Bellingham author: 'Lean' design for hospitals can save space, money and lives


In 2007, Seattle Children's Hospital began early plans for a new clinic and surgery center in Bellevue that was projected to cover 110,000 square feet and cost $100 million.

Then the Great Recession hit, so the hospital chose a new way to design the center at less cost without sacrificing patient care.

To do that, the hospital set aside space in its parking garage for full-size mock-ups of patient rooms, hospital floors and sequences of hospital space. Staff members, administrators and family members walked through the mock-ups with an eye to improving the layout.

Is there a shorter path for patients to travel? Is the storage closet in a convenient location? Will the space work smoothly during a patient emergency?

Using the mock-ups helped catch problems before they were locked into place in architects' designs and contractors' work. By planning ahead, and by seeking input from everyone, from housekeepers to executives, Seattle Children's trimmed 25,000 square feet and saved $40 million.

The result was leaner. It was also Lean.

"Lean" refers to Toyota Corp.'s management approach based on continuous improvement and on respect for all people involved, not just the top dogs.

Bellingham author Naida Grunden wrote about the Lean approach in her 2007 book, "The Pittsburgh Way to Efficient Healthcare," based on her time working for a regional health initiative in Pittsburgh. The book won an international award, The Shingo Prize, for its contribution to smart management.

Now Grunden has a new book out that applies Lean ideas and methods to the physical space of health care: "Lean-Led Hospital Design: Creating the Efficient Hospital of the Future."

For me, the book's strength is its numerous case studies of how Seattle Children's and hospitals improved patient care and saved money through cooperative, ground-up planning. Lean design ranges from big issues, such as the optimal flow of patients and staff throughout a hospital, to such particulars as storage cabinets and sink locations.

Example: A new hospital in Virginia had cabinets that reached to the ceiling. Bad idea, because it's inefficient and unsafe to store things that high.

Also, the cabinets were attached to the wall. Also a bad idea, because it will take time and money to change the cabinets if use of the space changes.

"The best thing you can do is to design the building so you change in the future," Grunden said.

Another example: To save on plumbing and wiring costs, hospitals often build mirror-image patient rooms on opposite sides of a common wall. Bad idea, because that means the sink, for example, will on the left side of the patient's bed in one room and on the right side in the other.

Mistakes are reduced when sinks and other fixtures in patient rooms are in identical locations. That way, medical workers don't have to think twice about where to find something.

A factory worker assembling a Toyota shouldn't have to look here and there for a door handle to install. Neither should a nurse looking for supplies.

"Things that make sense in an industrial setting make sense for hospitals, in most cases," Grunden said.

Yet the biggest challenge with Lean isn't installing sinks in the same location. It's breaking through barriers that arise between caregivers and administrators, between this hospital department and that hospital department, and between architects who design first and tweak later, and those wiling to listen first, and then design.

"It's a way of thinking," Grunden said. "Let the people who do the work supply the answers."


To learn about Naida Grunden's writings, see

Reach DEAN KAHN at or call 715-2291.

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