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A key principle of Lean is continuous improvement. The team has changed over the years, but many more projects have been done in the ED. This systematic way of improving processes has enabled the ED to overcome challenges with a volume increasing from 67,000 in 2007 to over 120,000 in 2016.

It also means that in times of crisis, all of the ED staff has a clear vision of the goal, and processes do not fall apart. The use of Lean methodology has been pivotal in creating this sustained operational change. Engaging the frontline staff and utilizing a bottom-up approach has provided sustained results. In the next chapters, each of these Lean processes will be described in more detail with an operational guide to improving ED psychiatry.


Crane, J, and Chuck N. 2011. The Definitive Guide to Emergency Department Operational Improvement. New York: CRC Press.

Doshi, A, Boudreaux E D., Nan W, Pelletier A J., and Camargo C A. 2005. National Study of US Emergency Department visits for attempted suicide and self-inflicted injury, 1997—2001. Annals of Emergency Medicine 46(4): 369—375. doi:10.1016/j.annemergmed.2005.04.018.

Liker, J K. 2004. The Toyota Way: 14 Management Principles from the World’s Greatest Manufacturer. New York: McGraw-Hill.

National Institute of Mental Health. 2017. n.d. Statistics. index.shtml.

Womack, J P., and Jones D T. 1996. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York: Simon & Schuster.


Goldratt, E M., and Jeff C. 2004. The Goal: A Process of Ongoing Improvement. Great Barrington, MA: North River Press.

Jensen, K. 2007. Leadership for Smooth Patient Flow: Improved Outcomes, Improved Service, Improved Bottom Line. Chicago, IL: Health Administration Press.

Song, H, Tucker A L., and Murrell K L. 2015. The diseconomies of queue pooling: An empirical investigation of emergency department length of stay. Management Science. 61(12):3032—3053. doi:10.1287/ mnsc.2014.2118.

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