Lean Hospital Design


    To reduce errors, hospitals use innovative designs

    This article appeared Monday in the Wall St Journal, it reminded me of Jamie's postings on lean factory design. Facility layout and design, while not the only driver of lean practices, definitely plays a role.

    In the above article, you see examples of lean concepts, although they aren't called “lean”:

    • Designed in Quality:
      • Passthrough windows for drugs, so nurses don't enter the room as often, reducing risk of infections
      • Slip-proof floors
    • Visual Management:
      • Making sure all patient rooms are visible from the Nurses Station, by eliminating pillars
    • Standard Work, 5S, and Waste Reduction
      • All 80 patient rooms are identical, “doctors and nurses quickly can find everything from syringes to emergency oxygen lines.”

    The results have been clear:

    “Though the changes are relatively new, the hospital says it is reaping benefits on both safety and financial fronts. Anecdotal evidence suggests that infection rates, injuries from falls and medication errors are lower than at the old facility. The hospital expects that over the next year, the average length of stay could decline by as much as half a day — freeing up beds more quickly and allowing St. Joseph's to serve more patients.”

    I liked the description of the collaborative and team-based room design process. I've used a similar process for doing layouts, both in manufacturing and laboratory environments:

    “Many ideas came from doctors, nurses and patients. At the old facility, architects built life-size mock-ups of what the new rooms would look like, and invited the medical staff to stick notes or scribble suggestions on the walls. One such test room went through more than 30 revisions before the final design was pinned down.”

    One closing thought: I don't want anyone to get the impression that the only way to “get lean” is to build a new hospital (or a new factory, for that matter). Lean is mostly about management practices and principles that can be implemented in any “brownfield” environment. But, if you have the opportunity to start from scratch, try to “Design in” as many lean ideas and concepts as you can!

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


    1. the notion that the people actually using the facilities, and especially the patients and families, can provide ideas and valuable information is unfortunately not recognized to most architectural practices. there seems to be an “i know best” attitude that prevents architects from seeking this information and input. thanks for giving this example. can you say who specifically is doing participatory co-design of patient environments – the designers, architects, hospitals?

    2. I know there are some participative facility design and process design efforts where hospitals include patients and families, I just don’t know of them first hand. It’s worth googling.


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