Applying LEAN Design Principles to Healthcare: Making Lives Better, One (Literal) Step at a Time LEAN Design principles have long been associated with the manufacturing industry. Toyota originally pioneered this process for its automotive assembly lines, and LEAN principles have since been disseminated and applied worldwide. Eliminating waste- whether in materials, motions, or time- is a fantastic way to improve production and reduce errors, whether the product is cars or widgets or boxes of cereal. What if, instead of cars or cereals, the “widget” is a patient in a healthcare setting? And instead of eliminating wasted steps to make more things, more quickly, what if the goal is to make that injured or ill person feel better as soon as possible? LEAN principles can be applied to any process, and I believe environments for healing are the perfect place to use LEAN strategies to create authentic, human-centered positive outcomes for patients, their families, and their care providers. Lean methodology identifies eight types of waste that contribute to less-than-optimal production, and these translate from the manufacturing floor directly into a hospital setting. The acronym “DOWNTIME” gives us a handy framework for identifying and eliminating waste, leading to measurable improvements that make a nurse’s day easier or a patient’s experience more comfortable. We can break this acronym down for healthcare as follows: Defects: In the healthcare industry, reducing defects in the process can greatly improve patient safety and potentially save lives. Defects in a medical setting can have grave consequences from hospital-acquired infections to medication mishandling to fatalities, so eliminating defects in systems is critical. Overproduction: On your last visit to a healthcare provider, how many times were you asked to state your name and date of birth? How many pieces of paper did you have to fill out after you checked in? While information gathering is necessary and verification of patient identity is very important, redundancies in the process result in wasted time for the patient and extra work for the care team. Waiting: Waiting for an appointment, waiting for the doctor, waiting for insurance approvals, waiting for test results- LEAN design can help optimize spaces and systems to minimize wait time, freeing up care providers to treat more patients, and patients to get back to their routines more quickly. Non-utilized talent: Ideally, each healthcare professional should be “working to the top of the licensure” for his or her position. When procedures are designed for efficiency, care providers can maximize the energy they spend on patient-care tasks, using their knowledge and training for the decisions which are most important. Conversely, LEAN thinking can help us reduce the time care providers spend on lower-level tasks by finding ways to handle these tasks more efficiently or eliminate them altogether. Transport: In medical environments, continuous movement of patients, staff, and supplies can create wasted steps which lead to wasted time, wasted energy, and wasted effort. Unnecessary movement increases fatigue for the staff and can be stressful (and in some cases, dangerous) for patients. The design team can be instrumental in helping care providers think through required adjacencies and designing units to reduce the need for transport. Inventory: Managing inventory can be an ongoing frustration for a healthcare team, whether the supplies are surgical implements or cleaning products. Optimizing systems for supplies to ensure that supplies are available when needed and accessible with as few steps as possible, but also that valuable medical space isn’t used for unnecessary stockpiling of items and that re-supplying is easy. Motion: In some medical situations, every second counts. Eliminating extra movements can be life-saving in an emergency room or an operating room, so it is especially important that these spaces are optimized with everything at waist-level and within reach. Even in non-emergency situations, the shape and configuration of a medical unit can provide transformative effects on efficiency for physician rounding, wayfinding, and patient care. Excess Production: Everything from filing of duplicative forms to food waste can lead to inefficiencies in the system. At best, these excess efforts are time consuming; they can also drive up costs for everyone involved. Eliminating waste is a win-win-win for providers, patients, and the bottom line. A common misconception is that LEAN design is all about “bean counting” and numbers. While it’s true that we use measurable elements such as steps per nurse or readmissions per patient to identify and minimize waste in the process, we never forget that what we’re measuring has significant impacts on real nurses or real patients. When we can minimize inefficiencies that lead to unnecessary fatigue, undue stress, rising costs, staff burnout, or longer treatment times for patients, we can make incremental, cumulative, positive changes to the process. These changes, step by step, lead to better outcomes for everyone involved. About Esperanza Esperanza Harper, EDAC, Six Sigma GB brings 18 years of specialized expertise in healthcare planning and design. A Six Sigma Green Belt with a Master of Architecture from the University of Michigan at Ann Arbor, Esperanza is highly skilled at design research, design data analysis, lean design principles, and design thinking in service to leading-edge healing environments. She is well-versed in using her strategic insight as it relates to functional programming, right-sizing of the facility, flexibility, and master planning, and is a frequent presenter on patient-centered design at national conferences.