“Lean” challenges healthcare’s status quo

New Approach Leads to Cost Reduction and Greater Efficiency
The challenge of healthcare reform is that there is so much to reform. Every facet of the industry presents opportunities for chipping away at the system’s daunting costs. To name just a few: electronic medical records, wellness programs, group purchasing, consumer insurance reform, and a relatively new addition—lean design, construction, and operations.

“Lean” has its origins in Toyota’s successful lean manufacturing and management processes. Many industries, including healthcare, have adapted its tenets in an effort to cut costs. The essence of the lean approach is seeking to create value by eliminating waste, increasing efficiency, reducing errors, working collaboratively, improving communications, and standardizing operations. When applied to healthcare, it acknowledges that medical practice and procedures have defined processes and share, at a macro level, basic similarities to moving parts down an assembly line.

SSOE has first-hand experience in transferring the lean ideology from automotive to healthcare. Having designed Toyota’s last three U.S. facilities, we’ve been true participants in its “gold standard” lean approach. At the same time, our healthcare clients are asking us to help them deliver leaner facilities and operations. We’re putting our Toyota lessons to work in hospitals and clinics.

To get a clear understanding of lean healthcare, think of it as having two distinct but interrelated facets. One focuses on design and construction of facilities; the other relates to improving ongoing operations.

Lean Design and Construction
Lee Warnick, AIA, Principal /Healthcare Design at SSOE explains, “The lean philosophy directs us to design a building in the most effective and expedient way to meet the client’s current needs, offer flexibility and capacity for changing needs, and be a quality product. It’s neither overbuilt nor under-built.”

SSOE’s Director of Quality Systems and Lean Six Sigma Black Belt, Gordon MacDonald, describes the process as methodical and deliberate.“Lean design methodically and deliberately identifies, measures, and eliminates waste and verifies the results.” A critical component of lean is that the entities work collaboratively and take on a shared responsibility to reduce waste—of time, money, and energy. In the construction industry’s vernacular this level of collaboration is called integrated project delivery (IPD). IPD differs from the traditional model where the design is established before the contracor has an opportunity to offer input. This creates the potential for additional plan revisions and missed opportunities to save costs. In IPD, the designers, contractors, and owners are involved in the design process early on and share some level of risk. Together they define the project goals and how they can be reached with a high level of efficiency. We’ve seen the advantages:

  • Fewer revisions, communication glitches, and delays as the project moves forward
  • Compressed project schedule
  • All entities committed equally to attaining the lean goals

Lean Operations

To embrace the lean approach to operations, hospitals need to look at caring for patients more like producing a repetetive product, in this case a service. Putting the very personal nature of illness aside, examining and treating patients involve a predictable sequence of steps in the diagnosis, treatment, and recovery phases. The size and layout of facilities can either help or hinder the efficiency
of those steps, creating a tight relationship between lean
design and lean operations.

Collecting and analyzing data helps hospitals identify areas for operational improvement. Technology makes it easier and much more effective. One example used by SSOE is simulation modeling which can enhance collaboration and eliminate the physical barriers to achieving leaner operations. Simulation modeling creates a 3D visualization of how the design would actually work if constructed—complete with the simulated movement of people and equipment through the spaces. It empowers the team to evaluate the design based on functional needs. For example, when a hospital wants to determine the minimum size and number of triage spaces they need to achieve the greatest efficiency. SSOE feeds data into the modeling program including the expected number of patients that come to the Emergency Department (ED), at what times, historical data on frequency, clinical diagnosis and percentage, duration expected, how many are admitted, x-rayed, or treated and released. The model simulates the ED traffic and validates “choke points,” i.e. the ideal space needed at every point in the “assembly line.”

Standardization, an important tenet of manufacturing’s traditional lean approach, is also applicable to healthcare. Many aspects of healthcare are governed by rigid codes and repetitive procedures. This is an advantage to creating leaner operations because if you can reduce variation you can reduce error and costs. Imagine that a hospital wants to minimize waste of any kind related to the movement of staff, patients, and equipment in a recovery room. They’ll need to define the most efficient layout of the room itself and its location within the facility and repeat that configuration for every recovery room. With variation eliminated, the supplies, position of equipment and orientation of the patient will be standardized. Tasks can be completed more quickly and errors are less likely.

There are many lessons to be learned from lean’s proven success. One is that well- conceived management processes—whether they are applied to design or operations—can translate from one industry to a radically different one. And although a traditional approach may be “tried and true” it pays to be receptive to “inventive and new.”