Lean is the buzzword for 2009. Faced with expenditures that are 17.6 percent of the current GDP (and which are expected to rise to 20.8 percent by 2019), the healthcare industry is leading the Lean movement. The economic crisis, however, has forced many architects, facility managers, developers, and business owners outside the healthcare arena to examine things more closely.
Lean = Knowledge Sharing
Lean is a production-management approach to project design and delivery. Toyota started implementing Lean production management in the 1950s, shifting away from a mass-production assembly line to a decentralized manufacturing design, supply, and assembly process. The Toyota Production System (TPS) focuses on eliminating problems before they occur by encouraging workers to stop production if they find a defect and eliminating waste by pulling inventory.
If Lean design is about eliminating waste and increasing value, then the opportunities to scale back operations begin with the flow of people, processes, space, and technology. Applied to design and construction (integrated project delivery), Lean methodologies change the way a project is delivered by reducing the time to design, permit, and build.
Integrated project delivery fully integrates all stakeholders early on in the process, allowing participants to optimize project results, increase value, reduce waste, and maximize efficiency throughout the project life-cycle. In terms of knowledge-based design, Lean methodologies encourage the project team to share information up front to increase innovation, design and delivery speed, and reliability. With Lean design, there’s greater sharing of knowledge through the integration events. Each workgroup reports back to the project team and informs team members of their progress toward overall goals and confirms budget and schedule.
With Lean, the design model shifts from “command and control” to a non-hierarchical “team” culture. Close discussions throughout the entire design process empower architects, staff, and clients to make decisions that support innovation, creativity, and efficiency. All team members contribute to the process and the end result, but it means that constant communication is required.
Because Lean inspires a collaborative spirit, knowledge-sharing technologies are vital to the design process. Perhaps the ultimate arrangement is to physically co-locate the project team – including the client – so that information flows between workgroups continuously and integration events can be scheduled more fluidly. Virtual communication platforms ultimately serve the same purpose, but it may be useful to consider them in four categories: project space technologies, meeting technologies, design technologies, and research technologies.
Project Space Technologies = Creating a Community
Our understanding of how we learn is growing rapidly, which has a profound impact on how we communicate. While formal meetings continue to play an important role in pushing out information to a group, there’s a growing emphasis on impromptu exchanges and individuals pulling the information needed.
Web-based software combines file sharing, blogs, discussion forums, and scheduling to create virtual communities where users can share and retrieve multiple content types at multiple scales. For a recent healthcare project in California, the project team was co-located onsite, but information gaps persisted due to the number of groups and complexity of the project. Who was in what meeting? What was the data presented in the blue team work session? In order to keep track, Web-based software was used for capturing the information, posting schedules and agendas, and supplementing the culture through blogs. Rapid flow of information from disparate sources was the key to the team’s success in reducing cost and scope without affecting quality.
Meeting Technologies = Growing the Bandwidth
Naturally, the design industry is visually dependent. The fax machine may have been the first great leap forward in terms of communicating semi-real-time graphic information. Unfortunately, the delays were an exaggerated form of what the Apollo astronauts faced: a 5-minute face-to-face was protracted to 45 minutes of faxing back and forth, interspersed with a series of 2-minute phone calls. We may be in the middle of the next leap forward with virtual meeting software, such as WebEx or Bridgit, and hardware, such as SMART Boards. WebEx and Bridgit allow voice and graphics to be shared in real time, though visual material still must be “passed” to each other in a manner reminiscent of the challenges faced by fax. Input devices, such as SMART Boards or Sympodium tablets, address this issue head on, since each of the Web conference attendees can draw at the same time on the same image.
When connecting a team in Milwaukee and Los Angeles with a client in Philadelphia, SMART Boards enabled the WebEx sessions to morph from presentations to work sessions for a 350,000-square-foot hospital project. This greatly streamlined decision making by allowing real-time creating, sharing, and understanding of diagrams, sketches, and calculations. Technology enabled an 8-week schedule to create an operational model, program, and design of a 220-bed hospital for a city zoning submittal, and saved resources by greatly reducing airline trips.
Design Technologies = Less Reworking
Building information modeling (BIM) software increases productivity and enables tighter coordination between team members. The 3-D, real-time software provides the design team with the potential to dovetail with trade partners, such as steel manufacturers, mechanical engineers, and painters.
The 60,000-square-foot Fairfield Medical Office Building for Sutter Health is a milestone project for the application of Lean principles. The project team was divided into small, multi-disciplinary workgroups (including subcontractors) to design sub-components according to overall goals. Each discipline used BIM as part of its own process while NavisWorks integrated the various trades’ work, resolving physical and sequencing conflicts through clash detection. This served to smooth the construction workflow, which resulted in a project cost that was reduced over the life of the project (and during a period of enormous cost escalation). The building was designed and completed in only 25 months, and finished $3.2 million under budget.
Research Technologies = Higher-Quality Data to Analyze
Part of the Lean design process includes mapping how an end-user flows through a particular building. Designers must understand current processes to create ideal flows, adjacencies, and spaces that provide the best functionality for each process, department, or organization. Current flows are tracked in two ways: physically and conceptually. A labor-intensive, yet very effective, method for observing the staff engaged in different processes, observers with clipboards can physically track flows. A new solution is to use radio frequency identification (RFID) tags to track this staff movement through the facility. The data is then reviewed in real time, creating a traffic control center where blockages can be identified and addressed rapidly.
Whether gathered with clipboards or technology, from this information we can find out the sequence of activities and the travel distance between these activities. From there, we can collaborate with staff members, clients, and users to determine the activities that add value to the process, which activities add waste, and the desired adjacencies based on the ideal flow. The benefits of the ideal flow can be tracked by using “workflow sampling devices,” or PDAs. The devices can be programmed to ask a question at certain times during the day. In the case of mapping processes for healthcare facilities, the PDA might ask, “Are you with a patient or not?” By using these devices, HGA found that the amount of time the caregiver spent with a patient greatly increased due to the elimination of wasteful steps in the process.
Lean = Common Purpose
Lean methodologies have been known to save millions of dollars in construction costs, shave months off of project schedules, decrease operating costs by up to 40 percent, and deliver a higher level of building efficiency for users. Technology made these metrics possible by increasing our ability to collaborate. Traditional communication barriers are broken down so every team member shares a common goal: to do what is best for the client and the project. This is the central Lean concept: team clarity about that common purpose and elimination of energy that does not contribute toward it.
Stan Chiu, AIA, LEED AP, serves as vice president and lead designer in the Los Angeles office of HGA Architects and Engineers, one of the nation’s leading firms specializing in Lean design. With more than 15 years of experience, he is a leading architectural voice in healthcare design with an extensive design portfolio of higher education and healthcare facilities.
