Efficiency Revolution

Seattle Children’s and NBBJ’s shared commitment to continuous performance improvement and integrated delivery shaved three months, 30,000 square feet and $30 million off its new Bellevue clinic, proving the theory that the highest quality care is also the most cost effective.

To lessen patient load at its core hospital, Seattle Children’s embarked on a plan to offer ambulatory surgical care at a series of regional centers, of which Bellevue is the first. Using Continuous Performance Improvement (CPI) and Integrated Project Delivery (IPD) methods allowed the client, design and construction teams to program more service in less space and build it more effectively.

Continuous Process Improvement

CPI takes a holistic look at the “flows of healthcare” with the goal of identifying the safest, most efficient and family-friendly experience. By evaluating these flows early in the process, the design team selected smarter solutions and integrated them faster and cheaper than a traditional hospital project of this kind.

Before CPI: All healthcare flows would traditionally move through the same door into an exam room that is positioned around a staff work area. This results in congestion and compromises the optimal experience of staff, patients and families.

After CPI The circulation flow has been optimized. Patients and families have their own circulation and by giving staff a secondary entrance to the exam room, their immediate environment can store equipment and supplies closer to the point of use within a secluded “teaming area.”

“ The clinic team room design has had a major impact on my clinic flow. I no longer run an hour behind – I have everything I need, and all my staff are right at hand. ”

Orthopedic Surgeon

One Piece Flow

The project team gave a lot of thought to the experience of taking a child into surgery. The “one piece flow” design concept creates a parent journey focused on easing the mind through use of daylight and calming views and by allowing parents to stay with their child for as long as possible, including the administering of anesthesia.

One of the most significant outcomes of CPI was the decision to connect induction rooms to the operating room. The idea, which was developed during prototype testing, gives peace of mind to parents who can accompany their child until the time of surgery.

Video: Walk & Talk Post-Occupancy Tour

Awards and Publications


AIA Academy of Architecture for Health, Healthcare Design Award
AIA BIM Award, Delivery Process Innovation
AIA Seattle, Merit Award
IIDA, Northern Pacific Chapter, InAward Design in Healthcare
Interior Design magazine, Best of the Year, Healthcare


GreenSource, “Health Care Goes Lean and Green,” March 2012
Contract magazine, “Beautifully Lean,” October 2011
The New York Times, “Factory Efficiency Comes to the Hospital,” July 9 2010
Structural Engineering & Design, “Benefits of Reinventing the Wheel” February 2010