Most of us can relate to a patient safety issue that you, a family member or a close friend have experienced.  Whether it be something as minor as a fall with no injury or as extreme as a medication error resulting in death – patient harm costs billions of dollars a year.  It’s not only physically harming but also emotionally detrimental for both the caregiver and the patient.

Early on in my healthcare career, I wore a Risk Manager hat which gave me the opportunity to review, track, and reduce patient injuries.  At this time, I was unfamiliar with Lean Healthcare methodologies.  I was doing everything I had been taught including tracking, trending, conducting Root Cause Analysis (RCA) and Failure Mode Effect Analysis (FMEA), and sharing the information at quarterly Safety/Risk Management meetings but I had no idea of the concepts of andon, push versus pull, or the 5 Whys.

After beginning to learn and understand Lean methodologies, I was privileged to work for an organization that was building a replacement hospital.  It was at this time that I began to see the correlation of the design of the new hospital with new technology and equipment and the impact it would have on patient safety.  I had never considered the fact that the outdated existing building contributed to risks to our patients.  For example, the existing hospital inpatient rooms were back-to-back mirror images of each other – which meant the caregiver didn’t always care for their patients on the same side of the bed.  A dear friend of mine, Teresa Carpenter, RN, , shared a great example around using the 5 Whys to explain the importance of standardizing patient rooms:

WHY standardize patient rooms?

The predominance of right-handed people make working from the patient’s right side more efficient.

WHY is it more efficient?

When the environment is precisely standardized, quality work is done quickly and safely.

WHY is it safer?

      Because it permits instant familiarity with the environment.

WHY is it better for staff to know their environment so well?

 Variation is eliminated.

WHY is it important to eliminate variation?


John Reiling, author of Safe by Design: Designing Safety in Health Care Facilities, Process, and Culture, outlines the general design principles a facility should exemplify in order to promote patient safety:

  1. Patient Centered. The hospital will be designed to meet the patient’s physical, emotional, and spiritual needs and respect each patient’s dignity and privacy.
  2. Environmentally Healthful. Beauty, quiet, nature, light, and peace will create an atmosphere conducive to healing and comfort.
  3. Efficient. The hospital will be designed to make the movement of people, services, and supplies easy and efficient now and in the future.
  4. Safe. The hospital will be designed to create error-free systems and a culture of safety for the protection of the patients and staff.
  5. Quality Care. High-quality care will be ensured by providing an environment that fosters clinical excellence through systems, technology, and a culture of safety.
  6. Technologically Advanced. A wide range of information, resources, and technology will be provided to develop service lines that promote high-quality patient care in the hospital and in the community.
  7. Staff Friendly. The hospital will be known as a place where people are proud and happy to work, where employees and their families are valued, and where opportunities for learning and personal growth are encouraged.

Lean Healthcare and Lean-Led Design combined are exceptionally effective tools that will consistently produce quality outcomes and eliminate waste.  The decisions you make in your next construction project will impact safety, cost, and efficiency for as long as the building remains operational.

EinbeckNicole_resizeToday’s blog was written by Nicole Einbeck, Lean design consultant with HPP.

Nicole works primarily in healthcare lean led design and facility consulting services, involving improving workflow and documenting new standards.

For nearly two decades, Nicole has worked across the healthcare field, including human resources, risk management, occupational health, employee health, safety and wellness, and process improvement. She spent five years assisting in the Lean transformation at Monroe Clinic in Monroe, Wisconsin, where she also served as the Clinic’s move project manager and process improvement specialist.

Nicole holds a Bachelor’s degree in Health Promotion/Wellness and Psychology from the University of Wisconsin, Stevens Point.


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