Patient Flow Redesign in a Hospital Lobby: Combining Discrete Event Simulation and Multi-criteria Decision Analysis

Improvement of hospital efficiency through designing streamlined processes and implementing new tools and technologies for flow management leads to reduced patient waiting time and minimized provider operational costs while increasing resource utilization. An urban hospital sought to enhance security while improving efficiency by redesigning its patient flow through the lobby, leveraging evidence-based insights and collaborative decision-making to ideate lobby design concepts and select the ideal configuration. The objectives of the study were to identify various inflows and outflow types in the lobby, quantify the inflow volumes, assess the impact of diverting certain employee flows to other locations/entrances on flow volumes, understand and document of current state lobby processes and functions, and determine capacity for turnstiles and other self-service check-in technologies. During the COVID-19 pandemic, extra considerations for the safety of patients were added to existing processes such as screening surveys and sanitization activities. These activities added to waiting times, congestion, and other complexities in the hospital lobby, resulting in highly manual processes for registration, verification, and admission that increased time spent in the lobby and negatively impacted the overall experience in the lobby. This study presents a value-focused thinking process integrating discrete event simulation (DES) methodology. Through collaborative sessions, the joint design, research, and clinical teams identified key design criteria, ideated options for fulfilling the criteria, and amalgamated design options into five lobby design concepts. DES was used as a quantitative approach to examine inflow volume, processing times, waiting times, and congestion areas by designing and testing various scenarios for each of the new lobby design options. The experimental results of the simulation model were used to optimize the utilization rate of various resources and to determine the optimal number of controlled access points and their location in the lobby layout. A multidisciplinary team conducted observation studies to understand the lobby environment, identifying pain points and inefficiencies. Using multi-criteria decision-making (MCDM), they evaluated design options based on patient and visitor experience, flow, and risk reduction. With DES, the team found the optimal layout: two self-service kiosks, five standing desks, and three turnstiles. This reduced waiting times by 5–8 min, minimized congestion, and decreased personnel resource utilization by 80%. For scheduled patients, a “one-stop” admitting and badging station reduced check-in time by 2–20 min. The re-engineered system improved flows, with modified podium-style desks and optical turnstiles enhancing staff and patient safety. The developed model used MCDM techniques and simulation under a short time frame, approximately six weeks from discovery through schematic plan option development and final decision on the optimal plan, while ensuring different stakeholders were engaged in the discovery process and decision-making through real-time collaboration in a virtual space. Therefore, this paper has practical significance for facilitating the conception of the complex processes of flow redesign in a healthcare setting and provides managers with analytical results based on real data and visual scenarios to make sound decisions.