One statistic that I find absolutely fascinating is that it is estimated that 10%-12% of every healthcare dollar is spent on all capital improvements, including medical equipment. The rest of that healthcare dollar—roughly 90%—is spent on operational costs. I have wondered for many years how we architects might design hospitals that substantially reduce operational costs. I now realize that if we can help our clients achieve a 10%-12% reduction in operational costs we can effectively neutralize the cost of capital investment. Is this real? Is this possible?

David Chambers, director of health facility planning and development at Sutter Health, is projecting a possible operational cost savings of 50%-60% by applying Lean and Six Sigma principles to the delivery of care in their hospitals. Coupled with this is the expectation that Sutter can save up to 20% on the space requirements in their proposed new prototype hospital.

If David Chambers is accurate in his projections, I believe we can easily shave 10%-12% off the operational costs through design alone. However, to get there we now need to develop new skill sets as healthcare planners. We now need to become highly conversant with operational practices within every department, and work with our clients, through a Lean planning process, to achieve these savings. We are making this shift as we work with Sutter on the planning and design of its CaliforniaPacificMedicalCenter in San Francisco, one of the largest projects ever to use Lean principles.

Should we now, as healthcare architects and planners, become Lean experts to help our clients facilitate these kinds of changes? I believe we should. Traditionally, our programming process has been instilled with a relatively thorough analysis of functional and operational criteria to justify space requirements. We now need to take the operational aspects of this to a much greater level of detail and sophistication, mapping both current and future states with an eye to defining value while describing new, alternate organizational structures and behaviors.

Simon Bruce, RIBA, is vice president and senior medical planner at SmithGroup, a leading healthcare architecture and engineering firm with 10 offices across the U.S.