As a Lean Clinical Design Consultant with 10 years experience working along side well meaning hospital employees in the planning and design of numerous building projects, I have come to recognize the signs and symptoms of a very insidious infirmity. I have termed it Post Traumatic Space Deprivation Disorder or PTSD(D). It can dramatically distort reality, lead to improper allocation of square footage and interfere with project goals such as improving the quality of care and operational efficiency.

Just as is the case of the mainstream mental health affliction, post traumatic stress disorder, hospital caregivers have endured great difficulty, frustration, and even helplessness in performing their daily responsibilities. They have battled the inefficiencies of aging, antiquated environments with semi-private patient rooms, cluttered workspaces, and distant, small supply closets. When called upon to participate in the design of a new work environment, excitement can quickly turn into anxiety. Making decisions about process and space can be overwhelming even for lean thinkers.

Even under the most ideal circumstance, as when an organization is one to two years into their lean transformation, the typical design process focuses on floor plan development by individual departments which can create work process barriers for today’s extremely multidisciplinary treatment model. Left unchecked, PTSD can negatively influence attempts to reduce waste in the new environment and even contribute to the most dastardly budget buster; scope creep.
The symptoms associated with PTSD are remarkably similar to those of its medical counterpart. Early recognition and aggressive treatment is essential in overcoming the negative effects of PTSD.

Symptoms of Post Traumatic Space Deprivation:

  • Flashbacks – Valiant attempts to recreate a perceived happier time in the past (like medical school or a previous work situation)
  • Bad Dreams – Exaggerated memories of the rare or occasional occurrences when limited space or capacity caused delays in patient care delivery. (“Feeling like you must build the church to accommodate the crowd on Easter Sunday”)
  • Frightening Thoughts – An uncontrollable fear of not having enough storage space, windows and bathrooms.
  • Rationalizing – Creating endless logical reasons for maintaining sub-optimal or dysfunctional current state processes. (Holding on to “the way we do it now”)

Steps to Overcoming Post Traumatic Space Deprivation:

  1. Get on the Lean Path and Stick to it! – It is never too late to begin transforming culture and process using lean thinking. One word of caution – Lean design is a little like purchasing a size 6 wedding gown on clearance in January and vowing to lose 50 pounds before your June wedding. There are no refunds on new construction if you have “fallen off the lean wagon”!
  2. Value Stream Map Current State Processes – Value stream map current state processes and pay special attention to understanding how the environment may have shaped process. Identifying existing building barriers will prevent them from being transferred in the new environment.
  3. Perform Direct Observations – There is no substitute for going to the Gemba or where the work is done. It is rare that the reality of direct observation matches how the process is perceived to be working.
  4. Utilize 3P (Production Preparation Process) – Develop ideal future state processes by focusing on waste elimination in process design. Lean processes can then accurately inform the architectural design.
  5. 5S the Current State Environment – The exercise will not only give design participants a more accurate picture of how much space is really necessary to accommodate supplies and equipment in the future state, it will improve efficiency and staff satisfaction with the existing work environment.

PTSD can be overcome through diligent application of basic lean principles. Design team participants can redirect their natural human tendencies toward more value added design solutions that focus on healthcare’s most important customer – the patient.

This week’s blog was written by Teresa Carpenter, the Director of Lean Clinical & Facilities Design at HPP. Teresa 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 our Nashville area 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. Among these projects, 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 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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