Lean Shaping Design

University of Minnesota

Amplatz Children’s Hospital

Lean Shaping Design

University of Minnesota Amplatz

Children’s Hospital

Learning Objectives

• Review design decisions that user groups made by incorporating LEAN principles

• Summarize the effects that the use of LEAN principles can have on hospital design

• Appreciate the value of LEAN processes in making informed clinical design decisions

Project Overview

• New building attached to existing facility

–New building-beds, ED, surgery suites, dialysis,

radiation oncology, imaging, observation/sedation,

lobby, parking

–All other services in existing facility

• Square foot size difference of the units

–Current patient care units: 15,000 square feet

–Planned patient care units: 27,000 square feet

Project Overview

• 96 all private inpatient acute care beds–48 Med/Surg/Onc beds (two -24 bed units)

–24 BMT beds

–24 PICU beds

• Identical/same handed (right handed) patient rooms– 72 Med/Surg/Onc and BMT all identical/same handed

– 24 PICU all identical/same handed

• 390 square foot patient rooms –90 square foot

dedicated family space

– 3 zones -caregiver, patient, family

Project Overview

• Guiding principles

–LEAN

–Optimize the patient and family experience through a plan and design that fosters patient and family-centered care

–Design building to optimize light and visibility to facilitate way finding, healing, and safety for all

–Design to facilitate collaboration and the education of the nextgeneration of healthcare professionals

–Promote the integration of patient care, education and research

• On stage/off stage design concept

Pre-LEAN Design

LEAN Applied to New Design• Team workspace

• Medication process

• Equipment process

• Personal Protective Equipment (PPE)

• Satellite lab/blood bank

• Nutrition center

• Patient room

–Location of bathroom

–Nurse server for PPE’s and linen

–Family space

–Caregiver space

How LEAN Was Applied

• In-house staff and external consultants

• Facility layout -what is next to/close to what

• Unit layout -again what is next to/close to what

• Specific room layout

• Data gathering

• One specific example (nurses and meds-case study)

Tools Used

• Spaghetti diagrams

• Frequency counts

• Observation/interviews

• Door counters

• Pedometers

• Photo journaling

RN walking pattern-Current Unit

Adjacency Diagram

1

5B Adjacency Diagram for One RN 7:00 to 10:30July 26, 2007

Med Room Entries

First Dose Dispensing Location

Unit % Pyxis % PharmacyU5C 39.15% 60.85%UCCA 49.50% 50.60%UCCB 58.63% 41.37%U4A 46.68% 53.32%

Medication Storage Location

U5C67.70% Med Room Storage32.30% Potential for Bedside Storage

UCCA54.60% Med Room Storage45.60% Potential for Bedside Storage

UCCB73.80% Med Room Storage26.20% Potential for Bedside Storage

U4A79.88% Med Room Storage20.12% Potential for Bedside Storage

Support Function Room

Entries

Photo Journaling

5th FLOOR

Existing Operations Improved Operations

MED SURG

Exg process New ProcessRN1 Time minutes 19 10

Distance feet 3768 1,925

Bottlenecks

Overview of Design Changes

• Patient Room Layout

- Same handed

- Supply Storage/Nurse server

- Point of use supplies in the best possible location

- Distinct family and clinician space

- Location of bathroom (falls, no walking around the

bed for the nurse, easier to clean and stock)

Patient Room Layout

Overview of Design Changes

• Overall Unit design changes

- 4 Decentralized med rooms

- Team Desk orientation toward patient

rooms

- Snack corners

- Employing Technology enabler

Overview of Design Changes

Lessons Learned• What would we do differently?

–Start sooner with LEAN application in design process

–Provide education to the staff about LEAN application

• Lessons learned– Data driven decision making using LEAN frame of work

– Importance of sticking to guiding principles

– Mock ups

University of Minnesota Amplatz

Children’s Hospital

Questions?