Comments on: An Article about Lean Design and Construction for Hospitals http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/ Mark Graban's leanblog.org - Lean Healthcare, Lean Thinking, Lean Manufacturing, Toyota Production System Fri, 10 Feb 2012 10:01:31 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Steve http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-26359 Steve Fri, 07 Oct 2011 20:11:07 +0000 http://www.leanblog.org/?p=4592#comment-26359 Yes, If delivered correctly it can save companies a lot of time and money. Its just educating companies how it can work and beneifit them / users and employers in the long term. Good resources can also be found on en.wikipedia.org/wiki/Lean_construction. Yes, If delivered correctly it can save companies a lot of time and money. Its just educating companies how it can work and beneifit them / users and employers in the long term. Good resources can also be found on en.wikipedia.org/wiki/Lean_construction.

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]]> By: dan anderson http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-13476 dan anderson Mon, 18 Oct 2010 23:27:26 +0000 http://www.leanblog.org/?p=4592#comment-13476 I quite agree. The concept of lean design if properly understood and executed will change the present landscape of design. The focus will be more directed toward the structures ability to support and drive a higher level of productivity for an organization. http://www.andersonporter.com/blog/shaping-practice-to-the-client/ I quite agree. The concept of lean design if properly understood and executed will change the present landscape of design. The focus will be more directed toward the structures ability to support and drive a higher level of productivity for an organization. http://www.andersonporter.com/blog/shaping-practice-to-the-client/

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]]> By: andrew http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-8368 andrew Thu, 18 Feb 2010 11:46:13 +0000 http://www.leanblog.org/?p=4592#comment-8368 We are currently designing a new surgical centre. Having visited in excess of 100 hospitals across the UK, europe and the US, both public and private, my experience is that the variability in the quality of architects is enormous and that many fail the most fundamental tests when it comes to optimising design. There are so many classic hospital design failures; nice building but no dirty theatre corridor, nice design of a childrens wing, but the entire thing is made of glass and in the summer with no air conditioning and no windows that open you can have baked toddler (that one won an award), sterile services located more than a mile away from their highest user and 4 floors difference. We're currently designing a new surgical centre, comprising outpatients, theatres, procedure rooms and beds / wards. The architect was given a brief by someone other than us 4 months ago. We came in, told him it would not work, spent 3 months working with surgeons, nurses, wards and clinics on how it should work, re-drafted a brief, provided a schedule of accommodation, made the architect present revised drawings along with an explanation of why some things could be incorporated and others could not (space constraints, it was limited by square footage and some infrastructure constraints). Some of the guidelines included but were not limited to: The building would be designed around the future processes, not the current ones on the basis if we did the latter we might as well simply paint the walls Every room must be identical in layout, none of this left handed backing on to right handed layouts you see in hotels to save on plumbing All rooms can be flexed for procedures The ratio of waiting area to clinic rooms needs to be appropriate, not 35% of the square footage given over to 140 waiting seats for 8 clinic rooms just so they could have a nice entrance. Clearly an architect that had not heard of form following function. And so on and so forth........the briefing with comments from all staff extended to thousands of words, meetings, briefings and workshops to come up with the future state....... We are currently designing a new surgical centre.

Having visited in excess of 100 hospitals across the UK, europe and the US, both public and private, my experience is that the variability in the quality of architects is enormous and that many fail the most fundamental tests when it comes to optimising design.

There are so many classic hospital design failures; nice building but no dirty theatre corridor, nice design of a childrens wing, but the entire thing is made of glass and in the summer with no air conditioning and no windows that open you can have baked toddler (that one won an award), sterile services located more than a mile away from their highest user and 4 floors difference.

We’re currently designing a new surgical centre, comprising outpatients, theatres, procedure rooms and beds / wards.

The architect was given a brief by someone other than us 4 months ago.

We came in, told him it would not work, spent 3 months working with surgeons, nurses, wards and clinics on how it should work, re-drafted a brief, provided a schedule of accommodation, made the architect present revised drawings along with an explanation of why some things could be incorporated and others could not (space constraints, it was limited by square footage and some infrastructure constraints).

Some of the guidelines included but were not limited to:

The building would be designed around the future processes, not the current ones on the basis if we did the latter we might as well simply paint the walls

Every room must be identical in layout, none of this left handed backing on to right handed layouts you see in hotels to save on plumbing

All rooms can be flexed for procedures

The ratio of waiting area to clinic rooms needs to be appropriate, not 35% of the square footage given over to 140 waiting seats for 8 clinic rooms just so they could have a nice entrance. Clearly an architect that had not heard of form following function.

And so on and so forth……..the briefing with comments from all staff extended to thousands of words, meetings, briefings and workshops to come up with the future state…….

