Webinar | Health Care Facility Design and Flow — Benefits to Quality and Revenue

Q&A

During the presentation of our webinar, Chris Backous, MHA, answered a few questions from participants:

Q: What principles can help guide an organization to optimize flow and eliminate waste?

A: In health care, you always want to ensure that value is determined and measured from the patient’s perspective. They are the customer. Then, using this principle of patient-centeredness, you want to empower frontline staff – those individuals who deliver patient care – to identify and remove waste from their current processes to improve care. Wasteful processes are those that do not add value from the patient’s perspective. Finally, involve the health care delivery team in designing new, more efficient processes. We know from experience that these principles contribute to creating facilities that best support both staff and patient satisfaction.

Q: What percentage of additional space is needed to accommodate both a staff hallway and a patient hallway?

A: The key to determining what the spatial requirements are for creating “on-stage/off-stage” areas is understanding the desired process flows. This is a great example of how form follows function. We should not allocate space percentages until we understand the desired flows of medicine.

Q: Once you separate patient flows and create homogenous groups, what can be done to prevent inefficiencies on the staff side?

A: A great idea is one that has been vetted by the team actually doing the work through many simulations. I believe, the only bad idea is one that has been left unshared. Making the simulation as real as possible will allow you to harvest every great idea and select an approach and design that best meets your objectives. We can’t accept an idea that works for patients yet places an unnecessary burden of work on team members, nor can we make things ideal for our team at the expense of the patient experience. Lean thinking and our approach to 3P facilitation allows teams to move from a mindset of “either” to “both” so that everyone wins in the final design.

Q: Who should be involved in the early design processes of simulation, and how can a 3P help the process of designing a building?

A: Facilitated 3P workshops aid the building of spaces to improve health care delivery and serve patient populations with a level of quality, service, and reliability that cannot be met with traditional design work. A 3P sets a new vision for optimized care delivery and informs the future environment that will best support it.

The earlier you engage that the staff who work in the current space to create new and improved process flows, the sooner you will have the essential elements to inform the design of the new space, and the more likely you will have a design that helps deliver care in the most efficient way possible. In addition, input from representatives in other areas of the organization, such as: pharmacy, supply chain, environmental services, and facilities departments, are essential to making sure that spaces and processes are designed to remain sustainable for years to come.

Q: The design is done, and ground-breaking has occurred – then the C-suite asks to incorporate lean patient flow concepts without design changes. How would you proceed?

A: Evaluating and improving flow in order to meet patient demand and reduce the burden of work can occur at any stage of a facility design project. The ideal is when lean thinking starts at the beginning of the project. The time from determining an initial need to opening a care environment is often long. Many changes may occur within an organization, including the adoption of lean thinking, methods, and tools.
It is crucial to understand what stage the project is in, the timing of next steps, and work within those parameters. For example, if the facility is complete you must engage the team to determine what further is required to produce the best results from the completed design. Changes late in the project may cause expensive delays in business.

Q: Do you feel that having workstations in each exam room is efficient? What about the patient’s perception?

A: The Virginia Mason Production System (VMPS) teaches us to first understand the process then design the ideal process based upon the desired outcome and service required. Exam room design and equipment needs must be informed by the actual work that will take place. In order for teams to complete paperwork, in flow, during a patient visit, having a workstation available in the exam room makes the most sense. The key is to understand your flow, determine your desired process and bring supplies, equipment, medications and team members together in such a way that you achieve your vision and see positive results.

Q: When using existing resources, how can you make the most of the current layout you have?

A: We have worked with many organizations that needed to improve service delivery but lacked the necessary funding to build a new facility. Understanding the current state of flow, and then developing new processes to reduce waste, serves to optimize care delivery within the spaces available.

Q: When is the best time to test out flow with a prototype?

A: Once you have an idea and want to see if it is a possible solution to achieve your desired outcome. Real-time simulation is the best method for evaluating ideas. We have worked with many organizations and their design partners to move the mock-up and simulation process ahead of the drawing process so that fewer revisions and drawing sets are needed.

Q: With the “on-stage/off-stage” model, how have you addressed staff members who don’t want to lose their office?

A: There is a role for leadership in setting team expectations going into the design phase. Having clarity from leadership on issues is essential. From our experience, when health care providers experience the value and benefits of working in flow, away from an office, close to their work, and their work is getting done more efficiently, they value the presence of an office less. This is an opportunity for the team to see and feel the change.

Q: Do you use a standard project management document?

A: The beauty of a lean management system is that we determine the tools that are needed based on what we are trying to accomplish. Standard project management documents tend to have more capacity and options than what we truly need to do the work. We encourage people to create what they need first so that minimal time is spent managing a tool and more time is spent managing the process.

Q: What metrics are critical for tracking and evaluating the outcomes of lean urgent care and primary care clinic designs?

A: Time and utilization of resources are the most effective measures in urgent care situations. Measuring total time against value-added time to determine the percentage of value-added time is our goal. If we can provide services with urgency, and with a higher percentage of value-added work time, then we have an opportunity to create more capacity to care for patients and address care needs faster without creating an additional burden to our work.

