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Planning and Selection of Facility Layout in Healthcare Services

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Planning and Selection of Facility Layout in

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Vinaytosh Mishra

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Hospital Topics
https://doi.org/10.1080/00185868.2022.2088433

Planning and Selection of Facility Layout in Healthcare Services

Vinaytosh Mishra
College of Healthcare Management and Economics, Gulf Medical University, Ajman, UAE

ABSTRACT KEYWORDS
Facility layout planning (FLP) is an integral part of the hospital layout design. The purpose Diabetes clinic; facility layout
of this article is to develop and elaborate a FLP method for a diabetes clinic using a case planning; Systematic Layout
study approach. In this study, the Systematic Layout Planning (SLP) approach was used to Planning (SLP); Fuzzy–TOPSIS;
design three alternatives to diabetes clinic design using group decision making. A modified digital logic (MDL)
multi-criterion decision-making (MCDM) approach, fuzzy-Technique for an order of preference
by similarity to an ideal solution (fuzzy-TOPSIS) was used to select the best among the
alternatives. The method used for the calculation of weight for various selection criteria was
modified digital logic (MDL). The study elaborates the method using a diabetes specialty
clinic but can be used for solving more complex selection problems as well. The research
is the first of its kind to address the problem of FLP in the case of a diabetes clinic. The
method can be easily adapted for layout selection in other specialty and multispecialty
hospitals.

Introduction in the health care industry. This situation makes

Facility layout problems are predominantly related
to manufacturing organizations. It is typically
associated with the location of facilities, like
machines and departments, in a manufacturing
unit (Drira, Pierreval, and Hajri-Gabouj 2007).
It is a special type of location problem which
aims at minimizing in-house travel distances or
costs associated with the positions of organiza-
tional units inside a facility (Laporte, Nickel, and
da Gama 2015). It is also widely used in the
service industry for designing block layout plans
as it considers the assignment of services to the
proper locations. FLP helps an organization in
enhancing its potential to prosper in a dynamic
business setting (Tranfield and Akhlaghi 1995).
There is sufficient extant literature to suggest that
a good layout helps an organization improve its
business performance (Canen and
Williamson 1996).
It is desired that hospitals are easily accessible
by patients hence are located at prime locations
(Schultz 1970). Thus, real estate cost becomes
one of the major components of the fixed cost
it imperative that facilities get efficiently utilized.
Lin et  al. in their work conclude that the facility
layout not only addresses the problem of cost
reduction but also contributes to the efficiency
of the process in a healthcare setting (Lin et  al.
2015). Literature is abundant on facility layout
planning (FLP) in manufacturing but it is scarce
about FLP in health care, especially diabetes care.
The management of diabetes requires an inter-
disciplinary team of healthcare professionals
(Childs 2005; Willens et  al. 2011). A diabetes
clinic has various departments like physician con-
sultation chambers, pathology, diabetes education
(DE), and medical nutrition (MN) therapy
(Mishra, Samuel, and Sharma 2018). A
well-planned layout can help in reducing the
effort of healthcare professionals and improve the
overall healthcare environment in the case of
diabetes management. To the best of our knowl-
edge, there is the absence of any literature on
facility planning using a case of diabetes clinics.
This article attempts to fill this research gap. The
article uses the case of a diabetes clinic for

