title: Integrating Lean Exploration Loops Into Healthcare Facility Design.
abstract: OBJECTIVE
  To explore what, when, and how Lean methods and tools can add value during the programming 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 a surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and postop, central processing and distribution, and materials management. Surgical services project leadership asked for support from Lean practitioners 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 were primarily focused on the relative advantages of a large footprint with few floors or a smaller footprint with more floors and support spaces not collocated adjacent to ORs on the same floor.
  
  
  RESULTS
  LELs resulted in quantifications of key operational and design features (e.g., design preferences of employees and patients, horizontal distance travel, and elevator utilization studies), which in turn complemented the architectural design process and created an opportunities to gain buy-in and consensus from stakeholders through their active participation in many of the analyses.
  
  
  CONCLUSIONS
  We found Lean tools and methods to be of most value during programming phase when focused on the high-level operational and design issues to help establish buy-in and consensus among stakeholders, while acknowledging that there is often not enough design detail to perform accurate analysis.
authors.affiliation: 1 Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.|2 Carolina Health Informatics Program, School of Information and Library Science, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Lukasz M
authors.initials: LM
authors.lastname: Mazur
authors.affiliation: 1 Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Kendra
authors.initials: K
authors.lastname: Johnson
authors.affiliation: 3 Industrial and Systems Engineering Department, North Carolina State University, Raleigh, NC, USA.
authors.forename: Pegah
authors.initials: P
authors.lastname: Pooya
authors.affiliation: 1 Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Chadwick
authors.affiliation: 4 Poole College of Management, North Carolina State University, Raleigh, NC, USA.
authors.forename: John
authors.initials: J
authors.lastname: 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: Lean; case study; hospital; participatory design; surgical centers