Over the last decade, we’ve been hearing a lot about the need to right-size our healthcare environments, and both hospital organizations and the healthcare design community have made attempts to do so with very mixed success.

However, this commitment to right-sizing has also been mixed, with the concept not yet embraced by all.

Right-sizing as a concept may be described in a number of ways, but the simple definition is: the process of defining and separating user group wants from user group needs in terms of the healthcare built environment.

When this effort is successful, the appropriate square footage is included within specific departments and areas, which results in an appropriate total square footage for an overall project.

Although the need for right-sizing has always been important in healthcare, a number of factors are converging to increase the probability that pursuing it will be effective.

The first factor is the rapid increase and effectiveness of technology. One way this touches facilities is by eliminating the need for physical adjacencies of certain functions and departments. Another important facility impact includes the speed and rapidity of treatments and modalities thanks to advancements in technology.

The second factor is the increase in the knowledge, acceptance, and evolution of Lean and Six Sigma concepts in healthcare. This has permeated throughout the industry and, practically speaking, every healthcare organization has implemented some type of Lean or Six Sigma program, providing a sound basis for emphasizing right-sizing initiatives in an industry already utilizing process improvement principles.

Another critical element of right-sizing is the timing of such efforts as they relate to project development. Success in defining the right square footage is often determined by how early right-sizing begins within the planning and design of a project.

The most effective approach is to align and begin planning and design, Lean and Six Sigma, and right-sizing simultaneously.

Selecting a user group for involvement in the process should be done in parallel.

It’s ironic that one of the most important decision-making steps for any project is often dependant on subjectivity and internal politics within healthcare organizations, resulting in team members selected for user groups who aren’t, in fact, the best for creating innovative built environments.

A team member should possess the following characteristics and attributes:

  • Has had exposure to many different healthcare built environments throughout his/her career
  • Is certified or specifically trained in Lean/Six Sigma processes
  • Is open-minded to alternative solutions and methods of accomplishing them
  • Has been successful at implementing innovative and creative ideas
  • Is a good problem solver who collaborates with colleagues
  • Doesn’t have an agenda or vested interest in a specific solution.

The healthcare industry is at an important point where the need for right-sizing of the built environment is critically important. Fortunately, healthcare organizations are positioned well to achieve this alongside professionals who are knowledgeable of the processes required for success.


Gary L. Vance will speak more on this topic at the Healthcare Design Academy being held Feb. 26-27 in Bethesda, Md., where he’ll be joined by Derek Selke, director of architecture for BSA LifeStructures, and Tim J. Spence, regional director, Raleigh, for BSA LifeStructures, in the session “New Facility Planning Criteria & Metrics: Five Takeaways to Share with the C-Suite.”

Gary Vance, AIA, FACHA, LEED AP, is the director of national healthcare for BSA LifeStructures. He can be reached at gvance@bsalifestructures.com.