Lean Healthcare Exchange

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Albert Einstein once said, “The best design is the simplest that works.” On the surface, this does not sound like a statement with deep meaning from someone so intelligent. However, with the proper context, we can learn to understand how profound this statement really is.

Our hospital compensation is now tied to how well we meet patient satisfaction goals. The challenge is clear: “Satisfy the patient.” The problem should also be very clear, “Our current process design for achieving 100% patient satisfaction is not working.”

Hospitals around the country are now aggressively responding to this challenge in a variety of different ways. Some are hiring consultants to help leadership align with this challenge. Others are realigning staffing and clinical roles, evaluating and questioning the data systems that collect patient satisfaction and making every effort to target focus areas. Efforts to improve patient satisfaction are also being linked to broad scoping organizational changes such as: Magnet certification, Computerized Physician Order Entry (CPOE), Malcolm Baldrige Award or criteria, Lean, Six Sigma, Continuous Improvement, and a variety of Total Employee Involvement (TEI) programs. In healthcare, it is a veritable cornucopia of change initiatives.

Perhaps the real problem hospitals face around the topic of patient satisfaction is that the process design to deliver patient care in order to exceed patient satisfaction is too complex. It is not simple. There are too many variables to control and the process itself is out of control. Again, let us consider what Einstein said about design. I believe that hospitals will need to fundamentally rethink all of the processes that feed patient satisfaction in order to be successful going forward. This means we reduce complexity, we reduce the number of steps required, we align to patient needs, and we throw out what is not working and do the work in a different way.

There are many tools that can help healthcare organizations leap forward in process design for the future. However, there are none as effective as the tool of 3P (Product, Preparation, Process). The 3P tool is still relatively new and not well known to healthcare. However, it is not a new tool at all. In fact, the tool was introduced in the US in the early 1980’s. The premise behind the tool is rapid design and testing of multiple options with two goals in mind:

1. Meet the design requirements. In our healthcare example, one requirement might be to achieve patient satisfaction.
2. Adopt the simplest design that meets the design goals.

The beauty of this tool is that it utilizes the people that work in the processes in order to design the new process. The resulting ownership by the people who work daily in those processes is absolutely overwhelming. There is a sense of hope that emerges as barriers evaporate and what was once seemingly impossible now appears possible.

There is no doubt in my mind that the 3P tool can be utilized to help in a major way as healthcare struggles with the challenges of today and tomorrow. However, 3P is only a tool. It is not a replacement for great leadership that guides and directs the organization toward simplistic process designs that work.

If you are planning a remodel or process redesign, make sure you optimize your resources.  Learn more about the 3P tool in the recently published book, “Lean Led Hospital Design” and see its effectiveness in the case study “Creating Emergency Department Capacity Without Major Expansion.”

Today’s blog was written by Ronnie Daughtry, a Director with HPP.

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Call it “Monday morning quarterbacking”, “20-20 hindsight”, or just “lessons learned” – twelve years in healthcare design all over the United States has afforded me a very unique point of view in regard to the impact of decisions made at the design table. My role as a clinician in the architectural design process has evolved from what I fondly remember as a “marketing hood ornament” to a valued member of a very integrated and Lean-led design initiative.

In 1999, before Lean Healthcare and certainly before Lean-led design was even a twinkle in my CEO’s eye, the focus on medical error with the landmark report by the Institute of Medicine, “To Err is Human, Building a Safer Health System” opened the dialogue and begged the question, “Can and does the physical environment contribute to patient safety?” The IOM’s report was the catalyst for what has become one of the most spirited debates in the healthcare design world over the past 10 years. I am speaking of the use of standardization as a fundamental design driver for everything from the patient room to operational support spaces such as supply and nourishment rooms.

Until I was introduced to Lean Healthcare, my rationale for believing in standardization was likened to a “religious epiphany” by those who worked on projects with me.  I believed because of personal experience as a healthcare provider, my intuitive sense of organization, and because of natural human behavior…it just made sense to me. “To Err is Human” brought forth the message of salvation from medical error and standardization was one of its highest commandments. It seemed so obvious…such common sense…why the controversy?

