1. Engaging Staff in Lean Facility Design
Going Beyond “Form Follows Function” to a Perfect Patient Experience
Sarah

2. What happens when you put Lean/process planners, physicians, and other clinicians, hospital administrators, and architects in an unimproved medical suite for an entire week?  That is what Greater Baltimore Medical Center (GBMC) did, and the collaboration resulted in an architectural solution that reflects its new delivery processes and the incorporation of the patient-centered medical home model. Incorporating the key principles from this Lean workshop, the resulting design solutions eliminated patient waiting, introduced a self-rooming concept with exam rooms all handed the same way, and created a forum within which the patient-care team could work collaboratively. Take a look inside their process and the results.
Sarah

3. Learn the methods used to realize truly Lean-designed facilities.
Follow the steps necessary to prepare for and execute a Lean facility design.
Identify Lean-thinking methods that can be applied to your own facility designs.
Explore how Lean-thinking principles can engage and inspire owner and design teams regarding process flow and design.
Sarah

4. Why we needed this
Practice was located in two separate locations with different cultures, 8 physicians
No room for growth
Existing suites were not conducive to quality patient care
Exam rooms were too small
Corridors too narrow for wheelchairs
Poor wayfinding (2 locations)
Needed to recruit new physicians
Sarah

5. Why we needed this Falling patient satisfaction scores
Spaces inhibited flow for staff and patients
Current lead time (door to door): 56 minutes, with 20 minutes of cycle time (patient/physician contact)
Hospital Initiative for Patient-Centered Medical Home
Sarah

6. What is Patient-Centered Medical Home Model?
Team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcome
Sarah

7. What did we do?
GBMC gathered metrics of current state to be evaluated in workshop
HCAHPS
Day of Service Lead time – time from patient arrival to departure
A multi-disciplinary team gathered for a five-day 3P Workshop led by the Virginia Mason Institute
GBMC physicians, leaders, facilities support, front-line staff and patients
CR Goodman Associates team members
Robin

8. © 2015 Virginia Mason Medical Center
What is 3P?
3P stands for:
Production
What do we make?
What do we produce?
Preparation
What opportunities do we have?
What barriers must we overcome?
Process
How will we move from good to INSANELY great?
Reasons for a 3P:
New spaces are needed
New products or services
New processes or providers
Chris
© 2015 Virginia Mason Medical Center

9. What’s the Difference Between 3P and RPIW or Kaizen?
3P = Kaikaku or radical change
RPIW (Rapid Process Improvement Workshop) = Kaizen or continuous incremental improvement
Reinventing services, processes or
Products
Design a future state and an action
Plan to achieve the future vision
Return to “12 year old mindset” to
Generate creative ideas
Not incremental improvement – breakthrough improvement
Revolutionary…innovation is critical CB
© 2015 Virginia Mason Medical Center

10. The new service/process/product must meet requirements for:
Quality
Care delivery without defect
Meeting desired/required outcomes
Exceeding customer expectations
Quantity
Services and spaces to accommodate current and future demand
Timing
Care without delay
Cost
Best utilization of resources before additional resources are requested CB
© 2015 Virginia Mason Medical Center

11. Pursue Quality Above All Else
The Virginia Mason Production System Quality Equation
Q = A × (O + S) W
Quality
Build quality into the production process
Identify and validate specifications and appropriateness of the process
Document, use, and improve standard work
Establish quality check systems
Establish safety and maintenance management systems CB
Q: Quality
A: Appropriateness
O: Outcomes
S: Service
W: Waste
© 2015 Virginia Mason Medical Center

12. Add Value to Every Step of the Process$ $ $ CB $ $ $ $ $
© 2015 Virginia Mason Medical Center

13. © 2015 Virginia Mason Medical Center
Use Ideas, Not Money CB
© 2015 Virginia Mason Medical Center

14. Understand and Optimize Flow
VMPS Flows of Medicine®
CB: We have learned to look at how our work should flow by understanding many levels of flow. It is important to optimize process and space by considering all of these flows to ensure synchronization.
When only some of these flows are optimized, other flows may inherit more waste so our overall flow is not better and potentially worse.
It is important to note that the flow of providers is not only the physician or nurse but whomever on our team is in contact with the patient at any given moment of the process flow.
© 2015 Virginia Mason Medical Center

15. Balancing Priorities
Safety for our patients and staff
Capacity to provide care now and in the future
Strong Economics
CB: Virginia Mason has worked hard to find the right blend of scope for facility development and renovation.
Finding the balance between all three of these dimensions ensures that we will continue to do and build what is right for our patients.
Safety:
As we design future processes and spaces, we must look for ways to optimize processes and layouts that make Virginia Mason safer for our patients.
Strong Economics:
Allowing for growth and expansion for current and future needs ensures that what we design has the flexibility to keep Virginia Mason a strong and viable resource for our patients and our community.
Capacity to Provide Care:
This final element in a balanced approach to designing new spaces and processes is critical to ensuring that the full value stream of services and facilities are there to support the patient along their entire journey. As an example, if we decide that it is time to build new operating rooms, we want to make sure that there are enough recovery and inpatient resources to support added growth.
© 2015 Virginia Mason Medical Center

16. Traditional vs. Lean Design
Current Space
Realize the need for improving space and process
Design and Construction
Unclear about new process flows
Assumptions made about future work flows
Move in
Realize old processes won’t work in the new space
Improve process flows
Adjust space and process based upon what was built
Realize the value of the new space
Traditional vs. Lean Design
Total Project Lead Time
Traditional  CB
Lean
Current Space
Understanding of current state processes
Vision created for new process flows
Design and Construction
Clarity on space requirements
Coordination and shared learning between all teams
Ongoing mock up and simulation
Flexibility for future learning
Move in and Realize the value of the new space 3P
Lean improvements implemented in the current space
© 2015 Virginia Mason Medical Center

