In this article, “Go Lean in 2010: Reducing Waste in Construction,” there's a nice description of the design process that Seattle Children's Hospital uses to get staffed engaged in making sure new space is designed and built to support their processes and patient needs.
From the article:
[Seattle Children's] gathered the major stakeholders in the project, including medical and management staff, the architectural firm, the contractors, and the construction manager, and discussed how they could not only take the project Lean and fast-track it.
This is a great example of the hospital (as client and process owner) not letting the architect dictate the layout.
I've seen many a few organizations, as they are learning about Lean and using the principles to redesign space, get into conflicts with architects who, sometimes, don't listen. In one case, the architect completely disregarded the hospital's re-design of the laboratory to give them something that was like the laboratories they always built at a typical hospital. That was exactly the problem to begin with! The architect brought a typical silo-ed layout with separate mini-departments within the department, even AFTER being given guidance by the lab that their new cellular cross-functional layout was the way to go.
Lean thinking and lean processes drive different layouts than a typical hospital. Thankfully, that other hospital's leadership pushed back and educated the architects about why their Lean design was better and why that was the only path forward.
Seattle Children's has a very proactive process for managing Lean design. I saw this first-hand when I visited last August, seeing staff members engaged in what's often called a “3P” process – for Production Process Preparation.
I saw many elements of what's described in the article:
Rather than have the team continually review and alter the architects' paper design plans, which often takes facilities months, they decided to take the design to scale and finish the process in two weeks. The architect and contractors measured out and built a version of a patient room and sections of the floor to scale. The medical and administrative teams then toured the mock-up and tried out the design. Design flaws could be swiftly spotted and modified on the fly allowing the hospital's team to test out suggestions and changes.
Being able to see and touch the space helped everyone see where the inefficiencies in the layout were from the location of the patient bed to where the equipment should be positioned. They went so far as to analyze storage space, determining the exact size of the supply closet based on the historical supply dataâ€”thereby eliminating the need for large supply closets with unused space that was badly needed for exam rooms. The team mapped the flow of patients, supplies, and providers and even counted the actual number of physical steps it would take for different processes to be completed, such as a nurse gathering needed supplies.
I've heard of other hospitals building cardboard mockups of new spaces out in the parking garage so staff members can walk through it and make PDCA revisions before it's built. That's the time to make changes, when the changes are easier and less costly. I saw where Seattle Children's used foam board mockups (small ones) before they got to the full-size mockup phase.
My advice to hospitals?
- Design your process BEFORE you design your space
- Analyze the existing process and layout to understand the waste and problems, so you can incorporate those lessons into new space
- Take control of your design process – don't abdicate responsibility to the architects. Work with them, but realize it's YOUR space that you have to live with for years after construction
What have you or your organization done to incorporate Lean methods or learnings into new construction or the redesign of existing space?
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