Lean-Led Hospital Design Creating the Efficient Hospital of the Future

Introduction to Lean-led Hospital Design
The Typical Timeline
Are We Too Late?
Are We Too Early?
Standardization Creates Flexibility
Learning from the Past to Create Bed Towers of the Future
St. Patrick Medical Center Emergency Room Transformation
Integrated Project Delivery and Lean - Can They Work Together?
Lean Goes Viral: An Architecture Firm Takes a Second Look
Appendix
Glossary

Biography

Naida Grunden is a Lean healthcare consultant and has been a business and technical writer for over 25 years. She speaks and teaches nationally and internationally (Denmark, Cuba) on the application of Toyota-based Lean techniques in healthcare. Her clients include Captain Sullenberger, Pittsburgh Regional Health Initiative, Healthcare Performance Partners, and Global Link.

Grunden is the author of The Pittsburgh Way to Efficient Healthcare published by CRC Press. She was also responsible for launching the PRHI Executive Summary, a monthly newsletter published by the Pittsburgh Regional Health Initiative, when she was Director of Communications. In Grunden received the 2006 Challenge Award from the American College of Clinical Engineering for her article, "Industrial Techniques Help Reduce Hospital-Acquired Infection," in Biomedical Instrumentation and Technology magazine. She has published numerous articles for various healthcare publications and was the keynote speaker for the HIMSS 2010 Conference awards breakfast. Grunden completed her BA in English at California State University, East Bay, and her secondary English teaching credentials at California State University, San Francisco. She lives in Bellingham, Washington, USA.

Charles Hagood, MBA, President and Founder of Healthcare Performance Partners (HPP), has overseen the introduction and implementation of Lean Healthcare systems in numerous healthcare organizations including some of the largest non-profit hospitals, national systems, small critical access hospitals, clinics, and large for-profit systems. HPP is one of the few organizations that have successfully translated Lean manufacturing and the Toyota Production System (TPS) to the healthcare industry. Charles also is a founding Principal of The Access Group, LLC (TAG), which is headquartered in Nashville, Tennessee USA area along with HPP, and has worked with Fortune 100 companies throughout the world (GE, Tyco, Cessna, Nissan and many others) in their Lean transformation and process improvement initiatives. Charles also oversees the application of Lean/TPS methodologies into the planning, design, and construction phases of a wide range of clinical and hospital renovation and construction projects.

Charles speaks throughout the USA and Europe, and most recently China, on the subject of Lean Healthcare and the application of Lean and other process improvement methodologies to healthcare industries. Charles is the founding faculty member of the Lean Healthcare Certificate Program at Belmont University. In 2003, Charles was awarded the State of Tennessee’s top award for his work in Economic Development by the Tennessee Economic Development Council. In 2008 he was recognized as Alumnus of the Year by the Belmont University Massey School of Business. Charles received his MBA degree from Belmont University.

There are tens of billions of dollars being spent on construction of new healthcare facilities in the U.S. today. Before spending another dime healthcare executives should read this book and learn how it’s possible to take as much as 40% of the building cost out before a shovel ever goes in the ground. This result has now been proven over and over by many healthcare organizations on the Lean transformation journey. As a bonus, but even more importantly, we can improve staff satisfaction and clinical quality at the same time as the cost goes down. Naida Grunden and Charles Hagood beautifully document these outcomes by the use of real case studies in addition to her own extensive experience as a careful observer of Lean healthcare.
—John Toussaint, MD, CEO, ThedaCare Center for Healthcare Value

Leading Lean hospitals have learned they need more than ongoing continuous process improvements. Given the chance to build new or expanded facilities and space is a unique opportunity to build in efficiency and patient-centered care from the start. Lean-Led Hospital Design is a fantastic book that shows the reader exactly how to incorporate process design with space design in a collaborative and iterative manner. The vivid examples shared by Naida Grunden and Charles Hagood bring these principles and practices to life. This book will help your organization immensely, whether you are just starting to plan for a new facility or whether you are ready to move in.
—Mark Graban, Shingo Prize-winning Author of Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Second Edition

Naida Grunden, author of The Pittsburgh Way, and Charles Hagood have nailed an important oversight in Lean and other industrial engineering applications in health care. Too little attention is focused on the role of the environment and physical plant in making exceptional performance possible. Would a world-class symphony perform in a substandard hall with poor acoustics, uncomfortable seats, audible distractions and visual impediments? Excellent case studies demonstrate how health facilities can be designed to advance safety, clinical quality and efficiency. This book argues effectively that performance excellence must be aligned with a supportive physical environment.
—Karen Wolk Feinstein, President of the Jewish Healthcare Foundation of Pittsburgh and Founding co-Chair of the Pittsburgh Regional Health Initiative

Hagood and Grunden have engaged one of the most complex and important subjects facing our great nation. This generations place in American history is taking shape and in no small part will be valued on how we responded to the health care cost crisis. This book provides useful insight as to how we can design care that fulfills its obligation ‘to do no harm’ and yet provide it in a cost effective manner.
—John Bardis , Chairman, President, and CEO of MedAssets

