Using lean processes and management in the design process resulted in savings and a more efficient design for ThedaCare, a health system based in Appleton, Wis. When it began planning an ambulatory clinic in Shawano, Wis., ThedaCare’s manager of facility development, Albert Park, AIA, wanted a more efficient way to complete such projects. Although the health system had been working with Simpler Healthcare (www.simplerhealthcare.com), Ottumwa, Iowa, to use lean management with its health care processes, it had never used it with design and construction. The facilities department embarked on using “production preparation,” called the 2P process, in designing the two-story, $18 million facility. “In the past, we had the feeling we were getting different stakeholders engaged, but we were only asking them about a piece of the project,” says Park, “not asking them to envision the whole thing.”

In the 2P process, much data is gathered about patient and staff work before a week of meetings is held with physicians, nurses, patients and support workers, such as housekeepers. After dividing into groups, each team is asked to work on specific design features or problems. The group creates criteria, such as safety and travel distances, to judge the solutions the teams devise.

One change made as a result of the process, says Park, is that the clinic’s exam rooms now feature the same layout and are not located next to physicians’ offices. “We had assumed that it took three exam rooms to keep a doctor productive, and those three rooms should be located next to his or her office,” he explains. But during the process, designers learned that doctors weren’t constantly returning to their offices during the workday and the number of exam rooms each needed often varied.

In addition, the project used integrated project delivery, which saved time. One example: Instead of having the hospital’s mechanical engineer detail the plans for the ductwork, the ductwork’s fabricator performed this task. “It’s directing the work to those who are best equipped to do it most efficiently,” says Park.

Park credits the 2P process and integrated project delivery for contributing to the center coming in $45,000 under budget when it opened in 2006. And the early project completion added 70 days of clinic revenue. “It’s all about eliminating waste and creating standard work,” says Park. “Simpler Healthcare gave us the tools to help us start thinking that way.”

This article first appeared in the February 2009 issue of HFM.

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