January 22, 2019

A system for continuous improvement, Lean has been adopted into hospital and healthcare facility design to add value by eliminating waste from existing processes, improving workflows, maximizing efficiency, enhancing the staff and patient experience, and improving that all-important bottom line.

When it comes to incorporating Lean principles into the design of a healthcare facility, architects typically think about the design phases of a project and how our design can affect operational improvements once a facility has been designed and constructed. But wait! We can actually put on our Lean thinking caps both before and after the traditional phases of design. In this post, I explore how.


Embarking on the Journey

A Lean journey for a healthcare facility should begin long before an architect is engaged to plan and design a project. For successful growth, a hospital should have a good understanding of its internal problems and obstacles, and perhaps most importantly, if they can be resolved effectively by a renovation/addition effort.

The initial question a hospital must ask themselves is: Are we providing our customers, aka patients, visitors and staff, with the very best service? If the answer is No, then obviously it’s good indicator that improvements are needed, and the hospital team should begin a high-level evaluation of which departments require the most attention.

Once an area for improvement within a department has been determined, management buy-in is key before a successful “kaizen” event—or a short-duration group project focused on improving a specific task or process—can be held. To gain the most value out of kaizen events, it is important to engage physicians, nurses and staff so they are empowered and enthusiastic when it comes to solving internal problems. Instead of a quick fix, these sessions should focus on the long-term implications of decisions and confirm the root cause of each issue, establishing a vision for the future, improved state.

When this groundwork is complete, a design solution can positively impact operations, staff utilization, quality and the user experience, and reduce the need for rework while supporting improvement initiatives adopted by the hospital.


Transitioning Into Design

To make sure the Lean journey takes you in the right direction, a design team experienced in Lean thinking should be brought in early to brainstorm and evaluate solutions that support the vision established in the group project.

During the typical design phases of a project, the focus is to design a facility or department around an optimized process for delivering service to patients. By utilizing the knowledge gained from kaizen events, and by collaborating with key stakeholders to understand the optimized future processes/flows for the department, a design team can make educated decisions about both the space layout and program—decisions that not only support work efficiencies and the facility’s business case, but also improve customer satisfaction.

As healthcare designers, we need to drive changes that will improve a facility’s work-process efficiencies, which is at the heart of Lean thinking and ultimately Lean design solutions that provide added value to both hospitals and their customers. For example, wasted steps are reduced and workflow efficiencies are improved by designing staff areas in close proximity to the patient.

By eliminating unnecessary square footage, travel distances are reduced, staff workflow is more efficient, and building and ongoing maintenance costs are reduced. These Improved departmental efficiencies all add up to enhancing the human experience—a key driver in Gresham Smith’s value-added design approach.

Another Lean solution that adds value to design is the incorporation of technologies such as virtual reality (VR). By utilizing this tool, designers can develop a 3D model of a patient room or department. The virtual mockup allows the client to have an interactive experience of the space, streamlining the owner-decision-making process, and supporting an iterative redesign process virtually as opposed to making costly changes to a physical mockup.

The use of VR and other technologies also allows the rapid prototyping of spaces to test various concepts developed earlier in the Lean design process. This is especially valuable in assessing the design of prototype rooms that will be repeated multiple times in a facility or across a system.


Design for Construction/Lean Construction

After construction has started, it is often too costly to make changes to the design. Any potential impact that the design, or Lean improvements, may have on constructability, schedule, phasing or cost needs to be thoroughly evaluated and addressed well before construction begins.

As prototype rooms are developed, designers should evaluate the potential for prefabrication of standardized components. Other elements of the design should be evaluated for potential standardization. Although general constructability is always a consideration during design, a deeper consideration of construction processes and planning for prefabrication is critical to producing the most successful project at completion.

It’s also important to note that Lean thinking doesn’t stop once construction has begun, and any issues that occur during construction should be approached with Lean in mind. A part of the Lean process is to constantly think ahead about the next steps toward further improvement. Post-occupancy evaluations, for example, provide a vital framework for beginning the next steps of workflow improvement.


The Best Opportunity for Improvement

Ultimately, applying Lean philosophy to the complete timeline of a project, from the point of a facility identifying a problem that needs to be addressed to post-occupancy evaluations, provides the best opportunity for improvement. The strength of this comprehensive Lean approach lies in the value added for the healthcare facility—both in improved user satisfaction and in increased operational efficiency.


Learn how Gresham Smith put Lean thinking into action with the renovation of the John N. Whitaker Building at UAB in Birmingham in Using Lean Principles to Generate Physician and Staff Buy-in, authored by Eddy Alonso, AIA.