Current State
Defining the current state of Emergency Medicine and outlining the case for improving Emergency Department flow and operations.
Emergency Department Simulation Phase I
The entire class participates in an active simulation designed to recreate an actual 24-hour period in the Emergency
Department. Students take on the role of docs, nurses, x-ray and lab technicians, supply management, receptionist, triage, quality control
and data entry. The goal is to process as many patients as possible during this simulated 24-hour period using existing knowledge and
experience. The group is judged based on walkout rate, value-added and non value-added time, overall LOS and quality. This Simulation
serves as a baseline of the dysfunctional Emergency Department.
Lean Tools I
Understanding the significance of Value Stream Mapping along with swim lane and spaghetti diagrams and how their use can
help redefine the Emergency Department process. Also, how value added ratios are calculated and used to improve Emergency Department
performance.
Lean Healthcare Tools II
Workplace organization, 6-S (Safety, Sort, Straighten, Shine, Standardize, Sustain) and how these actions help create a
more professional work environment. Organizing the workplace, eliminating the need to search for items, and implementing visual signals
helps to reduce the probability of errors, increase productivity, and improve quality and morale while creating a more professional work
environment.
Lean Healthcare Tools III
Understanding TAKT Time, which is the time required producing a component or set of components to meet customer demand.
Work Sequence: The manner in which a healthcare provider uses tools, instruments and procedures in interacting with patients. We’ll evaluate the
current situation to identify areas of opportunity while learning to modify existing processes and then substantiate and enumerate improvements
towards implementing new standard work.
Understanding SWIP (Standard Work-In-Process), which is the minimum work-in-process needed to perform repetitive operations
thus allowing process to “flow.”
Inventory Management – An overview of materials management, kanban systems, and discussion of “Pull” vs. “Push” systems.
Lean Healthcare Tools IV
Rapid changeover and mistake proofing are covered. A detailed approach and the tools for problem solving are
discussed. Approaches to data collection, analysis, and presentation are reviewed at a high-level overview.
Emergency Department Simulation Phase II
The class is divided into groups where they use the knowledge learned during the four Lean Tools lectures to plan
strategies for layout design and rapid patient flow. Students are able to apply the tools they have just learned and redesign the
flow, layout, and work sequence of the Emergency Department. Groups are given fewer resources and challenged to improve throughput
and quality while decreasing LOS, and walkout rate, by focusing on the reduction of waste and non value-added time.
Queuing & Variation and Achieving Lean Healthcare Flow
Learn how Lean healthcare organizations flow products or customers through a system quickly, predictably, and in a
high-quality and resource-lite fashion and how to apply physics to a simple Queue. Understand practical strategies that can be applied
to improving Flow and how patient satisfaction can be achieved within a queuing network. The QueueCalc worksheet is used to teach key
concepts behind problems that plague service industries and specifically Emergency Departments.
Data-driven Assessment of your Emergency Department
Learn how to use Educate© as an effective tool for fast track and triage planning in order to match demand to capacity
throughout the process flow. From this, we’ll determine the correct team size, the impact of holds, diversions, walkouts on staffing,
throughput and revenue.
Emergency Department Simulation Phase III
In this final simulation phase students apply lessons from the Queuing & Variation and Achieving Lean Flow lecture,
combined with those previously learned in the Lean Healthcare Tools series to plan more efficient strategies for layout design and rapid
patient flow. Obtaining higher quality control and patient throughput than in Emergency Department Simulation Phase II is the
overarching goal.
The Lean Emergency Department: Applied Concepts
This lecture describes how Mary Washington Hospital in Fredericksburg, Virginia applied Lean Applications in a 100,000 visit
Emergency Department. After reviewing the background of Mary Washington Hospital the discussion shifts to a Lean Healthcare Vision focused
on processes to create patient value centered around reducing non-value-added procedures and waiting, while placing the focus on patient service
families. We’ll also use value stream to map the different steps in order to redesign processes based on the desired future
state. “Super Track,” and “R.A.T.E.D - ER” are discussed in detail.
Emergency Department Flow as a Network of Queues
Learn to understand the basic network of queues that make up Emergency Department flow; be able to identify all of the
common queuing interfaces seen in the Emergency Department; understand how to analyze these queues and correct common demand/capacity
scenarios.
Emergency Department Best Practices: Door to Doc – Fixing the Front End
This lecture begins with a discussion of Patient Value, which equals Realization minus Sacrifice and how the two are
managed and reconciled. Then it leads into Designing the Emergency Department of Tomorrow – Door to Doc which has the following
components: Super Track, a method to treat and release patients directly from triage; Intake Team, a pull system for patients to be
evaluated by the MD where there is always capacity; and designated ancillary services for the front end.
Targeting Lean Healthcare Improvement Using Theory of Constraints
The Theory of Constraints is introduced using a fictitious hospital showing students how to effectively target areas for
improvement. By taking a systems view, students learn how to identify and manage bottlenecks in complex lean healthcare systems.
Emergency Department Best Practices: Doc to Decision Interval
This lecture discusses steps for balancing critical servers while figuring ratios out and what to do if MDs are your
constraint. We’ll also talk about Scribes and point out where they can add value in your Emergency Department. Part of this lecture
discusses benchmarking RN productivity and illustrates how to effectively unload tasks from nurses so they can focus on more value-added
service. Why incentivizing nurses is critical to increase performance and morale. We’ll discuss the impact on holds and rationalizing
patient bed needs; bed ratios (RN,MD/Bed); ancillary services – best practices.
Emergency Department Best Practices: Decision to Departure
The overview of this lecture begins with a discussion of the effect of inpatient staffed, licensed beds and inpatient
utilization on Emergency Department flow. Countermeasures for boarding, overcrowding and fixing the root cause are reviewed as is the
effective disposition and handoff of patients. This discussion concludes with planning for daily disasters and how patient flow teams
should function.
Leadership and Change Management: Getting It Done
The value and role of leadership, vision, and continuous improvement are highlighted in the context of change in complex
lean healthcare settings. Change management is discussed, reviewing critical concepts such as choosing the right team and project,
rapid cycle testing, implementation, and dealing with resistance. This final lecture not only focuses on “Getting It Done,” but how to
create excitement and gain support from key staff members.