1. COST – Mirrored patient rooms permit the sharing of plumbing chases in multi-story buildings such as hospitals. The savings associated with repetitive construction due to standardization often offset this cost.
2. PROOF – Many studies have focused on the reduction of medical error, which is extremely multifaceted with numerous contributing factors. Isolating the benefit of standardization alone is impossible.
3. CONFUSION – The introduction of the term “same-handed rooms” has added to the confusion and misinformation regarding the benefits of standardization. A same-handed room does not mean the room is standardized!
4. VARIATION – Just like you can’t be a little bit pregnant, the environment is either standard or not standard. Variation in layout resulting from many types of intrusion from the building structure, MEP systems or the basic geometry conflict with an attempt to standardize. Standardization as a design driver must be declared at the beginning of the project.
5. CHANGE – The liability of changing a long-standing paradigm such as the use of mirrored patient rooms that is deeply embedded into multiple design disciplines and construction costing models is difficult.

In 2007, I was introduced to Lean Healthcare – Finally, the answer I had been searching for since I first heard the Standardization Gospel!

Lean Healthcare and Lean-led Design combined are incredibly powerful tools that will consistently produce quality outcomes and eliminate waste. The obstacles to standardization can be overcome. The benefits of standard work in Lean manufacturing are undisputed. The decision you make regarding standardization in your next construction project will impact safety, cost, efficiency and standard work for as long as the building remains operational.

“Compromising standardization is not in the best interest of patients and staff providing care; lack of standardization leads to complexity and error causing more harm, lower efficiency and less effective quality outcomes.” U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality grant number UCI HS15284

This week’s blog was written by Teresa Carpenter, RN, Director, Lean Clinical and Facility Design.

Teresa brings a unique perspective to lean healthcare as a registered nurse with extensive architectural design and facilities planning experience as well as move-in expertise.  She assists hospitals and healthcare systems in all aspects of applying Lean to the master plan, design, and operational aspects of a facility design or clinical expansion. Teresa serves as an educator, adviser, advocate, and interpreter for Lean healthcare integration into a wide range of clinical and hospital design, renovation, construction, and move-in projects.

Teresa holds a B.S. in Business Administration from the College of Charleston, and a B.S. in Nursing from Trident College in Charleston, South Carolina.

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I recently was part of a ‘move in’ effort at a brand new healthcare facility…at about the same point in time, I began to read to the new book Lean-Led Hospital Design, Creating the Efficient Hospital of the Future, written and published this year by my friends Naida Grunden and Charles Hagood. What a unique coincidence for me, reading a first class discussion about the application of Lean Healthcare concepts and tools to new healthcare buildings while intensively working to get an existing healthcare organization up and going in their brand new, sparkling facility!

From the beginning, Naida and Charles point out some unique ideas about the why and how of Lean Healthcare construction, including some ‘basics’ that everybody who is thinking about construction should take to heart! Three beginning points to contemplate:

1. The Building is Not an Excuse! Dysfunctional buildings never qualify as a legitimate excuse to not strive for continuous process improvement within the existing walls. Grunden and Hagood point out that while fairly recent healthcare quality outcomes for Cuba and the U.S. are very similar, the U.S. has the most expensive healthcare system in the world while Cuba’s has one of the lowest! Healthcare facilities in Cuba are nowhere near as good as what we have here but those buildings don’t seem to serve as excuses for their efforts for perfection.
2. Build Only If It Creates Value! Grunden and Hagood suggest that an appropriate time to build is when you note diminishing returns from existing process improvement activities. When your process improvement teams note the existence of more and more facility ‘monuments’, you’re probably ready to begin the ‘design and build process’!
3. If You Build or Remodel, Be Prepared to Invest Up Front! Investing in the involvement of those that perform the ‘regular’, everyday work in the design effort costs time and money. However, their participation typically results in better outcomes and  greater ‘buy in’  of the final design. Grunden and Hagood also suggest that a Lean–Led design effort means taking the ‘long view’ when we consider investment in buildings. This requires us to consider not only the initial costs but also the on-going or recurring operating expenses. If our new design allows us to minimize waste, we should clearly see those benefits in our continuing cost structure!

