Lean Training and Analysis to Improve an Under-Performing Emergency Department

Lean Training and Analysis to Improve an Under-Performing Emergency Department

The Challenge

A major southeastern metropolitan hospital sought to apply lean thinking and process improvement to identify and address hospital-wide operational issues. Boulder Associates—working as consultants to Business Improvement Group (BIG)—was part of the team challenged to change the experience for everyone. One that would implement standardized, streamlined processes that would improve the full patient experience and create a better work environment.

During an early week-long assessment phase, the team conducted a full review that identified best practices and opportunities for improvements in areas that included the emergency department, surgery, inpatient floors, lab, staffing, and deep data analysis. Based on this, hospital leadership proritized the ED for improvement. Operational and clinical staff were eager to support improvements to address the following:

  • Over-extended patient wait times
  • Length of discharged and inpatient stay
  • Slow turnaround times for patient admission and discharge
  • Duplication of work processes
  • Overwhelmed staff leading to blame, indifference, and employee turnover


The Process

During this next week-long phase, the hospital staff involved were trained and educated on lean practices, allowing them to gain a clear view of issues and expectations.  Through this lean training, the team was able to identify waste and think about the different processes of how an ED could run, rather than focusing solely on their clinical work. At the same time, simulations which re-created the current ED workflow in a virtual environment was developed.

The BA team, together with various roles from within the ED, followed working staff and patients in the ED to collect data and identify waste. This data was studied and used to create a current state value stream map that displayed how people flowed through their existing roles.

After creating this current state map, the following were revealed as the core of the problems in the ED:

  • Length of stay (LOS)
  • Wait time at various stations throughout the patient journey
  • Lack of a standardized workflow

Using the current state baseline, the team developed an ideal state lean care track process and a standardized workflow. They then began running trials in the simulation model based upon the ideal future state map.

12 different trials were implemented and run in the ED by following the “Plan, Do, Check, Act” Cycle. Through these trials, they tested multiple variables, collected data, and continually revised their processes until they were workable and efficient for the future state.

The Results

Over a 13-week period, the Lean Track Process was initially implemented during a short time frame during the week in the ED, then widened to include weekend hours, and finally expanded to peak hours ranging from 9:30 a.m. to 6:30 p.m. During this period, leadership and staff monitored daily progress, collected feedback, and continued to make improvements.

As a result, the average length of stay reduced from 240 minutes to 157 minutes, with a low of 84. Additionally, the average number of patients who left without being seen reduced from 5 to 2.5 per day. The ED team involved in the project have gained a better understanding of process engineering and how to evaluate their workflows—overcoming a big gap in the healthcare environment. They continue to run the lean track, further experimenting and evolving.


“Boulder Associates didn’t just come in and tell us what to do – they helped us understand the approach and taught us what we needed to identfy and reduce waste.”