A Lean approach to codes and standards

Lean process improvement can create more value with fewer resources. A popular misconception is that Lean processes are suited only for manufacturing, but they can be applied to any business or process. Lean is not a tactic or a cost-reduction program, but a way of thinking. The core idea is to maximize customer value while minimizing waste.

One aspect of the health care industry that could use a dose of Lean thinking is the building and fire codes and standards used to regulate health facilities. After decades during which more and more requirements were heaped onto obsolete codes, the International Code Council (ICC) and ASHE are partnering to revise the I-codes with the goal of reducing the waste caused by code application and enforcement.

Reform and advances in medicine and medical technology are changing the U.S. health care system, and building codes must keep up. Patient and staff safety is a primary responsibility of all health care organizations and cannot be compromised. However, ASHE has quantified the waste from overregulation and misapplication of building and fire codes at a staggering $5 billion to $6 billion a year. Most of this waste is caused by the difficulty of complying with building codes and standards that sometimes conflict. This cannot be sustained by a system challenged to reduce costs and provide more with less.

The mission of the ICC Ad Hoc Committee on Healthcare is simple: Its goal is to take a fresh look at how current codes and standards support modern health care practices and to recommend appropriate updates through the ICC code-development process.

The challenge is to put aside concepts developed decades ago, before the health care industry mandated fully sprinklered buildings. As a stable industry, health care has become an easy target for manufacturers, vendors, service providers and special-interest groups who use the standards process to maximize profit and market share. This no longer can be tolerated; continuing to spend precious resources on outdated, convoluted codes and standards is not part of the prescription for recovery.

Codes and standards must be developed and updated using Lean principles to allow health care organizations to focus on current facility issues. In particular, National Fire Incident Reporting System statistics show that between 2004 and 2006 medical care facilities were responsible for approximately one patient fire death per year. In comparison, statistics from the Centers for Disease Control & Prevention (CDC) estimate the annual number of health care-associated infections (HAIs) at 1,737,125, with a direct cost of $35.7 billion to $45 billion. During the same period, the CDC estimates that more than 98,987 patients per year died from HAIs.

Many of us know someone who has acquired an infection from a hospital stay, but how many of us know someone who has been injured in a health care fire? The statistics show it's time for change. We must write understandable, cost-effective, research-based standards to support efficient, quality health care into 2020 and beyond.

This month's column was written by Douglas S. Erickson, FASHE, CHFM, HFDP, CHC, ASHE's deputy executive director.

ASHE Insight

Resources available

ASHE offers a number of valuable resources at special prices to professionals in the health care industry.

They include the following:

• Health Facility Commissioning Guidelines. Written by health care professionals, this resource helps optimize construction or renovation delivery. It enables project teams to deliver cost-effective and efficient health care facilities that yield the desired return on investment. The guidelines can help ensure a suc­cessful transition from construction completion to a sustainable, high-performance operation.
• Guidelines for Design and Construction of Health Care Facilities. The 2010 guidelines cover minimum program, space and design needs for all clinical and support areas of hospitals, nursing facilities, freestanding psychiatric facilities, outpatient and rehabilitation facilities, and long-term care facilities. It also includes new material on acoustics, patient handling and movement, patient safety, bariatric patient care, cancer treatment and emergency services.

For information on purchasing either of these valuable references, click here.