Good luck on your building or remodeling effort! Lean-Led design, combined with Lean Healthcare principles, certainly makes sense to me!

This week’s blog was written by HPP consultant and engineer David Krebs.

David, a Six Sigma certified engineer, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA. David is also a Licensed Professional Engineer in the state of Tennessee, with over 30 years of experience in a variety of process and systems intensive industries, as part of firms in the U.S, Germany, and France.  David has achieved and maintained QS-9000 and ISO-14001 certification & received Nissans’ “Quality Master Award” on three occasions.  He holds a Bachelor of Science degree in Mechanical Engineering from the University of Detroit & an MBA from the University of Notre Dame. 

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Lean Healthcare PowerDay

April 9-10, 2012

The Mandalay Bay Resort

Las Vegas, Nevada

Join us for the Lean Healthcare PowerDay!  Hear from and interact with preeminent Lean Healthcare industry leaders who are transforming organizations into safe, high-quality, high-performing healthcare delivery systems.  Learn how others have overcome challenges including changing culture, sustaining results, and surviving transitions in leadership. 

Gain insight into how implementing an effective Lean system can help you improve quality outcomes in delivery and transition of care, which are becoming increasingly important measures for reimbursement in the wake of health reform. 

Click Here for Pricing, Registration, and Accommodation Information

Featured Presenters:

Lean Healthcare PowerDay
Tuesday, April 10, 2012
8:00 a.m. – 5:00 p.m.

The PowerDay is the best way for you to get caught up on Lean Healthcare’s rapidly progressing, constantly changing practice.  This full-day of session presentations provides knowledge on how to implement Lean Management Systems, address struggling transformations and leverage specialized Lean Tools and Methods for Healthcare Facilities Design. 

The Charge (Optional Introductory Educational Session – Register Separately)
Monday, April 9, 2012
1:00 – 5:00 p.m.

This half-day educational session provides Lean Healthcare training and an introduction session to attendees. Held on Monday, April 9, The Charge will present a broad brush of key concepts for healthcare providers new to Lean Healthcare, or for those who need a refresher on basic tools and techniques used in the practice. 

Networking Reception
Monday, April 9, 2012
5:00 – 6:00 p.m.

Included with The Charge or PowerDay, this reception will be a great opportunity to network with peers and PowerDay speakers.

Event Agenda

Tuesday, April 10, 2012 

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Lean-Led Design is a systematic approach to healthcare architectural design that focuses on defining, developing and integrating safe, efficient, waste-free operational processes in order to create the most supportive, patient-focused physical environment possible. 

Steven Spear identified the Four Rules-in-Use that permeate processes in his 1999 book, “Decoding the DNA of the Toyota Production System.”  The four rules have since become known as the fundamental building blocks for defining and optimizing the complex, multifaceted process steps that are inherent in today’s Lean healthcare delivery system.  As more attention is given to healthcare architectural design to support Lean processes, the four rules are a logical platform for articulating the characteristics of a supportive Lean-Led Design Project. 

The Lean Led Design Principles below align with Spear’s Four Rules to optimize the Healthcare Delivery System: 

Rule 1: Activities

• Think system, not silos. Look for opportunities for sharing spaces between services, for example, prep and recovery rooms that serve all invasive procedures.  If possible, co-locate exam room spaces between two departments with opposing peak census needs, such as Pre-admission Testing and the Emergency Department.  This will result in increased capacity for both.
•  Standardization in design promotes defect-free, standard work. Standardize configurations to reduce variations in work processes and promote long-term flexibility.  In shared workspaces such as medication rooms, a standardized layout permits instant familiarity and reduces the potential for error.

