As providers begin to understand the impact healthcare reform will have on their business, many hospitals and medical centers are looking to Lean process and design as a way to do more with less. Doug Grove of CollinsWoerman explores this topic in the second installment of a three-part online exclusive series.

Reinvent the medical planning process
Lean experts implement a rational approach to operational decision-making: Launch the decision-making leadership team, design teams, content experts, and Lean operations support to assure that the right decisions are carried forward in each design proposal. Base each decision on a set of team-formulated “guiding principles” or “enterprise values” that signify the organization’s mission, values, and strategy, and the project’s purpose. Virginia Mason Hospital in Seattle implemented this process when it was considering a major addition. The challenge was to design Lean and build Lean. Already a few years into its Lean journey, the hospital could visualize the advantages of this approach, so it created a Lean project-delivery method that focused on rational decision-making.
Standard work was developed for team participation, accountability, and decision-making authority. Standard work was also implemented for Production Preparation Process (3P), design charrettes, and project meetings. In addition to the “enterprise values,” an “umbrella” IDP agreement was developed to guide the owner, architect, and contractor through the project. Diagrammatic examples of the planning process and team organization accompany this text.
Implement experience-based design—the “voice of the customer” More than a poll, an interview, or a focus group, experience-based design captures the patient’s experience; patients (and caregivers) tell their stories to the architects and designers developing new spaces. Allowing this information to guide design enables healthcare organizations to work in partnership with patients to create new and improved processes, and enhance space use.
Evidence-based design From its roots in the Center for Health Design’s “Pebble Project,” evidence-based design continues to inspire knowledge capture and innovation. Current best evidence from the organization (along with industry research and practice validation) is used in a critical thinking environment to reach the most effective design solution.
Employ Lean design tools The gains from applying Lean observation, analysis, and design tools cannot be underestimated. Lean design takes evidence-based design to a higher level. Because Lean design is based on data and direct observation, it uses informed trial and error with testing and simulation, working models, and full-size mock-ups. The ideal venue for beginning Lean design is the 3P workshop, a highly facilitated, week-long event. This is the process through which a project team reinvents its business delivery model prior to launching a new product or building new facilities. It assures that the correct building program has been evaluated and approved by the organization. Prior to beginning programming, one Northwest-based hospital system conducts at least one 3P event for every facilities improvement project. Data collection, including patient volumes, time studies, utilization review, videos, and much more, begins four weeks prior to the 3P event. The 3P team uses the data to document existing processes, find waste, and design new processes. Often the new process design leads to conceptual space design.

One concept used at Virginia Mason Hospital is provider "touchdown" workstations.

When Virginia Mason Hospital used 3P events and experience-based design focus groups to design a prototype clinic model based on patient flow, it evaluated the impact of such unique features as kiosk check-in, no waiting rooms, GPS patient tracking (within the facility), on-stage and off-stage zones, no provider offices, and team “touchdown” workstations.

PHOTO CREDIT: CollinsWoerman

A kiosk check-in area at Virginia Mason Hospital.

The resulting design significantly decreased patient lead time and operating costs, while increasing patient volume and patient satisfaction. This is just one example of process redesign leading to a new approach in healthcare design.

Watch for the third installment of this online exclusive series. To read the first article in the series, go here.

Doug Grove is a senior medical planner with CollinsWoerman Architects in Seattle. He is a registered architect and a certified Lean leader who has trained in the United States and Japan. For more information, please visit or