Project Manager Paul Becks rallies his crews to accomplish great things

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(L-R) Becks discusses a safety concern with project executive Patrick Oaks after their weekly safety meeting.

Paul Becks admits he’s a demanding person. As Welty-Boldt’s field manager on Akron Children’s Hospital’s $200 million “Building on the Promise” expansion campaign, it’s a vital personality trait that helps him lead hundreds of crew members to keep the project on time and on budget.

“When you’re the type of person who has high expectations for your team, I think if the team respects that, they step up and the entire team performs on a higher level,” said Becks, a Lean Six Sigma-certified Team Leader Training instructor. “The entire culture is based on that mutual respect. It’s because of that we’re able to accomplish such great things.”

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Becks talks about progress in regards to the schedule with HVAC foreman Chris Fowler and his teammate.

Becks facilitates the process of planning each task on a rough basis about 6 weeks out. Then, as that specific task approaches, he’s busy getting all the details and components in place and finally, he rallies his crews to implement it.

He and his team set up the workers for success, thinking through all the potential pitfalls prior to implementation. If any issues do creep up, he works hard to resolve them quickly and efficiently so there’s minimal disruption on the job site.

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Paul Becks (on left) discusses the HVAC vertical risers with the installation team.

“I like to think we’re building one of the most complicated machines out there,” he said. “The number of pieces and parts that come together to make a building, I don’t know if anybody has ever counted, but it’s quite a lot. And we’ve scheduled it so tightly that if there’s a hiccup, it pushes back our ability to [complete the next step].”

To keep his team informed, Becks holds daily huddles with all the trade partner project managers. They discuss issues or concerns on the job and make every effort to resolve them right then and there.

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Field manager Paul Becks (on right) discusses logistics for the pedestrian bridge installation with iron worker foreman Louie Cataldo.

In addition, he hosts “Lunch and Lean” meetings on Wednesdays with the construction team, where they watch educational videos or hold discussions on ways to work more collaboratively and efficiently.

Becks also gets together with his construction crews for impromptu lunches and happy hours to keep the morale high.

“A lot of people talk about team building. We look at the root cause of it and say if you need to build your team, there’s probably something deeper,” Becks said. “If you just fix those underlying root causes … you won’t have to build your team. The team builds itself.”

Becks got his start in construction early on. His father also worked in the industry, but he discouraged his son from following in his footsteps due to the job’s demanding nature.

But while attending Ohio State University as an aerospace engineer, Becks realized construction was where he belonged. He wanted to build things. He wanted to be out in the field amidst the action, so he switched his major to civil engineering and has never looked back.

Since then, he has helped transform the region by working on major construction projects, including the Cleveland Clinic’s Intercontinental Hotel, Akron YMCA and Goodyear Tire & Rubber Co. headquarters.

“I always love these projects here in downtown Akron,” said Becks. “There’s just a certain sense of pride that you have building what I consider to be a landmark for our city. We’re not just building a building. We’re building a $200 million-plus life-saving machine. That’s a really good feeling.”

No kid wants surgery, but here’s to making the process the best it can be

How do we build a same-day surgery center that satisfies the needs and desire of everyone – patients, patient families, doctors, anesthesiologists, nurses and surgical support teams?

As Akron Children’s Hospital moves forward with its plans to build a $200 million critical care tower, teams continue to meet, brainstorm and test out architectural designs in a true-to-scale setting during weeklong Kaizens. Kaizen is a Lean term that refers to improving processes continually by making incremental changes.

Parents Beth Tenda and Judy Doyle participate in the Kaizen to design the new outpatient surgery space.

In September, a team representing outpatient surgery gathered in a warehouse, where cardboard-like walls defined surgical suites, recovery rooms, pre-op areas and other spaces and allowed doctors, nurses and patients to move through their typical day.

As the Kaizen began, several issues were front and center:

  • The need to create the ideal number of surgical suites based on current patient volumes as well as future growth.
  • The need to keep the ORs running as efficiently as possible, taking into consideration the ebb and flow of higher and lower volume procedures, as well as planned and emergency cases.
  • Focus on flow – How much walking will be required for patient families, as well as the doctors and nurses?
  • Movement of supplies in and out of the ORs. Surgical instruments come into the room sterile and the proper equipment must be assembled for each case, whether it’s an ENT procedure, an eye surgery or an orthopedic case.
  • Providing a calm environment that promotes privacy.

