Integrating lean thinking and spatial design for healthcare operational performance

Hospitals are increasingly adopting lean principles to improve workflow efficiency; however, their integration into spatial design remains limited in operational management research. This scoping review synthesizes evidence from healthcare operations, architectural planning, and systems engineering to examine how lean thinking can inform hospital layout decisions that enhance operational performance. The findings indicate that inefficient spatial configurations contribute to excessive staff travel, fragmented patient pathways, care-delivery bottlenecks, and overall process delays. Incorporating lean principles into spatial design by minimizing non-value-added movement, aligning processes with functional adjacencies, and creating flexible zones that can adjust to fluctuating demand can significantly strengthen patient flow and resource utilization. This review contributes to operations management theory by synthesizing evidence to underpin an integrated understanding of lean concepts and spatial design strategies, highlighting their potential to support operational resilience. The practical implications of this study include guidance for hospital administrators, facility planners, and designers seeking to translate lean principles into tangible layout improvements. The review also identifies gaps requiring future investigation, particularly empirical assessments of lean-based design interventions, patient-centered evaluations, and long-term performance outcomes. Overall, this study underscores the potential of lean-informed spatial design to advance efficient, adaptive, and patient-centered hospital operations. Critically, this review makes explicit how specific spatial features including functional adjacency planning, decentralized workstation placement, cellular zone layouts, and flexible multi-use spaces operationalize each of the core lean principles and directly link to specific operational outcomes such as reduced travel distances, minimized waiting times, improved throughput, and enhanced resource utilization.