CHAPTER

33

GO TO THE WORK
Introduction
Too often we think we understand all aspects of a project, but without physical
observation, we can actually miss a lot. “Going to the Work” is not simply about quality
control or ensuring that a project is on track—it helps us understand the intricacies of
how the work gets done in order to identify waste and improve performance.

Going to the Work (called Going to the Gemba in original Toyota

Production System language) is crucial to improving overall quality
control and eliminating waste in the workflow process.

1.0 Why
Going to the Work (called Going to the Gemba in original Toyota Production
System language) is crucial to improving overall quality control and eliminating waste
in the workflow process. It helps participants identify ways to standardize processes
and manage expectations from a first-hand perspective, rather than second or third

CHAPTER 33: Go To The Work 191

 hand.
Other benefits include:
• Gathering valuable insights to inform kitting, batching and sequencing;
• Improving the planning process;
• Supporting mentoring, training and cross-training efforts;
• Improving safety;
• Clarifying the scope of the project, components or task;
• Empowering participants to understand the process (including cross trades) and
suggest ways to improve it;
• Offering a venue to show respect for designers, technicians and craftsmen by
asking for their input and offering ways to improve their environment or remove
constraints; and,
• Realizing instant improvements to the process.

2.0 How
Experienced practitioners employ a variety of methods and tools to assist them
in the Go to the Work process. One of the most well-known is the Ohno Circle,
which involves observing a project for an established period of time to gain a full
understanding of the entire process.
Additional methods and tools include:
• Video Studies: Used for processes that are too long or impractical to observe
in real time. Instead, the process is taped and watched as a video. The videos can
be used later as training aids for continuous improvement.
• First-Run Study: Often the first step employed by project leaders to gain a
sense of work movements. The goal is to help standardize processes and mark a
baseline for continuous improvement.
• Skilled Craft Lunches: Provides an intimate setting to search for issues and
ideas from trades and other partners.
• Spaghetti Diagrams: Involves drawing a pencil sketch of the movement
associated with a process. If overly complicated, then the process is likely

192 Transforming Design and Construction: A Framework for Change

 inefficient and can be improved.
• RFID (Radio Frequency Identification): A form of location-based tracking
used to track the movements of materials, equipment or personnel.
• Mockups: Can help establish an end-product standard and prove its
functionality for end-user stakeholders. Any investment in mockups should be in
proportion to the benefits. In some cases, a virtual mockup may be sufficient.
However, it is worth noting that virtual mockups will not always yield the practical

The awareness gained from Going to the Work serves to educate the team on how
work is performed at every stage of the process, and leads to productive change.
Shown: Notes from observations on processes in an Emergency Department.

CHAPTER 33: Go To The Work 193

 insights provided by a physical mock up.
• Prototyping: The rapid development of a prototype used to prove or disprove
ideas.
While observing the work, everyone should understand the goal of the activity,
which is to make improvements in a collaborative and constructive manner. The
purpose is not to be punitive (Respect for People), but should be based upon a
genuine desire to work together for better outcomes.

3.0 What
Going to the Work refers to the act of observing a project’s moving parts, from
administrative tasks to specific construction processes. It is directly related to the
principle of “going slow to go fast” and Continual Reflection. The awareness gained
from these observations serves to educate the team on how work is performed at every
stage of the process, and leads to productive change. Information gathered can also
be used with other tools, such as Value Stream Mapping, A3s, PDCA and Swarming.
Everyone involved in a project can benefit from Going to the Work, from owner
representatives, project design leaders, project managers and leadership, to cross
trades and less experienced practitioners.

References
Gemba Walks, Jim Womack

Quick Reference
Respect for People .................................... 77

Continuous Reflection ............................... 65

Value Stream Mapping ........................ 213

194 Transforming Design and Construction: A Framework for Change

 CHAPTER
34

COLLABORATIVE BUDGET
MANAGEMENT
Introduction
While traditional project teams have sufficient budget management skills, typically
the focus is on individual participants rather than the entire project. Rarely are the
details of these outcomes shared with team members beyond those individual firms.
This silo method of reporting can lead to surprises down the road as firms review their
Cost to Complete (CTC) at different rates, often not identifying overruns until late in
the project. These surprises harm team morale, ruin relationships and cause significant
discontent among partners.

Participants assigned to a budget cluster should understand the entirety

of the document, and all budget data should be defined in common
language, and not be trade or partner specific.

CHAPTER 34: Collaborative Budget Management 195

 Conversely, collaborative teams are encouraged—and sometimes contractually
required—to share this data frequently and openly to help understand the overall
outcome. This is a challenge for many partners, as systems and methods vary widely for
cost accounting.
Although sharing this data requires a serious leap of faith, Collaborative Budget
Management is an essential step toward managing a project’s CTC.

1.0 Why
A Collaborative Budget Management Process is essential for accurately tracking
and projecting a project’s CTC. Unfortunately, many in the industry do not properly
manage the process, or have an unreasonable approach to managing CTC. This
frequently leads to unplanned cost overruns.
Cost Forecasting, as well as Risk and Opportunity data, are key components to
Budget Management and are necessary for projecting CTC. A proactive Collaborative
Budget Management Process creates a reliable barometer for participants to monitor
profits and outcomes throughout the duration of the project.
The principal advantages of Collaborative Budget Management include:
• Creates a platform for open, honest and frank discussions about the challenges,
opportunities, and progress of a project.
• Promotes CTC awareness.
• Encourages transparency.
• Discourages scope hoarding or avoidance.
• Enables shared procurement.
• Enables shared/consolidated scope.
• Facilitates efficiency discussions.
• Pinpoints cross-trade disruptions.
• Engenders a shared understanding of Current Working Estimate (CWE).
• Encourages shared goals/shared risk reward knowledge.

196 Transforming Design and Construction: A Framework for Change

2.0 How
During the Budget Management Process, the discussion should encourage
ownership of budget components, as well as challenge participants and transaction
detail. Participants assigned to a budget cluster should understand the entirety of the
document, and all budget data should be defined in common language, and not be
trade or partner specific.

The Budget Management process should not focus only on actual cost,
but should reach a determination as to why actual cost differs from the
original estimate.

Additionally, the team should have an understanding of the Added Scope vs. Team
Target, which is determined by asking probing questions such as:
• What specific scope drove the change in cost?
• Why did the scope change?
• Did we challenge the scope change in person? With whom?

