by Jason Costello and John Fowler
Just as healthcare delivery is evolving through new patient-provider approaches and transformative technology, so is the design of healthcare facilities rapidly advancing by the use of Lean process improvement methods. Lean in healthcare has focused on continuous, incremental improvement of existing processes that were primarily concerned with the operational aspects of the delivery of care. Recently, this focus on Lean has expanded to the design of clinical space, so the architecture supports simplified operational models with the goal of maximizing patient satisfaction while minimizing waste and using fewer resources. Today, healthcare designers are employing the more advanced Lean 3P (Production Preparation Process) approach to designing patient-centered spaces.
Hospitals are complex facilities with intricate workflows and dedicated patient care that greatly benefit from operational efficiencies provided by Lean process improvement. For example, the Lean 3P approach was used in designing a cancer center to reduce waiting times and improve patient flow. The process significantly decreased the times a patient had to move from one space to another. For patients receiving both radiation and medical oncology on their first day of treatment, patient room moves were reduced from 21 to 6.
A recent project for a metro-Boston community hospital utilized Lean 3P planning for the renovation and expansion of the hospital’s central sterile processing (CSP) suite. The project required a multiphased approach to keep the suite operational during construction. The Lean 3P process was introduced to minimize construction phases and provide a deeper understanding of the project’s priorities and functionality to identify critical adjacencies and flow for the CSP suite, accommodate new clinical programs for robotic surgery, and expand the hospital’s surgical capacity.
The planning process begins by going to Gemba (where the work is performed) to observe and question the current state of how materials, patients, and clinicians flow through a clinical department. The CSP suite was suffering from a lack of flow of surgical supplies from the decontamination process through the utensil washers, creating a backlog of case carts and requiring additional staff time to process sterile supplies for the next day. The project team observed the specific tasks and operations of the entire CSP cycle, from the operating rooms through decontamination, prep and pack, sterile supply, and then back up to the surgery department. The observations were then reviewed step by step with the end users to find opportunities to maximize flow and eliminate steps. This process forms the ideal or future state goal from the user group.
The Lean 3P process allowed the team to identify the root cause of workflow obstruction through the CSP department, which was originally believed to be throughput capacity of the washers but was identified as duplicative tasks performed during decontamination and prep and pack. By eliminating the cataloging step from the decontamination process, the processing time for soiled items could be reduced, thereby increasing valuable throughput.
The information derived from the existing state and the proposed ideal forms the basis mock-up portion of the 3P planning event. The complexities of renovating a CSP department in place required the team to understand the most efficient layout of the decontamination sink area to simplify phasing. The team created three mock-ups of the sinks and ran simulations through each option to study cross traffic, areas for carts, and required sorting space. The mock-ups provided a broader group of people to be involved in the design process, actively moving around boxes to replicate equipment in order to customize the space to meet their needs. Ultimately, this led to decisions in concept planning that held true throughout the remainder of the planning and design process.
The use of Lean 3P principles can help to improve end users’ understanding of the planning process and enable them to make informed decisions for their future space. The process can illustrate a complex workflow with many variables, identify obstructions, challenge original assumptions, and minimize duplication efforts. Using Lean 3P for healthcare can accelerate process design improvements and improve decision-making created in the early design phases of a project.
Jason Costello, AIA, EDAC, LEED AP, is an associate principal and partner, and John Fowler, AIA, EDAC, LEED AP, is an associate principal in the Health+Science studio at Margulies Perruzzi Architects (MPA).