Book Review: Lean-Led Hospital Design: Creating the Efficient Hospital of the Future

Lean-Led Hospital Design: Creating the Efficient Hospital of the FutureNaida Grunden and Charles Hagood, MBA. (2012). Boca Raton, FL: CRC Press, Taylor and Francis Group. Hardcover, 338 pages. ISBN-10: 143986828X; ISBN-13: 978-1439868287In June 2012, a group of CEOs from some of the most innovative healthcare organizations in the country issued an Institute of Medicine (IOM) discussion paper offering a CEO Checklist for High-Value Health Care (Cosgrove et al., 2012). The purpose of the checklist is to provide CEOs and their boards a guide for making sustainable transformation toward continuous improvement in the changing landscape of healthcare. The checklist is supported with case studies and experiences from their own organizations, including references to Lean and the Toyota Production System. So it is significant that several of the participants in the IOM discussion paper are also leaders of the hospitals whose case studies appear in this book by Grunden and Hagood.As we move into the immediate future, performance will be a key determiner of value for healthcare organizations and the facilities that support them. Finding value is going to be an increasingly critical role for designers of healthcare environments as the industry addresses growing policy and market pressures to improve quality and significantly reduce cost while maintaining high levels of patient and staffsatisfaction. During the past two decades the healthcare environments research and community has learned much about what works and why. Meanwhile, in the search for value, some healthcare organizations have successfully adopted a Lean philosophy and implemented operational changes with demonstrable results. These organizations now experience a steady stream of inquiries and visits from other organizations, curious about how they've adapted a manufacturing philosophy to healthcare, and what performance gains have realized.To create facilities for high-value healthcare, designers need more than a passive understanding of how care is delivered. Which brings us to the core message of this book written by a Lean Healthcare writer and Lean Healthcare Practitioner: Lean can inform the of healthcare facilities through active collaboration by care delivery designers and facility designers. This book is an introduction to what may be an emerging model of interdisciplinary design. It is a book that aspires to influence and move the industry in a new direction, to address years of process workarounds and poor space utilization. It is a practical book. And it opens the door to a conversation about the roles and relationship of Lean Healthcare and evidence-based (EBD).We learn that Lean is first a management philosophy. It is more an operating system than an isolated project or a set of tools. It uses a structured approach to continuous improvement through exposing and solving problems and removing waste in systems. The objective of Lean-Led Design is to a facility that paves the way for non-value-added activities to be removed from the processes and systems and hence out of the building. This book succeeds in making a case for the potential of Lean to inform architectural design. But as for leading design, the case for Lean is not as strong-in fact some of the case studies are instead examples of collaboration between Lean and architecture, which is the direction in which I believe we are headed. A similar thought was expressed in a recent Center for Health Design blog post about Lean and EBD, stating they should be considered symbiotic approaches to achieving better design (Marberry, 2012).If there is a Lean wave sweeping the industry, the success stories coming out of Virginia Mason Medical Center, University of Pittsburgh Medical Center, Seattle Children's, and ThedaCare are providing momentum. Even so, Lean is just getting started. It is estimated that only a small percentage of hospitals have full Lean deployment as a management philosophy. …