At first glance, it might look like a group of adults playing make-believe in a large garage. But what's happening at the Swiss Center for Design and Health (SCDH) in Nidau is far more serious–and far more Lean–than that.
In a recent Monocle article, the SCDH is described as a place where architects, clinicians, and staff role-play hospital scenarios in full-scale cardboard mockups. This “extended reality simulation space” brings floor plans to life before a single wall is built.
Step inside the Swiss lab where pretend patients find real solutions to hospital design
“For instance, in a recent simulation, an architect discovered that a standard hospital bed wouldn't fit down the corridor of an existing floor plan. Catching such problems early, says [SCDH director Stefan] Sulzer, can save governments and hospitals – and patients – down the line.”
This quote hits on something I've written and spoken about for years: the earlier we find problems, the easier–and less expensive–they are to fix. This is core to Lean Design and the principles of mistake-proofing.
Design Is More Than Aesthetics
In my book Lean Hospitals, I wrote about how hospital design–when done without front-line input or process thinking–can inadvertently create barriers to flow, safety, and staff engagement. I've seen examples like:
- Decentralized nurse stations that were too decentralized–leading to isolation and communication gaps.
- Patient rooms lack a consistent standard layout, resulting in constant searching for supplies and equipment.
- Medication rooms that were locked away or placed far from where they were most needed.
Too often, hospitals are designed by people who won't work in them, and built before the people who will use them ever see the blueprints.
Lean thinkers know: we need to design around the work, not the other way around. As I wrote in Lean Hospitals, it's not just about improving the process in an existing space–it's about ensuring the space itself doesn't create waste, delay, or harm.
You can read the “Lean Design” chapter from my book here:
Safe Mistakes Lead to Better Design
These Swiss simulations are a brilliant example of creating psychological safety and design safety at the same time. Nobody is punished for pointing out a design flaw. That's the point.
In The Mistakes That Make Us, I explored the idea that mistakes aren't the opposite of success–they're often a necessary part of getting there. These full-scale role-playing scenarios create space to make “safe mistakes”–ones we can learn from without real-world consequences.
It's not unlike how Toyota used mockups, cardboard layouts, and visual walkthroughs when designing new production lines. Hospitals should do the same.
What Can We Learn?
- Bring end users in early. Don't just show them a finished blueprint–let them co-create it. Their insights will surface issues architects might miss.
- Test before you build. It doesn't have to be high-tech. Cardboard and tape are cheaper than concrete and regret.
- Celebrate what the simulation reveals. A discovered flaw isn't a failure–it's a success of the system.
A hospital can be beautiful and still be frustrating or unsafe to work in. Or it can be thoughtfully designed to support Lean principles–flow, standardization, visibility, and respect for people.
We have a choice: build fast and fix later–or design carefully and build better. One of those paths is a lot more respectful–and a lot more sustainable.
Let's keep learning forward.
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Let’s build a culture of continuous improvement and psychological safety—together. If you're a leader aiming for lasting change (not just more projects), I help organizations:
- Engage people at all levels in sustainable improvement
- Shift from fear of mistakes to learning from them
- Apply Lean thinking in practical, people-centered ways
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