Case Study: Rapid Lean Design Assessment A Deeper Look Through observation and shadowing, a team of healthcare design and lean process experts can quickly assess the current flow and patient experience. These activities lead to a summary of potential steps the organization can take to move toward their ideal future state - as a means to define scope, both of improvement work and physical design, if appropriate.
Observation = Actionable Results Respect for Everyone’s Time
CHALLENGE
Rapid Lean Design Events (RLDE) are geared to help clients quickly assess their current condition, map patient flows impacted by the process, identify areas for improvement or streamlining and then establish an ideal future work flow. The Rapid Lean Design Assessment is a swift and targeted multidisciplinary series of one to two hour workshops in which the process
The client recognizes a patient flow problem, and needs assistance pinpointing the trouble areas and creating a path to future improvement.
is observed, preliminary data is collected, staff are briefly interviewed and suggestions for
SOLUTION
healthcare systems engineers to get to know the daily routine of the department interested
A brief and rigorous assessment format co-led by healthcare architects and systems engineers identified clear areas of scope, staffing model, communication and inter-departmental orders as imperative to improved throughput
improvements are developed as appropriate. Here, we highlight the value of each workshop contained within the Rapid Lean Design Assessment. PROCESS OVERVIEW The Rapid Lean Design Assessment allows a dedicated team of healthcare designers and in improving and determine which pieces of the RLDE are appropriate for the organization. A Senior Process Planner and a Healthcare Systems Engineer evaluated one department, focusing on the overall patient experience. During this day-long event, the team interviewed executive and front-line staff, observed the patient care process, and spoke with senior leadership about their vision for the future state of the clinic. Deliverables from this one-day assessment include a high-level process map, a waiting room volume line graph, a selection of notes from the observation, an executive summary of interviews, physical environment analysis, and suggested scope for the remainder of the engagement.
PAGE 2 | case study: lean event assessment
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FIGURE 1 Figure 1: The process map above shows the flow of patients observed during the assessment.
OBSERVATION After a tour of the facility to gain a high level understanding of the typical patient flow, the team sat down to observe the process. As patients arrived at the facility, their experiences were noted on observation records. The amount of time spent in each process step can be seen in the process map in Figure 1. Additionally, the track that each observed patient and staff member traveled can be seen in the
“Sometimes it takes unbiased eyes to see the potential for improvement.”
spaghetti diagram on the top of the previous page. Some common themes became apparent after two hours of observation:
- Laura Silvoy
• The team noted that at times patients were unsure of where to go next when unaccompanied by site staff.
Healthcare Systems Engineer
• Segregated staffing roles seemed to create disproportionate down time or burden for some team members.
• Patients who were unable to move around on foot had difficulty navigating the limited space in the waiting areas. Additionally, the team noticed that patients were aware of their arrival time relevant to other patients.
• At times, the team observed staff members attempting to “fight fires” caused by breaking points in the system. These observations allowed the team to develop a deeper understanding of how patients flow through the system. Initial analysis of these themes, combined with the remainder of the assessment led us to our proposed plan for improvement.
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case study: lean event assessment | PAGE 3
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Conversation
FIGURE 2 The graph above shows the ebb and flow of waiting room volumes. The times on the horizontal axis are not evenly distributed, giving the viewer an idea of how quickly volumes can change over time. because they are so familiar with the process or do not have
EXECUTIVE VISIONING This portion of the Rapid Lean Design Assessment was facilitated by Senior Healthcare personnel at Array. These individuals have specific experience in translating healthcare observations into realistic improvement goals. Hearing from senior-level staff about daily issues that arise allowed us to create an implementation strategy that was much more detailed and specific to our client than could ever be accomplished by providing a standard strategy for improvement. In one hour, we were able to determine current road blocks, highlight strategic goals and establish scope boundaries for the improvement initiative.
time to stop and think about how to improve it. As individuals who are unfamiliar with the current operating procedures, it is our job to see potential areas of improvement with an unbiased eye. Once again, we were able to draw upon the staff experiences conveyed in this interview setting to create an implementation plan that was unique to the organization. PHYSICAL ENVIRONMENT ANALYSIS The clinic includes 14 exam rooms and related staff work space. Increasing the number of exam rooms available would permit additional staffing model changes to operate more effectively if the number of concurrent providers is to remain the same. Additional physical space is understood to not be available
FRONT-LINE INTERVIEWS We believe the front-line staff provides the greatest insight for process improvement. These individuals encounter potential areas for improvement in their daily work. Interviews with this staff group allow us to make a connections with the people who interact most with the patient. The discussions lasted about
at this time. In touring and reviewing the current clinic some opportunity for capacity increase could be explored.
• Currently, some spaces are dedicated to support and administrative space.
fifteen minutes and included the following questions:
• Staff work areas are segregated and not shared.
•
What are the most pressing complaints from patients re-
Some flow challenges observed may be exacerbated by the
garding their clinical experience?
current clinic configuration.
•
What major issues do you encounter each day?
• Staff work areas are not always proximal to the point of
•
If you could change the way you do one thing in the clinic,
• Check-out is not easily identifiable.
what would it be? Often times, we find that the people who operate in the facility daily have a difficult time seeing the non-value added steps PAGE 4 | case study: lean event assessment
service.
• Poor lighting was observed in the waiting and check in/out area.
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Who We Are ARRAY-ARCHITECTS.COM SUMMARY Upon completion of the Rapid Lean Design Assessment, we provided some recommendations for further investigation. These options were offered to the client as separate services with the opportunity to best match services with current needs and resources. The recommendations involved improvements to the patient experience, the physical environment and staff interactions. Unlike organizations who focus on elements of a conventional improvement strategy, our one day assessment allows us to create a customized list of improvement services that focus on our observations. FINAL REMARKS The observed clinic was a well-run, high functioning patient services center. The custom improvement suggestions provided as a result of the Rapid Lean Design Assessment could be used to enhance the patient experience and move the clinic from good to outstanding. This assessment provided our client with an illustration of the improvement work we could deliver and allowed them to get to know our team on a deeper level. After the Rapid Lean Design Assessment, the client chooses which services fit with the current strategic goals. We work with them to develop a plan for implementing these improvement projects. Often
We Are Healthcare Architects We are a team of architects and designers with unique backgrounds, but we all have one thing in common- we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most. This focus makes us leaders in our field. There’s a degree of compassion, empathy, and sensitivity that goes into every project that we touch. It’s designing a nurse station with sight lines to every patient. It’s building a Behavioral Health facility without corners, so that patients are safe. It’s translating the operational needs through the technical details to fine tune the lighting system in a neonatal unit so caregivers can match the lighting to each baby’s stage of development. It is a deeper understanding, honed through relationships spanning decades.. Together, we discover optimal solutions with our clients. It is our three decades of specialization that allows for effective communication, collaboration and precision in the complex, changing world of healthcare.
times, the plan will include a detailed current state analysis session, future state visioning and a comprehensive execution plan.
Array’s Knowledge Communities We believe strongly in sharing our expertise and knowledge with others. We invite you to explore each of our thought leaders and share your thoughts with the healthcare design community. Click here to visit our Thoughts page.
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to view our thought leadership on simulation and continuous improvement
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case study: emergency departments | PAGE 5
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