Lean Healthcare Design - The Intent
Before going into the principles of lean healthcare design, it is important to look at the Intent of lean healthcare. What is the motivating power or influence that drives all individuals to seek better, more efficient ways of doing their work? This intent is the heart that pumps the blood into all of the various components, processes and participants in the healthcare field. This intent is more primal than the mission statement. The mission statement identifies the goals of the organization and brings forth the attributes of leadership and process to attain those goals. The mission statement is an organizational target or statement of truth that all individuals can focus on and drive towards in a united way. The intent is individual, personal. It is the 'Why I do this', that primal, core value decision that surfaced in your heart a long time ago and gives breath and appetite to your motivations and drives that shaped your reason to reach out and lay hold of those higher callings and purposes.
We hear a lot about the intent of the founding fathers in writing the constitution, what is their intent, and how do we identify it to give us a framework to view these current issues we are trying to resolve? What was the over-arching, ultimate intention that caused them to see the possibility of this nation and set the means into place to accomplish those ends? They saw inalienable rights that transcended the role of human government and that when these rights were conferred upon society they would lift up that society to its highest potential. And the reality of this mission statement of 'life, liberty and the pursuit of happiness' finds its fullest expression in the personality of every individual as when the heart pumps the blood to reach and nourish every cell.
Am I comparing lean healthcare design with the founding of this country? Well...not exactly, but then again, there is a quality to healthcare that is unique among the other professions. The Hippocratic oath sets two special objects or ideals before the physician in regards to disease, namely to do good and to do no harm. And the extents of doing good and doing no harm continue to expand beyond the treatment of disease. Research, technology, clinical processes continue to penetrate into the heart of this ideal for the patient from treating the symptoms to seeking to eradicate the causes and transforming lifestyle choices. Then the dark side of the moon came into view. Insurance and reimbursements, malpractice lawsuits, regulations, economics and the entire host of other issues the healthcare field has to contend with because one party's good is another party's harm. The ultimate intention that inspired so many young people to enter into the pursuit of promoting the health and well being of others began to be smothered by an obese system that seeks its own self-gratification.
The term 'lean' originated in the manufacturing industry in their efforts to battle their own form of obesity, which primarily revolved around eliminating waste and re-engineering the system to be more productive in every regards, to do better and provide a better product. In a certain sense, it is a modification of the Hippocratic oath, to do good and to do no harm. And deep in the heart of this was the intention to promote the good of all parties. It went from the quality of the product and its value to the client to the environment of the factory and the intrinsic value of the employee. It moved into the relationships with the suppliers and vendors, the transportation of materials, even better ways to load a truck to get better gas mileage. Each heartbeat of this intention flowed with the words of Florence Nightingale, "We can do better" to redeem time for better purposes and reduce waste to further outputs. The process was continually improved because the focus was not on their own self-interests but upon improving the value of their services for the sake of others, and through that intention the rising tide lifted all ships.
The desire or intention to promote the well-being of others is the essence of health. To seek to be fit, lean, healthy, strong and beautiful for your own sake only consumes the resources of others and in the end leaves another hole that needs to be filled, another breach that needs to be repaired. The driving force in the lean intention is to truly provide that which is of the utmost value to the client, to bring to light the ends and goals the client is striving towards and to establish the means by which to secure those ends. "Lean healthcare design' is a statement that encompasses the entire reasoning of the leadership team in setting forth policies and procedures that harnesses all of the resources in the world around them to promote the good of all parties. The focus may start with the patient and improving their outcomes, but because healthcare is a truly 'living profession' it must spread throughout the entire organization and system.
The simple path of a patient through the ER touches everything and at any one of these points of contact a compromise in the health of the organization can bring a compromise in the outcome of the patient. The delay of the physician in seeing the patient. The entry of information into the EMR. The lack of supplies. Locating the equipment. Infectious contamination in the air. Contradictions of medications. Tired staff. Poor lighting. The color of paint on the walls affecting the skin hue. Doing good and doing no harm to the patient must extend also to the well-being of the physicians and their access into and through the facility, their having the tools, resources, information etc at hand, as well as every other component that has a direct or indirect point of contact with the patient. And equally important in all of this is eliminating all other activities and components that have no value in contributing to the well-being of the patient... and all other parties. It is the same process as pruning away leaves and cultivating fruit.
Seeking to mandate this through greater, and more detailed requirements, more sophisticated technology and software can create even more waste and take away true value to all parties. It cannot be engineered through behavior modification. It is the intention, that wellspring of life in the hearts of all parties, that needs to be released. This intention will establish immediate ends and long term goals and reach out to make things happen. There is a tremendous responsibility on leadership to define those essentials, strengthen those policies and procedures, transform the layout and function of the facility, and provide the tools and resources that creates a framework for every party to flourish in its own capacity. One of the elements of lean design is the concept of 'pulling' as opposed to pushing. A proper framework is one which 'pulls' the best out of the system, again in the analogy of fruit bearing, it is the pulling of the earthly elements into the roots and through the branches and into the buds to bring forth fruit.
As said before, the healthcare profession is a 'living profession'. Every activity in the physical facility and of the operational organization is a flow of activity, information and substance. Every activity is not only networked into the entire facility and organization, it is networked into the greater environment and landscape in which the hospital is located. Lean healthcare design is fundamentally concerned with these flows. The essence of health for the organism is the flow of process of every system, whether it is circulatory, digestive, communicative, respiratory, etc. The body does not exist in a state of inertia but in continually bringing in outside resources, whether stimuli or substances, and processing them through all of the internal flows into tangible actions. The intention of the body will heal itself, providing the systems are operational and healthy and intelligent choices are made by the reason to secure the right and proper external resources.
This is the intent of lean healthcare design.