Every day more and more articles and blogs are written about the fact that operating margins are shrinking and financial capital is becoming scarce. It’s a fact we all would like to escape, but nonetheless is a reality for which we are all seeking to find solutions to keep responsibly moving forward. When these financial realities are discussed, typically in short order the subject of lean thinking, planning or operating is brought forward. Contributing to the complexity of the matter is a need to be mindful of energy consumption and environmental responsibility as we create facilities that are user-friendly, designed to promote positive outcomes and remain flexible for inevitable changes in healthcare delivery. Leaders can get buried in the enormity of these challenges.
It’s true—a facility should not be an excuse for poor outcomes or extended wait times. It’s a fact that planning around shorter pathways does extract waste and reduces errors. Training in a mocked up environment is proven to transition the culture to optimal future states. Facility design around processes is a very smart long-term investment. The use of the word sustainable often connotes “green” topics, but shouldn’t override its applicability in the development of spaces and environments to deliver cost effective healthcare. It also includes the concepts of adaptability and reuse supporting a business case for financial stability and quality of care. Realizing that facilities can be used more wisely, where do the opportunities lie for achieving these most critical goals?
When my father taught me basic principles of carpentry, the old adage of “measure twice, cut once” seemed a waste of time to a kid who just wanted to cut and hammer. At the end of the day, I learned much better quality construction and much more progress were achieved. As the leader of the crew, my father understood that if he did not live this value in his every move he could not expect any of his crew to believe in it. His leadership provides a great illustration in lean/integrated planning and design concepts, the “top dog” bought into it and lived it daily. No one has the concerns of each stakeholder group in mind more than a hospital’s top leadership. CEOs must own and lead the development of leaner processes reinforced by leaner designed facilities.
While leadership led, many variables and processes need consideration. Educators of lean concepts correlate its successes to the inclusion of stakeholders and front line users in the effort of developing lean processes and plans. But, it is not just for their input or approval as a step in the design process, rather for their ownership and implementation of decisions and outcomes. For this reason, a team is required. No “black-cape” designer or CEO can simply emerge with a workable concept without them. Inspired by leaders’ commitment, the group of stakeholders made up of each component of the provider and care delivery team plus the house staff is required to convey the needs of all work flows.
When applied facility-wide, perhaps the term integrated is a more descriptive approach in that it views the flows of medicine and the building performance both intra-departmentally and interdepartmentally. Patients, Providers, Families, Supplies, Information, Equipment and Medicine require planning in their own right relative to their application in diagnostic and treatment departments. Yet, design with linkages between flows coupled with the issues of sustainability requires the top-down ability of seeing the bigger picture. Integration of value streams of each flow in each department aligning with building cost performance creates a facility with great potential for improving care at reduced operating costs.
Collaboration of leadership with all stakeholders and the planning and design teams inevitably appears to bear all the marks of a “too many people to really get anything done” scenario. Indeed, a lot of ground has to be covered and much information gathered, processed, shared and implemented in a short period of time. But the payoff of building the opportunity to provide better care in a more efficiently operated facility designed with the patient, family and staff in mind is far greater than just the excitement of getting a new and shiny place to work. Led from the top, the implementation of objectives fitting those goals will yield long-lasting results for generations, and comfort to any board-reporting CEO.
— Dan Killebrew is a partner at Dallas-based FKP Architects.