The front entrance to Overlake Hospital and Medical Center in Bellevue, Washington. As providers begin to understand the impact healthcare reform will have on their business, many hospitals and medical centers are looking to Lean process and design as a way to do more with less. Several elements of healthcare reform beg Lean solutions, such as the expected growth in outpatient care and more cost-efficient inpatient care, and, increasingly, designers are employing Lean strategies to create spaces that encourage Lean operations. Doug Grove of CollinsWoerman explores this topic in the first installment of a three-part online exclusive series.

Setting the stage

The changing healthcare delivery system

According to proponents, The Affordable Care Act is designed to contain soaring medical costs, cover more uninsured people, and increase quality of care. It is estimated that the act will provide insurance for 31 million Americans who are not currently covered. Important financial incentives will benefit providers that improve quality of care, driving a transformation from current practice to implement “integrated health systems.” Healthcare organizations will be required to implement secure electronic medical records and establish standard billing methods, measures intended to reduce administrative costs and errors while also improving care quality.

The act’s provisions change the way providers do business, and how they will be compensated. Across-the-board reductions and productivity adjustments could result in $156 billion in cuts over the next 10 years. Physician ownership in hospitals will be more tightly regulated, requiring disclosure of physician self-referrals. Providers will not be able to shift their Medicare and Medicaid losses to other payers. Rate increases will no longer be tolerated. Competition-driven new building construction is expected to decrease, and already acquisition and merger markets are heating up as the industry comes to grips with the new rules. Impacting the built environment

The application of Lean principles can help some organizations streamline services enough to accommodate increased patient volumes in their existing facilities, while others may need to update spaces to maximize flow. Some regions will see an increase in family medicine clinics, which will act as “feeders” for hospital systems. It is expected that a decrease in physician-owned practices and the growth of provider/insurer models (such as Group Health or Kaiser) could spur increased medical office building development. An increase in urban neighborhood care centers, developed privately or by publicly owned providers, is forecasted to accommodate newly insured patients.

From reading numerous publications, we know that Lean is a way of thinking—a strategy for continuous improvement. The concept is straightforward: Lean is evaluating and improving healthcare—from the patient’s perspective. Removing waste from healthcare processes is the first step to improvement. Remember, waste is anything that does not add value for the patient. Improvements are measured by better outcomes, increased patient safety, and lower costs.

PHOTO CREDIT: CollinsWoerman

Improving healthcare designWhile design alone can be shown to improve some processes, a truly Lean approach generates operational improvements first, then follows with improved design, thus creating an apt example of Sullivan’s “Form Follows Function” rule. Both time-tested and new design tools are being applied to Lean healthcare projects. Watch for the online exclusive series in its entirety. To read the second installment, go here.

Doug Grove is a senior medical planner with CollinsWoerman Architects in Seattle. He is a registered architect and a certified Lean leader who has trained in the United States and Japan. For more information, please visit or