The discipline of Facility Management (FM) emerged in the 1970s triggered by the concomitance of (1) increasing complexity in the workplace and (2) understanding of an interdependence between users' behaviors and building design. Despite the existence of FM, a number of buildings today still fail to deliver value during the occupation phase. Although various causes contribute to such failures, this paper focuses on the lack of strategic involvement of Facilities Managers (FMs) in design. It uses the University of California, San Francisco (UCSF) as a case study to describe how an organization has-in the course of its Lean journey-learned the importance, not only of considering FM requirements during design, but more importantly of actively engaging FMs early in the design process. Benefits experienced by UCSF are multiple. One is that FMs understand, perhaps better than designers, the complexity of the programs housed by UCSF buildings and the constraints this complexity imposes on the design requirements. This helps FMs advise on trade-offs between their preferences for simple (e.g., easy-to-maintain) systems and the programs' needs for complex systems.