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Monroe Clinic – Lean Design for Surgery, Monroe, WI

September 2012
EDAC Advocate Firm Project
Kahler Slater


Firm's role on the project:  Planning, Programming, Architecture, Design, Interiors 


EBD Goal

To improve patients’ overall outpatient surgery experience by reducing wait times, reducing the number of transfers/handoffs for each patient, and increasing on-time starts for surgical procedures.


At the existing hospital on the day of surgery, patients walked (or were transported) between 16 destinations over three floors during their outpatient surgery experience. Communication challenges occurred when the surgery team was ready for a patient and again when surgeons had to travel to another floor to the patient’s post-op room. A series of bottlenecks occurred in both the pre-op and post-op processes. The design and construction of the replacement hospital allowed Monroe Clinic the opportunity to redesign both its physical space as well as its operational protocol related to outpatient surgery.


When planning began for the replacement hospital, the process was studied using a systems approach incorporating Lean and evidence-based design. The design team facilitated process improvement workshops for an integrated hospital and multi-specialty clinic using the basics of Lean thinking in combination with the Six Sigma DMAIC process: Define, Measure, Analyze, Improve, and Control. Representatives from areas of both the clinic and hospital worked together to collect baseline information. The current building layout was analyzed and the team completed value stream mapping exercises and workflow modeling. The multidisciplinary team worked to evaluate the current process and determine the best process and flow in the new hospital for scheduling, registration, check in, prepping the patient, transferring the patient to surgery and all the way through to discharge. It was determined that the existing layout created way-finding issues, extensive waiting for patients and material movement and worker motion and ergonomic concerns for movement of patients, supplies and equipment.

The layout of the new hospital creates an integrated interventional platform with pre- and post-op rooms on the same floor as the procedural rooms with cardiac catheterization just one floor below. The new surgery experience will improve patient flow with less waiting, improve on-time start of procedures, improve communication flow, reduce hand-offs, and supports increased cross-training of staff.