Planning and Building a

Lean Medical Center

Susan Sheehy, PhD(c), RN, FAAN, FAEN

Director of Education Programs
Lean Healthcare West
USA
Belgium
Don’t take the things with
you that don’t work well to
your new facility

If you have a leaky trash bag,

don’t put a band-aid on it and
move it to someone else’s desk
or take it to your new hospital

Relentless efforts to identifying

and eliminate waste
You Must Identify and
Eliminate Waste as You
Plan Your New Facility

• Do this prior to and during the

planning stages and for the final
move
• Don’t wait to do this until you
have moved into a new facility
Solid Pre-Planning
Identify a Planning Team
In-house people (include clinical
people)
Choose consultants who can work
together
Structure (Architecture)
Layout and Design
Lean

Establish a Vision and a Scope

Work from a Master Plan
Current State
• Create a current state Value Stream
Map and Future State Map
• Create service or department-
specific VSMs and FSMs
• Ask, “What is not working?”
• Ask, “What about this can we/should
we change?”
• Ask, “How can we make this
better?”
• What do you want it to look like?
Overall Site Analysis

• Traffic • Medical Offices

• Noise • Service Vehicles
• Access • EMS Access
• Neighborhood • Pedestrian Access
• Solar • Ring Road
Orientation • Design Layout
• Topography • Prevailing Winds
• Landscape
Dartmouth-Hitchcock
Medical Center

Lebanon,
New Hampshire
USA

Opened in 1991
Inpatient Beds

• Pro-active – not reactive

• Bed Czar
• “Pull” NOT “Push”
• Plans for direct, emergency, and
elective admissions
• “Plus-One” plan for overflow
Information System
Needs

• A new system? A modified

system? Do systems that need
to “talk” to each other do so?
• Should be in place before move
• All training done before move
Room Considerations

• Room utilization study

• Universal/multifunctional rooms
• Isolation (positive/negative
pressure) rooms
• Private rooms
• Bedside/hallway/hand-held
computers
 ST. PATRICK'S ED ROOM UTILIZATION STUDY JUNE 6 THRU JUNE 14, 2007

ROOM SPECIALTY 7A 8 9 10 11 12 1P 2 3 4 5 6 7 8 9 10 11 12 1A 2 3 4 5 6 TOTAL % UTIL.

HRS.

