Photoraphy courtesy of: CollinsWoerman. 

Providers that continue to sit on the fence about adopting Lean processes in their operations can look to the bottom line for evidence of need. This article, the second of a two-part series, explores how to remove waste and what effects the need for Lean processes will have on design.

Survival strategy: Remove the waste
Removing waste wherever it’s observed is not an easy task. For many caregivers, most types of waste are accepted as a “necessary evil.” Employing a Lean design approach will enable your healthcare client to significantly reduce or eliminate waste in their processes:
• Defects: Stop repeating mistakes that lessen the patient’s experience. We must “mistake-proof” our designs to make patient care mistake proof, such as placing hand-washing facilities in clear sight as one enters an exam room.
• Waiting: Facility design can enable organizational change to see patients “in-flow” (the “one-by-one” Lean approach). Not only will this improve patient satisfaction, but it will prepare the organization for expected patient volume increases with minimal facilities expansion. “Universal” exam rooms or procedure rooms must replace “my exam room” or “my OR.”
• Communication: Absence of standards or standard work, no visual controls, ineffective teamwork, and inadequate documentation all lead to defects. Effective communication requires and promotes an environment designed for interaction and collaboration. Our designs must not only incorporate a robust technology infrastructure, but promote visual control methods and logical wayfinding.
• Inventory: Every care provider must have the right equipment and supplies, in the right amount, in the right place, and at the right time. Facility design can enable a reliable system for obtaining the right supplies.
• Motion: Standard work, working in-flow, adequate training, and appropriate communication all lead to less “running around,” and more time caring for the patient. Why not bring all care to the patient? The bottom line for designers is to integrate the design process with operational improvement. Transformed healthcare delivery organizations leverage their design relationships to remove waste, improve operations and implement strategic measures. Effect on design
In planning for the future, designers should consider the impact technology will have on patient experience and patient care. For example, will primary care steer toward the “medical home” concept? Will there be less need for specialty clinics? Will increased use of phone and email consultations decrease the need for exam rooms? Will waiting rooms become extinct? Will clinic visits become more acute and turn exam rooms into treatment rooms? Lean design is not truly Lean unless it follows Lean operations. Transformed healthcare organizations will have adopted Lean principles in re-engineering their care delivery model. Can Lean design drive organizational change? We can map flow and design-in flow. We can test flow with mock-ups. We can plan for flexibility and adaptability. Lean is the methodology that holds the most promise to reform healthcare for the benefit of all patients: • Cost: If the Affordable Care Act survives the many challenges brought forth, healthcare organizations will see a considerable increase in demand for their services—but receive less reimbursement from the government.
• Patient: Lean is thoroughly analyzing the process of healthcare delivery from the patient’s perspective.
• Change: Lean accelerates organizational change to remove waste and attain zero defects, thereby improving patient safety, lead time reduction, quality of care, and patient satisfaction.
Lead the effort: Facilitate “guiding principles” development Establishing guiding principles will help organizations better facilitate decision making. All parties agree to align their priorities with principles such as:
• Deliver an extraordinary patient experience;
• Embrace Lean processes and methods;
• Build-in future flexibility and adaptability;
• Provide an exceptional staff experience;
• Adopt integrated project delivery; and
• Pursue sustainable design. Lead the effort: Help implement a Lean project planning process
Integrating operational and facilities planning with a rational decision-making process will produce value-added outcomes:
• Teams: Build the appropriate team(s) to provide oversight, accountability, review, approval, guidance, and expertise before design begins. Engage all team members now.
• Value: Incorporate value as a guiding principle in design. Before beginning design, there must be a clear understanding of program, quality, cost, and schedule.
• Methods: Employ Lean processes and tools including: concurrent set-based design, BIM virtual construction methods, and integrated project delivery.
The conclusion: The industry demands that successful healthcare designs must sustain a quantifiable return on investment. This can only be achieved by partnering with healthcare providers to integrate operational and facilities planning together.
Photo credit: CollinsWoerman. Evergreen Medical Center, Redmond, Washington, completed in March 2011. Exam rooms separate patient and provider entry.

Douglas K. Grove is a senior medical planner with CollinsWoerman. He can be reached at dgrove@collinswoerman.com . To read the first part of this two-part series, please go here .