ASHE Vista Award Recognizes LEAN Approach to Keeping UMass Memorial MC2020 on Track

SLAM is honored to partner with UMMHC in their endeavor to explore, plan and implement transformative upgrades and improvements—the future state of health care—at the academic medical center’s Memorial and University Hospital campuses.  Even more rewarding is to see your design approach make the difference, while offering lessons learned through an inclusive and collaborative teaming approach.

With an eye toward continuous improvement through a transformative process, the outcome of this work was to create a design for the space that could also be continuously improved.  Three main drivers helped to guide our team and the implementation:

• Community
• Communication
• Continuity of service

This framework made the UMMHC strategic goals manageable and achievable.  Throughout the project, our team was focused on:

• Enhancing patient and family privacy, safety, and comfort
• Improving the caregiver environment and standardizing staff areas on the floor
• Improving ADA accessibility and DPH compliance
• Supporting infrastructure upgrades for the implementation of a new EPIC medical records system

Critical to our success was taking the time to understand the perspective of key stakeholders, from physicians and staff, to patients and visitors.  A Planning Leadership Team (PLT) was created, consisting of these key stakeholders who were involved in the development of key principles. [These principles included adding value to the patients and staff and determining “must haves” for the design.] The PLT attended monthly meetings to address key decisions and approvals. A working task force was also created to meet weekly and drive the project forward.

Gemba sessions kicked off with architects observing the current processes on site. Opportunities for improvement, as well as existing successes to be maintained were identified. The design team developed the future state using multidisciplinary consensus-based processes.

The design process utilized the acronym PDSA – Plan, Do, Study, Act. Two mock-up rooms were completed with different fixtures and features in each. The rooms were opened to staff for questions and feedback. Over 800 surveys were completed and evaluated, leading to critical changes in the design for final implementation.

In addition to the PDSA approach, multiple 3P (Production, Preparation, Process) events were held in the mock-up rooms. These events focused on the advantage of rapid learning, innovation, and collaboration. Stakeholders were brought together and sequentially taken through a process (e.g. Administering medication, cleaning the room, delivering food, or changing the lights).

Designers interacted with these key groups as they identified their preferences and capabilities. The team then made selections and developed alternatives that aligned with the Project Charter, keeping in line with the goals of the Hospital. Considerations stemming from these events included operability, maintainability, standardization, ergonomics, and flow.

Following this, the team utilized Kaizen workshops focused on continuous improvement of all functions. These sessions involved all employees, from front line staff to executive leadership. A life-size mockup of the proposed Team Station (replacing the former Nurses Station) and private doctor charting areas were erected using cardboard walls. Walkthrough use of the space and opportunities for improvement were presented prior to construction. This promoted finding the ideal workflow, while improving the patient and provider experience.

The facility remained operational during the Construction Phase and without any lay down area for construction materials, leading Consigli to develop a series of LEAN construction initiatives.

Part of the Plan, Do, Study, Act (PDSA) LEAN process is to continually re-evaluate the work being done. As each patient wing was completed, the entire team gathered to evaluate “lessons learned” from the phase of work.

On the one-month anniversary of patient use of a space, the team met with the medical staff to both observe work patterns in the new space and to ask for comments. This work was then folded into the next floor renovation and, if updates could be made to the current floor, they were also completed.

This award means a great deal to the entire team, both internally at UMass as well as the design and construction team. It reaffirms that the right decision was made to renovate existing facilities and in making the capital investment to better serve patients and staff. We are thrilled and honored to be recognized for such a prestigious team award.

David Neal, AIA, ACHA, ASHE