Lean Healthcare Exchange

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As a Lean Healthcare practitioner, I partner with healthcare facilities to focus the entire organization on the elimination of waste in the systems and processes.  We do this by focusing on what adds value for patients.  It sounds simple. Focus on adding value for the patient.  However, achieving simplicity through so much complexity that has been practically hardwired into the delivery of care models is very difficult.  Daily I am reminded of what Apple founder Steve Jobs said: “Simple is hard to do.”  He was right.

Facility Design
I often see cutting edge technology while working as a lean healthcare practitioner.  The innovation is truly second to none and has added to our overall lifespan and quality of life.  However, the facilities that house this innovation are often not designed with the true understanding of supporting processes.  It often appears that the building was designed in advance of the processes.  The processes are a direct result of the building and not the other way around.  In these cases, the patient is often forced to go through extra steps in the process, additional travel, additional motion, and increased waiting due to the total throughput time.

Equipment Capacity

The CFO of a healthcare facility really wants to see the equipment utilized.  The return on assets is best met when the lab equipment is doing tests and the diagnostic machinery is occupied.  However, while doing Lean Healthcare observations in the “Gemba” (the place where work is done) I often see entire suites of equipment that are “lights out.”  It is also common to see several ORs that sit for days at a time or are poorly utilized.  In some of these cases, the organization feels they need more capacity and they are actually looking to build more.

Excess Space

Lean healthcare is about having what is needed, when it is needed, where it is needed, and at the time it is needed—all to support the value to the patient. Anything more is waste.  Across the country, the variances in the space that is used for the same process volume is massive.  In some cases, the space designed and used for identical processes is nearly three times more in one facility versus another.

We have a lot of work to do to in order to be able to deliver maximum value to our patients through Lean Healthcare, and based on the above observations, we have a long way to go to fully implement the system. The “management salad” approach of tossing together a kaizen event, a cup of shredded A3, a drizzle of OD, some sun-dried leadership Kum-ba-ya, and a crumbly topping of half-baked strategy deployment turns into nothing more than a mushy bunch of ineffective tools if there isn’t a deliberate system and intent driving all that activity. Piling on more tools is a path to lots of activity only. The success of those activities will vary and will likely be unsustainable over a length of time.

Many are moving swiftly in the direction of Lean Healthcare.  However, as a whole the industry needs a change in thinking and acting.  As a whole, we think we are focused on the value add for the patient, but saying it and making it true are worlds apart.  With what I’ve been exposed to, I have concluded that it is far too difficult to sneak in a little bit of value for the patient.  It has been shown time and time again that most of a caregiver’s time, however valiant their efforts, are heavily dampened by waste within the care delivery system.

Simple is hard to do. Simply delivering value-added care, simply having just what you need to do the work, simply using the resources that you have in an effective manner. What complex and time-consuming paths have you had to follow in order to achieve simple?

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You may have heard the saying, “Culture eats strategy for lunch every day of the week,” or some variation on this.  Recently a colleague and I discussed the validity of this statement.  He contends there is no scientific data proving such a phenomenon.  I, on the other hand, have been in many organizations where major change initiatives have failed due to existing habits and behaviors not conducive to supporting the change.  By the end of the discussion we agreed that change and organizational culture are inextricably linked.

So what does this have to do with Lean Healthcare or other performance improvement initiatives?  Most of the major change initiatives of the past 20 years (TQM, Reengineering and Employee Engagement Programs, among others) have both a technical element and a human element.

The technical elements of change are generally approached through training and “learn by doing” practice in real work situations. These are essential elements of the learning process.  If the people engaged in the change process do not have the necessary skills, a learning cycle needs to be designed and implemented.

Yet, what in addition to training is required?  If a new tool or required change is compatible with the current behavioral norms of the organization, then the adoption process accelerates.  For instance, an organization steeped in Plan, Do, Check, Act cycles will more readily adopt A3 problem solving due to the positive relationship of the two.  However, if the norms are incompatible, then being exposed to and practicing the use of the tool is insufficient.  The behavioral norms have to change concurrent with exposure to the tool.

