Leveraging Lean for Healthcare: An Inside Look at HCA Healthcare
Introducing HCA Healthcare
HCA Healthcare (HCA) is among the pioneering hospital companies in the United States. What started with a single hospital in Nashville, Tennessee has evolved into a healthcare leader, now managing 186 hospitals and approximately 2,400 ambulatory care sites across 20 states and the United Kingdom.
With nearly 100 construction projects completed each year, HCA Healthcare’s infrastructure efforts play a vital role in advancing its mission to deliver high-quality care. What sets HCA Healthcare apart is its unique approach to construction and design, with internal teams of design and construction managers collaborating with partner architects, contractors, and vendors. In many instances, they’ve worked with the same firms for over 20 years. These long standing relationships help ensure consistency, efficiency, and alignment with HCA’s overarching goals.
The Role of Design and Construction at HCA Healthcare
HCA Healthcare’s design and construction processes are rooted in standardization, driving both efficiency and predictability.
“When our team was formed nearly a decade ago to implement Lean practices, the goal was clear: ‘How can we stretch the dollar and make our capital go further?’” shares Ashley Aye, Director of Strategy & Productivity for HCA Healthcare and a Lean Six Sigma Black Belt.
Reflecting on the early days of HCA Healthcare’s Lean journey, Aye recalls, “At the time, our role was new, and there was some initial uncertainty as team members adjusted to our approach and the questions we were asking about their processes.” Fast forward to today, and HCA Healthcare’s Lean team has established credibility through collaboration and results.
A cornerstone of HCA Healthcare’s strategy is collaboration with clinical professionals and their design partners to develop comprehensive standard design guidelines. By involving end-users in the design process to establish programmatic standards, HCA Healthcare ensures that critical spaces, such as women’s and surgical services, nursing units, and more are optimized for clinical and operations workflows and provide a “best practice” approach to designing a space. “This consistency allows our hospital colleagues to maximize their ability to provide quality patient care,” explains Aye.
Through Lean practices and a focus on collaboration, HCA Healthcare continues to innovate, delivering high-quality healthcare facilities that meet the needs of patients and staff alike.
The Benefits of Lean for HCA Healthcare
Implementing Lean principles has transformed how HCA Healthcare approaches construction and design. Aye shared that a commitment to Lean has generated the following results:
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Workflow Optimization
HCA Healthcare’s standard design guidelines allow project teams to “Focus on Flow,” a core LCI tenet, specifically combatting waiting and rework. Leveraging their guidelines, designers have a starting point from which to begin each design, never starting from a blank page.
From a procurement perspective, HCA Healthcare has material standards. As an example, they are the sole source with one mechanical and one electrical vendor. This enables teams to design engineering systems to a particular vendor spec versus having to speculate which supplier will be selected only to find work was awarded to another vendor. Having to design to different specifications is rework.
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Cost Efficiency
With their Lean-minded standards as it applies to material procurement, HCA Healthcare has been able to mitigate the financial risks posed by market fluctuations. “Thirty-four percent of our construction materials are under contract with price certainty for three years,” Aye notes. “This has helped us hedge against inflation and maintain budget stability.”
Additionally, bulk purchasing and streamlining material options—such as reducing the variety of SKUs for fittings and fixtures—decreases overproduction and improves inventory control for their partner suppliers, driving further enhanced cost efficiency.
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Faster Delivery
“Standardized designs lend themselves to prefabrication, which helps us speed up construction timelines and reduce on-site labor needs,” Aye explains. “Prefabrication not only enhances speed but also minimizes disruptions at active healthcare sites, significant in a sector where continuous operation is critical.”
HCA Healthcare’s supplier partnerships also play a key role promoting faster delivery. For example, when lead times were critically long, their sole source electrical supplier stepped up. The supplier partner agreed to reserve a manufacturing slot for complex engineered equipment shortly after project funding based on an owner LOI (Letter of Intent). In a typical process, a purchase order would be issued by the electrical contractor once they were on-boarded. As a result of implementing the LOI process, long-lead equipment was ordered several months sooner to ensure project schedules were maintained.
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Predictable Outcomes
“Standardization is what enables us to be Lean, whether it’s in sourcing materials or designing clinical spaces,” Aye explains.
Standardization not only ensures consistent quality but also simplifies the construction process, making it easier to predict project outcomes. For HCA Healthcare, this reliability is crucial when managing the complexity of healthcare construction, where intricate workflows and regulatory requirements must be seamlessly integrated.
A Highlighted Success: Medical City Plano Tower
One of HCA Healthcare’s standout Lean projects is the Medical City Plano Tower in Texas, a four-story hospital expansion recognized as a Top 5 presentation at the 2019 Lean Construction Institute (LCI) Congress.
