Guest Post: Operations-based Healthcare Design


Mark's note: Today's guest post is by Alica Simmer, a Senior Healthcare Consultant with KHC. I'm happy to have her as a guest blogger as we've had the chance to compare notes on Lean healthcare and process-space design, she's an excellent thinker and writer on these topics.

You can read her regular blogging on the KHC website and you can find her on Twitter as @aliciasimmer.

Operations-based Healthcare Design

There is a golden rule in architecture: Form follows Function.   Much like the orchid has evolved to perfectly match the insect in the picture above, a new hospital or health care facility should eloquently marry operations with space.   The design must intentionally support efficient processes and a positive patient experience.

Easier said than done, right?

Every hospital/health care organization that decides to build a new facility would stipulate that operations were an important part of the design.   However, this is certainly easier said than done!   And, as is true in many challenging situations, experience has shown that successful projects all contain similar elements:

  • Leadership, physicians, staff, and (when possible) patient participation. Creating a new facility is a chance for the hospital to transform itself, both operationally and culturally.   Leadership involvement ensures that staff and administration understand the importance of active participation in the project.   Patient involvement, through focus groups, plays a critical role in highlighting and understanding what the users of the facility want from it.   Operationally driven facility designs use the expertise of physicians and staff members to envision the ideal facility and then create it.   Key stakeholders and individuals are the content experts of their culture, their vision, and must eventually own the new operating model.
  • An integrated, multidisciplinary design team. Building anything is complicated.   Building a hospital is extremely complicated, and it requires the talents and expertise of healthcare planners, architects, engineers, and construction firms.   Just as transitions in a hospital cause errors and information gaps, so do transfers between phases in an architectural team. The most successful design teams are integrated: architects actively participate during planning and programming; planners actively review the architectural layouts for operational alignment.   The iterative process of creating the layout is also when Lean tools, such as mapping out the future state value stream to the space, spaghetti diagrams of work flow, and walking distance calculations, can effectively be used to evaluate the efficiency of the layout.
  • Systems focus. Systems thinking is one of the biggest opportunities of operationally-driven facility design.   Modern hospitals are often organized around individual processes of care, but patients move through the entire system.   During the planning sessions, elements of care that are often utilized by the same patient may be co-located with the intention of better serving the patient population.   The same adjacency opportunities are available for hospital departments that frequently work together, such as Central Sterile and Surgery.   Hospitals that use the new facility design to break down silos and communicate between departments can develop innovative designs that improve the function of the building.

Active participation by key stakeholders, an integrated design team, and a systems focus lay the framework for a new facility that is operationally functional and set up to provide excellent patient care.

About Alicia Simmer: Ms Simmer works with hospitals and health care organizations in the US and Canada providing functional planning and programming services, operational / lean improvement, and strategy and master planning services.     She  utilizes her six sigma black belt and lean training to facilitate patient experience and process improvement in large and small planning projects through hands-on collaborative workshops with clients and behind-the-scenes data analysis and interpretation. Ms. Simmer often works within integrated hospital systems that actively seek to manage care processes to achieve best-in-class performance through application of principles such as “standard work,” process flow, and population-based performance metrics.   Prior to joining KHC, Ms. Simmer was a management fellow with  Trinity Health, where she worked on new program launches, six sigma and lean projects, and data management. She has completed both the Trinity Health lean Training module and the lean Healthcare Certificate Program at the  University of Michigan College of Engineering, a training program for lean healthcare professionals.   Ms. Simmer earned a Bachelor of Science in biopsychology from the University of Michigan LS&A program and a Masters in Health Services Administration from the  University of Michigan School of Public Health.

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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. Alicia,

    How involved do you think architects should be, especially early in the design process? I’m inclined for them to have little, if any involvement early on but certainly later in the process, my point being that a person being paid by the square foot might have somewhat of a conflict of interest. I’d like to hear your take on this.


  2. Alicia, I like the three key elements that you have for designing a hospital. I think they apply to designing systems in general but may have a slightly different spin on them.

    Take for instance, designing KPIs. You need Leadership, staff, and customers involved to get all the perspectives and to gain total buy-in so the KPIs are used to drive the business.

    An integrated team will give a system wide view of how the KPI migh dictate some behaviors and a discussion can begin about whether that is a behavior the organization wants exhibited.

    System focus to drive end-to-end or system wide thinking. Don’t design a KPI for a silo that would cause issues for another area.

    “Form follows Function” couldn’t be more true. Great post.

  3. Mark:
    Architects don’t necessarily have to be present during planning, but it’s good for them to know the intent for the space. Actually, we’ve found the biggest ‘bang for your buck’ is when architects and lean planners can work together to develop the schematic design layout. The lean planner makes sure the space is organized around the operating model and uses lean tools (spaghetti diagrams etc) to make sure that internal adjacencies are as efficient as possible. The architects understand code and can draw the building according to the site plan. Both of these talents together end up creating the best solutions. If you’d like to talk more, feel free to contact me via email and we can set something up:

    Thanks! You’re right – there’s a definite correlation to how to design any system. Inclusion of key stakeholders, elimination (rather than shifting) of waste, and a system focus are crucial elements to success.

  4. Unfortunately, Louis Sullivan’s “form ever follows function” is not really a golden rule, but a philosophy only adopted by some. The contrasting view, “function follows form” is much too prevalent in healthcare design. Unfortunately, when I was an intern architect, I had several experiences when I was required to provide space planning within the demands of the designer’s predetermined form.

    Alicia has laid out three important elements that (in my opinion) should be incorporated in every project. With this in mind, architects and planners involved in the early phases of operational decisions will be more inclined to take on the challenge of creating a form that follows the function-without sacrificing good design.

    I encourage designers and planners to engage with the users and to gain a complete understanding of the systems that will be incorporated in each facility. This is not a one-time activity; every organization is unique. Further, while I don’t suggest that every designer and planner become experts at Lean, I recommend familiarity with the vocabulary and ideas of process improvement, and how that affects design.

    Finally, in response to Mr. Welch’s comment, I’m sorry to hear that people have the impression that architects and planners are out to increase their revenues by increasing square footage.


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