In this series, Healthcare Design magazine asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Here, Frank Zilm, Chester Dean lecturer on healthcare design, University of Kansas School of Architecture, Design & Planning, poses some questions as he shares his five “mindfulness meditations on healthcare design.”

1. Is Lean a method or a religion? 

During my career, I’ve experienced operations research, management by objectives, quality circles, management by walking around, Six Sigma, and now Lean. We can learn a lot from these tools, particularly Lean’s focus on eliminating waste. My concern is when a concept turns into a dogmatic religion where everything has to be done by the “Toyota” way. We can work on communications and problem-solving without having to have everything on an A3 sheet of paper. Early design is a reflective process, not a manufacturing production line problem. How we adapt these management tools to the creative process will be a major challenge/opportunity for healthcare architects.

2. Will profit close our open communications? 

At the beginning of my career, healthcare consumed 7 percent of the GDP in the United States—which was considered an unsustainable expenditure. Well the pundits were right, it wasn’t sustainable—it’s now 13 percent (I think) and continuing to grow. As money becomes a bigger part of the drivers of healthcare (particularly for the investor-owned systems) will the open communications and sharing of planning and design information continue? Or will the desire for marketing proprietary solutions and trade secrets close access to site visits, benchmarks, construction costs, etc.  Will larger systems be willing to share post-occupancy information and planning guidelines? I hope so, but I’m concerned.

3. A new isolationism in a global economy? 

As our government struggles with the recession recovery and political foolishness, are we collectively losing sight of our role in supporting healthcare in developing countries? Can we let the Gates Foundation, China, and others take the responsibility for advancing healthcare or should we continue to support appropriate healthcare design in countries other than Abu Dhabi, Saudi Arabia, and Qatar? 

4. The hospital is no longer a machine

In addition to being functional, there are many examples of aesthetically creative designs in today’s healthcare architecture. The challenges will be to maintain good design with the current pressures for cutting costs.

5. Home alone

As boomers like me age, the desire to stay at home as long as possible will become a design opportunity. Information technology is already allowing monitoring and video conferencing for patients with chronic healthcare problems. Robotic assist devices, currently under development in Japan, could help resolve the lifting problem for home healthcare. Is there a role for healthcare architects in supporting this segment of care or will this be better served by residential designers? Is this a new market opportunity to integrate design, construction, and healthcare management?

Frank Zilm

Want to share your Top Five? Contact senior editor Anne DiNardo at for submission instructions.