Lean, Green
Caring Machine

Using Lean design principles and Lean construction methods, the Miami Valley Hospital (MVH) Heart and Orthopedic Center challenged the assumption that there must be a trade-off between time, cost and quality.

Miami Valley, Dayton’s busiest cardiac center, struggled to deliver advanced care in three 1970s-era facilities. In seeking to add a new 178-bed tower, the hospital’s owners, Premier Health Partners, were eager to integrate state-of-the-art practices into the daily operations, while at the same time managing construction costs and minimizing waste. This project represented an opportunity to rethink patient floor design and flows, pursue a collaborative prefabrication strategy and green the campus.

The $137-million facility was the first major healthcare project in the U.S. to use prefabricated components — as much as 35% of the project — assembled off-site in a field-built structure. Prefabrication yielded higher-quality construction, zero worker injuries, and a construction schedule reduced by more than two months.

Miami Valley Hospital Heart and Orthopedic Center
Increasing Efficiency with Prefabrication
Increasing Efficiency with Prefabrication
Increasing Efficiency with Prefabrication
Increasing Efficiency with Prefabrication
Increasing Efficiency with Prefabrication
Increasing Efficiency with Prefabrication
Increasing Efficiency with Prefabrication

Floor Plan

The patient floor departs from the traditional “racetrack” design of most hospitals, where patient rooms surround a central service core. Instead, 16-foot-wide hallways, patient rooms on both sides, corporate-inspired workstations and staged supply locations turn the entire corridor into a caregiver work space.

Room Layouts

Miami Valley Hospital presented an opportunity to rethink patient floor design and flows. The room layout may be unconventional, but it achieves greater flexibility, safety, and staff and patient comfort.

The toilet room typically impedes staff sightlines or outdoor views. The MVH patient room, however, has excellent visibility, and the bed is angled to the windows for optimal connection to daylight.
The MVH room geometry maximizes the wingspan of the work zone around the patient’s head and chest, compared to a more conventional layout.
In a traditional patient room, a patient must cross the room to access the toilet. The MVH room geometry minimizes travel distance from the bed to the toilet and provides a handrail for support.
Caregiver stations typically compromise either bed maneuverability or the workspace around the patient. Positioning the caregiver station by the entry maximizes both maneuverability and workspace.

Off the Shelf. On the Money.

To make way for the new tower, two centrally located buildings had to be demolished first, but patients and staff still needed to travel building buildings on opposite sides of the site. This required a temporary pedestrian bridge, but after running the numbers, the hospital would have to pay $2.1 million, and take six months, to build the bridge — only to demolish it when the project reached completion.

Then our design/build team hit on a simple, innovative solution from far outside the healthcare industry. Why not purchase an off-the-shelf, temporary jetway pedestrian bridge designed for airports instead? The price tag? A much more modest $980,000. What’s more, the bridge took only three days to install and didn’t interfere with the hospital’s operations. In the end, the idea saved $1.2 million.

Video: The Temporary Bridge

Green Design

The Heart and Orthopedic Tower meets the stringent energy requirements set by the 2030 Challenge, which outlines a path to carbon-neutral buildings by 2030. With 54% better energy performance than similar regional hospitals — and a 14% improvement over LEED standards — the project is expected to save Miami Valley Hospital $182,000 each year in energy costs, and to reduce carbon dioxide emissions by 2,743 metric tons annually.

“ This building has become a wonderful physician recruitment tool for us. Cardiologists are coming to us because of the new building. ”

Mary Boosalis President/CEO, Miami Valley Hospital

Awards and Publications


Healthcare Design, Citation of Merit
Modern Healthcare, Award of Excellence
AIA Ohio, Merit Award
AIA Columbus, Merit Award
Bentley Innovation in Building Award


Metropolis, “Building Blocks: The Miami Valley Hospital uses a construction strategy to stay nimble,” December 14, 2012
Healthcare Design, “Citation of Merit Winner: Miami Valley Heart and Orthopedic Center,” September 20, 2012
Modern Healthcare, “Award of Excellence: Miami Valley Hospital Heart and Orthopedic Centers, Dayton, Ohio,” September 26, 2011
Building Design + Construction, “Prefab Trailblazer,” October 2010
Engineering News-Record, “Racking Up Big Points For Prefab,” September 8, 2010
Modern Healthcare, “Prefab construction praised as time-saver,” March 23, 2010
ArchitectureWeek, “Hospital Renewal in Dayton,” July 7, 2010
Healthcare Design, “How BIM advances cost-saving planning and prefabrication,” May 1, 2009