Horizon Hospital is a new hospital within Lakeview Healthcare (LHC) (Case 1). LHC is a nonprofit, comprehensive health care system on the Eastern Seaboard. LHC consists of four hospitals (1,084 beds), an ambulatory care center, physician offices, rehabilitation services, long-term care centers, home care services, physical therapy services, and Mobile Intensive Care Units. Lean has been implemented as part of a larger set of tools and initiatives to ensure quality and outstanding patient experience. It is viewed as an organization-wide initiative and part of a larger quality improvement strategy that predates Lean.
A new chief operating officer (COO) at LHC was a driving force in LHC's adoption of Lean as a means to reduce waste. LHC tasked its internal management engineers to launch and implement Lean. The management engineers began to implement projects (or "Kaizen events") within different areas of the organization. A Kaizen event brings employees together from various departments to examine a problem, propose solutions, and implement changes.
To implement Lean, the leadership at LHC first assessed what tools were missing from their toolbox to be able to achieve their goals in terms of people, process, and strategy. Lean was selected as a complement to Six Sigma to address an identified gap in tools targeting process goals. Senior leaders worked with an external process improvement consultant and LHC's management engineers to identify potential projects and collect initial data for those projects.
As part of a multisite study of Lean implementation, we conducted a rigorous comparative case study of LHC and several other delivery systems. At LHC, we selected five Lean projects for analysis. This case study concerns one of these projects—the planning and construction of a new hospital using Lean principles. We focused on two specific process changes implemented at the Horizon Hospital to enrich our findings. Overall, 67 interviews with 65 staff members at various levels in the organization were conducted between December 2009 and September 2011. Data were collected during three site visits, through digital diaries recorded by Lean project participants, and through phone interviews.
LHC experienced increased staff pride and considerable cost savings by using internal resources, careful planning, and Lean tools to build the new hospital. A reduced need for change orders during construction meant that LHC saved 2.65 percent—4.65 percent of the total project costs of over $434 million. LHC received multiple quotes of upwards of $2 million to plan and facilitate the hospital move-in process, but instead they were able to use Lean tools to manage the move internally.
The Horizon Hospital case highlights the importance of ensuring that the culture of the organization supports undertaking the building of a hospital using Lean principles. The planning team should carefully select an architecture firm that will support a strong staff role in the planning process. Management engineers are vital to bridging communications between staff and architects and facilitating the overall planning process. Organizations should prepare for contingencies, such as turnover of project leadership. Some unexpected consequences from process changes are likely following the move-in, and leaders and frontline staff should anticipate the need to continue to put forth extraordinary effort in the months following a new hospital opening.