The Participative Design of an Endoscopy Facility using Lean 3P

Abstract

In the UK, bowel cancer is the second largest cancer killer. Diagnosing people earlier can save lives but demand for endoscopies is increasing and this can put pressure on waiting times.To address this challenge, an endoscopy unit in North East England decided to improve their facilities to increase capacity and create environments that improve the experience of users. This presented a significant opportunity for step change improvement but also a problem in terms of creating designs that meet user requirements whilst addressing structural or space constraints.The Lean design process known as ‘3P' (standing for the production preparation process) was utilised as a participative design strategy to engage stakeholders in the design of the new department. This involved a time-out workshop (or 3P event) in which Lean and participative design tools were utilised to create an innovative design based on ‘point of delivery' (POD) principles. The team created a design that demonstrated an increase in treatment room capacity by 25% and bed capacity by 70% whilst reducing travel distance for patients by 25.8% and staff by 27.1%. This was achieved with an increase in available space of only 13%.The Lean 3P method provided a structured approach for corporate and clinical staff to work together with patient representatives as cross-functional teams. This participative approach facilitated communication and learning between stakeholders about care processes and personal preferences. Lean 3P therefore appears to be a promising approach to improving the healthcare facilities design process to meet user requirements.

Adapting Lean methods to facilitate stakeholder engagement and co-design in healthcare

“…Box 3 presents an example from the NHS in North East England, which adopted Lean using knowledge from Virginia Mason 45. The Lean 3P method was used to involve stakeholders in simultaneously designing healthcare facilities and service systems 38434446. The example illustrates challenges to participation that may be generally applicable (specifically the perception that patients are unable to contribute because of a lack of knowledge or ability).…”

“…The project showed that Lean 3P design workshops can provide an effective process for engaging a wide range of stakeholders43 and a structured approach for corporate and clinical staff to work together with patient representatives 44. The Lean concept of end-user value contributed to the design process by drawing out the perspectives (clinical, operational, and experiential) of multiple stakeholders in terms of what mattered most to them.…”

Operationalising the Lean principles in maternity service design using 3P methodology

“…22 The application of Lean 3P to design healthcare facilities has been pioneered by VMMC 44 61-63 and they have reported significant financial benefits as a consequence. 21 43 Beyond our own research, [22][23][24][25][26] there are, to our knowledge, no cases reported in the literature of Lean 3P being applied to design healthcare facilities in the NHS in the UK. This case used the Lean 3P format to operationalise the Lean principles 13 in the design of a new maternity facility.…”

“…21 43 56 Lean 3P is typically comprised of three phases which are: scoping and planning; a time-out participative design workshop; and follow-up and implementation. 25 In the scoping and planning phase, a meeting was held with key stakeholders in the maternity unit to facilitate a diagnostic exercise. The meeting focussed on sharing information about the upcoming time-out 3P design workshop and comprised midwives, healthcare assistants, consultants of various disciplines (e.g.…”

“…[14][15][16][17][18] Lean has also been reported as a practical means of improving the design of healthcare facilities by early adopters in the USA. [19][20][21] Beyond our own research however, [22][23][24][25][26] there are few examples in the literature of application of Lean to healthcare facilities design in the UK NHS where the context differs significantly from the US' privately provided, insurance based system.…”