As the week began, it felt like this was an impossible task to come up with a floor plan that addressed all of these concerns and made everyone – from the anesthesiologists to the surgeons and the surgical support team – happy.

We were reminded again that Akron Children’s is a dedicated pediatric hospital and that children are not “just small adults.” The team worked to ensure excellent sight lines of patients in the recovery unit design to enhance patient safety.

“Unlike an adult hospital, children in the recovery unit don’t necessarily stay in bed,” said clinical coordinator Tina Sanzone, RN, BSN. “We need to have patients in view to ensure patient safety.”

The team went through phases of anticipation, discouragement and hope as each day welcomed success, frustration and new architectural drawings of the space. Each layout, when constructed three-dimensionally, generated dissatisfaction that the ideal plan still had not been developed.

Until Day Four.

When the exhausted team found their architectural team had worked overnight to meld the best ideas from two of the previous designs, they realized they finally had a winner.

The last design greatly improved patient flow. It offered easy access to storage. Doctors and nurses were not wasting extra steps within surgical suites or between them and other key spaces. The plan built in flexibility for growth and change down the road.

“The translation of design from paper to three dimensions can be eye opening,” said Beth Carr, MSN, MBA, RN, director of Nursing for Surgical Services. “When you see a design on paper, you envision it to work correctly. It’s not until you are actually in the space, and moving within it, that you realize it may not be ideal. The process takes time and patience. When you think there are no options, options present themselves.”

‘Saving lives’ in a mock trauma room

It’s 3 a.m. in the ER when the call comes in. There’s been a car accident. A 16-year-old boy – unrestrained and the driver – is being life-flighted. He is in respiratory distress and has head injuries.

His 10-year-old brother and front-seat passenger is coming by ambulance. His injuries, neck pain and an obvious deformity to the lower body, appear less serious.

The team – a doctor, nurses, a surgical resident, transport team members, staff from lab and radiology, and others – gather in a trauma room. But this trauma room is different. Its walls are made of Falconboard® (heavy duty cardboard) and it’s actually in a 90,000 square foot warehouse where stacks of new automobile tires seem more “in place” than a pediatric medical team.

The mock drill is part of the innovative process Akron Children’s Hospital is using to design its new medical tower, which will include a new emergency department, neonatal intensive care unit, outpatient surgery center and expanded clinical areas.

Leading the mock trauma drill is Laura Pollauf, MD, director of Emergency Services for Akron Children’s Hospital.

“Our goal with this scenario is to really test the size of this room,” said Dr. Pollauf, through a megaphone with the team assembled around her. “When we have a trauma like this, we can have up to 16 people in the room, including the doctor, three nurses, a trauma surgeon, a lab tech, a fellow, child life, a social worker, and the parents.”

During the scenario, the participants pay attention to details. Is the hallway wide enough for a stretcher? Is life-saving equipment in quick reach? Where will the mother enter and how will she be escorted to meet her sons? If the mother is being registered near her children, will this create a bottleneck in the hall?

Jackie Smolinski, a mother of three, including a son with special needs who is well known in Akron Children’s ED, raises the concern that the 10-year-old boy may be traumatized by seeing his older brother undergoing life-saving measures. But Dr. Pollauf suggests that a pull-back curtain could help with that while still allowing the mother to be with both her sons.

Smolinski and five other mothers who serve on the ER design team have also raised issues such as the need for more restrooms in the ER and a larger waiting room, giving Security a stronger presence, and improving overall flow and wait times.

After an informal discussion about the trauma scenario, team members emerge from their cardboard maze ED and return to tables in another location of the warehouse. They will discuss what they liked and didn’t like in the scenario with architects, engineers and construction team.

The goal is to get the design perfect. So when Akron Children’s new emergency department opens in 2015, it will be more than ready to care for two brothers hurt in a 3 a.m. car accident and all other patients who enter its doors round the clock.

Learn more about Akron Children’s building expansion project, called “Building on the Promise.”

How to build a better ED: Learning from Seattle Children’s

Akron Children’s Hospital, firmly rooted in northeast Ohio and the Midwest since 1890, is looking to a West Coast children’s hospital for guidance as it begins a $200 million expansion of its main campus.

