The Origins of Lean Design in the Healthcare Industry: Q&A with Healthcare Architect Robb Sharrow

We sat down with Robb Sharrow, AIA, Vice President, Director of Healthcare Planning at award-winning architecture and engineering group, Albert Kahn Associates, Inc., to talk about lean design and how it applies to hospital construction projects.

Healthcare Technology Corporation (HTC): How did the hospital industry come to adopt the concept of lean design?

Robb Sharrow (RS): Historically, lean refers to a system of operating that was initially thought of by a man by the name of Deming, who developed “Deming’s Quality Management Process,” and summarized by his “14 points for management.”  Nobody in the U.S. wanted to talk to him. He went overseas to Japan in 1950 and they were all ears.

Toyota really adopted his system and created the Toyota Operating System. When Toyota came to America, one of the first firms they hired was my firm, Albert Kahn Associates, because we designed auto plants. We became ingrained in this Toyota Operating System. Basically, it’s a continuous improvement process to create high quality and efficiency. It’s done through standardization, combining like processes, eliminating errors, and a number of other strategies.

When Toyota came to America, one of the first firms they hired was my firm.

Applied to healthcare, you look at refining processes to maximize efficiency. For example, there’s a lot of evidence that shows private rooms contribute to a higher-quality patient experience. The evidence shows that it’s safer for the patients, satisfaction increases, you can accommodate visitors 24 hours a day, you can accommodate a care partner, you can provide privacy to a patient, the patients get better rest, and so on. All of these different factors lead to higher quality care.

HTC: Can you talk about a hospital construction project you worked on that used lean design principles?

RS: Sure. We designed a hospital in Illinois that was tracking its safety metrics. Certainly, if you are going to provide a high quality service and eliminate waste, you have to eliminate errors. Medical errors can be very costly. You can injure or even kill a patient. There are all sorts of metrics that can be improved through this one idea of providing private patient rooms.

This hospital that we designed in Illinois eliminated medication errors. This was achieved in the way that we designed the room. The room had a computer system we put in at the bedside that allowed staff to include barcodes on the patients’ wristbands and then pull up the information on the computer to verify that the patient was on the correct medication. There are a lot of administrative errors that can happen and this eliminated those errors. So there’s just one example of lean thinking that creates excellence.

HTC: What are some misconceptions people have about lean design and construction when it comes to hospital projects?

RS: A lot of people think that lean just means you make things efficient. So, for example, we had a hospital project that included a lot of private rooms. In the old unit, the average engagement time for nurses with their patients was between 20 and 25%. We were afraid we were going to make it even less efficient because they were going from two bedrooms in the old building to single rooms in the new building, and the walking distance would be even longer.

One of our team members mentioned that in the aircraft industry, when they organize the assembly line for F-16 jets, they put all of the supplies within 5 seconds of the worker. We decided to try that in this hospital. So we asked the nurses, “What do you normally use?” We wanted to put those things right in the room or right outside of the room. We figured out how much storage we’d have to provide, what had to be locked, what had to be in the room, what could be right outside of the room, how it would be stocked, etc.

One of our team members mentioned that in the aircraft industry, when they organize the assembly line for F-16 jets, they put all of the supplies within 5 seconds of the worker. We decided to try that in this hospital.

Two years after moving into the building, the average amount of time the nurses spend with the patients is now between 50 and 60 percent. It doubled the amount of time nurses spent with their patients. It’s also so efficient that their nurse staffing ratios are some of the best in the nation.

People look at that and say “How can you have this quality with such a low staffing ratio?” Well, because everything the nurse needs is right there. They’re not spending their whole day hunting and gathering supplies. So that is efficiency. That is lean. The nurse spends more time with the patient, and chances are that nurse will get to know the patient better and end up providing a higher level of heartfelt care.

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