3P: Product, Process, Preparation. This model, adapted from the way Toyota
designs new equipment quickly, helps teams conceptualize, design
and refine work as the project unfolds.
5S: Toyota-based discipline involves Sort; Set in order; Shine; Standardize;
Sustain. Workers decide how the building will function and where
things will go, in a disciplined and standardized way. (See Workplace
A3: helps frontline teams analyze problems to their root causes, envision
a better way to work, and devise countermeasures and experiments
to get there. It is a one-page, hand-drawn document that relies on
observation and teamwork and doubles as both guide to scientic
process and as an easy, visual communication tool for consensus
A3 Thinking: the scientific method behind the A3, starting with problem
statement; working through root causes; proposing experiments to
remedy the problem; and measuring results.
ACO: Accountable Care Organization. Within the new 2011 federal health-
care legislation is a provision that provides compensation to organiza-
tions that provide a continuum of care, instead of pieces of care.
ASC: Ambulatory Surgery Center
Bidding/documents/construction: Construction phase of the project.
Input from staff is complete.
BIM: Building Information Model, advanced real-time architectural software
that tracks the model in 3D, and includes every detail across every
Cath lab: cardiac catheterization laboratory
CNA: certified nursing assistant
CT scanners: computed tomography X-ray system
CV: cardiovascular
288 ◾  Appendix D: Voices From the Field
Current state value stream map: a map describing the flow of : a) infor-
mation contained in the request for service, and b) a step-by-step
chart showing how the request is carried out. The current state map,
based on actual frontline observations, provides graphic evidence of
where the process works, and where it breaks down. It points the
way to waste that needs to be eliminated.
Design development: Architectural stage where refinements are made,
room by room. The plan is already fixed.
DOWNTIME-acronym for eight wastes: Defects; Overproduction;
Waiting; Not using talent; Transporting; Inventory; Motion; Excess
ED: emergency department
Evaluation Criteria (in 3P, things participants must consider):
Key assumptions—things that cannot be changed
Design criteria to examine work flows and pathways
Organizational criteria, which include the mission, vision and values
and make sure that what is being planned aligns with them.
FMEA: failure modes and effects analysis. Typically considers:
1. What is the probability of failure?
2. What is the severity of the effect if a failure does occur?
3. Is a failure detectable or not detectable?
EKG: electrocardiogram
Future state value stream map: a value stream map, based on the current
condition, that outlines a better way to work in the future.
Gemba: the place where work is done
GI: gastrointestinal
ICU: intensive care unit
IFD or IPD: Integrated Facility Design or Integrated Project Delivery grants
a single contract for all of the major players in a project: architect,
engineer, construction trades, etc. Everyone is jointly responsible for
the outcome.
Kaizen (rapid improvement event): generally translated as “change for
the good.” A way to look closely at processes or problems, analyzing
how they arose and using the wisdom of the team to quickly devise
experiments and improve. Kaizen is done within the existing walls
with as little resource as possible.
Kanban: This word translates from Japanese as “signboard.” Hospitals think
of “par levels,” or amounts of things to be kept on hand. Kanban is a
way to ensure that the right amounts of the right items are on hand

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