Healthcare Design - March 2014 - 30

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HCDmagazine.com 03.14

out of the simulation to help us get the full
spectrum of information," he says.
For ZGF, taking the information provided and keeping it on track with project
goals was a critical piece. "We were
charged with helping the facility document direction, evaluate, and figure out
best models to facilitate that," Stellmacher
says. Johnson adds that having an integrated team, including ZGF and general

Top: As part of the Lean design process,
the team constructed a full-scale unit
mock-up on the roof of a parking garage
to get a feel for space configurations.
Middle and above: Next, a warehouse
was rented where an entire floor was
constructed in much more detail, with the
design's universal patient rooms, support
areas, and care team porches built to
scale to see if the concepts worked
during real-life simulation exercises.

COURTESY OF ZGF ARCHITECTS LLP

hear people say that it's about 'learning to
see.' When you build, you're able to see much
more clearly; it's easier than working in BIM.
So we used mock-ups and simulation liberally
throughout the process," Johnson says.
Starting with tabletop exercises using pieces
cut to scale, users were asked to move those
pieces around to decide on things like adjacencies, proximities, and shapes, with a focus on
seven flows of medicine: patients, families, providers, medications, supplies, equipment, and
process engineering. The next step was to take
the results and create mock-ups on the roof
of the hospital's parking garage. With details
kept to a minimum, the mock-ups consisted
only of exterior walls to get a feel for the space
configuration. And it worked-the team realized
the right angle in the middle of its L-shaped
wings caused a pinch point. The solution was
to tweak the design to bring more of a curve to
the wing.
Next came the big event. The team rented
a 70,000-square-foot warehouse in Seattle,
where a cardboard mock-up of an entire
32,000-square-foot floor was built. Influenced
by previous design events, the mock-up
included established ideas for universal patient
rooms, support areas, and a concept for "care
team porches" outside patient rooms, to get
a feel for them at scale. Patients and families
were among those taken through the space,
with about 50 to 60 people overall involved in
the process. But there was a large focus on
staff, from nurses to housekeeping supervisors,
who simulated their activities on the mock-up
floor in as real-life a fashion as possible. Daily
rounds were conducted, travel distances were
measured, and all the data collected was compared against a baseline to ensure changes
were making things better. "The whole goal was
to improve operations while also building a new
space," says Mark Gesinger, principal at ZGF.
"It was our task to synthesize all of that architectural information, knowing their aspirational
goals."
Once out of the warehouse, a final phase of
Lean design homed in on refining the patient
rooms, with more mock-ups built-this time
with real materials and equipment, where care
delivery could be simulated and the design
tested. Overall, Johnson says, he saw the
Lean effort as a consensus-driven process
that refined divergent views to create a single
approach. "We would use data and anecdotes


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Healthcare Design - March 2014

Table of Contents for the Digital Edition of Healthcare Design - March 2014

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Healthcare Design - March 2014 - Cover1
Healthcare Design - March 2014 - Cover2
Healthcare Design - March 2014 - 1
Healthcare Design - March 2014 - 2
Healthcare Design - March 2014 - 3
Healthcare Design - March 2014 - Contents
Healthcare Design - March 2014 - 5
Healthcare Design - March 2014 - 6
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Healthcare Design - March 2014 - Cover3
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