Lean ICU Layout Re-Design: A Simulation-Based Approach

Abstract

Healthcare facilities require flexible layouts that can adapt quickly in the face of various disruptions. COVID-19 confirmed this need for both healthcare and manufacturing systems. Starting with the transfer of decision support systems from manufacturing, this paper generalizes layout re-design activities for complex systems by presenting a simulation framework. Through a real case study concerning the proliferation of nosocomial cross-infection in an intensive care unit (ICU), the model developed in systems dynamics, based on a zero order immediate logic, allows reproducing the evolution of the different agencies (e.g., physicians, nurses, ancillary workers, patients), as well as of the cyber-technical side of the ICU, in its general but also local aspects. The entire global workflow is theoretically founded on lean principles, with the goal of balancing the need for minimal patient throughput time and maximum efficiency by optimizing the resources used during the process. The proposed framework might be transferred to other wards with minimal adjustments; hence, it has the potential to represent the initial step for a modular depiction of an entire healthcare facility.

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

“…Simulation stands out as a powerful decision-support technique among the main trends of the Industry 4.0 era [ 139 ]. We identified two approaches to the use of simulation in LH projects: (i) practical interventions using simulation as a means to model different scenarios in a healthcare setting followed by the adoption of the best solution, and (ii) theoretical studies that combine LH and simulation to propose potential solutions, with no reported implementation [ 130 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 ].…”

Application of Simulation Technique for Improving Plant Layout in Ceramic Factory

“…Although the manufacturing and technology used in the ceramic industry are quite mature, such disruptions as the global pandemic and climate change may adversely affect the supply chains resulting in the lack of raw materials, interrupted production, insufficient inventory, and late delivery (Furrer et al, 2022). Therefore, in addition to product development, ceramic manufacturers must reduce manufacturing costs and lead times in order to prepare for unforeseen events.. One of the key techniques is an improvement of the facility layout (Romano et al, 2022).…”

Lean, Six Sigma, and Simulation: Evidence from Healthcare Interventions

“…Notably, the dual intervention of improvement approaches (lean, SS, and LSS) and simulation in healthcare has increased in recent years. For instance, lean and system dynamic (SD) simulation for an ICU re-design [35]; just-in-time approach and simulation for inventory management of surgical instruments in operating rooms (OR) [36]; LSS and simulation for reducing the patients' length of stay in the ED [37]; transforming an ED workflow combining lean, machine learning, and simulation [7]; or reducing waiting time through system dynamics and value stream map [27] have not only demonstrated the possibility but also the practicality of dual interventions. Despite the increasing popularity and adoption of LSS and simulation, not all organizations have reported successful outcomes.…”

“…Dual intervention entails the use of specific tools. Particularly, different paradigms of simulations have been utilized, including DES [35,36,41,65,66], SD [67][68][69], and agentbased simulation (ABS) [7]. Although DES is the most common simulation approach, our research also looked at ABS, SD, and other paradigms in order to examine which best fits improvement approaches.…”