First, the existing culture, or the composite of behaviors and habits that members of an organization engage in order to conduct daily business and solve problems, must be mapped.  There are many tools available to do this including “The Organization Culture Assessment Instrument” (Cameron and Quinn) and “The Leadership Circle” (Anderson), among others.  Assessment methods such as these are designed to expose the underlying operating system composed of the lived values and behaviors of the organization.

Once the current culture is identified, the leadership group engages in purposeful dialogue to understand the impact these norms have on the current change initiative.  This shared knowledge can then be applied to the development of cultural change strategies that support the desired set of norms and behaviors.

To illustrate, I once worked with an organization whose culture can best be described as command and control.  The new CEO sought to “install” performance improvement tools and methodologies throughout the organization.  He chartered a group of middle managers, without vice president involvement, to address the current poor financial performance of the organization.  The group gladly accepted and charged forward, generating many new change ideas.  Within short order, it became apparent the managers did not know how to implement the changes using simple performance improvement tools, hence a knowledge deficit and a learning opportunity.

Most problematic was the insidious nature of the command and control culture.  Every change idea was blocked by members of the leadership team.  Turf protection increased and middle managers, seeing the incongruence in what they were hearing from the CEO and what they experiencing, became disillusioned.

In order to successfully implement performance improvement, the CEO, in collaboration with his direct reports, middle managers and employees, developed an organizational vision and a set of core values that overtly stated expected behaviors.  The chartered middle manager group was revamped to include a blend of leaders and middle managers with a stated mission, a set of expectations and group ground rules.  The CEO established coaching sessions with each of his direct reports using the values as expected norms – “rules of the road.”  Lastly, a training program on performance improvement was implemented for leaders, middle managers and front line supervisors.

Over the following year, the culture began to shift and organizational performance metrics improved.  Lest I mislead, this was a messy process and many times along the way it appeared the culture strategies were ineffective.  In my experience there never is an easy change process, especially when the current state culture is not conducive to the change initiative.

Culture can be changed, but time, patience, brutal honesty and constancy of purpose on the part of leadership are a must.

Bill has 30 years healthcare leadership experience in both system and individual hospital settings in the Mid-West and North-East, and oversight of change management activities and Lean Transformation engagements.  This experience includes serving in an executive capacity in Quality, Operations and Human Resources. 

He holds a Masters in Health Administration from Xavier University and a Doctorate of Philosophy in Organizational Behavior from the Union Institute and University.  

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“But this isn’t an assembly line!”

When you start talking about standardizing processes in healthcare, people begin to perspire, lips clamp tightly and are pursed thin.  The declaration, “we don’t make widgets”  is oft proclaimed.  You see, “healthcare is different,” I am frequently told.  “We’re dealing with people’s lives and every patient is unique and most are complex….this isn’t an assembly line!”

When I left the automotive industry and joined healthcare, my response to such statements was that everything involves a process.  Whether you’re building cars or delivering life-saving patient care, it takes a sequence of highly coordinated tasks and processes to deliver the end result.  When this sequence of tasks is standardized, you’re well on your way to radically improving patient safety and eliminating significant sources of waste.

Standard work establishes the best method to perform a task with the least amount of waste while providing the best patient care.  It is an agreed-upon method and procedure for the best sequence and timing to perform a task.

Standard work is frequently misinterpreted and misunderstood.  Generally, people have a tendency to resist standard work until there is understanding of what it really means and how it impacts both themselves and the organization.  People don’t want to do their work the same way every time, nor do they think everyone should perform work the same way.  For this reason, it is not uncommon for healthcare providers to be cautious of jumping onto the standard work bandwagon. Medicine is a combination of art and science after all.  Surely, implementing a “standard” is comparable to throwing darts at the artistry that is needed to understand the nuances of medicine.  If standard work was rigid and unchanging, this point of view could indeed be valid.  However, it is important to understand that standard work is neither rigid nor inflexible.  Quite the contrary, standard work is alive and should change in response to changes in work conditions.

