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A Lean-Led Design Approach to Senior Living

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Over the past year, we’ve seen a seismic shift in the operations of senior living communities throughout the country. With all the new guidelines, research, articles and infinite amount of commentary regarding the spread of Covid-19, it can be difficult to know how best to utilize your available resources in the most valuable way. Communities need to find ways to maintain the health and safety of their residents and staff while maintaining a sustainable business. While the challenges of today may be unprecedented, we can look to tested methodologies to find creative solution. Lean-led design offers insight into how operators can provide more value using fewer resources, resulting in the highest quality of life and experience for everyone involved.

Lean-led design is an approach focused on minimizing waste. Adapted from the manufacturing industry, lean provides insight into processes and operations utilizing key iterative tools with the intent of creating more value with fewer resources. A few of these tools include value stream mapping, rapid improvement events, flow diagrams and pull planning. The advantage of using these tools is that they create dialogue between all stakeholders and are equally important for new and existing communities. New community planning can utilize these tools to design around specific needs and goals, maximizing the value of the project. An existing community can utilize these tools to analyze the current space and operations while finding ways to reorganize and reimagine existing operations to be more efficient. The success of a senior living community is critically dependent on the operational model and efficiency of operations. The built environment can either enhance or hinder the operational model and efficiency. The Lean-led design process is a way to ensure the built environment is an asset to your communities’ operations. 

Value Stream Mapping
Value stream mapping is a visual tool that traces different types of activity through a sequential path. The map provides an overview of the order in which things happen and what activities occur concurrently. The goal of a mapping exercise is to identify opportunities for improvement. In our current circumstances, a value stream map is also a great way to identify the activities with the greatest risk of infection transmission. Once identified, solutions can be developed to mitigate the potential for risk and inevitably find new ways to engage with residents. A tangible use of this tool can be the resident move-in process. The value stream map will identify each time a resident may be waiting during the process. While the goal would be to reduce this time, each of these instances becomes an opportunity for engagement.  Seeing a value stream map can truly be eye opening. 

Rapid Improvement Events
As its name suggests, a rapid improvement event is a way to quickly test new ideas and develop actionable next steps. Under normal, non-pandemic circumstances, such an event would include gathering as a large group to discuss ideas, however the same can easily be achieved through technology such as video conferencing and shared documents. The primary focus is to test ideas before implementing them on a large scale. Begin by gathering all the solutions your team has developed to solve a problem. Test each idea by creating a mock-up of the solution and see if it functions as intended. If the solution doesn't perform exactly as you envisioned, make minor adjustments and test again. In existing communities, for example, senior living operators can use an unoccupied room as a living lab to test items like grab bar locations, bed placement and other simple adjustments to solve operational issues experienced elsewhere in the community. In the design of a new community, a full-scale mock-up could be constructed to highlight specific components and test them with a diverse group of project stakeholders. By continuing this iterative process, you will be able to determine if the potential solution is viable in short order. Whether a solution is successful or fails is valuable. This tool is also useful for establishing buy-in from the stakeholders. You will be one step closer to solving the problem regardless of the outcome of the mock-up, without wasting resources on a full-scale implementation.

Flow Diagrams
Another visual tool of Lean-led design is the flow diagram. This tool allows you to easily see operational waste that may not otherwise be visible. Flow diagrams focus on movement of both people and materials. Overlaid on a floor plan of your community, the diagram will document footsteps of staff and/or residents, as well as the spatial adjacencies and operational protocols which influence the number of footsteps required to complete a task. The key components of a flow diagram are the observation of the activity and accurately documenting what is observed. Following an operational review and the development of flow diagrams, you may notice care partners frequently making trips to one part of the building to get a specific item; this not only costs the staff valuable time but also increases their contact with residents throughout the community, potentially increasing risk of viral spread. You may determine having multiple locations of often used items strategically located through your community would decrease retrieval time as well as minimize risk within your community.  

Pull Planning
If you fail to plan, you plan to fail. The incorporation of pull planning into your process will undoubtedly improve your ability to plan for the future as well as the unknown. Pull planning is a method of controlling the flow of resources based on the actual demand of consumption, which is guided by downstream activities informing upstream activities. One of the easiest ways to understand this flow of resources is to think of the food service operation in your community. For dinner to be served to a resident, it must first be prepared, which depends on the food being in the pantry, which depends on the food being ordered, which depends on staff knowing the food needs to be ordered. Each of those steps involved different people within a community working together in functional communication. The foundation of pull planning is built on the reality that all activities rely on the completion of other activities and that all stakeholders add value to the planning process. When implementing a pull plan, make sure that all stakeholders are present. Everyone involved in the supply chain can provide insight into what their component requires. Each activity in the plan is clearly defined and connected to the related activities. Opening this dialogue ensures the resources needed to complete a task arrive just in time, minimizing the potential for waste. 

Lean-led design encompasses far more than the few tools outlined here. These tools are a starting point to crafting creative innovation and efficient use of resources. With new challenges facing senior living communities every day, the need to gather stakeholders together to re-evaluate operations and the built environment is arguably more important than ever.

With so many operational challenges in front of us, how could you provide more value using fewer resources? Share your thoughts on LinkedIn.

Dan Schindhelm, AIA
Project Manager

Dan is a Project Manager for EUA in the Living Environments Studio in the Madison office. His role allows him to take part in a collaborative way, working with the Living Studio to schedule, budget and design requirements. Dan enjoys taking part in outdoor activities with his wife and two young children.

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