Lean-led hospital design : creating the efficient hospital of the future

Instead of building new hospitals that import old systems and problems, the time has come to reexamine many of our ideas about what a hospital should be. Can a building foster continuous improvement? How can we design it to be flexible and useful well into the future? How can we do more with less?

Winner of a 2013 Shingo Prize for Operational Excellence!

Answering these questions and more, Lean-Led Hospital Design: Creating the Efficient Hospital of the Future explains how hospitals can be built to increase patient safety and reduce wait times while eliminating waste, lowering costs, and easing some of healthcare's most persistent problems. It supplies a simplified timeline of architectural planning--from start to finish--to guide readers through the various stages of the Lean design development philosophy, including Lean architectural design and Lean work design. It includes examples from several real healthcare facility design and construction projects, as well as interviews with hospital leaders and architects.

Check out a video of the authors discussing their book, Lean-Led Hospital Design at the 2012 Med Assets Healthcare Business Summit. www.modernhealthcare.com/section/LiveatHBS

Author Notes

Naida Grunden is a Lean healthcare consultant and has been a business and technical writer for over 25 years. She speaks and teaches nationally and internationally (Denmark, Cuba) on the application of Toyota-based Lean techniques in healthcare. Her clients include Captain Sullenberger, Pittsburgh Regional Health Initiative, Healthcare Performance Partners, and Global Link.

Grunden is the author of The Pittsburgh Way to Efficient Healthcare published by CRC Press. She was also responsible for launching the PRHI Executive Summary, a monthly newsletter published by the Pittsburgh Regional Health Initiative, when she was Director of Communications. In Grunden received the 2006 Challenge Award from the American College of Clinical Engineering for her article, "Industrial Techniques Help Reduce Hospital-Acquired Infection," in Biomedical Instrumentation and Technology magazine. She has published numerous articles for various healthcare publications and was the keynote speaker for the HIMSS 2010 Conference awards breakfast. Grunden completed her BA in English at California State University, East Bay, and her secondary English teaching credentials at California State University, San Francisco. She lives in Bellingham, Washington, USA.

Charles Hagood, MBA, President and Founder of Healthcare Performance Partners (HPP), has overseen the introduction and implementation of Lean Healthcare systems in numerous healthcare organizations including some of the largest non-profit hospitals, national systems, small critical access hospitals, clinics, and large for-profit systems. HPP is one of the few organizations that have successfully translated Lean manufacturing and the Toyota Production System (TPS) to the healthcare industry. Charles also is a founding Principal of The Access Group, LLC (TAG), which is headquartered in Nashville, Tennessee USA area along with HPP, and has worked with Fortune 100 companies throughout the world (GE, Tyco, Cessna, Nissan and many others) in their Lean transformation and process improvement initiatives. Charles also oversees the application of Lean/TPS methodologies into the planning, design, and construction phases of a wide range of clinical and hospital renovation and construction projects.

Charles speaks throughout the USA and Europe, and most recently China, on the subject of Lean Healthcare and the application of Lean and other process improvement methodologies to healthcare industries. Charles is the founding faculty member of the Lean Healthcare Certificate Program at Belmont University. In 2003, Charles was awarded the State of Tennessee's top award for his work in Economic Development by the Tennessee Economic Development Council. In 2008 he was recognized as Alumnus of the Year by the Belmont University Massey School of Business. Charles received his MBA degree from Belmont University.

Richard P. ShannonMark GrabanDavid MunchGary BergmillerTeresa CarpenterMaureen Sullivan

