From a climate change perspective, the governance of natural common-pool resources—the commons—is a key point in the challenge of transitioning to sustainability. This paper presents the main strategic advances of the São Paulo Urban Living Laboratory (ULL) regarding Food, Energy and Water (FEW Nexus) analysis and modelling at the border of a high biodiverse forest in a peri-urban region in southeast Brazil. It is a replicable and scalable method concerning FEW governance. The FEW Nexus is an analytical guide to actions that will enable a colossal set of innovative processes that the transition to sustainability presupposes. Sustainable governance of the FEW dimensions, seen as an innovation-based process, is approached by a decision making tool to understand the past and future dynamics of the system. The governance framework is based on a multi-criteria and multi-attribute set of sustainability-relevant factors used as indicators to model complex system dynamics (SD) and the stakeholders’ future expectations through a Delphi approach. Based on the three main dimensions of the Ecosystem Services Approach—Physical and Material Conditions, Attributes of Communities, and Rules-in-Use—the tool comprises thirteen specific sustainability indicators such as water and carbon footprints, land use social development, payment for ecosystem services, and land use gain indices. Its development was designed to generate a long-term network of socioenvironmental stakeholders’ decision making processes and collective learning about a higher level of sustainable systems. System Dynamics modelling demonstrates the associations between sustainability indicators and the impacts of payment for ecosystem services on the land use social development index, or on the trophic state index. The Delphi foresight approach, using the Promethee-Gaia method, allows us to understand the positions of multiple agents regarding the transition process. In this context, decision making tools can be very useful and effective in answering the “how to” questions of ULLs and paving the way for transition, providing collective planning and decision support frameworks for sustainability transition management.

The purpose of this paper is to applied systematically Lean Healthcare to improve mobility accessibility in the medical clinic ward of a medium-sized hospital.