Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department

Emergency Department, Hôtel-Dieu Grace Hospital, Windsor, Ontario.
Canadian Journal of Emergency Medicine (Impact Factor: 1.16). 01/2010; 12(1):50-7.
Source: PubMed


In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds.
In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project.
Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles.
Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

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    • "Naturally these are not the only methods used by organizations which are applying Lean tools and principles. Toyota itself uses Kaizen workshops that usually last a week, together with teams that work on long-term problem solving (Herrmann et al. 2008; Ng et al. 2010). These types of initiatives usually generate data and information, "
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    ABSTRACT: Some authors believed that Lean has to be strategically implemented just in a bottom-up way, involving production processes and trying to reduce waste in the so-called Gemba or shop-floor. However, since the 1990s many companies have implemented the Balanced Scorecard, integrating economic and financial strategies with strategies linked to operations management in general, to widen the satisfaction of their different stakeholders. In this way it can be affirmed that BSC is a well-consolidated system for deploying Lean strategies. However, BSC is not the only system that can be related to Lean deployment. Since the 1960s, a similar system has been put forward in Japan. The system is named Hoshin Kanri and it has been implemented by companies all around the world. This research wants to contribute to the debate concerning how to implement Lean Production from a strategic point of view. In this sense two different systems, Hoshin Kanri and Balanced Scorecard will be compared. The research is based on three manufacturing case studies investigating in particular how to combine the top-down and bottom-up approaches and the techniques used for the deployment and implementation. Interesting findings show a difference in terms of workers involvement and day-by-day performance measurement.
    Understanding the Lean Enterprise - Strategies, Methodologies, and Principles for a More Responsive Organization, Edited by Andrea Chiarini · Pauline Found · Nicholas Rich, 09/2015; Springer., ISBN: 978-3-319-19994-8
    • "e are the quick initiatives for reducing waste carried out by operative teams every day . Naturally these are not the only methods used by organizations which are applying Lean tools and principles . Toyota itself uses Kaizen workshops that usually last a week , together with teams that work on long - term problem solving ( Herrmann et al . 2008 ; Ng et al . 2010 ) . These types of initiatives usually generate data and information , which are then summarized on a particular sheet called A3 . A3 sheet or A3 problem report is usually employed for better managing Kaizen workshops . Table 3 illustrates an example of this . The A3 size was also useful in the past , before the computer era , because i"
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    ABSTRACT: Objectives. The main purpose of this paper is to investigate whether or not strategies such as Total Quality Management (TQM), Lean Six Sigma and Corporate Social Responsibility (CSR) are in some ways implemented in artistic and cultural organisations. Indeed, it is well-known how they are already implemented in the manufacturing industry. Specifically, this research wants to bring to light what other scholars until now have inquired and demonstrated in terms of limitations and benefits, opening in this ways new and interesting directions for further research Methodology. Methodology is entirely based on a literature view of selected papers from different databases. Through a first literature review the most important methodologies related to TQM, Lean Six Sigma and CSR have been founded. Through a second literature review, the research then has demonstrated whether or not TQM, Lean Six Sigma and CSR strategies are implemented in artistic and cultural organisations and in particular how the methodologies of the strategies are taken into account and implemented Findings. Interesting findings show how TQM and in particular ISO 9001 have been discussed from several authors. While there is a lack in the literature about Lean Six Sigma, standards linked to CSR and artistic and cultural organisations Research limits. The research is only based on a literature review Practical implications. The research proposes new directions for research which can affect also practitioners. In particular the application of Lean Six Sigma and the standards linked to CSR in the artistic and cultural industry Originality of the study. For the first time the possibility of implementing strategies such as Lean and Six Sigma in the artistic and cultural industry has been investigated
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    • "With respect to healthcare domains, a common problem is long waiting time [13], while inpatient service and outpatient clinic are experiencing the issue of long LOS [27], patient "
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    ABSTRACT: The quality of healthcare services has been negatively affected by long waiting times in hospitals. Additionally, surging patient care demand, caused by a growing and aging population, results in pressures of high cost and increased capacity requirements in healthcare services. With limited resources and increasing demand, healthcare institutions are exploring approaches to do more with less. Lean is one such technique, aiming at creating continuous flow by eliminating waste while maximizing customer value. Although healthcare practitioners have been proposing different lean implementation solutions for healthcare services in different types of clinics, the applications are fragmented and cannot be generalized in all healthcare settings. In this paper, three systematic lean frameworks are defined based on various healthcare features and traditional lean systems, specifically replenishment pull and sequential pull systems. Three healthcare domains, the emergency department, outpatient clinic and inpatient serviceunit, are studied to help develop these frameworks. The purpose of proposed frameworks is to provide a guideline to transform traditional healthcare systems into lean systems. A case study in an outpatient clinic is presented subsequently. After current processes are mapped and analysed using value stream mapping, an improved patient flow is achieved by applying the outpatient clinic lean framework.
    IEOM 2015; 03/2015
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