Planning and Design for Hospitals Belongs to Lean Equation
The business of healthcare in the United States today faces the challenge of change on many fronts. Care delivery and reimbursements are evolving. Technology and medical advances are altering patient expectations. And the healthcare marketplace is dynamic with competition. Hospital organizations must take a critical look at every aspect of how they meet or exceed standards of care and stay solvent when they do.
Physical environment is a critical component of healthcare delivery. It affects patient satisfaction and worker performance. Increasingly, the thinking behind design of patient rooms and surgical suites and the engineering of spaces that support efficient workflow patterns is that they are integral to the success of a hospital—now and in the future. One approach applies the tools of "Lean thinking" to the equation, creating value by increasing the quality and efficiency of care at a lower cost.
Workshop Explores Effective Solutions
A 2011 workshop, presented by the Healthcare Facility Planning Group of Engineering Professional Development at the University of Wisconsin–Madison, brings together experts who explore the impact of physical environment on patients and healthcare workers. They will discuss how facility designers and planners can educate themselves to provide healthcare customers with valid, real-world solutions.
Among the speakers for Planning and Designing Hospitals for Optimal Performance is W. Brent Peterson, Vice President with the Milwaukee-based architecture, engineering, and planning firm Hamel, Green and Abrahamson (HGA). Peterson is a process engineer who uses Lean design principles in his work with healthcare organizations, helping them rethink how people, technology, processes, and space intersect. At the workshop, he plans to examine strategies for designing environments that sustain quality care while helping to reduce waste and maximize efficiency.
"For me, the approach starts with asking whether the expectation on a project is to support existing processes by changing the space, to preserve the physical environment by modifying processes, or to dig deeper and evaluate what's good about both variables," Peterson says. Supporting questionable current processes limits how Lean a design can be, he points out, so it becomes an issue of the philosophy inside the walls of an organization. "Does the organization think every day about how to eliminate waste, manage costs, deliver quality, increase safety, and improve morale? If not, what can they do to get there?"
He does see an important role for design to play given that space is one of four key elements—along with people, processes, and technology—that affect how an organization operates in a Lean way. It takes all these elements, working in concert, to create a high-performing building.
Peterson describes his method of negotiating these relationships as a kind of timeline survey of past, present, and future. He starts by drawing benchmarks from past projects. Next he takes a snapshot of what works and what does not work in the present. He then focuses on what the future holds for healthcare, the changing demands of the customer, and market-specific attributes of the organization.
Challenge Assumptions
Research that unearths measurable insights about the needs and wants of the customer aligned with the goals of the organization is the basis for weighing the value of each process and design solution. In talking about how he gathers information in the pre-design stage, Peterson asks, "Are we here to meet current operational assumptions or, as a team, challenge them?" He engages people at the executive level of an organization first to hear what they envision. From there, the engagement moves deeper into the organization.
Peterson gives the example of a current project where the customer told him they wanted their organization to be the epitome of "experientially superlative, operationally efficient, and flexible for the future." Incorporating those terms into questions for groups of patients, family members, staff members, and other stakeholders, his team listened to the "voice of the customer" and identified where to make significant changes in the organization's care model. Those changes include streamlining a pre-exam process, eliminating repeated testing, and re-engineering the exam rooms. The result saves everyone's time, improves communication between patient and provider, and helps the organization reallocate resources to the most value-added activities.
The findings in this case illustrate a close relationship between work processes and physical space. Facility design depends on planners and designers going beyond a building program that outlines adjacency requirements and, in some cases, spatial characteristics, to understand the activities that take place in a hospital and the spaces that can best support those activities.
What Does It Take?
It is important that all organizations involved in hospital planning or design allocate time and money for research and planning. By gathering and applying evidence-based data, studying trends in healthcare, and incorporating what they learn into building a better hospital, design firms can add competitive strength.
Peterson suggests several approaches besides having a Lean expert in house. He sometimes collaborates with a customer's internal resources skilled in Lean methods. Another outlet is teaming up with an independent consultant versed in Lean and with experience in the healthcare sector. "One of the major failures in design is the hand-off between one content expert and another," says Peterson. "However planners and designers educate themselves, they have to be proficient enough to internalize the value proposition of the culture, processes, and technology plan so they can use their talents to create a high-performing hospital environment that achieves the customer's vision."
The Planning and Designing Hospitals for Optimal Performance workshop was held June 28 and 29, 2011 in Madison. The complete list of speakers includes Peterson of HGA; Martha Gaines, Director of the Center for Patient Partnerships; Terrence Houk of HDR Architecture, Inc.; Cyndi McCullough, Registered Nurse and Senior Healthcare Consultant with HDR; Julia Wright, Senior Medical Officer with the Hospitalists Management Group; and Robert Shaver of the UW–Madison School of Business. Workshop participants earn 12 Professional Development Hours (PDH), 12 AIA Learning Units (LU), 1.2 Continuing Education Units (CEU), HSW and Sustainability Credit.
For further questions, browse programs, email Program Director Ray Matulionis, Ph.D., AIA, or call 608-263-3372.
Written by Mary Maher
This material is based upon work supported by the University of Wisconsin–Madison. It is for general information and distribution and not intended to provide specific solutions or advice for specific circumstances, which should be sought from appropriate professionals.