When standard work is consistently and uniformly adhered to, it drives continuous improvement by exposing problems within the process.  Making problems easier to see inspires planned experimentation to discover better ways to perform the work.  Standards are the foundation for continuous improvement.  Without them, you can’t effectively measure where you are.  Standards are the yardstick by which you analyze and test improvements that can then be systematically adopted by everyone.

When continuous improvement activity becomes part of your culture, creativity will flow from employees at all levels of the organization.  Problem solving at the front line often results in creative solutions never dreamed of in the boardroom.  Recognition for solving problems and making improvements builds self-esteem while skill levels increase through training to the standard work.  As the training becomes more effective and widespread, communication increases. People know what they’re supposed to do, when to do it, and how it should be done.

So, by all means, set up an environment of improvement activity that becomes part of daily work and see creativity skyrocket!   Once standard work is in place, creativity bubbles to the surface as people continuously improve their work.  This results in improved morale and job satisfaction, which can also lead to reduced turnover and, yes, improved creativity!

Needless to say, none of this happens overnight.  It’s a long process that requires a lot of determination and even more perseverance.

Does standard work destroy creativity or perpetuate it?

Let’s look back at past articles that discussed how standard work can be implemented in healthcare:

• Lean Healthcare:  Implementing the Standard Work, by David Munch, M.D.
• Becoming a Transforming Leader – What Does Your Daily Standard Work Reflect by Michael Kellner
• The Standardization Gospel by Teresa Carpenter
• Redefining your “Real Job” through Leadership Standard Work by Steve Taninecz

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The Belmont University Lean Healthcare Certificate Course is now registering for July and August course dates.

The program is an intense one-week course that gives participants a hands-on, learn by doing experience applying Lean philosophies and tools in a healthcare environment.  It is taught and facilitated by Lean practitioners, leaders, and coaches each with multiple years of successfully applying Lean in healthcare organizations.

The Lean Healthcare Certificate Program is designed for anyone in your hospital or healthcare organization who wants to better understand and apply Lean concepts.

For more information on the Belmont University Lean Healthcare Certificate Course, agenda, and registration information visit www.BUleancourse.com .

Upcoming Courses:

July 15 – 19, 2013
August 5 – 9, 2013

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What is the most important resource you have and how do you manage it? 

Before you read any further, take your eyes off of this page and stop for a moment to reflect on this question and then read on.

What was your answer?  It may be interesting to pose this question to some of your colleagues and see what they come up with.  It could be a very interesting discussion and could lead to some interesting actions.  Also, did you answer this from a personal perspective or a professional one?

Let me pose to you that the answer to this question both professionally and personally is time.

From the lyrics of “No Time to Kill” by Clint Black, my favorite country artist:

If we had an hourglass to watch each one go by
Or a bell to mark each one to pass, we’d see just how they fly
Would we escalate the value to be worth its weight in gold?
Or would we never know the fortunes that we had ’til we grow old?
And do we just keep killin’ time until there’s no time

How many of you thought that the most valuable resource is people?  People are extraordinarily important in what we do in healthcare but it is what they do with their time that really matters to our patients.  Interestingly, our patients are also investing their time as well, not only for the time they spend in the experience of care but possibly with the time they have left on the planet.

So, are you measuring time with respect to your people? With respect to yourself?  Can you tell me how much of your day is spent in the various categories of tasks and responsibilities that you have by percentage without guessing?  Can you tell me how much of your time is spent in value-added work and non-value added work?  How much of your time is spent in meetings and how much of that time is value added to you? To your patients?  Is there any measure of the effectiveness of all those meetings you go to?

One of the most common barriers to successful Lean Healthcare transformations is the lack of executive and middle management engagement in the improvement efforts including their ability to support and sustain those improvements.  These activities are competing with other things on their very full plates that take their time. Unless they deal with all of those tasks, the time it takes to do them, the inefficiencies in them, the prioritization of them, and so on, they will simply not have the time to engage adequately in organizational improvement efforts.

Therefore, we need to apply Lean principles to their individual schedules, their management systems and their leadership methods if we are to be successful in creating the time to engage.  We must take things off of their full plates if we are to put something else on.  The responsibilities of Lean management and leadership cannot be a bolt-on to, but rather must be a replacement of, other activities. This must occur through prioritizing or creating efficiencies in their current work that gives them the capacity to assume these new roles.

