Robert Safian, the editor of Fast Company, recently wrote that “creativity is unpredictable and disruptive. The quest for a new idea often inspires fear–about whether the idea is the right one, whether the execution is possible, whether cost is worth the benefit.” 

These words cause me to think about the need to transform healthcare through Lean principles. Is it the right way to cause change? Is its implementation throughout healthcare possible? Is the effort worth the benefit? Well, “Yes” I say. What other mechanism is there to cause a radical change in the way we see things, the way we do things, and have the potential for dramatic reductions in cost and effort? 

What about my own firm’s attempt to adopt lean ideology to transform how we deliver healthcare design services to our clients? This transformation is athwart with fear–of where it will take us, of the tough questions we must ask and answer of ourselves, of who we will become through the journey. 

The transformation effort is uncomfortable, it is disruptive, but change is just that. Yet, I believe we have no choice. To do nothing leaves us standing still in an era that is moving across our bow like a giant wave. 

We can lean on our creativity. It can solve problems that seem insurmountable. We must find a way to use our creativity and the Lean tools we have at hand to forge a new way of providing design services, and through our transformation journey, enable ourselves to assist our healthcare clients in their Lean transformation journey to reduce the cost of healthcare while breaking down the barriers so that there is access to healthcare for all whom desire it. 

How can we use these tools to assist our healthcare clients:

Gemba walk–see it to understand it. As designers, we see most problems visually, un-mired by protocols and special limitations. How often has a client said, “If only we had more space," when, actually, the problem is staging, process, and flow? We walk the gemba, we watch, we observe patterns.

I recently observed a busy day at a clinic. The problem was not that they needed a larger waiting room to handle the patients and families that stacked up in front of the registration desk. The problem was that the waiting area was around the corner and out of sight of the desk, and that this population of patients liked to visit with others they recognized upon check-in.

The result was that they’d remain standing at the registration desk, chatting and visiting, long after they’d checked in, and block the access to the desk for the next arriving patient. Solution, move the waiting area and desk so there was space to step aside and continue social conversation, while also moving the waiting room closer to the first destination in the appointment journey, the phlebotomy draw stations. 

Fishbone diagramming–dig down deep into the process flow to really understand all the contributing factors to a process flow. You may discover there is something “upstream” or “downstream” that affects your ideal flow, which you need to go and solve before you can solve the immediate process flow you’re trying to correct. 

I recently participated in a discussion around the process of patient discharge, and the goal to discharge patients by 1 p.m. What’s so magical about 1 pm? Why not noon? Why not 2 p.m.? And what does discharge “really” mean? Does it mean they are out of the room so that housekeeping staff can turn-over the room for a new patient? Does it mean that their physician has signed discharge orders? Does it mean that all the activities that support the discharge are completed, such as pharmacy prescription fills, additional tests scheduled, post op visit scheduled? Does it mean that the patient has actually left the building? 

Until everyone at the discussion table agrees with the definitions, you are all solving different problems, either “upstream" or "downstream” of the problem at hand. Developing a common agreement of the goal is essential to reach the solution. 

Value-stream mapping–How often do we believe something is essential to the end result, simply because we’ve always done it that way?

The easiest question to ask here is, “Why do we call them waiting rooms”?" Recently, I went to have the oil in my car changed. The mechanic didn’t tell me to step into the waiting room, he gave me the option to step into their Internet café, or return in 20 minutes. 

He never mentioned I’d have to wait while they drained the oil from my car and replaced it with new oil. At least, in that situation, I knew something of value was going to happen while I “waited." What of value is happening when a patient arrives for an appointment with their physician, and that physician is not ready for the appointment, and the patient and accompanying family member sit? 

Let’s really observe and “map” each action the patient is doing along the process. Why are they waiting? Why do we call it a waiting room? Isn’t that italicizing and underlining the obvious? 

A3 thinking–We work with our clients to peel away the layers of onion to find a root to a problem. Only then we can work on a solution. 

Make a problem statement. It’s most likely really a symptom of the real problem, but we don’t know that until we ask how long the situation has gone on, what causes it, what are the contributors to the cause? Only then can we assess the statement and define a possible true condition, then recommend resolution. 

Sound familiar? You go to the doctor’s office. You tell him you have this nagging red spot that itches. Is that a problem statement or a symptom? The doctor will take a history, check your vitals, do a physical exam, make a diagnosis, and then he or she will determine a course of action. 

Creativity is unpredictable and disruptive, but it is also revealing, invigorating, dynamic, and fulfilling. Using the appropriate Lean tools to help our healthcare clients through their Lean transformation, as well as using these tools to facilitate our own Lean transformation can distill the fear of the unknown into realistic, tangible bites of achievable goals.