Framework of Capacity Dimensioning Principles in Hospital Planning – Case Outpatient Department

Healthcare systems around the world are facing an enormous pressure to increase efficiency and effectiveness. Vast system and process level improvements are needed to overcome challenges, which include soaring demand and backlogs for healthcare services and a shortage of skilled work force. New cost-effective patient- and user-centric operational models need to be implemented to meet the expectations of individual customers and society.  A major trend is the transition from inpatient care services to outpatient department (OPD) services, in order to full fill healthcare services demand with lower costs and better customer experience. According to OECD, in Finland the total amount of hospital beds per capita has more than halved since the year 2001. Respectively, the total costs of OPD care have surpassed the total costs of inpatient care. Many operations, medical treatments, examinations, and therapies that previously required overnight stay are increasingly being treated in OPDs. This shift has been achieved through systematic operations analysis, service design, conceptualization, and in many cases facilities development, having major impacts on Finnish hospital design and engineering.

The shift to a more OPD based operations mode in Finland has been accompanied by a few other main developments, including a rapid increase in eHealth services, self-care, evening times being increasingly used in ambulatory care compared to the traditional peak hours. In addition, the workforce is multi-skilled, and innovative appointment concepts are used in many places. Based on over a hundred different hospital development cases, the writers have seen the difficulty, which architects, hospital engineers, and developers face: how should the changing care processes, changing volumes and changing resources be considered when the spaces and other resources are calculated in future hospital programs? The resource calculation and dimensioning of OPDs is perhaps the most challenging part of the early design phase. Healthcare systems in Europe could now benefit from the know-how and experience from Finland.

Based on our experience, we propose a solution how to systematically take all the relevant factors into account when calculating the resource requirements for future hospitals that fully enable all the benefits of OPDs. This idea is depicted in Fig. 1. We will also describe different approaches that have been used in the past and at current: 1) Empirical dimensioning, 2) Resource driven dimensioning, 3) Supply driven dimensioning and 4) Demand driven dimensioning. The outcome of an empiric dimensioning process is unreliable, and typically the person giving the empiric opinion base their estimates on the current mode of operations. Resource and supply driven dimensioning approaches are better than an empiric approach. The data from the operations is typically included in the calculations and change management methods are used. Only with a demand driven dimensioning approach all the fundamental factors are included. By following a systematic framework, all the right questions are presented, and management and users included in the process. Data analysis and modelling supports the decision process and the output from the calculations needs to be synchronized with e.g. service and workplace concepts.