For more than a decade, Japanese innovator Taiichi Ohno’s Lean principles for the Toyota Production System—techniques for streamlining work processes to eliminate waste in human effort, materials, and time—have been adapted and incorporated into various American manufacturing processes, with positive results for the bottom line.
More recently, Lean principles have been migrating into the design and construction of healthcare facilities. In today’s challenging economy, medical facility administrators are avidly seeking ways in which to reduce unnecessary square footage in the predesign phase of a new facility. They are also planning for a more streamlined work process that increases efficiencies and lowers costs, while incorporating new technologies and clinical techniques.
Lean principles are highly effective as a method—during the design prior to construction—of identifying and eliminating unnecessary square footage, along with the materials and labor embedded in wasteful construction of unnecessary space. During the design phases and preconstruction, Lean thinking addresses the flow within a building through thoughtful planning of the internal spaces, as well as their connections and adjacencies.
More efficient flow within and between workspaces and treatment areas can add up to significant savings in constructions costs, energy efficiency, and employee productivity. These days, as facility managers and administrators consider whether to invest in the time and expense of new construction, we’ve been engaging in Lean principles during the preconstruction phase of such projects with significant cost savings in capital, space, inventory, and staff.
Planning for future flexibility during preconstruction design phase
The preconstruction phase of a healthcare project provides an excellent opportunity for trimming square footage and materials from the design, and operating costs later. This is also the time to determine a building’s future flexibility and potential for expansion. As the Baby Boomers age and the American population continues to grow, the need for diverse, innovative options in state-of-the-art healthcare will become increasingly necessary and more competitive.
A Lean audit of a new building’s design can provide unforeseen space and capital for future expansion, innovative technologies, and new services and procedures. It’s an opportunity to wire for upgrades in technology and to design areas within the building’s program with flexible materials and floor plans that easily adapt to or accommodate changes in healthcare delivery.
Of note: If you are building new and have not thought of Lean design, it is much more difficult to apply these principles after you’ve begun the construction process as there would be changes to your design. It can be done, but it means additional time, energy, and costs.
However, you can apply Lean principles at any stage in a building’s lifecycle. For one of our clients, for example, by selecting just one area within an existing medical office building for a Lean audit of work processes, we doubled the number of patients seen without the client needing to hire additional staff or build additional square footage.
Another example is Park Nicollet Health Services, an integrated healthcare-delivery organization. The organization has incorporated Lean practices into staff work processes for several years, and when the organization proposed construction of a 50,000-square-foot replacement facility in Chanhassen, Minnesota, they asked us to review with them their preliminary design before construction began.
The original plan, unsurprisingly, was already quite efficient. But we engaged them in a 3P (production, process, preparation) design workshop based on Lean principles to further trim wasteful steps from their patient-care delivery services. Also referred to as a Lean audit, the 3P workshop is a week-long simulation of daily work processes—with staff and often patient input—followed by four to six weeks of data gathering. The goal of the audit is to reduce time, resources, and materials incorporated into those work processes.
