Dan Kratz, Sr. Director Real Estate and Hotel Services

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Integration of Family-Centered Care and LEAN into
Project Design
The 3rd International Conference on Patient- and
Family-Centered Care Seattle, WA July 31, 2007
Dan Kratz, Sr. Director Real Estate and Hotel
Services Tessa Billman, Family Member
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Design Goals

• Improved decision making
• Avoidance of re-work
• Improved efficiency of work
• Use of Lean principles

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Opportunities for Improvement

• Improving efficiency and safety (infection
  control)

• Improve value, process flow and improvement of
  end user satisfaction

• Practical, visually pleasing

• Added perspective-representation is broad

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Attributes and Criteria for Family
Representatives

• Problem solver vs. complainer

• Voice for all families

• Able to wear multiple hats

• Assertive and diplomatic

• Honor confidentiality

• Mutual respect for skills and knowledge

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Successes
Karen Astromsky Mannes

• My daughter, now five, had open-heart surgery
  at four months and was subsequently diagnosed
  with AML at five and a half months. She had
  repeat and often emergent surgeries during four
  and a half months of treatment. These
  experiences formed my opinions and point of view
  while I served on the design team for the
  outpatient surgery unit.

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Successes
Krista Bergert NICU Design Team

• It's my daughter, a premature baby born at 30
  weeks gestation, who introduced our family to
  Children's. For 49 days, Children's was our home
  away from home. And today, Children's is still
  our home as we return for speech therapy weekly
  and surgeries.

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Recruiting Family Representatives

• Identifying families

• Interpretive Services
• Other families
• Providers
• Rehab units
• NICU units

• Families as Partners Coordinator

• Communication

• Compensation
• Expectations of role

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Family Involvement

• Advance notice of scheduling

• Flexibility

• Two family representatives for each team

• Match veteran family representative with
  inexperienced family representative

• Solicit input

• Check in 11 during process

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Practical Support for Successful Family
Involvement on Design Teams

• Bring families in at the beginning

• Explain terminology

• Provide pertinent information prior to meeting

• Adequate and timely reimbursement for child
  care, parking and time

• Evolution of family participation/curriculum
• development

•  

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Complementary Approach Design
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Synergy

• Improving Project Design through Principles of
  LEAN and Family Centered Care.

• Efficiency

• User input

• Waste (muda)

• Evidence-based design (informal)

• Rapid process design (R.P.D.)

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Contrast

• Typical-tokenism

• Examples of real active involvement- beginning

• Facilitation of Familys active participation

• Group dynamics must be established and managed

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1
0
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Little Family Involvement
Increased Involvement
1. Characteristics

• Staff leads and runs

• Families absent

• Focus on the outside experts

• Emphasis upon perceived efficiency

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2
6
0
Little Family Involvement
Increased Involvement
2. Characteristics

• Survey(s) data

• 1 X focus groups (often late in the process)

• Motivation of the user input

• Little impact on the process

• Some impact on the outcome

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3
0
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Little Family Involvement
Increased Involvement
3. Characteristics

• Families involved but within a limited scope

• Furniture selection

• Finishes selection

• Outcome focus only

• Little impact on the other users

• Little/no ownership

• Often feels like tokenism

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4
6
0
Little Family Involvement
Increased Involvement
4. Characteristics

• Beyond rubber stamping approach

• Plans developed then shown periodically

• Feedback requested and utilized

• Allows for good catch opportunities

• Some effect on process or flow outcomes

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5
6
0
Little Family Involvement
Increased Involvement
5. Characteristics

• Help select architect/contractor

• Design steering committee

• Families on teams x2 for each unit/area

• Attend all meetings

• Design charettes w/architect

• Tour other facilities/site visits

• Sign off on floor plans

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5
6
0
Little Family Involvement
Increased Involvement
5. Characteristics

• Sign off on finishes

• F/B for mock-up for exam rooms

• F/B furniture/artwork/mobiles/toys

• Ability to tour unit while under construction

• Final walk-thru

• Grand opening event-invite/participate

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Positive Outcomes of the Approach

• Collaboration

• Meeting needs of both families and staff
• Reconfiguration of space
• Adds value/less rework of design and/or space
• Ownership, word of mouth advocacy

• Partnerships

• Mutual awareness of staff and family needs
• Alliances formed between patients/family and
  staff
• Pride in the process and outcome

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Costs

• Increase coordination

• Facilitation of the Familys involvement

• Careful selection of constructive input
  (practical)

• Education and training acronyms

• Timing

• /contracts to consultants

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Learnings/Take Away

• Every project represents opportunity

• Build credibility with/of families

• Tremendous marketing opportunity

• Enhanced value

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Benefits

• Standard application to all family areas

• Impact design

• Process

• Cost Benefit

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Involving families in the design process from
start to finish maximizes the opportunity to get
it right the first time, its just good
business.