Decision Making and Decision Support During the Design of Healthcare Facilities: A Systematic Review
Abstract
1. Introduction
1.1. Decision Analysis, Behavioral Decision Making, and Related Areas of Inquiry
1.2. What Defines the Quality of a Decision?
1.3. Objectives of This Review
- Identify trends and areas of focus with respect to HCFD DM, including the types of decision problems that arise during design and the methods and approaches that have been proposed to improve decision quality.
- Examine how HCFD decision-making processes are described and what challenges and approaches have been discussed, including group processes and dynamics as well as decision-making tools and methodologies.
- Identify knowledge gaps with respect to group decision-making processes and interprofessional dynamics.
- Identify opportunities for future research related to a better understanding of decision flows and improved decision quality.
2. Methods
2.1. Identification
- ((ALL = (“healthcare design”)) OR ALL = (“healthcare design”)) AND ALL = (“decision”).
- ((ALL = (“facility design”)) OR ALL = (“healthcare”)) AND ALL = (“decision”).
- ((ALL = (“healthcare”)) OR ALL = (“facility design”)) AND ALL = (“design process”).
2.2. Screening and Inclusion
- Exclusion Criteria:
- Conference papers to limit scope to peer-reviewed journals.
- No specific references to HCFD decision making or process.
- Papers focused on facility location problems.
- Non-English-language articles.
- Eligibility Criteria:
- Published between 1 January 2013 and 15 February 2024.
- English-language articles.
- Related to healthcare facility planning and/or design, defined as activities related to the shape, sizing, layout, or configuration and interior design (equipment and/or materials) and associated operational aspects of a new or existing healthcare facility, including hospital, residential, and outpatient facilities.
- Containing specific references to decision making or decision support.
2.3. Coding and Thematic Analysis
3. Results
3.1. Trends
3.2. Decisions and Decision Making in HCFD
3.3. Decision Making in the Context of HCFD Frameworks
3.4. Decision Flows and Decision Quality in HCFD
3.5. Stakeholder Roles and Participation in HCFD Decision Making and Design Process
3.6. What Types of Decision Problems Arise During Design, and What Methods and Approaches Have Been Proposed and Studied to Improve Decision Quality?
3.6.1. Decision Problem Focus Area 1: Specialized Room or Departmental Design
3.6.2. Decision Problem Focus Area 2: Departmental and Interdepartmental Facility Layout or Spatial Relationships/Space Planning
3.6.3. Decision Problem Focus Area 3: Point-in-Time Selection of Materials, Equipment, or Departments
4. Discussion
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Abbreviations
ABM | Agent-based Modeling |
AHP | Analytic Hierarchy Process |
AI | Artificial Intelligence |
BIM | Building Information Management |
BOR | Behavioral Operations Research |
CBA | Cost-Benefit Analysis |
CEDM | Cognitive Engineering and Decision Making |
COMET | Characteristic Objects Method |
DA | Decision Analysis |
DCE | Discrete Choice Experiment |
DANP | DEMATEL Analytic Network Process |
DES | Discrete Event Simulation |
DM | Decision Making |
DQ | Decision Quality |
DQC | Decision Quality Chain |
EBD | Evidence-based Design |
EFA | Exploratory Factor Analysis |
ELECTRE | Elimination and Choice Expressing Reality |
FMEA | Failure Mode and Effects Analysis |
HCFD | Healthcare Facility Design |
HFLP | Healthcare Facility Layout Problem |
LEL | Lean Exploration Loops |
MCDM | Multi-criteria Decision Making |
NDM | Naturalistic Decision Making |
OR/OM | Operations Research/Operations Management |
PDP | Participatory Design Process |
POE | Post-occupancy Evaluation |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
QAP | Quadratic Assignment Problem |
SSA | Space Syntax Analysis |
