Page 120 - Lean six sigma demystified

Chapter 3 a Fa S ter Ho S pita L in Five D ay S 99

A Faster Hospital Design in Five Days

The vast majority of health care organizations…are not really “designed” at all. The
elements of most general hospital buildings, technologies, clinical services—have accreted
over time.
—Richard M. J. Bohmer

I recently worked with an architectural firm to come up with a Lean design for
two rural hospitals. Although the health care company asking for the design had
been a longtime customer, the new designs were up for grabs.
Most rural hospitals are designed long and flat (which to me meant lots of
walking for employees and patients and no sunlight for many patients). The
architecture firm told me that the lab could be anywhere, to which I said “Non-
sense, it should be next to the ED!” Everyone in health care, including architec-
ture firms, have limiting beliefs about how health care should be conducted.
“The lab can be anywhere” is one such belief.
Patients want easy access to the ED, lab, and radiology, rooms with sunlight
and minimal travel (I’m sick; don’t make me walk a mile!). Clinicians want
many of the same things. The ED needs to be close to ICU to minimize trans-
port. Transport between the ED and nursing units needs to be short and fast.
Due to variability in patient census, hospital operations might want smaller
nursing units (smaller batch sizes) so that some could be shut down during slow
seasons.
The architecture firm had brought in other Lean experts who baffled them
with takt time and value-streams and SIPOCs and so on. I pulled out several
sizes of Post-it notes and started configuring various designs. I started from the

patient’s point of view (patient-centric, not physician-centric). In a few hours
we’d come up with a couple of designs that minimized movement of ED
patients, inpatients, outpatients, visiting families, clinicians, food service, and
supplies while optimizing the number of patient rooms with sunlight. When
you abandon what you know about how to deliver health care and focus on the
patient, it’s easy to come up with fresh ways of doing business that are better
for everyone involved.
At the end of my 1 day with the architecture firm, I suggested they use the
Post-it note approach to pitching the designs to their client. Get the client
involved in configuring the overall design! What a radical idea! And guess what?
They won the contract for both hospitals.