NORR was hired to design a replacement facility for one of Lancaster General Health’s large and long-lived Pediatric specialty practices. Consistent with LGH’s commitment to LEAN process improvement, NORR’s healthcare team led the clinical team of physicians, nurses, senior management and administrators in a series of “Big Room” workshops, in which all participants are asked to voice their ideas. The LEAN process, in architectural design (as in manufacturing and now many other arenas) is dedicated to removing waste from the system – in this case the healthcare service delivery system. This meant that NORR’s team facilitated a comprehensive analysis, with interactive client participation, to determine ways to improve process efficiencies, reduce errors, reduce lag times, improve outcomes, etc. We then translated the resultant goals for process improvement into building design solutions that would support those goals.
The architects led workshops in which the clinicians and administrators were divided into several teams and charged with developing planning concepts. The teams then voted on which best satisfied the desired results and the NORR team refined them into floor plans. Decisions about specific planning approaches are based on a carefully crafted scoring methodology where the options are scored against comprehensive “waste reduction” and “design drivers” matrices developed by the client team and facilitated by NORR’s healthcare planner/designers.
The final solution is characterized by three practice “pods” of six exam rooms each and respective team work rooms. This allows the practice to flex up and down depending on utilization volumes. It also allows for improved collegiality with smaller teams working closely together on any given day. It also reduces the scale of waiting rooms to create more calming environments and to allow parents to feel more directly connected to providers. Exam rooms are designed for the highest degree of flexibility and interchangeability. One pod can serve as a pediatric urgent care center and any of the pods can be focused on a particular sub-specialty as needed depending on the season or the prevalence of certain diagnoses.
Furthermore, the overall organization of the practice supports the concept of “on-stage” and “off-stage” zones of activity. The clinical staff favored the idea of creating graduated levels of “observability” of the staff by the patients – “we want our patients to be able to see some of the processes we undertake when we’re not in the exam room with the patient”. While there are very much “off-stage” clinical team rooms, there are also team work areas that can be seen by patients and families.