ASID: Lean 101 – How Lean Relates to Healthcare Design
I've been hearing the word "Lean" a lot lately. So what exactly is Lean and how does it relate to us as designers? As a young designer, I wanted to explore the bare-boned basics of how the whole Lean concept can be applied to design in basic form.
Lean in regards to healthcare is based upon getting rid of waste and inefficiency. If a hospital wants to go "Lean", they look at things such as ways to eliminate processes that are unnecessary in the overall quality and value-adding activities. The main categories Lean looks to improve upon are productivity, cost, quality, and timely delivery of services. There are at least three areas in design and design process that we can consider in order to achieve some of those areas of improvement: space planning, design in regards to the quality of the patient experience, and integrated project delivery.
Space-planning is one area to tackle the concept of Lean. With nurses clocking miles and miles of walking per shift, how can the floor layout be more efficient? In high patient turnover areas, how can we provide easy access to cleaning materials for quick cleaning and prep for a new patient? How close are our surgery prep areas to the operating room? What is the typical patient flow for transfers and procedures and how can it be improved? Those questions alone emphasize how important the steps of researching, observing, and programming are when beginning a design project. I once heard about a nurse that would walk up to 10 miles within the hospital just from the work in one shift. If we take extra time during programming to speak with staff about their workflow and operations, we can create adjacencies that drastically reduces the amount of time and energy staff spend walking, therefore improving the timely delivery of services and productivity.
In regards to value-added, we're viewing the value from the patient's eyes. From a design perspective, what design solutions are most important to the patient? Evidence has shown us that access to views not only results in shorter hospital stays, but it also improves the patient's level of satisfaction. The same thing goes for single-person rooms. So, although planning hospital rooms around windows and eliminating double rooms may be more expensive, they may actually be a better return on investment because of patient satisfaction.
And overall, we can Lean our design process by using Integrated Project Delivery (IPD). Involving nurses and other medical professionals in our design process helps us to understand how they can work more efficiently. Perhaps a rearrangement of some work stations could yield a drastic increase in efficiency and productivity — we would only find that out by learning about the staff's work processes. Lean solutions evolve from employees suggesting improvements to management, not the other way around. Several hospitals are now taking on the initiative to form Lean groups of professionals across multiple departments and levels in the hospital, and as designers I feel that we need to be involved as well. Everyone understanding each other's roles and processes can only lead to better solutions and a higher quality of healthcare, which in turn can save time, cost, and improve productivity.