Lean Planning and Sustainable Design in Health Care

There is a common saying in the construction industry that the most sustainable space is the space never built. For health care organizations planning to expand or renovate their facilities, the idea of eliminating unneeded space holds real cost benefits, as the most cost-effective space is the space never built.

Yet eliminating space does not mean doing without — it means designing and building more efficiently. Lean planning is at the core of efficient and sustainable space planning, especially in the health care industry where changing care models and reimbursement standards are placing greater emphasis on cost containment and improved patient outcomes.

Here are three lean planning guidelines to consider for achieving sustainable results.

Organize Like Activities around the Patient

Bring skill sets to the patient by sharing resources and space. In an outpatient setting, a flexibly designed universal exam room with plug-and-play infrastructure allows different specialists and caregivers to bring their expertise to the patient. Equipment can be wheeled in as necessary depending on patient needs. In an inpatient setting, a flexibly designed universal patient room works under the same principle, with the patient remaining in the room as technology and specialties are brought in. Ultimately, this universal care concept saves space, reduces construction costs, decreases energy load and increases space utilization because it eliminates the need to build extra space that remains idle between patient visits.

Listen To the Voice of the Customer

In any health care setting — outpatient or inpatient — one of the primary goals is to increase patient comfort level and sense of well-being. The customer (patient) ultimately can tell you what they want and need to feel comfortable. By listening to the patient in the early pre-design stages through user surveys or focus group interviews, health care organizations can discover patient comfort levels and create usable spaces to achieve that comfort level. In other words, don’t design spaces or finishes that the patients do not need or want, only design what directly impacts patient needs.

Similarly, listen to your staff and caregivers (your internal customers) to learn what they need to accomplish their jobs efficiently. Anything you design beyond needs is wasted space. Ultimately, if you start to design without understanding customer needs, you may increase waste. But if you understand needs, you can right-size spaces and create leaner, more sustainable results.

Design Multi-Use Spaces that Optimize the Whole

As the emerging multi-disciplinary, team-based medical home model focused on preventive care gains traction, more caregivers will be sharing the same spaces and resources. Smart planning accommodates the bulk of patients and caregivers coming through a health care facility. For instance, in an outpatient facility, you can plan to have teams of doctors working in a flexible hub-and-spoke plan in which the hub is organized around the care team to promote collaboration and shared information, with universal exam rooms positioned along the spokes. In acute care or inpatient facilities, standardized space planning similarly enables adjacencies to flex back and forth according to needs (such as prep/recovery rooms or ED/exam rooms), essentially creating a universal care platform that improves workflow and patient outcomes. Likewise, flexible nursing units can accommodate multiple bed types that allow for acuity variation.

Sustainable design has always been about using resources more efficiently and reducing waste. Likewise, the core of lean planning has always been about understanding operational processes within a space and then reorganizing those processes to reduce waste and square footage —essentially, right-sizing spaces by building only what is needed. As care shifts toward the medical home model, health care organizations will have opportunities to rethink how they plan space and share resources — optimizing resources more wisely in a leaner, more sustainable health care environment.

Stan Chiu, AIA, LEED AP, is a principal at HGA Architects and Engineers in Los Angeles, where he specializes in health care and higher education work.