The challenges facing health care today are significant in developed and developing nations worldwide. Responding to the need for appropriately planned and executed health care facilities with innovation, sustainability and recognition of human needs requires a unique understanding of the means about which to address fundamental elements of decision making and management as distinct from planning and drawing production.

This project for the last independent hospital in San Francisco, California, USA is a highly regarded example of a replacement facility within extremely tight spatial constraints. The methodology for executing the planning, design and construction is both termed Lean and an Integrated Project Delivery System.

This paper will provide a overview of the historic circumstances which brought about the need for the hospital and its development over the years. After many attempts to build a new facility the current effort is successful because of the process by which the design team and the contractors have engaged the problem.

This methodology encompasses traditional services such as programming and planning, architectural and engineering design and construction but integrates elements such as Process Mapping, Gaming, BIM, Last Planner, Pull Scheduling and other attributes of LEAN.

In addition the process has led to an operational and facility solution which (at the time of this writing) is two points short of Gold in the USGBC LEED system of measurement.

This paper will discuss the positive points of this process and the expectations which were not met. The positive lessons learned and the disappointments.

The processes used to develop and integrated approach covered the entire breath of the project from inception through integrated detailing and modeling by teacnical teams working together to develop a systems approach to a unique problem.

The project is a demonstration project for the California State agency OSHPD.

If permitted the presentation will include members of the hospital representatives and OSHPD. They will provide their perspective of the processes used, the challenges including the sometimes sharp differences in work culture.

While the presentation is the story of one $160 million facility it is one which explores methodologies which are transferable and scalable. The final plans are also a demonstration of clinical solutions coupled with highly efficient small spaces developed through process mapping and consideration of staffing, patient satisfaction, and staff satisfaction.