Applying Lean Principles to a Hospital Emergency Department

Applying Lean Principles to a Hospital Emergency Department

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  • On January 30, 2015
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Applying Lean Principles to a Hospital Emergency Department


When it first was popularized, I think many people felt that Lean was the newest management fad. For me, the realization that Lean was here to say was when service-based industries started incorporating the mindset into the business. One industry in particular, healthcare, has embraced Lean principles throughout the organization.


My first opportunity to apply Lean principles in a healthcare setting was in the University of Michigan Emergency Department (ED). The charge doctor initiated the project because wait times in the department were increasing even though patient volume was not. My team was tasked with improving patient throughput in the department.


As I would recommend in any Lean project, the first step was to perform research. We studied time logs, patient volumes, complexity of cases, doctor staffing, nurse staffing, support staffing, experience of medical personnel, and a variety of other factors. This most certainly included talking to the professionals that worked in the department.


Though Kanban and one-piece flow are perhaps most commonly thought of in relation to Lean, there is another very powerful tool: visual management. The idea behind visual management is that a lay person should be able to walk into the work area and be able to tell the flow of work and how well the team is doing. This was sorely lacking in the ED. In this particular ED, there were two resources deemed the most valuable: rooms/beds and doctors. Our team chose to focus on the availability of doctors.


In a stark contrast to the high-tech equipment in the ED, our team implemented a simple whiteboard that the doctors would use to track patient load. The goal was to make visible how many patients each of the doctors had treated up to that point in the shift. The results were interesting.


First, the doctors gave many reasons why the board would not work. We eliminated as many as possible but could not eliminate all of them. To overcome the objections, we simply asked for their patience while we performed a trial run.


After the trial was in progress, we noticed that the doctors that saw fewer patients complained more loudly than the doctors that saw more patients. Some of those doctors stopped updating the board altogether. The doctors that saw the most patients thanked us profusely for allowing others to see that they were carrying more than their fair share.


In the end, the charge doctor agreed with most of our proposals and commissioned the project. Even though we argued strongly to continue the use of the low-tech whiteboard, the committee chose to develop custom software instead. It came down to a difference in philosophy. My philosophy was and continues to be that a higher technology solution should only be implemented when low tech does not work.


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