Applying lean principles to the design of healthcare facilities

The National Health Service (NHS) in England has a capital budget of approximately £4bn per year to spend on the construction and refurbishment of new and existing buildings. The majority of capital costs are committed by early stage design decisions, which have a large impact on operations, costs and performance. It is necessary to incorporate a sociotechnical approach to design as healthcare is a service environment in which patients are part of the system. The design of facilities determines the allocation of space and the interacting flows including: patients, clinicians, visitors, medication, supplies, equipment, and information. The design requires many trade-offs and has a major impact on the patient experience and the quality and efficiency of care. This paper evaluates the application of the Lean 3P (production, preparation, process) participative design method as part of a pilot project to design a new endoscopy unit at Gateshead Health NHS Foundation Trust. The research, which was funded by the Health Foundation, used participant observation, and an analysis of the layout drawings and the 7 flows of medicine to appraise 3P. The existing and proposed designs were compared. The results show that 3P is an effective tool that can develop designs that meet the requirements of multiple stakeholders. A framework was developed that positions 3P within the overall design process. The seven flows of medicine classification was extended to include subcategories and to identify interrelationships between the flows. This will help inform the design of healthcare facilities.