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Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction

Kane, Marlena MPH, MSW; Chui, Kristen; Rimicci, Janet MSN, RN; Callagy, Patrice MPA, MSN, RN, CEN; Hereford, James MS; Shen, Sam MD, MBA; Norris, Robert MD, FACEP, FAAEM; Pickham, David PhD, RN

JONA: The Journal of Nursing Administration: September 2015 - Volume 45 - Issue 9 - p 429–434
doi: 10.1097/NNA.0000000000000228

A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department’s current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

Author Affiliations: Director Value Stream Initiatives (Ms Kane), Vice President Emergency Services (Ms Rimicci), Director of Emergency Services (Ms Callagy), Chief Operating Officer (Mr Hereford), and Director of Research, Patient Care Services (Dr Pickham), Stanford Health Care, and Emergency Physicians (Drs Shen and Norris), Stanford Medicine, California; and Student (Ms Chui), Department of Engineering, University of California, Los Angeles.

The authors declare no conflicts of interest.

Correspondence: Dr Pickham, Stanford Health Care, 301 Ravenswood Ave, Ste I238, Menlo Park, CA 94025 (

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.