• Don’t:  Just tell the managers they need to support the Lean activity then complain when it doesn’t happen.

• Do:  Map the value stream of a manager’s work using the eight wastes and the four rules in use.  Identify the value added and non-value added activity.  Determine the target condition to help prioritize their tasks including the added work they will need to engage in continuous improvement.  Use Lean Healthcare principles to redesign and define their daily, weekly, monthly and annual standard work with measures and visual management.  Coach them for as long as it takes to achieve stability. Use A3 to course correct if you run into barriers.

In A Factory of One: Applying Lean Principles to Banish Waste and Improve Your Personal Performance, Daniel Markovitz takes a fascinating approach to using Lean principles that we normally apply externally and instead applying them internally to an individual’s work.  It guides the development of a person’s standard work using visual management at a personal level.  One of my favorite examples is the use of time as a metric for the effectiveness of meetings.  Most of the time an hour or two is blocked off for a meeting and the whole allotment of time is used whether it is needed or not.  Talk about putting the cart before the horse! Meeting attendees should be present to deal with the issues listed in the agenda, not to spend a specified amount of time together.  If one uses time as a measurement of the meeting’s effectiveness, then it becomes a priority to remain focused on the management of the agenda, staying on topic and dealing with the issues as quickly as possible so the meeting can end early and give back time.

Consider time as a valuable resource and worth measuring at many levels.  It will tell you where the waste is and where the opportunities are.

“Time is what we want most, but what we use worst.”
William Penn

This week’s blog was written by Dave Munch, M.D. and HPP Senior Vice President and Chief Clinical Officer.

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While recently explaining Lean Healthcare concepts, I was told that we were just repackaging old concepts.  I think the individual who made the comment was looking for me to protest.  However, much to their surprise, I agreed.  I shared that Lean Healthcare is built on proven principles that have been around for decades.  Specifically, I referred to Deming’s 14 Points.

To those who aren’t aware of Dr. Deming, he is widely known as the “father of quality”.  He is perhaps best known for the “Plan-Do-Check-Act” cycle popularly named after him.  In Japan, from 1950 onward, he taught top management how to simultaneously improve service and quality as part of the U.S. government’s efforts to rebuild Japan after World War II.  Deming is credited with helping revive Japanese manufacturing and was seen as somewhat of a hero in Japan.  Ironically, in the United States we didn’t widely accept Deming’s philosophies until the end of his life in the late 1980′s and early 1990′s.

You can find out more about Deming’s 14 Points in this previous post, and here as well.

I believe you will find many parallels between Lean Healthcare principles and Deming’s Points.  I especially like the 14th  point:

“Put everybody in the company to work to accomplish the transformation.  The transformation is everybody’s job.”

This concept includes ideas such as:

• Improve your overall organization by having each person take a step toward quality improvement
• Analyze each small step, and understand how it fits into the larger picture
• Use effective change management principles to introduce the new philosophy

So many people that are new to implementing Lean Healthcare focus only on the tools such as Kaizen, 5S, or 3P.   However, by taking some lessons from the past we can learn to look beyond the tools.  We can look for transformation.  Thanks, Dr. Deming!

What is your organization doing to take Lean beyond tools?

Today’s blog was written by Tom Stoffel, Vice President with HPP.

Tom has led healthcare organizations in both the development of high-level Lean Strategies down to hands-on implementation of Lean in a clinical setting.  He has achieved the levels of Certified Lean Specialist from the Business Improvement Group and the National Institute of Standards and Technology (NIST), along with being an ASQ Certified Quality Engineer.  Tom is the developer of TGI Healing Healthcare – a brand of Lean Healthcare training tools designed to share lean principles through hands-on learning. 

Tom holds an Engineering Degree from the University of Michigan.

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I was recently asked by a hospital executive what I think is the True North in healthcare. The reply I gave: “It is “Hoshin Kanri.”

Hoshin Kanri, or strategy deployment, are complicated words to describe a very simple concept: breakthrough initiatives to improve the health of patients. It can be likened to the way that the point of a compass always points towards the North Pole.

