Eliminating waste

Aug 27, 2018

Giving your clients a say in the layout of their new healthcare space will improve that client’s processes, enhancing overall flow.

Why is LEAN-based space planning so important in healthcare facilities? It’s a simple answer: New buildings won’t fix broken processes.

LEAN-based space planning departs from the old architectural approach by focusing first on the client’s process. By focusing on process and flow, both the client and EAPC can identify wastes and determine where the flow of the process is being limited. After these improvement opportunities are identified, the space planning process moves into the 3P application stage (Production, Process, Preparation). The 3P process was developed by Toyota to compress their automotive design cycle (e. g. concept to showroom) from three to four years to 18 months and has been applied in the healthcare industry in the last five to 10 years with great success.

One of the tools of 3P, called “try-storming,” is utilized with the client to help them develop their new space layout based on their improved process. Try-storming utilizes an iterative approach where the stakeholders of the process “try” multiple layouts to determine how they will address the flow issues identified during the LEAN observation phase and ensure waste does not enter back into their process. By pushing the stakeholder teams to “try” multiple options, the effect is a final hybrid layout where stakeholders have total ownership. Through this process, they have addressed much of the flow and waste issues identified and validated by the team. The result of the LEAN-based space planning process is a stakeholder-owned design that will compress the time to realization in the build phase of the project, improve flow and patient satisfaction, and ultimately reduce costs to the client both from an operations and capital perspective. Following are three ways LEAN-based space planning reduces costs:

  1. Less waste. LEAN defines waste as anything the patient is not willing to pay for during their interaction with our client. It’s a tough concept to get the client to understand because they view the process from their point of view rather than the patient’s point of view. Once you switch this process, then you begin to ask questions like, “Why do we do this and what value does it have to our patients?” If the answers are, “We’ve always done it that way” and/or “I’m not sure,” then it’s possible you have defined a waste in your process that needs to be reviewed and possibly removed, or lessened immediately. A recent example of waste was identified when observing a client’s process which involves archiving lab samples that are performed multiple times a day. The placement of the archive fridge and associated computer required to archive the samples was a significant walking distance for most of the lab technicians. The excessive movement of samples between process steps is called travel waste. Once the team identified this waste, they were able to implement changes to the process to significantly reduce the travel waste and increase utilization of fridge space within their own work area. The solution, defined by the team, will increase productivity and reduce the turn-around time to complete these services for the patients/providers.
  2. Efficient flow/space patterns/circulation. LEAN focuses on the flow of a process to determine where it stops and starts and where it flows smoothly without interruption. The overall efficiency of a process is highly dependent upon the flow of the product or service through the process. If the process involves multiple stops, starts, and waiting for the delivery of the product or service to the next step, then the efficiency will be poor for this specific process. Most interruptions to the flow of a process are created by waste. By identifying the wastes in the process, you can begin to improve the flow of the process and thereby its overall efficiency. A recent example of poor flow was identified when observing a client’s process for routing patients for lab work during an urgent care visit. The stakeholder team value-stream mapped the various steps of the process and found a considerable amount of waiting and travel wastes were experienced by the patient, resulting in a much longer-than-necessary stay. The stakeholders focused on the identified steps to see which ones could be removed entirely and which could be reduced significantly by managing tasks/flow differently and making architectural changes to the future layout during the 3P space planning exercise. The client was able to reduce the wastes considerably and defined other areas for potential improvement and efficiency gain who were supporting this process as well.
  3. Inventory/overall extra space. We ask our clients this question before launching a LEAN-based approach: “What should be the top three priorities of this space planning exercise?” The dominating response is always “Adding more space!” Believe it or not, in many of the LEAN-based space planning projects we have done with clients, we have found that more than enough space exists in the current layout! To understand how this happens, many departments do not have steady growth plans, but rather grow based on sudden increases in demand or by the rare instance of investment. The result of this approach is a patchwork of processes, spaces, and inventory closets that were forced to fit versus creating spaces to support the original process. During the iterative 3P approach of the LEAN-based design process, EAPC collaborates with the stakeholder teams to create multiple versions of the final layout. We then ask the teams to compress the space to help reduce the wastes of travel and motion and to help them visually see how much space is left over from the original layout. Immediately, the client sees the benefits of this process because in most cases a new building isn’t needed due to all the additional space that is generated during the planning process.

By using a LEAN-based space planning approach, the client experiences significant capital cost savings with a remodel versus a new building and the increase in efficiency enhances patient experience and satisfaction.

Chad Frost is LEAN design specialist at EAPC. He can be reached at 701.775.3077 or at chad.frost@eapc.net.

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