A Waste-Free Approach to Healthcare

David Schlappy implements lean design systems for the construction of the new, $346-million Reading HealthPlex for Advanced Surgical and Patient Care

The concept for the new Reading HealthPlex for Advanced Surgical and Patient Care was conceived in 2010, two years before David Schlappy came on board at Reading Health System. As it turned out, however, a discussion that the current vice president and chief quality officer had with executive leadership would set the course for the eventual design and functionality of the tower—a $346-million expansion project that opened in the fall of 2016.

Prior to joining Reading Health, Schlappy worked with another hospital expansion using a process called lean design. Leadership at Reading Health gave Schlappy the greenlight to bring in lean consultants to meet with the executive team and put together a sound proposal. The consultants conducted preliminary walk-throughs, data collection, and interviews to assess the situation. Based on what they learned, they determined the workflows that would benefit from the lean approach. From there, a steering committee organized project teams and began scheduling process redesign meetings.

The concept behind lean, in simplistic terms, is to design space and processes with an eye for reducing, if not eliminating, waste. The goal is to boost the efficiency of the hospital and its workers, a benefit which trickles down to the patients themselves. “When I talk about waste, I’m talking about things that add no value to patient care delivery, but still cost time and money,” Schlappy says. “If we have a process that creates a problem and we have to spend time and energy to fix it, the better process is to never have the problem in the first place. Lean is about finding out where the waste is and setting up processes and physical space to eliminate it.”

Schlappy says an example of this occurred at another hospital when it came to lab specimens. The specimens arrive at the lab by tube and get checked in at a space forty-five feet away. That forty-five foot jaunt by a technician may not seem like much, but consider the fact that hundreds of thousands of samples are processed each year. One can now see the degree of waste involved in these thousands of miles of extra walking every year, which does nothing to convert that sample into meaningful results for the doctor and patient.

A key principle in coming up with the lean design is the importance of input from staff members directly involved in the processes, rather than relying on outside consultants. Schlappy and his team would have meetings with twenty to thirty employees at a time broken down by department and workflows to walk through the state of the current system. These teams would locate examples of the lean philosophy’s types of waste and decide how things could be done differently. “Once you’re trained to see waste, you see it everywhere,” he says.

There was a session with perioperative staff members, one for the emergency department, and another for patient care units. Medication administration, physical therapy, occupational therapy, materials management, and lab and diagnostic services all had their own sessions, too. In short, everyone on the front lines was involved. “The staff and physicians know the waste; they see the symptoms every day,” he says. “They really were empowered to work with the consultants to redesign workflows. And there is much better adoption when you have staff providing input, as opposed to a consultant dictating changes.”

Each group met for three consecutive days, and at the end of each session, members of the team would report back to the steering committee. One may presume that workers who were accustomed to a certain way of doing tasks might grumble over the changes, but Schlappy says that because of their involvement in the process, almost all the feedback was positive. “We pulled them out of their regular job and asked them to help us work on this,” he says. “So they felt valued and also knew that the process they were helping design would make their work better and better for patients.”

These sessions resulted in brand new workflows, with compass documents stating all the major steps in every workflow. The training itself was also designed around the new workflows. In some cases, processes just needed tweaking, and in other cases, a complete redesign was in store. Schlappy says he foresees an enormous impact from the design. “It will improve workflow and decrease wait times for patients in the emergency department or for those waiting for surgery,” he explains. “The other people it will affect are the staff. If we can decrease the amount of wasted walking, searching for supplies and equipment, or dealing with avoidable problems—which is time away from a patient—that equates to more time spent with the patient. By getting waste out of the system, we can apply our clinical care more effectively.”

Perhaps just as important, Schlappy believes the mentality of the organization and its staff has undergone a change through the collaborative process of coming up with the design. He says when most people talk about lean, they focus on the tools, which he believes is a mistake. “It’s about engaging the staff; valuing and respecting the individual,” he says. “People will go to a seminar and talk about huddle boards, standard work, or other techniques to drive improvement in patient care, but those are just the tools. The tools support the desired behaviors, but tools are not the end goal. The principle is to engage and respect the staff’s contributions by guiding continuous improvement efforts at the front line and aligning each employee’s work with the organization’s purpose. When you do that, you’ve tapped into something about human nature that makes us want to do better. It’s like fireworks going off.”