Hospital planning and designing

Lean healthcare
Introduction

Lean healthcare is the application of “lean” ideas in healthcare facilities

to minimize waste in every process, procedure, and task through an
ongoing system of improvement.

The aim is to deliver healthcare at optimum cost.

It is estimated that 60%–65% of healthcare waste can be removed.

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• A hospital is a productive organization with a purpose.

• The organization exists to integrate and coordinate the activities of

various clinical specialties and provide an infrastructure of sites,
buildings, equipment, maintenance, and supply chains.

• In healthcare, the principles of integration and coordination have not

attracted the same level of attention as in manufacturing.

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Donabedian model

“Evaluating the Quality of Medical Care” (Ayanian & Markel, 2016; Donabedian, 1966).
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 Type of wastes in lean healthcare

There are seven types of waste:

1. Waste of transportation
2. Waste of inventory (equipment and medicines stored over long periods),
just-in-time inventory;
3. Waste of motion (unnecessary movement of people, searching for
investigation results, etc.);
4. Waste of waiting
5. Waste of overprocessing (unnecessary ordering of tests that are not
required)
6. Waste of overproduction (preparing drugs that are not required)
7. Waste of defects such as medication errors, wrong operations, and so on
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Framework for using lean in facility design

Current state
analysis

Future state
process
development

Future state
testing and
layout design

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Differences
Traditional architectural design
• Focus – functional design
• Functional and space program
• User group : staff in department
Lead- led design
• Value of patient
• Observation at point of work
• Multidisciplinary teams
Multidisciplinary team

• Cross-functional groups, includes

• Staff nurse
• In-charge nurse
• Physician
• Housekeeper
• Nursing administrator
• Material management
• IT and clinical informatics
• Facilities department
• Architect
• Medical planner
• Interior designer
• Patient and family representative

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Lean concepts used in facility design

• Improving flow of work

• Value stream mapping 7 flows of healthcare
• Spaghetti Diagrams • Patient and family
• Staff
• Provider
• Medicine
• Supplies
• Equipment
• Information

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Spaghetti Diagrams

• A spaghetti diagram, or spaghetti map, is a visual representation of

physical space using a continuous flow line tracing the path of an item
or person through a process.
• The continuous flow line enables process teams to identify movement
and redundancies in the process and find opportunities to reduce
motion and other obstacles.
• Common and simple tool for lean and architectural practices.
• Used in current status analysis phase and future state testing and
layout design phase

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Visual management

• Visual management is a concept applied during a 5s activity

• Goal - “status at glance”
• Visual Management is designed to create a visual workplace with controls communicating
without words and interruptions in process.
• Visual Controls have the potential to
 help identify problems
 reduce waste
 reduce production costs
 shorten lead times
 reduce inventory
 create a safe working environment
 even increase your profits.
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5s

• Sort
• Set in order / straighten
• Shine/ scrub
• Standardize
• Sustain

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Denver Health Eastside Clinic

• Problem : good number of its patients did not show up for maternal
postpartum check-ups due to long waiting times and transportation
barrier.
• Solution: New design- the clinic merged maternity and infant
facilities and appointments.
• This drastically reduced the number of patients that did not turn up
for appointments from 50% to 5%.

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5 ways to design hospital

• Multifunctional rooms with portable equipment

• Number of rooms, divisible by 3,4,5
• Shared changing areas
• Sufficient storage
• Centralized registration

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Lean strategies

• Simulations
• Prototypes
• Flexible and modular design

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Summary

• Lean healthcare is the application of “lean” ideas in healthcare

facilities to minimize waste
• 60%–65% of healthcare waste can be removed
• Use of cross/ multi -disciplinary team
• Use of 5 s in visual management
• Development of standard practice, standardized systems and space

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Thank you

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