Going Lean in the Emergency Department
8/2/2007

Tauber Institute students apply lean principles to help UM Hospital improve emergency department performance

A hospital emergency department (ED) is a vital component in any community’s health care safety net. A steady increase in the volume of ED patients -- now at more than 115 million Americans annually according to the Center for Disease Prevention and Control – has led to the saturation of many emergency department resources. The resulting phenomenon of ED overcrowding threatens access to emergency service for those who need it the most.

Roman Kapuscinski, Associate Professor of Operations and Management Science and co-director of the Tauber Institute for Global Operations, is well aware of the University of Michigan University Health System’s issues with ED overcrowding, and has focused his students’ efforts on finding solutions using lean processes.

In partnership with Dr. Jeffrey Desmond, Emergency Medicine Service Chief at UM Health System, Kapuscinski and his students have worked in phases starting in 2005 to find ways to eliminate delays and ensure complete and accurate discharge of ED patients. The lean teams were assembled to review the current state value stream map, draft the ideal future value stream map, and develop a workable implementation plan.

Significant delays in patient flow within the system – from the time a bed-available notification is given to the actual time of transfer to the hospital – result in a much higher than desired length-of-stay for patients. UM’s ED senior management, consisting of the Nurse Manager Nancy Mamolen and Dr. Desmond, had the objective of reducing current transfer times through improving patient process flow and thus welcomed the research and input from the lean teams.

Lean Project #1: Analyze Data

An initial project was conducted in January through April 2005 by Tauber student Pinar Yaprak and Ph.D. candidate Ling Wang. The team analyzed large amounts of data to identify the contributing factors to overcrowding of UM’s ED. They were assisted in this endeavor by Dr. Desmond and his staff.

“Pinar and Ling evaluated capacity levels across days of the week and time of the day based on detailed simulation and on limited pilots. As a result, the ED department modified staffing levels, rescheduled residents' activities, and abandoned an attempt to introduce a triage option,” said Kapuscinski.

Lean Project #2: Uncover Inefficiencies

The next step in the lean team research took place from September through December of 2005. Tauber students Daryl Sanford, Gabriel Thoumi, and Mathieu Van Assche, along with MBA students Manali Desai and Bertrand Hamon, worked to establish the root of the inefficiencies within the ED.

This team first diagnosed that a major factor accounting for the relative inefficiency in the assignment process was a lack of visibility. The second step was to design a pilot and to have it running live in the hospital’s main Emergency Room.

“We recommended the implementation of two visual aids in the ED, a magnetic white board that allows everyone to view the current workload of each doctor in the ED and their availability to take on additional patients, and a real-time scorecard of how many patients each doctor had dispositioned during their shift. Doctors would place a patient ID sticker on a sheet of paper once that patient was cleared to leave the ED,” said Daryl Sanford.

“The pilot showed that the new performance measure system allows the attending physicians to keep track of individual performances, regardless of their belonging to one team or the other. Also, it was clear that a one-queue, multiple server performed well and was perceived as acceptable by all stakeholders,” said Kapuscinski.

Lean Project #3: Recommendations

The lean team of Tauber students Damon Dance, Rahul Deshmukh, Kok Keng Goh and Isaac Jacob built on the body of research conducted by their peers to analyze root causes of performance delays and make suggestions for lean process improvements to the system.

The team conducted a period of observational studies, interviews and statistical data analysis with heavy involvement from service staff at UM’s ED. Recommendations were made in three key areas – Coordination, Communication and Signaling, and Measurement Systems.

“Implementation of some of the recommendations was conducted through a pilot program during the final phase of the project, and the results were much to the satisfaction of the ED,” said Kapuscinski.

Kapuscinski supervised all the teams’ work through weekly updates and said he was extremely pleased with the output. Similar consulting efforts to implement lean manufacturing principals in unconventional settings will be forthcoming.

Tauber media contact:
Paula A. Baker
Phone:(734) 647-0308
Email: bakerpa@umich.edu