Many organizations are talking about their work with Lean. But what does it really mean to be Lean? Is it simply a process, a sheet of paper with boxes to check off as you design and implement a plan? Or is it an ideology, a mindset that your organization has to embody?

Because there’s no recipe to follow, BSA LifeStructures has found that the only way to truly change is to dive in headfirst. We are taking steps to engrain Lean in every aspect of our design for clients and our internal operations.

Our journey started with an evaluation of where we were as a firm and how we were providing services for clients. Lean isn’t new; it’s something we’ve been discussing with clients for years. But the firm was not embracing some of the core Lean philosophies we were preaching.

Recognition of this fueled the decision to fully invest in these practices, and it’s changing the way we define our success and goals.


A lesson on Lean
The benefits of Lean principles in healthcare are well documented, but we had to ask ourselves why we weren’t able to mirror some of the ideas and processes we were implementing in the buildings we were designing.

Changing culture isn’t something a two-hour seminar or reading a textbook can accomplish; it takes time, dedication, firm-wide commitment, and the ability to communicate that change through an entire organization.

The Lean Healthcare Yellow Belt Certification Program offered by Purdue University is designed for organizations and individuals who work in healthcare settings to enhance their ability to provide robust reliable care and treatment to each patient, every time.

Participants in the program don’t just learn the principles; they identify how and when to apply them in healthcare processes and facilities to create a more efficient environment for healing.

Today, more than 30 of BSA LifeStructures’ architects, planners, engineers, and interior designers have gone through the program alongside operational healthcare experts in the field. The program has equipped the firm with a meaningful knowledge on Lean, but it’s nowhere near the end of the journey. The real emphasis is on sharing these concepts and ideas through our designs and the way we communicate with clients.


Aligning with our clients
Our Lean philosophy is rooted in improving customer satisfaction. For healthcare clients, that means improving patient satisfaction and outcomes. Achieving this through Lean requires breaking the concept down into three themes: 

  • Eliminate waste;
  • Pursue perfection; and
  • Improve the outcomes of the customers. 

Implementing Lean techniques reduces waste and improves quality, efficiency, and safety in the healing environment—all outcomes that can be measured for success. Healthcare organizations are looking for a facility and an operational plan that guides the patient through the healing process and provides accountable care at all levels. Using Lean helps identify how successful a design is at providing that type of care.

A Lean process improvement is about getting from point “A” to point “B” more efficiently. How can we eliminate the distance from the nurses’ station to the patient room? How can we shorten patient waiting and check-in times? The answers to these questions are based on measuring success before and after the design, and also relying on the use of metrics. Lean represents the evolution of how metrics can be used to measure success.


Linking Lean to satisfaction
Our Lean journey has shown us that Lean culture starts and ends with one thing: improving patient outcomes. However, Lean also demands a quest for continuous improvement and perfection. The constant search to become better and more efficient leads to growth and success—and there will always be room to eliminate waste and improve.

Using Lean design principles for inpatient and outpatient settings has been proven to benefit many healthcare organizations. Facilities that adopt these practices have seen a measurable improvement in patient outcomes and the efficiency of their operations. Using this perspective helps identify and eliminate hurdles and non-value-added steps that help organizations overcome workflow barriers and improve quality and reliability, translating into improved care for patients.

If Lean is truly about providing the absolute best and most appropriate care possible for patients, then an important connection can be made between Lean design principles and patient satisfaction. In 2013, the Patient Protection and Affordable Care Act will mean that hospitals’ reimbursements will be based in part on scores received on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

Consumer answers to three questions on the HCAHPS evaluation can be affected by design and evaluated by the five key Lean concepts: identify value, identify and eliminate waste, create flow, establish pull, and seek perfection. Those questions are: 

  • “During this hospital stay how often did nurses treat you with courtesy and respect?”
  • “How often were your room and bathroom kept clean?”
  • “How often was the area around your room quiet at night?” 

Using Lean concepts as a guide, design solutions can be charted on an HCAHPS improvement grid that identifies the most effective design solutions for improving caregiver behavior, keeping rooms clean, and maintaining quiet at night within the hospital.

The journey continues
At BSA LifeStructures, we’ve recognized that the Lean journey requires complete dedication to delivering accountable care that achieves new levels of efficiency. These processes are new and different, but the Lean mindset is in full swing and changing how the firm operates and designs. And the process is far from over, because there is always room for improvement. That’s what Lean is all about. 


Gary Vance is the Director of National Healthcare for BSA LifeStructures. Keith Smith, AIA, ACHA, is President of BSA LifeStructures. For more information, please visit