Lean meth­ods trim hos­pi­tal’s con­struc­tion costs

Modern Healthcare - - BEST PRACTICES - By Mau­reen McKin­ney

Four years ago, the lead­ers of Akron (Ohio) Chil­dren’s Hos­pi­tal faced a press­ing ques­tion as they be­gan plan­ning a new fa­cil­ity to house their neona­tal in­ten­sive-care unit, out­pa­tient surgery and other grow­ing ser­vice lines. Should they un­der­take such a ma­jor cap­i­tal pro­ject through tra­di­tional de­sign and con­struc­tion meth­ods, or take a risk and try a new ap­proach that could save money and pro­duce a bet­ter re­sult?

The hos­pi­tal had been us­ing Lean Six Sigma process-im­prove­ment meth­ods to boost qual­ity and re­duce waste in its clin­i­cal and busi­ness oper­a­tions since 2008, even send­ing some em­ploy­ees for Lean train­ing at Johns Hop­kins Medicine. Us­ing a Lean ap­proach to the de­sign and con­struc­tion of a fa­cil­ity seemed like a log­i­cal next step, said Bill Con­si­dine, Akron Chil­dren’s long­time CEO.

“We knew if we did it right, we could put a build­ing up for 20% less cost with­out sac­ri­fic­ing any­thing,” he said. “We said, ‘Let’s do it and let’s not sec­ond-guess our­selves.’ ”

What they ended up with was a seven-story, 369,000-square-foot fa­cil­ity known as the Kay Jewel­ers Pav­il­ion, com­pleted two months ahead of sched­ule at a cost of $180 mil­lion, $60 mil­lion un­der orig­i­nal cost es­ti­mates. “It ex­ceeded all of our ex­pec­ta­tions,” Con­si­dine said.

While most hos­pi­tal lead­ers still opt to con­struct new fa­cil­i­ties in the tra­di­tional way, a grow­ing num­ber of hos­pi­tals are turn­ing to Lean prin­ci­ples to guide build­ing projects, said Dan Heine­meier, ex­ec­u­tive di­rec­tor of the Lean Con­struc­tion In­sti­tute, a not-for-profit based in Ar­ling­ton, Va. “It’s a nat­u­ral pro­gres­sion be­cause so many of them are us­ing Lean in their hos­pi­tals al­ready,” he said.

Akron Chil­dren’s be­gan by as­sem­bling a team of com­pa­nies that would work on the pro­ject, in­clud­ing Dal­las­based ar­chi­tec­ture firm HKS and the Boldt Co., an Ap­ple­ton, Wis.-based con­struc­tion man­ager. Both firms have ex­per­tise in Lean prin­ci­ples. The hos­pi­tal’s lead­ers also chose Welty Build­ing Co. and Hasen­stab Ar­chi­tects, both based in Akron, to work col- lab­o­ra­tively on the pro­ject.

“Our lo­cal con­trac­tor and lo­cal ar­chi­tect had not done Lean projects be­fore, so it was a huge learn­ing process for them,” said Linda Gen­tile, Akron’s Chil­dren’s vice pres­i­dent of con­struc­tion and sup­port ser­vices. “One of our goals was to ed­u­cate our lo­cal trade part­ners so they could sup­port us in fu­ture projects.”

What dif­fer­en­ti­ates Lean projects, Con­si­dine said, is the fo­cus on col­lab­o­ra­tion and ex­ten­sive plan­ning long be­fore con­struc­tion be­gins. That col­lab­o­ra­tive process in­cluded not only hos­pi­tal lead­ers, ar­chi­tects and con­trac­tors, but also front-line clin­i­cians, pa­tients and their fam­i­lies. “The key to this process is the front-end plan­ning,” he said. “It looks like you’re not do­ing much of any­thing for a long time. But ac­tu­ally, you’re do­ing ev­ery­thing.”

In a lo­cal ware­house, the team built full-scale card­board mock-ups of each floor of the new fa­cil­ity. That al­lowed clin­i­cians to sim­u­late pa­tient-care sce­nar­ios and see first­hand whether the planned spa­ces worked well. The de­sign and con­struc­tion team then was able to make ad­just­ments that im­proved pa­tient and staff flow.

Based on those sim­u­la­tions, the de­ci­sion was made to con­struct six op­er­at­ing rooms rather than the pro­posed eight—at a sub­stan­tial cost sav­ings. The de­sign team also changed the place­ment of emer­gency depart­ment en­trances to avoid con­ges­tion, cre­ated al­coves in hall­ways to keep equip­ment out of the way, and added win­dows to pro­vide plenty of nat­u­ral light.

Boldt and the other com­pa­nies ne­go­ti­ated shared pay and in­cen­tives ahead of time, said Dave Kievet, a Boldt group pres­i­dent. That way, any ad­di­tional ex­penses raised the hos­pi­tal’s to­tal bill but pro­vided no ad­di­tional profit for the com­pa­nies.

The de­sign and con­struc­tion team was able to trim more than 34,000 square feet of build­ing space from the orig­i­nal plans, he said.

Once con­struc­tion be­gan in mid2013, the work­ers used the so-called train-car method to en­sure the build­ing process flowed smoothly. Each floor of the fa­cil­ity was di­vided into four sec­tions, and a sin­gle crew—for ex­am­ple, elec­tri­cal—worked ex­clu­sively in one sec­tion, per­form­ing a pre­de­ter­mined amount of work per week. “We tried to pace the pro­ject so it moved as fast as the slow­est worker and we could avoid stops and starts,” Kievet said.

The process was not with­out chal­lenges, es­pe­cially be­cause it en­tailed such ex­ten­sive plan­ning and col­lab­o­ra­tion among so many dif­fer­ent groups. “But it was worth it,” Gen­tile said.

The new fa­cil­ity opened May 5. “We’re so pleased with the end re­sult,” she said.

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