2. • Bachelor of Architecture
Philadelphia University
• Bachelor of Science, Interior Design
Philadelphia University
EDUCATION
CERTIFICATIONS
• AIA
• Lean Six Sigma Black Belt
• Lean Green Belt
JONATHAN Bykowski
Principal & Practice Leader, Continuous Improvement
3. • Master of Engineering, Healthcare Systems Engineering
Lehigh University
• Bachelor of Arts, Architecture
Lehigh University
EDUCATION
CERTIFICATES
• Lean Bronze Knowledge, SME
LAURA Silvoy
Healthcare Systems Engineer, Associate
5. provides a way to do more with
less, create new work and deliver
value as defined by the customer.
LEAN
It’s not just for Toyotas, or
Hospitals, or everyone but
Architects.
8. Solution
• We can design
flexible spaces to
support future
growth
• We can save
money by building
8 flexible rooms
instead of 12
single-purpose
rooms
WOULD IT WORK?
13. Design Analysis SPACE UTILIZATION
Scheduled
Appointment
Time
Scheduled
Appointment
Time
(50% Volume Increase)
+/- 10 Minute
Appointment
Time
+/- 10 Minute
Appointment
Time
(50% Volume
Increase)
Average patients
seen each day
31 59 31 59
Rooms in use at 9:36
AM on Day 1
3 10 3 5
Maximum number
of rooms used at
same time on Day 1
8 15 10 15
Average waiting
room utilization
44% 79% 50% 83%
Average maximum
registration queue
length
1.3 2.6 1 2.8
Average maximum
check out queue
length
1.6 5.1 1.1 2.6
Name
Total
Entries
Average Time Per Entry
(Min)
Maximum
Contents
Waiting Room 3446.6 18.5 29.2
Patient Exam 1 470.5 33.3 1
Patient Exam 10 341.6 37.2 1
Patient Exam 13 335.4 40.8 1
Patient Exam 11 334 37.6 1
Patient Exam 2 331.9 33.0 1
Patient Exam 12 297.7 46.5 1
Patient Exam 9 230.5 38.8 1
Name
Total
Entries
Average Time Per Entry
(Min)
Maximum
Contents
Waiting Room 3440 6.6 29.7
Patient Exam 1 496.4 47.1 1
Patient Exam 2 464.6 46.5 1
Patient Exam 3 417.1 47.0 1
Patient Exam 4 363.9 48.9 1
Patient Exam 5 320 48.5 1
Patient Exam 6 270.2 48.3 1
Patient Exam 7 228.3 47.6 1
Scheduled
Appointment
Duration for 31
Patients
Scheduled
Appointment
Duration for 59
Patients
Rooms Dedicated to Specific Clinic
Rooms Shared Among All Clinics
Jonathan
I am a healthcare architect. I have degrees in architecture and interior designer. I have green and black belt certifications in Lean and Six Sigma. I clearly have a thirst for knowledge, and a serious control issue. I am the practice leader for continuous improvement at Array Architects and have been for about two years. But that’s not where this story begins.
Jonathan
Jonathan
Jonathan
Lean is a conceptual approach to thinking about systems, identifying problems, and improving them. It is a philosophy about people and process, not simply a manufacturing tool or applicable only to repetitive micro processes.
Jonathan
About a year and a half ago, our client approached us with a challenge. As a result of some extreme success in their business, they were poised for a large national expansion, but wanted to completely reconsider the way they were doing business. While they are a for-profit healthcare provider, which comes with all the bottom-line driven decisions one might expect, they were seeking to be much more patient-centric providing the utmost comfort for their patients and their families --- objectives not typical of for-profit institutions. So much so, they were seeking to be the first “Planetree designated” for profit health provider in the country.
Jonathan
The client’s current state of operations was not in alignment with their goals. Their existing facilities had grown organically over time – leading to inferior work environments and inefficiencies. We needed to address both increased efficiency and increased patient amenities. And we needed to do it fast: their plans for expansion included opening 3 new sites per year. They themselves are a very data-driven organization: they actually track the origin of all calls from across the country, map them, and then target their next expansion project for the regions with the greatest concentration of calls.
