ER-Forum Blog

Is emergency medicine heading for "lean" times?

By Ellis Weeker MD

You don't have to be an emergency physician or nurse leader to know that healthcare costs are rising too quickly and too many preventable errors occur. But there's a lot of discussion today in health care about the benefits of Lean Methodology.

Emergency physicians often ask how Lean, a methodology associated primarily with Toyota and manufacturing industries, can apply to life in the pit. The answer is, it's not just a set of tools for improving quality in a factory - it's a set of methods, principles, and philosophies as applied to any team of people forming a management and performance system. And, in the emergency department, the end result is providing the best care for patients.

An increasing number of health care organizations strongly believe that Lean Methodology is our best hope for improving quality, reducing waste and excessive costs, and increasing the value provided by our healthcare systems.

Lean can be applied anyplace work is done in a team setting, where medical providers face problems, or people lead or manage others in a group work setting. This includes emergency healthcare. Lean supports the purpose of any healthcare organization - providing the best quality patient care using the minimum number of resources in the most efficient manner.

As an experienced emergency physician, I understand that the services we provide are complex, involving diverse professional skills to serve a variety of patient needs. How Lean relates to the emergency department is by maintaining a strong focus on patients as the primary customer for the medical team treating them. A heightened patient focus means implementing new Lean methods for ensuring patient safety and quality of care, such as checklists and error proofing methods. Patient focus also means designing processes and physical spaces (such as Triage and Rapid Medical Evaluation®) with the patient in mind - minimizing wait times and improving throughput.

Lean also places a premium on supporting healthcare professionals and staff to maximize their patient care time and activity. It focuses on doing more with less.

Before lean, healthcare organizations typically believed their problems could only be solved with "more" - more space, more people, and more money. However, more space costs money - money hospitals are increasingly pressured to avoid spending. Costs aside, adding more people is often not even an option because of extreme shortages of professionals. Through Lean, hospitals learn methods that allow them to increase capacity without adding people through better coordination of their resources and efforts- true productivity. Many hospitals have been able to cancel multi-million dollar capital expansion projects as they learn how to use their existing space and personnel more effectively with Lean principles.

While Lean can assist healthcare providers in reducing costs, improving service levels and increasing value, that is not its only goal. Lean methodology also seeks to improve quality of care, compliance and patient safety. This is the challenge, but I'm optimistic that the application of Lean methods in emergency medicine will bring benefits for patients and all concerned -- medical professionals, providers, and the hospital.

What are your experiences or thoughts on using Lean Methodology in emergency medicine?