

Katherine Reyes, Senior Vice President of Ambulatory Services at University Health in San Antonio, Texas, has almost two decades of transforming healthcare organizations through establishing a Lean management system. Lean is a process-improvement approach that seeks to eliminate waste and drive customer value at every level of the organization. For her, it’s more than an operational framework. It’s a culture.
In a tag-team interview, Katherine and Muhsin Lihony, LPA’s Director of Healthcare, share insights into how Lean operational principles inform design thinking by fostering a culture of shared ownership to create a powerful framework for improving healthcare environments and outcomes.
Katherine Reyes: Design is meaningless if it doesn’t prioritize the patient and the people delivering their care. It’s not about aesthetics alone; it’s about flow, functionality and the experience of patients and care teams. When design focuses on making the care delivery process easier for staff and better for patients, it creates a powerful impact.
For example, in Lean, waiting is considered waste. In some of the best medical office buildings I’ve worked on, we’ve reduced waiting room footprints by improving patient flow. This resulted in patients spending less time waiting and enabled providers to focus more on delivering care. You also think about things like the distance a patient with mobility challenges needs to travel or how easily staff can access supplies. These details matter — they make a building not just pretty, but functional.
Muhsin Lihony: Lean design begins with understanding operations. How does a healthcare facility function? What processes take place every day? Traditionally, design drives operations, but I believe it should be the other way around. Operations should inform design. Our role as designers is to partner with the people who work and receive care in these spaces, understand their needs and expectations, and create environments that support their processes and make their work more efficient.
Take the time to observe, listen and learn directly from your patients and staff. That’s how you uncover the real issues and opportunities for improvement." – Katherine Reyes, SVP of Outpatient Services, University Health
KR: One of Lean’s core principles is reducing waste. That applies to everything from eliminating unnecessary movement for staff to minimizing inventory storage. For example, we’ve designed buildings where vendors can deliver supplies quickly and efficiently without disrupting the flow of the space or clogging the parking lot. Another core principle is to show respect to people, and we do so by involving those who directly interact with the patients in the design process.
It’s also about aligning space with operational goals. If you design with a target — say, reducing patient wait times by 50% or increasing provider time with patients by 30% — your spaces start to support those outcomes. That could mean rethinking exam room locations or reducing non-value-added spaces like oversized waiting rooms.
ML: Lean design goes beyond aesthetics to remove inefficiencies like overproduction and overprocessing. For example, reducing motion isn’t just about efficiency — it prevents injuries and saves time for everyone in the building, from providers to patients and families.
KR: It’s about empathy, too. I’ll never forget a man who regularly sat in our oncology waiting room even after his wife had passed away. He said the reception team had become like family, supporting him through a tough time. That experience reminded me how critical it is to design spaces that foster human connection. While we often have to design reception areas with enough distance to ensure privacy, too much distance between the patients and front desk may result in reducing the important connection between reception and patient.
KR: Stakeholder buy-in is critical. One example is rethinking physician office placement. Traditionally, provider offices are built around the building’s perimeter so providers can have windows. But we moved care teams closer to the entry to make it easier for mobility-impaired patients to access services. Convincing providers to give up their window offices wasn’t easy, but we used data to demonstrate the impact.
We showed how far patients in wheelchairs or walkers had to travel to exam rooms, and how many steps staff took to escort patients back and forth. Once the care teams saw the data and experienced the difference, they became the biggest advocates for the new design. The key was involving them early and making the “why” clear — it wasn’t just a top-down directive; it became their solution.
ML: Training and education play a big role in making Lean stick. When team members understand the purpose behind the changes and are involved from the beginning, they feel a sense of ownership. LEAN becomes second nature because they’ve lived it throughout the process.
KR: You can’t learn Lean from books or YouTube. You have to experience it. Take the time to observe, listen and learn directly from your patients and staff. That’s how you uncover the real issues and opportunities for improvement.