Lean in a New Zealand E.R.


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!

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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 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.

  2. […] In 2008 (as Mark blogged about), Dunnedin Hosptal launched their ‘Putting Our Patients First’ project, looking to leverage the 6 hour rule to provide better care to their patients. By 2009 (new post), it had become clear that despite good strides toward improvement in the ED, accomplishing their goal of reducing ED wait times would only be achieved by the engagement of other departments in the hospital. ‘Lowering the stream’ revealed a new set of stakeholders. Did they then pause to make sure they had gained the necessary agreements? Without these in place, it is tough to craft countermeasures that will work and be accepted. See this recent blog post with a 2010 update on the hospital’s lean journey. […]


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