Hoshin Kanri is more than a compass for steering the direction of your organization and your processes. It is the strategic means of control that allows your organization to make quick turns, changes, and adjustments before you become trapped in a crisis.  Success in a highly competitive healthcare environment requires more than focus and direction. You must have innovation. Hoshin Kanri is the means for keeping the actions and innovations of your people aligned with your organization’s strategic intent.

Another definition explains Hoshin Kanri as a method to set breakthrough priorities to transform healthcare, and then to obtain feedback from staff closer to the work on how to prioritize and implement them.

Traditional Japanese management system ideas flow bottom-up from the workplace to management.  However, in Hoshin Kanri there is also a top down approach to planning change. Strategic direction must be determined by discovering the alternatives for achieving the organization’s vision and choosing the direction that will accomplish it.  This direction is modified through the power of the incremental change to act as the rudder that steers the ship by making finely tuned changes to the general direction of the strategy.

I see a critical need for healthcare organizations today to align their strategic direction with their daily work systems so that they work in concert to achieve the desired state.  Alignment must include linking cultural practices, strategies, tactics, organization systems, structure, pay and incentive systems, building layout, accounting systems, job design and measurement systems – everything.  In short, alignment means that all elements of the company work together much like an orchestra leader integrates various instruments to conduct a symphony.  Organizations that apply the most mature aspects of Hoshin do not put in place any random mechanisms or processes. Instead they make careful, reasoned, strategic choices that reinforce each other and achieve synergy.

As I told the healthcare leader who asked the question, the main focus of Hoshin Kanri is to deploy and track only a few priorities at each level of the organization.  Given all of the rapid changes and increasing distractions that healthcare organizations face today, individuals must be able to focus on the things (the vital few vs. the trivial many, as my boss always says) that offer the greatest advantage to the organization. The clearer the priorities, the easier it will be for people to focus their energies on what really counts. How often has your healthcare organization made dramatic improvements in a process that suddenly became obsolete due to the lack of these communication tools?

Invest in Hoshin Kanri. Drive your healthcare organization in a focused strategic direction for the future.

Today’s blog was written by Michael Kellner, a Director with HPP.

With more than 30 years of experience, Michael has optimized organizations’ delivery systems through Lean, Six Sigma and continuous quality improvement methodologies.  He has led lean transformations in Healthcare for both private organizations and the military, including the Office of the Surgeon General.  Michael has also held senior leadership roles with Johnson Controls, Tenneco Automotive, and Warner Electronics.  Additionally, he served with the U.S. Navy in Vietnam.

Michael holds a Bachelor’s degree in Industrial Technology from Tennessee Technological University. He also holds a Senior Sensei and Master Black Belt Certification.

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In Lean Healthcare, we frequently use the word sustainability.  In the Lean training sessions I lead at hospitals, I stress time and again how important it is to think in sustainability terms and how difficult it is to sustain a Lean Healthcare initiative unless and until it becomes part of the culture.  Even then it requires work to ensure continued sustainability.

The concept of sustainability intrigues and fascinates me. I find myself thinking about it and using it regularly in conversation.  My colleagues and I talk about the importance of it.  When I am with a client or a colleague, we often talk about how it requires great commitment and diligence from anyone seeking to build a Lean culture.

We have to constantly articulate a clear definition of what sustainability means to the organization of which we are a part.  It is dangerous to assume that employees share a common definition.

Here is an illustration about the difficulty of sustaining something we start.  It’s an example many can relate to: losing weight.

I just dropped to 189 pounds for the first time in a year. I generally carry 10 extra pounds around.  I start on a diet every day – well, practically every day.  By the evening, I am telling myself that I will start again tomorrow.

My challenge lies in the fact that I can lose seven to eight pounds very easily.  I am a weight-loss Yo-yo.  I will lose it and gain it, lose it and gain it, never getting to that 10 pound goal.  Why does this happen?  Why can’t I lose it and maintain it over a long period of time?  Why am I not sustaining?