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]]> By: Mark Graban http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-8180 Mark Graban Thu, 11 Feb 2010 02:45:16 +0000 http://www.leanblog.org/?p=4592#comment-8180 Andrew - I think that approach would apply. Designing for flexibility is a great design concept when you can pull it off. Using a lab example again, the old-school approach had either separate rooms (which created silos and interrupted flow) or it had the classic black-topped permanent benches that couldn't be adjusted. Modern lab design is a big open space with a utility grid in the ceiling for flexibility about where you plug in stuff (for power and networking). Tables on wheels, everything being modular, those are great design principles for kaizen or growth. Andrew – I think that approach would apply. Designing for flexibility is a great design concept when you can pull it off. Using a lab example again, the old-school approach had either separate rooms (which created silos and interrupted flow) or it had the classic black-topped permanent benches that couldn’t be adjusted.

Modern lab design is a big open space with a utility grid in the ceiling for flexibility about where you plug in stuff (for power and networking). Tables on wheels, everything being modular, those are great design principles for kaizen or growth.

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]]> By: Jefferson Martin/synfluent http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-8171 Jefferson Martin/synfluent Wed, 10 Feb 2010 17:19:22 +0000 http://www.leanblog.org/?p=4592#comment-8171 Andrew Bishop: Interesting comments on creating flex space under the premise of future re-purposing. An equally interesting architect that I am sure you are familiar with would be Albert Kahn, whose open floor plan buildings for Henry Ford are almost mythologized. Kahn had some help, though, when Tesla's portable AC electric motor replaced overhead driveshafts and belt takeoffs for machinery in those settings. .-= Jefferson Martin/synfluent´s last blog ..Middletown Ignition Source =-. Andrew Bishop: Interesting comments on creating flex space under the premise of future re-purposing.

An equally interesting architect that I am sure you are familiar with would be Albert Kahn, whose open floor plan buildings for Henry Ford are almost mythologized.

Kahn had some help, though, when Tesla’s portable AC electric motor replaced overhead driveshafts and belt takeoffs for machinery in those settings.
.-= Jefferson Martin/synfluent´s last blog ..Middletown Ignition Source =-.

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]]> By: Andrew Bishop http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-8169 Andrew Bishop Wed, 10 Feb 2010 16:58:34 +0000 http://www.leanblog.org/?p=4592#comment-8169 We are building a new production laboratory (not medical, but plant tissue culture) under sort of forced march conditions in Bogota due to loss of a lease. Unfortunately the lab has not yet been a major focus of our lean transformation in Colombia, so we are not fully prepared with new thinking and processes and the local leadership is not trained in lean process design. We haven't really studied the current state, let alone envisioned an ideal state or near term future state. So what do we do, knowing what we know about lean but required as we are to commit resources to new construction on a short schedule? Two things: We took a high level view of material flows to assure that pathways were as simple and direct as possible at a site-wide level, since we can see this even without detailed process or value stream mapping. And, more important possibly, we made sure that NOTHING in the space except the bearing walls (four exterior) would be fixed or expensive to move in the future if process or value stream change called for it. A fairly primitive level of design, but our experience with lean deployment at other sites has been that <i>facilities layouts will be required to change</i>. My goal was to accommodate future changes of layout at minimum expense as we transform processes and value streams in the new lab. Probably not completely applicable in practice in a hospital setting but some principles to keep in mind, nonetheless. We are building a new production laboratory (not medical, but plant tissue culture) under sort of forced march conditions in Bogota due to loss of a lease. Unfortunately the lab has not yet been a major focus of our lean transformation in Colombia, so we are not fully prepared with new thinking and processes and the local leadership is not trained in lean process design. We haven’t really studied the current state, let alone envisioned an ideal state or near term future state.

So what do we do, knowing what we know about lean but required as we are to commit resources to new construction on a short schedule?

Two things: We took a high level view of material flows to assure that pathways were as simple and direct as possible at a site-wide level, since we can see this even without detailed process or value stream mapping. And, more important possibly, we made sure that NOTHING in the space except the bearing walls (four exterior) would be fixed or expensive to move in the future if process or value stream change called for it. A fairly primitive level of design, but our experience with lean deployment at other sites has been that facilities layouts will be required to change. My goal was to accommodate future changes of layout at minimum expense as we transform processes and value streams in the new lab.

Probably not completely applicable in practice in a hospital setting but some principles to keep in mind, nonetheless.

