CÉSAR RODARTE RANGEL – ARCHITECT, ARQMEDYCA DESIGN


A new way to build the most efficient hospitals


The idea that the physician is the most important client in every clinic or hospital is outdated. Today, there is a new way of designing and constructing medical centres and hospitals where everything is planned around the patient. The ‘lean’ hospitals method, which involves making processes more effective and efficient, places the patient at the centre of the action and thereby adds value to the development.


Many hospitals have the same problems because they were often designed using the same template. Physical layouts share similar characteristics as they are often designed by architects with a poor understanding of how hospitals work and processes are therefore developed using the same paradigms and similar educational perspectives. Copying other hospitals and their ‘best practice’ may bring incremental improvements, but we can drive more dramatic change by looking at our processes in a new way, engaging hospital employees to identify waste and develop their own solutions. The idea that the physician is the most important client in every clinic or hospital is outdated. Today, there is a new way of designing and constructing medical centres and hospitals where everything is planned around the patient. A few years ago, we began to use the ‘lean’ hospitals method, which involves making the processes within hospitals more effective and efficient, placing the patient at the centre of the action and thereby adding value to the development. The lean management method was


developed about 50 years ago using a system invented by Toyota, which aimed to increase productivity by designing a process to manufacture cars at a minimum cost and with zero waste. Taiichi Ohno and Shigeo Shingo, who developed the Toyota production system, defined business goals that included more than the factory. Ohno wrote: “All we are doing is looking at the timeline from the moment a customer gives us an order to the point when we collect the cash. And we are reducing that timeline by removing the


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Using the methodology at the Virginia Mason Medical Center led to improvements in the quality of patient care alongside reduced errors and waiting times.


non value added wastes.” In a hospital setting, this could be the time between a patient being referred by a physician to the actual care that is provided and ending at the point when the hospital gets paid. Ohno’s approach is time based,


whereby reducing delays leads to better quality and lower costs; these lower costs


César Rodarte


César Rodarte is a Mexican certified architect in healthcare facilities and specialises in hospital architectural design and the use of ‘lean’ methodology. He is also undertaking a masters in hospital


architecture at the Catholic University of Murcia, Spain. He is the founder and


director of ARQmedyca, a company that designs healthcare facilities and a


counsellor for the Mexican Society of Architects, specialising in health.


are the result of improvements to flow. It is important to define ‘lean’ in terms of the goals and objectives of a hospital. Like other types of organisation, hospitals need to do more work with less. Providing customers with exactly what they want includes providing care that is right the first time.


Improving operations With the main goals being improvements in quality, cost and deadlines, the lean method targets the optimisation of every aspect that does not increase value as the client sees it. A successful first attempt at using the methodology at the Virginia Mason Medical Center led to improvements in the quality of patient care alongside reduced errors and waiting times. The main goal was to improve


operations and logistics as well as the way in which processes are carried out overall. Therefore, it was possible to


IFHE DIGEST 2019


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