Harvard Vanguard Medical Associates: Leaning the Practice
In the brave new world of U.S. healthcare, Lean has become a buzzword. Recognizing that forthcoming financial realities and the demands of patients will call for cheaper, faster, and more efficient healthcare, many facilities are looking to the Lean process to streamline the works, hopefully leading to faster throughput, better outcomes, and more satisfied patients.
One such medical group, Concord Hillside Medical Associates, a practice of Harvard Vanguard Medical Associates in Concord, Mass., worked with Simpler Consulting to use Lean concepts and principles to design a new building it’s moving into in June 2013. Simpler and Concord Hillside held five week-long events to design the building over an eight-week period where they got many layers involved in the process—patients, medical secretaries, clinicians, nurses, and representatives of SBA Architects.
The efforts were spearheaded on the facility end by Dr. Ron Kwon, medical director at Concord Hillside. “If you look at today’s healthcare environment, it’s clear that things are changing,” says Kwon. “It isn’t about just building a new building and adding more space to enable more services; it’s about changing the paradigm of care and how you deliver it in a physical environment. We really wanted the building to be patient-centric, enabling as much one-stop shopping as possible, but to do it in a therapeutic, healing environment. We wanted to make something that was truly innovative.”
“The activity started in late 2011 with the 2P, or Process Preparation, events to prepare them to put their processes for outpatient, lab, radiology, and pharmacy in line,” says John Gallagher of Simpler Consulting. “The idea was to ensure that these departments were operating in the most efficient, least wasteful way moving into the new building.”
Those week-long events focused on five specific topics: the size of the pods needed for internal medicine and pediatrics; lab and radiology; the check-in; pharmacy; and overall building design, choosing the best location for those areas. While some aspects were left as-is, some areas underwent fairly radical transformations.
For example, a current traditional layout of a physician’s practice would have all of the exam rooms in one area, a nurses’ station for nurses or medical assistants (MA), with doctors’ offices clustered together, as well, usually in the back. “During the 2P event, a concept was established for the pediatric and internal medicine pods to have a dedicated workstation right next to each physician’s office,” says Kwon. “The doctor actually has to cross that space to go between the exam room and his office. In the workspace, the dedicated MA will have a message board so the doctor will see important messages; the MA will basically function as a flow manager. Because of this physical configuration, that entire process is sped up and the communication is really enhanced. This addresses not only the patient visit, but a lot of the other things that happen around the visit that might potentially frustrate patients—things like a timely lab result or prescription refill. The design really enhances the idea of working as a team.”
So, too, does the inclusion of pharmacy, lab, and radiology eliminate many patients’ needs to have multiplestops either before or after their visit. In particular, the pharmacy was designed with an express pick up window with access next to the building entrance, and the pediatric pod was designed with "onstage and offstage" corridors to diminish traffic and ease patient and staff flow.
“Lean really focuses on how the patient goes through the journey,” says Gallagher. “If you can eliminate the number of waiting steps that they have to go through, the time that it takes for them to get to care, the patient will be much happier. But it also has a domino effect on other areas of the facility, such as a need for fewer parking spots. Everything comes into play when you utilize the Lean toolbox.”
The original plan for a 43,000-square-foot clinic was reduced to 38,000 square feet for the clinical pods (the building will be 50,000 square feet total), reducing construction costs and enabling the addition of a pharmacy, imaging services with MRI, and complete visual services with an optical shop. One key decision that enabled the reduction in square footage was the design of each and every room—from exam rooms to physician offices—as a 10-by-10-foot modular space. “I wasn’t sure how the clinicians would accept that move,” says Kwon. “Initially, I got some pushback, but at the end of the day, we got 100% consensus on the plan. We’re doing it for the good of the patient, and that’s what matters most.”