Foreword	p. xiii
Preface	p. xvii
Acknowledgments	p. xxiii
Authors	p. xxv
Section 1 Lean Backround and Model
1 The Two Faces of Lean: Process Design and Facility Design	p. 3
Introduction	p. 3
New Healthcare Policies May Force the Issue	p. 4
What Is Lean?	p. 5
Leadership: The Key to the Kingdom	p. 6
Lean Process Improvement: Rules and Tools	p. 9
When Lean Succeeds	p. 17
Lean-Led Architectural Design	p. 18
Summary	p. 23
Discussion	p. 24
Suggested Reading	p. 24
Notes	p. 24
2 Traditional versus Lean-Led Hospital Design	p. 27
Introduction	p. 27
More Is Not Necessarily Better	p. 28
Traditional Design	p. 29
Lean-Led Design	p. 34
Summary	p. 47
Discussion	p. 47
Suggested Reading	p. 47
Notes	p. 48
3 A Model for Lean-Led Design	p. 49
Introduction	p. 49
What Happens during a Typical 3P?	p. 51
How Does 3P Differ from Kaizen?	p. 52
Evaluation Criteria	p. 54
Seven Ways	p. 55
Using 3P as an Overarching Model	p. 56
Summary	p. 68
Discussion	p. 68
Notes	p. 69
Section 2 Lean Design at Every Stage
4 Are We Too Late?	p. 73
Introduction	p. 73
Establishing the Culture	p. 73
Value Stream Mapping	p. 75
Workplace Organization	p. 76
Prototype Rooms	p. 77
Great Expectations: The Nurses Speak	p. 90
Visual Management Helps That Fifth "S"ùSustain	p. 90
The Leadership Perspective	p. 92
Results	p. 94
Summary	p. 95
Discussion	p. 95
Suggested Reading	p. 95
Notes	p. 96
5 Are We Too Early?	p. 97
Introduction	p. 97
Lee's Summit Medical Center: Lean Process Improvements Obviate Expansion	p. 98
Regional Medical Center of Acadiana: Hospital Staff Conducts Its Own Predesign	p. 104
Summary	p. 112
Discussion	p. 112
Notes	p. 113
6 Standardization Supports Flexibility	p. 115
Introduction	p. 115
Standardization: Easy to Say, Hard to Do	p. 116
Flexibility: For Those Moments of Truth	p. 117
What Is a Standardized Room?	p. 117
Monroe Clinic: Lean-Led Design Meets Lean Process Improvement	p. 119
Summary	p. 132
Discussion	p. 132
Suggested Reading	p. 132
Notes	p. 133
Section 3 Broadening Collaboration
7 When to Break the Rules	p. 137
Introduction	p. 137
Boulder Community Hospital: Complex Project Yields to Simplicity	p. 138
Getting Started	p. 139
A Bold Idea	p. 140
Building Trust and Building a Business Case	p. 141
Learning from Current- and Future-State Data	p. 142
Key Assumptions Kick Off Seven Ways	p. 144
Can We Break the Rule?	p. 145
Takt Time Reveals Savings	p. 148
Summary	p. 151
Discussion	p. 151
Suggested Reading	p. 151
Notes	p. 152
8 At the Tipping Point	p. 153
Introduction	p. 153
Seattle Children's Hospital: Process Improvement Improves Building Design	p. 154
ThedaCare: Creativity before Capital	p. 164
Sutter Health: Rethinking Everything	p. 172
Summary	p. 178
Discussion	p. 178
Suggested Reading	p. 179
Notes	p. 179
Section 4 Extended Applications
9 Cultural Context for Lean-Led Design	p. 183
Introduction	p. 183
Nanaimo Regional and Fort St. John Hospital: Cultural Sensitivity Improves Quality	p. 184
The Abu Dhabi Health Service (SEHA) Foreign Worker Disease Prevention and Screening Center (DPSC): Cultures within Cultures	p. 186
Summary	p. 199
Discussion	p. 199
Suggested Reading	p. 200
Notes	p. 200
10 Lean Technology	p. 201
Introduction	p. 201
Seattle Children's Hospital: Cans and Strings	p. 202
Swedish Hospital, Issaquah, Washington: The Nerve Center	p. 204
University of Pittsburgh Medical Center: Lean Thinking and the "SmartRoom"	p. 206
Summary	p. 216
Discussion	p. 217
Suggested Reading	p. 217
Notes	p. 217
Section 5 Conclusion and Resources
11 Looking to the Future	p. 221
Note	p. 224
Appendix A A Little History	p. 225
Introduction	p. 225
Early History	p. 226
Florence Nightingale Movement: 1860-WWII	p. 227
An American Chronology	p. 228
Conclusion	p. 247
Summary	p. 248
Discussion	p. 248
Suggested Reading	p. 249
Notes	p. 249
Appendix B Nine Questions to Assess Your Organization's Lean State	p. 253
Note	p. 259
Appendix C Selecting the Right Design and Construction Team	p. 261
Appendix D Voices from the Field	p. 263
Be Leah, Not L.A.M.E	p. 263
Eyidence Based Design: Boon or Boondoggle?: Except from Efficient Healthcare, Overcoming Broken Paradigms: A Manifesto by David Chambers (By permission of the Author)	p. 270
Sustaining Improvements	p. 277
Teach Your People Well	p. 280
Planning for Hospital Renovation or Replacement? Beware of PTSD (Posttraumatic Space Deprivation Disorder)	p. 283
The Voice of the Customer	p. 285
Glossary	p. 287
Index	p. 291

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