I cringe when I hear the word lean. Not because I do not believe in the work of the Toyoda family and Taiichi Ohno and others that ultimately led to the term, but because most instances when I hear “lean” it is has nothing to do with the spirit of that work. The expectation is that saying a process, design, or project is “lean” somehow a magical happening occurs that enables the delivery of “bigger, better, faster, cheaper” without adjustment. I have during my lean studies and work on lean projects developed a few tricks up my sleeve, but that is not the fundamental basis of Lean Design.
The pure intention of a lean approach to anything is to improve processes by eliminating waste and that expending resources for any goal that does not add value to the end customer is waste. It sounds pretty simple, but it is a difficult task. Process improvement does not imply that it will take less time (on its own); its intention is the goal of a better product, by improving that process. A design approach to lean insists that we look inwardly to what we do as design professionals and examine our process and discover the waste within them.
We first need to examine our work and what is broken about the current process, and the answer is not always to fix it, maybe we should be doing something else. We should also look at what is NOT broken, and improve on it, that is something that is rarely done. In design the biggest hurdle is always communication. Communication is a challenge between the design professionals and the end users, also between the design professionals and the constructors. So instead of fixing what is broken, the communication and understanding, what happens if we acknowledge it, and instead of learning our counterpart’s language or attempting to teach them ours, we develop a new one? Sometimes a conversation, a site visit, or a photograph will save you hours of time and reams of paper. Eliminate a hand off in your process, and you will eliminate countless possibilities of errors.
As part of a Lean Process Improvement effort on an Integrated Project Delivery project, the design process was evaluated as part of a process mapping exercise. The results can be found in these images. As a narrative to the images, the design team felt that in many cases information that was exchanged in a traditional delivery of a project was lost during the design phase, or portions of detailed information informed what was happening in schematic portions of the work. As a result a more integrated approach to the design was implemented. This work was evaluated over time to make improvements beyond the original modifications. Essentially portions of a traditional Pre Design, SD, DD and CD’s were done concurrently.
Gembas (the real place) are a great way to improve communication in design. Spending time looking at user’s current spaces and other facilities that are implementing different models of care the gap of knowledge and understanding is closed.
Gembas can also be done as research. Mark Graban with Constancy, Inc., conducted Gemba studies at the Riley Hospital for Children in Indianapolis which is currently being designed by HKS, Inc. The facility was able to research time spent on tasks and record time at the bedside, time searching for supplies and see paths of travel for nurses over the course of hours that were studied. This helped the users see how they worked, and how design could improve the ideal state of how they operate their departments.
Making the communication visual, 3-dimensional and real between user groups and design team members solves communication problems, and translating that physical solution to a document should be simple too. I often say, “If a picture is worth a thousand words, save the words, use the picture.” Documentation in the lean world is simple, to the point, structured, standardized and visual.
Designers are trained problem solvers. Instead of jumping to solve the problem though, it may be a good idea to spend time evaluating what the problem is. We need to make sure we solve the real issue instead of focusing on effects of that issue. There are advantages in healthcare design (one could argue any design) that could have profound affects beyond what a designer touches traditionally. Solving the real, root cause of problems that staff and physicians face, improving the environment for patients, and reducing costs by the designs that support the solution should be the goal of the design, not simply responding to issues users face with their current space. In order to do this we must encourage facilities to develop an ideal state for the operation of their facility and design to support of that ideal state.
Value Stream mapping and Process Mapping are tasks that help users identify what is happening in their current state of operations, and identify the waste, problems, and potential opportunities within that current state. It is those burst of improvement opportunities, Kaizen, that changes the focus of designing a facility to fix existing problems to designing a facility that eliminate the problems from occurring.
A final test that HKS had the opportunity to facilitate on the Riley Hospital for Children is scenario testing of the ideal state. Portions of the design were constructed simply on the shell floors to do day in the life testing to validate the design. The affectionately called “plastic hospital” enabled the users to see what they could not see on paper, and that is how they would work in the new design, before the new design was complete. Each department ran 6-8 scenarios from changing of shift to code blue tests on the design to make sure the design supported the operational plan BEFORE construction.
If we simply focus on the goal of eliminating any task that does not add value to the end customer we are taking our first big step. Stop and think about it, how much of what you do really adds value to the end product, or if you stopped doing that task, would value decrease? How can we improve how we work and how our customers work? And did you ask your customer what value means to them?
Often times the waste we eliminate in lean design process improvement does decrease time, it also usually decreases cost. But that is not the goal we should focus on, that is just a bonus. The fundamental reason a lean approach to design should be implemented is to increase value to the end customer. If we as healthcare designers could increase value to the our end customer AND enable that customer to do their job better and change their focus to increasing the value to THEIR end customer, now that would be where the magic happens.