Lean Thinking in emergency departments: a critical review
- PMID: 21035904
- PMCID: PMC6548198
- DOI: 10.1016/j.annemergmed.2010.08.001
Lean Thinking in emergency departments: a critical review
Abstract
Emergency departments (EDs) face problems with crowding, delays, cost containment, and patient safety. To address these and other problems, EDs increasingly implement an approach called Lean thinking. This study critically reviewed 18 articles describing the implementation of Lean in 15 EDs in the United States, Australia, and Canada. An analytic framework based on human factors engineering and occupational research generated 6 core questions about the effects of Lean on ED work structures and processes, patient care, and employees, as well as the factors on which Lean's success is contingent. The review revealed numerous ED process changes, often involving separate patient streams, accompanied by structural changes such as new technologies, communication systems, staffing changes, and the reorganization of physical space. Patient care usually improved after implementation of Lean, with many EDs reporting decreases in length of stay, waiting times, and proportion of patients leaving the ED without being seen. Few null or negative patient care effects were reported, and studies typically did not report patient quality or safety outcomes beyond patient satisfaction. The effects of Lean on employees were rarely discussed or measured systematically, but there were some indications of positive effects on employees and organizational culture. Success factors included employee involvement, management support, and preparedness for change. Despite some methodological, practical, and theoretic concerns, Lean appears to offer significant improvement opportunities. Many questions remain about Lean's effects on patient health and employees and how Lean can be best implemented in health care.
Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
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Comment in
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Can Lean Thinking transform American health care?Ann Emerg Med. 2011 Mar;57(3):279-81. doi: 10.1016/j.annemergmed.2010.11.027. Epub 2011 Jan 12. Ann Emerg Med. 2011. PMID: 21227539 No abstract available.
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Lean is a tool in the toolbox, not the silver bullet.Ann Emerg Med. 2011 Oct;58(4):398-9; author reply 399-400. doi: 10.1016/j.annemergmed.2011.04.036. Ann Emerg Med. 2011. PMID: 21943581 No abstract available.
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References
-
- Institute of Medicine. Hospital-Based Emergency Care: At the Breaking Point. Washington, D.C.: National Academies Press; 2007.
-
- Berger EA $9,000 hill to diagnose shingles? Ann Emerg Med. 2010;55:15A–17A. - PubMed
-
- Kellerman AL. Crisis in the emergency department. N Engl J Med. 2006;355: 1300–1303. - PubMed
-
- Smits M, Groenewegen PP, Timmermans DRM, et al. The nature and causes of unintended events reported at ten emergency departments. BMC Emerg Med. 2009;9 Available at: http://www.biomedceutral.com/1471-227X/9/16. - PMC - PubMed
-
- Young TP, McClean SI. A critical look at Lean Thinking in healthcare. Qual Saf Health Care. 2008:17:382–386. - PubMed
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