In this third part of a series on the planning and strategy of healthcare design, Amanda Mewborn discusses how she works with the architects at Perkins+Will and their healthcare clients on efficient design that enhances the quality of the patients’ experience.
When I first joined Perkins+Will, I understood that I would have two main roles:
- Working with healthcare clients to improve their operational efficiency, patient experience and quality
- Working with architects to improve the speed and quality of the design process
While my career had focused mainly on the first role, I was intrigued at the opportunity to do the second role. How would I apply industrial engineering tools, such as Lean, to the architectural process? After all, architecture involves a lot of creativity and drawing, and how would I make creativity and art happen faster?
I have quickly learned that the discipline of architecture is far more than art and drawing (although, I have a hearty respect for that aspect of the work). In shadowing some of my peers who are architects, they listen for the root cause or issue that the client is trying to address. Often, because architects don’t live in the same world as the client, they have a fresh perspective and innovative ideas to address challenges. Not only do they create beautiful spaces to provide patient care and work, they design spaces that help improve efficiency, experience and quality.
Before the Design is Drawn
The adage “form follows function” is old and tired. However, I didn’t truly understand the meaning and implications until I saw this in action. While there are many phases in the process of designing a new building or space, it is important to note all of the activity that takes place before any design is ever drawn.
Generally, there is a master plan that follows an organization’s strategy. The master plan demonstrates how the facilities and space will need to change over a period of years to support a strategy. For example, the plan may include building a new bed tower, renovating an existing unit or changing the use of existing space without renovations.
Space programming is usually the next step. This step determines the amount of space needed, including the number and size of each type of space.
The next step (and one that is sometimes skipped) is planning. Once we know how much space is needed, we have to figure out how the space will be used. How will patients flow through the space? How will staff work in the space? What spaces need to be nearby other spaces? This phase is the one that is most exciting for me, as this is the time when current operations can be analyzed to improve the way that staff works in the space.
Observational studies are analogous to the Lean concept, Gemba. Gemba is a Japanese term that means going to the place where the work is done. It is amazing what we can be learn by seeing the environment where the work is done. Often, the people working the front line have the best ideas for how to improve things. Empowering these people by including them in design meetings, listening to their ideas and executing on their ideas can have the biggest impact on improving efficiency and experience for patients and staff.
At other times in Gemba walks, some front-line workers are so involved with their daily routines or have been doing their role one way for so long, they can’t imagine another way of doing the work. Involving a multi-disciplinary team in the Gemba walk allows for a third-party to see the opportunities and suggest more efficient ways for accomplishing the work.
Master planning, space programming and planning all happen before design, ensuring that form follows function. This means that the space (form) will be designed to support the work (function) that takes place.
In most of my career, when working to improve efficiency, quality and experience, I have worked around the existing walls and placement of sinks, utility rooms and the entire built environment. In working with an architectural firm, we can actually design those spaces to be located in the areas that will help facilitate the most efficient, highest quality patient care.
Integrating the Design Process
It was important for me to understand the traditional architectural process of strategic plan, master plan, space program, planning, and then all the other pieces of the process that follow. However, when the architects took an interest in “this Lean thing,” they were quick to jump on the bandwagon and started with looking at their own processes for improvement.
It turns out that you can hurry creativity. What if we could have the phases of the design process overlap? We could start drawing the building design earlier, using some of the latest technologies to visualize the potential space, such as Building Information Modeling (BIM). So far, we’ve found that we could cut the design time almost in half by integrating the various phases of the design process! Not only do we reduce the length of the process, we also reduce the number of meetings, and therefore the time spent by clients, by combining some of the phases. Further, workflow and operations take a more prominent role in the process, which was often missing in the traditional process. Additionally, in the traditional process, each phase tends to invalidate parts of the previous phase. For example, during planning, one may change the space program based on workflow patterns identified. When doing the phases in an overlapping manner, the invalidation (also known as “rework” in Lean terms) doesn’t exist.
Many clients are also changing their current workflows before they move into their new building. This allows them to test the new processes and tweak them, starting their continuous improvement journey before moving.
While I hadn’t worked with architects before, and I was concerned there wouldn’t be a way to Lean the process of creativity and art, I have been pleasantly surprised. The architects are enjoying the more efficient processes, clients understand the impact of the physical environment on workflow, and both parties are enjoying the more expeditious process that is resulting in a better outcome.
Amanda Mewborn, RN, CPN, CPHIMS, PMC, DSHS is a senior healthcare consultant with Perkins+Will where she assists clients with improving operational efficiency, patient experience, and quality.