CHAPTER 34: Collaborative Budget Management 197

 • What was our basis for challenging the scope?
• Was the decision to add the scope a “whim?”
• Should we have known?
It is essential that there is a solid handoff from the person managing the cost during
development to the person handling construction cost details and forecasting, i.e. a
solid handoff from Cost Forecasting in Early Project Phases to Collaborative Budget
Management. Participants should also define the leading indicators necessary to
determine Cost to Complete. If errors are pinpointed, the project team should stop and
make adjustments via a Root Cause Analysis.
Other important attributes of Collaborative Budget Management:
• Bad news should be reported immediately, and not by proxy.
• All costs should be identified and shared with all stakeholders, along with cost
estimates and target information.
• There should be one point of aggregation.
• The process should encourage open, honest and regular sharing.
• All partners should participate and come prepared with data.
• There should be accurate monthly cost data in real numbers.
• The team should develop a consolidated project cost and make those goals
obvious.

3.0 What
Collaborative Budget Management ensures that project teams are accurately
reporting the collective health of a project. It is a method for both design and
construction to ascertain their Cost to Complete and should be perceived as a
management (not accounting) tool.
While Cost Forecasting in Early Project Phases focuses on time and materials on the
front end of a project, Collaborative Budget Management focuses on costs through
the end of the project. In fact, Burn Rate and Risk and Opportunity data from the early
development stages should flow into the Budget Management process.

198 Transforming Design and Construction: A Framework for Change

 Necessary components of effective Budget Management include:
• A consolidated, shared, single spreadsheet to encourage transparency;
• Detailed monthly transaction details, necessary via a transaction register to track
scope and dollars for innovation, constructability, and integration of the team;
• Risk/Opportunity Log to provide a path back to the budget and to get the project
back to target;
• Graphical output for visual reference;
• Established targets provided to all participants;
• Benchmarks; and,
• A “Budget Champion” to collect, collate and present the documents, although they
are not necessarily responsible for the data.
The Budget Management process should not focus only on actual cost, but
should reach a determination as to why actual cost differs from the original estimate.
Additionally, the process should push for ownership and drive accountability.
Ultimately, the Budget Management process provides a good way to tie directly into
the “Team Health Dashboard.”

Quick Reference
Cost Forecasting in
Early Project Phases................................... 53

Risk and Opportunity Register................. 95

Visual Management and

Communication........................................... 33

CHAPTER 34: Collaborative Budget Management 199

200 Transforming Design and Construction: A Framework for Change
 CHAPTER
35

PLUS/DELTA
1.0 Why
A primary pillar of a Lean culture is Continuous Improvement. One very effective
way to strive for this is through Retrospection. Plus/Delta is a quick, simple retrospective
to improve meetings, planning sessions or repetitive activities. By using Plus/Delta,
teams can continuously improve meetings or activities and show respect for people by
discussing the value of or ability to improve the time spent on events. Using this practice
appropriately will help develop and sustain the Lean culture. Over time, participants
will ideally develop a regular practice of making timely assessments and adjustments.

Plus/Delta is a quick, simple retrospective to improve meetings,

planning sessions or repetitive activities.

2.0 When
Plus/Deltas are typically done in last 10 minutes of a meeting or activity. Projects
and organizations that really look to maximize their learning from the practice also
use it mid-way through a longer meeting or work session. It can be particularly helpful
as a coaching tool when a meeting is going off-track—it will help recalibrate the team
around the meeting’s objective and potentially help them identify a new objective.

CHAPTER 35: Plus/Delta 201

 3.0 How
Typically, the facilitator does the following:
1. Plan 10 minutes in the agenda for the Plus/Delta. Make sure the time slot doesn’t
get used up by another topic. This is not something to be rushed and completed
for the sake of completion. Attendees may at first be unwilling to appear to criticize
the meeting. They may be afraid to participate. The facilitator should expect to
encourage participation until the practice becomes commonplace.
2. Explain to the group every time what a plus/delta is.
a. Plus: what brought value and how does the team repeat it?
b. Delta: what can the team change or add to bring more value? How can the
team do better?
c. The team should focus on the process of each particular meeting rather
than focusing on people. The facilitator should be prepared to return to
emphasizing the objectives of the meeting and how to better achieve these
objectives.
3. Draw a line down the middle of a flip chart or white board, label the top with
“Plus” and “Delta”
4. Ask the team for pluses and deltas—in action phrase format. They should start their
comment by stating whether it is a Plus or a Delta.
a. Again, all comments should be discussed in action format. If someone says
“There was good conversation” as a plus, ask “What action occurred to allow
that to happen?” If someone says “we had too many sidebar conversations,”
ask “What action can we take to prevent that next time?” Try to get to the root
cause so the appropriate countermeasure can be determined.
b. This may take some probing. Some teams go around the table so that
everyone provides a plus and a delta, others let the group organically
respond. If the room remains quiet, wait for a few minutes. You may eventually
need to call on some participants to get the exercise started.
c. Encourage both deltas and pluses. The intent is to both improve and sustain
what is working well.
d. Don’t let people off the hook. Encourage all to speak up. Validate comments
with the group to ensure value to most before helping define the action.
e. Ask in terms of “Who has another plus or delta?” or “What else?” until it is time

202 Transforming Design and Construction:

 The facilitator should expect to encourage participation
until the practice becomes commonplace.
to close the session. Then shift the question to “Is there anything else?”
f. Capture these actions on the flip chart. If an action has too many words or
is not easy to write, ask the person who said it to rephrase it in a few words.
“Translating” is not recommended as often the intent is missed.
g. Ask for owners of each action, along with a commitment date. It is O.K. to
decide not to take action.
h. At the beginning of the next meeting, review the status of the actions from the
prior Plus/Delta.

Helpful facilitation points:

• No “junk words” allowed. If someone says “the meeting was too long,” ask
them to define “too long” or to rephrase the statement into a recommended
improvement. (For example: “We should meet for 45 minutes.”)
• If a participant found nothing to be of value in the meeting and has no
improvements to offer, ask that participant if he really needed to attend. What
action can be taken for the next meeting to ensure the right participants are there
at the right time?

CHAPTER 35: Plus/Delta 203

 • Everything brought up is fair game. Do not discount anyone’s pluses or deltas.
Discounting feedback can prevent others from speaking up. Anything brought up
that is completely off-topic should then be captured in a “Parking Lot.”
• Pay attention to the mood of the group. The group must be open and feel safe to
speak up.
• Ensure your application is appropriate for the environment. For very large groups
(like conferences) a technical application may be helpful. Generally, more value
comes from the group discussing these together.
• Set the goal of not having the same delta from one meeting to the next. Having the
same delta means the action was not implemented the first time.
This process can become stale and not add value if not facilitated as described
above. There may come a time when the team agrees the meetings are high
performing and do not need a Plus/Delta. However, if the meeting value becomes
suspect, begin the practice again, perhaps in a more intentional way to bring the value
back.
Meetings tend to become habit, the need for the meetings change with time, the
length of the meeting may need to change, or any number of factors may alter the
value proposition. The Plus/Delta process can help the change occur as needed.

