The four step process to designing a new physical environment for healthcare delivery begins with defining lean operations, technology, and customer service patterns through analysis of strategies, patients, and operations. This informs the project scope definition and early design concepts. Meetings are then held with various stakeholders to discuss issues, review data, develop proposed workflows, and consider the needs of the future emergency department through presentations and benchmarking other facilities. The goal is to create an efficient, flexible physical solution that supports the future vision for patient care.