Process improvement at a newly established emergency department: A kaizen approach

Abstract

Emergency Department (ED) overcrowding has been a national problem faced by many hospitals in the United States. Continuous improvement at ED is of extremely important so as to deliver quality care to the patients not only in the ED but through the ED to the downstream inpatient units. In this research, we adopted "lean" principles, collected and analyzed data, identified a focus area, and implemented a Kaizen Event to improve processes in a newly established community hospital ED. The focus of the Kaizen Event was to reduce the discharge process time i.e. the time from decision to discharge in the ED till the time the patient leaves the ED. The ED has all the usual stakeholders with the exception that the physicians at the ED are "contracted" and not employees of the hospital, this presented the Kaizen team members with unexpected challenges thru the Kaizen. In a three-and-half-day-event, a Kaizen team, none of whom had ever before participated in a Kaizen, worked together to learn and implement "lean" methodologies to enhance the workplace, eliminate waste, and produce innovative solutions to re-engineer the processes. A variety of tools such as process mapping, value stream mapping, spaghetti diagrams, Ishikawa charts, and statistical data analysis were used in the Kaizen Event. The event yielded an average 50% reduction in ED patient discharge time.