lean 3p and building design - chd | the center for health … · 2011-05-13 · lean 3p and...
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Lean 3P and Building Design
BC Children’s and Women’s Redevelopment Project
CW Redevelopment Project
May 2011
PHSA
BC Children's Hospital and
Sunny Hill Health Centre for Children
BC Women's Hospital & Health
Centre BC Cancer Agency
BC Centre for Disease Control
BC Mental Health & Addiction
Services
BC Provincial Renal Agency
BC Transplant Cardiac Services
BC
Lean for Space Design?
• consistently resulted in reduced space requirements in new facilities
• strong team buy-in to program requirements
• future needs vs wants
• building flows and design requirements
• operational savings from more efficient processes – efficient space results in better utilization of staff
Park Nicolette Chanhassen Clinic (Minneapolis)
• Decrease walking:
– patient reduced 27%
– nurse reduced 27%
– clinician reduced 42%
• Reduce inventory:
– Reduced 21 exam rooms
• 20% reduction of square footage:
– Created flexibility, team work among disciplines; lean
concept of 'open room'; less steps for patient and staff;
improved flow and visual control.
8
Seattle Children’s Outpatient Center - Bellevue
• Original design estimates were 20% over budget.
• Used Lean 3P to reduce size and budget by 20%
without reducing the scope of services.
7 Flows + 3
Patients Providers Medications Supplies Information Equipment Instruments/Processes Food Families
Students
Where is there Waste in Healthcare?
Type of Waste Example
Motion Staff Travel
Time Waiting
Inventory Unit stockpiling
Over-Production Food, medication, sterile instruments
Transportation Transfers
Defects Med Errors, Charting
Processing Collecting same info
Design Planning using Lean 3P
3P events are an iterative process building on the
work from the previous events and forming the
basis for future ones. Each 3P event studies
recommendations made in the previous events as
more data and information becomes available.
This process allows for the validation of
information; creates opportunities for change and
information refinement.
Where we are at
3P Events
Macro Flows and Service
Relationships
Patient Arrival – Planned and Unplanned Admissions
Inpatients
Procedures and Interventions
Requiring Sedation or Anaesthesia
3P Event Charter – Macro Flows and Services
Objectives
• Study the 10 flows of medicine
• Recommend the macro level adjacencies
• Recommend the range of services to be included in the Acute Care Building
Assumptions
• Results will focus on increasing patient safety, quality and infection control
• Space allotments will be consistent with Canadian Standards
• Future demand projections will continue to be developed to reflect future volumes and patient mix
3P Event Charter – Macro Flows and Services
Scope
• Analyze the macro level service flows for BCCH and BCW to study the range of services to be included in the new acute care building and to inform the correct macro level service adjacencies
• BCCH inpatient and specific outpatient services (ie Medical Daycare, Daycare Surgery, Oncology)
• SHHC – inpatient and outpatient services
• BCW – inpatient and specific outpatient services (ie. Gyne Day surgery)
• Ancillary support services
Deliverables
• Recommend the range of services to be included in the Acute care centre
• Recommend the macro level adjacencies of these services
3P Event – Macro Flows and Services
Outcome
• Those service areas with highest volumes and shortest LOS (low acuity) should be located closest to the main entrance; conversely, longest LOS should be located furthest
• Identified high level adjacencies and building stacking
Outstanding Questions
• Determine appropriate patient mix on all IPU’s and number of rooms and function on each floor
• Determine flow of support services for each IPU
A Week in the life…
Lean 3P Education
7 Ways Exercise
Flow (string exercise)
Fishbone Current
and Future Flow
Takt Time Map
Determine Adjacencies
Inform
Design
Report Out
3P and P3
3P Events (design
flow)
Functional Program/
Clinical Spec’s
Indicative
Design/RFP Preferred
Proponent Final
Design