Monday, October 11, 2010

Lean Thinking and Evidence Based Hospital Design

Rady Children’s Hospital to use Evidence Based Hospital Design

On October 10, 2010 Rady opened a new 4-story building which makes Rady Children’s the largest pediatric hospital in the state of California expanding its capacity from 288 to 442 licensed beds. As part of this new building Rady used a new trend called “evidence-based design.” The research results of using this design links the environment/atmosphere to better patient outcomes.  The elements of evidence-based design include such things as natural lighting, air flow, and room design – private rooms with space for family members to stay with loved ones, soothing atmosphere, and use of sound with waterfalls, aesthetics like artwork and the use of color.

Many hospitals are beginning to expand, and they are using evidence-based design.  As I thought about these new methods of construction, I had concerns about the use of space and what it does from an efficiency perspective. Does evidence-based design address the physical work flow inefficiencies in our current system? These designs include input from patients and families, but how much are users consulted? Historically new plans fail to consult the users of the system, resulting in an increased waste of time with movement in the new design.

As I was doing Lean consulting at other hospitals, I found some examples of new construction that did not include input from users.  In the entrance of a new building there was a long beautiful atrium, with patient care services housed along all sides of this atrium. When I first observed this space, I thought this is going to be a long walk for nursing to deliver care, it was about a quarter of a mile one way. There were Pod designs where the nurse could only see only a small section of patients and had to walk around the whole pod to get to the nursing station. Another nursing station had only one way in and out creating congestion, confusion and increased walk.  Ancillary departments were not moved along with the new space increasing the walk and turnaround time for service. 

A hallmark of Lean Thinking in healthcare is to remove waste which will increase efficiency, improve quality and decrease cost. Lean includes the front line workers in all process improvements, including new construction. The implementation of Lean Healthcare prior to new building improves the physical design and efficiency.

The costs of these new buildings is increasing, so can we consider smaller square footage for new buildings?   In the past, implementation of Lean has lead to cost avoidance by decreasing the size of new projects. This is due to the fact that as Lean improves the turnaround times for care, it increases capacity without adding beds.    

After the Rady hospital opens it will be interesting to see how the design impacts patient flow and the movement of staff.  As research continues to evaluate the use of evidence- based design, efficiency must be one of the measures included.


2 comments:

Daniel said...

It is indeed true that a patient's fast recovery also depends on the atmosphere of the hospital he's into. The great design a hospital has, the better chances of fast recovery a patient will have. And I believe that most dental construction (Chicago-based) companies really did a great job in giving their clients better design services. Dental contractors (Chicago area) is more innovated and they are really unique and creative in designing for different medical offices.

Dong Henze said...

From a sociotechnical aspect, Lean intercession will most likely make jobs simpler or turn them into jobs that require more thinking, planning and responsibility. The function of lean tools mechanically triggers further dynamics. A conceptual framework of lean thinking “is an integrated operational and sociotechnical approach of a value system, whose main objectives are to maximize value and thus eliminate waste, by creating cumulative capabilities.”
Dong Henze