Call it “Monday morning quarterbacking”, “20-20 hindsight”, or just “lessons learned” – twelve years in healthcare design all over the United States has afforded me a very unique point of view in regard to the impact of decisions made at the design table. My role as a clinician in the architectural design process has evolved from what I fondly remember as a “marketing hood ornament” to a valued member of a very integrated and Lean-led design initiative.

In 1999, before Lean Healthcare and certainly before Lean-led design was even a twinkle in my CEO’s eye, the focus on medical error with the landmark report by the Institute of Medicine, “To Err is Human, Building a Safer Health System” opened the dialogue and begged the question, “Can and does the physical environment contribute to patient safety?” The IOM’s report was the catalyst for what has become one of the most spirited debates in the healthcare design world over the past 10 years. I am speaking of the use of standardization as a fundamental design driver for everything from the patient room to operational support spaces such as supply and nourishment rooms.

Until I was introduced to Lean Healthcare, my rationale for believing in standardization was likened to a “religious epiphany” by those who worked on projects with me.  I believed because of personal experience as a healthcare provider, my intuitive sense of organization, and because of natural human behavior…it just made sense to me. “To Err is Human” brought forth the message of salvation from medical error and standardization was one of its highest commandments. It seemed so obvious…such common sense…why the controversy?

  1. COST – Mirrored patient rooms permit the sharing of plumbing chases in multi-story buildings such as hospitals. The savings associated with repetitive construction due to standardization often offset this cost.
  2. PROOF – Many studies have focused on the reduction of medical error, which is extremely multifaceted with numerous contributing factors. Isolating the benefit of standardization alone is impossible.
  3. CONFUSION – The introduction of the term “same-handed rooms” has added to the confusion and misinformation regarding the benefits of standardization. A same-handed room does not mean the room is standardized!
  4. VARIATION – Just like you can’t be a little bit pregnant, the environment is either standard or not standard. Variation in layout resulting from many types of intrusion from the building structure, MEP systems or the basic geometry conflict with an attempt to standardize. Standardization as a design driver must be declared at the beginning of the project.
  5. CHANGE – The liability of changing a long-standing paradigm such as the use of mirrored patient rooms that is deeply embedded into multiple design disciplines and construction costing models is difficult.

In 2007, I was introduced to Lean Healthcare – Finally, the answer I had been searching for since I first heard the Standardization Gospel!

Lean Healthcare and Lean-led Design combined are incredibly powerful tools that will consistently produce quality outcomes and eliminate waste. The obstacles to standardization can be overcome. The benefits of standard work in Lean manufacturing are undisputed. The decision you make regarding standardization in your next construction project will impact safety, cost, efficiency and standard work for as long as the building remains operational.

“Compromising standardization is not in the best interest of patients and staff providing care; lack of standardization leads to complexity and error causing more harm, lower efficiency and less effective quality outcomes.” U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality grant number UCI HS15284


This week’s blog was written by Teresa Carpenter, RN, Director, Lean Clinical and Facility Design.

Teresa brings a unique perspective to lean healthcare as a registered nurse with extensive architectural design and facilities planning experience as well as move-in expertise.  She assists hospitals and healthcare systems in all aspects of applying Lean to the master plan, design, and operational aspects of a facility design or clinical expansion. Teresa serves as an educator, adviser, advocate, and interpreter for Lean healthcare integration into a wide range of clinical and hospital design, renovation, construction, and move-in projects.

Teresa holds a B.S. in Business Administration from the College of Charleston, and a B.S. in Nursing from Trident College in Charleston, South Carolina.

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