During the last round of cost cutting at the hospital, the number of patient transporters (staff who take patients from their rooms to the imaging department and back) was substantially reduced. Therefore, the department needed the space for patients waiting to return to their rooms.

The architect conducted an operational analysis of patient flow with the cooperation of transport, imaging, and nursing staff. Using facts derived from the client, the architect concluded that in the short term, the first cost of construction for the larger holding area was less than the cost of increasing the number of the transportation staff, after factoring in recurring costs for salaries and benefits. In the long term, however, the hospital could most likely reduce lengthy patient wait times, increase patient comfort, enhance patient safety, and increase patient, staff, and physician satisfaction by finding ways to manage the ongoing needs for patient transport, including reinstatement of the cut staff positions. In simple terms, the analysis allowed hospital leadership to use factual data to explore options and develop an informed decision on the most optimal way to provide patient care.

“Operational analysis” and “process mapping” are among the latest organizational evaluation tools to help hospital leaders uncover solutions that will potentially optimize operations and patient outcomes. Architects and planners use the continuous quality improvement (CQI) process as a guide to operational analysis and process mapping—in this case, how facility design features might facilitate improvements in policies and procedures. When used in comparing current hospital operations with national benchmarks, these processes help the hospital discover the bottlenecks, inefficiencies, and opportunities for change in its delivery systems.

How does process mapping work? Starting with the big picture, a current process (such as the patient transport scenario described above) is observed and recorded. The sequence of events is displayed graphically for the mapping team, which notes areas of possible improvement. A hospital team of staff, physicians, and administration approves a new process map and confirms the space requirements for architectural design.

Process mapping often shows that the work of other departments is being layered on nursing staff. Using the patient transport example, if one registered nurse has to leave the floor to transport a patient to the imaging department because a patient transporter is not available, then another registered nurse must take her place on the floor because of current staffing requirements. This search for opportunities to improve internal care delivery systems can help hospitals achieve improved patient care, enhanced patient safety, and increased satisfaction at all levels. Operational analysis and process mapping allow hospitals to identify opportunities to revise procedures and realign appropriate staff with requisite functions—and perhaps reduce the scale of planned expansion or new construction projects.

Architects and consultants who provide operational analysis and process mapping allow a hospital to shine a bright light on its inner workings. The search for improvements can lead to improved patient care, enhanced patient safety, and increased satisfaction at all levels. HD

Gary Burk, AIA, NCARB, and Terrie Kurrasch, FACHE, are part of the leadership team of the healthcare practice for Ratcliff, a planning, Architecture, and interiors firm. They will offer a presentation entitled, “Hospital Design for the Future Informed by Operational Analysis and Process Mapping,” at HEALTHCARE DESIGN.06 in Chicago, November 4-7. For more information, visit

http://www.ratcliffarch.com.