This document discusses the concept of Lean Clinical Workplace Design, which integrates Evidence Based Design, Design Thinking, and Lean Process Efficiency. It traces the development of this concept through the author's professional experiences at various healthcare organizations. These experiences demonstrated how observing clinical processes, workflows, and spatial layouts can improve efficiency. The document also discusses how Evidence Based Design, Lean Thinking, and human factors research have independently aimed to optimize healthcare design and delivery. It argues that combining these three approaches into Lean Clinical Workplace Design could provide more comprehensive, balanced solutions that improve both financial and clinical outcomes for healthcare professionals and patients.

2. Lean Clinical Workplace Design
Part I: A Professional Retrospective
Leveraging the integration of Evidence Based Design, Design Thinking and Process Efficiency
to drive a new standard for the development of architectural workplace solutions that improve
the quality of life for healthcare professionals and their patients worldwide.
A White Paper
Written by:
Henry J. Rahn
AIA Associate, DBIA, IDSA, M.Arch
June 2014
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

3. Table of Contents
I. Introduction
II. What is Lean Clinical Workplace Design?
III. Concept Development & Professional Experiences
A. CIBA-Corning Diagnostics
B. ValuMetrix Consulting (Johnson & Johnson Ortho-Clinical Diagnostics)
C. RAHN Design Research
D. Evidence Based Design
IV. Implications & Conclusion
V. About the Author
VI. Bibliography
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

4. I. Introduction
This is the first of series of white papers aimed at tracing the development path of Lean Clinical
Workplace Design as it evolved in the professional work, experiences and accomplishments of
the author over the past two decades. Ervin Laszlo’s book A System’s View of the World
served as the spark for the author’s quest for understanding how people ‘do things’ or perform
tasks and the processes they develop and use to accomplish a “value set”.
This three part series of white papers is organized as follows:
• Part I: A Professional Retrospective - Chronicles the origin of the Lean Clinical
Workplace Design concept for the author as well as the critical professional projects and
outcomes demonstrating the viability, usability and business success that resulted from
merging evidence based design, design thinking and lean process efficiency.
• Part II: Clinical Process Efficiency Case Studies - Details the process and outcomes
across five healthcare organizations. More specifically, this paper provides in-depth
analysis and recommendations based on engagements with Johnson & Johnson’s
ValuMetrix L6S consulting service, clinical process efficiency consulting delivered by
Rahn Design Associates, and process research performed by Masimo, Incorporated.
The case studies highlight specific qualitative findings such as significant increased
process efficiency reducing the FTEs required resulting in part from spatial layouts
sympathetic to workflow improvements, as well as quantitative findings such as 12% of
a department’s square footage driving 80% of the revenues.
• Part III: Current Methodologies & Thought Leaders – Highlights the work of current
and emerging leaders across the three distinct but merging disciplines of evidence
based design, design thinking and lean process efficiency.
This is a living document that chronicles the development the author’s thinking and the practical
application and advancement of his unique approach to workplace design in healthcare
environments. The work represented here serves as a basis for the ongoing pursuit to build
highly predictive and productive operations through the design and building of integrated
programs and circulations defining space, light, and layout in healthcare workspaces.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

5. II. What is Lean Clinical Workplace Design?
Current EBD + Design Thinking + Lean Process Efficiency =
Lean Clinical Workplace Design
Today’s field of architectural healthcare is loosely organized into three methodologies for mining
organizational and spatial data, determining process efficiency and extracting medical efficacy
and patient wellness information from existing healthcare systems:
• Evidenced Based Design (EBD)
• Design Thinking
• Lean Process Efficiency
This paper explores the premise of merging these three methodologies to create Lean Clinical
Workplace Design, a methodology and integrated approach with the prospect of improved
results in financial, operative, and brand ROI.
PRINCIPLE CONCEPT
Leveraging the integration of Evidence Based Design, Design Thinking and Process Efficiency
to drive a new standard for the development of architectural workplace solutions that improve
the quality of life for healthcare professionals and their patients worldwide.
The work discussed in this paper will show how the value of process efficiency + quantitative
Evidence Based Design (EBD) can be integrated with the qualitative value of design thinking +
qualitative Evidence Based Design (EBD) to enable a comprehensive, multi-hierarchy
perspective and high-value event discovery for clinical workplaces found within healthcare
facilities. This approach is presented as potentially a new standard to advance the design and
development of architectural workplace solutions that improve the quality of life for healthcare
professional and their patients worldwide.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

