"Lean Building Techniques" for a Hospital?


SignOnSanDiego.com — Skeptical councilmen now brag about hospital plans

From the article about a planned hospital:

The district hopes to reduce the figure to $983 million over the next five years by delaying completion or only partly completing some buildings, and by hiring a construction-management company that specializes in “lean” building techniques.

I hope they mean “our Lean” — Lean, as in the Toyota Production System concepts. Does the construction company use Lean methods in construction (reducing delays and improving quality) or do they design so the hospital can be operated with Lean in mind (reducing travel distances for patients and staff, having properly sized and designed spaces)?

Hope they don't mean the colloquial “lean” — meaning “less space they need.”

Many hospitals *are* using Lean concepts in design or re-design. Some of those stories are covered in my book, particularly the case of LeBonheur Children's Hospital in Memphis and the design of their new emergency space…

Has your hospital used Lean methods for design or re-design? Click “comments” to share your experiences. Do the architects usually “get it” or are you having to re-educate them what a “Lean Hospital” would look like?

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Delaying completion or “partial completion” is a slippery slope. On a recent vacation trip to Cairo Egypt, one of the most visible things (other than the pyramids) was all the partially completed apartment buildings. In addition to funding problems and overly ambitious construction plans, the building owner starts to pay property tax on the completion of a building, go guess what? … The government recently changed the tax code to to start taxes three years after electricity is first hooked up if the building is not completed by then. The grandfathered buildings will start paying taxes 15 years after construction was started.

    On the positive side, I received a newsletter in the mail from St. John Health System about their new hospital near Novi Michigan. They boast of technology and process advances that will allow the patient to stay in the same room even if their condition changes. Another feature the have adopted from Disney is the “on-stage” / “off-stage” concept, with dual corridors, so that the deliveries and all the things they don’t want the patients and visitors to see is in the service corridor (is this a good thing?).

    I tried to find the information online but I could not come across it quickly.

  2. I think the service corridor is a great concept, but often requires new construction to make it happen. Going through a typical hospital main cooridor, it’s not fun to dodge powered vehicles pulling carts with food trays or maintenance carts… it’s not fun as a working visitor to the hospital, it sure couldn’t be fun if you were using a walker and a truck came racing around the corner (ignoring the “standardized work” of slowing down or stopping, or using the mirrors up above the cooridor intersection.

    In another instance, I know of a hospital that designed a U-shaped set of emergency department bays. The rooms were accessed by staff and patients from the inside of the U (with a nurses’ station in the middle). Supply restocking and other activities took place in a hallway around the outside of the U. The E.D. rooms could be restocked from the back, by people who never entered the E.D. room or interfered with patient care (loading supplies from the back, the way milk is loaded at the supermarket).

  3. It could be that “lean” will be the new buzzword for anything and everything in healthcare. I blame you, Mark!! :-)

  4. My brother may very well be the first lean hospital architect. ;)
    He recently began a personal lean journey that’s effected mostly his approach to doing his design work:
    -Standardized template approach to drawings
    -Checklists for processes and procedures, including meetings with his customers, the users of the space.
    I don’t know how much it effects *what* he designs, but lean has resonated with him because his goal as an architect has always been to make spaces that meet the users needs. Often times in renovating a lab or surgical space you are tearing down an old process, understanding the value added steps and building an equipment layout that is optimized to the optimum process.
    I’ll be sure to get his opinion on on-stage off-stage.

  5. Lean in design – both operational design and facility design – and construction is alive and well. Have a look at the Lean Construction Institute and International Group for Lean Construction on the internet. Sutter Health, here in California, has been recognized by Engineering News Record for its efforts to bring lean concepts to design and construction. If you are interested in more information, feel free to let me know.


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