A healthcare plan is a physical expression of an operating model. When flow is tested late, teams can spend valuable design time repairing symptoms—long travel, contested corridors, mismatched capacity—rather than shaping the system that produced them.
Map the care pathway, quantify demand and test variability before fixing departmental boundaries. Rooms are then positioned as resources in a working system, not isolated items in a program.
01
See flow as a system, not a corridor
Patient flow is shaped by decisions across the care system: arrival patterns, triage, preparation, staffing, procedure duration, recovery and discharge. A bottleneck seen in one department can originate elsewhere. The Agency for Healthcare Research and Quality’s hospital flow guidance similarly frames improvement as an organization-wide effort, supported by a multidisciplinary team and measurable performance aims.
For planners, this suggests beginning with a shared pathway map. The map should show patients, staff, supplies and information separately; identify priority and exception routes; and mark where a delay in one step blocks the next.
Source 01 · AHRQ patient-flow guide ↗02
Model before committing
Static averages hide the variability that creates queues. Two departments with the same daily volume can perform very differently when arrivals cluster, case lengths vary or shared staff are unavailable. Discrete-event simulation represents individual entities moving through a sequence of events, making it useful for testing capacity, schedules and operational reconfiguration before implementation.
A 2018 systematic review identified 211 healthcare applications of discrete-event simulation. Health-system operations accounted for most of the reviewed work, with applications spanning scheduling, capacity, resource allocation and operational change. This breadth supports simulation as a planning aid—but not as a prediction detached from local data and stakeholder review.
Source 02 · Zhang, BMC Health Services Research ↗03
Translate findings into spatial choices
A model is valuable when it changes a decision. Peak demand can inform the number and distribution of prep or recovery spaces. Staff movement can shape decentralized work points. Supply replenishment can influence clean-core, perimeter or hybrid logistics. Exception paths can determine where privacy, observation or separation is needed.
The translation is not automatic. A utilization result does not prescribe a room count, and a short travel path is not always the safest or most humane path. Teams should use model outputs to compare scenarios, then evaluate each scenario against safety, experience, staffing policy, resilience and capital constraints.
04
Make assumptions part of the design record
Simulation models simplify reality. Their value depends on the quality of inputs, the visibility of assumptions and the range of scenarios tested. Reviews of patient-flow simulation have also identified uneven reporting, limited implementation evidence and challenges in transferring models from one organization to another.
Every planning model should therefore travel with an assumption register: data period, demand profile, process times, staffing rules, prioritization logic, exclusions and validation method. That record lets future teams understand what the design was prepared to handle—and when the plan should be retested.
Source 03 · Boyle et al., Emergency Medicine Journal ↗05
Use built-environment evidence selectively
Evidence-based healthcare design connects characteristics of the physical setting with patient, staff and organizational outcomes. The literature has reported findings across topics including infection risk, acoustics, daylight, ergonomics, room configuration and layout. Yet evidence strength varies by intervention and context.
For a project team, the responsible approach is to separate three layers: established requirements, research-informed design hypotheses and local operational preferences. Each deserves a different level of confidence and a different validation method.
Source 04 · Ulrich et al., HERD ↗ Source 05 · 2024 inpatient-design scoping review ↗For the next planning meeting
Five useful questions
- Which pathway are we designing, including exceptions?
- Where does variability—not just average demand—create pressure?
- Which resources constrain the system at peak conditions?
- What spatial decision could relieve or worsen that constraint?
- Which assumptions should be validated locally before design advances?
Sources
Evidence base
- McHugh M, Van Dyke K, McClelland M, Moss D. Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. Agency for Healthcare Research and Quality.
- Zhang X. Application of discrete event simulation in health care: a systematic review. BMC Health Services Research. 2018;18:687.
- Boyle J, et al. Patient flow within UK emergency departments: a systematic review of computer simulation modelling methods. Emergency Medicine Journal. 2017.
- Ulrich RS, et al. A review of the research literature on evidence-based healthcare design. HERD. 2008;1(3):61–125.
- Scoping review: association of inpatient hospital design features with patients’ clinical outcomes. 2024.
This OC Architects research brief is for planning discussion and does not constitute clinical, regulatory or operational guidance. Findings should be evaluated against current requirements and local data.