As healthcare providers strive to strike the balance between operational efficiencies and maintaining a high-level of patient-centered care, Lean design strategies can play an important role in healthcare facility design. At its most basic premise, a Lean designed facility aims to maximize value while reducing waste and resources. To be truly successful, staff and patients should be engaged throughout the design process to ensure the final solution meets everyone’s needs.
I recently read an Advisory Board article describing four keys to engaging staff and patients in process improvements. As I read this article, I was struck by how the recent implementation of Lean facility design for the new Cancer Center at All Saints followed these lessons in engaging staff and patients to improve the design process. At the start of this project the client outlined their goals of reducing patient wait-time by increasing capacity and improving patient access while creating a calming and healing space. Related to four tenants of this article, I want to share some of the ways we engaged staff and patients to help you understand how to apply Lean facility design concepts in your next project.
Lesson 1: Start small to familiarize staff and physicians with performance improvement methodologies
As an organizational driver, Lean strategies weren’t new to the staff at All Saints Hospital. Leadership had already gone through Lean training and had been instrumental in creating a culture of Lean throughout the hospital. If you are unfamiliar with Lean, visit this site for an overview of the core principles and concepts.
After creating value stream maps of a typical patient visit, the Cancer Center staff made small changes to the registration process, improving the patient experience even before the construction project began. One example was the addition of cameras at every registration desk, reducing the number of staff and patient footsteps when taking patient identification photos.
Lesson 2: Engage stakeholders with data
Before jumping into the facility design we spent time collecting information on how staff and patients used the current space: wait times, travel distances for staff and patients and patient satisfaction scores all became quantitative data points. Additional resources and data from the Advisory Board including growth of the market and cancer patient preference survey results were also shared with the stakeholders. By providing stakeholders with relevant data, the design team was able to make informed decisions and solutions that addressed existing inefficiencies and supported a transformative patient experience.
In the new space, the Cancer Center staff continues to be engaged with data through the use of daily huddle boards to share their Lean initiatives and goals.
Lesson 3: Give patients and families a seat at the table
Focus groups with patients and caregivers were held during the design phase of this project. A visioning exercise was conducted with the group to discover the ideal treatment experience. Outcomes of these focus groups included solutions to improve the patient experience like creating multiple room options for privacy during treatment, waiting rooms with quiet zones, spaces where visitors can work while waiting and increased accommodations for patient comfort. Other ways to engage patients and families during the process include reviewing mock-ups of the new space and allowing for feedback through surveys and Post-Occupancy evaluations.
On a personal note, this project was especially meaningful to me since a family member was receiving cancer treatment at this hospital throughout the project. She experienced both the existing and the new spaces as a patient and hearing her positive experiences about the new center was extremely gratifying.
Lesson 4: Consider all changes provisional until proven effective
Lean design is a continuous cycle. The goal is to seek perfection and to continue to test improvements and refine processes. The Cancer Center at All Saints is still refining their operational processes after several months of occupying the new space. After occupancy, the registration process for Radiation Oncology patients had to be revised based on new insurance verification requirements. The registration staff was able to accommodate the increased volume of patients checking in because of the improved layout of the registration desks.
The design experience for the Cancer Center at All Saints was a positive one. The staff and patients were involved and empowered throughout the design process, resulting in an efficient yet comfortable healing space. With improved way-finding and flows, a larger backstage space and streamlined services, staff can efficiently provide care to their patients and make cancer treatment as pleasant as possible. Patients now experience a full-service cancer center focused on bringing the highest level of clinic care in a warm and welcoming environment. The new facility leverages state-of-art technology and access to a variety of support services to meet the needs of current and future cancer center patients.
If you ask me, the biggest impact during this design process was engaging stakeholders in the process, to create a Lean design that maximizes efficiencies while providing value to the patients and staff. I would love to hear from you, how have you used Lean practices to help improve your facility design or even your daily life?
Robin Anderson, AIA, EDAC, LEED AP