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The Lean Paradox

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Jan Golembiewski

on 12 October 2017

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Transcript of The Lean Paradox

The Lean Paradox:
How can healthcare facilities shrink
while clinical spaces expand?

Mungo Smith - MAAP
Prof. Jan Golembiewski MAAP & QUT

THE WALKING SKELETON:
a shortlist of essential features
The list of a-priori requirements - a list of rooms.
A. Staff/Clinical spaces
1. Facility Public Entry: 16m2 x 2
2. Waiting area - visitors: 20m2 x 2
3. Staff Station: 16m2 x 3
4. Office - handover(1 shared): 12m2 x 2
5. Medication room: 12m2 x 3
6. Treatment room: 16m2 x 3
7. Consultation/Interview room: 14m2 x 6
8. Store (general): 14m2 x 3
9. Toilet (staff): 3m2 x 3...
B. Assessment spaces...
C. Staff/Treatment spaces
D. Patient/Residential spaces



Schedule of Accommodation:
Lean: What is it?
Lean is a suite of strategies to maximise value and minimising waste.
Lean focuses on end-user value: it understands that complexity is impossible to control and it's a waste of resources trying.
Lean welcomes and uses change - that's how things improve.
A well-functioning project is the best measure of success.
Simplicity: 'the art of not doing things' is central.
Value management is part of the process - it isn't an afterthought.
ADL kitchen
ADL Bathroom
Basketball court
Real bathroom
Glazed staff
station
Separable
living rooms
The wish-list
Kennel for pets
Lockers for staff
A computer
room
Value=4 (high)
Cost=1 (v.low)
(4)
Value=5 (v.high)
Cost=2 (low)
(2.5)
Value=2 (low)
Cost=3 (medium)
(0.7)
Value=3 (average)
Cost=3 (medium)
(1)
Value=4 (high)
Cost=3 (med.)
(1.3)
Value=3 (med.)
Cost=1 (v.low)
(3)
Value=5 (v.high)
Cost=3 (med.)
(1.7)
Value=4 (high)
Cost=4 (high)
(1)
Value=3 (med.)
Cost=3 (med.)
(1)
The list is assessed for clinical value and cost - usually on a simplified scale (1-5) this then becomes an action- priority list.
Stakeholders brainstorm a wish-list.
Values:
Simplicity
Function-led
High-quality
Adaptable
These values maintain future usefulness.


Hospitals change Models of Care on average about 7 times in their lifespan.
Health capacity planning
is a fuzzy logic

Flexibility should be maintained
as long as possible.

The backbone:
Simple circulation
Virginia Mason
The Kidderminster, UK (MAAP Architects)
PRIORITY:
to maximise activity
and usability of space:
100% activity in 70% of the space
All public space
connects with
external space
Waiting space minimised
Natural ventilation, light and ameity maximised
Dispensed with:
Standard NHS schedules of accommodation (SOAs)
Departmental structures
Corridors (except for escape).

MANDATORIES:
reuse the old hospital
Re-use of buildings is often inefficient, in this case, the generous hospital planning grid “Nucleus” helped make it “super-efficient” .
Maximise use of available space for core clinical activities

Space for personal offices and dead storage eliminated .

Staff support areas separated from clinical activity.

OBJECTIVES:
High quality, hotel-like finishes throughout - not only in public areas.
Association with high-quality care.
First 100% single room NHS hospital (2004)
Simple way-finding - atrium and stairs access all destinations and obviate signage

Background
NHS Northern Region had signed up to a Lean philosophy in all capital projects.

Queen Elizabeth Hospital, Gateshead
A Virginia Mason facilitator conducted workshops at Gateshead.
Stakeholder attendance was very high.

Priority:
Efficient flows and
clinical communication

MAAP was appointed to design
Emergency department
Short stay ward
Medical assessment unit

SIMPLICITY
A simple resolution to clarify complex relationships
The new building is standardised and modular
Assignment of 72 generic assessment/treatment rooms for acuity and flexible management
BENCHMARKING SPACE

Why separate nett and gross?ED as a special case
Medical Assessment Unit (stage 1)
Developed design by Ryder Architects

All rooms are identical and same handed - wherever they are in the hospital (including emergency bays)

Images during commissioning - Opens March 2015
Staffing accounts for over 90% of the building cost over its life. Design about 0.3%
Design for maximal (and minimal) capacities.
Be explicit about gateways and thresholds.
Flows generate the planning order.
Treat the ED as ONE BIG ROOM.

Gateshead ECC – Conclusion
Full transcript