Rule 2: Connections

• Create a visual workplace. Build in visual cues that permit the staff to instantly determine normal from abnormal in their workplace. Designate parking places for frequently used equipment to prevent time spent searching when it is in use.
• Caution! Waiting is waste. Carefully scrutinize waiting rooms beyond the point of entry (public lobby and reception areas).  Don’t design sub-waiting areas to queue patients: rather than shift the wait from one area to the other, strive to move patients through the system with smooth, one-piece flow.

 Rule 3: Pathways

• Pathways should be direct. Make way-finding intuitive.  Make it easy to visualize the destination from the point of entry.  Remember that straight corridors make stretcher travel easy with minimal motion waste. 
• Design in smooth flow and motion. Design the layout for smooth flow, where work proceeds in one direction and the start and end are in proximity.  Consider how the work starts and ends and consider the hand-offs and travel in between.  For example, are the patient and family member arriving for imaging able to enter and exit the same door near their car? 
• Make the trip to the toilet a Lean journey.  Configure patient rooms with the toilet room on the same wall as the headwall to reduce travel, promote patient autonomy, and reduce the risk of injury to patients and staff through falls. 
• Space should be intentional.  Design for every square foot needed and no more.  The belief that space will solve problems is a myth:  excess space leads to increased travel distance (motion waste) and stockpiling of supplies and equipment (inventory waste).  Process redesign solves problems. 

Rule 4: Continuous Improvement

• Make the environment easy to change.  Consider using standardized modular equipment, casework and workstations on wheels to provide flexibility for continuous improvement.  Make storage accessible, flexible, visual and temporary.  Create long, shallow equipment rooms to keep items from being lost and prevent having to move items reach equipment behind. Designate visible parking spaces for each piece. 
• Think quality at every step. Design in inspection (quality checks) before the product/patient/service is passed on to the next level. Incorporate ways to visually communicate real-time progress toward continuous improvement goals.

Whether it’s a small department renovation or a large hospital replacement project, when Lean Healthcare processes and a supportive building work together the result is the same – higher quality at a lower cost. 

Interested in Lean Design? Check out www.leanledhospitaldesign.com for more information on Lean-Led Hospital Design: Creating the Efficient Hospital of the Future, the new book from Naida Grunden and Charles Hagood, available March 2012.

This week’s blog was written by Teresa Carpenter, RN, Director, Lean Clinical and Facility Design.

Teresa brings a unique perspective to lean healthcare as a registered nurse with extensive architectural design and facilities planning experience as well as move-in expertise.

Teresa assists hospitals and healthcare systems in all aspects of applying Lean to the master plan, design, and operational aspects of a facility design or clinical expansion. Teresa serves as an educator, advisor, advocate, and interpreter for Lean healthcare integration into a wide range of clinical and hospital design, renovation, construction, and move-in projects.

Following more than 12 years in acute care, Teresa transitioned to clinical operations coordinator for an internationally recognized leader in healthcare architectural design. Among her project experience, she was the lead planner on the nationally recognized St. Joseph’s Hospital in West Bend, Wisconsin, the world’s first hospital designed to reduce medical error.

Teresa holds a B.S. in Business Administration from the College of Charleston, and a B.S. in Nursing from Trident College in Charleston, South Carolina.

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Too often I lead teams whose goal it is to improve the workflow of caregivers, only to find that the team is hamstrung by a facility design that doesn’t support that team’s vision.  There are all kinds of explanations for how these physical design barriers come to be, but I won’t try to list them all.  I would rather focus on one of these explanations and leave the other hundred or so for another blog posting.

