Automated compliance checking in healthcare building design

Regulatory frameworks associated to building design are usually complex, representing extensive sets of requirements. For healthcare projects in the UK, this includes statutory and guidance documents. Existing research indicates that they contain subjective requirements, which challenge the practical adoption of automated compliance checking, leading to limited outcomes. This paper aims to propose recommendations for the adoption of automated compliance checking in the design of healthcare buildings. Design Science Research was used to gain a detailed understanding of how information from existing regulatory requirements affects automation, through an empirical study in the design of a primary healthcare facility. In this study, a previously proposed taxonomy was implemented and refined, resulting in the identification of different types of subjective requirements. Based on empirical data emerging from the research, a set of recommendations was proposed focusing on the revision of regulatory documents, as well as to aid designers implementing automated compliance in practice

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Exploring Mistakeproofing in Healthcare Design

The process of verifying the compliance of design solutions to regulations is critical in healthcare design due to the complexity of the requirements present in healthcare settings. The majority of previews research concentrates on “mistake-searching”, assuming that design will not be compliant and, as such, necessitates an approach focussed on finding inconsistencies, rather than avoiding mistakes during the design process. This paper reports findings of an ongoing research that follows the Design Science Research approach, with the aim of exploring how existing technologies can support incorporating mistakeproofing (poka yoke) into healthcare design, framed within the regulations compliance process. A set of technological strategies was assessed according to mistakeproofing principles. The analysis evidenced their characteristics, benefits, limitations and examples of application. These technologies rely on the use of hybrid approaches, providing assistance to designers across all design stages, which in turn supports better decision-making and contributes towards improving value generation. A theoretical framework was proposed based on the synergy between design support systems, requirements subjectivity and jidoka. It highlights the importance of better understanding and enhancing the relationship between human designers and different technologies through automation

Designers’ perspective on the use of automation to support regulatory compliance in healthcare building projects

Automation has been long explored to improve regulatory compliance during building design. Despite substantial research efforts on developing means to enable this process, there has been limited success in practical implementations. Designers’ inputs are often undervalued in such developments, leading to solutions that are not effectively incorporated into the design process. This issue is even more difficult in healthcare projects due to their complexity and convoluted regulatory frameworks. In this paper, we describe how designers perceive the use of automation to support regulatory compliance in healthcare projects, through the analysis of a series of semi-structured interviews. We found that regulatory documents have a large influence on design and their compliance often consists of an unformalised process in practice. Furthermore, we identified that subjectivity is perceived in requirements as needed due to the creativity involved in design, whereas automation can be understood as liberating in this context depending on how it is used. Improvement needs focussing on the revision of the regulatory framework as well as on software development have been highlighted by participants during the interviews, which led to the proposition of recommendations to help achieve their benefits in practice

Regulation checking during facility design

This article presents a short overview of research outcomes that will be of benefit to practitioners in dealing with checking healthcare designs regulatory compliance and how compliance checking could be automated during the design process

Automated Regulatory Compliance towards Quality Assurance in Healthcare Building Projects

Healthcare building projects are severely constrained by their associated regulatory frameworks. In this context, regulatory requirements define a basic outline upon which design is developed, as well as aid designers towards compliance to minimum standards. Automation has been explored by existing research focusing mostly on compliance checking (i.e., quality control). There has been limited developments within this domain related to quality assurance. This paper aims to highlight what are key needed improvements to enable the use of automation to promote quality assurance for regulatory compliance in healthcare building projects. For this purpose, an ongoing revision of a British healthcare design guidance document (HBN 11-01) was analysed according to a requirements' taxonomy. Key areas of improvement needs were highlighted based on a series of interviews. Our main findings relate to identifying that despite the guidance character of regulatory documents in the UK, they are rarely used for this purpose, revealing the focus on quality control. In this context, the regulatory framework could be repositioned as a catalyst towards automated design quality assurance as long as (i) the regulatory documents are developed and revised to fit automated design processes; and (ii) there are compatible software developments to streamline design processes through automation

A Semantic-based Framework for Automated Rule Checking in Healthcare Construction Projects

Healthcare projects are known for having a high degree of complexity. Furthermore, the design of healthcare facilities is highly constrained by regulations containing a wide range of requirements. Using BIM for automated rule checking has been pointed out as an opportunity to improve requirements management in these projects. However, most existing research is focused on hard-coded approaches or on limited sets of requirements. The aim of this investigation is to propose a semantic-based framework for automated rule checking in the context of healthcare design. An empirical study was conducted in the redevelopment of a university hospital, using Design Science Research as a methodological approach. Results indicate that the nature of regulations and the subjectivity of requirements have a major impact on the possibility of their translation into logical rules, which is needed to enable automated checking. The main theoretical contribution is a taxonomy for automated rule checking and information transformation.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author