CONTACT Vinaytosh Mishra vinaytosh@gmail.com College of Healthcare Management and Economics, Gulf Medical University, Ajman, UAE.
© 2022 Taylor & Francis Group, LLC
2 V. MISHRA
elaborating the FLP but the approach can be used
for solving the facility layout problem for other
clinics also.
Literature Review
The FLP is an integral part of the hospital
layout design. Although facility planning is a
strategic decision, the spatial organization
within hospitals directly influences the quality
and efficiency of healthcare as well as patient
satisfaction (Chaudhur y, Mahmood, and
Valente 2005; Choudhary et  al. 2010; Hignett
and Lu 2010). There are two approaches for
solving a FLP namely qualitative and quanti-
tative. A qualitative approach is appropriate
for designing the layout when quantitative data
is difficult to obtain. From extant literature,
we can find many approaches to solving a FLP.
Many of these approaches use advanced algo-
rithmic techniques like the genetic algorithm
or ant colony optimization algorithm (Chen
2013; Gonçalves and Resende 2015). It has
been over six decades since Koopmans and
Beckmann published their seminal article on
modeling the FLP. Since then, there have been
numerous attempts to improve these research-
ers’ original quadratic assignment problem
(QAP) (Rabbani, Elahi, and Javadi 2017;
Hosseini-Nasab et  al. 2018). Dokeroglu et  al.
in their article use artificial bee colony opti-
mization for solving the QAP (Dokeroglu,
Sevinc, and Cosar 2019). Şahinkoç and Bilge
in their article uses a genetic algorithm to
solve the Facility layout problem with QAP
formulation under scenario-based uncertainty
(Şahinkoç and Bilge 2018). Abdel-Basset et  al.
in their research work integrate the Whale
Algorithm with Tabu Search for QAP
(Abdel-Basset et  al. 2018). Yeh in his work has
tried solving QAP using an Annealed Neural
Network (Sharma and Singhal 2017). These
algorithm approaches are complex and require
advanced training in mathematical models.
There is another category of an approach
called the procedural approach for solving an
FLP. These approaches use qualitative as well as
quantitative data for the facility design process.
The prevalent procedural approaches for solving
a FLP are Nadler’s procedure, Immer’s procedure,
Systematic Layout Planning (SLP), Apple’s pro-
cedure, and Reed’s procedure (Tompkins et  al.
1996). SLP is a procedural layout design approach
developed by Muther in 1961. Since then, it is a
widely used tool used by academicians and
researchers (Mardani, Jusoh, and Zavadskas
2015). The SLP can be used for generating the
choices of layout out of which we can select the
alternative on the basis of different decision
criteria.
Layout design often has a significant impact
on the performance of a hospital and is usually
a multiple-objective problem. Mardani et  al. pre-
sented a two-decade review from 1994 to 2014
on fuzzy multiple criteria decision-making tech-
niques; their study highlighted the application
of fuzzy DEMATEL, fuzzy VIKOR, fuzzy AHP,
and fuzzy TOPSIS approaches for solving the
problem of facility layout (Yang and Kuo 2003).
In their research article, Yang and Kuo proposed
a mix of the Analytic Hierarchy Process and
Data Envelopment Analysis approach to solving
a FLP (Bozorgi, Abedzadeh, and Zeinali 2015).
Bozorgi et  al. in their article attempt to solve
the dynamic facility layout problem using data
envelopment analysis with consideration of some
specific criteria which are cost, adjacency, and
distance (Çebi and Otay 2015). Çebi and Otay
have implemented the fuzzy TOPSIS methodol-
ogy in facility location selection problems
(Elshafei 1977).
Layout planning problems in healthcare were
first introduced four decades back by Elshafei
(Yang and Hung 2007). In his seminal article,
Elshafei modeled a hospital layout problem as a
QAP and developed a heuristic to solve it. The
criteria for decision-making are usually vague in
the case of hospital layout planning. Fuzzy AHP
and fuzzy TOPSIS are the more preferred and
widely used techniques when the problem consists
of vague and inaccurate criteria weights and per-
formance (Yang and Hung 2007; Ataei and Branch
2013; Çebi and Otay 2015). This study uses
fuzzy-TOPSIS methodology for selecting the facility
layout for a diabetes clinic from the alternatives.
The reason for the selection of the methodology
being its relative simplicity and ease of implemen-
tation (Sharma and Singhal 2017).

