Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Civil Engineering

Committee Chair

Phillip S. Dunston

Committee Member 1

Daniel DeLaurentis

Committee Member 2

Theodore Weidner

Committee Member 3

Lefteri Tsoukalas


With the healthcare industry in a state of change, one focus is on efficiency in the healthcare environment. The trend for architects is a focus on an evidence-based design decision making process. In this context, simulation is gaining acceptance as a source of evidence. This research developed the Layout Evaluation by Simulation (LES) protocol to evaluate the design of a healthcare facility layout. The approach contains a Systems-of-Systems analysis for developing a healthcare delivery (HD) model, a computer model and simulation of an existing medical facility validated by existing data. Then simulations are run through the validated model inserting the future facility design to evaluate efficiency in a proposed new spatial layout. Through a real-world case study, the research contains an evaluation of the predictive capacity of the LES protocol. In the research, a completely Agent Based Modeling and Simulation, a completely Discrete Event Simulation, and a hybrid were investigated. As detail was added to all models, simulations were run creating a matrix of results for comparison to existing data. The LES protocol was confirmed to be effective. The results demonstrate that the healthcare delivery (HD) model provides a sufficient basis from which to develop the computer model and simulation. The LES protocol is a valuable tool for evaluating situations for emergent behavior. The research also confirmed the need for some degree of agent based modeling to detect emergent behavior.