Quick Reference
Facilitation.................................................... 57

High-Performing Teams.......................... 113

Continuous Improvement....................... 179

204 Transforming Design and Construction:

 CHAPTER
36

AGENDAS
1.0 Why
Lean/IPD teams are encouraged to work in groups, not silos. This reduces rework
by incorporating the needs of many stakeholders before a solution set is presented
or moves forward. Though this way of working seems to require many participants
attending many meetings, it ultimately reduces the total time spent in meetings. Having
an effective agenda respects the participants’ time and the value they add to the
subject matter. Good agendas effectively move work forward by aligning participants
with objective outcomes. Collaboratively-built agendas support the development of a
Lean culture. It is equally important for the agenda to be well-facilitate.

Good agendas effectively move work forward by aligning participants

with objective outcomes.

CHAPTER 36: Agendas 205

 2.0 When
Prepare agendas for all meetings, sessions and group events where three or more
people are involved. Agendas can be used for singular subject matter situations and
can support the weekly plan for co-located teams and Big Rooms.

3.0 How

Preparation
• Develop the agenda collaboratively. Involve all participants.
• Prepare the agenda at the end of a recurring session for the next session. Another
option is to prepare the agenda earlier in the recurring session, particularly if
attendance drops off or participation wanes during the meeting. This is a critical
step.
• Publish or post the agenda well before the session meets. This advance posting
allows participants to prepare—and also allows others to participate if they feel
they will add value.

Elements of the Agenda

• Determine the intention and type of session (planning, decision-making, work, etc).
• Identify the clear expected outcomes to advance the work for each agenda item.
• Identify the customer(s) of the outcome of each item/session and align the
expected outcome with their expectations.
• Determine the necessary participants based on their stake in the outcome, their
input on the subject matter, and their empowerment to make decisions. When
inviting participants, be mindful of the time and other costs they must devote to the
meeting.
• Optimize the amount of time needed to drive to the expected outcome while being
respectful of participants’ time.
• It is acceptable to include time buffers and flex time, but be transparent about their
inclusion; and only use them if needed. End items or sessions early if the outcome is
reached early.

206 Transforming Design and Construction: A Framework for Change

 Use visual cues such as color-coding by type of session,
visual timeframes, etc., when appropriate to provide clarity.

• Be mindful of participant’s constraints in organizing agenda items.

• Be mindful of participants’ time constraints when scheduling back-to-back sessions.
• Open the session with a review of previous plus/deltas for a recurring session.
• When appropriate, lead with Hot Topics. Allow for adjustment to the agenda if
needed, and ensure that the group meets consensus.
• Leave time on the agenda to develop the next agenda for a recurring session.
• Include time for plus/deltas.

Tips for Building an Agenda

• Identify the facilitator of the overall agenda and individual agenda items.
• Use visual cues such as color-coding by type of session, visual timeframes, etc.,
when appropriate to provide clarity.
• Identify participants.

CHAPTER 36: Agendas 207

 • Include contact information (location, virtual connectivity instructions, etc.) for
venue(s).
• Plan to have a Parking Lot to assign actions and owners when off-subject topics
arise to avoid derailing the session.
• Be prepared to build a Commitment Log for Action Items.
• Consider the manner in which output of session will be shared. (For example,
determine whether minutes add value.)

Resources
Read this Before Our Next Meeting, Al Pittampalli
Death by Meeting: A Leadership Fable…About Solving the Most Painful Problem in Business,
Patrick Lencioni
Effective Big Room Agenda, Inside Out Consulting/Kristin Hill

Quick Reference
Visual Management.................................. 33

Respect for People..................................... 77

Plus/Delta................................................. 201

208 Transforming Design and Construction: A Framework for Change

 CHAPTER
37

THE MINDSET OF
AN EFFECTIVE BIG ROOM
1.0 Why
An effective Big Room supports cross-functional team collaboration by advancing
work and bringing the larger team up to speed on the activities of other groups or
individuals. It allows teams to understand their impact across clusters or work groups.
The Big Room also provides teams with the time to discuss project-wide concerns
such as budgets, hot topics or global changes. The term Big Room refers more to the
behaviors and actions of the team than the physical space. The Big Room is more than
co-location of people; it is about collaborative behavior and the work it produces.

The Big Room is more than co-location of people; it is about

collaborative behavior and the work it produces.

CHAPTER 37: The Mindset of an Effective Big Room 209

 2.0 When
The behaviors and activities of the Big Room environment should begin as early
in the project as possible even if the whole team is not yet formed. The frequency
of Big Room sessions varies from project to project and within different phases of
the project. The team must therefore continuously determine the right frequency and
duration of sessions. For example, a half-day per week may be appropriate for a very
small project. A complete co-location might be suitable for other situations. Again, the
demands of each project will determine the frequency, duration and location.
Over the course of the project, the key participants in the Big Room should and will
change according to the type of work being produced and the type of team members
who add value to each phase of the project. It is important that the team include
the right people at the right time having the right information to do the right work. It
is important to discuss regularly this value proposition. Along with smaller monthly
changes, the entire nature of the Big Room will change several times throughout the
project life.

Although forming a Big Room requires a significant investment of time and money,
the Big Room adds value to the project and drives down overall project cost.

210 Transforming Design and Construction: A Framework for Change

3.0 How
The Big Room is about fostering behaviors that lead to high levels of collaboration
and thus to High-Performing Teams. Although forming a Big Room requires a significant
investment of time and money, when conducted well the Big Room adds value to
the project and drives down the overall project cost. Teams rapidly advance work
in a relatively short amount of time with less rework because they have the collective
brainpower in the room working together.
Having a well-established, effectively facilitated agenda is crucial to a Big Room’s
productivity and efficiency. The team should collaboratively create the agenda well in
advance of the Big Room session. This ensures that all team members are prepared to
advance the work. A good agenda has an expected outcome for the agenda items,
timeframes and required key participants. While it is important to have an effective
agenda, it is equally important to have it be well facilitated.

