To date, only 1 other study tracked throughput in an ED and patient satisfaction metrics. This was conducted at Hotel Dieu Grace Healthcare (HDGH) in Ontario, Canada,30 and was led by Lean consultant Dr John Long. The study focused only on Canadian Triage Acuity Scale levels 2 to 5 patients who were thought to not require admission to the hospital. A comparison of data is provided listing the results collected from the 2005 HDGH study in comparison to the SOS outcomes (Table 3). While both groups did not increase their ED footprint, we report a 7% increase in volume during the study period, while maintaining an increase in patient satisfaction scores and decreased overall wait time. This contrasts with the study by HDGH. We also provide a detailed description of Lean methodology used to obtain these results and introduce the concept of ADM in healthcare as part of our SOS. ADM is a key driver for the outcomes shown and are essential to ensuring these changes are being sustained.