• Led and coordinated by the North East Transformation System team, hosted by Gateshead Health NHS Foundation Trust.
  • Pilot sites from across NHS North East in acute, mental health and primary care settings.
  • Collaborative design intervention that has helped NHS trusts to reduce waste and improve processes by redesigning space more effectively.
  • Brought together estates staff, clinicians and quality improvement staff to design and test a Lean facilities design intervention. 


Lean is a philosophy that aims to reduce waste and improve processes. Processes, however, can be constrained by the space they operate in. Redesigning space offers unique opportunities for step change improvements using Lean thinking.

Despite cuts in NHS capital budgets of around £4 billion a year, a significant proportion is still spent on improvements to premises or development of new premises. Although guidance is available to support estates projects, this does not incorporate information on how to design in Lean concepts and flow.

This project by the North East Transformation System team has helped NHS trusts to reduce waste and improve processes by redesigning space more effectively, and subsequently improve patient experience, safety and effectiveness of care.

Estates and quality improvement corporate functions were brought together with clinicians to design and test a Lean facilities design intervention that could be applied to new or refurbished spaces/premises.

The project involved two local NHS foundation trusts in three facilities design interventions.  The designs that have been developed will significantly increase the levels of safety, privacy and dignity for patients, and minimise the opportunities for infection control risks through innovative separation of clean/used supply routes being physically built into designs.

In order to measure and verify the outcomes of the interventions, the facilities designs created would have to be built, which can be a lengthy process in the NHS. To overcome this, the team encouraged staff to make extensive use of simulation using scale and full-scale models of their designs.

Contact details

For further information about the project, please email Iain Smith, Head of the North East Transformation System at Gateshead Health NHS Foundation Trust.

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