چكيده به لاتين
With the ever-increasing demand for receiving urgent and emergency treatments, the exorbitant costs for the construction of treatment spaces, and the dissatisfaction of hospital users with the existing spaces, it is necessary to use the Lean's new approach to meet these needs. The Lean approach is proposed as a method or a collaborative approach in hospital design and construction to optimize medical processes, physical spaces of the hospital (including emergency department or ED) and to find the right balance between customer needs and design solutions, which aims to increase the value and best services for patients, saving costs, overall efficiency and high safety in all dimensions. In general, Lean is a comprehensive, integrated, multidimensional and structured approach that tries to identify and eliminate waste and non-value-added activities by changing the culture and work process as well as the space and architecture of that environment through its toolbox and methods. Therefore, by eliminating hospital waste, Lean is trying to change the current situation to an ideal situation and continuous improvement, which focuses on continuous quality improvement, increasing efficiency, improving safety, reducing defects, saving costs and increasing value and the satisfaction of patients and staff. Finally, using such an approach in sensitive treatment spaces, especially the emergency room, can have a significant effect on improving the quality of treatment and speeding up its process. The main goal of the research is to apply Lean principles in design. Among the other goals of this research, it can be mentioned that the principles of Lean are explained and extracted, and then with the basics of hospital design in the world's authoritative standards, such as: England, America, Australia, and the UAE, as well as the Iranian standard, which is called "Standards for Planning and Design of SAFE HOSPITALS" is recognized, conformed and checked. Also, another sub-goal includes: applying the extracted principles in the design of the emergency (Firouzgar emergency) as an optimization and improvement of the emergency design. The data were collected using comparative-analytical method. These emergency design requirements data are based on the information obtained from chapters 2 and 5 of the standards of Iran, Australia, the United Arab Emirates, the United Kingdom and the United States, as well as the book "Emergency Department Design: A Practical Guide to Planning for the Future" by John Hadi (based on the approach Lean) was compared and adapted in 130 pages and the results of analyzes and final requirements of emergency design were arranged and extracted in 90 pages. These analyzes and final requirements are presented in detail in the appendix and a summary of the final requirements is mentioned in the first speech of chapter 3. Then, the results obtained from these data were applied in the ED redesign and to confirm the positive results of Lean's approach, it was modeled and simulated through discrete event simulation using the new FlexSim Healthcare software in the field of health. The findings of the research show that the definition of the process flow in the ED through the Lean approach can have a direct and significant impact on the micro to macro spatial layout of the ED (including: the layout of areas, the layout of microspaces, the layout of equipment in each microspace , the layout of Supplies in each equipment), the number and dimensions of each microspace, the efficiency of the department, the safety and security of emergency users, etc. and ultimately improve the quality of treatment and providing efficient care. In this way, the emergency design requirements have a role on the designed environment, and as a result, the built environment increases performance, productivity, and accelerates the treatment process and increases the satisfaction of hospital users, such as: patients, patients' companions, medical staff, and other employees. Finally, the results of this research show that the Iranian standard should have a serious revision and revision in its design requirements. The findings of this study help a set of knowledge of different people, including architects and designers and students of healthcare spaces, to design the physical environment of the ED in such a way that by reducing costs, high performance and productivity for users and hospital administrators.
