Webinar | Lean Building Design in Health Care
Chris Backous answers questions from participants:
We have standard work for the six-week planning period that leads up to the 3P workshop week. As part of this planning period, we make observations of the current-state process flows and space challenges. Data collection is most intense during the start of the six-week planning cycle and then typically tapers off by the final week leading up to the 3P. We encourage those who are observing to allocate at least 50 percent of their time to do so. As part of the observation process, current state value stream maps are developed, along with demand data, opportunity data, market demographics, and patient and staff experience.
The metrics to draw from the observation period are those that best describe and reflect the current-state process flow and layout challenges, including: current-state lead time, or the time for the process from beginning to end, cycle time for each operator providing care, process defects, and all wastes that cause burden of work for staff and challenges for patients.
Yes! Virginia Mason Institute provides Lean Facility Design seminars, as well as, 3P facilitation. Each year we provide several opportunities for individuals or small groups to come to our training headquarters to learn and see firsthand how we integrate lean thinking into facility design, as well as, provide examples through guided tours of Virginia Mason lean facilities. Organizations with specific projects in mind benefit from a Lean Facility Design seminar that has been customized just for them.
Many of the clinics we have designed using our 3P methodology place the staff work areas, or offstage space, along the windows because of the time staff spend at work is much greater compared to the amount of time a patient spends in the clinic. In the case of our Cancer Care Outpatient Infusion Center, however, we gave the windows and the view to our patients, who are often with us for up to eight hours of infusion. One thing that we are careful to do when we provide windows to patients is to make sure that their privacy is protected with appropriate screening materials.
We recruit patients by reaching out to them. Some patients have expressed their desire to be more connected with Virginia Mason’s work to improve care and the patient experience. We formed the Patient-Family Partners program so that we could better match their interests to our needs for their involvement. When we work with clients who have requested 3P facilitation, we encourage patient outreach and engagement as well as workshop participation as part of the planning process. We work within the patient-engagement structure that already exists within our clients’ organizations. When clients lack formal patient-engagement activities and programs, we share our best practices for reaching out to patients during the preparation and planning process.
Virginia Mason uses all of the same metrics for facility development and performance. In addition to these metrics, we also look to metrics that reflect our desire to improve our use of all spaces. We look at flexibility, sustainability and adaptability. The interstitial spaces are a side benefit of connecting a building built in the 2000s and its associated ceiling height requirements with a facility built in the early 1960s, when ceiling height requirements were lower. We looked for a way to connect every other floor of the new Jones Pavilion tower to the existing Central Pavilion tower so that we could take advantage of the horizontal adjacency between the two buildings. As we worked on the matching of the every-other-floor concept, the additional ceiling height spaces provided this opportunity for the interstitial spaces.
Virginia Mason’s Department of Design, Renovation and Construction (DRC) is an equal partner on all facility-related projects along with our executive leaders and our Kaizen Promotion Office. Leaders in the DRC are expected to become certified in the Virginia Mason Production System (VMPS) and lead improvement, just like all members of leadership at Virginia Mason. The lean process improvements they have made using VMPS has touched the capital-planning cycle, construction safety, and the way they assign, plan and manage all Virginia Mason facility-related projects. We have realized significant gains in quality, delivery, service and cost as a result of bringing lean thinking into the work.
Each lean facility design 3P workshop requires metrics for success. When we bring lean thinking into outpatient clinic design, quite often the throughput and productivity gain metrics are declared. Our work on the design of both the future-state process and facility is not done until we can demonstrate that these designs can deliver their desired performance for organizational success.
We have measured improvements to service, delivery and financial performance with each lean facility design effort by setting clear performance criteria in the preparation and planning process of 3P facilitation events we lead. Lean, evidence-based design is a growing trend within the facility design industry. The key to success lies in the ability to declare measurable targets and the ability to achieve these targets. Our experience at Virginia Mason Institute has shown that successful implementation of new process flows contributes greatly to the performance of any facility designed using lean methods.
Yes. We offer Foundations of Lean in Health Care as well as Creating Flow in the Ambulatory Setting at our regional training sessions held several times per year across the United States, as well as, onsite in our Seattle training headquarters.
5S (sort, simplify, sweep, standardize and self-discipline) and mapping the flow using tools such as standard work sheets (spaghetti diagrams) are not static activities. Waste is eliminated and we achieve more reliable flow and quality in our processes when we use 5S. 5S allows us to better organize our workspaces and workflows, and it becomes easier to see the next improvement opportunity, and the next, and so on. Kaizen is continuous improvement, where one effort builds upon the previous effort and highlights where to go next with lean improvement.
RPIWs (rapid process improvement workshops), kaizen events, 3P workshops and everyday lean activities should be done by the people who do the work. They are the best experts to improve the work. By understanding the current-state flow in the form of direct observation and value stream development, it becomes clear who should participate in the improvement work. The general rule is that if the work they do is represented in the current-state value stream, then they should be included in the improvement activity.
We believe in the importance of “go see, ask why, show respect,” which means that before any judgments or assumptions are made, we must go to the front line, see the actual work and document the opportunities as we see them. Waste, or “muda,” is anything that does not add value to the process and can take the form of motion, defects, time, overproduction, inventory, processing or transportation. Waste can either be Type 1 activities that add no value but must be done to meet regulatory requirements or Type 2 activities that contribute no value and must be eliminated. We also look at “muri,” which is the waste of unreasonableness, and “mura,” which is the waste of unevenness. In order to understand waste, you also must understand value. Our definition of value includes all of those activities that a patient is willing to pay for or those activities that can change the patient experience for the better.
We haven’t removed or eliminated waste if another team upstream or downstream inherits it. The key is to “trystorm” (brainstorming plus quick prototyping) the ideas that improve the process for all in the value stream.