A Lesson From Patients, written by Tammy Smith Thompson, NCARB, EDAC

As the Institute continues to expand its reach, I have been fortunate to participate in a number of opportunities in which I have learned from patients. Earlier this year, I attended "Hospitals and Communities Moving Forward with Patient- and Family-Centered Care: An Intensive Training Seminar" hosted by the Institute for Patient- and Family-Centered Care (IPFCC). This seminar, which is offered twice per year in various locations, was designed on a smaller scale than IPFCC's annual international conference. With about 300 attendees, this seminar is the ideal environment for its participants (comprised of healthcare executives, senior leadership and other administrators, clinicians, healthcare professionals, consultants, innovators, patient and family leaders, patient experience specialists and other stakeholders in the healthcare system) to engage in meaningful dialogue on the improvement of the patient and family experience from a wide range of perspectives.

As a patient advocate, I was particularly moved by a session entitled "Learning from Patient and Family Stories." This plenary session enabled all seminar participants to listen to a diverse cross section of personal accounts by patients and their families of memorable healthcare experiences. I thought the stories were invaluable, particularly for professionals who are in a position to make decisions that influence the patient experience, but may not have regular access to patients in order to learn firsthand about their needs. With representatives from many different organizations and professions in the room (including over 100 nurses, 25 physicians, 40 patients and family members from 100 organizations across the U.S and abroad), I am certain that the messages taken away from this session were quite diverse. I left with the following messages from their stories:

1. Patients want to be treated as individuals, with consideration of who they are outside of the medical conditions that bring them in for treatment. Whether a newlywed, a business professional, a mother or grandparent, the patients made it clear that the normalcy of their lives mattered. They wanted the caregivers to respond not only to their medical conditions, but also to their personalities that make them individuals, not numbers. One patient felt most comfortable when she was able to bring her work in during treatments.

2. Patients were equally, if not even more concerned about the family members who were their partners in care. They wanted these important team members to be well-informed, comfortable, and treated with respect. When reflecting on the kindness shown to his new bride, one patient remarked, "I knew that I was dealing with people who were not just looking after me, but the 'rest of me'."

3. Patients appreciate due diligence performed not only by front line medical staff, but also from other staff members who may have an impact on their care. In the words of a patient, "When you pick up that file, it is just as important as when the surgeon picks up the scalpel, because until you do your job, he can't do his[job]."


These messages have been echoed in my interviews with patients and participation in patient focus groups. Later this year, we will have the opportunity to explore design strategies for engaging patients and their families. Our Patient Experience Simulation Lab, which will be introduced at the 2012 Healthcare Design Conference, will enable patients and patient advocates, clinicians, other healthcare stakeholders and designers to gather in small groups inside a full-scale model of an inpatient room to discuss common design decisions that create obstacles for patients and to brainstorm for solutions. We hope you will join us for this exciting learning experience. In the meantime, let's all keep our eyes and ears open for the opportunity to learn from patients and their families!

Lean Design is Patient Centric!

In my role as the co-chair of the American Institute of Architects (AIA) Academy of Architecture for Health (AAH) of Georgia, I serve as one of the organizers of this group’s quarterly events.  During the planning stages of the most recent event, we administered a survey to the AAH of GA mailing list of healthcare designers and allied professionals to allow them to select the topics that they consider important in the profession.  I was not surprised to discover that the majority of our group's participants were most interested in learning about lean healthcare.  As an architect, I find that more and more designers are seeking information on this subject to respond to the needs of their clients and to become well versed on an emerging design consideration in healthcare projects.  

Last month, Herman Miller Healthcare presented an AIA registered Continuing Education lecture during AAH of Georgia’s quarterly meeting in Atlanta.  The lecture was delivered by Roger Call, AIA, ACHA, LEED AP; Director of Healthcare Architecture and Design for Herman Miller Healthcare and presented by Herman Miller Healthcare in Atlanta. 

Call explained to the group that Herman Miller has entered into a mentorship relationship with Toyota in order to learn about its lean processes (although Toyota doesn't call it lean) with the intent of implementing a similar system for its operations.  He went on to explain the core concepts of lean, what lean is not, and how it relates to healthcare clients. 

According to Call, lean design is a system that focuses on understanding and meeting customers' needs through engaging and investing in the development of employees.  He explained that its goal is not to eliminate jobs, but rather to identify waste and inefficiencies in an assembly line process model and to empower every member of the team to contribute to successful outcomes, getting what they need, when they need it, in the correct amount, thereby eliminating waste. 

Roger Call highlighted seven forms of waste, giving healthcare examples for each.  Many of his examples are summarized below.

1.  Over production:  Scheduling all patients to arrive at one time

2.  Waiting:  Caregivers required to wait for the necessary tools to provide patient care

3.  Conveyance:  Transporting patients, equipment and supplies

4.  Process:  Numerous schedules in systems that are not in sync

5.  Inventory:  Wrong supplies in the wrong locations

6.  Motion:  Inefficient travel distances or unsafe movement for caregivers

7. Correction: Unnecessary time and expense to resolve a problem created by a flawed process, such as medical errors

As I listened to these examples, there seemed to be an apparent relationship between the forms of waste and the common obstacles that lead to patient frustration and dissatisfaction.  As an advocate for thoughtful patient-centric design, I found it quite refreshing that such a thoroughly tested, well-defined process is currently being implemented in health facilities.  This not only positively transforms the operations of health systems, but it also supports improved patient outcomes and patient satisfaction.  

Herman Miller Healthcare identifies lean as “a system that focuses on understanding and meeting our customer’s needs exactly through the engagement and development of our employees” and a “system that seeks and enables higher and higher levels of performance through thinking and learning (Call, 2012).”  This strategy can be embraced by healthcare designers, developing solutions that allow each member of the healthcare team to perform to the standards that today’s patients expect.  In essence, lean healthcare design is also patient-centric, offering a structured approach for positioning patients’ needs in a healthcare project and maintaining momentum with continuous evaluation of its success.  This is a promising step forward that will surely benefit our patient-end users and the entire care team! 

Institute for Patient-Centered Design offers 10 Principles of Patient-Centered Design developed as guidelines for the design process.  To view these principles, please visit www.patientcentereddesign.org/fordesignprofessionals. For more information on Herman Miller’s work in lean healthcare, please visit www.hermanmiller.com/research/solution-essays/lean-healthcare.html.

References:

Call, R. (2012) “Lean Design in Healthcare Facilities.”  AIA AAH of GA Quarterly Networking, Continuing Education Event.

Other Resources:

o     To view the report that sparked the movement to reduce medical errors, see Institute of Medicine, To Err is Human, http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx

o     For more information on patient dissatisfaction, please view http://intqhc.oxfordjournals.org/content/20/6/412.full.pdf+html

o     For more information on healthcare quality standards, see

·            The Joint Commission, http://www.jointcommission.org/

·            Agency for Healthcare Research and Quality (ARHQ), www.arhq.gov

 - Tammy S. Thompson, NCARB, CLC

Institute for Patient-Centered Design, Inc.