Lean in HealthcareApplying Lean Tools to Healthcare Design

• Bachelor of ArchitecturePhiladelphia University

• Bachelor of Science, Interior DesignPhiladelphia University

EDUCATION

CERTIFICATIONS• AIA• Lean Six Sigma Black Belt• Lean Green Belt

JONATHAN BykowskiPrincipal & Practice Leader, Continuous Improvement

• Master of Engineering, Healthcare Systems EngineeringLehigh University

• Bachelor of Arts, ArchitectureLehigh University

EDUCATION

CERTIFICATES• Lean Bronze Knowledge, SME

LAURA SilvoyHealthcare Systems Engineer, Associate

We are problem solvers.Not problem identifiers.

provides a way to do more with less, create new work and deliver value as defined by the customer.

LEAN It’s not just for Toyotas, or Hospitals, or everyone but Architects.

Case Study: Laser Spine Institute

THE PROBLEM

28,000 SF

Solution

• We can design flexible spaces to support future growth

• We can save money by building 8 flexible rooms instead of 12 single-purpose rooms

WOULD IT WORK?

Design Validation LOGN(1.5, 0.736)

Case Study: Northeast Academic Children’s Clinic

THE PROBLEM

Combine three separate clinics

1N Surgery 7N Genetics 7C GI

Requests• Maximize number of

exam rooms• Maximize waiting space• Dedicated space for

each clinic

Design Analysis SPACE UTILIZATION

Scheduled Appointment

Time

Scheduled Appointment

Time(50% Volume Increase)

+/- 10 Minute Appointment

Time

+/- 10 Minute Appointment

Time(50% Volume Increase)

Average patients seen each day 31 59 31 59Rooms in use at 9:36 AM on Day 1 3 10 3 5Maximum number of rooms used at same time on Day 1

8 15 10 15

Average waiting room utilization 44% 79% 50% 83%Average maximum registration queue length

1.3 2.6 1 2.8

Average maximum check out queue length

1.6 5.1 1.1 2.6

NameTotal

EntriesAverage Time Per Entry

(Min)Maximum Contents

Waiting Room 3446.6 18.5 29.2Patient Exam 1 470.5 33.3 1Patient Exam 10 341.6 37.2 1Patient Exam 13 335.4 40.8 1Patient Exam 11 334 37.6 1Patient Exam 2 331.9 33.0 1Patient Exam 12 297.7 46.5 1Patient Exam 9 230.5 38.8 1

NameTotal

EntriesAverage Time Per Entry

(Min)Maximum Contents

Waiting Room 3440 6.6 29.7Patient Exam 1 496.4 47.1 1Patient Exam 2 464.6 46.5 1Patient Exam 3 417.1 47.0 1Patient Exam 4 363.9 48.9 1Patient Exam 5 320 48.5 1Patient Exam 6 270.2 48.3 1Patient Exam 7 228.3 47.6 1

Scheduled Appointment

Duration for 31 Patients

Scheduled Appointment

Duration for 59 Patients

Rooms Dedicated to Specific Clinic

Rooms Shared Among All Clinics

Solution• 14 exam rooms• Reduce waiting space• Add staff lounge

Case Study: Mid-Atlantic Academic Children’s Emergency Department

THE PROBLEM

Minimize ED waiting timeImprove patient experience

Acuity Count Percentage1 - Resuscitation 607 1.47%2 - Emergent 3,986 9.64%3 - Two+ Resources 12,547 30.35%4 - One Resource 18,979 45.91%5 - No Resources 5,221 12.63%Total 41,340 100%Data taken from 1/1/14 thru 6/30/14

Process Step Value Add (min)Security N/ARegistration/Triage 3 minutesAssessment 7 minutes

TimeArrivals per

Hour12 AM -- 7 AM 27 AM -- 11 AM 1011 AM -- 2 PM 152 PM -- 4 PM 104 PM -- 8 PM 208 PM -- 10 PM 1010 PM -- 12 AM 5

Average Process Step Duration

Estimated Arrival Rate

Patient Acuity DistributionData Provided by Hospital Lean Department

Data Conjectured by Array

Process Step Distribution (min)

SecurityTriangular (1.5, 2, 3)

minutesRegistration/Triage/Assess

Triangular (8, 10, 15) minutes

Estimated Process Step Distributions

Data Analysis

Simulation

7 triage rooms2 security desk positions

Data-Driven Decisions

• Quick registration at security• Vitals only during triage• Assessment in room

Out of 42,000

Solution• 5 triage rooms• 3 security desk

positions• 56 private

treatment rooms• <.08% of Patients

wait longer than 5 minutes for triage

We don’t have to know the answer.