The end customer defines value.

When using Lean methods on healthcare design projects, the goal is to maximize value for your customer and minimize waste. Designers have to ask the question: “Who is my customer and what do they value?”

The end customer of a healthcare project design is the patient, and that person defines value.  

Riley Hospital for Children at IU Health started construction on a patient tower in 2006. After stopping and starting again in 2010, another design and construction team was hired. A precedent had been set for the size and configuration of the patient rooms. Infection prevention standards and procedures had been written to support operations. When the project continued, would those standards apply to every patient?

The design team met with the hospital physicians and staff as well as the end customer, patients, and families. During family meetings the vision included the following requirement:

Riley Hospital should have a family environment defined as a homelike unit with the amenities needed to create a sense of normalcy; both parents can stay overnight, and siblings are welcome. Provide music and encourage physical fitness.

Family care is an important part of patient-centered pediatric care. Families provide a sense of normalcy to young children during their stay and are part of the care team. During family focus meetings, this was expressed but not fully realized until the families saw the proposed patient rooms.

The patient room had many of the requested amenities, with the patient bathroom the source of debate. The hospital standard provided space for a toilet, sink, and shower in every patient bathroom, but the shower was the point of contention. Patients diagnosed with cancer typically have extended periods of stay in the hospital. Children receiving chemotherapy treatments often experience symptoms ranging from moderate to severe fatigue, pain, and nausea, and sometimes a warm bath and holding their parent’s hand is an important part of their healing process.

The request for a bathtub was brought back to the staff for further consideration. Infection prevention standards didn’t allow bathtubs and there was concern regarding the potential of unsupervised children around standing water.

The response from families was this:

The concern over infection prevention and patient safety regarding tubs was explained, but the parents still feel strongly about having tubs in the patient room bathrooms for the following reasons:

  • Baths are soothing to patients with skin irritations related to their treatments
  • Younger children are often scared of showers
  • It may be easier to keep lines, ports, etc., dry in a tub versus a shower
  • Portable tubs are very cumbersome for the patients and their parents assisting them, and they wouldn’t be practical for patients who are sick in the middle of the night and want to take a bath to clean up.

The families weren’t backing down from their request, so the hospital and infection prevention team had to evaluate risks and benefits. A collaborative approach from architect, interior designer, MEP engineer, and plumbing trade was required to evaluate getting a standard-size tub in a room built for a shower.

Parents tested the design in mock-ups, selecting the best layout and size for the tub, and even compromising on other features to get the right clearances.

As design professionals, it’s important for us to listen to the needs of our clients and the staff. We also must remember our most important customer: the patient. They are who ultimately decides what is value-added, and it’s that patient’s experience that provides the value test to all involved.

Bernita Beikmann is associate principal and senior vice president, and director of Lean strategy at HKS Inc. She can be reached at