This paper describes collaboration efforts of a project team that implemented lean concepts in the course of structural system selection during the design phase of a hospital project. Out-of-the-box thinking, contractual incentives for team work, early collaboration, and a set-based design approach led to the development of an innovative and cost-effective structural system that may set precedent for other medical facilities to be constructed in seismically active zones. The structural design team on this project rigorously explored the design space and tested design alternatives against project value propositions. When pushed by the owner to think more broadly, the structural engineer proposed using a new technology, namely viscous damping walls. This concept was developed in Japan but has not yet been tried on projects in the United States. Because it is a first, this solution requires not only rigorous analysis and testing by the structural engineer but also detailed investigation by the state's regulatory agency that issues building permits. This paper describes the team's efforts at defining the design space and the set-based design approach they used. A key lesson from this case study is that teams have a lot to learn about how to make requests and commitments while pursuing set-based design to be lean.