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

Children’s and Women’s Health Centre Project

A Three Phased Project

But We Don’t Build Cars??

Why Lean 3P for Design?

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

Lean 3P Tools

Patient Quantity Analysis (PQA)

10 flows

7 ways

Simulation/Modeling

Mock-ups

Layouts

Identifying Flows (Fishbone Chart)

Understanding Flows

Simulation

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

21

Takt Time Maps

22

23

24

25

Before You Start

Patients/Families Champion

3P Lead

Communications Faith+

Commitment

Stake holders

Before You Start

Knowledge

Time

Data

Space

3P and P3

3P Events (design

flow)

Functional Program/

Clinical Spec’s

Indicative

Design/RFP Preferred

Proponent Final

Design