Potential Big Room Venues

• Co-Located: Participants continuously located together with continuous
collaboration
• Recurring: Participants meet in person on a regularly scheduled, recurring basis
• Hybrid: Combination of in-person and virtual attendance by select participants

Quick Reference
Cluster Groups......................................... 155

High-Performing Teams.......................... 113

Agendas.................................................... 205

CHAPTER 37: The Mindset of an Effective Big Room 211

212 Transforming Design and Construction: A Framework for Change
 CHAPTER
38

VALUE STREAM MAPPING

Introduction
Traditional projects typically are managed by evaluating and optimizing individual
tasks or small sets of work with a single idea or a few individual ideas of how best to
perform the entirety of the work. This often leads to inefficiency because the approach
doesn’t represent all of the details or knowledge about the work. Collaborative teams
are encouraged to evaluate the entirety of the value stream; map the process; consider
the value of each step; and optimize the process through Value Stream Mapping.
Value Stream Mapping is best used for mapping the flow of value for processes
performed multiple times. It is not to be confused with pull-planning, process mapping
or hand-off work-planning, which typically are used for mapping a pathway of work
and decisions to get to a particular endpoint.

Value Stream Mapping is best used for mapping the flow of value for
processes performed multiple times.

CHAPTER 38: Value Stream Mapping 213

 1.0 Why
A Value Stream Map (VSM) is a tool that helps individuals visually see and
understand a given process rather than simply looking at results. This is vital because
understanding the current state of a process is integral to identifying and removing
waste.
A VSM enables people to see the flow of value—Customer Value-Added vs.
Business Value-Added vs. Non Value-Added—as well as the percentages of each in the
process. Non Value-Added components tend to creep into a process over time, and
by understanding the process, a project team is better able to design a solution that
optimizes functionality and eliminates waste.
Additionally, a VSM:
• Identifies opportunities for process improvement;
• Identifies pinch points and helps level the workflow to optimize use of resources;
• Encourages continuous improvement philosophy;
• Enables cultural change by allowing people to identify and improve the process;
• Provides a great mentoring tool; and,
• Helps drive toward a goal.

2.0 How
As a critical first step in the development of a VSM, it is important to accurately
assess and gain consensus regarding the current state of the process. This requires input
from all who actually participate or use the system/process. Systems often are loaded
with non-value-added steps; therefore, it is valuable to assess the current state of the
process.
The creation of the VSM should begin with the end in mind, be customer-focused,
and be completed by someone who is close to the work. Ultimately, the VSM will lead
to quick wins or “just do its,” but inevitably will need a deeper dive to solve the larger
issues in the process, such as A3 thinking and Root Cause Analysis. The process does
not necessarily require technology.

214 Transforming Design and Construction: A Framework for Change

 NICU Current State Value Stream Map
Main Campus
Social Care Management RADIOLOGY 2011 Infant Palliative
Urology Chaplain Respiratory Echocardiogram Nutrition Care Opthalmology
Pharmacy Services And Discharge Audiology Laboratory Therapy Lactation
Circumcisions Services Care In NICU Services Consults
2011 Preparation OT/PT/Speech
In Portable
40-50% of Total doses: 1,846 enc. 64 unique cs 100 % x 1 Radiology Imaging 70% of all pts. 2010 & 2011 – 80% 2010 – 33 cases 100% screened
15.6/dy 02 (30%) 2011 – 716 (96%) 19.9 lab orders/day 2011 - 284 100% screen
Total Patients 2010 – 90,228 11 baptisms 82 contact/mn ___ % x 2 24 pts.visits Dedicated Rm. Not
FTE – 1.0 Deaths - 27
179.4 doses/pt. 35 deaths See below DME – 22% 0.8/adm. 2.6/adm. 68% of orders are 100% wkly review used, @ bedside
FTE – 1.5 FTE – 1.0 daily
445 Total 1,404 Total 2011 – 58 cases
2011 – 109,426 75% @ bed Home Care – 66% Between 7am – 4pm 30 lactation trays/day 6,240 per year
200.1 doses/pt. 25% private Deaths - 30
Delivery x 2/day
SMS Central EPIC
LEGEND
Portal of Entry Computer System June 1, 2012
Ground Transport Surgery
Housed Within Less than 1% of NICU
NICU Patients enter via ED
2010 – 577 – 90%
2010 – 136 patients (27%)
2011 – 670 – 90%
Facilities
Surgeries – 272
Within NICU
Time to Unit – 2:12
Cardiac – 53 (21 were PDAs)
Personnel FTE – 1.0 RN
Only 2011 – 128 patients (23%)
Distance – 178 ft. Move to Second
Admission Neonatal Intensive Surgeries – 211
Position in Discharge
1 floor To Unit Care
Staff Count NICU
Cardiac – 26 (11 PDAs) (12%)
Physicians – 8.0 FTE Portal of Entry
Air Transport PT – 6 minutes 2010 data: 100% move x 1 162 Discharges
NNPs – 13.0 FTE
FTE: 2.0 RN 4,189 ventilator days or 11.5 patients on a ventilator/day PT – 10.5 min. 73% between 1pm – 6pm Telemetry
Residents.- 2-3 2010 - 62 - 10%
1.0 MD/NP 2011 data: FTE – 1.5 RN 22% Required DME
Fellows - 0
2011 – 78 - 10% 1.0 Therap. 13.9% of patients were on a ventilator 66% Required CHCG visit Capacity – 16 beds
Manager – 1.0 FTE
Time to Unit - ?? 9.5% on vapotherm therapy Multiple Births in 2011 15% Required Ext. Nsg. Care Usage - TBD
RNs – 110.9 FTE
30% on some type of o2 therapy Total screened for need - 716
Clinical Coor. – 8.1 FTE FTE – 1.0 RN
Average Direct Care FTE 2010 2011
Techs – 3.3 FTE Distance – 299 ft, Per Shift - 26
Twins 75 69 ECMO
Clerical - 9.6 FTE
- 4 floors Triplets 12 5
Case Manager – 2.0 FTE 2010 – 2 procedures
Quads 0 0
Lactation Counselor – 0.8
Qunits 5 5 0 2011 – 1 procedure
LPN – 5.1 FTE 2.12 mins.

LT – Ave. LOS 25.3 days

In Unit Procedures - 2011
Length of Stay Groupings
2011- Over Capacity
73 days when at least 50% stay < 14 days Pulse oximetery – 13,072 events
one shift was over the
bed capacity of 59 Aerosol by Nursing – 238 events
10% stay 15 – 21 days
Central Venous Cath – 190

Blood Transfusions – 187 events

22 % stay 22 – 63 days
Average Length of
Straight Bladder Cath – 77 events
Stay
2011 – 25.3 (3.06 stdv)
Enterostomal Therapy – 17 events
2010 – 25.6 days 14% stay > than 64 days
Indwelling Catheter – 20 events

Chest Tube Placement – 9 events

Acute vs SubAcute
Days Lumbar Puncture – 16 events
Acute – 8,777 – 46% Exchange Transfusion – 1 event
SubAcute – 10,302 – 54%
Epidural Infusion – 9 events

Non Value-Added components tend to creep into a process over time, and by
understanding the process, a project team is better able to design a solution that
optimizes functionality and eliminates waste.

