Lean and LEED-not to be confused with one another-continue to be two of the most prominent terms in the healthcare design industry; the former, a process of streamlining design, operations, and construction; the latter, a sustainability standard accepted industry-wide. But despite their implicit overlaps, it's not always that the two ideals are approached in the same project. Denver Health's Park Hill Clinic-an outpatient facility intended to supply quality healthcare to an underserved, low-income area in Denver, Colorado-in order to cut costs, was able to apply principals from both practices to create a low-cost, efficient facility.

“Originally, we intended to design the building as a LEED building,” says Eric Frans, construction project manager, Denver Health. “We took all of the steps that we would need to in order to get it LEED certified. Then through discussions, we decided that for the good of the agency, we would have done these things so that the building was more efficient and green, but we did not go forward with the LEED certification because of the cost associated with that.”

And cost was certainly a major factor for Denver Health in the new clinic's design and construction, even more so than usual in the capital-strapped times that most hospitals and clinics are currently experiencing. Because the Park Hill Clinic serves a low-income community, capital was even more difficult to come by, such that, despite the prestige that comes along with being LEED certified, the facility forewent the certification due to the cost of application. “We do believe that the sustainability initiatives are worth it in the building process,” says John Thompson, associate COO, Denver Health. “But we have a high degree of the underserved population. Capital dollars are extremely tight with us, so $60,000 or $70,000 to us is an awful lot of money. That's really the only reason we didn't go for the LEED certification.”

Denver Health

Denver Health stood at a crossroads then: How do they offer the community high-quality healthcare services while implementing worthwhile green design aspects and keeping costs low. In order to do so, they utilized a longstanding relationship they had with Simpler Consulting, a firm that specializes in Lean processes in hospitals among other industries. “We have a longstanding relationship with Denver Health, back into the 2005-2006 timeframe,” says Mike Chamberlain, president, Simpler Consulting. “We helped them to identify, regardless of who the patient is, the best way to go through Denver Health to be treated with the highest quality, at the shortest lead, at the lowest cost.”

To ensure the greatest efficiency, Denver Health brings together a wide variety of representatives to form a team in charge of the design and construction process. “We get a team together that consists of a number of people-they can be clinicians, physicians, nurses, HCPs, operational people, and can include architects and people from our department-to do the planning and construction,” says Nancy McDonald, Lean facilitator, Denver Health. “This could be maybe 12 people with consultants. Using maybe four or five consultants during the week, you could get up to 15 people having input. In particular, the process that the architects like is having the users involved in the process so that they can get a sense of what the work is; how the work gets done; and a sense of the patients, who they might be, and what needs they might have. There's some preplanning to those events but that's where we really hammer this out.”


What Denver Health found was that many of the green/LEED aspects they were hoping to include in the new Park Hill facility worked in perfect concert with Lean processes and thinking. For example, occupancy sensors in patient and staff rooms both reduce electricity costs, and contribute to sustainability. They also utilized a unique rooftop daylighting system that funneled sunlight directly into the building, reducing the need for artificial light and again lowering costs.

“I think there's also something in the efficiencies that you look at through Lean, and it comes down to saving the green dollars as well as the environment,” says McDonald. “We just look at the space differently when we're looking through both of those lenses. There's a synergy about getting very efficient, right down to not building certain things because they're unnecessary: unnecessary storage, unnecessary inventory, those kinds of things. It just helps you to use less materials from the planet.”

Denver Health

Denver Health

Frans continues, “Certainly with our maintenance costs and maintaining the building, it's a tremendous help. Also, some of the time-saving things that we did for staff and locating the building certainly helps with building efficiency-I think the automatic lighting; the way the staff moves through the space and the lights do their thing to maintain the light levels the staff needs but keep electrical costs at a minimum.”

Boulder Associates

In fact, Denver Health included so many green aspects that they even had to scale back on a few of them. “The biggest issue we've had is the amount of daylight we brought into the building,” says Frans. “We found that we needed to dial that back a little. We got a little carried away with the daylight, so we've gone back in and put some protective films over the glass and dialed that back a little. Now the staff is much happier, our heat gain is a whole lot less, so everything is working in synergy now.”

Denver Health

In the end, the Lean/LEED synergy that Denver Health was able to create not only helped establish a successful clinic-one that Frans notes was built in the spirit of LEED despite not carrying the title-but also one that the local, low-income community can be proud of. “Some of the patients in this community have been coming to Park Hill Clinic for 25 years, and so for them to come to opening day and celebrate the completion of the brand new clinic, it shows a community pride that we really appreciate,” says McDonald. “As people who deliver medical care, we want people to feel pride in the clinic because it's part of the community.”


For more information, please visit www.denverhealth.org.

Healthcare Design 2010 September;10(9):14-17