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Architecture and Lean: Increasing Efficiency Through Institutional Design

By R. Cameron Shantz, Director, Parkin Architects Limited

Did you know 22,000 checks are deducted from the wrong bank accounts every day? Or that 16,000 pieces of mail are lost by the Postal Service every hour? How about the fact that there are 500 incorrect surgeries completed per week? And 2 million lost IRS documents in a year?

At Parkin, we believe zero defects is the only acceptable standard; and Lean design will take us there.

What is Lean?

Lean is a system first developed by Toyota to relentlessly eliminate waste in its productions. Lean design is focused on providing value to the end user. It’s based on improving quality and productivity of everything that is done. Today, Lean is used to shape the future of all industries, especially healthcare.

Canadian healthcare providers have the potential to save millions of dollars by implementing Lean principles and processes in the earliest stages of hospital design. Contact us to learn how.

Lean is NOT a method to downsize the organization. Nor is it a top down strategy. It’s not about working harder; rather, it is about working smarter.

Parkin participates in, facilitates, and runs the Lean process design for clients. Our day-to-day focus is on designing and developing effective environments for users. We aim to help clients streamline processes and be more effective at what they do.

Lean Concepts

Lean principles are dedicated to achieving perfect workflow. This means getting the right things in the right place at the right time and in the right quantity.

There are five principles of Lean thinking:

1. Specify value from the standpoint of the end customer.
2. Identify all steps in the value stream, eliminating steps that do not create value.
3.Make the value added steps occur in a tightly integrated sequence so work flows smoothly.
4. Let customers pull value.
5. Pursue perfection through continuous improvement.

Lean Tools

Lean work redesign is facilitated by a set of standardized tools, which were established by Toyota and have since been refined specifically for the healthcare field. These include:

Value Stream Mapping
A set of actions to bring a product through three critical management stages of a business (problem solving, information management and physical transformation).

Standardized Work
Work must be analyzed in order to define the best way of doing a task or process. It’s about working in the same efficient way every time, and reducing errors in the system.

Visual Management
Makes waste, problems and abnormalities visually apparent to the users. Follows the 5S list: sort, store, shine, standardize, sustain.

Kanban/Pull Systems
A visual method for managing supplies and inventory. It is used to reduce space for storage of unnecessary materials, reduce costs of stocking more supplies than needed and it ensures stocking out does not happen. There are two Kanban systems: the Two Bin system and the Kanban Card System.

5 Whys
A powerful tool to get to the root cause of a problem. The idea is to ask “why?” five times. This is especially effective in group settings. Examples of questions would be:
a)    “Why did the specimen arrive at the lab unlabeled?”
b)   “Why did the nurse walk back to the computer at the nursing station rather than use the mobile computer?”

Spaghetti Diagrams
A tool to map how a process or workflow is conducted. This is used to improve workflow and take the waste out of the process.


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