A Layout Design Decision-Support Framework and Concept Demonstrator for Rural Hospitals using Mixed Methods by Ingé Christine Kruger Thesis presented in fulfilment of the requirements for the degree of Master of Engineering (Industrial Engineering) in the Faculty of Engineering at Stellenbosch University Supervisor: Ms Louzanne Bam March 2017 Stellenbosch University https://scholar.sun.ac.za DECLARATION By submitting this thesis electronically, I declare that the entirety of the work contained therein is my own, original work, that I am the sole author thereof (save to the extent explicitly otherwise stated), that reproduction and publication thereof by Stellenbosch University will not infringe any third party rights and that I have not previously in its entirety or in part submitted it for obtaining any qualification. Date: March 2017 Copyright © 2017 University of Stellenbosch All rights reserved ii Stellenbosch University https://scholar.sun.ac.za ABSTRACT Layout design is an ever-present problem that has a significant effect on the operations of an organisation, especially in the context of healthcare which deals with the lives of patients. It is a complex problem that has long-term consequences and oftentimes competing objectives. Literature has focused almost exclusively on using either quantitative or qualitative layout design methods for designing layouts. This study develops a generic framework using both quantitative and qualitative layout design methods that will guide the user to design a near optimal layout for a rural hospital while taking into consideration the relevant laws and standards as well as the health outcomes of the surrounding rural community. Rural and urban lifestyles, health, and illnesses differ in many ways. General hospital design methods are therefore not necessarily appropriate for hospitals in these areas. There is thus a need for a framework to be tailored for a rural community. Following a mixed methods methodology, a systematic literature review of quantitative and qualitative layout design methods along with hospital design considerations were conducted in order to determine the most adequate methods for designing a hospital layout at the block diagram level of detail. Furthermore, the commonalities and differences between rural and urban hospitals were investigated including laws and standards relevant to hospital layouts. The qualitative layout design methods involved different layout procedures and Muther’s Systematic Layout Planning Procedure was found to be most adequate. Furthermore, hospital design considerations such as patient-centeredness, efficiency, flexibility and expandability, sustainability, and therapeutic environment were identified and linked with the quantitative layout methods. It was also found that rural communities have different needs to urban ones with regard to access to medical care, prominent illnesses, and attitudes towards health. The healthcare personnel shortages are particularly problematic for rural communities. The quantitative layout design methods involved layout models, solution methods (exact methods, metaheuristics, and hybrid metaheuristics), and layout software. Using criteria of objectives, assumptions, inputs, outputs, and hospital design considerations, the Quadratic Set Covering Problem was determined to be the most appropriate model for designing a rural hospital block diagram layout. It was deemed possible to integrate the quantitative and qualitative methods by embedding the qualitative data into this quantitative model. The rural hospital design framework was developed using Excel VBA and RStudio. The framework was validated via two routes. Firstly, semi-structured interviews were conducted with experts in the field, i.e. expert analyses. Secondly a case study of the Semonkong Hospital Project was employed wherein the framework was applied successfully. The framework was deemed valid according to both the expert analyses and the case study. iii Stellenbosch University https://scholar.sun.ac.za OPSOMMING Die uitleg van ‘n gebou het ‘n belangrike impak op die bedrywighede van ‘n organisasie – veral in die konteks van gesondheidsorg waar daar met pasiënte se lewens gewerk word. Dit is ‘n ingewikkelde probleem wat oor langtermyneffekte beskik en dikwels teenstrydige doelwitte. Die literatuur vir uitleg ontwerpsmetodes het meestal gefokus op óf kwantitatiewe óf kwalitatiewe uitleg ontwerpsmetodes. Hierdie studie ontwikkel ‘n generiese raamwerk wat beide van hierdie metodes gebruik om ‘n gebruiker te lei om die uitleg van ‘n plattelandse hospital te ontwerp wat die gepaste wette en standaarde en die gesondheid van die omliggende gemeenskap in ag neem. Landelike- en stedelike gemeenskappe verskil in terme van hul lewenstyl, gesondheid en tipe siektes. Algemene uitleg ontwerpsmetodes is dus nie