By now, readers of the Lean Healthcare Exchange know that the focus of Lean healthcare is waste elimination.  It is also widely accepted that two of the most prevalent forms of waste in healthcare are motion and transportation.  A common cause of both these types of waste is searching for supplies and equipment.  It is my experience that the way we design our facilities creates an environment where we are destined to have significant searching.  Many well meaning healthcare designers have actually exacerbated this searching by using typical design paradigms regarding the use of casework and cabinetry.   Let me explain:

In healthcare design, there is a tendency to furnish most workspaces with plenty of cabinetry and casework.  Often, there seems to be a “more is better” approach and designers endeavor to squeeze as many cabinets and drawers as possible into a given space.  I want to challenge this approach.  The number and size of cabinets and drawers in a work space should be defined by the work flow in that space.  Sometimes this means that we will have fewer cabinets and drawers than the space will accommodate.  I realize that this is a counter-intuitive assertion.  I know because from care givers I hear, “we never have enough cabinets to store all our stuff.”  And from designers I hear, “in the interest of the staff, I look for opportunities to maximize the use of casework so that there will be plenty of storage.” 

Let me also clarify that for purposes of this discussion, I am referring to clinical care areas rather than public spaces or even areas where patients will spend a lot of time. 

Certainly, cabinetry serves a useful purpose.  It serves to hold the stuff that we wish to store near the point of use.  It can also provide a level of security and safety for our stuff and our patients.  Cabinetry also provides an aesthetical benefit by obscuring the negative appearance of clinical supplies.  But, in these clinical areas, where patients rarely go, safety, security and appearance are secondary or tertiary considerations.  The primary consideration instead, is quick and efficient access to care supplies for purposes of restocking and providing care.  In this case, more visibility to the supplies rather than less visibility is desirable.  Cabinetry and casework are tools that limit visibility.  The result is more searching and an unnecessary barrier to ensuring reliable replenishment. 

The design of casework and cabinetry should be purposeful.  There are certainly appropriate applications of casework and cabinetry but, its use should not be the default in all situations.  It is the front-line staff, with their intimate knowledge of the workflows in a workspace who should inform the placement of design elements.  Favoring more open, visible storage will provide for a more efficient workflow by easing access to the supplies and increasing the likelihood of proper replenishment.

Given that I have no architectural or design expertise, how can I recommend a new paradigm in healthcare design?  It is the front-line staff that I have worked with that have, through observation of their waste-filled current state processes, pointed out this built-in waste.  They have, on several occasions, recommended a more open and visible storage in work spaces such as Medication Rooms, Nourishment areas, procedure rooms and the like.  But, by the time these counter-measures are requested, it’s too late.  The prospect of replacing cabinetry valued at several thousand dollars is a non-starter with most leaders.  So, they continue to deal with an inefficient process and develop other workarounds.

What is the solution? Engage front-line staff earlier in the design phases of a hospital construction or remodel project.  By doing so, we can eliminate some of this built in waste.  This is just one example but there are many potential benefits that can be realized by applying Lean Healthcare principles during the design of a healthcare facility. 

Interested in Lean Design? Check out www.leanledhospitaldesign.com for more information on Lean-Led Hospital Design: Creating the Efficient Hospital of the Future, the new book from Naida Grunden and Charles Hagood, available March 2012.

This week’s blog was written by Jeff Wilson, a Director with HPP.

Jeff leads Lean design, new facility move-in preparation, and Lean transformation engagements with healthcare clients. He has developed Lean transformation plans, facilitated Rapid Improvement and 3P events and developed training materials for numerous client companies in healthcare. Throughout Jeff’s career, he has delivered and applied progressive management and process improvement tools to help organizations reach new levels of performance. The industries span from healthcare to manufacturing, financial consulting and accounting. Most recently, Jeff served in a consultant role with the Manufacturing Extension Partnership where he had the opportunity to support other organizations as they seek to improve processes by implementing Lean. Jeff has a Bachelors Degree in Economics from Western Kentucky University. He also holds a Certificate in Production and Inventory Management (CPIM) designation.

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Many hospitals and health systems are either implementing Lean Healthcare improvements or considering to do so.  What many are discovering is that the improvements achieved in their Lean Healthcare activities are short lived.  The chaos of the work prevails and eats away at the standard work processes that had been developed, even though initial improvements were quite substantial.  When I visit these organizations, I am commonly asked, “How do we sustain our improvements?”  What is ironic is that the answer to this question is in the literature, everywhere, but usually ignored.  It is ignored because it is not the easy part.  It involves the adaptive change in people’s work and minds; a culture change.  True lean transformation involves change management, which requires observation, questioning, dialogue, design and coaching at all levels. 

