Considering the ‘seven flows’ of healthcare

As an Architectural Design manager specialising in healthcare facilities, I prioritise the critical importance of the seven flows of healthcare — patient, staff, equipment, medication, waste, information, and supply chain, in every project, from small theatre upgrades to remote 22-bed clinics in Africa, and large-scale 350-bed masterplans in city centres. These flows form the backbone of efficient, compliant, and patient-centred healthcare environments.

In this article, I delve into each of these flows, highlighting their complexities, and the challenges in aligning them with stringent regulations (building and Department of Health) and end-user expectations. Often, these elements face pushback due to a lack of understanding or regulatory constraints, making clear communication vital. I emphasise the importance of presenting a comprehensive visual outline early in the process to ensure that all stakeholders share a common vision. This approach not only streamlines project execution, but also optimises the design, to enhance safety, workflow efficiency, and overall functionality.

Objectivity the key

Over my years of experience, I’ve learned that the key 
to successful healthcare design is objectivity — approaching each project without personal opinions that may not reflect end-user needs or future realities. By adhering to these principles, I aim to create healthcare environments that are not only compliant and functional, but also truly supportive of healthcare professionals and patients alike.

1: Patient flow

The most crucial flow in a healthcare facility is the movement of patients, from initial arrival to discharge. There are many elements within this process that can cause confusion and frustration. I consider patient flow to start from when a patient enters the site — from the street, through parking, and into the main reception. First impressions count. The priorities are always clear directional signage, easy access, and a friendly face to greet patients.

Effective design ensures smooth and efficient patient pathways, minimising waiting times and optimising the patient experience. If directional signage is unclear on the way to an appointment, it can cause anxiety. Our goal is to keep every patient or visitor calm and at ease upon entering the facility.

Patient flow also includes movement between units, such as to theatres, delivery rooms, or radiology. In very old facilities, the limited options for vertical circulation can be a challenge, but there is always a way to make it work. Regulations address passage widths, room sizes, and more. In some instances, where buildings are very old and passages cannot be widened, creativity is required. For example, forming a ‘lay-by’ in a passage can help alleviate congestion in restrictive areas.

2: Family/attendant flow

The phrase ‘family heals faster’ highlights how supportive family relationships can positively impact recovery from physical and emotional injuries or illnesses. As a designer, I always consider the needs of families.

The proximity of waiting areas to critical care units, theatres, and emergency centres, is crucial — both for open and closed spaces. The layout and design intent of waiting areas are critical. I always consult with my interior designer to ensure that a consistent ‘design theme thread’ runs throughout the facility. This can be subtle, but is important for creating a sense of calm. Patient rooms are also designed to avoid interfering with clinical care. Each room is divided into clinical/patient and public zones. This ensures that clinical providers can access the patient easily without having to move visitors.

3: Doctor/Care provider flow

This flow is vital to the efficiency of a facility. If the movement of medical staff, doctors, nurses, and other healthcare professionals is hindered, it can cause significant problems.

Regulations require central nurse stations, and some designs include satellite stations. We ensure that staff rest areas and unit manager offices are in close proximity for optimal control. Access to utility rooms is centralised to assist with rapid patient response.

While it is easier to design from scratch, such as with a greenfield facility, I enjoy the challenge of improving flows in existing layouts — and especially this particular flow. It’s not just about the movement to patient rooms, but also within patient rooms, theatres, or procedure rooms. Understanding what each provider does and their typical routes allows us to improve these flows, ensuring that all regulations and infection control measures are in place. This can be life-changing.

Implementing changes in existing facilities, especially where providers have worked the same way for 30 or more years, can be more challenging than meeting regulations. However, this is what inspires me as a designer: making change understandable and easy to adapt to.

4: Medicine flow

The flow and access to pharmaceuticals and other necessary medicines within a facility can sometimes be quite distant for certain units. Some facilities use pneumatic tube systems to transport prescriptions and deliver medication, but these come with their own challenges.