In evaluating my behavior, I find that my tendency is to relax once I reach a certain point. Instead, I need to learn to sustain the momentum and use the accomplishment of one goal to move to the next one.

The apostle Paul had some very descriptive comments about sustainability that I find helpful. He didn’t call it that, but it fits so well here.  From the letter to the Romans, we find the following:

“I don’t really understand myself, for I want to do what is right, but I don’t do it.  Instead, I do what I hate.”

What a powerful sentiment. This applies to losing weight as well as other aspects of daily life.

It seems to me that sustainability in our Lean journey is much like that.  When we achieve a goal or a certain level, we tend to relax and take it easy for a while, which inevitably causes us to lose the momentum which we have built.

Bulletin:  You cannot both relax and sustain Lean.

It must become no different than keeping the books for your company or brushing your teeth.  You have to make it a part of how you live your life.  What company do you know that keeps its books for a year and then decides to take a year off? A company that adopted that behavior probably wouldn’t be around for long. Have you ever knocked it out of the park while cleaning your teeth in the morning, and rewarded yourself by skipping a few days?  Highly doubtful.

I certainly do not mean that we should not enjoy the gains that we make and the victories that we achieve.  But, we must use those victories and the ensuing celebrations to move us further toward our Lean Healthcare goals.

So, following my meanderings about this most interesting word, what can we do to sustain those things that we want to sustain?  How can we achieve and maintain ever more powerful levels of Lean in our hospitals and clinics?

Within the context of the illustrations above, perhaps the following thoughts will inspire you to think deeply about how you can sustain Lean in your organization.  Consider putting some of these things to work or, if they are already in place, renew your commitment to them.

1. Set goals on a regular basis and share the goals – more than once.  Keep them alive throughout the year.
2. Communicate, communicate, and communicate!  Communication is the constant creation of understanding.  To say, “I told them,” and think that once is enough, is a pipe dream.  People need to constantly be reminded of goals and action plans so that they sink in over time.
3. Review goals regularly.  Share results.  Enjoy accomplishments but use them to spur greater progress. Review progress in order to stay on track. After all, people do that which gets reviewed.
4. Establish accountability that is truly accountable.  A powerful action plan asks Who, What and When  and describes the desired outcome.

Sustainability. What a fascinating word. It can be achieved by purposefully working at sustaining what we start on an ongoing basis.  In a Lean Healthcare environment, the word refers to systems that can be expected to be productive for long periods of time, or the capacity to support, maintain and endure.

How will you maintain and support your Lean Healthcare effort in order to sustain?

Today’s blog was written by Jay Conner, Ph.D., a Senior Manager at HPP.  

Jay has more than 30 years of experience in communications, human resources, and human resources development.  He has worked in both higher education and in the private sector.  In healthcare, he has consulted in training and development, executive and managerial coaching, recruiting and hiring, employee relations, performance management, compensation, employment law compliance and employee manuals and handbooks.

Jay holds a B.A. from Georgetown College and an M.A. and Ph.D. in Communications from LSU. 

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Training, education, seminars…these are often thought of as solutions to problems in not only healthcare, but all industries.  Check any A3 problem solving project and you’ll probably find one of these listed in the Countermeasures area.

The Lean Healthcare question for today is this:  Is training always needed or even helpful?

For the sake of this discussion I’m going to give you a “bye” if your problem’s solution lists training as complementary to changes in process, equipment, job roles, or any other significant systemic changes.  Whenever something is changed, education, or at the least, communication is needed to make sure that everyone understands and can perform to the changed requirements.   What we’re going to focus on today are those cases where the solution suggested is entirely and only education.

If you decide that education is the only solution needed to solve a problem, you have decided that the root cause of your problem is a people and performance problem.  You have decided that the human resources involved either can’t or don’t want to perform up to standard work.  You are in essence asserting that the system in which those people work is perfectly fine to produce the outcomes needed.

To the contrary, I would maintain that in most cases if we stop with an education-only solution we have not dug deep enough and we have stopped short of finding true root causes.  We have not asked why five or more times to find the true source of the errors, mistakes, waste, and problems.

