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Integrated Lean Project Delivery (ILPD): A forwArd -thinking design Process By David Chand, MD AS AKRON CHILDREN���S move s for wa rd w it h its $200 million campus expansion, a crystal ball would come in handy. With healthcare reform, changing demographics, and other uncertainties, our goal is to build flexibility into our design in every way possible. We can make educated guesses regarding future patient volumes and acuity, reimbursement levels, the always-changing technology and best practices for care, but they are just that ��� educated guesses. The first phase of the plan includes a critical care tower to be built on Locust Street, west of our main hospital. The tower will include a new Emergency Department, Neonatal Intensive Care Unit, and Ambulatory Surgery Center. A new parking deck, which will connect to the tower, is already under construction. Later projects include an expansion of the Ronald McDonald House of Akron and additional space for clinical programs. Akron Children���s is using a forwardthinking design process called Integrated Lean Project Delivery (ILPD), which has brought all stakeholders ��� physicians, nurses, parents, and staff ��� together with the architects, contractors, and engineers to design a new space which promotes functionality and efficiency while enhancing the patient experience. The guiding principles echo back to the hospital���s original promises of: + Treating each child as if our own, 22 H O S P I TA L | Cleveland/Akron/Canton MD News + Treating others as we would want to be treated, and + Turning no child away regardless of ability to pay. Using this process is a natural evolution for Akron Children���s, which began to embrace the Lean Six Sigma process improvement principles when it created the Mark A. Watson Center for Operations Excellence in 2008. I have been most closely involved with the team designing the Emergency Department, which was originally built to serve 45,000 patients annually but has been serving closer to 60,000 in recent years. Through the design process, we have worked to maximize the seven flows of health care: patient, family, staff, medications, supplies, equipment, and information. A full-scale mock-up of the new design, constructed from cardboard in a local warehouse, has allowed us to more accurately assess proposed dimensions and compare distances to the current state. We have tested the design using common ED scenarios, including a patient with asthma and a trauma patient. Furthermore, we have sought the input of other hospital professionals who provide ancillary services, including our social workers, dietitians, chaplains, transport team members, pharmacists, lab and radiology technicians, security, and housekeeping staff to make sure we have captured multiple perspectives. ��� MDNEWS.COM ��� JANUARY-FEBRUARY 2013 We believe that this process will result in a reduced number of change orders, thus reducing construction costs and providing an end product which best suits the needs of patients, families, and staff members. There were a few key features we wanted, such as separate entrances for ambulance and pedestrian traffic, standardization of rooms to promote safety and efficiency, and universal rooms, able to change in function by simply moving equipment in and out, so that we can respond to changes in the patient population The parents on our team told us they hope for improved way-finding and easy check-in. A good sense of safety and security is also a top priority. We were reminded that they often come to the hospital with baby carriers, diaper bags, strollers and siblings in tow, and few pediatric ED visits are ever planned. The input they have given us has been invaluable. Construction will begin this spring, with completion scheduled for 2015. We can only wonder what changes we will see in health care by the time the doors of our new critical care tower officially open, but we are confident that through this process we will be well positioned to adapt. Dr. David Chand is a pediatric hospitalist and member of Akron Children���s Hospital���s Mark A. Watson Center for Operations Excellence. ���