The Impact of Lean Principles on the Design and Improvement of Emergency Department Performance

ObjectivesEmergency departments (EDs) constitute essential components of most healthcare systems; However, in many countries, its efficiency has diminished due to the reliance on outdated guidelines and flawed operational systems. Redesigning the ED through modern approaches, such as Lean, can enhance process flow and service delivery. The purpose of this study is to apply Lean principles to improve ED performance through optimized design.MethodologyA comprehensive literature review, combined with a comparative, analytical, and synthetic approach to evaluate ED design guidelines, was conducted to examine new systems related to patient stratification, triage, and process flow. In addition, the field method and direct observation (Gemba), along with a Fishbone diagram, were employed to understand treatment processes and identify bottlenecks.FindingsThe Lean approach influences access and the layout of ED spaces, resulting in substantial modifications. Key differences include the use of an Intake system (a combination of First Look and Rapid Medical Evaluation), result waiting and results/ECG rooms in the shared zone, internal waiting areas within the emergency and outpatient zones, standardized dimensions of examination rooms and acute and observation cubicles, among others.ConclusionIn this study, we established a revised operational process flow and a concise set of ED design guidelines. The study recommends maintaining flexible shift scheduling and staffing levels during periods of crisis and peak patient volume, with staff overlap extended to 2 hr to better manage patient flow and operational demands.