Stakeholders in the VSM development include:

• A facilitator;
• Participants closest to the work; and,
• Customer(s) of the work product.

An example VSM exercise could follow these steps:

1. Assemble a team of stakeholders
2. Identify a process to study
3. Go and see the process (see Go to the Work) and collect actual data
4. Avoid assumptions about the process
5. Map the process visually to establish the current state

CHAPTER 38: Value Stream Mapping 215

 6. Identify and discuss opportunities for improvement
7. Map the process visually to establish the ideal future state
8. Document the process and changes required and follow through

3.0 What
A VSM is a picture (map) of the entire process being studied and includes both
material (product/service) and information flows, decision points, handoffs and
interactions with other systems. Once a process is accurately documented, the
team determines which steps are value-added and which are non-value added.
Subsequently, a VSM identifies waste within a process and areas for potential
improvement. Seeing the system laid out visually allows participants to remove the
waste through step elimination and helps them understand the true value of the
process/system.
The VSM is a scalable, actionable exercise and should prompt action to reduce
waste in the process. This waste reduction frees up resources for other value-added
activities.
A VSM should be Defined, Documented, Distributed and Monitored in order to
ensure that it is an actionable document, because the VSM is created as a prelude to
action.

Quick Reference
Learning to See Waste............................. 23

Continuous Improvement ...................... 179

Go to the Work....................................... 191

216 Transforming Design and Construction: A Framework for Change

 CHAPTER
39

WORK STRUCTURING

Introduction
Work Structuring can be described as a path taken from chaotic work to optimized
work. It involves implementation of a number of strategies and tools, including defining
standard processes, working to optimize those processes, and seeking one-piece flow;
while employing tools such as mistake-proofing and built-in quality. The construction
industry must work to eliminate the celebration of heroic behavior—taking on a nearly
impossible task and putting the project at risk—by taking a step back and being more
intentional about work structuring. The potential exists for significant transformation,
resulting in massive improvements in productivity and quality.

The complaint that standardization stifles creativity isn’t valid. Rather,

standardization creates the platform from which innovation can spring.

CHAPTER 39: Work Structuring 217

 1.0 Why
The fundamental grounding of Work Structuring involves the identification of
repetitive processes and subsequent structuring into standard work. Repetitive actions
can be transformed into standard processes. The complaint that standardization stifles
creativity isn’t valid. Rather, standardization creates the platform from which innovation
can spring. Companies should always seek the new standard. Additionally, the
complaint that construction isn’t repetitive isn’t valid either. While every project itself is a
different product, the processes that make up the final product repeat from one project
to another.
Standardization and optimization produce outcomes that include higher quality
of work, better safety, increased efficiency and higher productivity. These results are
sought universally by all organizations.

Foster the improvement process by teaching people to think of work

process in terms of mistake-proofing.

2.0 How
As with many Lean approaches, Work Structuring seeks to optimize the whole. For
work structuring to be effective, there must first be an awareness of local optimization,
followed by an understanding of how the various local systems interact from the
perspective of global optimization. Under Work Structuring, a system-centric view is
preferable to a product-centric view, with the key focus being the integration of systems.
Local improvements must be evaluated within the context of the entire project; building
to a global level is a logical progression.
Work Structuring often begins with an effort to standardize repetitive work. However,
it is important to note that non-repetitive work is ripe for improvement as well. In non-
repetitive work, individuals should seek hidden repetition and find opportunities to
optimize and strengthen connections and the handoff of work.
Companies should always seek the new standard by elevating the baseline through
innovation. As new innovations arise, the baseline moves in concert to become the
new better practice that is spread through the company as the updated standard. This
cycle can repeat perpetually and is the basis of Continuous Improvement.

218 Transforming Design and Construction: A Framework for Change

 Document the new process in a visual manner and distribute to all
workers who will implement it. Post the process so it can be seen and
referenced from where the work is being performed.

The contractual terms can help or hinder the ability of the team to optimize the
whole and properly structure work. Traditional ways can hinder in optimizing work but
relational contracting methods such as an Integrated Form of Agreement (IFoA) can
help overcome the methods of the past. An identified standard process can be used as
a baseline for continuous improvement. Refining the balance.
Mistake-proofing can be a powerful tool in Work Structuring. A mistake-proof step
in a process prevents the one doing the work from performing the step incorrectly. A
simple example can be taken from operating a car. In most cars with an automatic
transmission, the car cannot be started unless it is in park or neutral. Most of these
cars cannot shift out of park unless the brake pedal is depressed. Furthermore, the
key cannot be removed unless the car is placed in park. Most cars with a manual
transmission will not start unless the clutch is depressed. These are examples of mistake-
proofing because they only allow the driver to behave in one, optimal, safe manner.
Built-in-Quality can also significantly shape Work Structuring. Building in quality
improves the work by reducing or eliminating the need to check or monitor a process.
Most critically, quality occurs at the point where a discrete step in the process occurs
instead of at the end of a process where defective work has already taken place.

CHAPTER 39: Work Structuring 219

 Traditionally, the work product was inspected in a finished state, meaning that any
defect that occurred would have been replicated multiple times. With Built-in-Quality,
elements requiring inspection or verification are addressed at the point where they are
implemented, often through a mistake-proofing process. An excellent example comes
from the original Toyota loom, which featured a device that stopped the loom when a
thread broke. Rather than having to constantly monitor the loom or waiting to find that
the woven goods were defective, the Built-in-Quality of the device removed the need
for monitoring or checking.

3.0 What
Work Structuring involves the following steps:
1. Identify an activity with repetitive work: Carefully examine the work your
organization performs. Select an activity that is repeated frequently and that has
some number of discrete steps. Start with a common process that is relatively
simple, and yet still substantial. This increases the chance of beginning your
improvement effort with an easy win, a key component to initial buy-in for the Work
Structuring effort. Start small to gain experience through repetition, then take on
increasingly difficult and complex processes as your team gains experience.
2. Develop a standard process for executing the repetitive work: Carefully map the
steps of the activity in a thorough manner. Involve the people who perform the
work and have them work together, using sticky notes to illustrate their discussion.
Pay careful attention to detail and be prepared to spend time defining what
each step entails. Encourage participants to share their stories of performing the
work—what went well, what didn’t work as planned, what they wish they had to
do the job better. Translate these recommendations into steps for the process. It is
important to reach consensus on how to best do the work with the people present
in the process. Also, define what you are seeking to improve and how you will
measure it. Common metrics include greater installation speed; fewer workers
required; less material needed; reduced number of errors, etc.
3. Implement the standard process: Document the new process in a visual manner
and distribute to all workers who will implement it. Post the process so it can be
seen and referenced from where the work is being performed. Plan for review and
training of the standard process and prepare to monitor its initial implementation
with all workers. Seek agreement that people will rigorously follow the standard
process, even if it is not the way that they have personally performed the work
in the past. Monitor the outcome of the process against the developed metrics.
Publish and celebrate the results.