In South Africa, load shedding often leads to prolonged power outages. While all facilities have generators (as required by regulation), these may only support essential services, and tube systems may not be included. Often, human delivery is the most efficient and reliable, which requires clear pathways for medicine transport.

The placement of the pharmacy is critical. Ideally, it should be on the patient’s exit route for convenient medication collection, but its proximity to the units it supplies is also important. Each unit type has a specific process for medical storage, governed to some extent by the pharmaceutical council. However, only the main pharmacy designs are submitted for approval.

Most units have a clean utility (sterile store/medicine room), which is always central and visible from the nurse station. These rooms are temperature-regulated, and may have specific layouts and requirements. In our more critical units — such as critical care, neonatal, delivery, and theatre, schedule 5 and 6 drugs are stored in cupboards at the nurse station.

5: Information flow

Information flow refers to the movement of patient data, medical records, and other important information. This area is often overlooked or misunderstood. From the moment a patient is booked for a procedure, or assessed at the emergency centre, the information flow begins.

Currently, this flow is largely manual, whether by hand or computer, and can be time-consuming. As more facilities across Africa become electronic, I am always amazed at the background work required for this transition — not just training and change management, but also the unseen groundwork by users. While I believe this is the way forward, most facilities I have worked in still use a combination of manual and electronic record-keeping.

Patient information is captured electronically, printed on stickers, and carried in a patient file. This file is confidential. Once the hospital stay is complete, the file is handed to Administration, where all handwritten information is captured online and files are stored. Regulations require files to be stored for between 8 and 21 years. Most facilities have on-site archives for recent cases, but after a few years, files are moved off site for secure storage.

6: Supply flow

Supply flow refers to the movement of general supplies, such as linens, cleaning materials, and other consumables. I map out this flow in detail for every facility, though it is often left until last. The amount of storage required is determined not only by the facility’s size, number of beds, and type of procedures, but also by its accessibility to services and supplies. Outlying areas may need larger storage to minimise costly supplier trips.

The design of laundries, central cleaners’ stores, and kitchens, is critical. These spaces should be designed for efficient storage and distribution. Understanding how each unit operates ensures the correct placement and sizing of these areas, and access to deliveries.

The location of central cleaners’ stores and laundries can significantly impact turnaround times for patient units — an often overlooked factor. Each unit has its own cleaners’ room and clean linen room, but if these are not large enough to hold stock for a full day’s rotation, it causes major delays, and negatively impacts the patient experience. We have sizing ratios based on the number of beds, but it’s essential to ask how often deliveries are made, in order to keep these units efficient.

7: Equipment flow

Equipment flow involves the movement of medical equipment such as beds, monitors, and diagnostic tools. This aspect is critical to the functioning of any healthcare facility. Proper movement, flow, and storage of equipment, are essential for effective operations. If equipment is not stored correctly or in the right place, it becomes difficult for units to function efficiently. To assist staff, equipment is stored in clearly labelled parking bays in theatres, resuscitation rooms, and units.

Room data sheets are vital in our design process. 
These structured documents outline specific requirements for each room or space within a building project, 
ensuring that equipment can be placed with minimal interference. We also consider services for equipment 
to ensure that all health and safety requirements are met, in accordance with building regulations.

Conclusion: designing for excellence in healthcare

The intricate flows within a healthcare facility — whether of patients, families, care providers, medicines, information, supplies, or equipment, are all interconnected threads that define the quality and efficiency of care. Thoughtful architectural design is not just about creating functional spaces; it is about shaping environments that support healing, streamline operations, and enhance the experiences of everyone who enters the facility.

By continually assessing and optimising these flows, we can overcome even the most complex challenges — from outdated infrastructure to evolving technological needs. As healthcare architects and designers, our responsibility is to listen, innovate, and collaborate — ensuring that every detail contributes to safer, more compassionate, and more effective care.

Ultimately, excellence in healthcare design is achieved not through isolated solutions, but through a holistic approach that places people at the heart of every decision. When we design with empathy and precision, we create spaces that truly make a difference in the lives of patients, families, and healthcare professionals alike.