noodwendig geskik vir ‘n plattelandse hospitaal nie. Daar is dus ‘n behoefte om ‘n raamwerk te ontwikkel wat spesifiek is vir die uitleg van ‘n plattelandse hospitaal. Hierdie studie volg ‘n gemengde metode benadering en ‘n sistematiese literatuurstudie is gevolglik afsonderlik gedoen op kwantitatiewe- en kwalitatiewe uitleg ontwerpsmetodes met die doel om die mees geskikte ontwerpsmetodes vir ‘n hospitaal uitleg te bepaal. Die verskille en ooreenkomste tussen landelike- en stedelike hospitale was ook ondersoek. Hierdie sluit in wette en standaarde wat van toepassing is op hospitaal uitlegte. Die kwalitatiewe uitleg ontwerpsmetodes het verskillende uitleg prosedures ondersoek en dit is gevind dat Muther se Sistematiese Uitleg Prosedure die mees geskik is vir die probleem van hierdie studie. Daar is gevind dat die hoof ontwerpsoorwegings vir die uitleg van ‘n hospitaal pasiënt- gesentreerdheid, doeltreffendheid, aanpasbaarheid, volhoubaarheid en terapeutiese omgewing is. Daar is gevind dat landelike- en stedelike gemeenskappe verskil in terme van hul toegang tot mediese sorg, prominente siektes, en hul houdings teenoor gesondheid. Een van die grootste probleme in landelike hospitale was hul tekort aan personeel. Die kwantitatiewe uitleg ontwerpsmetodes sluit uitleg modelle, oplossingsmetodes (presiese metodes, metaheuristieke en hibriede metaheuristieke) en uitleg sagteware in. ‘n Kriteria van doelwitte, aannames, insette, uitsette en hospitaal ontwerpsoorwegings was gebruik om die mees geskikte uitleg model te kies naamlik: die ‘Quadratic Set Covering Problem’. Dit is gevind dat die kwantitatiewe- en kwalitatiewe uitleg ontwerpsmetodes deur middel van ‘embedding’ geïntegreer kan word. Die uitleg ontwerp raamwerk vir plattelandse hospitale was ontwikkel met behulp van Excel VBA en RStudio. Die raamwerk is bekragtig deur twee roetes. Eerstens, semi-gestruktureerde onderhoude was gevoer met kundiges in die velde van gesondheidsorg, plattelandse gemeenskappe en uitleg ontwerp. Tweedens, die raamwerk is toegepas op ‘n gevallestudie van die Semonkong Hospitaal Projek. Albei roetes dui daarop dat die raamwerk geldig is. iv Stellenbosch University https://scholar.sun.ac.za ACKNOWLEDGEMENTS “Not to us, Lord, not to us but to your name be the glory, because of your love and faithfulness.” Psalm 115:1 NIV I would like to express my sincerest appreciation to the following people who played an important role during the course of this study: First and foremost my supervisor, Ms Louzanne Bam, for her constant guidance, wisdom and patience throughout this study. I wish you every success and happiness. The Department of Industrial Engineering, for assisting me throughout my studies. The Semonkong Hospital Project, for their time, assistance and advice. My family, for their love and support. Michael, your encouragement, support, and company has made time spent working a treasured memory. v Stellenbosch University https://scholar.sun.ac.za TABLE OF CONTENTS DECLARATION .............................................................................................................................................. ii ABSTRACT ................................................................................................................................................... iii OPSOMMING ................................................................................................................................................ iv ACKNOWLEDGEMENTS ............................................................................................................................. v LIST OF SYMBOLS ..................................................................................................................................... xii LIST OF ACRONYMS .................................................................................................................................. xv LIST OF FIGURES ......................................................................................................................................xvi LIST OF TABLES ..................................................................................................................................... xviii LIST OF ALGORITHMS ............................................................................................................................xxi CHAPTER 1 INTRODUCTION ................................................................................................................... 1 1.1 Introduction .................................................................................................................................................................. 2 1.2 Background ..................................................................................................................................................................