Q: Do you have any examples of this being completed with limited funding for an aging infrastructure?

A: All 3P workshops have desired metrics and targets. It is common for the teams who are given the charge to develop a final answer to also be challenged to do so within a very tight budget. It is crucial to find the right time to bring cost limitations to the team. Any idea could have high-cost or low-cost options. We cannot assert just one idea, but rather must encourage seven or more ideas to solve the same problem. This gives us more options and choices that keep us financially responsible.

Q: What percent of your total staff are involved in the 3P process?

A: Each 3P team is determined by the processes and services being addressed. Our standard is that at least fifty percent of the team is comprised of individuals who provide care or are primary operators in the process we are studying. We also include patients. Additionally, we are careful to balance the need to continue to provide patient care during the 3P with the need to have people offline to join the 3P. These are key discussions we facilitate in the 3P preparation and planning process.

Q: Using the lean facility design method, is there still significant value in the development team visiting similar spaces in other facilities?

A: There is always value in visiting other examples. Many people find that thinking differently is a challenge without getting inspiration. It is essential to use what you see from other organizations to develop ideas and concepts of your own. Keep in mind that every idea has come from an organization’s desire to solve their own problems. One organization’s solution may not work for another but the concepts will always be helpful.

Q: Could you address your thoughts on how reception areas in primary care should be modeled? How many chairs, etc.?

A: We have to think about the purpose of reception areas, and help teams realize the function of a reception area is to start the patient experience, not hold it in a wait state. As such, what does the space communicate? What should it communicate? Is it welcoming? These are the questions we ask the teams and patients who engage in facilitated 3P workshops. As they think creatively about an area that is designed to begin the experience, they begin to think beyond how many chairs are needed and discuss furnishings that support the desired experience.

Q: What are your thoughts on dual entry exam rooms?

A: Dual entry for exam rooms separates the flows of off-stage work and on-stage, patient-focused, work. This is a fantastic execution if you have the space available and your teams have developed a process that is optimized for the concept. Make sure any idea that leads to a design for your team solves the challenge you seek to eliminate in your current state space and process.

Q: Can you elaborate on what the architects’ role in the process?

A: Architects, if selected before the workshop, are invited to participate in the 3P workshop. Our lean health care experts are intentional in working with them to make sure that the 3P results feed the next steps of the design process.

Q: Are you using different people for different parts of the 3P process (e.g., senior leaders and frontline management)?

A: We assign a “sponsor” role to executive leaders in charge of the areas to be affected by the change and engage the entire team in the process. The team is a blend of frontline staff and leaders so decisions can be made quickly and things can be moved forward throughout the workshop. We also spend the six weeks leading up to a 3P workshop gathering data and developing value stream maps that help make a case for revolutionary change and design. Frontline leaders are involved in gathering data so that they can be present with their teams to engage, inform and facilitate idea generation.

Q: Should administrative assistants work virtually or in another facility? How can assistants meet with their provider? Is this an efficient process?

A: The answer here depends on the work that is shared between the administrative assistant and the provider. If the work is collaborative in nature, meaning that it requires frequent conversation, and the bulk of the work relates to patient care, then proximity between the provider and assistant is critical. Our experience has led us to recommend that team members who frequently collaborate throughout the day to provide high-quality patient care benefit from proximity that allows for seamless communication.

Q: How can we address a high patient need and a high-load practice (i.e. Oncology) with a minimal waiting area?

A: The key to solving the dilemma of high demand and minimal non-value-adding spaces, such as waiting rooms, is flow. Optimizing flow from the patient’s arrival to departure in an ambulatory setting minimizes the need for space to accommodate waiting patients during the in-between moments of their care experience.

Q: What are the steps involved in a 3P?

A: We have a proven method and standard work for preparing, running and following through on the outcomes of a 3P workshop. We also understand that each organization’s needs and challenges are unique. We want to make sure that we are using our method effectively. We begin the process with a discussion so that we can find the best use of our 3P methodology. Explore a more detailed overview of the health care facility design process, here.

We invite you to reach out to us to discuss how 3P workshop facilitation will help your project move forward more effectively and efficiently at: info@virginiamasoninstitute.org.

Chris Backous, MHA, is a transformation sensei at Virginia Mason Institute. He leads improvement activities, workshops and training for health care leaders and providers worldwide. By embedding innovative methods into the lean concepts he teaches, he works with clients to unlock the revolutionary thinking necessary to transform health care. In his 3P projects at client sites, he works with health care leaders, architects, medical planners and general contractors to design or redesign ambulatory surgery centers, emergency departments, inpatient and outpatient care environments, urgent care centers, labor and delivery facilities, cancer care facilities and patient safety programs. Prior to joining Virginia Mason Institute, Chris led the integration of lean methods into the design of Virginia Mason’s 350,000-square-foot hospital addition, the first environment of its kind to be built from the ground up using the Virginia Mason Production System. He also led numerous improvement events using lean tools and methods to improve health care processes. Chris is certified in the Virginia Mason Production System® and 3P (Production, Preparation, Process) facilitation.

Health Care Facility Design and Flow

Inform your new health care facility with meaningful design choices that will increase efficiency.

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