Book Review

Health Environments Research

& Design Journal
1-2
Book Review ª The Author(s) 2015
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DOI: 10.1177/1937586715584775
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Grunden, N. & Hagood, C. (2012). Lean-led hospital design: Creating the efficient hospital of the future.
New York, NY: CRC Press, Taylor & Francis group, LLC. 338 pp. $70, ISBN 978-1-4398-6828-7.

Reviewed by: Ahmed Hassem Sadek, Department of Architectural Engineering at Assiut University, Egypt;
Center for Health Systems & Design, College of Architecture, Texas A&M University, USA.
DOI: 10.1177/1937586715584775

Lean philosophy is a quality assurance approach

that follows the pursuit of organizational perfec-
tion. It is derived originally from the tenets of the
Toyota Production system with the aim of
improving facility performance by minimizing
waste and eliminating nonvalue-added elements
from the process. Lean principles, along with
other methods, have been increasingly applied
into the health care context during the past
10 years with noticeable sweeping improve-
ments in the clinical quality and costs of hospital
operations.
Lean-Led Hospital Design: Creating the Effi-
cient Hospital of the Future, by Naida Grunden
and Charles Hagood, is an effective resource that
offers valuable information for a wide range of
people associated with healthcare operations and
planning, including, but not limited to, healthcare
administrators, scholars, planners, architects,
engineers, and construction managers. The book
consists of 11 chapters organized into five main
sections. Within each chapter, the reader is edu- accelerating process transformation. With this
cated about various Lean terms and methods view, Section 1 starts by introducing the concept
accompanied with practical case studies from the of Lean and its role in process and facility design.
healthcare realm to demonstrate the applicability The differences between traditional ways of
of the concept. The content is supported by designing hospitals and Lean approach are illu-
distinctive illustrative photos to increase the strated in the subsequent chapters. Integrating
understanding of the processes and the design Lean techniques, as early involvement of hospital
applications. staff, observation of current situation, value
Efficient design of buildings, equipment, and stream mapping, and 3P, throughout the design
technology is a main facet of supporting and stages constitute the main difference between
2 Health Environments Research & Design Journal
Lean-led hospital design and traditional design
process. A detailed Lean model depending on the
3P concept (product, process, and preparation) is
presented also in Chapter 3 to serve as a guide for
breaking through old thinking and improving
healthcare delivery systems.
Reaping benefits of Lean can be achieved by
applying its principles early, before, and during
the design phases, in order to have the chance
to define clearly the organizational needs that
allow for designing efficient facilities. This is
documented in Section 2, which explains how the
variety of tools provided by Lean allows for their
successful implementation within different stages
of a project design. Nevertheless, even if the
facility has already been built, chances for apply-
ing Lean still exist and are worth trying before
move-in. As demonstrated in Chapter 4, simulat-
ing the major processes by front line workers
allowed for catching glitches related to furniture
and equipment arrangements before the hospital
opening day. The authors concluded this section
by introducing the functionality and safety bene-
fits of standardizing work spaces that allow care-
givers to find their needs quickly and reliably,
thus releasing their mind to focus on tasks that
require critical thinking.
Avoiding various types of waste that could
affect healthcare industries is continued to be
introduced throughout Chapters 7 and 8. Flexibil-
ity of applying Lean tools and the approach of
integrating project delivery through design and
construction are represented among the practical
case studies of these chapters. Furthermore, pos-
sibilities of approaching cultural differences in
the application of Lean thinking is distinctly pre-
sented in the redesign of Abu Dhabi health ser-
vice foreign worker disease prevention and
screening center, United Arab Emirates. Apply-
ing queue theory and simulation software program
allowed for validating current work processes and
testing alternative layout design and resource allo-
cation for better patient flow through the clinic.
Lean methodology is extended also to benefit
information technology solutions, support effec-
tive operations, and enhance patient and staff
experience.
Following the main content of the book are four
appendices provided by invited Lean professionals.
This includes a scoring matrix, developed by
Healthcare Performance Partners Company, to
assess the Lean state of an organization and to
help in selecting the appropriate team for design
and construction. A brief history of hospital care
and insights from experienced Lean practi-
tioners, including engineers, physicians, regis-
tered nurses, and scientists, are provided as
part of this concluding section.
Lean-Led Hospital Design provides a unique
contribution to the field of healthcare facility
design and research. Merging Lean principles
into the process of designing and delivering
healthcare facilities sets this work apart from
other initiatives that focus mainly on operational
processes as in the Lean Hospitals book by Mark
Graban. The thorough discussion of Lean tech-
niques along with their applications in hospital
settings and designs provides a strong view and
lends credibility to the role of the physical envi-
ronment in supporting operational performance
and improving healthcare delivery. Designing
environments that support patient flow, work pro-
cesses, and staff productivity is crucial not only
for saving resources and budget but also for
enhancing patient satisfaction and well-being
which may alleviate sources of stress and increase
patient capacity to experience healing.
Reference
Graban, M. (2012). Lean hospitals: Improving quality,
patient safety, and employee engagement (2nd ed.).
Boca Raton, FL: CRC Press.