Making Hospital Form Follow Function


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Lean integrates with evidence-base design for healthier patients and improved ROI

   In its landmark study, The Institute of Medicine reported that an estimated 44,000 to 98,000 people in the U.S. die annually from preventable medical errors. Healthcare policymakers, healthcare professionals and architects are determined to create safe, efficient and effective hospitals for patients, their families and staff. Looking to improve the design process by integrating more rigorous findings, many healthcare design professionals have embarked upon a new era of work that is centered on the following two initiatives. First, healthcare has begun to embrace evidence-based design (EBD). According to the Center of Health Design, EBD is an approach to healthcare that gives importance to design characteristics that affect the health, well-being, moods and safety of patients, their families and hospital staff. EBD has the potential to improve significant the return on investments in hospital renovation, expansion and new construction.

   A second healthcare initiative is the movement toward lean, the long-term philosophy of continuously and relentlessly driving out waste from systems. The goal of lean is to provide the desired amount of product or service at the highest possible level of quality with zero waste.  Lean is a continuous improvement philosophy founded on respect for people, individual empowerment and a set of system design principles. At the operational level, lean is equipped with many tools. Two of the most popular in practice are value stream mapping (VSM) and kaizen events. VSMs graphically represent the key people, material and information flows required to deliver a product or service and are design to distinguish value-adding from non-value-adding steps. These maps are used to identify areas of opportunity for rapid improvement through the use of kaizen events, which typically are two to five days activities where teams of employees engage n small cycles of improvement. Kaizen events are critical component in implementing lean practices and lean design and help to close the gap between an organization desired and actual operating performance.

The Integration

   It shows that EBD is integrated into each of the five steps in a typical design and construction engagement process. The first step is to discover the goals and objectives a client has for a project. During the second step, pre-design, EBD focuses on prioritizing key design issues suited to research investigation for which the practitioner lacks appropriate information and then finding relevant sources of evidence. In the third step – design – EBD activities are geared toward critically interpreting the gathered evidence and developing and evaluating innovative design concepts that incorporate that evidence. The four and fifth steps – construction and occupancy – which are outside the scope of this article, are to construct and then perform post-occupancy analysis to check if the built facility meets pre-established expectations. The conclusion is implementing a lean-EBD process requires major change throughout an entire organization, which can be difficult.

The full version of the article is available in IIE Laboratory. It is also readable online for IIE member through accessing the website. Contact Maya (President of IIE BINUS University Chapter) at for more information on the IIE membership.