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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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Ally Yue

1 year ago

Hi, it's so honorable to catch so many interesting posts about evidence-based design of yours. I am a Chinese student of design major, and I am doing research about EBD preparing to communicate about it with my classmates, since you are also very interested about EBD, do you have any comments or advice to design students in the angle of EBD? What can EBD do for every kind of design, not only for medical environment? Thank you so much, hoping for your reply!

Sara Marberry

9 months ago

The 8-step EBD process can be applied to any discipline, depending on what outcomes you want to achieve. For more on the 8-step process, check out this blog post: https://www.saramarberry.com/why-many-use-term-evidence-based-design-wrong/

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What's my story? I'm a healthcare and senior living design knowledge expert who writes and speaks frequently about trends and issues affecting these two industries. I'm also a strategic marketing consultant and content creator, working with companies and organizations who want to improve the quality of healthcare and senior living through the design of the physical environment. You can reach me at .

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