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Summary
Summary
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.
Table of Contents
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 |