The participative design of lean healthcare facilities

The NHS capital budget total is approximately £4 billion per year. This is spent on improvements to premises or the development of new premises. The design of facilities has a large impact on efficiency and outcomes. Healthcare is a service environment in which patients are part of the system. It is therefore necessary to incorporate a sociotechnical approach to design. The design of healthcare facilities is complex because there are multiple stakeholders and several types of flow that interact, patients, clinicians, visitors, medication, supplies, equipment and information. The paper briefly reviews the literature on the design of different types of manufacturing facilities from technical and sociotechnical perspectives. It then develops classifications of healthcare design problems. The traditional approach to hospital design and recent Lean-based approaches are reviewed. Appropriate approaches for designing various types of facilities are then considered. A good design will streamline these individual flows, but will also minimise unfavourable interactions, such as minimising the probability of visitors introducing infections to the patients. Improving flow helps minimise waste. The Lean 3P design process adopts a participative approach that takes into account people, products and processes.