Lean in a Canadian Emergency Department


Hospital News: Markham Stouffville Hospital makes 50 improvements to the emergency department

Here's a news story that describes the beginning of a Lean journey in a Canadian hospital:

The leadership team at Markham Stouffville Hospital turned to the LEAN methodology, a process that brings together teams to examine current processes and identify opportunities for positive change and improvement. The goal of LEAN is to increase efficiencies and improve patient and staff satisfaction. “Patient care is always enhanced by this process,” says Beed. “We look at things from the patient's perspective and find ways to make it better.”

The process also supports staff satisfaction and engagement because the team is made up of a variety of staff from the hospital. The strength of the process is that everyone on the team is treated as equals and their ideas are valued. There is no hierarchy, there are no defined roles. LEAN brings together a group of staff committed to making it better for patients and each other. It doesn't matter if you are a doctor, nurse, lab technician or a clerk, your ideas are valued and taken into consideration.

It's great that they seem to be focusing not just on tools, but also on culture and staff engagement.

They are following a “kaizen event” focused approach (misspelled as kazien by the paper… oops, a “defect”). I have my doubts about event-driven Lean, but they are making some improvements, at least. The question is about sustainability and the management system will change through the short events.

One example of improvement:

A light was installed at the triage desk that flashes when an ambulance is waiting to be offloaded. “It's a little thing, but this visual cue allows our staff to immediately know when an ambulance is waiting. And if there isn't, our staff can spend those extra minutes caring for our patients.” The result has been shorter turnaround time for ambulances and an improved relationship between paramedics and staff.

I like how there is a focus on the measures that the changes impact. It's not enough to just “do Lean” or even just to make changes… the results should be measurable in some way. Turnaround time is a good example of that.

The response from the staff to all of the improvements has been equally enthusiastic. “Many of our staff has participated in the improvement events,” says Pedersen. “By being part of the solution, they have a real sense of ownership over the changes and are always looking for ways to make things better…

I hope they can keep up the enthusiasm. Sounds like a great start…

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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. I agree – looks like a great start. And it looks like they “get it” in terms of Lean not just being a bag of tools that will solve their problems, but a total management system. Good stuff.

  2. Very good post and looks like the start of some real tangible improvements. Having management support that can drive this type of process is very key as well, and it looks like the whole organization is buying into this new technique.


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