How Akron Children’s Hospital saved millions on construction and improved outcomes with Lean principles

Accountability, transparency

Changes were also made within the hospital to improve communication and share information. In 2008, the hospital established its Mark A. Watson Center for Operations Excellence, which uses Lean Six Sigma principles to develop staff and improve quality of care and organizational processes.

Considine says Kaizens, hyper-focused deep dives to explore specific areas of improvement, and huddles, very brief group meetings, have become commonplace — 95 percent of all departments huddle daily to talk about the work ahead and issues that occurred the day before.

“When you’re trying to be responsive and when you’re trying to be transparent, these are things you got to do,” he says. “It’s not one thing, it’s the package, and it’s got to be part of the culture.”

The hospital has sent some of its staff to Johns Hopkins University to get their Lean green and black belts, visited colleagues at Seattle Children’s Hospital to see how they incorporated the Toyota way and Lean Six Sigma to their work.

Back in Akron, front-line employees were finding ways to be more efficient in their day-to-day work and departments were brought up to Lean standards. According to the hospital, the initiative has generated savings of nearly $13.4 million and reduced patient wait times by more than 48,000 days.

The solutions, dollars saved and the patient convenience that came from these practices convinced the hospital and its staff that Lean made sense. So when it came time to approach planning for the new building, Children’s turned to Integrated Project Delivery, a Lean approach to construction.

“People are, and should be, demanding accountability from health care,” Considine says. “There’s a lot of talk about how expensive health care is and we wanted to be able to look people straight in the eye and tell them that we’re doing everything we can to be as efficient as we possibly can be, and we’re not stuck in the mud relative to past practice. And with what has been shown in research and literature, Lean provides benefit.”

The Lean lens

Early on, Considine and his team estimated that the new facility might cost $240 million.

“We knew that through the traditional approach, we could probably do some value engineering, you know, cut out some things that probably were over the top,” he says. “But I know in the old days I probably would have been willing to sign a guaranteed maximum price not to exceed, oh, $205 (million) to $210 million.”

Then he looked at it through a Lean lens.

“Without taking anything out of the project, they got that target price down to $180 million,” he says.

At the beginning of the project, Considine says there was a time when it seemed as if they’d never build anything. Prior to the start of construction, hospital staffers and patient families began meeting with architects to discuss their ideas on building spaces that made sense for those who’d spend much of their time within them. The focus was on creating efficiency and flexibility. Small models were initially used to design the layout. Then full-scale cardboard mock-ups were built in a warehouse so staffers could test out the spaces. There, staffers hauled stretchers and other equipment through the cardboard mock-up, testing different scenarios to find design flaws. That helped eliminate mistakes that later would have been costly to fix.

“I mean, I know organizations that have spent considerably more money than we spent, they move into a brand new facility and right away they have to redo the emergency room because the doors aren’t wide enough for stretchers and things of that nature,” he says. “I mean, that stuff happens.”