As the hospital undertakes a year-long process to design a new medical tower that will include a new emergency department, neonatal intensive care unit, outpatient surgery center and expanded clinical space, it borrows greatly from the experienced learned at Seattle Children’s Hospital in the early 2000s.

Working closely with Joan Wellman & Associates, Seattle Children’s followed a process called Integrated Facility Design to expand its campus, adding a universal clinic, outpatient surgery center, imaging center, lab and pharmacy.

Early estimates indicated the Seattle project would span 110,000 square feet and cost $100 million. The hospital board approved a $70 million total cost. In the end, the 80,000 square foot (a 30 percent reduction) facility ran under the allocated budget by $3 million and opened a month early.

The secret was turning to the Lean Six Sigma principles perfected by Toyota and other Japanese manufacturers that focus on eliminating waste, improving efficiency and focusing on customer satisfaction.

CNO Lisa Aurilio

A team from Akron Children’s has visited Seattle Children’s. The hospital created the Mark A.Watson Center for Operations Excellence in 2009 and this staff has been tackling problems big and small for the hospital. Successes range from improving the efficiency of the hospital sterile process department (essential to meeting the demand for more surgeries) to improving the scheduling of MRIs.

The approach to building design essentially flipped the traditional method.

“Right now we have everyone working together from the very start,” said Magnus Nilsson, a senior consultant for the KLMK Group, a key player in the project. “Typically, an owner works with an architect for a year and then they bring in the mechanical, electrical, structural and civil engineers and the construction team. The goal here is to have a seamless communication process.”

Nilsson said the goal of having zero change orders – costly changes in the plan once construction starts – is a realistic goal.

Lisa Aurilio, chief nursing officer for Akron Children’s Hospital, said she remembers earlier in her nursing career pushing a patient on a stretcher in a hospital that had just opened. But as they approached the treatment room, she couldn’t get the patient into the room – the door width was too narrow.

“As nurses, we known how to give really good patient care, but we don’t know how to read blueprints,” Aurilio said. “This process [including using life-size mock-ups of an ED or NICU] lets us avoid those mistakes. It allows us to get the patient’s voice in the process. After all, it’s about them.”

Doug Dulin

Doug Dulin, senior director of the Mark A.Watson Center for Operations Excellence, said the process so far has reduced Akron Children’s new medical tower from 360,000 to 330,000 square feet.

According to Dulin, in Lean Six Sigma language, patient/customer flow is often compared to a river. Good building design will keep patients moving along “downstream.” Bad design will cause waits, confusion and bad experiences.

“We want patients to come into the ED, get registered, see a provider, get the care they need and then go home as quickly as possible,” Dulin said.

Learn more about Akron Children’s building expansion project, called “Building on the Promise.”

Credit: “Leading the Lean Healthcare Journey; Driving Culture Change to Increase Value”  by Joan Wellman, Howard Jeffries and Pat Hagen.  This book was published by CRC Press, a Taylor and Francis Company.

Integrated Lean Project Delivery flips the design process

For the past few months, hospital leaders, patient families, doctors, nurses and clinical staff have been meeting regularly with architects, builders and Akron Children’s Lean Six Sigma process improvement team to plan the new patient tower, which is part of a $200 million expansion.

The process, known as Integrated Lean Project Delivery, is expected to:

  • improve productivity
  • eliminate waste
  • enhance the overall patient experience

It’s expected to reduce costly change orders in the construction phase and the project’s overall cost.

“We plan to build flexibility into our design so that we can be prepared for the changing health care environment,” said Grace Wakulchik, chief operating officer. “For example, we are designing our new neonatal intensive care units so they can become pediatric intensive care units or even general patient rooms if our patient volumes and patterns change.”

Akron Children’s Chief Operating Officer Grace Wakulchik

Department teams, in conjunction with the architects, are using small scale models, including paper dolls, to design their floors. Blueprints will be tested in full-scale mock-ups constructed in a local warehouse.

This will allow doctors, nurses and patients to walk down hallways, enter exam rooms and reach for supplies – catching potential problems – well before the real construction begins.

Construction will begin in the spring of 2013 and will be competed in 2015.

The companies assisting Akron Children’s with project management include: