Use of Lean in the emergency department: a case series of 4 hospitals

Lean implementation in reviewed emergency departments was associated with decreased proportion of patients leaving the emergency department without being seen.

“Decreased proportion of patients leaving ED without being seen [ 72 ] [ 75 ] [ 76 ] [ 77 ] [ 81 ] [ 83 ]”

Not every study adequately reported pre- and post metrics; in some cases measures of success were taken but not reported, patient satisfaction was not described, statistical tests were not used, or no numerical data were given.

“Fourth, not every study adequately reported pre- and post metrics. In some cases, “measures of success” (e.g., door-to-balloon time, door-to-needle-time) were taken but not reported [69]. In others, measures such as patient satisfaction were not described [83], statistical tests were not used to test pre-post differences [20, 75], or no numerical data were given to support reported changes [83]”

Lean implementation in reviewed emergency departments was associated with decreased emergency department length of stay.

“Decreased ED length of stay [ 72 ] [ 73 ] [ 75 ] [ 76 ] [ 79 ] [ 80 ] [ 81 ] [ 83 ] [ 85 ]”

With one exception, all Lean initiatives involved frontline staff in some way.

“Project team composition varied among sites, but with one exception (Hospital C in [75]), all Lean involved frontline staff in some way.”

Some reviewed studies reported that employees became empowered to control the design of their own work.

“some studies indeed reported that their employees became empowered to suggest future changes [72] and to control the design of their own work [75]”

Only one reviewed study, Dickson et al., included multiple Lean implementations across multiple EDs and therefore only this study was able to directly address contingencies.

“Only one study, Dickson et a1 [75], included multiple Lean implementation across multiple EDs and therefore only this study was able to directly address contingencies.”

Based on a comparison of four EDs, Dickson et al. proposed that the two key contextual contingencies were involvement of frontline staff in Lean initiatives and leadership commitment to Lean.

“Based on a comparison of four EDs, Dickson et a1 proposed that the two key contextual contingencies were (a) the involvement of frontline staff in Lean initiatives, and (b) leadership commitment to Lean.”

Lean implementation in reviewed emergency departments was associated with increased patient satisfaction.

“Increased patient satisfaction [ 73 ] [ 75 ] [ 81 ] [ 83 ] [ 85 ]”

Dickson et al. proposed that Lean's variable success could be understood as "context + mechanism = outcome," where context refers to the local context of the ED and mechanism refers to Lean.

“more formally proposed that Lean’s variable success could be understood as “context +mechanism = outcome,” where context refers to the local context of the ED and mechanism refers to Lean [75].”

In one reviewed study, there was decreased patient satisfaction.

“Decreased patient satisfaction [ 75 ]”

There is a current trend of reporting bias toward publishing positive-and more often than not immediate-results because hospitals who failed to achieve intended behavioral changes do not come forward to openly analyze reasons for failure.

““there is a current trend of reporting bias toward publishing positive—and more often than not immediate—results because hospitals who failed to achieve the intended behavioral changes do not come forward to openly analyze the reasons for their failure” [75].”