6. III. Concept Development & Professional Experiences
A. CIBA-Corning Diagnostics Research
Studying Industrial Design at the prestigious University of Cincinnati’s Design, Art, Architecture
and Planning (DAAP) was a daunting challenge. A rigorous five year curriculum started with
approximately 60 students and graduated only 25. DAAP embraced a culture to explore and
develop the very depths of your intellectual and intuitive capabilities. It was in this environment
that I read Ervin Laszlo’s book A System’s View of the World as part of my senior curriculum.
Laszlo’s systems philosophy offered a kernel of inspiration and placed me in uncharted waters,
“where danger and opportunity collide and create a fertile plane for innovative growth.” Laszlo
unlocked the concept that process, i.e., the steps we use to accomplish a task, such as baking a
cake, is the glue that enables us to deliver practical creativity to market. From a designer’s
perspective, you need all of the human “touch points” identified from space to appliances to
baking pans and cups. Similarly, an architect could consider the spatial layout and how it best
supports room to room process or steps required to not only bake a cake, but all the individual
tasks, and destination points required to cook any meal. Additionally, the architect may wish to
consider how walls would create space and promote flow from one room-task-destination point
to another.
As a professional industrial designer and usability researcher, I translated this critical concept
into the study of how people ‘do things’ or perform tasks and the processes they develop and
use to accomplish a “value set”. I did this by applying human factors observational research
skills in the clinical space to identify the processes developed by physicians and scientist to
diagnose and treat patients in that space.
The approach I developed translates an instrument and the operative spatial layout it requires to
complete a task into practical measures. The charts on the following page document the output
of my approach. This methodology first observes a diagnostic instrument’s “ease of use” with
how much time it took a laboratory technician to complete a singular task and to complete the
process. Next, I observed and measured the physical path an individual would take going to and
from each destination point as a result I could determine the efficacy of the spatial layout as well
as the user interface (or user experience) of this particular clinical process.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

7. This attention to detail (L6S thinking) offers a keen insight into the occupant’s process and how
technology was configured so that unskilled technicians could use diagnostic instruments to
derive a specific and repeatable result. Further, this level of detail enables multiple evaluations
of the spatial layout and how it affects the process and productivity measures.
This methodology was fully embraced by CIBA-Corning Diagnostics for both marketing and
usability research and was rolled out in a two-phase international study. The first phase included
the construction and completion of a comprehensive workflow analysis of hospital diagnostic
testing laboratories in the major metropolitan areas of the US and Germany. The analysis
documented the spatial layout, equipment layout within that space, and the workstation location
of the lab technicians with the flow between destination points. The second phase of the work
included the evaluation of the layout with the intent of reorganizing workstations and spatial
layouts to improve management metrics like, “time to result”.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

8. III. Concept Development & Professional Experiences
B. ValuMetrix Consulting, Johnson & Johnson Ortho-Clinical Diagnostics
Moving forward ten years, Don Mooney a marketing executive from CIBA-Corning’s Immuno-
Diagnostics (CCD) Division assumed the position Sr. VP of Marketing with Johnson &
Johnson’s Ortho-Clinical Diagnostic division. A key to his advancement was an understanding
the consultative relationship with his clients and the value added service of workflow analysis in
the testing laboratory; a decision later supported with the 2006 ISOR&MS white paper,
“Modeling Patient Flows Through the Healthcare System”19.
In an evolving market of automation
and robotic systems in testing laboratories, Don recognized the value of CIBA-Corning’s
research methodology and brought Rahn Design Associates (RDA) in to assist Jim Ellis,
another CCD executive, with defining ValuMetrix, a process efficiency and “activity based
management” consulting service for Johnson & Johnson’s Ortho Clinical Diagnostics, see charts
below and Appendix C (MGH “Arc Light” presentation)
At the core of ValuMetrix’s service offerings, is a multi-disciplined team tasked with defining a
comprehensive solution for hospital administration to reach their targeted management metrics.
RDA designed a workflow analysis and spatial reorganization program that served as one of the
key elements of the service. In addition to expertise in determining the efficacy of the spatial
layout based on user actions and interactions, RDA brought an architectural perspective to the
work with ValuMetrix.
After the ValuMetrix team successfully demonstrated the validity of the service offering in
several hospitals, Lean Thinking3
and Six Sigma process efficiency techniques were added with
“value stream mapping”3
, see below. These service solutions formed Lean Six Sigma (L6S)4
, a
new segment of the consulting service. The ValuMetrix and RDA partnership went on to
develop more than fifteen major hospital testing laboratories’ workflow and space planning.
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9. Lean Critical Workplace Design Page 9
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10. Lean Critical Workplace Design Page 10
A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

