The sustainable improvement of patient flow in an emergency treatment centre using Lean

We report the two-year experience of an academic emergency treatment centre with using Lean – a technique that focuses on adding value and eliminating waste in a service line – to continuously improve patient flow. Lean helped us make changes in the process that were designed and adopted by our frontline providers. Two years after we adopted Lean, our total length of stay has decreased 3% despite an 18% increase in the patient volume and a 22% increase in admissions per month. The implementation of Lean has also been associated with a 9% decrease in the direct expense per patient (from $112 to $102.50) and a 9% increase in patient satisfaction. We conclude that Lean, when applied as a value-driven tool and adopted by the frontline workers in accordance to the local culture of care delivery: (1) yields the enhancement of patient flow and patient satisfaction that is sustainable beyond its short-term effects and (2) adds value; patients receive higher quality care at a lower cost.