The boom in outpatient facility construction shows no signs of slowing. But these projects are becoming increasingly complex as medical groups and hospital systems demand spaces that can keep up with their rapidly changing strategic and organizational requirements.

February 14, 2013

5. Watch for healthcare providers to put you on a ‘Lean’ diet.


Exposed wood elements were also used in the interior of the Everett Clinic project to create a warm, modern design aesthetic. Photo: Benjamin Benschneider


A growing number of healthcare organizations are turning to so-called Lean principles as a means to increase efficiencies and reduce cost in their day-to-day operations. The core tenets of Lean dictate that organizations identify and remove all waste in their products, services, and processes––everything from lengthy waiting times for patients, to excessive costs for supplies and equipment, to unnecessarily long walking distances for clinicians and staff. Implementing Lean operations can involve mapping and evaluating thousands, if not hundreds of thousands, of processes for continual improvement.

Because the design, construction, operation, and maintenance of facilities all play a major role in these Lean efforts, healthcare clients will be looking to their Building Teams to take part in their Lean efforts on new construction projects. This requires a deeper level of team collaboration much earlier in the planning process than some AEC firms may be accustomed to. In some cases, it may be the client’s first foray into applying Lean principles toward facilities construction, thus adding yet another level of difficultly for you to deal with.

“We’re seeing that across the board for projects in our area,” says Rossen. “Healthcare groups that have implemented Lean in their operations are now using it to drive the design and construction on their new facilities. And we’re at that moment in history where most clients haven’t done this before for a new building.”

As a result, clients are relying on their AEC firms to facilitate the Lean process for the project, so be prepared to know your stuff. This may include facilitating integrated design events and building full-scale mockups to get input not only from your Building Team partners but also from patients, staff, and facility operations professionals. And if the client is not fully committed to Lean, expect a rocky road, says Rossen.

“We get RFPs all the time that ask about how much Lean experience we have and if we can facilitate the process,” she says. “You want the clients to own the process and be fully committed to it.”

There is also the potential for conflict between Lean and evidence-based design. “Lean requires a highly flexible environment,” says Rossen. “So how do you create a high degree of flexibility while maintaining the healing qualities of evidence-based design?”

For example, applying Lean principles in an outpatient clinic could mean having no cabinets on the wall––all exam-room supplies would have to be housed in a mobile cart, and all clinician tools would be out in the open. Such an arrangement could be considered a violation of EBD principles.

To solve this conundrum, the Building Team on the Smokey Point Medical Center specified integrated systems furniture with a mix of demountable partitions and tables and chairs that makes it easy to reconfigure exam room spaces.

The same approach was applied in the main lobby, where the front desk and check-in areas use demountable partitions and systems furniture instead of permanent construction. “The trick is to make it not look like a workstation that was designed for an office building,” says Rossen.


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