11. III. Concept Development & Professional Experiences
C. RAHN Design Associates, Inc. (RDA)
After the 2001 recession, the healthcare marketplace started to experience a fracturing of its
traditional hospital centric strategy. A new approach focused on patient access to specialty
practices began to emerge. To support the physician requirement for stronger balance sheets
and profit margins in an increasingly difficult reimbursement economic climate, practices turned
to process efficiency. Leveraging RDA’s success with ValuMetrix, RDA introduced ValuLine
Consulting services, see charts below.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

12. ValuLine Consulting is a multi-disciplined, lean process efficiency service identifying muda, a
Japanese term for waste and a key to lean thinking, an efficiency process developed by James
Womack and Daniel Jones for Toyota and embraced by GE.
The team consists of four primary disciplines, workflow analyst, technology analyst, architectural
analyst and business analyst.
 Workflow Analyst - Provides most of the observational and quantitative research of the
site’s FTEs as they perform their specific skill-sets while circulating through their
workspace accomplishing a value-set. Typically, a hybrid between a human factors
specialist and product designer.
 Technology Analyst - Evaluates the technology or product application required to
accomplish a task. Typically this would be someone with a scientific degree and
experience in performing the site’s value-set.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

13.  Architectural Analyst - Documents the current built site and works with the workflow
analyst with understanding the use circulation. Typically, an architect with significant
experience in work space design.
 Business Analyst - Performs the P&L analysis on the site working directly with the
site’s management to breakdown expenses and how they relate to the specific tasks,
technologies and FTEs required to accomplish the value-set.
Applied here, muda identified waste in specialty healthcare practices’ process of delivering care
to its patients, or in this case the value-set. Through onsite research the team used several
observational and quantitative techniques to define evaluative criteria of existing practices
healthcare delivery processes, the medical devise use, and the spatial layout of the practice’s
location, see chart below and Appendix A (Midmark Inc. Podiatry Specialty Practice workflow
analysis)
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

14. RDA synthesizes this information reengineering the workflow of the process and redesigns the
spatial layout of the facility to better support the practices healthcare delivery process.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

15. III. Concept Development & Professional Experiences
D. Evidence Based Design in Healthcare Architecture
Another architectural research methodology that developed out of healthcare administration’s
need for a more efficient and informed spatial and programmatic layout is Evidence Based
Design (EBD).
Formalized with their 2009 publication, “Evidence-Based Design for Multiple Building Types”2
,
D. Kirk Hamilton, FAIA and David H. Watkins, FAIA, EBD developed a nine (9) step process for
evidence based design (EBD):
1. Establish the Client’s Project Goals
2. List the Practitioner’s Project Goals
3. Identify the One to Three Key Design Issues
4. Convert Key Design Issues into Research Questions
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

16. 5. Collect Information and Gather Evidence Relevant to the Research Questions
6. Critically Interpret the Evidence
7. Develop Concepts to Achieve Desired Design Outcomes
8. Hypothesize Predicted Outcomes Linked to the Evidence-Based Concepts
9. Select Measures Suited to the Questions Posed by the Hypotheses
As stated in their research, these milestones and action items in Hamilton and Watkins’
process are developed and evaluated by a multidiscipline group of architects, engineers,
interior designers, and a variety of other consultants. The team is tasked with identifying the
evidence required to define specific architectural impact of the client’s program or intra-
program/inter-program relationships. It is additionally their responsibility to define their
evidence sources as well as establish its credibility and value to the project. Finally, one of
the key decisions this team needs to make is when to develop their own research and what
does that look like.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

