Evaluating the impact of clinic spatial arrangements on glaucoma patient journey times: a comparative analysis of iterative changes in project HERCULES

Background/aim Glaucoma services face increasing demand, yet the impact of clinic spatial layout on efficiency is poorly understood. We evaluated how spatial arrangements influence operational efficiency in a diagnostic and monitoring glaucoma clinic and whether glaucoma severity modulates this effect. Methods We analysed prospectively collected data from glaucoma patients attending a single diagnostic clinic that underwent four sequential spatial reconfigurations: a primarily linear ‘lane’ arrangement (iteration 1) and three ‘clustered’ configurations, one of which included concurrent cataract services (iteration 4). We included patients completing the expected glaucoma monitoring examinations. Data comprised journey times from the patient administration system (PAS) and ultra-wideband (UWB) tracking, device timestamps and visual field (VF) results used to classify glaucoma stage. Linear models assessed associations between clinical iteration, glaucoma stage and journey time; pairwise comparisons tested differences across iterations and VF-loss stages. Results We analysed 1757 PAS-derived and 1012 UWB-derived journey times. Mean PAS journey times (minutes) were 80.6, 71.5, 71.6 and 93.9 for iterations 1–4; corresponding UWB times were 73.5, 62.3, 63.2 and 91.1. All pairwise comparisons between iterations were statistically significant except between iterations 2 and 3. Longer journey times with more advanced glaucoma were observed only in iterations 1 (PAS and UWB) and 4 (PAS). Conclusion Collaborative, interdisciplinary redesign of clinical space can reduce glaucoma patient journey times. Clustered spatial arrangements were associated with shorter journey times than a lane-based layout and appeared more robust to variation related to glaucoma severity, identifying physical layout as a modifiable driver of glaucoma service efficiency.