Learning from the cathedral hill hospital project during the design and preconstruction phases

This article explores opportunities and limitations of implementing and experimenting with Lean Product Development ideas and practices in the design and engineering of a complex hospital project. In this environment, new forms of contracts have given rise to new forms of organizing teams to deliver capital projects in which architects, engineers, and contractors are co-located to promote collaboration and deliver projects with a strong focus on clients' needs. The Cathedral Hill Hospital (CHH) project is a 1.2 million square feet urban replacement hospital in San Francisco, California. It is not just designed to be a state-of-the-art hospital but also to break new grounds in multiple areas of design, construction and operations. Since the beginning of project validation in 2007, the Integrated Project Delivery Team has been applying and testing Lean ideas, concepts, tools and processes to develop this very complex project. The article's nurturing proposition is that CHH has implemented most principles related to the Lean product development system at Toyota, and that these principles are the foundation for the evolving operational system that supports its processes on a daily basis. The article contributes to the literature by providing an account of how different processes worked in a co-located environment.