220 Transforming Design and Construction: A Framework for Change

4. Encourage innovation from those executing the standard process: Incentivize
compliance with the standard by promising the opportunity for innovation. Explain
that workers can start with the standard process as the baseline and that when
they find a better, more innovative way to perform a step in the process, their
innovation will become part of the next standard process and will be spread
across the organization. Recognize innovation by publicly celebrating the
innovator and the improvement they made. Explain that this cycle of standard
> improvement > new standard > improvement will continue forever. Tie the
improvements back to the metrics and share the story of how each improvement
helps to better meet the metric.
5. Stabilize the standard process, then stress to optimize: Once you are comfortable
that the standard process has taken hold and the team has achieved results as
demonstrated by measuring against the metrics, begin to optimize the standard
process. Reassemble the people performing the work and challenge them to
push steps in the process. Work step by step with the intent of maximizing each
step until it breaks. Then, stop and assess why the step broke and refine how
it is performed. Stress the process until the team reaches an optimal state. As
you develop more standard processes, move from one to the next, stressing to
optimize. Don’t stress more than one process at a time to avoid over burdening
the team, but maintain a vigorous rotation so that there is an improvement effort
occurring at all times. Then, continue to cycle through various processes. Before
you know it, your team won’t just be performing the work—they will be perpetually
improving the way that they work.
6. Seek opportunities for mistake-proofing steps in the process: Foster the
improvement process by teaching people to think of work process in terms of
mistake-proofing. Challenge them to structure the process in a manner that
reinforces the correct method by removing the opportunity to perform the work
incorrectly.
7. Introduce elements of built-in quality to the process: Establish gateways in the
process where work is checked for quality. At a minimum, place these at points
where work is handed off from one stakeholder to another, both internal and
external to the organization. Once established as gateways, work to pull the
elements of the quality check upstream into the process. Couple these built-in-
quality elements with mistake-proofing to further decrease the chance of defects.

CHAPTER 39: Work Structuring 221

 4.0 When
The timing of Work Structuring is key to its successful implementation on a project. As
a general rule, the earlier Work Structuring is performed the better, in order to achieve
maximum impact. Implementing later in the project can still bear fruit, so it should
always be considered.
Work Structuring should be discussed within the Pull Planning Process. Once
developed, it should cascade down and be monitored and improved at the weekly
work planning levels, allowing it to be refined and improved over time.

Quick Reference
Continuous Improvement....................... 179

Go to the Work....................................... 191

Value Stream Mapping......................... 213

222 Transforming Design and Construction: A Framework for Change

 CHAPTER
40

A3 THINKING
Introduction
Projects are developed by experts and contributors with various backgrounds and
experiences making thousands of decisions. Those experiences inform decisions,
whether appropriate or not, and ultimately determine project cost and outcome.
Collaborative projects have learned that waste is often imbedded in those decisions
that don’t directly apply to the current project Conditions of Satisfaction (CoS). A
High-Performing team will create a decision making process and rigorously perform
the A3 Thinking decision making process to identify and reduce waste while improving
compliance to the CoS.

Done correctly, A3 reporting can provide concise project updates for

senior oversight individuals and drive faster input and feedback.

CHAPTER 40: A3 Thinking 223

 1.0 Why
Teams should use an A3 to improve collaboration, outcomes and the problem
solving of specific issues. Due to the size of an A3 (typically displayed on an 11 x 17
sheet of paper), teams are required to focus each A3 on a complicated or broadly
compelling decision or a single small to mid-size problem.
Done correctly, A3 reporting can provide concise project updates for senior
oversight individuals and drive faster input and feedback. It can also provide a regular
snapshot of project health.
Another advantage of an A3 is the historical record of the issue that it provides,
along with the rationale behind various decisions or solutions and how the team arrived
at them. This can be a useful document to reference later in the project to understand
the thinking at various critical points.
A properly executed A3 should reveal the rigor and thought a team used to resolve
an issue, thereby increasing confidence with senior leadership. Other benefits include:
• Identifying root causes;
• Creating a dashboard of useful information to reference throughout the project;
• Sharing information and knowledge among team members;
• Reaching consensus among team members; and,
• Promoting deliberative, thoughtful decision making.
The A3 process is also a good learning tool. Authors are mentored by more
experienced reviewers. Everyone involved in an A3 has an opportunity to sharpen their
problem solving skills.
A word of caution—producing A3 documents without utilizing the A3 thinking process
could still lead to various types of waste.

2.0 How
An A3 is a collaborative document usually managed by a single author or champion
who has ownership of the document and oversees its development. The champion
drives the process and encourages contributions from team members. A more senior
team member or leader serves as a reviewer and mentor, guiding and challenging
its assumptions, recommendations, and conclusions.This process is performed with the
author in mind so that the information can be consumed in a short time period, thereby
yielding sharper thinking.

224 Transforming Design and Construction: A Framework for Change

 While there are many ways an A3 process can work, the following image provides
a good example of how these steps often look:
PROBLEM SOLVING A3 PROCESS
Problem
7. Obtain Approval
NO
Perceived
Return to
STEP 1

1. Grasp the
YES
Current Condition
8. Execute the
Implementaion Plan

2. Identify the Root Cause

9. Execute the
Follow-up Plan
3. Devise
Countermeasures and
6. Discuss with Affected Parties

Visualize the Future State

NO
Are Targets Met?

4. Create Implementation
Plan YES
Identify Next
Establish Process Problem
Standrad
5. Create Follow-up Plan

In pursuit of building perfection® JEDUNN

Remember that an A3 is a high-level tool that does not prescribe specific steps.
Those can be shaped by the champion, reviewer,and team members. With that in mind,
below are a few tips for using an A3:
• Prominently define the problem that A3 is addressing.
• Include a list of participants so it is clear who contributed to the process.
• Make sure each A3 has an owner or champion.
• Don’t feel compelled to fill up the entire 11 x 17 paper if it’s not needed.
• If the problem doesn’t fit in the space, break it into a smaller problem that can fit on
the paper, or reshape the presentation more precisely.
• Use a platform that provides version control and allows editing by all team
members.
• Integrate visuals if they are more effective than text in communicating ideas or
illustrating points.
• Update the document as new information becomes available.