17. VI. Implications & Conclusion
Current EBD + Design Thinking + Process Efficiency =
Lean Clinical Workplace Design
Why is today’s healthcare executive management embracing “Lean” and “Design Thinking”
solution generating methodologies as successful processes for their current institutional and
organizational problems? Is it symptomatic of the perception that healthcare in the United
States is “broken”? Or methodologies that offer insight into the advancement of humanizing the
hospital infirmary image while building process improvement that measures a balance between
performance metrics like “Time of Patient Stay” and “Clinician Satisfaction”. Finally, what is the
value of “evidence” to the healthcare system’s board of directors in evidence based design
(EBD) and can EBD function as a predictor of the constant demand for knowledge growth in
today’s global healthcare society. A simple answer is a measured yes.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

18. An organizational result of the last three decades of meteoric growth in the information
technology sector is the dismantling of vertical silos and the evolution of integrated matrix
management, or cross-discipline teams. This team structure can be witnessed across problem
solving professions both tangible and intangible, product/architecture to intellectual
property/finance. In healthcare architecture, these teams have evolved from EBD to lean centric
in response to healthcare management’s market demand. To add another level of quantitative
vs qualitative balance to this multi-discipline team’s output this paper proposes to introduce
design thinking methodologies to the mix, as seen North York General Hospital in Toronto,
Ontario Canada and SSM DePaul Health Center in Bridgeton, MO.
The synergy in joining the scientific rigor of EBD, the process efficiency of lean and the creative
problem definition and solution generation of design thinking combine to focus on a balanced
outcome that can address intra-organizational relationships, enhanced management
performance metrics, and the humanizing results to clinician and patient workplace well-being.
As the previous documented section of this paper reveals, all three processes have proven
individual track records of providing significant results to healthcare management. The
evolutionary combination of these disciplines and processes derives a logical outcome of a
simple, balanced result addressing the continuum and complexity of an ever changing global
healthcare system and their individual architectural requirements.
To implement these findings of Integrated Evidence Based Design (IEBD) and multi-discipline
applied research teams requires complete buy-in from the client with an understanding of how
the team’s involvement during pre-design, schematic design, and post occupancy evaluation.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

19. Possibly the more crucial informed decision making stage of the architectural process, pre-
design would benefit from the tri-IEBD team research methodology. Starting with assisting with
the executive management client and architect team with the defining the scope of the program
and identifying primary areas of value, the pre-design research team would identify like
healthcare facilities within the client’s healthcare system and build a research project build
around the executive strategy and required value based data.
Design thinking focusing on qualitative observational information, EBD on the current
therapeutic environment data, and process improvement on the clinical protocols of each
department/program. These groups would develop the potential opportunities, like the 12% of
the program’s square footage accounts for 80% of the program’s revenue, and together with
executive management decide which opportunities to pursue and which do not possess the ROI
to integrate into this program. Next the team would work with the project architect to develop the
project specification with the value points integrated.
During the schematic design (SD) phase of the program there would be joint research and
design architect brainstorming session to develop multiple solutions, comparable to the Design
Thinking process. Decision making points would be developed with the insurance that the
concept value would be retained throughout the process.
A management dashboard would be developed as a tool for post occupancy evaluation (POE)
with on-going observational research during the design development (DD) stage of the project.
The integration of the dashboard into the sites information technology as well as establishing an
observational measure would be part of the POE stage of the program.
This integration of design thinking and lean process efficiency into an up-to-date EBD data
base has individually proven positive ROI precedence on the financial, operative, and brand
segments of healthcare systems and would advance the application of Lean Clinical Workplace
Design.