17. The Lean Equation for Design
Design and Implementation of New Processes Created from VMPS
Design and Construction of New Facilities Built to Support Services Created by VMPS
Facilities that Work for Us!
Reduced Waste
Improved Quality
Increased Safety
Enhanced Service
Greater Efficiency
CB:
This deliberate strategy of redefining process before we design new spaces insures that we are closer to getting facilities that work for us in the immediate future with the built-in flexibility to evolve as continue our journey to transform health care.
© 2015 Virginia Mason Medical Center

18. 3P Workshop Week Daily Objectives
Monday:
Define Opportunities
Tuesday:
Imagine Perfection
Wednesday:
Harvest and Create
Thursday:
Develop and Refine
Friday:
Share and Engage
3P Workshop Week Daily Objectives CB
© 2015 Virginia Mason Medical Center

19. If Form Follows Function Then…
Lean Form
Follows
Lean Process
CB:
In healthcare, it’s time for those of us in healthcare to take back healthcare design.
We have used VMPS to really understand our current flows and create our future processes with a tremendous amount of attention to creating flow for our patients and remove the burden of waste for our staff.
© 2015 Virginia Mason Medical Center

20. The Results- Deliverables from 3P
Future State defined
Action plan for implementation
Immediate, 6 months & 1 year
Lean Form Follows Lean Process
Pre-visit Needs
Welcome
Enrollment
Assessment
Evaluation
Care Planning
Patient-Centered Medical Home Model
Robyn

21. The Results-Deliverables from 3P
Robyn

22. The Results- Deliverables from 3P
Daily & Week end summary report out to hospital leadership = immediate buy in from leadership
10 months from 3P workshop to practice open for business in new space
Robyn

23. The Results- Deliverables from 3P
The patient is the center of care in the medical home model
Patient in wellness room
In-room check in
In-room check out
In-room Vitals
In-room patient care planning
Robyn

24. The Results- Deliverables from 3P
ON STAGE FUNCTIONS
LAB
CONTACT CENTER
ENTRY/
GREETER
CONSULT
LOUNGE
WELLNESS ROOMS
Robyn
CARE TEAM
FLOW STATIONS
SUPPORT FUNCTIONS
PHYSICIAN HUDDLE
OFF STAGE FUNCTIONS

25. The Results- Deliverables from 3P
Robyn
On Stage
Off Stage

26. Prebys Cardiovascular Institute
The Results- Deliverables from 3P
7 Flows of Medicine
● Patients
● Family & Relationships
● Providers
● Medications
● Supplies
● Information
● Equipment
● Process
Engineering
Robyn
Private Room
Prebys Cardiovascular Institute

27. Supply & Waste Pass thru
The Results- Deliverables from 3P
Patient
Vitals
Separation of flow
Single handed rooms
Robyn
Physician work station
Supply & Waste Pass thru
Care
Team

28. The Results- Deliverables from 3P
In-room check in/check out
Barn Doors in lieu of swinging doors
Space saver
Allows for larger openings for ease of patient and equipment movement
Sarah

29. The Results- Deliverables from 3P
In-room Vitals
Sarah

30. The Results- Deliverables from 3P
Powered examination chair/table in lieu of traditional exam table
Patient at eye level of care team
ADA and Bariatric friendly
Sarah

31. The Results- Deliverables from 3P
Standardized supplies, stocked off-stage with nurse server concept eliminating downtime of room
Sarah

32. The Results- Deliverables from 3P
Technology integration
Future telemedicine
In room check in/check out
Patient education
Sarah

33. The Results- Deliverables from 3P
Action plan: Immediate, 6 months & 1 year
Sarah

34. Lessons Learned- Where are we now?
Model is well received
HCAAP scores improving
Improved patient care
Replication of model within organization
Creation of Standard Workflow
Sarah

35. Prebys Cardiovascular Institute
Lessons Learned- Where are we now?
Materials at point of use
Just-in-time ordering of supplies
Sarah
Private Room
Prebys Cardiovascular Institute

36. Prebys Cardiovascular Institute
Lessons Learned- Where are we now?
Know your metrics:
Staff satisfaction
Patient time to provider
Run simulations
Sarah
Private Room
Prebys Cardiovascular Institute

37. Lessons Learned- Where are we now?
Don’t design until you know your flow.
Robyn

38. Prebys Cardiovascular Institute
Lessons Learned- Where are we now?
Don’t wait for your new facility; make changes now.
Robyn
Private Room
Prebys Cardiovascular Institute

39. Prebys Cardiovascular Institute
Lessons Learned- Where are we now?
Think of your new space as a lab.
Keep measuring; keep improving.
Robyn
Private Room
Prebys Cardiovascular Institute

40. Lessons Learned- Where are we now?
Onstage/offstage concept requires more space (1.4 vs 1.9 circulation factor)
Potential increased upfront project costs
Robyn

41. Lessons Learned- Where are we now?
Risks:
Willingness to give up autonomy and work as a team
No private offices
Sarah

42. Lessons Learned- Where are we now?
Increase patient and
staff recruitment
Sarah

43. Christopher Backous, MHA
Faculty Member, Virginia Mason Institute

44. Robyn Dubick, CID, IIDA, LEED AP ID+C, EDAC
Associate, CR Goodman Associates
Phone:

45. Sarah Whiteford, MD
Physician, Family Care Associates
Greater Baltimore Medical Center
Phone:

46. Questions?