The Positive Trend of “Lean Design” of Space & Processes in Healthcare


It's been nice to see the “lean design” approach taking hold in healthcare the past few years. I think the first book on the subject was a “manifesto” by an architect, David Chambers:  Efficient Healthcare – Overcoming Broken Paradigms

My good friend Naida Grunden has a new book out next year called  Lean-Led Hospital Design: Creating the Efficient Hospital of the Future  and I was able to contribute an essay for the last part of the book.  There is also come material on the work done by Seattle Children's Hospital in their book  Leading the Lean Healthcare Journey: Driving Culture Change to Increase Value.

Mike Wroblewski, who you might know from his blog “Got Boondoggle?,” is now with the Kaizen Institute  and they have posted an introductory lean design, or “3P” video that's part of their Gemba Academy  subscription series. Mike provides a nice introduction:

I've been doing some consulting work recently in this area, working with alongside hospital staff members and managers, architects, and construction companies. This work is sometimes done under the banner of “Integrated Project Delivery.

Lean design is a very iterative process, one that engages front-line staff in creating space and processes that are amazingly patient centered and staff friendly. The entire cross-disciplinary team works to understand the work being done (and patient needs) and they then work through a series of mockups that allow refinements and improvements to be made BEFORE the building is actually built.

A cardboard patient room mockup, Mercy Medical Center, Iowa

There's been a flood of articles recently related to Lean design and construction:

And here's a video about lean healthcare design in Saskatchewan, from the Saskatoon Health Region (again with an appearance from Mike Wroblewski).


Also, check out this video about the patient-centered lean design at the Park Nicollet outpatient cancer treatment center:

You can also check out the series of video interviews I did on lean healthcare design  I did with St. Joseph Mercy Health System and The Neenan Company.

As I wrote in the essay for Naida's book, we have to be cautious about architects or others using “Lean” as an empty buzzword. If staff members aren't deeply engaged in the process, it would be an example of “L.A.M.E.” instead of Lean.

What do you see going on out there with lean design in healthcare? How would this be helpful to your organization?


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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

  1. Anonymous says

    Question for you Mark (and your readers and maybe Naida too)… does the ability to effectively do lean design require that the organization already effectively have lean processes, like Seattle Children’s and Park Nicollet have? I don’t know where the Saskatoon hospital is on their lean journey?

    I guess my question is can you start with lean design as a way to then eventually get lean management?

    1. Mark Graban says

      I don’t know if there’s a single general answer to Anonymous’ question. Some of the best lean design examples come from hospitals that were already at least 6 years into their lean journey (seattle children’s, thedacare, etc). Hospitals already using lean methods and management are probably more likely to follow into lean design. Engaging staff, looking at processes, following the PDSA cycle will come naturally to lean hospitals.

      If you are new to lean, I don’t see how being led through a lean design process by an architect or construction firm could be necessarily harmful… I’d hope that it could spur the organization to then investigate lean management and use the new hospital as an impetus to get that going…

  2. Jon Miller says

    Hi Anonymous

    Lean design does not require that an organization already have lean processes. In fact an organization may realize that with the physical infrastructure they have (hospital) they may never get very far in lean and decide 3P / lean design is necessary.

    However, this is not to say that it is impossible for a hospital to become lean without lean design.

    You can start with lean design and eventually get to lean enterprise-wide, because the lean design process requires change management, education, experimentation – all of the things that get you to lean management.

  3. Naida Grunden says

    Jon is right that lean-led design has the potential to help swing the whole hospital culture, and that a simultaneous lean “transformation” can work. It can…but it’s not optimal.

    Obviously, the organization that has traveled some distance on their lean journey is beginning to be familiar with the thinking, and will squeeze more value out of the lean design process. One sincerely hopes that top leaders are living the philosophy, because if not, both lean transformation and lean building design will flash smartly in the pan.

    In the upcoming book, Lean-Led Hospital Design: Creating the Efficient Hospital of the Future, I talk about three basic principles of lean design: 1) The building is not an excuse. Do not let the constraints of building or budget prevent you from improving every process every day; 2) Build only if it creates value. The heyday of hospital building is over; now every dollar and square foot must be justified. Building won’t solve problems; and 3) If you build or remodel, be prepared to invest a whole lot up front. Remember, in the beginning, the architect is your customer, not your project leader. YOU know your processes, and the architect must be educated about them before ever picking up a pencil. Process, then design.

    Hmm…just pretty much gave away the store. Still, hope you’ll look at the book Charles Hagood and I have put together, which is due out in February. Thanks to Mark for the great post (as usual).

    1. Anonymous says

      Thanks Naida. Looking forward to the book (I’m *more* likely to buy it now!). I disagree, though, that the architect is the customer. They are a supplier (and sometimes they forget that…). Or maybe I’m misunderstanding you…

  4. Naida Grunden says

    Yes, I think that is right, good call. They are the supplier. At any rate what they are NOT is the project leader, at least not in the beginning. The torch gets passed to the architect only after exhaustive, cross-disciplinary process examination, preferably with the architect in attendance.

  5. Mark Graban says

    I just learned about this informative and very detailed blog post (with pictures) by Bernita Beikman, from HKS, who I have worked with as part of an Integrated Project Delivery (lean design) effort:

  6. […] The Positive Trend of “Lean Design” of Space and Processes in Healthcare by Mark Graban – “Lean design is a very iterative process, one that engages front-line staff in creating space and processes that are amazingly patient centered and staff friendly.” […]

  7. Nick Castelucci says

    Great stuff. I’m a small business owner who is fairly ignorant about Lean processes in general, but will be delving into it. Is this practical for small business?

  8. Al Norval says

    Mark – I love the picture of the cardboard mock-up patient room at Mercy Medical. To me, this is the essence of 3P – very fast trials of our ideas.
    Most people can’t take drawings and picture what the patient flow would look like. 3P forces us to mock-up the flow so the team can see problems. Making adjustments is easy since we’re using cardboard and mobile equipment. By iterating, the team can get to an optimal design fairly quickly. Works great as long as the team comprises mainly front line staff.

  9. Patrick Anderson says

    I just sat with some of my employees who were working on a conceptual lean design for a new rural clinic. They created a 5000 square foot base and cut out scaled rooms and work areas. We had a pre design concept that evolved every time a new employee came to see. Every comment contributed to our knowledge. The original concept gave way to a second concept and I have no doubt that there will be a fabulous evolution of patient and provider flow in future concepts. Contrast this with 2 rural clinics built during my tenure where we were given no say at all in the design. Neither clinic really works for us. If we are allowed to build this one, the savings over current cost and the convenience of patients should be phenomenal.

  10. Mark Graban says

    That’s great, Patrick. Good luck with that initiative. I hope you have architect and construction partners who are enthusiastic about that iterative, staff-driven approach.

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