Array Advisors Insights

Undercover Transformation: Overcoming Process Obstacles Using Lean

Posted by Guest Contributor on May 11, 2016

Prior to the conceptual design phase for an ICU expansion, the project architect engaged me to review the client’s existing drawings. The client was looking to duplicate the existing design, and the architectural team wanted a consultant’s opinion. At the time, I worked for a construction company as the Director of Healthcare on many of the client’s previous projects, forming a familiarity with the architect. He knew my background as a nurse and believed I would go the extra mile when reviewing the drawings.

Despite the challenges, nurses have been responsible for some disruptive innovations in healthcare design. From pioneering single-occupancy maternity rooms to devising the design of private rooms for NICUs and leading the charge for acuity adaptable patient rooms, nurses contribute great value to the planning, design and construction of optimal healthcare spaces. This made identifying with staff and getting their honest, transparent feedback challenging for the architectural team.

After a thorough review, I knew I could provide some insight, but noted that I could add more value for the client if I spent time with the staff to observe and interview them. This would give me a clear understanding of their processes, enabling me to provide a more robust analysis.

Undercover NurseUpon entering the facility, prior to transformation planning, broken paradigms were unapparent to the untrained eye. My background working in critical care areas, as an ICU and combat casualty nurse, helped me earn the staff’s trust. They knew I was one of them. By dressing in scrubs, observing a day and night shift and interviewing staff, it became apparent to me that there were many boulders to overcome with dammed-up streams interfering with smooth flow.

When interviewing staff for candid recommendations, I learned that they were walking great distances to access supplies and deliver care. This minimized the time they spent at the bedside. One of the more notable process bottlenecks was the location of the soiled utility room.

The soiled utility room was not only located at the opposite end of the facility, away from the patient rooms, down a hallway adjacent to a family waiting area, but also oriented in the opposite direction of the workflow. This caused nurses to walk past the door, which opened into the hallway, pull it open with gloved hands and prop it open with their hip; all the while trying to reach into the laundry hamper, open the laundry shoot door and dispose of the soiled linens.

While those waiting in the family area adjacent to the soiled utility room received an eye full of soiled sheets, the family and visitors in the waiting room located in close proximity to the nurses’ station got an ear full of confidential information, compromising privacy. Those in this waiting area could also potentially overhear disappointed grumbling around the recruiting and retention problems.

Had the client duplicated their existing ICU design in the expansion, they would have also duplicated the existing problems uncovered during my  in-depth shift observations. By evaluating these broken paradigms; incorporating revisions; and enhancing approaches to workflow, operational process and intended usage, we began laying the foundation for transformation.

By subtly redesigning the floor plan, tightening adjacencies, and creating a pass-through for an enhanced workflow, we were able to design an optimal workspace. The new design positively affected staff, patients, family and visitors by eliminating waste. Staff morale was notably brighter as staff embraced streamlined workflows borne of empathetic listening, which enabled successful retention and recruitment efforts.

Blog authored by Mary Ann Derr, Array Advisors' former Transformation Services Advisor.

Topics: Lean Operational Improvement, Transformation, Guest Post