Recently, HKS’s Clinical Solutions & Research (HKS CS&R) team partnered with Northern Lights Navigation to conduct an operations analysis for Orlando Regional Medical Center (ORMC) in Orlando, Florida. It was a fascinating effort that preceded and informed programming and conceptual planning for a $250 million expansion project. 

By developing both static (spreadsheet) and dynamic (simulation) operations models, our team was able to validate process flow and room-need results by both top-down and bottom-up methodologies.  

Models were created for four major departments: Inpatient, Surgery, Interventional Cardiology, and Emergency. While each model was created separately, they informed the others. The operation simulation process began with a current-state assessment, both quantitative and qualitative. Volume data used was historical and provided by the hospital, and process flow was anecdotally explained by staff members and observed.  

We created baseline models in both formats. Since simulation modeling is a more labor-intensive exercise than spreadsheet modeling, we were able to use the spreadsheet results to give our programmers and designers a feel for the approximate space need, while simulation models were being developed. Spreadsheet-generated values were then vetted later by simulation results. 

Both types of models ran various operational preferences, i.e., hours of operation, operating days per week, utilization preferences, and acuity percentages, among other factors. 

The effort was an intense pre-design project that gave substantial confidence to the owner and planners moving into the expansion project. The new expansion was designed with targets in mind and a solid foundation of analyzed data. Often, pre-design can be sticking a licked finger into the wind to decide in which direction to proceed, but with this effort, we had a whole weather station’s worth of tools guiding the hospital into the future. 

Process improvements were identified from the baseline models and suggestions were made to increase throughput without adding space. Lean principles were employed, and a team of ORMC staff members were engaged in pre-design to be abreast of necessary operations changes that needed to be championed to make them a reality. 

Process improvements included skipping triage, reducing PACU recovery time, improving discharge time of day, reducing Cath/EP in-room time, and creating a discharge lounge. These were just some of the necessary changes discovered through the pre-design simulation and spreadsheet analysis effort. 

Is simulation always merited in the pre-design phase? No. But it can be very appropriate in some complex cases. HKS recommends that when dynamic operations simulation is used, it always be conducted in concert with static spreadsheet operations analysis, so as to inform and give context to the extreme detail of simulation. 

For more information on this project or others of a similar nature, please contact me at or Frank Kittredge at We would be more than happy to discuss this in further detail with you. 

Also, if your institution has been through a similar effort, please share your thoughts with us through this blog forum!