PHOTO CREDIT: CollinsWoerman Left: The front entrance to Pullman Regional Hospital in the rural community of Pullman, 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. Doug Grove of CollinsWoerman explores this topic in the third and final installment of a three-part online exclusive series.

Set-based design

The medical planning process usually consists of a number of initial concepts, which are then narrowed down to one and further developed until approval. A creative evolution of this process is “concurrent set-based design,” developed originally for manufacturing prototypes (and adapted from Sobek, Ward & Liker). The set-based process has been successfully adapted to serve as a Lean design tool. Key process steps include:

  • Multiple concepts are developed in charrettes using an integrated design process model;

  • An “evaluation gate” is used to select the concept(s) that align with the project’s guiding principles;

  • The concept(s) with the highest probability for success are advanced and refined in subsequent design charrettes;

  • After clearing a number of “gates,” the final integrated design is selected and documented; and

  • A significant value of this process is that knowledge gained during design is not lost. If a potential solution is determined not to be viable, the team can look to prior design concepts for a solution.

Concurrent set-based design process

  • Simultaneously develop multiple concept solutions.
  • Review and evaluate each concept based on project criteria.
  • Advance the most successful concept.
  • Refine final choice for design integration.
  • Retain ruled-out choices as alternates.

Recently, a medical center in the Northwest applied this approach when planning a major building addition to its existing campus. A vital connection scheme between buildings was proposed, along with a few less-desirable options. When the construction and engineering teams investigated the existing concrete structure and plumbing lines, a number of major conflicts were identified. The connection option appeared doomed. With no feasible solution in sight, the team revisited the previous concepts and discovered that the scheme initially perceived to be too expensive was actually far more cost-effective, and even provided an outstanding opportunity for company branding by using a large expanse of window wall.
With the scheduled implementation of healthcare reform, the healthcare industry already is changing radically. It is no longer business as usual. Organizations are searching for solutions to improve processes filled with waste. They are looking for ways to streamline their operations and reduce costs. They may need to remodel or add space, but this will only come after a thorough review of their current processes and facilities. The use of Lean design methods can be an important part of the solution. Read Part 1 of Doug Grove's series here . Read Part 2 of the series here .
Doug Grove is a senior medical planner with CollinsWoerman in Seattle. He is a registered architect, and a certified Lean leader, who trained in the United States and Japan. For more information, please visit or .