do not build a new hospital in the rear view mirror

8/7/2019 Do Not Build a New Hospital in the Rear View Mirror

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Bel ium


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Dont take the things with

you that dont work well to

your new facility

If you have a leaky trash bag,

dont put a band-aid on it andmove it to someone elses desk

or take it to your new hospital

Relentless efforts to identifying

and eliminate waste


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You Must Identify and

Eliminate Waste as You

Plan Your New Facility

Do this prior to and during theplanning stages and for the final

move

Dont wait to do this until youhave moved into a new facility


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Solid Pre-PlanningIdentify a Planning Team

In-house people (include clinical

people)

Choose consultants who can worktogether

Structure (Architecture)

Layout and Design

Lean

Establish a Vision and a Scope

Work from a Master Plan


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Current State

Create a current state Value StreamMap and Future State Map

Create service or department-specific VSMs and FSMs

Ask, What is not working?

Ask, What about this can we/shouldwe change?

Ask, How can we make thisbetter?

What do you want it to look like?


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Overall Site Analysis

Traffic

Noise

Access

Neighborhood

Solar

Orientation Topography

Landscape

Medical Offices

Service Vehicles

EMS Access

Pedestrian Access

Ring Road

Design Layout Prevailing Winds


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Dartmouth-Hitchcock

Medical Center

Lebanon,

New Hampshire

USA

Opened in 1991


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Information System

Needs

A new system? A modified

system? Do systems that needto talk to each other do so?

Should be in place before move

All training done before move


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Room Considerations

Room utilization study

Universal/multifunctional rooms

Isolation (positive/negative

pressure) rooms

Private rooms

Bedside/hallway/hand-held

computers


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S T . P A T R IC K ' S E D R O O M U T I L I Z A T I O N S T U D Y J U N E 6 T H R U J U N E 1 4 , 2 0 0 7

R O O M S P E C I A L T Y 7 A 8 9 1 0 1 1 1 2 1 P 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 A 2 3 4 5 6 T O T A L % U T I L .

H R S .

T R 1 - 1 G E N E R A L 3 3 5 7 7 7 2 6 7 8 7 7 8 7 6 6 6 6 4 3 3 5 4 4 1 3 1 6 0 . 6 %

T R 1 - 2 G E N E R A L 3 3 4 4 4 6 7 6 6 6 6 9 7 6 5 6 6 5 5 7 4 1 1 1 1 1 8 5 4 . 6 %

T R 2 - 1 G E N E R A L 2 3 4 4 6 6 6 9 6 5 6 4 6 6 5 5 7 6 3 3 1 0 2 3 1 0 8 5 0 . 0 %

T R 2 - 2 G E N E R A L 5 7 6 7 9 8 9 6 6 6 8 9 8 6 9 9 6 3 5 6 5 4 3 3 1 5 3 7 0 . 8 %

T R 3 - 1 M A J O R T R A U M A 3 3 2 1 6 6 6 5 6 5 2 4 4 2 2 2 5 4 4 3 3 1 1 1 8 1 3 7 . 5 %

T R 3 - 2 M A J O R T R A U M A 0 0 1 1 1 0 1 2 3 1 2 3 3 3 3 3 1 2 2 1 0 0 0 0 3 3 1 5 . 3 %

E 4 S U T U R E 2 4 3 5 4 5 7 6 4 4 4 3 3 4 6 6 5 2 3 1 2 2 3 0 8 8 4 0 . 7 %

E - 5 P E D I A T R I C S 2 3 3 3 4 6 5 9 8 8 8 8 8 5 5 6 3 5 5 2 1 0 0 0 1 0 7 4 9 . 5 %

E - 6 O B / G Y N 2 4 4 4 3 4 7 6 7 6 5 3 3 2 2 5 3 4 3 4 2 0 0 0 8 3 3 8 . 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 5 9 2 7 . 3 %

E - 8 P S Y C H 0 0 0 2 6 6 6 7 8 4 7 7 5 7 7 2 3 2 2 2 2 0 0 0 8 5 3 9 . 4 %

H A G E N E R A L 6 7 5 5 8 8 7 8 7 7 5 5 6 6 6 7 6 5 4 1 3 1 1 0 1 2 4 5 7 . 4 %

H B G E N E R A L 1 2 5 5 5 6 6 8 8 7 6 4 4 7 6 6 2 2 3 2 2 1 0 0 9 8 4 5 . 4 %

H C G E N E R A L 2 4 5 3 6 6 6 8 5 5 7 7 6 5 7 5 6 2 3 2 1 1 1 1 1 0 4 4 8 . 1 %

H D G E N E R A L 1 3 4 5 7 8 9 8 8 7 8 7 6 4 6 6 5 3 5 2 2 2 2 0 1 1 8 5 4 . 6 %

T O T A L 3 4 4 6 5 2 6 0 8 1 8 7 8 9 # # 9 2 8 3 8 2 8 2 8 0 7 2 7 7 7 9 6 4 5 3 5 5 4 0 3 1 1 8 1 8 1 4 1 4 9 0 4 6 . 0 %

% U T I L . 25.2

%

34.1

%

38.5

%

44.4

%

60.0

%

64.4

%

65.9

%

74.8

%

68.1

%

61.5

%

60.7

%

60.7

%

59.3

%

53.3

%

57.0

%

58.5

%

47.4

%

39.3

%

40.7

%

29.6

%

23.0

%

13.3

%

13.3

%

10.4

%

H R S .

W A I T 0 0 0 0 1 1 4 5 2 2 1 2 2 0 0 0 0 0 0 0 0 0 0 0 2 0


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Zone 2

Zone 1

Zone 3

Zone 4


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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

1920

Zone 2 3 7a - 7p RN 7p - 7a RN

4

5

6

7

Zone 3 8 9a - 9p RN Float9 covers.

10 Closes

11 Zone 3

12 at 12 am

Zone 4 13 11a -11p

14

1516

17 Close Zone 4 at 11pm

12n - 12 a Float RN

ED Tech ED Tech

ED Tech ED Tech

Triage RNCharge RN Charge RN

9a 9p RN 9p - midnightFloat RN

Close Zone 3 at midnight

11a 11p RN

Close Zone 4 at 11p


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Supplies

Must be close to patients

Storage rooms organized/par levels

Supply specialty carts

Special procedure kits

Consolidate workplace equipment inthe order of the work


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Specialty Carts

Suture

Dressings

EENT

Isolation

OB/Gyn

Latex-free Geriatric

Burns


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Specialty Kits

Central IV line kit

Shunt de-clotting kit

Etc.


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Utility Rooms

Must be close to the work

Must have as many as needed

given the patient population

Toilets in rooms


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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.)


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Support Spaces

Conference Rooms

Break Rooms (natural light and

lockers)

Family Consult Rooms (with

toilets and phones and internet)


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Simulations/Schematics

Layouts

People Movement

Location of major medicalequipment

Routine scenarios

What-if?Scenarios


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Helipad/Heliport

Prevailing winds

Power lines and obstacles

Lighting

Hospital access

Visitor safety Debris/snow


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Parking

Enough?

Valet service? Where?

Easy hospital access Way-finding


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Non-Traditional Thinking

24/7

What a concept!


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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


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The Move to the New

Hospital Carefully planned and

choreographed

Everything in place beforepatients

Consider moving patients in the

evening hours Time a patient move

Floor patient

ICU patient


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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


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Be sure to include a Lean

expert (internal or external) on

your planning andimplementation team

Prepare your team and staff for

Lean implementation


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Bon Lean Voyage!Enjoy the planning

as well as arrival atyour destination.


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Questions?

do not build a new hospital in the rear view mirror

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