CHAPTER 40: A3 Thinking 225

 3.0 What
A3 thinking is a collaborative process management and improvement tool
developed by Toyota. The applications of an A3 are broad. It can be used for problem
solving, decision making, planning or reporting of a specific issue from the proposal
stage to commissioning. For example, an A3 might be used to decide which system
to select, or how to accomplish LEED certification. Often, it is part of a PDCA cycle or
DMAIC cycle.
An A3 is an indispensable tool due to the structure, focus, collaboration and
consensus it brings to problem solving and decision making. The flexibility of the tool
also makes it easy to adapt to a variety of tasks and contexts.
No special software or tools is needed to use an A3. It can be developed using a
pencil and paper or commonly-used programs like Excel, Word, and PowerPoint. The
only formatting requirement of an A3 is that it be presented on an 11 x 17 sheet of paper.

References
How to Use A3 Reports on Projects, Lean Project Consulting
Project Development for the Lean Enterprise, Michael Kennedy
Understanding A3 Thinking, Durward Sobek and Art Smalley
Managing to Learn: Using the A3 Management Process to Solve Problems, Gain Agreement,
Mentor and Lead, John Shook

Quick Reference
Facilitation.................................................... 57

Continuous Improvement....................... 179

Conditions of Satisfaction...................... 133

226 Transforming Design and Construction: A Framework for Change

 CHAPTER
41

CONCEPTUAL AND
CONTINUOUS ESTIMATING
Introduction
A collaborative project environment is intended to solicit and share input from
various constituents across the delivery supply chain. To maximize the value of
this interaction and to facilitate true value-based decisions, participants must have
conversations about solution Set Based Design concepts that lead to the need to
understand the cost impact of these decisions.

Continuous Estimating is the effort of regular, frequent updating of the

estimate, while also tracking specific variances from the last update.

Understanding these cost impacts requires Conceptual Estimating, a rare, high-

value skill that differs from other more common estimating skills. This skill is particularly
important in the collaborative environment, where cost information informed by well-
grounded time and schedule assumptions is critical to determining which asset solutions

CHAPTER 41: Conceptual and Continuous Estimating 227

 can be provided to stakeholders within the given time and financial constraints.
Continuous Estimating is the effort of regular, frequent updating of the estimate, while
also tracking specific variances from the last update.

1.0 Why
Conceptual Estimating requires the constant re-evaluation of a project’s value
proposition, established from the beginning and updated frequently throughout the
process. Ultimately, Continuous Estimating allows constant confirmation of the viability
of the project, providing validation of the business case from the earliest stages.
Conceptual Estimating, along with Set Based Design, seeks to validate the business
case and answer the question, “What is the delta between what the owner wants
and what the business case will support?” Owners need to recognize whether they
can ultimately afford the development and whether the required capital investment is
appropriate. With Conceptual Estimating, the owner is provided with significant options
that can lead to various outcomes, with one possibility being not to proceed with a
project.
In order to make accurate, value-based decisions, meaningful real-time
understanding of the cost implications of each decision is necessary. Continuous
Estimation provides early validation of Want vs. Need—a balancing act with constant
tradeoffs. Cost can and should inform design. Understanding the cost implications of
design decisions is a valuable tool for designers to better align with owner intent and
maximize the value of their design. In many cases, a continuously updated estimate
prevents the frustrating and expensive re-design common to capital projects.

2.0 How
Two-skill sets are key elements of Conceptual and Continuous Estimating—one “soft”
involving necessary interpersonal skills, and the other “mechanical” having the actual
experience and knowledge. It is important to note how these required skills differ from
those of a traditional estimator.

Mechanical
At the outset of a collaborative project, the team should develop a detailed cost
projection of the “want.” When possible, benchmark what is feasible based upon
historical experience. This is balanced against what an owner can spend by way of
the business case, and a target is then established.

228 Transforming Design and Construction: A Framework for Change

 The overall target budget is often broken into systems or components and shared
with various cluster groups to use as a guide for further development. This arms them with
a tool to inform their design decisions. A format for incorporating up-to-date data and
benchmarking is required, so that all participants understand the costs and target in the
context of the whole project. It is crucial that all participants understand the makeup and
adjustments to this budget tool. Cost data should be pushed out into or inform A3, BIMs,
CBAs and other decision-making tools.
Participants must have a rich understanding of what is required for the project without
the need of a sketch. Accuracy is paramount, but a balance of the appropriate level of
accuracy as the situation demands will ensure less overwork and speedier decisions.
This also requires Onboarding the right experts at the last responsible moment to aid in
the accuracy, and requires good handoff of ownership of those scopes. Estimators who
have problems imparting information should be pressed to explain.
When design decisions are made without understanding the cost, rework is a direct
outcome, so estimators should be party to all conversations. Estimate with an optimistic
yet realistic view and take the time to document and share risks as they are imagined or
discovered.
Continuous Estimating is not re-estimating the entire project on a specific frequency. It
is continually reporting out changes since the last report in an easily consumed format,
as the design solidifies.
Estimators need to have an understanding of what their project customers need.
Information that is too vague is not adequate for a design decision, while too much
detail can restrict the process as well. Reference materials, such as photographs or
plans from past projects, can help bridge the understanding gap between designer and
estimator.

Soft
Communication is crucial. Listening intently is important to understand wants and
needs of the owner and intent of the designer. An understanding of the level of detail,
value proposition, or level of accuracy is critical. The confidence and trust to share
opinions is valuable.
Facilitation of negotiation continues to be integral to the process. Design elements
beyond program basics must earn their way into the project, rather than be dropped in
and backed out. Therefore, continuous value discussions are required.
The success of this process demands that the owner share its historical knowledge
with the team. Many products or processes are unique and have little industry

CHAPTER 41: Conceptual and Continuous Estimating 229

 comparative cost data, but owners should still share this information with builders to
better inform set based decisions. Hiding these costs only pushes challenges further into
the process when less opportunity for resolution exists.

3.0 What
The primary focus of estimating is to create—with an applicable level of accuracy
and fidelity—a construction plan that can be successfully executed per the project
Conditions of Satisfaction and is key to the Target Value Design process. Continuous
Estimating will inform set-based design and reduce re-design by keeping the team
aligned with the project intent and designing within the range of affordable solutions.
Early and constant monitoring is necessary to make sure the team stays within its
parameters. Early validation of the business case is necessary, in addition to arming the
team with information to enable it to make informed future decisions and stay within the
business case. Early Stakeholder Involvement (See Early Stakeholder Involvement) is
critical to the success of the process and validity of this information.

