Objective and Approach
This research took place within a process-led approach to the redesign of three intensive care units. The mixed method approach integrated Lean process improvement methods, process mapping, extensive DOTT® workflow observations, collaborative stakeholder engagement, and discrete-event simulation modeling.
The objectives of the study were to discover opportunities to improve workflow, optimize the location of key support resources under multiple layout scenarios, and measure design performance based on a dynamic model of key ICU workflows.
Informing design process
During the design and research process, “what-if” scenarios for the simulation model were determined based on the research questions of interest to the hospital design team members, as well as design variables correlated with patient care and workflow outcomes.
The simulation modeling results demonstrated that a centralized medication dispenser device with a dual entry corridor would offer the most efficient and cost-effective option. Flow and frequency diagrams, generated through modeling, showed opportunities for decentralization of clean supplies.
Measuring design performance
The current and future state model comparison showed that the new ICU layout is expected to result in significant reductions in indirect care activities (e.g., retrieving supplies) for medication administration and monitoring and arrival activities, as well as reduced congestion.
Leveraging research in design
In highly dynamic environments such as the ICU, simulation modeling allowed the design team to compare, in real-time, the potential benefits of different design options on workflow efficiency as measured nurse time in transit, time retrieving materials, congestion, and time at bedside. Together with Lean process improvement methods, continuous stakeholder engagement, and a keen focus on workflow dynamics, this study demonstrated the value of bringing increased rigor to the design process to advance performance in healthcare environments.