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Lean Methodologies and Institutional Design

Healthcare facilities are embracing Lean principles by redesigning processes to reduce waste and to improve the quality of service delivery through the eyes of their client, the patient.

Lean methodologies use a prescribed set of tools, developed by the Toyota Production System, to relentlessly eliminate waste in processes, to focus on providing value for the end user and to improve the quality and productivity of everything that is done. Lean is heavily reliant on the front line staff to improve the processes that they know best.  Lean looks across departmental boundaries to make sure all non-value-added activities are eliminated.

Successful Lean initiatives require the complete commitment of the management of a business to support process change initiatives, to provide communication and training while trusting in the changes being implemented by the cross-departmental front line staff.  Ultimately a Lean strategy will be successful if everyone works to relentlessly remove waste from their systems and to improve the quality of their service in the eyes of their client.

Three Examples of How Lean Influenced Parkin Healthcare Design

We have successfully applied Lean principles within the context of design on several P3 and hospital redevelopment projects.

Critical Care Tower, Surrey Memorial Hospital, British Columbia: For the new Critical Care Tower for Surrey Memorial Hospital we worked with a Lean consultant to improve staff working conditions on the patient floors. A triangular four-pod layout was developed for optimal workflow and patient care instead of two rectangular pods, as shown in the hospital’s indicative design. Our Lean consultant confirmed that walking distances for staff were reduced by 50% with our Lean influenced design.

Traffic flows were also analyzed to determine which spaces were most commonly visited by staff on each floor. The three most visited areas were the care station, patient rooms and the medication room.  As a result, the medication room was placed immediately behind the centralized care station to streamline movement within the unit.

Hôtel-Dieu Grace Hospital, Windsor, Ontario: We used a structured approach from Lean called the A3 process to observe and document all activities within a process. At this level of detail we can view the “work-arounds” and “rework” being undertaken by staff to complete a current process due to existing parameters and conditions.  The A3 analysis allows us to better understand the barriers facing frontline staff and to redesign the processes to take the “work-arounds”, and the waste, out of the system.

Simpler Inc. conducted the A3 process and we participated fully with the user groups to assist in the analysis and development of future state concepts. This “ground-up” process occurred in the programming and schematic design phases for a major ambulatory care addition at the hospital.  We were highly successful in clarifying and providing a common knowledgebase for workflow and operations within departmental areas. The Lean process led to a thorough review of proposed program areas, which in turn allowed reductions in space requirements for the project.

New Oakville Hospital, Ontario: As part of the P3 submission we worked with Lean consultants to analyze the hospital’s indicative design and create a solution that improved upon it by using specific Lean tools. Upon winning the project, the Lean consultants and Parkin conducted several two-day workshops with the hospital user groups and staff. These iterative workshops with multiple user groups, facilities management teams, ‘hotel’ support services staff and building operators were held in order to review operational flows, inpatient and outpatient flows, visitor access, and support, supply and distribution movements with the goal of optimizing the hospital’s processes.  Appropriate departmental adjacencies were achieved and connected by straight, simple corridors, maximizing operational efficiency for staff, thus providing value to the patients. 

When Lean methodologies and principles are incorporated in institutional design projects, they not only provide value to clients, but also benefit staff by simplifying their processes and the work of those who maintain the property.


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