Lean in a New Zealand E.R.

by Mark Graban on October 28, 2008 · 4 comments

Hospital aims for shorter wait times | Otago Daily Times Online

Here’s today’s positive blog post. For cynicism and negativity on a different Lean topic from yesterday afternoon, scroll down or click here. Be warned, the article I blogged about made me very crabby.

This is an article about a New Zealand E.R. that’s implementing Lean methods. After an intro about how some patients are tolerant of waiting times because of the care they receive, the article focuses on Dr. Kerruish’s efforts to change that:

He said it was important that this work, based on the Toyota vehicle manufacturer’s lean thinking methods, started in the emergency department because almost everyone in Dunedin had some contact with it at some stage, either as a patient or they were involved with a patient.

He hoped the project, which concentrates on reducing waste and getting all staff (not just doctors and nurses) to work together on solutions to problems, would help break down the silo mentality common to hospitals where the relationships between different disciplines were not always good.

He has a classic example of reducing waste by starting to work across department silos:

He recently found out by chance that patient wrist bands used in the emergency department had to be replaced with water-proof ones once patients went on to wards.

“We didn’t know they’d changed them. No-one told us and we hadn’t asked.”

The doctor saw the opportunity for what sounds like a GOOD application of 5S:

He especially wanted to reduce the time spent on what he called “treasure hunting” (looking for equipment) and unnecessary interruptions which disrupted his patient care.

And the doctor was focused on his staff:


More generally, he was looking forward to working in a less stressful environment, where people had time to be polite and friendly to each other, and patient care was central, he said.

Sounds like they are off to a good start!

Mark Graban 2011 Smaller Lean in a New Zealand E.R. leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology, focused on improving quality and patient safety, improving access, reducing costs, and fully engaging healthcare professionals. He is also the Chief Improvement Officer for KaiNexus.


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{ 3 trackbacks }

Another Annual Update on a New Zealand Emergency Department — Lean Blog
October 7, 2010 at 5:01 am
An American Emerg Doc in New Zealand – His Reflections — Lean Blog
January 31, 2011 at 5:01 am
The Need for Lean E.D. in N.Z. — Lean Blog
July 28, 2011 at 8:24 am

{ 1 comment… read it below or add one }

1 ALB October 28, 2008 at 2:07 pm

I experienced awesome “cellular service” (or something like that) at a diagnostic imaging center yesterday. Moments after signing in, before I had even sat down, the x-ray tech was at my side. Helped with carrying my jacket, briefcase and coffee, and led me back to the x-ray room. Did the procedure, walked me out (carrying my stuff again – I was on crutches), and was at my side with my doctor on a cordless phone within 5 minutes advising me on next steps based on results.

The distinguishing feature of this experince was that she handled the whole transaction from beginning to end, with no hand-offs. All aspects of the service. Made it seamless, personal, friendly and quick. This is a big difference from the old model of being led from place to place by different people in a series of staged waits. I was paying attention to other patients coming and going and my experience did not appear to be an anomaly.

Maybe this isn’t such a big deal – I don’t visit the hospital much! But I’ve been hearing about our local hospital working on lean. It looks as though they are getting some results.

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