Chapter 4
Are We Too Late?
Although we started late with Lean-led design, we still managed to
do a lot of streamlining before we opened. Our only regret is that
we didn’t incorporate it sooner.
Tim Tobin (FACHE)
CEO, Spotsylvania Regional Medical Center
Case study: Spotsylvania Regional Medical Center, Fredericksburg, Virginia
The beautiful new Spotsylvania Regional Medical Center (SRMC),
Virginia’s newest hospital, was almost complete (Figure4.1). It would be
that rare hospital built strictly to handle growth, rather than to replace an
aging facility somewhere else. Along with the new facility would come
new leaders, a new staff, and, shortly before opening day, new supplies
and equipment.
Establishing the Culture
Once the hospital has already been built, is it not too late to factor in Lean-
led design? There are definite points along the construction continuum
where the introduction of Lean ideas will bring the most benefit. Move-in is
one such point.
74 ◾  Lean-Led Hospital Design: Creating the Efficient Hospital of the Future
Spotsylvania Regional Medical Center (SRMC)
This 126-bed, $175 million hospital opened June 7, 2010, on a
74-acre campus south of Fredericksburg, Virginia. SRMC is a new
hospital, not a replacement for another facility. Staff numbers
around 400 people. Few employees had any prior experience with
Lean process improvement.
No matter when it is introduced, Lean thinking provides an organiza-
tion with the chance to introduce workplace efficiencies and a healthy
work environment. As staff members learn to confront and solve problems
together, they create the foundation for a new work culture that is more
open, respectful, and free of blame and in which all suggestions are hon-
ored, no matter where they originate in the hierarchy. Instead of higher-ups
deciding who is at fault, frontline staff decide what happened and how to fix
the underlying trip wire so that the same thing does not recur.
Changing the work culture from top-down to collaborative is hard,
because the current set of values in established institutions has long been
cemented in place, and doing things differently will require wrenching (and
usually unwelcome) change. One advantage of a brand-new hospital with a
brand-new staff is that the culture is being created as the supplies are being
put away, from the first hello.
Figure 4.1 Beautiful new flagship, Spotsylvania Regional Medical Center, where
Lean-led design began at move-in. (Photo by Naida Grunden, with SRMC permission.)
Are We Too Late? ◾  75
As one Lean practitioner said:
It is so much easier to teach Lean philosophy to people as they
come on board. We arent undoing anything. As we begin together,
we just say, these are the commonsense principles we’re going to
use to operate this facility. Lean is very rational, and people are
excited by its simplicity and sense. And not having to fight the sta-
tus quo is thrilling.
Here is how it happened at SRMC.
Value Stream Mapping
As construction neared completion at SRMC, or Spotsy, the enormous job
of move-in loomed. Leaders realized that they would need help to bring the
right equipment and supplies into the new facility in an organized fashion.
They thought Lean-led design could help them do that, while introducing
members of an entirely new staff to their workplace and fostering teamwork
among them.
The first order of business was to conduct frontline observations and
value stream mapping
for the current and future states—something that
would be impossible to do in a hospital that did not yet exist. The Spotsy
team, which at this early stage comprised a handful of leaders and employ-
ees, conducted a simulation at a sister facility, CJW Medical Center’s
Chippenham Campus in Richmond, 50 miles away. Observing how work
was done there, the Spotsy team drew up current- and future-state value
stream maps for their new hospital’s service lines.
Value stream maps provide a visual analysis of the flow of information and
material during each process—from assessing a patient in the ER to draw-
ing blood. Visualizing each process helps all involved to see and fix glitches,
remove steps that do not add value, and move ever closer to ideal care.
Not only did these value stream maps benefit the Spotsy team in its
planning, but they also provided insight on process improvements at
Chippenham. In fact, the value stream maps were shared widely with the
hospitals across that Virginia health system.
“If Lean-led design had not been made available to us, we would not have
spent the time examining so many flow processes preopening,” said SRMC
CEO Tim Tobin, FACHE. “Our only regret is that we didnt do Lean sooner.

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