Patients were so frustrated with wait times, some left without being seen. It was a terrible situation. Through Kaizen, we set out to improve it.

While business consulting in Toronto early on, I worked with a hospital. The medical staff were brilliant caregivers: doctors, nurses, social workers, and many more. But they knew little about process improvement and certainly not specialized methods like kaizen. The challenge was effectively serving patients arriving in the Emergency Department on a timely basis. Patients were so frustrated with the wait times, some left without being seen. It was a terrible situation, and our objective was to improve it.

Mapping the process was daunting, even with my training. Every patient was unique, both in terms of the emergency as well as chronic conditions that may or may not be relevant to a treatment plan. One doctor was skeptical any improvements could be made, and he made his opinion clear.

Kaizen Business Consulting

In terms of business consulting, I leaned on kaizen to address this challenge. In three days, a team of eight, led by the nurse manager, mapped and tested key changes to the ER process that ultimately yielded a 25% improvement throughout. Team members were assigned to observe patient care upon arrival. These team members brought back data from each patient during the day. The patient’s first assessment, orders placed, laboratory work complete, imaging read, treatment started. They saw the common elements that made up each emergency room visit, despite each patient’s unique circumstances and challenges

Figure 1. Swim Lane Map for Emergency Room Visit

I identified several opportunities for improvement: moving orders to the first assessment, a better signaling system for lab requests, improved patient preparation for faster/better imaging results. As a result, not only did wait times reduce, patient volumes increased. Walkouts, the patients who left without being seen, fell to a fraction of a percent. As for the doctor who said it couldn’t be done, his response was “I never would have believed so much improvement was possible.”

Figure 2. Length of Stay (LoS) Improvements after Kaizen