4.0 Who
All team members need to have a sense of cost when considering design decisions.
If those skills are not within the cluster, an expert with the required knowledge should be
engaged.

Quick Reference
The Value Proposition................................ 19

Onboarding............................................. 187

Project Conditions of Satisfaction........ 133

230 Transforming Design and Construction: A Framework for Change

 CONTRIBUTORS

BERNITA Beikmann
Bernita Beikmann, AIA, EDAC, LSSBB, is a Principal
with HKS Inc. (Dallas office) and the Director of Lean
Strategy for the office. She graduated from Kansas State
University with a Bachelor’s of Architecture and Certificate
in Regional and Community Planning in 1996. She is a
registered architect in the state of Texas and has completed
projects in Texas, California, Oklahoma, Florida, Washington,
Ohio, Indiana, Washington D.C., and Nevada.
Ms. Beikmann has been with HKS for 19 years and has spent the last 17 years
primarily on healthcare projects. The last eight years her work has been focused on IPD
and Lean Project Improvement on projects and with project teams. She is a successful
advocate for Lean planning, design and construction.
She has served integral roles as a project architect and project manager and as a
coach and facilitator for project teams. As Director of Lean Strategy and a Lean Six
Sigma Black Belt, she works with all departments at HKS to improve internal processes.
She has shared her expertise with more than 12 organizations and conferences in the
last several years, and was one of the original Core Team members of the DFW LCI
Community of Practice. Ms. Beikmann currently is serving on the joint committee for the
American Institute of Architects and Associated General Contractors of America.

CONTRIBUTORS 231
 CHAUNCEY Bell
Chauncey Bell has enjoyed a long career of industry-
reshaping projects spanning many industries, including:
• Cement and aggregates
• Semiconductor construction and manufacturing
• Hospital construction
• Heavy equipment manufacturing
• Mining
• Electric utilities, electric distribution and wind farms
• Wholesale and retail banking
Mr. Bell’s projects shift clients’ cultures, shift the way that their commercial networks
operate, and add hundreds of millions to revenues and profits.

REBECCA Bettler
Rebecca Bettler is the National Director of Lean with JE
Dunn Construction. She leads a group of coaches and
trainers for all employees and project teams implementing
Lean practices and behaviors. She started in the
construction industry in 1996, beginning her Lean journey in
2006. She is also the Chair of the Lean Construction Institute
Education Committee.
Prior to JE Dunn, Ms. Bettler spent more than five years consulting
on the application of Lean principles in various organizations and project types. This
includes working with Owners, architects, contractors and engineers, Integrated Lean
Project Delivery teams, leading strategic planning sessions, implementing Last Planner®
System and various other Lean practices. She has developed and delivered training
materials and written white papers on various Lean Construction applications. In
addition to being an active member of the Lean Construction Institute, she is also a
Master Trainer of the Choosing by Advantages Decision-making System. Ms. Bettler
holds a degree in Business Management from the University of Phoenix.

232 Transforming Design and Construction: A Framework for Change.

 DIGBY Christian
Digby Christian is the Senior Regional Program Manager
overseeing the teams that are designing and building
two new hospitals, representing a $2 billion investment in
San Francisco for Sutter Health, a not-for-profit healthcare
provider located in Northern California. Previously he
managed the project to build the $309 million Sutter Health
Eden Medical Center in Castro Valley, Calif. It was delivered
using an Integrated Project Delivery (IPD) contract, under budget, ahead of
schedule, with no compromises to Sutter’s conditions of satisfaction for the building.
On these projects, Mr. Christian leads Sutter’s effort to create a work environment
that supports understanding what’s valuable to the client and encourages the teams
to actively and continually figure out how to align their work practices with delivering
that value. This has required changing the way project teams look at risk, at contracts,
at estimating, at work planning, at design and construction coordination, at supply
chain management, at production tracking—all leading to a radically different team
culture—one of engaged continuous reflection and improvement, of mutual respect and
accountability.
Outside of project management, Mr. Christian represents Sutter within the Large
Owner’s Group, an international grouping of approximately 20 companies that
each spend at least $500 million per year on capital assets and are committed to
transforming the design and construction industry.
Mr. Christian is an active participant in the Lean Construction Institute’s Knowledge
Transfer sessions that seek to spread what is being learned by leading Lean
practitioners. He also is a supporter of and an engaged contributor to the efforts of UC
Berkeley’s Project Production Systems Laboratory (P2SL).

SAMIR Emdanat
Samir Emdanat is the Director of Ghafari Management
Services and Director of vPlanner Product Development. He
is an industry-recognized leader in managing Integrated
Project Delivery teams. He is known for his approach
to overall project integration, which consistently results
in breakthrough results in various industries. In 2005, Mr.
Emdanat was recognized by ENR as one of the top 25
newsmakers for his work with General Motors on the Virtual
Factory Initiative, which resulted in breakthrough innovations in schedule, cost, quality
and safety.

CONTRIBUTORS 233
 Most recently, he developed vPlanner, a visual planning solution that supports the
Last Planner® System. He also continues to lead the implementation of Lean and VDC
construction initiatives for owners in automotive, government, hospitality and healthcare;
as well as contractors and architects/engineers around the world.

CHARLES (Chip) Hill

As Senior Principal and Co-Owner of Stengel Hill
Architecture, Chip Hill’s responsibilities include all facets
of the Architectural Profession and business ownership
including operations management, business development,
quality control, design standards development, planning,
design and construction administration.
Mr. Hill has more than 20 years of experience in the planning,
design and construction of healthcare, commercial and educational facilities. He is a
member of the American Institute of Architects, the National Council of Architectural
Registration Boards, and the U.S. Green Building Council.

KRISTIN Hill
Kristin Hill brings over seven years of Lean consulting
expertise to the design and construction industry. Prior to
being a Lean Consultant, Ms. Hill founded, grew and
subsequently sold an architectural firm in the Boston Area.
As President of InsideOut Consulting Inc., Ms. Hill currently
provides coaching to teams for projects being delivered using
Lean principles and tools.

JESSICA Kelley
As Director of Learning and Development for Southland
Industries, Jessica Kelley is using her past experience
to grow and refine the organization’s learning and
development strategy to support project execution, team
function, and Lean thinking.

234 Transforming Design and Construction: A Framework for Change.