Optimisation approaches for organising hospital infrastructure function

Given the premise that flexible infrastructure offers a way to increase hospital capacity, we present the first general optimisation framework and guide for systematically (re)organising the function of treatment areas and treatment spaces within a hospital to increase capacity. To motivate the need for our approach, we first demonstrate how sensitive the throughput of a hospital is to the function of infrastructure. This is achieved via the application of a novel multicriteria optimisation approach. In our illustrative example, a case mix landscape (i.e. a set of non-dominated case mix) was generated for various hospital configurations. A comparison of the case mix landscapes is insightful. It shows where differences in output occur and the exact nature of the outputs which can/cannot be realised. Motivated by these findings, we applied mixed integer programming techniques to optimise the function of treatment areas and treatment spaces subject to various technical constraints. Two novel strategic models are proposed for this purpose. In different ways, they revise access of specialties to different operating rooms, wards, and their associated ward beds. A case study of a large tertiary hospital demonstrates the efficacy of these models and the practical ramifications.