As an example I am reminded of a large multi-specialty clinic that decided to educate everyone — again — on the importance of providing all patients with a printed after-visit summary and reconciled med list.  They did this without trying to find out why patients weren’t getting these documents.  Had they performed a little excavation on the problem, they would have found that the placement and capacity of the limited number of printers as well as flow issues made it virtually impossible for staff to deliver these documents to patients in a timely fashion.  For the sake of not delaying and dissatisfying patients, the staff often bypassed the requirement.

Educating again will do nothing to change the outcomes in this situation.

So, the next time you find yourself teetering on the verge of implementing a purely educational countermeasure, take a breath and ask yourself:  Have we dug deep enough for root causes?

• Have we asked why, why, why, why, why to uncover issues related to work flow, environment, layout, equipment, materials, job assignments, materials, and so on?
• Have we asked why, why, why, why, why to uncover the lack of helpful standard work documentation and job aids?
• Have we asked why, why, why, why, why to uncover issues related to cultural performance barriers such as norms about deferring to physicians who bypass standard work and best practice?
• Have we asked why, why, why, why, why to uncover whether we inadvertently reward non-performance by allowing some individuals to under-perform and punish performance by expecting others who are consistent and trustworthy to pick up the slack ?

Finally, if you find yourself truly believing that you have found the root cause and it is a knowledge or skill gap, ask yourself, “As of today, could the staff members perform to standard if their lives depended on it?”  If they could, you don’t have a root cause that education will greatly affect.  Look elsewhere for solutions.

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Change is the new normal in healthcare. The hospital building boom of yesteryear is over, and so is the disconnected, cottage-industry approach to providing services. The new Patient Protection and Affordable Care Act demands something wholly different: competition based on quality, safety, and effectiveness of care, not quantity.

Medical providers and institutions can no longer afford to perform any service that does not add value for the patient.  And likewise, when it comes to designing a new building or new space, hospitals cannot afford to build one extra square foot, cannot count on remodeling in a couple of years, and cannot take on massive new debt.

Where is Lean thinking in this Brave New World?

Fortunately, the Lean philosophy that has begun to streamline processes in hospitals across the country is extremely useful in designing the buildings where those processes take place. Lean thinkers are used to observing all sorts of process waste, like:

• Nurses running for supplies.
• Pharmacists calling for clarification.
• Readmissions, infections, medication errors.

Now, think of ways in which the building itself fosters waste:

• The pharmacy is one-quarter of a mile from the ER.
• Beds in the Ambulatory Care Center lie empty after 4 pm.
• Rooms are not standard. Supplies, equipment, and approach to the patient vary from room to room.

When Lean thinking begins on Day One of design, long before the architect raises a pencil, massive amounts of waste can be designed out of the building. Lean-led design provides a way to use the genius of the staff to redesign the patient journey as they design space. This way, the architect has the information required to draft space that supports the processes within it—now and into the future.

Typical vs. Lean-Led Design

In a typical building project, the architect will interview department heads and draft a concept of the new building, based primarily on the past several hospitals designed. The function of the hospital remains essentially the same, or as one hospital exec put it, “We imported the same old problems.”

Lean-led hospital design differs dramatically from this formula. Starting with Lean, collaborative teams of staffers redesign the patient experience. The architect, a team member, is not expected to have answers up front. The information revealed in these sessions breaks old paradigms and brings in better ways to work. The architect spends a fraction of the time drawing, because he or she has a true understanding of the need.

Silo-Busting with Lean-Led Design

The design of a new facility is an underappreciated way to accelerate Lean thinking throughout an organization. Designing according to the patient’s journey tends to break down departmental silos, increase cooperation, and reduce the number of patient handoffs—all of which result in a better, and higher quality, hospital experience for patient and staff member alike.

Do you have a Lean design example to share? Tell us in the Comment Section below!

This week’s blog was written by Naida Grunden. 

Naida is the author of The Pittsburgh Way to Efficient Healthcare, and with Charles Hagood, is the co-author of Lean-Led Hospital Design: Creating the Efficient Hospital of the Future. Both books have received the Shingo Research and Professional Publication Award for 2013.

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