A New Book That Says “Incrementalists Need Not Apply”
I'm very interested in the interface between healthcare architecture, space design, and processes. I've seen so many cases where poor design (often done without the input of nurses, medical technologists, and other front-line staff) leads to systemic inefficiency. Classic bad examples would include not having enough local storage space in a department for equipment and supplies that are truly needed or not having the chemotherapy center close enough to the oncology clinics. A great example of Lean patient-centered design is the cancer center at Park Nicollet, where “care comes to the patient” (yes, it makes a great ad slogan too).
I recently discovered a book, a “manifesto” the author calls it, titled Efficient Healthcare – Overcoming Broken Paradigms. It's not only the Lean people who get frustrated with the sorry state of typical layouts and space planning – it's this architect and author, David Chambers from Rice University.
The book is a slim tome (just over 100 pages), but the pages are packed full of text (so there's more content than you'd expect from a manifesto of this length). I've read 40 pages, but felt compelled to share it with you already.
“Efficient Healthcare” alludes to and dances around Lean terminology in the introduction and the first chapter, then it hits on Lean and Toyota methods directly in Chapter 2. There are many gems and insights that are conceptually aligned with what would you have read in Lean books – but the latter half of the book appears to get into more details about the design and construction process. The target for this book seems to be architects while other Lean books, like mine, are more directly targeted at hospital staff and leadership. So I think this book fills an important role – a book you can give to the architects and construction people you work with.
Some of the things I highlighted as I read:
From the first chapter (called “A Call for Change: Incrementalists Need Not Apply”):
“What if the build that houses clinical programs were to reduce the staffing need and required cycle times for care per outcome by 50% or even more?”
Yes – there's so much systemic waste in healthcare, aiming for 5% productivity improvement when designing a new space isn't aiming high enough. Looking to the manufacturing world for parallels, the transition from a functional “job shop” layout to a cellular layout with one-piece flow often leads to 50% productivity improvements (with less waiting time and better quality… and lower cost). Lean design is transformational, not incremental. We can save incremental for continuous improvement or “kaizen” activities. Design and construction can be a “kaikaku,” or radical change, event when we are given the chance.
For example, ThedaCare (not referenced in the book from what I read), held an open house last week for the new patient tower designed and built around the Collaborative Care model – this was such a huge opportunity for them to take advantage of. If they didn't build it right this time, they would have been just stuck with many of the core design decisions for the life of the building.
Chambers emphasizes key Lean principles without yet referencing Lean, such as:
“…this manifesto is not about cutting jobs… By building a care model that works far better than the current model, we can deliver quality care without overworking staff (which is too often the case)…”
I think Chambers might agree with my complaint about healthcare architecture awards being given for pretty spaces, as he writes:
“… I am engaging in vastly more than mere rhetoric about the healing environment… goes far beyond making spaces attractive or aesthetically pleasing…”
Chambers rightfully complains about the existing view of a hospital build as a group of departments, as overhead rather than “…view them as the machines by which we provide care.” He continues, “…and we learn that someone has invented a much more efficient and effective machine – then they become far more than mere costs in the conversation, they are an essential aspect of the value proposition.”
He's speaking to the role of the building (and value streams, as he covers more in Chapter 2) as it creates and encourages productivity, which correlates very well to better quality. Beyond looking at the value stream, Chambers is correct in pointing out that the patient is often missing from the design discussion and there's a huge opportunity in getting them involved.
He ends the chapter with:
“The potential for value, therefore, is far greater in rethinking care delivery processes and flows than it is in value engineering the building.”
I like how he thinks. We have to design a systemic whole, not just a bunch of locally efficient pieces.
My goal here was to introduce you to this book, to tempt you to get a copy yourself. I'll reach out to the author about a possible podcast interview. I'll most likely post again about Chapter 2, where Chambers addresses Lean in healthcare more directly. The introduction and Chapter 1 should sound very familiar (and congruent) to Lean thinkers.