SLP | Systematic Layout Planning |
SMEs | Subject Matter Experts |
SRF | Simon Roy Figueras Method |
TOPSIS | Technique for Order Preference by Similarity to Ideal Solution |
WSM | Weighted Sum Method |
Appendix A
Specialized Environments Decision Problems | DQC Dimensions | |||||||
---|---|---|---|---|---|---|---|---|
Setting | Method(s) (Citation) | Country * | Clear Values | Helpful Frame | Creative Alts. | Useful Info. | Sound Reasoning | Commit. to Action |
Behavioral and Mental Health Hospital | Literature review [138] | INTER (AUS) | ✓ | ✓ | ||||
Children’s Hospital | Delphi technique [110] | IND | ✓ | ✓ | ||||
Children’s Hospital | Simulation-based Hospital Design Testing (SbHDT) & mock-ups, FMEA [64] | USA | ✓ | ✓ | ||||
Children’s Hospital | SAFEE/SbHDT & mock-ups [114] | USA | ✓ | ✓ | ||||
Children’s Outdoor Therapy Spaces | Delphi technique (fuzzy), survey, EFA, DANP [111] | CHN | ✓ | |||||
Community Health Center | Causal relation mapping, survey, AHP, TOPSIS [107] | USA | ✓ | |||||
Healthcare Design (generally) | Physical mock-ups & clinical simulation [141] | USA | ✓ | ✓ | ||||
Healthcare Design (generally) | Literature review & synthesis [104] | N/S (USA) | ✓ | |||||
Hospital Admissions Lounge | Erlang loss model, survey [144] | NLD | ✓ | ✓ | ||||
Hospital Elevator Maintenance | Literature review, survey, checklist [61] | SAU | ✓ | |||||
Hospital Emergency Department | Mixed methods (interviews & surveys) [137] | USA | ✓ | |||||
Hospital Emergency Department | Lean thinking with DES [145] | CAN | ✓ | |||||
Hospital Infection Mitigation | Mock-ups SME engagement [129] | SWE | ✓ | ✓ | ||||
Hospital Infection Mitigation | Literature review, SME consultation [106] | USA | ✓ | |||||
Hospital Infection Mitigation | Literature review, survey, ANP, DEMATEL, EFA [172] | CHN | ✓ | ✓ | ||||
Hospital Inpatient Room | BIM collision-detection method [65] | CHN | ✓ | |||||
Hospital Inpatient Room | Computational modeling [98] | USA | ✓ | ✓ | ||||
Hospital Inpatient Room | Design advisory council, augmented reality, & heat mapping [23] | USA | ✓ | ✓ | ||||
Hospital Inpatient Room | Literature review [103] | INTER (USA) | ✓ | |||||
Hospital Inpatient Room | Discrete choice experiment, survey [143] | NLD | ✓ | ✓ | ||||
Hospital Inpatient Room | Literature review [60] | INTER (USA) | ✓ | ✓ | ||||
Hospital Inpatient Room | Mixed methods (interviews & surveys) [108] | USA | ✓ | ✓ | ||||
Hospital Inpatient Room | Literature review, stakeholder SME consultation [99] | USA | ✓ | ✓ | ||||
Hospital Intensive Care Unit | Delphi technique; PSSI [173] | CAN | ✓ | ✓ | ||||
Hospital Intensive Care Unit | Observation/work mapping [105] | CAN | ✓ | ✓ | ||||
Hospital Medication Room | VR mock-ups [82] | USA | ✓ | ✓ | ||||
Hospital Operating Room | OR evaluation toolkits, including clinical simulation/mock-up [142] | USA | ✓ | ✓ | ||||
Hospital Operating Room | Lean Exploration Loops (process mapping & stakeholder workshops) [130] | USA | ✓ | ✓ | ||||
Hospital Radiology and Imaging | Case studies, BIM [81] | SWE | ✓ | ✓ | ||||
Hospital Temperature and Lighting Controls | Construction document review & literature synthesis [174] | USA | ✓ | |||||
Inpatient Room - Patient Falls Mitigation | Literature review [60] | INTER (USA/GBR) | ✓ | |||||
Inpatient Room - Patient Privacy and Comfort | Construction document review & literature synthesis [140] | USA | ✓ | ✓ | ||||
Inpatient Unit Team or Nurse Stations | Literature review, survey, synthesis [102] | USA | ✓ | ✓ | ||||
Occupant health | Literature review & synthesis [91] | N/S (USA) | ✓ | |||||
Oncology Inpatient unit | POE, survey [126] | USA | ✓ | |||||
Outpatient Breast Care Center | Literature review, survey, checklist [175] | INTER (USA) | ✓ | ✓ | ||||
Outpatient Supervised consumption | Surveys [109] | CAN | ✓ | ✓ | ||||
Rehabilitation Hospital | Mixed methods (interviews & surveys) [139] | AUS | ✓ | ✓ |