Research Objective
The first objective of this study is to identify
various departments/functional units in a diabetes
specialty clinic. The second objective is to pro-
pose and use an approach for solving facility
layout problems in the case of a diabetes clinic.
Research Methodology
This research uses a two-phase approach for solv-
ing the FLP. Firstly, it uses SLP for generating
alternatives for the facility layout for the diabetes
clinic. Then it uses Fuzzy-TOPSIS for selecting
the best alternative out of those choices gener-
ated. For both phases, this study uses group
decision-making of the healthcare professionals.
A focus group containing one doctor, one dia-
betes educator, and one physician assistant was
created for the group decision-making. A rela-
tionship diagram is created using the input data
such as the frequency of communication and the
need for adjacency. Muther’s grid was used to
draw the relationship diagram using the group’s
input. The degree of closeness was represented
using six letters: A, E, I, O, U, and X. An exam-
ple of Muther’s grid in the case of the manufac-
turing system is depicted in Figure 1.
The unstructured interview of the focus group
helped us in identifying eight departments of the
diabetes clinic. The departments of a diabetes
clinic identified were: Patient Registration (PR),
Diabetes Consultation (DC), DE, Eye & Foot
Examination (EF), Pharmacy (PH), Pathology Lab
(PL), MN, and Waiting Area (WA).
Figure 1.  Muther’s grid and description of codes.
Hospital Topics 3
From the relationship diagram, the pairs repre-
sented by letters A and X were identified. The pair
of departments related to A was first placed as
close as possible then the departments related to
X were placed as far as possible. This arrangement
gave us different alternatives. The alternatives were
judged on four criteria namely: initial cost in set-
ting up the layout (CL), expected operating costs
(OC), the amount of effective capacity (EC) cre-
ated, and the ease of modifying (EM) the system.
These criteria were finalized based on focus group
discussion. The Fuzzy–TOPSIS method was used
for ranking the alternatives in order of preference.
Fuzzy Logic
A fuzzy set A  in a universe of discourse X is
characterized by a membership function µ A (x )
that associates each element x in X with a real
number in the interval [0,1] . The function value
µ A (x ) is termed as the grade of membership of
x in A  . This study uses linguistic variables for
the rating of alternatives on different criteria. The
linguistic variables are then converted into trian-
gular fuzzy numbers for further processing.
Linguistic variables help deal with the situation
which are complex or ill-defined. A triangular
fuzzy number can be defined by a triplet (a, b, c)
shown in Figure 2. The membership func-
tion µ A (x ) is defined as given in Equation (1):
 0 x  a,
x a
 a  x  b,

 A (x )   b  a (1)
x c b  x  c,
bc
 0 x  c,

Fuzzy–TOPSIS
This section describes the steps used in
Fuzzy–TOPSIS.
Step 1: The three decision-makers were asked
to rate the three alternatives on four criteria,
which gave us three decision matrices of
order 3 X 4 . The linguistic variables in these deci-
sion matrices were replaced with a triangular
fuzzy number using the rule given in Table 1:
4 V. MISHRA

Table 2. Criteria used and categories.

Criteria Description Category
CL Initial cost in setting up layout Cost
OC Expected operating costs Cost
EC Effective capacity created Benefit
EM Ease of modifying Benefit

 aij bij cij 

Figure 2. A triangular Fuzzy number di * . rij   * , * , *  , c *j  max{cij }(benefit criiteria)
 cj cj cj  i
 
(5)
Table 1. Linguistic variables for the rating.
 a j a j a j  
rij   , ,  , a  min{aij }(coss t criteria)
Linguistic variable Fuzzy number  cij bij aij  j i
 
Very low (VL) (1,1,3)
Low (L) (1,3,5)
Average (A) (3,5,7)
Step 6: The weights calculated in Step (3) were
High (H) (5,7,9) used to calculate the weighted normalized fuzzy
Very high (VH) (7,9,9)
decision matrix from the normalized fuzzy deci-
sion matrix, Equation (6).
Step 2: The next step is to calculate the combined 

decision matrix for further calculation. The ele- v ij  r ij  w j (6)
ment of the combined decision matrix:
Step 7: Now the next step in the process is to
x ij = (aij , bij , cij ) (2) calculate Fuzzy Positive Ideal Solution (FPIS) and
Fuzzy Negative Ideal Solution (FNIS) using the
following rule:
1 K K
aij  min{aijK }, bij 
k

k k 1
bij , cij  max{cijK } (3)
k A*  (v1* , v2* ,....., vn* ) where v *j  max{vij 3 }
i
(7)
A   (v1 , v2 ,....., vn ) where v j  min{vij1 }
i
Step 3: The weight of the criteria was calculated
using modified digital logic (MDL). Pairwise Step 8: Once FPIS and FNIS are identified dis-
comparison of the criteria was done to fulfill this tance of each alternative from these points were
objective. The priority was assigned as 1 for less, calculated. The study uses the vertex method to
2 for equal, and 3 for more important. The sum calculate the distance between two fuzzy numbers
of the priority was called a positive decision for as follows.
the criteria given by p j . The positive decision
for criteria was divided by the sum of all positive 1
decisions to get Wj as: d( x , y )  [(a1  a2 )2  (b1  b2 )2  (c1  c2 )2 ] (8)
3
Pj
Wj  n
(4) This exercise gave us two matrices having a dis-
P j
tance, one each for FPIS and FNIS.
j 1 Step 9: Now the distance from the best solu-
Step 4: The next step is to categorize the criteria tion di* was calculated by summing the distance
as benefit and cost criteria. The benefit criteria of each criterion for the given alternative.
were maximized whereas cost criteria were min- Similarly, the distance from the worst solution
imized. Table 2 classifies various criteria used in di− is calculated. These values were used to cal-
this study into two categories. culate the closeness coefficient CCi using the fol-
Step 5: It is to compute the normalized fuzzy lowing formula.
decision matrix from the combined decision di
matrix using the rule given in Equation (5): CCi  (9)
di  di*
 Hospital Topics 5

Figure 3. Summary of research methodology used.

