Background: Rapid design process for NICU space development and implementation using principles from Lean, six sigma, change theory, and structured communication.

Case:

Rapid design process of a level III NICU had mutual goals and benefits with considerable constraints. Most importantly providing a local space for NICU families would result in healthier families and better outcomes for the patients of the region.  Previously NICU patients or antenatal patients would be flown out of state for a higher level of perinatal care services.  Each stakeholder had competing and complementary priorities that all needed to be captured and expressed in an efficient and effective way for patient care as well as process.  A purist type of design did not develop due to multiple demands and constraints; rather a hybrid evolved out of focus groups, site visits and a literature review.  The design elements of the four seasons paired with materials from nature resulted in an environment that was both welcoming and functional.  The best elements of each types of NICU layout were selected to give the best outcomes for patients, families and the healthcare team.  Despite the application of structured communication methods, shared governance, Lean as well as six sigma concepts -  lessons were revealed at every step of the process.  Each dedicated decision was centered around the patient and the family, now and for the future. Satisfaction with the space post occupation varies positively and variably as other studies have revealed. Other intended outcomes of the space design is that the space would positively result in shared learning of staff and promote nurse-parent closeness.   

Conclusion: Communication, site visits, increased all parties' understanding of the space design, function, flow, efficiency, and ultimately patient and family outcomes.  Intended outcomes of the space are increased team satsifaction with flow and function as well a collaboration with novice and experts within the staffing mix.   The space lends itself to privacy as well as accessibility of staff by families.  The semi-open space allows for families to interact and come together to support each other.  

Keywords: NICU design, healthcare economics, rapid design process, structured communication methods