Loading presentation...

Present Remotely

Send the link below via email or IM


Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.


The Lean Paradox

No description

Jan Golembiewski

on 12 October 2017

Comments (0)

Please log in to add your comment.

Report abuse

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

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
living rooms
The wish-list
Kennel for pets
Lockers for staff
A computer
Value=4 (high)
Cost=1 (v.low)
Value=5 (v.high)
Cost=2 (low)
Value=2 (low)
Cost=3 (medium)
Value=3 (average)
Cost=3 (medium)
Value=4 (high)
Cost=3 (med.)
Value=3 (med.)
Cost=1 (v.low)
Value=5 (v.high)
Cost=3 (med.)
Value=4 (high)
Cost=4 (high)
Value=3 (med.)
Cost=3 (med.)
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.
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)
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).

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.

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

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.

Efficient flows and
clinical communication

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

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

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