Layout/Spatial Decision Problems | DQC Dimensions | |||||||
---|---|---|---|---|---|---|---|---|
Setting | Method(s) & Citation | Country * | Clear Values | Helpful Frame | Creative Alt. | Useful Info. | Sound Reasoning | Commit. to Action |
HCFD (generally) | Multi-objective QAP, genetic programming [112] | TUR | ✓ | ✓ | ||||
HCFD (generally) | DES, RTLS & SSA [150] | USA | ✓ | ✓ | ||||
HCFD (generally) | Integrated multi-attribute group decision making (MAGDM) [155] | CHN | ✓ | ✓ | ||||
HCFD (generally) | SSA [154] | INTER (EGY/ USA) | ✓ | ✓ | ||||
Hospital Emergency Department | Fuzzy TOPSIS and Graph Heuristic Theories [68] | EGY | ✓ | ✓ | ||||
Hospital Emergency Department | Survey & Checklist [157] | USA | ✓ | ✓ | ||||
Hospital Emergency Department | DES & SSA [21] | USA | ✓ | ✓ | ||||
Hospital Facilities | MCDM Hospital Design Support System with Simulation [27] | INTER (NLD) | ✓ | |||||
Hospital Facilities | Entropy & Graph Heuristics Theory [153] | EGY | ✓ | ✓ | ||||
Hospital Facilities | Hybrid MCDM: ELECTRE/Apple’s Layout Procedure [151] | IND | ✓ | ✓ | ||||
Hospital Facilities | Hierarchical modeling with decomposition algorithm [149] | GER | ✓ | ✓ | ||||
Hospital Intensive Care Unit | Lean principles; systems dynamics [79] | ITA | ✓ | |||||
Hospital Medical/Surgical Unit | Multi-objective optimization & simulation [75] | CHN | ✓ | ✓ | ||||
Hospital Radiology and Imaging Dept | SLP with cluster analysis [152] | BRA | ✓ | ✓ | ||||
Hospital Sterilization Unit | Integrated SLP, MCDM, with Lean techniques [148] | BRA | ✓ | ✓ | ✓ | |||
Hospital Surgery Unit | SHELL; Fuzzy AHP [156] | CHN | ✓ | |||||
Hospital Surgery Unit | Lean Exploration Loops [131] | USA | ✓ | ✓ | ✓ |
Selection Decision Problems (Equipment, Materials, Departments) | DQC Dimensions | |||||||
---|---|---|---|---|---|---|---|---|
Setting | Method(s) (Citation) | Country * | Clear Values | Helpful Frame | Creative Alts. | Useful Info. | Sound Reasoning | Commit. to Action |
Healthcare Facility Design (generally) | Survey, Nominal Group Technique, DEMATEL, WSM [77] | IRN | ✓ | ✓ | ||||
Healthcare Floor Finishes | Weighted checklist based on literature review, survey [67] | USA | ✓ | ✓ | ||||
Healthcare Infection Mitigation Materials | Mixed methods (literature review & surveys) [119] | USA | ✓ | ✓ | ||||
Healthcare Interior Materials Selection | Design Environment Material Integrative Control (PtD-EMIC) instrument [158] | USA | ✓ | |||||
Hospital Corridor Connector | Systems focused Simulation with FMEA [117] | CAN | ✓ | |||||
Hospital Indoor Air Quality Selection | Hospital Environmental Appraisal Thermal comfort (HEAT) tool [89] | N/S (SAU) | ✓ | ✓ | ||||
Hospital Infection Mitigation | Algorithm and integrated MCDM techniques [26]) | IRN | ✓ | ✓ | ||||
Hospital Radiology room shielding alternatives | LCA [159] | ESP | ✓ | ✓ | ||||
Hospital Ventilation systems | Survey, Bayesian decision modeling [29] | USA | ✓ | ✓ |
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Mastrangelo Gittler, A.B.; Lam, S.S. Decision Making and Decision Support During the Design of Healthcare Facilities: A Systematic Review. Buildings 2025, 15, 2474. https://doi.org/10.3390/buildings15142474
Mastrangelo Gittler AB, Lam SS. Decision Making and Decision Support During the Design of Healthcare Facilities: A Systematic Review. Buildings. 2025; 15(14):2474. https://doi.org/10.3390/buildings15142474
Chicago/Turabian StyleMastrangelo Gittler, Alice B., and Sarah S. Lam. 2025. "Decision Making and Decision Support During the Design of Healthcare Facilities: A Systematic Review" Buildings 15, no. 14: 2474. https://doi.org/10.3390/buildings15142474
APA StyleMastrangelo Gittler, A. B., & Lam, S. S. (2025). Decision Making and Decision Support During the Design of Healthcare Facilities: A Systematic Review. Buildings, 15(14), 2474. https://doi.org/10.3390/buildings15142474