Applying Lean to Hospital Emergency Rooms

Applying Lean to Hospital Emergency Rooms blog header
Applying Lean to Hospital Emergency Rooms blog header
Applying Lean to Hospital Emergency Rooms blog header

Applying Lean to Hospital Emergency Rooms

Lean transformation is an approach whose core idea is to maximize customer value in the production of goods and the delivery of services. Those working in the automotive, manufacturing, or processing industries are likely familiar with the principles of lean transformation. Professionals in other industries are also noticing the benefits of lean, especially those in the healthcare industry. Kettering University Online Master of Science in Lean Manufacturing is the only program of its kind in the United States and offers a certificate in healthcare management.


Enhancing Patient Flow and Eliminating Waste


Consider this scenario:

You are in a great deal of abdominal pain, and your friend takes you to the closest emergency room. You spend 90 minutes waiting to be triaged. Then, another 30 minutes waiting to be called into an exam room. Once in the exam room, it is likely that you will even more time for the doctor. He or she might order tests after your examination. Then you have to wait for those results.. Finally, you wait to be discharged. It is not an exaggeration to say that someone going to the emergency department can spend four, five, or even six hours waiting.


A team of researchers in Melbourne, Australia authored a study in which they investigated the application of Lean Six Sigma principles in healthcare. They focused their research on a large hospital and wanted to see if implementing the tools of Lean Six Sigma could reduce the amount of time it was taking to assess and stabilize patients in the emergency department (News Medical Life Sciences, 2015).


“The project found that introducing Lean Six Sigma in hospitals was more challenging than in manufacturing, but it can help to improve patient flow from the emergency department to hospital beds. Implementation also allowed the hospital studied to open more beds as well as install new software for monitoring bed availability. At the ward level, opening more rehabilitation beds, which improved the discharge process, enhanced patient flow” (News Medical Life Sciences, 2015 para. 9).


One of the main goals of lean transformation is the elimination of waste. The first steps in making hospital emergency departments lean are to identify and eliminate the seven sources of waste. Since lean is most associated with manufacturing, the following table lists types of waste and an example of it within the context of an emergency department:


Type of Waste

Emergency Department Example

1. Overproduction

Unnecessary patient tests, peak staffing during non-peak hours, ordering unnecessary medication

2.  Waiting

Patients waiting for triage, nurses waiting for test results, patients waiting to be discharged


Moving patients and equipment from department to department, medication being moved from the lab to the ER, supplies being relocated

4. Over processing

Redundant paperwork, unnecessary surgical intervention

5. Inventory

Expired medicine, overstocked consumables, excess bedside equipment

6. Motion

Workflow is not smooth, equipment is inconveniently located, lab is far from where it’s most needed

7. Defects

Incorrect coding, administration of wrong medication, misdiagnosis


Deanna Chase, RN, BSN has been an emergency department nurse for nine years. In that time, she has seen many examples of waste. She recalls when triage nurses would waste time trying to locate something as simple as a thermometer. “Somehow they were never where they should be. So, either the patient waited while the triage nurse went to find one or the paperwork would go through with that particular vital sign missing.”


The emergency department she spoke of recently went through some transitions, and now there is a thermometer secured to the wall in every exam room. This is one small example of how implementing lean principles can reduce the waste of motion and the waste of time.

The pace in an emergency department can be still, harried, or evenly spread out. The E

D staff can be frenzied, competent and steady, or unmotivated. Often, when addressing these issues, changes in procedures and protocol are often made hastily, without careful thought toward the long-term sustainability of those quickly made decisions. Investing the time it takes to learn the philosophy of lean and thoughtfully introducing the tools and techniques to the employees can contribute to sustainable changes such as a decrease in patient waiting times.


Lean Management in Healthcare


Leaders in healthcare often implement lean manufacturing processes but forget that success can depend on making sure employees are well suited to the tasks they are assigned.


“In order for lean principles to take root, leaders must first work to create an organizational culture that is receptive to lean thinking. The commitment to lean must start at the very top of the organization, and all staff should be involved in helping to redesign processes to improve flow and reduce waste. Although health care differs in many ways from manufacturing, there are also surprising similarities: Whether building a car or providing health care for a patient, workers must rely on multiple, complex processes to accomplish their tasks and provide value to the customer or patient” (Going Lean in Healthcare 2005).


Healthcare organizations can have lean principles, practices, and processes securely in place, but if the right employees are not implementing those processes, the organization’s lean transformation initiative, and ultimate success, may be jeopardized. For example, if you have a machine that runs perfectly but the person running the machine is not skilled in that particular area, mistakes are likely to occur which can slow down, or in some cases, completely stop a process.


Successful organizations understand that they have to adapt to the internal and external environments in which they operate. Finding new ways to streamline work, and implement changes that support organizational optimization, are going to be the things that differentiate great healthcare organizations from failing healthcare organizations.


A master's degree in Lean Management from Kettering University provides you with the tools, techniques, and strategies necessary to leverage both processes and people so that you can play a direct role in helping your organization improve patient outcomes and reach its strategic goals.


Going Lean in Health Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2005. (Available on


News Medical Life Sciences (2015, January 31). Study: Lean management and Six Sigma techniques could reduce wait times in emergency departments. Retrieved from


Personal Interview with Deanna Chase. November 25, 2017