Laura
Designed a solution and wanted to validate it.
Needed to validate because we were going against guidelines (8 flexible rooms instead of 12 recommended rooms)
Laura
Did observation and documented the current state process
Nurses were already collecting data through the EMR and some analysis was done in the past
They passed the data onto us and we were able to distill it down and analyze the major process steps
Main goal was to minimize waiting time between OR and Recovery
Designed and built a simulation model to represent the actual system. Tested and validated it. Changed it to match proposed plan
Planned space works! Best option is to have 8 flexible rooms with 3 ORs and 2 surgeons
Simulation helped validate the building design. One way to use it. Let’s explore it’s use during the design process.
Jonathan
A leading academic institution with several physician clinics spread across different sites on campus wanted to bring together those with opportunities for care coordination synergies
Jonathan
Three separate clinics operating in three separate parts of the hospital
Each had different problems – not enough waiting space, not enough rooms, not enough space for residents
Client thought they needed as much space as they could possibly get out of this renovation
Laura
Resulted in an initial design with 14 exam rooms and waiting space for 52 patients and 4 strollers or wheel chairs
Not enough! Still wanted more waiting! Also thought that there should be more rooms because the rooms were to be dedicated to each clinic
Laura
Collected data using paper forms at each clinic. Some clinics were better than others at collecting the data. Also used appointment data from the EMR
Model was developed so that rooms would be shared among all three clinics, but remember, our client wanted to assign exam rooms to each clinic.
When exam rooms are assigned to a clinic, waiting time triples from 6 minutes to 18 minutes
Waiting room volumes never exceeded 30 people (patients and caregivers combined)
Variation in arrival times compared to appointment times help keep the registration queue shorter
When volume is increased 50%, room utilization, as expected, is much higher
Laura
Still want to keep 14 exam rooms to stay flexible
Able to reduce waiting space and provide a staff lounge
Simulation proved that there was enough space for everyone to wait and there could be a space for staff to relax
Jonathan
With more than 100,000 visits per year, this pediatric ED was overwhelmed with ALOS of more than 5 hours. Believing their bottleneck came at the front end with a spit flow for triage and assessment the wanted to renovate the ED to increase the number of triage rooms and combine assessment.
Jonathan
They thought there were too many steps on the front end
Wanted to combine steps to make things quicker. The idea that fewer patient steps would be faster seemed to make sense.
Before designing a ____ SF renovation we wanted to be sure the basic planning driver held water
Laura
Received data from the hospital’s lean department
Developed basic simulation model based on current process and data.
Added some variability to the data to the model and confirmed with the nurses and physicians that it was reflecting their current operations.
Laura
After confirming the model’s accuracy, we changed the model so it would reflect the desired future state.
Results are in: ED must staff 2 security staff and 6 triage rooms at peak volumes to keep waiting time under 5 minutes
Laura
Managers decided that they cannot commit to staffing 6 triage rooms at peak volumes.
What’s a better way to do this?
Do a quick registration at security and try moving assessment to the treatment room and only doing traditional triage upon arrival
With these changes, registration takes a little longer, triage is a little quicker
Now we need 3 security staff and 5 triage rooms at peak volumes –Staff managers are ok with this
Jonathan
Decreasing the number of triage spaces allowed for more space dedicated to treatment rooms in the ED
Jonathan
We don’t have to know the answer before the meeting begins (as we are so used to being expected in our role as our client’s problem solvers). We assemble a team of experts. The people who actually do the work, and then follow the steps to understand the problem, what’s happening currently, what we want to happen, and why that isn’t what we do. Its almost magical to watch. Consensus and discovery run rampant in the first work session and the team often rapidly focuses in on a path to improvement. I could come up with a proposed solution for every problem that comes across my desk, but they would be half as sustainable and viable as the solutions the cross functional teams develop.