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]]> By: Mark Graban http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-8160 Mark Graban Wed, 10 Feb 2010 14:04:24 +0000 http://www.leanblog.org/?p=4592#comment-8160 And to be more fair, there ARE many architects and construction firms that are learning about Lean. I think we just have to be careful it isn't a buzzword. For example, there is the Lean Construction Institute: http://www.leanconstruction.org/ And to be more fair, there ARE many architects and construction firms that are learning about Lean. I think we just have to be careful it isn’t a buzzword.

For example, there is the Lean Construction Institute:

http://www.leanconstruction.org/

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]]> By: Mark Welch http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-8157 Mark Welch Wed, 10 Feb 2010 13:51:25 +0000 http://www.leanblog.org/?p=4592#comment-8157 We've had four 2P (process preparation - redesign of existing areas, not new construction) events in my hospital since I arrived in 2006. We deliberately left the architects out or at most involved them minimally. Here's the question we asked ourselves... "What do you think a guy who is paid by the square foot is going to recommend?" On the other hand, we have brought one in for just small sections of our design phase and he was very reasonable, open-minded, and truly wanted to understand Lean concepts as they applied to the designs. We had a construction manager from the same firm as the architect participate fully with three of the four 2Ps. He had a detailed knowledge of the construction our hospital and was very receptive to lean and out of the box thinker - a solid asset to the team. He truly saw us as a customer and helped us reduce motion and total square footage using lean concepts. So, I think it comes down to the particular individuals, but you've always got to be on the alert for the conflict of interest. We've also involved our infection control specialist in each case so that her expertise could play a role. Using the best infection control practices for design and construction were of great value. We’ve had four 2P (process preparation – redesign of existing areas, not new construction) events in my hospital since I arrived in 2006. We deliberately left the architects out or at most involved them minimally. Here’s the question we asked ourselves… “What do you think a guy who is paid by the square foot is going to recommend?” On the other hand, we have brought one in for just small sections of our design phase and he was very reasonable, open-minded, and truly wanted to understand Lean concepts as they applied to the designs. We had a construction manager from the same firm as the architect participate fully with three of the four 2Ps. He had a detailed knowledge of the construction our hospital and was very receptive to lean and out of the box thinker – a solid asset to the team. He truly saw us as a customer and helped us reduce motion and total square footage using lean concepts. So, I think it comes down to the particular individuals, but you’ve always got to be on the alert for the conflict of interest.

We’ve also involved our infection control specialist in each case so that her expertise could play a role. Using the best infection control practices for design and construction were of great value.

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]]> By: Jefferson Martin http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-8154 Jefferson Martin Wed, 10 Feb 2010 12:52:42 +0000 http://www.leanblog.org/?p=4592#comment-8154 Someone needs to offer CHOP some help here in Philadelphia. Consider a children's hospital which places new PC workstations to capture patient information digitally into each of their examination rooms and designs the 'cart', for lack of a better word, with it's 10baseT ethernet wiring and router, complete with blinking lights and other interesting paraphernalia six inches above the floor level. My two year old's examination devolved into one of a snarky doctor chastising us for not being able to keep our child from touching all the interesting, blinking stuff placed directly into my child's visual field. My complaints about inappropriate design of the cart setup met with only an indignant about the importance of the digital information gathering process which, to me, has replaced doctor patient interaction and ended in a stalemate between a doctor and an engineer. This may not be an example of an architectural issue, but it surely qualifies as an example of a design issue which cost CHOP a customer. .-= Jefferson Martin´s last blog ..Middletown Ignition Source =-. Someone needs to offer CHOP some help here in Philadelphia.

Consider a children’s hospital which places new PC workstations to capture patient information digitally into each of their examination rooms and designs the ‘cart’, for lack of a better word, with it’s 10baseT ethernet wiring and router, complete with blinking lights and other interesting paraphernalia six inches above the floor level.

My two year old’s examination devolved into one of a snarky doctor chastising us for not being able to keep our child from touching all the interesting, blinking stuff placed directly into my child’s visual field.

My complaints about inappropriate design of the cart setup met with only an indignant about the importance of the digital information gathering process which, to me, has replaced doctor patient interaction and ended in a stalemate between a doctor and an engineer.

This may not be an example of an architectural issue, but it surely qualifies as an example of a design issue which cost CHOP a customer.
.-= Jefferson Martin´s last blog ..Middletown Ignition Source =-.

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]]> By: Mark Graban http://www.leanblog.org/2010/02/an-article-about-lean-design-and-construction-for-hospitals/#comment-8150 Mark Graban Wed, 10 Feb 2010 12:13:25 +0000 http://www.leanblog.org/?p=4592#comment-8150 Stacy - thanks for your comment. I didn't mean to smear all architects, but I have seen troubles with a few of them. Stacy – thanks for your comment. I didn’t mean to smear all architects, but I have seen troubles with a few of them.

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