University of Minnesota Amplatz Children’s Hospital Lean Shaping Design
Oct 19, 2014
University of Minnesota
Amplatz Children’s Hospital
Lean Shaping Design
University of Minnesota Amplatz
Children’s Hospital
Learning Objectives
• Review design decisions that user groups made by incorporating LEAN principles
• Summarize the effects that the use of LEAN principles can have on hospital design
• Appreciate the value of LEAN processes in making informed clinical design decisions
Project Overview
• New building attached to existing facility
–New building-beds, ED, surgery suites, dialysis,
radiation oncology, imaging, observation/sedation,
lobby, parking
–All other services in existing facility
• Square foot size difference of the units
–Current patient care units: 15,000 square feet
–Planned patient care units: 27,000 square feet
Project Overview
• 96 all private inpatient acute care beds–48 Med/Surg/Onc beds (two -24 bed units)
–24 BMT beds
–24 PICU beds
• Identical/same handed (right handed) patient rooms– 72 Med/Surg/Onc and BMT all identical/same handed
– 24 PICU all identical/same handed
• 390 square foot patient rooms –90 square foot
dedicated family space
– 3 zones -caregiver, patient, family
Project Overview
• Guiding principles
–LEAN
–Optimize the patient and family experience through a plan and design that fosters patient and family-centered care
–Design building to optimize light and visibility to facilitate way finding, healing, and safety for all
–Design to facilitate collaboration and the education of the nextgeneration of healthcare professionals
–Promote the integration of patient care, education and research
• On stage/off stage design concept
Pre-LEAN Design
LEAN Applied to New Design• Team workspace
• Medication process
• Equipment process
• Personal Protective Equipment (PPE)
• Satellite lab/blood bank
• Nutrition center
• Patient room
–Location of bathroom
–Nurse server for PPE’s and linen
–Family space
–Caregiver space
How LEAN Was Applied
• In-house staff and external consultants
• Facility layout -what is next to/close to what
• Unit layout -again what is next to/close to what
• Specific room layout
• Data gathering
• One specific example (nurses and meds-case study)
Tools Used
• Spaghetti diagrams
• Frequency counts
• Observation/interviews
• Door counters
• Pedometers
• Photo journaling
RN walking pattern-Current Unit
Adjacency Diagram
1
5B Adjacency Diagram for One RN 7:00 to 10:30July 26, 2007
Med Room Entries
First Dose Dispensing Location
Unit % Pyxis % PharmacyU5C 39.15% 60.85%UCCA 49.50% 50.60%UCCB 58.63% 41.37%U4A 46.68% 53.32%
Medication Storage Location
U5C67.70% Med Room Storage32.30% Potential for Bedside Storage
UCCA54.60% Med Room Storage45.60% Potential for Bedside Storage
UCCB73.80% Med Room Storage26.20% Potential for Bedside Storage
U4A79.88% Med Room Storage20.12% Potential for Bedside Storage
Support Function Room
Entries
Photo Journaling
5th FLOOR
Existing Operations Improved Operations
MED SURG
Exg process New ProcessRN1 Time minutes 19 10
Distance feet 3768 1,925
Bottlenecks
Overview of Design Changes
• Patient Room Layout
- Same handed
- Supply Storage/Nurse server
- Point of use supplies in the best possible location
- Distinct family and clinician space
- Location of bathroom (falls, no walking around the
bed for the nurse, easier to clean and stock)
Patient Room Layout
Overview of Design Changes
• Overall Unit design changes
- 4 Decentralized med rooms
- Team Desk orientation toward patient
rooms
- Snack corners
- Employing Technology enabler
Overview of Design Changes
Lessons Learned• What would we do differently?
–Start sooner with LEAN application in design process
–Provide education to the staff about LEAN application
• Lessons learned– Data driven decision making using LEAN frame of work
– Importance of sticking to guiding principles
– Mock ups
University of Minnesota Amplatz
Children’s Hospital
Questions?