Finding Architecture to Apply Lean Workflow in Acute Care

• Redefining the Problem in Healthcare: While capital costs can be daunting, at less than 10% of the annual healthcare spend, they are not the primary reason our healthcare spend in this country is greater than the entire economy of Germany. Looking at the big picture, staffing represents over 70% of our costs. What are the fundamental issues that cause this and what might be done to change this? What role might architecture play in facilitating change?

• Borrowing from the LEAN experts: Lean is a name used to describe dramatically improved manufacturing processes intended to minimize waste. In the healthcare industry, it is being applied through several strategies. Most efforts, however, tend to be too granular. Kaisen, six-sigma, and CQI tend to focus on streamlining processes, but fail to challenge the reason why the process exists in the first place. We are implementing a process referred to as LAMDA (Look-Ask-Model-Discuss-Act). The strategy of LAMDA differs greatly from more granular processes and provides the industry an opportunity to think more globally. How does this concept work? How have we implemented it?

• The Sutter Health Prototype Hospital (Next Generation Hospital): In a collaborative development process, Sutter developed a facility based on optimized workflows to improve workflow efficiency (resource use by 40%, decrease space per unit of capacity by 30%, decrease costs per unit of capacity by 50%, and decrease our dependence on fossil fuels per unit of area by 25%. What did we learn? What do we think we have achieved? How could we achieve such dramatic metric improvements? Did we compromise on the quality of care? In developing our optimized models, we borrowed a concept from manufacturing which we have called "cellular care." What is this and how is it different from legacy hospital thinking?

• Improving the Project Delivery Process: Waste is the bane of any industry. Since the prototype initiative sought to remove waste, we also believed it was essential to look at project development and remove the waste from this process as well. Key strategies include practical implementation of the five big ideas of lean: collaborate, really collaborate, increase the relatedness of the participants, develop a network of commitments, optimize the whole-not the pieces, and tightly couple learning with action. Among the practical changes we have made, we regularly use the Integrated Form of Agreement (one agreement between owner-architect-CMGC), Target Value Design, design collaboration, and Last Planner Scheduling. How are these strategies helping eliminate waste?

About the Speaker

David Chambers, Strategic Facility Planner, Sutter Health System

A registered architect and the Director of Planning Architecture and Design for the Sutter Health System, Mr. Chambers has devoted the majority of his 30-year professional career to the healthcare field.

For over twenty years he has evolved architectural planning concepts through envisioning optimized patient flows as the value stream, driving out waste and enhancing quality outcomes. He has developed this approach by bringing together high-level multidisciplinary care teams to map these flows. This planning approach has been recognized for its high value outcomes both nationally and internationally.

In addition to overseeing several billion dollars of planning implementations for both acute and ambulatory care centers, Chambers is named as a source for the Healthcare Advisory Board and the Rice Building Institute. He consults with international healthcare authorities, presents at national symposiums and international congresses, and was named one of the "Twenty who are making a difference" in HEALTHCARE DESIGN Magazine. His planning concepts have led to "one-stop" patient intake centers, integrated interventional services platforms, and deeper implementation of acuity adaptable inpatient nursing platforms.