Step 10: The alternatives were arranged in Results and Discussion

decreasing order of closeness coefficient. The
This section discusses the results of the SLP and
alternative having the highest value CCi was
Fuzzy–TOPSIS method used for the selection of
selected.
facility layout for the given diabetes clinic. Using
The summary of the research methodology
heuristic as discussed earlier three alternatives of
discussed in this section is depicted in Figure 3.
the layout were generated. The alternatives are
depicted in Figures 5–7.
Case Study Now, these three alternatives were ranked on
basis of four criteria: initial cost in setting up the
The organization selected for the cases study is
layout (CL), expected OCs, the amount of EC
a diabetes specialty clinic in India. The eight
created, and the EM the system. The MDL was
departments/sections identified for the hospital
used to calculate the weight of various criteria.
were PR, DC, DE, EF, PH, PL, MN, and WA.
Three decision makes were asked to do a pairwise
The diabetes clinic wanted to design the layout
using a four-by-two grid with a gallery in
between. The research also identifies the various
criteria for the selection of the alternatives as
initial cost in setting up the layout (CL), expected
OCs, the amount of EC created, and the EM the Figure 5. Layout alternative 1 (A1).
system. The relationship diagram for the diabetes
clinic is depicted in Figure 4.

Figure 6. Layout alternative 1 (A2).

Figure 4.  Relationship diagram for diabetes clinic. Figure 7. Layout alternative 1 (A3).
6 V. MISHRA

comparison of these four criteria. The group con-
sensus was used to finalize the value of the pair-
wise comparison. The result is listed in Table 3.
Once the criteria weight is determined three
decision-makers were asked to rate three alter-
natives on four criteria in terms of the linguistic
variable given in Table 1. The decision matrix
for three decision-makers is listed in Tables 4–6.
The linguistic variables in the decision matrix
were replaced with the triangular fuzzy number
from Table 1, and the resulting matrix is listed
in Tables 7–9.
The decision matrix was then collated to get
a combined decision matrix using Equation (3)
mentioned in the methodology section. The
combined decision matrix is depicted in Table 10.
Once the combined decision matrix is obtained
Multiplying matrix given in Table 11, with cri-
teria weights the weighted normalized fuzzy deci-
sion matrix was obtained (Table 12).
Now, the next step is to calculate the FPIS and
FNIS from the Weighted Normalized Fuzzy
Decision Matrix (Table 13).
Once the FPIS and FNIS are determined, the
distance of alternatives from these solutions was
calculated using Vertex Method. The values di *
are calculated by summing up the distances for
each criterion. The distance of the alternatives
from the FPIS is listed in Table 14.
Similarly, the distance of the alternatives from
the FNIS was calculated. The distance of the
alternatives from the FNIS is listed in Table 15.
Finally, the last step is to calculate the close-
* −
ness coefficient CC using di and di . The closeness
i

the next step is to compute the normalized fuzzy coefficient for the three alternatives is listed in
decision matrix using the rule mentioned in Table 16. From Table 16, it is clear that A2 is
Equation (5). The resultant matrix is depicted in the most preferred alternative of layout fol-
Table 11. lowed by A3.

Table 3.  Weight of criteria using MDL.

CL OC EC EM Positive decision Weight
CL 2 3 3 3 11 0.3
OC 1 2 3 2 8 0.3
EC 1 1 2 2 6 0.2
EM 1 2 2 2 7 0.2

Table 4.  Decision matrix for doctor.

CL OC EC EM
A1 A H L L
A2 A A A L
A3 A A A L

Table 5.  Decision matrix for diabetes educators.

CL OC EC EM
A1 A A L L
A2 A A A A
A3 A A A L

Table 6.  Decision matrix for physician assistant.

CL OC EC EM
A1 A VH L L
A2 A A A A
A3 A A A L

Table 7.  Decision matrix for doctor with Fuzzy number.

