Case Study: Use of Lean Practices in the Emergency Department

With the practice of Lean methodology in healthcare emerging across the industry, the question was raised about the value of the methodology as applied to Emergency Departments (ED) of hospitals.

A recent Institute of Medicine Report on Emergency Medicine warns of a looming crisis in emergency care in the United States. Even though there is a variety of factors affecting emergency departments, it is recognized that internal organization and processes in the emergency departments are a prime source of the issues experienced.

In this case study, the team sought to describe how Lean was used as a tool for eliminating waste (fight crowding) and adding value (improve care quality) in four self-selected EDs with different culture of care and patient demographics. Secondly, it sought to pinpoint some of the local factors leading to either identifiable process improvement when Lean is adopted as the single quality improvement tool, or Lean’s failure to produce such improvement.

The study looked at emergency departments (EDs) from two teaching and two community hospitals, who agreed to share their experience and data for this participant observation study. The team used this approach because Lean implementation occurs in the real world and is contingent on people who interact in a manner that cannot be isolated and controlled. Each of the four EDs adopted Lean independently in its own way. In each of them, a team coordinator took field notes and informally assessed the team members and leadership interactions over time. All were using similar metrics to routinely measure performance, and this allowed a comparative description of the links between Lean implementation and outcomes. In all four settings, there were no other improvement initiatives overlapping in time with Lean.

Results of the study showed three of four hospitals had process and patient satisfaction improvements despite higher ED volumes one year after initial implementation. Qualitative analysis suggests that leadership and ED provider “buy-in” were keys in the successful sites.

Get more details from the complete study here.