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20. V. About the Author
Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture
Within the new millennium, society recognizes that the working population
spends more than half of their lives interacting in and with designed space.
Whether physical, cognitive or perceptual our reality is being shaped by an
ever expanding global cultural and intellectual awareness. As a designer and
emerging architect, my personal and professional life mission has been and is
dedicated to creating inspiring workplaces and innovative products that
motivate people to excel within the boundaries of our ever fragile earth.
Henry J. Rahn
Henry Rahn is an experienced, award-winning industrial designer, UX researcher, and emerging
architect with expertise in observing, documenting and building evidence based solutions. His
analysis and design solutions provide high impact, measurable and high-value content for
globally innovative medical devices, industrial products, user protocols and professional work
spaces.
Henry received a master’s degree in architecture from the University of Colorado College of
Architecture and Planning in May 2014. He is a member of Tau Sigma Delta, the Architecture
Honor Society. Additionally, he was awarded 1st
place for the 2013 AIA College of Fellows
Student Award. His designs were recognized as winner of the 2014 Young Architect AG for
Unbuilt Architecture and Honorable Mention for the 2014 Young Architect AG Build Architecture.
Henry’s professional work as an industrial designer in medical devices was recognized in 1990
as “Design of the Decade” by the Industrial Design Society of American. He also won Gold level
recognition at the Hannover Fair iF in Germany. Henry holds a Bachelor of Science degree in
Industrial Design from the University of Cincinnati.
For over 20 years, Henry has served as leader of RAHN Design Associates, a research and
consulting firm he founded. Additionally, he has served in various corporate design leadership
positions that have allowed him to demonstrate his commitment to improving the human
experience in healthcare.
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014

21. VI. Bibliography
BOOKS
1. Change by Design, Tim Brown, HarperCollins, 2009
2. Evidence Based Design for Multiple Building Types, D. Kirk Hamilton, FAIA & David H.
Watkins, FAIA, John Wiley & Sons, Inc., 2009
3. Lean Thinking: Banish Waste and Create Wealth in Your Corporation, James P. Womack,
& Daniel T. Jones, Simon & Schuster, 1996
4. The Lean Six Sigma Guide to Doing More with Less, Mark O. George, John Wiley & Sons,
2010
5. The Systems View of the World, Ervin Laszlo, George Braziller, Inc., 1972
ARTICLES
6. “Design Thinking”, Tim Brown, Harvard Business Review, June 2008, pp. 84-92
7. “The IDEO Cure”, Susan S. Szenasy, METROPOLIS, October 2002, pp. 2-9
8. “Applying Different Processes for Evidence-Based Design”, Jaynelle F. Stichler, HERD
Journal, November 15, 2013
9. “A Framework for Evaluating Evidence in Evidence-Based Design”, Debajyoti Pati, PhD,
HERD volume 4, number 3, pp. 50-71, 2011
10. “The Impact & Application of Evidence-Based Design”, Douglas V. Elting, AIA, axiom 411
blog, 1999
11. “The Future of Evidence-Based Design”, David Whitemyer, Perspective (IIDA Journal)
Spring 2010, pp. 9-14
12. “Evidence-Based Design: The Deeper Meaning to Sustainability, Building Performance,
and Everything Else”, Zach Mortice, AIArchitect This Week, June 26, 2009
13. “Checking the Pulse of Healthcare Architecture”, Sara Fernandez Cendon, AIArchiect,
February 18, 2011.
14. “Lean Design: Doing More with Less”, Gwynneth Anderson, Healthcare Design, January 7,
2014
15. “Lean Design: What’s it all About?”, Jeffrey Stouffer AIA, Healthcare Design, April 9, 2013
16. “Practice Evolution in the New Healthcare World”, Jeffrey Stouffer AIA, Healthcare Design,
January 9, 2014
17. “Using Lean Design to Overcome 8 Deadly Wastes”, Anne DiNardo, Healthcare Design,
December 6, 2013
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22. 18. “Therapeutic Environments”, Ronald Smith, AIA, Nicholas Watkins, PhD, Therapeutic
Environments Forum, AIA Academy of Architecture for Health, June 18, 2010
WHITE PAPERS
19. “Capital as a transformation tool, Design as a change tool”, Clifford Harvey, Health Capital
Investment Branch, Ontario Ministry of Health and Long-Term Care, UIA/PHG 2013 Annual
Healthcare Forum + GUPHA Meeting, September 24-28, 2013
20. “Modeling Patient Flows Through the Healthcare System”, R. Hall, D. Belson, P. Murali and
M. Dessouky, from, Patient Flow: Reducing Delay in Healthcare Delivery, International
Series Operations Research & Management Science, Volume 91, 2006
WEBSITES
http://www.healthdesign.org/
https://www.herdjournal.com/
http://www.healtharchitects.org/
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A White Paper Written By: Henry J. Rahn, AIAS, DBIA, IDSA, Masters of Architecture June 2014