Learning the Design Process

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Bruce KnepperBy Bruce Knepper

The Healthcare Industry is currently undergoing a major process redesign. The redesign began in the manufacturing industry that was forced to learn how to do “more with less” in order to compete.

Sound familiar?

This effort is now being embraced by many healthcare organizations across the United States. Hospitals are being forced to provide high-level medical care for an ever shrinking reimbursement, more with less.

Architects and healthcare planners have traditionally brought facility solutions to the industry based on evidence and their experience.  Design ideas were presented to key administrators or department leaders, sometimes tweaked, and subsequently put into place.   Experience was the great teacher.

The changes in process that are streamlining and improving the delivery of healthcare suggest that the process of healthcare planning and design change as well.  The facility design must support the process changes that need to occur; therefore, “defining the process” is the starting point of a good design.

Production   Preparation   Process   –  3P for short.

The Lean Design Process is a methodology that may enable healthcare providers to transform the care delivery model into one that is efficient, high quality and accountable.  The Lean Production Preparation Process (3P) focuses on eliminating waste through product and process design.

The 3P does not begin with pictures of existing spaces or previous designs but rather a hard look at the process.  We begin, with a tablet, not a roll of sketch paper.  First define the Guiding Principles for the program.  These principals set the goals and objectives that form boundaries and provide direction.   One common Guiding Principal may be

We will put the needs of the patient first.”  . . . a simple yet powerful statement.

The next task is to map the process that is currently in place.  This is where it may become clear to a group that something has to change.   The natural progression is to then create a map of how the process should work.   It is through this step that the team begins to embrace the change that is needed.   Keep in mind that most of us resist change unless it is our idea.    Following these discoveries a list is made, sometimes called a Fishbone Diagram, where resources are defined at every step in the new process, resources such as manpower, equipment, and supplies.

Basic space programming is used to develop a department or service gross area.  A comprehensive list of each room and square foot area is required.  For example there may be 12 ICU Rooms at 250 square feet each, 2 Medication Rooms at 120 square feet each, a Housekeeping Closet at 60 square feet, and so on until a comprehensive list of spaces is compiled.  The sum of rooms and areas is the Net Area. The Gross Area is obtained by adding an estimated area for circulation, walls, and inefficiencies.

No tracing paper yet!

More than 35 years of professional practice has taught me that most people want to design the space they live and work in. (There must be some subconscious desire in everyone to be an architect.)   What better way to embrace the changes necessary than enabling the team to design their space?

The next step is for the team to develop a department boundary that shows the outer limits of the space.  The boundary must accommodate the anticipated Gross Area calculation. If the project is a renovation to an existing space the stairs, elevators, and mechanical shafts should be included and honored.  Paper cutouts of each programmed space are then created.  By arranging the cutouts the team develops numerous two dimensional Plan Options. As a group the team vets which ideas best support the process changes and Guiding Principles that they defined.

After agreement is reached for a single Plan solution, the team constructs a scale model that represents the favored design. This helps the team to further visualize the solution.   Full-size cardboard mock-ups of technical spaces may be constructed simultaneously to allow the team to better visualize the clearances and details.

The architect then takes the information back to the drawing board and creates a hard-lined Schematic Layout with a practiced eye toward life safety, current codes, and healthcare regulations.

The end result is a schematic solution that began with the team-defined objectives, an improved process and flow, and a facility that will enable the caregivers to embrace a new and improved process.

Most importantly, it is their space, their design, their solution, all for their benefit and ultimately the benefit of the patient – more with less.

Bruce Knepper is a registered architect and Vice President of Healthcare East at Stantec.

Bruce works out of the Butler, Pennsylvania Office and can be reached at bruce.knepper@stantec.com.