Lanes, clusters, lines of Sight: Modelling diagnostic eyecare clinics to improve patient flow

Lengthy waiting times for ophthalmology appointments in the UK National
Health Service (NHS) increased further in the immediate aftermath of the
Covid-19 pandemic, necessitating a different approach to triaging patients
safely and at speed. Moorfields Eye Hospital NHS Trust therefore opened an
additional diagnostic hub designed with a linear spatial layout and
patient flow system, which is analyzed in this paper in comparison to an
existing clinic. We integrate direct observations of patient flows, and an
architectural layout analysis based on space syntax methods with queuing
simulations from operations research and show that the two clinics operate
differently and that both clinics have their advantages and disadvantages.
The newly opened clinic with a lane system supports flows and coordination
by line of sight between stations, which contrasts with a lack of
sightlines in the existing clinic. The latter layout with clusters of
stations compensates by enabling a more organic flow, especially in
conjunction with experienced technicians, which is beneficial when the
clinic gets busy. When high patient load is simulated in the queuing
models, the lane system results in slightly bigger bottlenecks and longer
clinic durations. An ideal allocation of the number of stations to
diagnostic activities based on clusters is suggested. This work stands in
the tradition of combining architectural and operations research. By
reflecting on the variability of diagnostic processes found in our
observations, we contribute to the understanding of routines as
performative. We also add insight to the growing field of evidence-based
design, particularly by highlighting the importance of line-of-sight
relationships in ophthalmology.