title: Integrating Lean Exploration Loops Into Healthcare Facility Design.
abstract: OBJECTIVE
  To explore how Lean can add value during the schematic phase of design through providing additional resources and support to project leadership and the architectural design team.
  
  
  BACKGROUND
  This case study-based research took place at one large academic hospital during design efforts of surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and post-op, central processing and distribution, and materials management. Surgical services project leadership asked for Lean practitioners' support during the design process.
  
  
  METHODS
  Lean Exploration Loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs during the schematic phase were primarily conducted using express workouts (EWOs) and were focused on the flow of patients, staff, and family throughout the pavilion.
  
  
  RESULTS
  LELs resulted in recommendations for key design features (e.g., number of pre- and post-op bays per OR floor, location of doors, scrub sinks, stretcher alcoves, equipment storage, and sterile core areas). Two-sided pre- and post-op bays with an inner clinical workspace and an outer patient transport corridor were recommended. Communicating elevator and a centrally located stairwell for staff to alleviate stress on the main bank of elevators at peak usage times were also suggested.
  
  
  CONCLUSIONS
  We found Lean tools and methods to be of most value during schematic phase when focused on detailed process and layout analysis, while acknowledging the usefulness of focused EWOs to generate the evidence needed for the decision-making.
authors: 1 Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors: Kendra
authors: K
authors: Johnson
authors: 1 Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors: Lukasz
authors: L
authors: M Mazur
authors: 1 Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors: Janet
authors: J
authors: Chadwick
authors: 2 Industrial and Systems Engineering Department, North Carolina State University, Raleigh, NC, USA.
authors: Pegah
authors: P
authors: Pooya
authors: 1 Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors: Alison
authors: A
authors: Amos
authors: 3 Poole College of Management, North Carolina State University, Raleigh, NC, USA.
authors: John
authors: J
authors: McCreery
mesh_terms: D000046:Academic Medical Centers; D017598:Efficiency, Organizational; D004607:Elevators and Escalators; D006749:Hospital Design and Construction / Q000379:methods*; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration*
keywords: case study; hospitals; lean; participatory design; surgical centers