 Lean Healthcare must be implemented as a system, not just a set of tools.  Engagement must occur at all levels of the organization; executive leadership, management and staff.  Each level has specific roles to play and the connections between them are critically important.  It is not the sole responsibility of the Kaizen improvement team or the improvement department to improve work.  This must be owned by operations and it must define how they work.

 To achieve a true transformation, as Steven Covey would advise, let’s begin with the end in mind.  What do you want to be in the transformed state?  What will a successful Lean Healthcare transformation look like for you and when will you get there?   This fundamental question should be asked and answered ideally before you start your Lean Healthcare journey.  If the answer to this question is: “Our quality department will have the skills to apply Lean Healthcare tools and improve our scorecard,” you will find the journey very difficult if not impossible because it doesn’t address the responsibilities of front line staff, your managers, your executive staff and operations in general.  If, on the other hand, your answer to this question is: “Every clinical service line and support area will be analyzing, improving and stabilizing their work on a continuous basis to improve the value we give to our patients and we will achieve this state within the next five years”, you may very well succeed if you are willing to maintain the focus on this transformation for as long as it takes to get there. 

 In this future state what do we see each layer of the organization doing? 

 Front Line Staff

Front line staff is doing the work as expected, surfacing problems and solving them as close to the work as possible in space and time.  This isn’t the ever-so prevalent “work-around.” A work-around avoids the deeper problem, does not address root cause and leaves a broken process that others will have to suffer with.  Solving the problem requires knowing the problem deeply enough, analyzing to root cause, implementing counter-measures and performing a project plan such that others don’t experience the same problem in the future. 

  Management

If the above is what we need front line staff to do, that helps define what managers need to do.  Managers need to support the front line in their responsibilities by knowing the standard work, observing, measuring and coaching the standard work (more on coaching in a future blog) such that the process is stabilized.  This is core management 101 and is understood as a given in almost every other industry.  A common problem in healthcare is that we don’t give managers the training and skillsets to manage.  We commonly assume that since they are good clinicians they will make good managers, and this is not so.  Management skills can’t be assumed, they need to be taught and these people need to be developed intentionally.

 Managers also need to coach problem solving and facilitate improvements.  Yes, managers need to be facilitating improvements, not just members of the quality or Lean department.  There is a problem, however.  Managers are likely the busiest people in your hospital and will be the first to tell you they don’t have time to do these things because they have so much on their plate.  They’re right.  Unless manager’s work is intentionally redesigned, failure will be the outcome.  What can be taken off their plates?  What waste can be eliminated from their current work habits?  Example: How many meetings are they attending, how much time is it taking and what have been the measurable outcomes from these meetings over the past year?  Based on this information, what can be eliminated or redesigned? 

Executive Leadership

If the above is what we need management to do, that helps define what executive leadership needs to do.  The executive must take an active role in the development and coaching of their directors and managers such that they can perform their responsibilities of front line oversight and as defined in the organizations mission, goals, strategies and plans.  The executive, therefore, needs to establish a manageable number of clear organizational goals and align the organization’s attention to pursuing them by providing the systems, structures, resources and coaching necessary.  This requires going to where the work is being done regularly where they can see the work, dialogue with staff, understand the issues and provide support. It is likely that executives will also need to critically evaluate how they are currently spending their time and redesign their work such that they have the presence required to lead the transformation.  The currency of leadership is presence.  

How to get started

Learn by doing.  You can start anywhere you see a problem.  Over the course of time align your improvement activity to your organizational mission, goals and strategies.  The experience of solving problems and using the Lean Healthcare tools will provide the means for cultural development.  It is easier to act your way into a new way of thinking than to think your way into a new way of acting.   Through problem solving and process improvement, you will see what else needs to be addressed.  You will gain new perspectives on your work and see things in a new way.  It will also help guide you in the skills and practices your people will need to develop in the (and their) transformation.  You can spread your improvement activity throughout your organization as you develop more and more of your people in the skills of Lean Healthcare.  In the end, your success will be determined by your people, your most important asset.  Develop them intentionally and you will succeed.

