DESIGN


Identifying waste and areas of opportunity.


elevate employees at the medical centre to a higher level; tasks would be done effortlessly, efficiently and continuously improved, thereby benefitting everyone involved, especially the patients. Lean is a set of concepts, principles


and tools used to create and deliver the best value from the customer’s perspective while using the least resources and fully utilising the knowledge and skills of the people undertaking the work. Discovering how healthcare can deliver the best value to patients while using as few resources as possible and maximising the use of people skills and knowledge is the primary goal. Before starting on the architectural design of a medical centre or hospital, it is essential to keep the following needs in mind: l to understand all the processes in each area in order to plan the location of each piece of furniture and equipment as well as the distribution of healing material


l to reduce the distances traveled by employees and widen corridors to ensure better circulation of patients and medical staff


l to locate the central nurses station as centrally as possible or add a sub station in the hospitalisation area for rooms that are futher away


l to create more efficient spaces, where everything is as close as possible. The logistics of the warehouse/storage rooms within each hospital department must be extremely efficient and if necessary, smaller storage spaces should be created nearby


l to use technology to optimise services. Technology can help employees improve and manage tasks as well as keeping patients better informed


l to understand how the hospital is managed. Most patients move through several areas during their stay in hospital (admission, pre-operative, surgery, recovery, hospitalisation) and therefore knowledge of the process helps to minimise problems


IFHE DIGEST 2019


Eight types of waste that can be found in hospitals.


due to inconsistencies or a lack of proper communication between them.


Identifying every aspect that does not generate added value for the patient means taking their experience to a higher level and improving overall perception of their care.


Identifying waste It has been shown that hospital employees spend a lot of their time engaged in useless activities. For example, it was observed that in a hemodialysis centre nurses walked about 6,500 m daily to carry out activities that were not part of their role. Only one-third of their time was spent on value added activities, which were defined loosely as any time that involved direct patient contact. There are eight areas in which waste can be identified in hospitals: l defects – any work activity that is not done right the first time. This may be an activity that has not been done correctly, taking into account that serious errors in a hospital can result in injury or death


l over production – producing too much of a product (more than the customer desires) or producing it before it is needed by the customer


l transportation - the excess movement of the product in a system and using an understanding of transportation waste during the design of a new hospital


l waiting – the time during which nothing productive is happening


l inventory – excess costs due to the cost of storage, movement, spoilage and wastage


l motion – walking is rarely a value added activity. It is therefore imporant to reduce or eliminate unnecessary movement and walking


l overprocessing - work that is not valued by the customer


l talent - waste and loss due to failure to engage employees, listen to their ideas or support their careers.


Conclusion Our goal is to see the waste that employees and physicians have to deal with on a daily basis. We need to see what the patient experiences to help identify causes of repetition, delay and other waste. Data may show that product flow to the laboratory, pharmacy or other support departments is in line with benchmarks, but direct observation will show the amount of waste and the opportunity for future improvement. Using this method will give users a set of tools, a management system and a philosophy that can change the way in which hospitals perform in different areas.


Finally, implementing the lean hospitals method from the time of conception of a new medical centre can enable hospitals to improve the quality of patient care and reduce errors and waiting times. It is designed with direct input from staff to support efficient workflow and value streams, rather than forcing departments and employees to adjust their work to the space. A lean hospital focuses more on what is functional and effective for patients and staff rather than glossing over bad processes with marble entryways and lobby fountains. A lean hospital incorporates process


technology, automation and information systems that make work easier and reduce the likelihood of errors. Hospital organisations may benefit from this method in the long term with a reduction in operating cost and risk, as well as promoting growth and expansion. As architects, we must step outside our office spaces and interact with those who stand to benefit from a project. This is the best way to achieve success.


Further reading l Graban M. Lean Hospitals: Improving quality, patient safety and employee engagement. (2nd edn) Taylor & Francis Group, 2017.


l Aguilar J, Gil M. Lean Healthcare: La Mejora Continua En El Hospital. (1st edn) Actio Books, 2012.


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IFHE


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