## 4 Discussion  
The analysis of the organization of the activities in relation to their allocation within the environment [16; 27] is a step towards improving healthcare services, especially in emergency departments, where intense work dynamics demand the optimization of resources [12]. The MC-MD is a lightweight computational instrument that proved to be a potential support for managerial decisions and pre-design activities by allowing a systematic evaluation of the allocation of activities in the built environment, even with little input data available. The ability to use such inputs is especially relevant in contexts where architects and construction managers renovate buildings based only on their professional insights [25]. The execution of the instrument demonstrated some of its potential uses for facility managers and designers. It presented a means of mapping the relationships between activities and environments in a complex system such as an emergency department and carried out congruence mapping between these two domains, relating them through a structure of multi-domain matrices [42]. Thus, it made it viable to model change scenarios in a simple and fast way. Without having to master geometric modeling instruments or any other specific instrument in addition to lists [12], it is possible to feed the software with the available data. Based on this case study, the following application opportunities in different situations were identified:  
1. The \(A_{nm}\) matrix points out the cyclical activities in the analyzed service, that is, cases in which the execution is repeated without a defined order. In order to reduce travel activity--which does not add value--and thus increase efficiency, the allocation of these activities must be combined and eventually integrated visually. This information is interesting mainly when an environmental arrangement has not yet been defined. When an environmental allocation exists, matrix \(aC_{nm}\) allows the same reading to be obtained and adds a congruence indication;
2. In the \(R_{nm}\) matrix, it is possible to identify mandatory passages (value one, yellow, in Table 1) in order to test the impact of restricting circulation through determined passageways. For example, when simulating the segregation of the flow of contagious inpatients or cleaning activities, the manager can verify that the existing environmental arrangement is not adequate, which demonstrates the need for a reformed design of the ED access spaces;3. The \(cC_{mm}\) matrix indicates a congruent relationship between environments, depending on the allocated activities. Thus, it is possible to identify a room for which the allocated activity is not congruent with the others and replace it with an activity that requires an adjacency relationship in order to gain efficiency. For example, one can test the alternative location of a local warehouse for cleaning materials and linen in order to reduce the travel distances for supplies. In the case that has been presented here, a situation of non-congruence was not identified (value one, red, Table 2) because it was a real case. In the case of a design process that has not been executed, the lack of some relationship will be pointed out when an interface is identified between the environments whose activities demand a relationship. This is a particularly interesting resource in regard to design requirements and the validation of new proposals;
4. The \(aC_{mm}\) matrix allows the mapping of the relationships between the activities that were not indicated as inputs, but which were mapped with potential relationships. This map can be used to investigate the reasons for pointed non-congruence, whether it is because of lack of input relationships, because the activities cross each other and coexist in the same environment, or because they require an environmental or procedural rearrangement. In addition to operational applications in facility management and design, the software supports a strategic approach.