In a recent conversation with the chief architect at one of the leading healthcare architectural firms, he indicated that many prospective clients are demanding hospital designs compliant with Lean principles.
He was not sure his clients fully understood what that meant.
In all fairness, neither did the architect himself.
What hospital executives know, or foresee, is that the current sybaritic approach to healthcare spending will come to an end within their professional lives.
This issue is of critical proportions at hospitals which now consume more than 30% of total healthcare spending in the US.
This is one of many reasons why hospitals need to do more with fewer resources.
That was the original definition of "Lean".
Less what, you may ask? Less floor space, shorter length of stay, faster lab response times, quicker imaging readings, and the list goes on and on.
In case you worry that what is coming is "less people", relax.
There is so much waste to eliminate and so many opportunities to turn that waste into better patient care that cutting staff is at the bottom of the list.
My firm has had first-hand experience with the idea of the "Invasive Center".
This is a single department within a hospital where all invasive procedures take place.
The exact make-up of the department would depend on the services offered by your institution.
The Invasive Center we helped design includes the OR Suites, Interventional Radiology Suites, Cardiac Catheterization Labs, Endo rooms, Lithotripsy room, and Minor Procedure rooms.
All these services will share common Registration, Pre-Surg, PACU I, and PACU II functions.
The productivity promises to be higher, and the level of care and teamwork is bound to improve substantially, in a smaller footprint as compared to all the services separately.
Some issues to consider in planning for an Invasive Center: • Figure out patient flow before the architectural design.
Do not expect the architects to have any knowledge of Lean patient flow.
It is not their specialty, regardless of how good they are.
• Plan for supplies management before you call the architects.
Supplies at a hospital are the epitome of an afterthought.
Materials managers at most hospitals are 30 years behind the latest thinking in materials management, and is not a wonder that this is the top complaint we hear in every new Lean implementation we undertake at hospitals.
• Make plans for the use of perpetual inventory disciplines.
This is one of those puzzling issues in healthcare: uncontrolled inventory.
This is unthinkable in any other line of business that uses supplies or materials.
No, I do not know why it is the way it is.
• Develop a strategy for case cart management.
When we say "case cart" we think "surgery".
You may choose to use case carts for all cases in the Invasive Center.
Plan for the path coming into the procedure rooms and going back to SPD.
Consider using the method of "In-process Kanbans" (IPKs).
The case cart IPK would cause you to pull the next case cart when a procedure was completed, not when we have some spare time to pick.
This would limit the number of carts picked and staged, as well as the number of returns whenever a procedure is canceled.
• Plan for staff flexibility.
This is a must for the Invasive Center.
The idea that a clinician will sit in the Cath Lab waiting for a patient must be abolished.
The concept we apply is the one we call "flexing".
Every time you find yourself without the ability to move a patient to the next care process you must ask "why?" and react accordingly.
If the room is ready and the patient has not arrived, the most likely cause is that is taking longer to prepare the patient than anticipated.
Move upstream from the Cath Lab to Pre-surg and help prep your patient.
Conversely, if the procedure is done, you may need to help with recovering your patient if there is blockage downstream.
There will be some limitations as to what clinicians can do to "flex" from process to process and hospital administration need to look into possible incentives to facilitate it.
These are just some pointers to get you thinking.
The main and overarching issue is to do your homework before you call the architects.
After you started construction, the issues will be very similar to implementing Lean in your current building.
You would like to avoid having to to deal with a building that is not conducive to productivity, quality, and flexibility.