Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction
A multidisciplinary team led by nursing leadership and physiciansdevelopedaplantomeetincreasingdemand and improve the patient experience in the ED without expanding the department’s current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.
The development of the Patient Protection and AffordableCareAct1 has placed increased pressure on healthcareproviderstoreducewasteandincreaseefficiency while maintaining and improving the quality of care. With finite operational resources, healthcare organizations are applying waste reduction principles, and in particular Lean methodologies, to address this issue. LeanmanagementprinciplesarederivedfromtheToyota Production System (TPS)2 and focus on maximizing efficiency. In the TPS model, efficiency is maximized
when tasks are completed with the least amount of resources or in the least number of processes, while maintaining the quality of the product being developed. As a system, the goal of TPS is to continually seek ways to improve. For these reasons, Lean has been adapted for use in healthcare settings in the United States and abroad.3,4
Background
In 2011, our organization was straining from year-toyear growth volumes in the emergency department (ED)ofbetween6%and10%andhigher-acuitycase mixes. The ED was experiencing overcrowding, and as a result, patient satisfaction scores were declining. A taskforce was developed, and in response to these findings,amult idisciplinaryteamimplementedprinciples fromourStanfordOperatingSystem(SOS)(Figure 1), our model integrating Lean management into daily hospital operations. Use of Lean method ologies is increasing in health care , yet few studies have explored in detail the concept sbehind Leanand their impact on clinical care.The following reports the outcomes related to the implementation of the SOS in the ED and the 2-year outcomes reported on throughput metrics and patient satisfaction. We believe this will serve as a useful model for other healthcare organizations addressing ED crowding or seeking to adapt Lean principles in their organization.
Methods
To understand the issues contributing to crowding intheED,anassessmentandplanningphaseconsisting