This week’s article was written by Dr. David Munch, Chief consulting and clinical officer at HPP. He comes from Exempla Lutheran Medical Center as their Chief Clinical and Quality Officer. At Exempla, Dr Munch led their Lean Production applications resulting in substantial improvements in both clinical and non-clinical processes. Dr. Munch is an instructor for the Belmont University Lean Healthcare Certificate Course, and was previously an instructor at the University of Michigan’s Lean Certification Program and has been a frequent speaker on the subject of leadership effectiveness and Lean transformation for a number of healthcare organizations including Institute for Healthcare Improvement (IHI), The University of Rochester Medical Center, Yale-New Haven Health System, Tulane University Medical Center, Pittsburgh Regional Health Initiative, Institute for Clinical Systems Improvement (ICSI), and the Voluntary Hospital Association (VHA). Dr. Munch has served on the Agency for Healthcare Research and Quality’s High Reliability Advisory Group, has an extensive background in hospital operations, health plan governance, physician organization governance and clinical practice in Internal Medicine. 

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When I was a little girl in the 1960s, the beginning of the Christmas season was marked by the arrival of the Sears Christmas Catalogue. With only three television channels, the toy commercials were relegated to Saturday morning cartoons. The Christmas Catalogue contained everything we could ever want! My sister and I spent hours studying the latest toy offerings. Each item was carefully assessed to determine its worthiness for the all important “Christmas list.” The choices seemed endless — and even Santa couldn’t bring it all. We prioritized our needs, narrowing down our list until we established an achievable, incremental improvement in our toy future state. 

Times have definitely changed. The Christmas Season begins as soon as the stores can clear out the Halloween merchandise. The Sears Catalogue is gone. There are television networks dedicated to marketing and entertaining every stage of childhood development. The handcrafted, meticulously selected Christmas list is now quickly disseminated on Twitter and Facebook as soon as something strikes our fancy.

My Christmas list is certainly very different these days as well. I no longer wish for material things. As a Lean Healthcare consultant, I am privileged to work with caring healthcare providers all over the country. Whether I am working in a small community hospital or large academic medical center, the needs of the healthcare provider are always the same. And yes, all you caregivers – I am here to tell you there is a Santa Claus! It does not require a marketing empire or expensive technological solution. It is possible to eliminate many of the frustrations plaguing healthcare today through common sense incremental process improvement. Your wishes can come true by consistently applying Lean Healthcare principles to your daily work.

I encourage you to start a Lean Healthcare Christmas List today. Share it with your coworkers. Ring in the new year with a renewed spirit of involvement in correcting the issues that have robbed the caring profession of the sense of satisfaction that comes with knowing our efforts are helping others.

This week’s blog was written by Teresa Carpenter. Teresa is the Director of Lean Clinical Design with HPP and brings a unique perspective to lean healthcare as a registered nurse with extensive architectural design and facilities planning experience. Teresa began her career in healthcare working through the ranks from Admitting Clerk to Patient Care Director of various critical care units, medical-surgical units, and support departments such as Respiratory Therapy and Cardiac Rehabilitation in several South Carolina facilities. With over 12 years experience in the acute care environment, Teresa moved to Nashville where she spent almost a decade as Clinical Operations Coordinator for an internationally recognized leader in healthcare architectural design. Teresa facilitated process engineering services as a component of the design process for hospital renovations, as well as large-scale green field and replacement facility projects. Teresa assists hospitals and healthcare systems in all aspects of applying Lean to the master plan, design, and operational aspects of a facility design or clinical expansion. Teresa holds a bachelor’s degree in Business Administration from the College of Charleston, and a degree in nursing from Trident College in Charleston, South Carolina.