Lean techniques and tools have been transformative in our organization as a means of systematically analyzing processes and office design to eliminate waste. However, the beauty of Lean principles is that the goal is not simply to eliminate waste or increase efficiency but to ensure that change is always patient centered and driven by the front-line workers who interact with these patients every day. Lean principles help us to keep our patients at front and center whenever we are contemplating changes. In Naida Grunden's Lean-Led Hospital Design, she writes with great clarity and wisdom about how Lean principles can be used to create the ideal Hospital of the future.
—Eileen Boyle, MD, Executive Director of East Liberty Family Health Care Center

Grunden and Hagood have produced an authoritative, compelling argument for adopting the principles of Lean management integrated through all aspects of hospital management from architectural design, construction through delivery of clinical care. In several examples they document the gains to be enjoyed in more functional design, construction cost savings, operational efficiencies, and more satisfying work conditions for healthcare professionals, and–most important–for the safety, satisfaction, and improved outcomes for patients. The unifying vision for building design and healthcare operation is ‘what is best for the patient.’
—Robert W. Mason, Managing Partner of CC-M Productions

Lean-Led Hospital Design is a work we’ve all been waiting for. The authors do a tremendous job consolidating this relatively new body of knowledge into a practical, applicable application that will impact millions of people - enhancing value delivery by removing non-value added waste from the patient experience.
—Mike Orzen, Shingo Prize-winning Author of Lean IT: Enabling & Sustaining Your Lean Transformation

High quality care and patient safety are requisites of the health care delivery system. This book is a must for every Lean practitioner with its practical real-time examples of facility improvement that engage frontline staff to remove waste and improve outcomes.
—Debra N. Thompson, PhD, RN, Principal, Debra N. Thompson, LLC and Adjunct Faculty, University of Pittsburgh, School of Nursing

There are many books on Lean management, but this one really sets itself apart in its clarity and readability. Grunden and Hagood offer a thorough discussion of Lean management techniques in building design. They share real-life stories of healthcare leaders and design teams who took the time to analyze their processes and ultimately achieve incredible project and operational savings through facility design. It’s written in a compelling tone (once you start, you’ll keep reading) providing a clear and actionable path to improved design.
—Margaret F. Schulte, DBA, Bestselling Author of Healthcare Delivery in the USA

Naida Grunden and Charles Hagood have produced a miraculous book integrating smarter and continually improvement management and architectural design. Just practicing the new management which dates back to last mid-century Japan has helped several hundred American hospitals cut costs by 50 percent, get rid of hospital-acquired infections and drastically reduce medication and medical errors saving untold lives. Constructing hospitals with the input of knowledgeable managers, doctors and nurses, who are themselves continually learning, hopefully is the key to solving America’s hospital and care delivery crisis. Gruden and Hagood have produced the next leap forward in consciousness and improvement.
—Clare Crawford-Mason, Producer, NBC White paper, If Japan Can, Why Can’t We?; PBS Documentary, Good News: How Hospitals Health Themselves; and Co-Author of The Nun and the Bureaucrat, How they Found an Unlikely Cure for America’s Sick Hospitals

This book by Naida Grunden and Charles Hagood speaks with engaging clarity about how Lean can and should be used as the guiding philosophy for designing hospitals. One compelling feature is its systems perspective that is sensitive to the interrelated roles of people, processes, leadership, and culture in making Lean work. Another is its emphasis on actionable understanding through a great selection of concrete examples, case studies, images, and insights from experienced practitioners. I cannot think of a better primer on Lean-led hospital design.
—Rangaraj Ramanujam, Associate Professor of Management, Owen Graduate School of Management, Vanderbilt University

While there are may be many faces of Lean, including process design and facility design, these many faces share one expression – no outcome, no income. Grunden and Hagood have done it! Their latest book points the way, in everyday language, as to how we can achieve an improvement in the quality and outcome of care and save money and reduce error at the same time. This book is a guide for survival under an era of accountability and will drive the ‘no outcome, no income’ agenda deep into the second decade of the 21^st century.
—David B. Nash, MD, MBA, Dean, Jefferson School of Population Health, Thomas Jefferson University

Finally! Proof that Lean—and visual—can do for hospitals what they have already so spectacularly done for industry: improve processes, create dramatic bottom-line results, and align the work culture…and now, while saving lives.　Grunden and Hagood make an irrefutable case. Hospital infrastructure in the United States in a disastrous state of decay and insufficiency. The need for new structures—and new paradigms of thinking—is urgent. All the more reason for getting this book into the hands of hospital management, administration, and planning—as well as architects, contractors, and builders. A beautifully researched and logically delineated book, Lean-Led Hospital Planning is a 'must read' for everyone associated with hospital running and planning—preferably before any action is taken in the old 'design-bid-build' sequence.
—Gwendolyn D. Galsworth, Ph.D., Visual workplace expert and Author of Work That Makes Sense & Visual Workplace/Visual Thinking