.

Evidence Based Lean Process Improvement in Healthcare

The 2022 Facility Guidelines Institute (FGI) Guidelines recommend that healthcare organizations develop an interdisciplinary design process to guide facility design. The intent of this process is to improve building performance by integrating sustainable design considerations from project inception. Key to achieving this objective is the alignment of operations with the physical layout of healthcare facilities. Lean process improvement, originally developed for the manufacturing industry, focuses on understanding customer value and streamlining processes to maximize it. In healthcare, this translates into optimizing workflows, reducing unnecessary steps that do not add value to patient care, and continuously improving processes to meet the dynamic needs of healthcare delivery. By implementing lean principles, healthcare facilities can improve patient outcomes, enhance efficiency, and reduce the burden on healthcare providers, making it a crucial strategy for modern healthcare systems.

 

 

Comprehensive Lean Process Improvement Plan for a 16-Bed Inpatient Unit: A Retrospective

 Introduction

Creating optimal healthcare environments required a strategic alignment between operational processes and the physical layout of healthcare facilities. This alignment was crucial for enhancing efficiency, safety, and quality of patient care. In this retrospective of the VA Phoenix Inpatient Renovation, we review the application of lean process improvement principles used to redesign a 16-bed inpatient unit, addressing inefficiencies stemming from poorly located support services and optimizing the environment for better outcomes.

Research

The project team utilized secondary research with a focus on A Systematic Literature Review of Empirical Studies on Decentralized Nursing Stations* published in the November 2018 HERD Health Environments Research & Design Journal as a springboard for defining value and through all stages of the integrated lean design process

Defining Value

In healthcare, the primary value was derived from providing patient-centered care that was efficient, timely, and led to high patient satisfaction and outcomes. For the 16-bed inpatient unit, value was defined by reducing staff travel time, minimizing delays in patient care, and enhancing the overall patient experience by ensuring medications and supplies were readily available at the point of care.

Value Stream Mapping

Existing Challenges:

• A centralized nurse station resulted in excessive travel and response times.
• Poorly located equipment, telemetry, and linen supplies caused delays.
• A remote satellite pharmacy and pneumatic tube system increased the time for medication dispensing and lab communications.
• Lack of swing beds during high census.

Implemented Changes:

•    Nurse stations were decentralized to minimize travel distances.
•  Critical support items like equipment and telemetry were relocated to be more centrally accessible.
• Medication storage was integrated into nurse servers directly at the point of care, • eliminating the need for a satellite pharmacy.
• Provision with of four acuity adaptable swing beds. All patient rooms configured to allow for future acuity adaptable configuration.

Creating Flow

Redesign for Optimal Flow:

POD +Alcove +WoW Configuration: Thorough analysis of alignment with value stream mapping, walk-thru of a floor and workstation mock-ups, support and alignment of design and operations was achieved.

 

• Satellite Nurse Stations: Each station was equipped with computer Workstations on Wheels (WOWs), allowing for real-time data access and immediate documentation at the bedside.

• Equipment and Supply Access: Telemetry and medical supplies were placed at strategic points within the unit to reduce walking distances and streamline care delivery.

Establishing Pull

·       • Medication Access and Delivery:

·       By eliminating the satellite pharmacy and incorporating a system where medications were stored within nurse servers at each station, medications were pulled to the point of care based on patient needs. This aligned inpatient services with pharmacy services, where common medications were pre-stocked based on usage trends and specific patient profiles, ensuring that medications were always available when needed.

·       • Responsive Supply Chain:

·       RFID technology was utilized to track usage patterns of supplies and medications, automatically replenishing stocks based on predefined thresholds to maintain optimal levels at all times.

Continuous Improvement

 

• Feedback and Iteration:

• A continuous feedback loop involving all stakeholders (nursing staff, pharmacists, management) was established to regularly assess the effectiveness of the new layouts and processes.
• Regular training sessions were implemented to adapt to new tools and workflows, ensuring all staff were proficient and could provide feedback on further improvements.

Process Outcome Synopsis

The reconfigured 16-bed inpatient unit significantly enhanced operational efficiencies, reduced waste, allowed patient type adaptability and improved both patient and staff satisfaction. By aligning the physical layout with streamlined processes according to lean principles, the unit achieved better patient outcomes through faster service delivery and more effective care. These improvements were pivotal in fostering an environment that prioritized patient safety, enhanced care quality, and optimized resource utilization in a dynamic healthcare setting. Continuous monitoring and adaptation were crucial to sustain these improvements and cultivate an ongoing culture of excellence and innovation.

*Decentralized nurse station typologies diagrams per A Systematic Literature Review of Empirical Studies on Decentralized Nursing Stations