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Like the chicken and the egg, it's sometimes hard to know which comes first, lean or evidence-based design? The answer is neither.  And here's why.

Evidence-based design is about basing design decisions on the best available evidence. Lean is about making design decisions that create more value using fewer resources.

They are both used with the end objective of creating better design solutions.

A lean approach can (and should) draw upon best available evidence. An evidence-based design approach can (and should) implement lean methods.

They should be considered symbiotic approaches to achieving better design.

Since the evidence connecting the design of the built environment to outcomes is always evolving, some may see evidence-based design as a more static process than lean -- which involves small iterative cycles of continuous improvement. Lean can just be one more piece of evidence to inform the design.

What's more, design can support or hinder lean processes, and lean process improvement can help define the design goals for a healthcare project -- as illustrated in this short case study from HKS about its work with Akron Children's Hospital.

Preserving value with less work is at the core of lean. Increasing safety and quality is at the core of evidence-based design. In today's healthcare, you can't do one without the other.

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Sara Marberry, EDAC, is a healthcare design knowledge expert, thought catalyst, and strategic marketing and business development consultant. The author/editor of three books, Sara writes and speaks frequently about industry trends and evidence-based design. She can be reached at sara@saramarberry.com.

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