Lean, No Wait ER’s


U.S. hospitals try to pick up the ER pace

You might have seen this sad case of a fatally broken ER on the news over the weekend and I have more comments on that later.

On a more positive light, “about a quarter” of U.S. emergency rooms are working on “no waiting” or “30 minutes or less” goals:

“Some hospitals are moving to eliminate waits altogether. The Adventist GlenOaks Hospital in Illinois promises no waits at all. As of last week, patients could skip the waiting room and go directly to a private room where treatment starts as registration is done bedside.”

The article doesn't explicitly mention Lean, but the process change shown above could come through a Lean process. Lean never says “do stuff faster,” whether it's a factory or a hospital. Lean thinking pushes you to take out waiting time by CHANGING the process.

As Deming said (I might be paraphrasing), the last thing we need is everybody trying their hardest as part of a bad system. We need to change the system, this is good for the patients, the employees, and the hospital.

That will be one of the major themes in my upcoming book, “Lean Hospitals.” The book is underway, I'll post my progress as we go (and my writing actual vs .'takt time'), stay tuned.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Our local hospital claims a 0-minute wait. It does this by taking all your registration and vital signs immediately and showing you into a treatment room. When I went there with lower back pains, I waited quite awhile in a private room to see a doctor and then to be taken to X-ray, then to see the doctor again.

    When my husband’s doctor sent him to the same ER with severe pneumonia a few months ago, however, they got him to a treatment room immediately and started an IV (he was dehydrated from vomiting, etc.) and got him X-rayed as soon as possible. It was not long after that they started breathing treatments and admitted him.

    Triage seemed to be working. Having been to the same ER back when the waiting room was ten times its current size with longer waits, I’ll take the current system.

    The only benefit to the old setup, when the treatment room was a lot of beds separated by curtains was that my 14-year-old son got to hear everything that happened when a guy who OD’d was dumped from a car at the ER entrance and resuscitated. While he was left alone after he’d made it back to consciousness, he disappeared. A lesson on what happens when you get into the drug life that he wouldn’t have witnessed from a private room.

    Still, I don’t want to go back to the old days.

  2. Thanks for the story, Karen. I’ve heard grumblings about the “fake flow” in some ER’s, the same way you often have “fake flow” or “fake lean” in factories.

    I think your story illustrates how people are clever at gaming metrics — tell me you want “zero waits” and I’ll give you “zero waits”, the way you measure it. It’s often harder to improve the system than it is to game the system.

  3. Lean+Six Sigma+Theory of Constraints has another name – value stream improvement or VSI. But before these powerful techniques will work there is another obstacle to remove – the “zero-sum game” mindset. The life limiting belief that if someone wins then someone else must lose. This mindset is learned very early in life … “You can only have a hug if you are good” is zero sum thinking. Rewards are conditional. It doesn’t add up though. In a battle who ends up better off than they started? Neither do – the losses on one side do not appear as gains on the other. Once you’re dead that’s it. And so it is with time – once it has been wasted it has been wasted forever. The core objective of VSI is to reduce the time wasted doing anything that results in a loss for anyone. VSI requires a win-win mindset. So if my goal is a win for me and a win for you then there is a better chance of a win for everyone else: quality, motivation AND performance. The Three Wins … check them out at http://www.ThreeWins.com!


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