Interactions between transformations: Flow and value at the design front-end for primary healthcare facilities

Design has been conceived from an operations management perspective as a process of converting inputs into outputs, as a flow of information, and as a process of generating value to customers. The integration, alignment and balance of the management needs arising from these three views has been hypothesised as essential to successful design outcomes, and it is an area in need for further research (Ballard and Koskela 1998). Such integration is challenging at the design front end, where uncertainty and poor information availability are common place. The aim of this paper is to examine the design front-end in four primary healthcare projects based on lean principles. A research hypothesis focused on better understanding the interactions between the conversion, flow and value generation aspects of the process has been developed and tested. Data has been collected through 22 semi structured interviews with diverse stakeholders involved with the projects. The 'as-is' design front end was mapped out and examined accordingly to good practices described in the literature. The paper identifies the influences of the procurement method used over lean design management, and the influences of design management and role definition over requirements capture and value generation. Finally, causal relationships between issues related to the transformation, flow and value views are discussed.