“This project was special,” Aye shares. “The team rallied behind a goal of prefabricating 60% of the building—a very ambitious goal. While we didn’t quite hit that target—we reached 40%—it was the most prefab we’d ever done. Some may view missing the goal as a failure; in every way, HCA Healthcare viewed this as a win. Setting a 60% target was a stretch goal; not something we were sure could be achieved. The collaboration between architects, contractors, and trades was incredible. It was, hands down, the best project I’ve ever been a part of.”
The Medical City Plano Tower project demonstrated the transformative impact of Lean principles, achieving significant milestones across multiple dimensions, including:
Prefabrication
The project pushed the boundaries of prefabrication, producing:
- 252 exterior skin panels
- 114 multi-trade overhead corridor (MEP, fire sprinkler, pneumatic tube)
- 105 bathroom pods, 90 headwalls, and 90 sink walls
- Underground electrical skids
- Electrical rooms, modular casework, and prefabricated drywall and acoustical shapes
Schedule Reduction
By leveraging prefabrication and tools like Last Planner System®, the project team reduced the construction schedule by 10%, enabling faster delivery and minimizing disruption at the active healthcare facility. What reinforced this was creating prefab specific LPS® milestones which provided the detailed sequence required to ensure prefab and trades were scheduled to promote the optimal flow.
Cost Savings
The streamlined Lean approach resulted in a 10% reduction in overall project costs, demonstrating the financial advantages of how cluster groups, big rooms, quality pauses, and co-location impact a project’s ability to streamline collaborative processes. The entire team was involved in SDs and performed a design evaluation for constructability and efficiency.
An early recommendation which resulted in a $3.7M savings was integrating the remote CEP into the tower. In addition to being a cost savings, this resulted in a better solution for the campus overall. The decision minimized operational impact during construction and provided the campus more flexibility for future expansion.
Sustainability
The tower expansion is the first LEED v4 for Healthcare Gold certified project in the United States. This was achieved by implementing practical and measurable strategies and solutions in areas including sustainable site development, water savings, energy efficiency, materials selection, and indoor environmental quality.
“The lessons learned from Plano became our benchmark for project collaboration and prefab program expansion,” said Aye. “At the time of this project, the prefab components incorporated were pushing industry boundaries. Six years later, these elements are routinely incorporated into our projects. Collaborative metrics collection platforms were created from the spreadsheets the team used for data tracking.”
LCI corporate members can learn more about this project by viewing the 2019 Congress presentation Medical City Plano Tower –A Lean Story on Maximizing Prefabrication.
The Challenges of Lean Implementation at HCA Healthcare
Despite its successes, implementing Lean at HCA Healthcare comes with distinct challenges. “As we grow larger, driving Lean becomes increasingly complex,” Aye explains.
One of the most significant hurdles is gaining buy-in from stakeholders. Aye emphasizes the importance of understanding the diverse priorities and concerns of those affected by Lean initiatives. “It’s about understanding what’s important to the people impacted and tailoring your solutions and messaging to resonate with them. Their ‘why’ might be different from someone else’s,” she says. “Listening actively to these concerns is key to building trust and alignment.”
Aye also highlights the role of data in overcoming resistance. “Bringing data to the table is critical. It helps validate the need for change and shows programmatic patterns that can unite the team around a shared understanding of the problem.” Data can bridge the gap between differing perspectives, providing an objective basis for decision-making and fostering collaboration.
Another challenge lies in navigating the differing objectives of various project teams. “Design and construction teams often have competing priorities,” she notes. “While designers focus on creating spaces that are aesthetically pleasing and functional for workflows, construction teams prioritize on-time, on-budget delivery. Aligning these objectives requires clear communication and a shared vision for project success. Design and Construction managers play a big role in melding these opposing viewpoints to ensure we’re creating environments that make a positive impact in patient care delivered in the most effective and efficient way.”
Despite these obstacles, Aye believes that the rewards of Lean far outweigh the challenges. By fostering a culture of collaboration and efficiency, HCA Healthcare has made significant strides in improving project outcomes and driving innovation across its healthcare facilities.
Advice for Organizations New to Lean
For organizations new to Lean, Aye advises to start small. “Don’t be afraid to get started, even if it’s just tackling the low-hanging fruit,” she says. Tackling smaller projects allows teams to focus on areas within their control, creating opportunities for quick wins that demonstrate the value of Lean principles to stakeholders.
Drawing from her experience mentoring colleagues pursuing their Green Belt certification, Aye encourages setting realistic goals, especially for those new to process improvement. “Often, people want to aim really high, but the key is to think smaller and identify initiatives that can be completed in a manageable timeframe, such as three to six months.” Achieving these initial successes builds momentum and generates buy-in from stakeholders who may initially be skeptical.
Additionally, Aye emphasizes the importance of understanding the concerns of those impacted by changes. “Listening is critical,” she explains. “You need to collect input, address specific pain points, and tailor solutions that resonate with your audience.” Bringing undisputable data to the table also helps to break down resistance. “When you can show programmatic patterns backed by data, it unites the team around a shared understanding of the problem and builds trust in the solution.”