TR 1-1 GENERAL 3 3 5 7 7 7 2 6 7 8 7 7 8 7 6 6 6 6 4 3 3 5 4 4 131 60.6%

TR 1-2 GENERAL 3 3 4 4 4 6 7 6 6 6 6 9 7 6 5 6 6 5 5 7 4 1 1 1 118 54.6%

TR 2-1 GENERAL 2 3 4 4 6 6 6 9 6 5 6 4 6 6 5 5 7 6 3 3 1 0 2 3 108 50.0%

TR 2-2 GENERAL 5 7 6 7 9 8 9 6 6 6 8 9 8 6 9 9 6 3 5 6 5 4 3 3 153 70.8%

TR 3-1 MAJOR TRAUMA 3 3 2 1 6 6 6 5 6 5 2 4 4 2 2 2 5 4 4 3 3 1 1 1 81 37.5%

TR 3-2 MAJOR TRAUMA 0 0 1 1 1 0 1 2 3 1 2 3 3 3 3 3 1 2 2 1 0 0 0 0 33 15.3%

E 4 SUTURE 2 4 3 5 4 5 7 6 4 4 4 3 3 4 6 6 5 2 3 1 2 2 3 0 88 40.7%

E-5 PEDIATRICS 2 3 3 3 4 6 5 9 8 8 8 8 8 5 5 6 3 5 5 2 1 0 0 0 107 49.5%

E-6 OB / GYN 2 4 4 4 3 4 7 6 7 6 5 3 3 2 2 5 3 4 3 4 2 0 0 0 83 38.4%

E-7 E,N,T 2 0 1 4 5 5 5 7 3 4 1 2 3 2 2 5 0 2 4 1 0 0 0 1 59 27.3%

E-8 PSYCH 0 0 0 2 6 6 6 7 8 4 7 7 5 7 7 2 3 2 2 2 2 0 0 0 85 39.4%

HA GENERAL 6 7 5 5 8 8 7 8 7 7 5 5 6 6 6 7 6 5 4 1 3 1 1 0 124 57.4%

HB GENERAL 1 2 5 5 5 6 6 8 8 7 6 4 4 7 6 6 2 2 3 2 2 1 0 0 98 45.4%

HC GENERAL 2 4 5 3 6 6 6 8 5 5 7 7 6 5 7 5 6 2 3 2 1 1 1 1 104 48.1%

HD GENERAL 1 3 4 5 7 8 9 8 8 7 8 7 6 4 6 6 5 3 5 2 2 2 2 0 118 54.6%

TOTAL 34 46 52 60 81 87 89 ## 92 83 82 82 80 72 77 79 64 53 55 40 31 18 18 14 1490 46.0%

2 5 .2 %
3 4 .1 %
3 8 .5 %
4 4 .4 %

6 0 .0 %

6 4 .4 %
6 5 .9 %
7 4 .8 %
6 8 .1 %
6 1 .5 %
6 0 .7 %
6 0 .7 %
5 9 .3 %
5 3 .3 %
5 7 .0 %
5 8 .5 %

4 7 .4 %

3 9 .3 %
4 0 .7 %
2 9 .6 %
2 3 .0 %
1 3 .3 %
1 3 .3 %
1 0 .4 %
% UTIL.

HRS.

WAIT 0 0 0 0 1 1 4 5 2 2 1 2 2 0 0 0 0 0 0 0 0 0 0 0 20
 Zone 2 Zone 3

Zone 1

Zone 4
Staffing by Geographic Zone - Proposed ED
7a 8 9 10 11 12 1p 2 3 4 5 6 7 8 9 10 11 12 1a 2 3 4 5 6
Zone 1 1 7a - 7p RN 7p - 7a RN
2
18
19
20
Zone 2 3 7a - 7p RN 7p - 7a RN
4
5
6
7
Zone 3 8 9a 9a – 9p
- 9p RNRN 9p - midnight
Float
9 Float RN
covers.
10 Closes
11 Zone 3
Close Zone 3 at midnight
12 at 12 am
Zone 4 13 11a -11p
11a – 11p RN
14
15
16
17 Close
Close Zone Zone
4 at 4 at 11p
11pm

12n - 12 a Float RN
ED Tech ED Tech
ED Tech ED Tech
Triage RN
Charge RN Charge RN
Supplies

• Must be close to patients

• Storage rooms organized/par levels
• Supply specialty carts
• Special procedure kits

• Consolidate workplace equipment in

the order of the work
Specialty Carts

• Suture
• Dressings
• EENT
• Isolation
• OB/Gyn
• Latex-free
• Geriatric
• Burns
Specialty Kits

• Central IV line kit

• Shunt de-clotting kit
• Etc.
Utility Rooms

• Must be close to the work

• Must have as many as needed
given the patient population
• Toilets in rooms
Support Team Spaces
• Offices
• Charge nurses
• Residents
• Attendings
• Case Managers (family place, too)
• Social Services
• EMS (work and equipment space)
• Administration
• Security
• Other (Flight Crew, etc.)
Support Spaces

• Conference Rooms
• Break Rooms (natural light and
lockers)
• Family Consult Rooms (with
toilets and phones and internet)
 Simulations/Schematics
• Layouts
• People Movement
• Location of major medical
equipment
• Routine scenarios
• “What-if…?”
Scenarios
Helipad/Heliport

• Prevailing winds
• Power lines and obstacles
• Lighting
• Hospital access
• Visitor safety
• Debris/snow
Parking
• Enough?
• Valet service? Where?
• Easy hospital access
• Way-finding
Non-Traditional Thinking

24/7
What a concept!
The Move to the New
Hospital – Staff Concerns
• Involved in planning from day 1
• Frequent site visits
• Posted floor plans
• Department move plans
• Time to grieve
• Time to orient to new facility
• Celebration
The Move to the New
Hospital
• Carefully planned and
choreographed
• Everything in place before
patients
• Consider moving patients in the
evening hours
• Time a patient move
• Floor patient
• ICU patient
The Lean Imperative

• Building a new medical center

presents a significant
opportunity to eliminate waste,
reduce patient and staff
dissatisfiers, improve patient
care, and move closer to IDEAL
• Be sure to include a Lean
expert (internal or external) on
your planning and
implementation team
• Prepare your team and staff for
Lean implementation
Bon “Lean” Voyage!
Enjoy the planning
as well as arrival at
your destination.
Questions?