The Blue Cottage Blog

Blue Cottage Knowledge Paper – Strategic Lean Services

by on August 11, 2016

Just outside of downtown Corner Brook, Newfoundland, Western Health is breaking new ground by taking a Lean-led approach to pre-design and conceptual design planning for the New Western Memorial Regional Hospital (NWMRH). Using the “Big Room” framework as the basis for the planning effort, Western Health embarked on a state-of-the-art approach to hospital facility planning that maximizes evidence based-design, opportunities for team interaction and collaboration, user buy-in and engagement and ownership, thought generation and innovation. With an eye on developing a healthcare system that functions as a whole, Western Health is striving to develop efficient, effective, and value driven solutions that aim towards a positively enhanced experience for the patients it serves. 

Click on the cover image below for a detailed overview of the Strategic Lean Services provided for this project during Campus Planning and the Big Room sessions.

Blue Cottage Knowledge Paper Strategic Lean Services Cover


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  1. This is a really interesting project. I was just wondering about the horizontal design and why it didn’t work out for reasons other than just distance and travel time, i.e. flexibility in design and locations of radiology and other adjacent departments. Don’t you think that the time from ER to CT or MRI is borderline? The Guidelines calls for a CT/MRI within 25 minutes of arrival to ED and interpretation within 45 minutes of arrival to ED, to exclude intracranial hemorrhage and start tPA? Is there a possibility that this can be decreased in the future? Does this facility have a protocol for EMS to bypass the ED and transport the patient directly to the CT/MRI? This also similar to acute coronary events (STEMI, etc) requiring PCI, although current door to balloon is 90 minutes or less.

    In my previous organization, for instance, the ED, Radiology, OR, and ICU were all on the same floor. The ED being a main point of entry to the hospital, had the radiology department on its north, the ICU on its South, and the OR on its west side. In addition, there were two different types of corridors; one for family or staff, and another that was strictly for staff use. The one utilized by staff only served as a shortcut and decreased travel time significantly. ED travel to OR less than 5 minutes, ED to ICU less than 5 minutes, and ED to RAD (CT/MRI) also less than 5 minutes. This very critical, of course, for specific clinical quality measures such as Door to Balloon Time, or Door to CT, and so on.

    Because of these special corridors, similar distances can be observed between OR and RAD, OR and ICU, ICU and RAD.

    Although structurally the building looks like a tall box, inside that box departments are spread out in a circular fashion to allow for more ease of flow and patient transfer. So, since the ICU is in the corner of the actual building, this allowed the inside of the ICU to be designed in a semi-circular fashion to allow for the Nurses Station to have excellent visuals of the ICU beds, sort of similar to what you were trying to achieve above.

    Medical/Surgical inpatient as well as Pediatrics all have their own floors integrated vertically.

    However, no design is perfect, and we need to be proactive while looking for opportunities and ways to improve every aspect of care delivery, whether it’s the design, the workflow, or processes. There lies the beauty about us as humans, we do not know everything; there is always room for improvement.

    Thank you again for sharing your work.

  2. Mohanned Afeef on October 27th, 2016 at 1:15 pm
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