Design-Build is Lean

Posted on August 17, 2011


Humans innately seek consistency. When a woman commits to something, we expect her to follow through. And if she doesn’t we are bothered, and look on her with skepticism for her lack of consistency.

Or when a man says he is a strong supporter of the environment, we find it troubling if he drives around town in a gas-guzzling SUV. We begin to question his word, intent and character.

As discussed here before, lean is a delivery philosophy particularly desirable in healthcare projects. It is derived from the Toyota Production System and is appealing for its efficient use of resources (reduction of waste), increased quality, control of outcome, and thus high-value product.

When hospitals buy into lean internally, they might be more likely to seek out design and construction teams who also understand and sympathize with the lean system—if for no other reason than consistency.

However, lean is not so easily accomplished, especially by teams that are not practiced in speed, quality and efficient service delivery. For those who want a lean project delivery method, design-build (DB) makes a lot of sense.

Design-build is an integrated way of producing a building that cuts all the waste and superfluous effort out of the system. Time is not wasted because DB moves the fastest of any project delivery method. Design-build overlaps as much of the design and construction process as possible, as opposed to a linear progression that is delayed until the previous step is 100% complete prior to moving on to the next step.

Design-build offers real time information on pricing and schedules because there are no time lags or waiting. Design-build is a method without buffers; its strength is its simplicity and transparency. Information is immediately actionable because it is coming directly from the source:  architect, engineer or builder.

When I was younger and skateboarding was the big fad, I remember the schism between the real skateboarders and those who simply found it stylish. The hard core skaters had a name for those who adopted the fad more as an aethetic, but without the substance; they called them poseurs.

As healthcare professionals committed to lean, it is important to be consistent in a holistic manner in order to reap the rewards of a lean system. Therefore, it makes sense to do two things on your hospital’s next project.  First, choose lean project delivery. Second, choose an integrated team that lives and is structured to work and produce in a lean manner. In the lean discussion, poseurs need not apply because design-build is lean.