CL OC EC EM
A1 (3,5,7) (5,7,9) (1,3,5) (1,3,5)
A2 (3,5,7) (3,5,7) (3,5,7) (1,3,5)
A3 (3,5,7) (3,5,7) (3,5,7) (1,3,5)
 Hospital Topics 7

Table 8.  Decision matrix for diabetes educator with Fuzzy number.
CL OC EC EM
A1 (3,5,7) (3,5,7) (1,3,5) (1,3,5)
A2 (3,5,7) (3,5,7) (3,5,7) (3,5,7)
A3 (3,5,7) (3,5,7) (3,5,7) (1,3,5)

Table 9.  Decision matrix for physician assistant with Fuzzy number.
CL OC EC EM
A1 (3,5,7) (7,9,9) (1,3,5) (1,3,5)
A2 (3,5,7) (3,5,7) (3,5,7) (3,5,7)
A3 (3,5,7) (3,5,7) (3,5,7) (1,3,5)

Table 10. Combined decision matrix.

CL OC EC EM
A1 (3,5,7) (3,7,9) (1,3,5) (1,3,5)
A2 (3,5,7) (3,5,7) (3,5,7) (1,4.33,7)
A3 (3,5,7) (3,5,7) (3,5,7) (1,3,5)

Table 11.  Normalized Fuzzy decision matrix.

Cost Cost Benefit Benefit
CL OC EC EM
A1 (3/7,3/5,1) (3/9,3/7,1) (1/7,3/7,5/7) (1/7,3/7,5/7)
A2 (3/7,3/5,1) (3/7,3/5,1) (3/7,5/7,1) (1/7,4.33/7,1)
A3 (3/7,3/5,1) (3/7,3/5,1) (3/7,5/7,1) (1/7,3/7,5/7)

Table 12.  Weighted normalized Fuzzy decision matrix.

CL OC EC EM
A1 (0.13,0.18,0.30) (0.10,0.13,0.30) (0.03,0.09,0.14) (0.03,0.09,0.14)
A2 (0.13,0.18,0.30) (0.13,0.18,0.30) (0.09,0.14,0.20) (0.03,0.12,0.20)
A3 (0.13,0.18,0.30) (0.13,0.18,0.30) (0.09,0.14,0.20) (0.03,0.09,0.14)

Table 13.  FPIS and FNIS solutions.

CL OC EC EM
* (0.13,0.18,0.30) (0.13,0.18,0.30) (0.09,0.14,0.20) (0.03,0.12,0.20)
FPIS ( A )
− (0.13,0.18,0.30) (0.10,0.13,0.30) (0.03,0.09,0.14) (0.03,0.09,0.14)
FNIS ( A )

Table 14.  Distance from the FPIS.

di*
CL OC EC EM
A1 0 0.03 0.06 0.04 0.13
A2 0 0 0 0 0
A3 0 0 0 0.04 0.04

Table 15.  Distance from the FNIS.

di−
CL OC EC EM
A1 0 0 0 0 0
A2 0 0.03 0.05 0.04 0.12
A3 0 0.03 0.05 0 0.08

Table 16. Closeness coefficients for alternatives.

di
CCi 
di* di− di  di*
A1 0.13 0 0
A2 0 0.12 1
A3 0.04 0.08 0.67
8 V. MISHRA
Conclusions
The FLP is an integral part of hospital layout
design. The cost of care largely depends on the
efficient utilization of the resources by the hos-
pital. If the resources like hospital space are not
efficiently utilized it will eventually result in
increased cost of care, which can make healthcare
out of reach of economically weaker sections of
the society. The efficient layout planning also
reduces the waste like undesired movement inside
the hospital. Moreover, a good layout has a pos-
itive impact on patient satisfaction. A method
like SLP can be used to create alternatives for
the hospital layout. The multi-criteria
decision-making approach like Fuzzy–TOPSIS can
be used to select the best alternatives out of these
alternatives. This study proposes and uses a SLP–
FUZZY–TOPSIS method for designing the layout
of a diabetes clinic under given constraint. The
method proposed in this study is simple at the
same time robust to deal with complex and
ill-defined conditions. The method proposed in
this study can be easily adapted for solving the
FLP problem for other hospitals.
Limitations and Future Directions
This article solves the FLP problem for a diabetes
clinic under given space constraint. The weight
given to the decision of different decision-makers
is taken as equal for simplicity. The future study
can use other robust methods like Fuzzy-Analytical
Hierarchy Process (AHP) for calculating the
weight of different criteria.
Funding
The author(s) reported there is no funding associated with
the work featured in this article.
ORCID
Vinaytosh Mishra http://orcid.org/0000-0002-6360-
910X
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