Being Lean Without Being Mean: The ‘Design Downside’ Dilemma for the Healthcare Industry

Updated on August 28, 2023

Anthony CavallaroBy Anthony Cavallaro

As a hospital CEO contemplating adding a wing, or a facilities manager looking for a way to add a new operating suite, there are more challenges today than ever in undertaking such a task.

There is, after all, a great deal of uncertainty in the healthcare industry these days. With the Affordable Healthcare Act (Obamacare) set to potentially change the way people do business and how healthcare reimbursements are handled, increasingly, hospitals and clinics are having their budgets cut and need to find ways to trim the design budget for the additions and new rooms that they need for practice.

Everyone who is tasked with planning such new construction instinctively understands the need to go forward with the construction but understand the challenges of being confronted with a reduced bottom line and the ensuing dilemma: how to do more with less.

This challenge often finds its way down to the architects and builders, and today’s healthcare architect must be adept at designing to an efficient space to accommodate budget – without sacrificing safety or patient satisfaction.

The challenge is to find the “right size” – that is, the appropriate size based on anticipated patient volumes, care give concerns, efficiency, safety and patient care.

One strategy that is helpful in the design is utilizing the appropriate, often proprietary, software program that can evaluate optimal performances for healthcare systems.  There are software solutions allowing for animated visualization of clinic process, with the ability to draw from CAD files. With certain programs, it is possible to show improvement in patient flow, facility design, logistical analysis and resource utilization.  This visualization allows the designer and client to test new ideas before dedicating time and capital, as well as optimizing their available resources and space capacity.

These software systems can look at all aspects of the healthcare system, while experimenting with different operating strategies and designs to achieve the best results. With this tool, an architect who is familiar with medical design can evaluate, plan and design/redesign the processes, procedures and policies of hospitals at an early stage of project assessment to improve investment of capital.

Of course, square footage equates to dollars spent, and the biggest savings can be achieved by reducing the footprint. With that in mind, the CEO or facilities manager should take a look at certain criteria that can help in determining the actual size needed:

  1. Bed capacity management, if applicable: what are the best projections for future needs, weighed against potential cost increases for construction and design?
  2. Patient capacity: projections for immediate and long-term need
  3. Staffing: What future needs are anticipated?
  4. Equipment: Size matters. Are there pieces of medical equipment that perform the same function that take up less space and can contribute to a smaller space needed?

Of course, square footage is the largest single way to save on costs, but there may also be some middle ground for the facilities manager or CEO to consider, and that may include:

  1. Energy-efficient construction: Look at what is available in the construction market that will provide for lower energy costs going forward and a quicker payback
  2. Equipment costs:  The appropriate placement of equipment/creating a shared opportunity with various departments could contribute to a lower bottom line.
  3. Maintenance Cost: Hidden costs for maintaining the site after construction is complete with materials always being selecting with these expenditures in mind.

Often, it is a combination of square footage and other considerations that can drive down the costs of construction. In contemplating this challenge and how to resolve it successfully, it makes sense to seek the counsel of an architect/designer with in-the-field experience, someone who has ‘walked the walk’ with cost design.

There is an old saying the design industry that talks about “lean and mean.” We believe that this type of smaller footprint, more efficient design should be “lean” but not necessarily “mean.” In other words, each design should reflect the institution’s goals and serve its needs. A good design will economize where it is safe and practical and look to find savings and efficiencies where it can.

Anthony Cavallaro is the CEO of JACA Architects,, an architectural firm in the Greater Boston area dedicated to healthcare design.

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