The 2P (Production Preparation) layout process requires that various stakeholders and departments are brought together with their builders, physicians, and staff.  This group follows a systematic approach that brings preparation data (confirmation of given volumes, products, type of processes, conception, targets, vision, and reconfirmation) to determine needs, goals, wants and metrics and create an initial design of the facility.  The process works by bringing a diverse team (cross-organizational, architectural, development, etc) together for workshops of varying lengths of time.  Included in this process is an understanding voice of the patient, the wants and needs of the clinicians and staff, and other factors to help prioritize the design requirements.  Basic knowledge of lean principles will make the team members that much more effective, as we hope to enlist lean principles of flow, 5S, Just-in-Time, and pull into the overall design ideas.  The people in the workshop actually go through several structured exercises to create multiple design options and then use their criteria to determine the one they feel fits their priorities or to go back to the drawing board.  By including all the key stakeholders in the process up front and by engaging all stakeholders at the table –everyone has ownership of the decisions, understands why they were made, and has the opportunity to have their voice heard.  The wastefulness (time, resources) of trying to make all these decisions through meetings, emails, and phone calls is eliminated.  Furthermore, with all the stakeholders at the table, defects and the resulting rework can be reduced or eliminated because issues are discussed during the design phase rather than after the start of construction.   All team members are incentivized to find ways to contain costs and maximize value.

Utilization of lean concepts in building design employs the concepts of  “Set-based Design”, adapted from Toyota’s Production System.  This process begins by broadly considering sets of possible design solutions and gradually narrowing the set of possibilities to converge on a final solution. A wide net from the start makes finding the best solutions more likely.  By delaying design decisions until the last responsible moment, design re-work can be minimized, learning from design alternatives can be documented for use in future designs, and the highest project value can be realized.


  • Design of pharmaceuticals delivery process for hospital rooms.
  • Design of a cart for material and laundry delivery to patient rooms in a hospital.
  • Design of standard exam room for a new medical office building
  • Re-design of 28,000 square foot new medical building to 11,000 square feet. The team succeeded to meet requirements for merging two clinic buildings and added space for therapy
  • Layout and plan for new production line for a new product pre-product launch
  • The tool and approach can be applied to processes as well.
    • Establishing new phone layout/flow/staffing model
    • Revenue cycle redesign
    • Operating Room
    • Cabinet re-engineering

The benefits include reducing the cost of the project, adding additional scope without cost, completing projects ahead of schedule or normal expectations, and reduced headaches.  The end result is a more efficient and purposeful building that meets the needs of all stakeholders.

Here is an example of a large Medical Office Building with an Outpatient Surgery Center.

  • A 75,000 square foot clinic comprised of exam rooms, physician offices, outpatient surgery that finished $45,000 under budget, included owner-added scope worth $840,000. The project was completed 3.5 months ahead of benchmark for similar projects resulting in 70 additional clinic days of revenue.

Call us today to learn how your organization may benefit from applying this Lean tool and process to your building project or new process design.