Lean Healthcare – a New Evidence-Based Design Strategy?

Carol Milgard Breast Center
Image from Clinic Design Website

The first quarter issue of the Patient-Centered Design Online Newsletter is up and features an article on Lean design for healthcare. I’ve often wondered what Lean Design is. It is a derivative of manufacturing experience, specifically that of the Toyota Production System (TPS). According to Tammy S. Thompson:

“Lean design is a system that focuses on understanding and meeting customers’ needs through engaging and investing in the development of employees. He explained that its goal is not to eliminate jobs, but rather to identify waste and inefficiencies in an assembly line process model and to empower every member of the team to contribute to successful outcomes, getting what they need, when they need it, in the correct amount, thereby eliminating waste.” ~ Lean Design is Patient Centric

As far as healthcare is concerned, the major issues the article presents are:

1. Over production: Scheduling all patients to arrive at one time
2. Waiting: Caregivers required to wait for the necessary tools to provide patient care
3. Conveyance: Transporting patients, equipment and supplies
4. Process: Numerous schedules in systems that are not in sync
5. Inventory: Wrong supplies in the wrong locations
6. Motion: Inefficient travel distances or unsafe movement for caregivers
7. Correction: Unnecessary time and expense to resolve a problem created by a flawed process, such as medical errors

University of New Mexico, Dental Clinic and Surgery Center
Image from Clinic Design website

The article directed me to the Lean Healthcare Research site, by Herman Miller. I found the article interesting. According to their research:

“This isn’t because healthcare workers are inept or uncaring. They, too, are often victims of systemic inefficiencies and of complex and ambiguous processes. While some estimates place waste in healthcare between 30 and 40 percent, “the reality of what we’ve observed doing minute-by-minute observation over the last three years is closer to 60 percent,” says Cindy Jimmerson, founder of Lean Healthcare West. *4 In fact, when one director of process improvement tracked nurses on a typical shift, he found they typically travel over five miles, much of it in wasted motion. *5” ~ Lean Healthcare: Applying Herman Miller’s Expertise to Improve Outcomes

Most of Herman Miller’s points deal with implementation problems, namely, how staff members can be more accountable and take ownership for tasks. The curious part is where design happens in Lean Solutions. Obviously, Herman Miller is using it to sell their own modular casework, a strategy many companies use. However, one major point is obvious:

In her report on the design of this laboratory, the manager wrote: “When designing the layout of a lean laboratory, flexibility is of key importance.…Adaptability and expandability within the laboratory can be greatly improved by the investment of flexible casework. Flexible casework provides a convenient method for easily modifying and configuring work cells.” ~ Lean Healthcare: Applying Herman Miller’s Expertise to Improve Outcomes

I find the characteristics of Lean Design similar to Evidence Based Design (EBD). As Lean Healthcare indicates:

The basic approach of TPS is to first understand the needs of the customer, then “go and see” every step of a process, whether it’s admitting a patient to the ER or installing a dashboard in a car, to determine whether it adds value in the customer’s eyes or is waste. Ambiguity is removed from processes by clarifying who is responsible for each task and exactly how and when that task will be performed. As problems are uncovered or better ways to complete the task are identified, they are addressed immediately with quick experiments to test the change. In that way, flexibility is built into fixed processes, and “root problems” are uncovered and corrected before they become embedded in the system. ~ Lean Healthcare: Applying Herman Miller’s Expertise to Improve Outcomes

This is similar from the way I learned to practice architecture. My boss once told me that because their designs weren’t working, they sent a student to find out and document everything a nurse did during her/his shift. This is EBD before it was even named, and its good design practice.

Evidence-based design (EBD) is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. ~ EDAC The Center for Evidence Based Design

Both practices evaluate what happens in the workplace before any design takes place. They look at the possibilities for improvement, and continue to monitor the differences long after construction is complete. The only differences I can see between them is 1) a company intent on selling their product promotes Lean Design and 2) Lean Design also tries to improve employment. I see both as a model for building and processes commissioning. And maybe I’m wrong, but perhaps a manufacturing plant is the wrong way to view a hospital. Maybe it would be better to look at buildings with various flows of items, people, and systems, like airports.

To any readers out there, which system do you prefer, Lean or EBD, and why?

*****

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