It doesn’t pay to incorporate a broken process into a new building, so say administrators at Children’s Medical Center Dallas and Children’s of Alabama. When designing their new facilities, they set out to do things differently. 

These two hospitals had in-depth expansion project experience, but neither considered innovation during the process of facility design. Faced with pressure to produce outcomes in operational performance, patient satisfaction, and physician approval that exceeded anything produced in the past, the systems knew they had to look at this challenge through a new lens.

Both systems engaged in Lean visioning and operational innovation sessions that mapped each functional activity (clinical, ancillary, support) and identified ways to radically improve the service that they were providing and change the way business is done.

Every process was mapped and new leaders emerged with the redesigned processes. In the end, both the process and the product were noticeably different. Following are some do’s and don’ts of Lean facility planning.


  • Listen to the voice of the customer.
  • Engage the patients and families as much as possible.
  • Learn from your current state—the good and the bad.
  • Bring in a fresh set of eyes.
  • Go to the gemba—the place where the work is being done.
  • Give the staff ownership. When it becomes “their” process, they’ll become the front line ambassadors for change.
  • Work backward from a target goal, so every meeting is purposeful and occurs at the right time.
  • Sweat the small stuff—it’s natural to spend lots of time on the big messy issues you’re trying to solve, but some of the “minor details” can make a huge impact on day-to-day work at the bedside. Examples: diaper scale shelf in bathroom, deeper isolation supply cabinets, theft-proof gaming systems, and task light for drawing labs.
  • Embrace the use of mock-ups and encourage rapid prototyping.
  • Require full participation from all stakeholders and adopt an “equal voice” rule in meetings.
  • Consider program development and operations concurrently with design and construction.
  • Implement a comprehensive review of organizational workflow and downstream effects.
  • Solicit more frontline staff input from onset of design through completion.
  • Appreciate the complexity and importance of equipment planning.
  • Use standardization as a primary guiding principle.
  • Synchronize the approach of the technology and construction implementation schedule.
  • Improve physician engagement.
  • Establish leaders for each floor/area.
  • Schedule and conduct meetings to meet their schedules.
  • Provide updates that are pertinent to what they want to hear.
  • Keep most decisions at project team level.
  • Escalate unresolved issues to the executive steering committee. 


  • Underestimate the logistics of managing and facilitating large groups of people during this process.
  • Get started too late—if you have the right team in place, operations should inform design, not vice-versa.
  • Forget the power and importance of visioning—from your customer, your staff, administration, and your design and construction team.
  • Deviate from principles of standardization.
  • View the project as “facility-centric.”
  • Avoid or postpone crucial conversations with staff and medical staff (transparency dispels many unrealistic expectations).
  • Implement electronic medical records, and construction and occupancy of facility within close timeframes.
  • Deviate from team/project goals.
  • Conduct team sessions longer than two hours—if you do, provide food.
  • Change direction after the final decision is made.
  • Allow scope creep. 

Rachel Saucier, AIA, LEED AP, is vice president with HKS. She was joined by Juliet Rogers of Blue Cottage Consulting; Dorothy Foglia, senior director, acute care services, Children’s Medical Center Dallas; and Deborah Wesley, senior vice president and chief nursing officer, Children’s of Alabama, to serve as panelists for the “Don’t Take a Broken Process into a New Building” session at the National Association of Children’s Hospital and Related Institutions Children’s Hospital Association 2012 International Facilities Design & Capacity Conference, held December 3-5, 2012, in Chicago.