Going Forward: A Lean Way to Design

Abstract

That's not what I meant. Generally speaking, this phrase does not mean the end of the world, and the affected parties can quickly come to terms and remedy the misunderstanding. In the world of design, how- ever, such a phrase can imply disaster for the designer and client, if not resolved early enough in the process of a building project. And in the history of design, this phrase is probably heard more often than many designers are willing to admit.As with many areas where inspiration evolves organically with the passing of time, the world of design and build is undergoing a renaissance. New tools and approaches, including patient-centered design, computer simulation and itera- tive data-driven design are being applied in the healthcare setting, and this issue of HERD is dedicated to examining them. In each of these thought-provoking articles, we challenge conventional approaches to design-and conventional wis- dom-and offer new techniques that promise to create more effective environ- ments in which to practice and receive care.The idea that conventional wisdom must be challenged in the world of design grew from the very successful application of Lean and Six Sigma principles in hospital operations, dating back over a decade. In 1999, nobody in healthcare had heard of these methods, and it might not be unusual to hear in the halls of the hospital is Sigma and why is she sick? Today, two separate studies, one by the American College of Healthcare Executives and the other by the Ameri- can Society for Quality, indicate that over 40% of hospitals have applied Lean and Six Sigma to improve quality and reduce costs.My own experience with these methods has been consistent with industry. In 2000, I earned a Blackbelt in Six Sigma and went about helping hospitals to realize their full potential in operational, workflow and quality changes. Unfor- tunately, even the smallest amount of data can be intoxicating to managers, who are often quick to conclude that they understand the root cause of performance problems. Executives were absolutely convinced they knew how to improve pro- cesses and many initiated performance improvement efforts with a solution in mind. The industry became replete with examples of performance improvement efforts that actually had a deleterious effect because they were based on flawed data. It would take another several years before the industry realized that for data-driven design to work, it must demand accurate data, patience, and the ability to surrender to the process of discovery before rushing to solutions.Fortunately, such patience has paid off. In a study conducted by Creative Health- care including over 150 projects conducted by 10 healthcare systems over the past 10 years, Six Sigma projects were shown to yield an average return on invest- ment (ROI) of 7:1. With this compelling evidence to embolden us, it's time to take these methods as far as they can go.How does one begin the process of undertaking a Lean or Six Sigma journey in an environment where such concepts are potentially new and unproven? A research paper offered by Maartje van Reedt Dortland et al. in this issue of HERD discusses the findings from an exploratory survey with options for con- struction that facilitate understanding of the contemporary view of available options, while another research paper by Vanessa Okken et al. …