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Ready, Set, Go! Using Lean processes to Prepare for Your New Facility’s First Patient Day

Barry Kowalsky, MAAA, Senior Principal, Stantec, Calgary, AB, Canada

Co-Speaker: Umair Gill P. Eng, PMP

Keywords: Occupancy Planning, Operational Readiness, First Patient Day

Industry: Healthcare

Level: Advanced


The energy and excitement of a building project can be a springboard for true transformation. Using lean process improvement to understand the delta between where you are and where you should be to operate efficiently and effectively in your new health care facility on First Patient Day (FPD) helps enable sustainable outcomes that results in improved patient care, occupant safety and staff morale. This presentation will be relevant for clinical and support services managers, facility managers, project managers, engineers and architects involved in the occupancy and transition planning for a new hospital project. It will give them meaningful and relevant tools that they can apply immediately to their new hospital capital project.

Problem statement

New health care facilities are being built to new standards (for example in Canada CSA Z800-11) that significantly increase the area per bed compared to older facilities and drive the need to change patient care and support service processes to maintain sustainable resource levels of staff, supplies and equipment. New procurement models such as Private Public Partnerships (P3) can exacerbate this as they may limit key stakeholder input in the early stages of design when fundamental decisions impacting operations are made.


Stanton Territorial Hospital (STH) engaged Stantec to develop an Occupancy Plan to identify gaps between current clinical and support services operations and the design for their new hospital that must be addressed prior to FPD. Using Lean work flow analysis, the current operational state for all clinical and support work flows was mapped against the proposed future state design identifying gaps and proposing operational and design changes to address them. At this stage of the P3 process opportunity for design changes where very limited, focussing changes on improvement of operational processes such as supply chain, patient registration, room scheduling, equipment management, and standardization of operating policies and procedures across all service lines to capture continuous process improvement. Wherever possible changes to operational processes prior to FPD were implemented in the existing facility.

Challenges and Barriers

As changes to the operational model are implemented challenges related to culture, change management, organizational structure and reimbursement/financing models emerge. Strategies to manage these risks are identified.


Based on the STH Occupancy Plan as a case study the presenters will demonstrate a multi-stage process that includes:

1.                First Patient Day Utilization Analysis –recommended number of beds and treatment spaces to open on first patient day.

2.                Hospital-wide Analysis – Provides an account of global issues recorded throughout the STH and hospital-wide best practice recommendations.

3.                Clinical and Support Areas occupancy development including:

a.    Functional Overview – Provides a brief description of the department/program

b.    Observations, Gasp Analysis and Recommendations – Documents the results and analysis obtained during the current state observation phase and the recommendations developed during the future state user workshops

c.     Current State Map – Process map of the department/program’s current state operations

d.    Future State Map – Supports the recommendations outlined in the gap analysis table

e.    Best Practices – Presents current industry best practices and standards for each department/program area in support of the recommendations of the gap analysis.

f.       Future state flow development that optimizes patient, clinician, medication, supply, equipment and information flows

4.                Risk analysis and mitigation


As a result of the Occupancy Plan the STH has a clear understanding of the gaps that need to be addressed as part of the next phase of transition planning to achieve operational readiness for FPD, priorities including those that will impact the project schedule, required resources and a road map identifying actions and responsibilities for detailed transition planning to achieve operational readiness.

Take aways

Participants will learn;

  1. How to use lean process improvement techniques such as flow mapping to identify gaps in their occupancy and transition planning (flow diagram template in Visio, gap analysis table in Excel spreadsheet)
  2. How to assess the suitability of proposed facility design to accommodate organizational clinical and support service processes (gap analysis tool Word document)
  3. How to develop an Occupancy Map that informs equipment planning, training and orientation, ITIM systems planning and staffing levels (Excel spreadsheet)
  4. Pitfalls of P3 and Design Build procurement models as they relate to the planning of clinical and support services operations (checklist Excel spreadsheet)
  5. The benefits of early implementation of process improvement on change management and operational readiness for FPD
  6. Risk management tool identifying transition planning risks that could delay project opening day and compromise service levels and relevant mitigation strategies to address these risks (Excel spreadsheet)

Participating Organizations at the Lean & Six Sigma  World Conference

Government Agencies

  • Department of Commerce
  • Department of Defense
  • Department of Energy
  • Department of Health & Human Svcs.
  • Department of Homeland Security

  • Department of Justice
  • Department of State
  • Department of the Treasury
  • Department of Transportation
  • Department of Veterans Affairs
  • Environmental Protection Agency
  • NASA
  • Naval Surface Warfare Center
  • Pentagon
  • U.S. Air Force

  • U.S. Army
  • U.S. Marine Corps
  • U.S. Navy
  • U.S. Veterans Affairs
  • United States Army Corps of Engineers


  • AIG
  • Alcoa
  • AT&T
  • Bank of America Corp
  • BASF Corporation
  • Bayer Corporation
  • BMW
  • The Boeing Company
  • Bose Corporation
  • Bristol-Myers Squibb
  • Campbell Soup Company
  • Cardinal Health
  • Caterpillar
  • Chrysler Corporation
  • Chevron
  • Cisco Systems
  • Coca-Cola
  • Comcast
  • Daimler Chrysler
  • Disney
  • Dow Chemical

  • Dr Pepper 
  • Duracell
  • Dupont
  • Eastman Kodak
  • Facebook
  • Google
  • Exxon Mobil
  • Fedex
  • Ford Motor
  • General Electric 
  • General Motors
  • Gillette
  • Goodyear Tire
  • Hewlett Packard
  • Honeywell
  • Humana
  • IBM
  • Kohler
  • Lockheed Martin
  • Macy’s
  • M&M/Mars
  • ManpowerGroup
  • Maytag Appliances
  • Mercedes
  • Merck
  • Mitsubishi
  • Mobil Chemical
  • Motorola
  • NASA
  • Nestle 
  • Northrop Grumman
  • PepsiCo
  • Philip Morris International
  • PNC Financial Services Group
  • Pfizer
  • Pratt & Whitney
  • Procter & Gamble
  • Prudential
  • Raytheon
  • Rolls Royce Allison
  • Target
  • Johnson & Johnson 
  • Schindler Elevator Corporation
  • Schneider Electric
  • Shell
  • Siemens
  • Southwest Airlines
  • Staples
  • Tesla
  • Tiffany & Co.
  • Qualcomm
  • Underwriter Laboratories
  • UnitedHealth Group
  • United Technologies
  • Union Pacific
  • UPS
  • USAA
  • Verizon
  • Walmart
  • Wells Fargo
  • Westinghouse
  • Whirlpool
  • Xerox


Lean & Six Sigma World Conference




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