The goal of Lean design is to eliminate waste. This isn’t a one-time effort, but a never-ending journey of continuous improvement. To determine how the built environment can foster this type of performance and process improvement, you need to identify what waste is and where it occurs.

In healthcare facilities, areas of waste typically include overproduction; waiting; inefficient conveyance; rework; excess inventory; unnecessary motion, such as over long walking distances for nursing staff or excessive patient transport; and correction, or steps undertaken to remedy situations caused by wasteful practices.

By carefully examining an organization’s current state of operation, we can design spaces that enable health professionals to work toward their ideal future state. It’s a process that requires input from a great number of people.

Those familiar with daily workflow are in the best position to describe current work processes and how they can be improved. Sophisticated computer simulation, rough mock-ups, and scenario testing, which may involve building an entire unit out of cardboard, can help project teams assess design ideas to more fully understand their impact on operations.

The time and effort invested in Lean design can pay off in many ways for hospitals. Staffing shortages, cost constraints, and changing demographics—including population growth and an aging population—are universal issues facing health providers.

With the new healthcare paradigm, in which everyone will have health coverage, hospitals will be responsible for an entire community’s health, rather than just treating individuals. Anything we can do in the design of a facility to support efficiency will result in lower operating costs.

While Lean design may not incur the lowest first cost, initial outlays are recouped through ongoing operational savings.

Lean design also creates better outcomes. Standardized workflow eliminates waste and reduces errors. It’s safer for patients and the people who care for them. As healthcare providers are increasingly measured and paid based on outcomes, this is a clear business benefit to hospitals—and it’s a health benefit to patients.

Beyond reducing waste and being more cost-effective and efficient, patient outcomes are what it’s all about.

Jeffrey Stouffer, AIA, is principal, academic and pediatric practice leader at HKS Inc. He can be reached at