**3. Concepts and methodology**

Based on industry 4.0, logistics 4.0, Healthcare 4.0 and lean manufacturing concepts presented above, a general framework, a global approach and a problemsolving method have been elaborated to insure the hospital digital transformation for respecting COVID pandemic constraints and optimizing hospital flows.

#### **3.1 The generic framework**

A general framework was developed in this study, correlating the methods, concepts and tools of Industry and Logistics 4.0 applying in the context of healthcare.

Based on sustainability, social and environmental criteria, the general framework for process optimization in hospitals has two main stages. With the main objective of having a good quality in the treatment of patients within the hospitals, the first stage has the patient at the center of all improvements. Then, the next stage will be to ensure the well-being, health, and productivity of health services, with the focus on increasing the efficiency of the hospital. Currently, this stage is even more relevant since the challenge of ensuring the health of nurses and doctors has become even more crucial due to the combat of the pandemic.

With this framework, the goal is to define a reference model for logistics in healthcare, aiming to achieve the following aspects: sustainability (health of professionals), social (quality in the treatment of patients) and environmental (optimization and reduction of costs of processes). The reference model will also serve as the basis for the decision-aided tool, which will be a model to be reached in the optimization of logistics in hospitals.

The **Figure 2** presents the general framework illustrating the progressive transformation of the hospital, in stages, for an optimization of logistics in hospitals.

#### **3.2 The global approach**

The **Figure 3** describes a global approach for implementing industry 4.0 and logistics 4.0 in the healthcare systems.

As shown in the figure above, the global approach has as its center the sustainability aspects for the implementation of the industry 4.0 and logistics 4.0 concepts. This approach uses new technologies such as cobots, mobile robots, IoTs, as *How to Improve Hospital Flows in the Context of the COVID Pandemic DOI: http://dx.doi.org/10.5772/intechopen.98672*

#### **Figure 2.** *Framework for healthcare logistics implementation.*

#### **Figure 3.** *Global approach for implementing industry 4.0 and logistics 4.0 in hospitals.*

well as new organizations such as Blockchain for transforming digitally the hospital. Finally, it becomes necessary to be flexible to the changes to implement them. The global approach has the following steps:


This process has been followed in the definition of the reference model and the decision aided tool. From the modeling, the simulation, the analysis, and the design of a real existing hospital structure, generalization reasoning has been applied for defining the reference model that would be used in a hospital flows digital transformation in the COVID pandemic context. Then the transformation of the existing hospital structure could be done by using the reference model developed.

### *3.2.1 Modeling*

To understand the logistical operation carried out inside the hospitals including the transportation of medicines carried out by the host pharmacy, it is necessary to collect information through data and interviews. Due to this need before the beginning of the COVID pandemic, several data on the hospital logistics process have been collected in two hospitals located in the south of the Ile de France region.

As these processes travel among different areas and long distances, in this article the focus is made on the medicine delivery processes and on the sterile medical devices. The **Figure 4** presents a complete flow of the medicine delivery processes.

To allow a clear analysis of the processes and with the interdepartmental locomotion the modeling of the processes was done following the BPMN methodology and BonitaSoft software. This methodology seeks to describe an organization's value chains and process in the form of a graphical representation.

#### *3.2.2 Simulation*

After understanding the process and its problems, a simulation (digital twin) of the hospital logistics flows was performed by using Flexsim software (**Figure 5**). This simulation, besides allowing better visualization of the process, provided us information on the transport time and distance data. Another advantage of the simulation was the possibility of changing the process to optimize it, bringing a clear comparison between before and after. This information can be obtained without the need to go to the field that during a pandemic period is not possible.

**Figure 4.** *Medicine delivery complete process flow.*

*How to Improve Hospital Flows in the Context of the COVID Pandemic DOI: http://dx.doi.org/10.5772/intechopen.98672*

**Figure 5.** *Sterilization process of equipment - simulation using FlexSim software.*