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Redefining what patient-ready means for a new facility’s opening day

If you have ever moved into a new home, you have experienced the same level of planning and organization typically involved in opening a new hospital facility. When you move, I would surmise that your basic packing and organization tenets are similar to visiting a national forest – “pack it in, pack it out.” Whatever came from your old kitchen gets packed into boxes marked “Kitchen,” and is then moved to your new home to then be unpacked and stored wherever you see fit.

In your home, you may be the only cook in your kitchen, so individual organization preferences are a fine tactic. A little disarray is okay since you’ve got great kitchen cabinets with solid wood doors to hide things behind. Chances are also good you probably only have one kitchen, so there is no need to plan and organize multiple spaces in tandem.

In healthcare, imagine where the problem lies in that move-in strategy: Many caregivers, many users of common spaces, many common spaces. Depending on who is unpacking boxes of new supplies – or old supplies – there are an infinite number of possibilities for where the basics should go. Often they are squirreled away arbitrarily behind cabinet doors which offer only an outward semblance of organization.

Wouldn’t it make the most sense to have all of these common spaces, with common purposes, standardized and organized identically, with common visual cues for locating items? Think about it this way: have you ever had to make a meal in someone else’s kitchen? Where are the measuring cups? Plates? The saucepan? Unless you were the lucky soul that unpacked the kitchen after a move, you’re going to have to search or ask. It takes a while to get acclimated to such an unfamiliar environment. If a caregiver is out of her comfort zone, on another floor or in another department, she will likely find each storage area organized either slightly, or drastically, differently. To complicate matters further, nothing is visually identifiable from a distance due to cabinet doors and a lack of labeling.

This naturally leads to confusion, searching, and ultimately, less time spent caring for the patient.

My “a-ha” moment came when I recently had the opportunity to participate in a new hospital’s move-in preparation engagement, just prior to opening day. The scope of HPP’s engagement involved preparing the hospital for a smooth opening through mass rollout of a workplace organization plan — every storage location imaginable, planned to the smallest detail. Lean Healthcare workplace organization principles were used to facilitate the creation of identical function and storage arrangements in medication, nourishment, exam, treatment, and supply rooms, as well as nurse stations, ED bays, ORs and any department with multiple same use areas.

We quickly found that some of the most beautiful, solid, and expensive portions of the new construction were only conceptually functional – non-uniform, built-in casework, counters and cabinets. In this facility, the upper casework shelves were too high for most caregivers, and issues arose in attempting to organize supplies in the deep cabinets and drawers.

Casework is traditionally designed into a room in the remaining space, almost as an afterthought.  The typical end result is a lack of uniformity of sizes of cabinets and drawers from room to room.

However, we were given a task to complete, and weren’t about to let this casework get in our way.

We developed a workaround to the casework issue by using Lean Healthcare workplace organization principles. We implemented an on-site fabrication team that worked with the caregiver’s input to determine storage arrangements needed for specific supplies in each type of identical room or area.  We were able to resolve the majority of the issues and create uniform work and supply areas with just a few tools and well-chosen organizational support devices.

New hospitals still in the design phase or facilities simply needing a remodel have the opportunity to design spaces that promote flexibility and standard work. This can significantly improve standardization of storage across departments or identical rooms.

As was the case with HPP’s move-in project, when you have built-in casework, you must adapt the work processes to the facility. While the solution was ultimately a workaround to total adaptability, the workplace organization strategies allowed for the best possible use of the casework. We were still able to change the facility to support the process, rather than having to change the process to adapt to the facility.

This week’s blog was written by Renee Hawk, with creative input from teammate Jason Baldwin. Renee, a senior associate with HPP, brings 14 years of corporate management experience with a strong record of achievement in Healthcare Facility Design during her 18 years with Herman Miller Healthcare. She holds a Bachelor of Arts degree in Environmental Factors and Interior Design from California State University at Long Beach, with advanced training in healthcare design, Lean process improvement and project management. Renee also holds LEED AP and California CID certification.

Jason Baldwin is a senior associate with HPP with a deep background in healthcare marketing and creative services. He previously served with an international healthcare architecture company as the firm’s marketing pursuit team manager.

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