Creating Synergy Between People and Process: Using Lean to Improve Emergency Department Efficiency and Patient Experience

Emergency departments (EDs) are a pivotal point of entry for patients requiring urgent medical attention, making ED efficiency a critical metric for hospitals. The Centers for Medicare & Medicaid Services (CMS) developed several performance measures to track how well hospitals manage patient flow, including the measure OP-18b: the median time from emergency department arrival to emergency department departure for discharged patients. This measure, while commonly used as a benchmark for time-based performance, is more than just a number. It reveals opportunities for improving patient flow, reducing bottlenecks, and enhancing overall patient experience through effective teamwork and process optimization.

By leveraging Lean Process Improvement principles, hospitals can reduce inefficiencies and enhance coordination between departments, allowing patients to move more seamlessly through the emergency department. But achieving these results requires more than just good processes—it requires a synergy between the people working at the front lines of patient care and the processes designed to streamline their work. This article explores how a thoughtful combination of “People” and “Process” can help hospitals not only meet the CMS OP-18b standard but also significantly improve the quality of care and the patient experience.

The Importance of Lean Process Improvement in the ED
Lean Process Improvement is a methodology aimed at maximizing value by minimizing waste. In healthcare, waste refers to anything that doesn't add value to the patient’s care or experience—such as long wait times, redundant paperwork, unnecessary tests, and delayed communication between departments. Lean focuses on identifying these non-value-added steps and eliminating or streamlining them to create more efficient workflows.

In the context of the ED, applying Lean principles can directly improve the OP-18b metric by identifying bottlenecks in the patient flow. For example, unnecessary delays in getting test results from radiology or the lab can extend the time a patient spends in the ED unnecessarily, adding to the patient’s stress and reducing overall department efficiency. Lean helps hospital teams see the patient flow from a holistic perspective and identify areas where time, resources, and energy are being wasted.

However, simply identifying areas of waste is not enough—staff at every level must be engaged and empowered to create sustainable improvements. This is where the synergy between "People" and "Process" comes into play.

The Synergy Between People and Process
The success of any Lean initiative depends not just on the processes being improved, but on the people responsible for carrying out those processes. Healthcare is inherently people-driven, and the care delivered in the ED relies on the coordinated efforts of physicians, nurses, radiology technicians, lab staff, and many others. When these individuals collaborate effectively, it becomes possible to dramatically reduce inefficiencies and improve care quality.

1. Cross-Departmental Collaboration: A Key to Success
   In the fast-paced environment of the ED, patients often require services from multiple departments—such as radiology for imaging or the laboratory for diagnostic tests. Each handoff between departments represents an opportunity for delay. By improving cross-departmental collaboration, hospitals can prevent bottlenecks and reduce the time a patient spends waiting for critical test results. For example, having radiology technicians and lab staff work in tandem with ED nurses and physicians can ensure that tests are prioritized appropriately and that results are communicated quickly and efficiently.

   Case Example: Imagine a patient in the ED who needs a CT scan and lab work. By using Lean Process Improvement, the team can establish a streamlined workflow where the test order is immediately transmitted to both departments, the patient is prepped in parallel, and results are flagged for priority review. With communication channels open and clearly defined processes in place, the patient’s test results can be returned more quickly, reducing their time in the ED and improving the overall quality of care.

2. Empowering Staff to Drive Improvement
   In Lean philosophy, the people closest to the work are the most knowledgeable about where inefficiencies exist. Nurses, physicians, and technicians know where the delays and frustrations are in their day-to-day tasks. By engaging these staff members in the Lean process and empowering them to suggest improvements, hospitals can uncover valuable insights that lead to meaningful changes.

   For example, ED nurses may notice that during certain times of day, there are predictable delays in receiving lab results because the lab is understaffed during peak hours. By addressing this issue through staffing adjustments or by introducing a standardized triage process for lab requests, the hospital can alleviate this bottleneck and reduce the overall time patients spend in the ED.

3. Standardized Processes: Reducing Variability
   One of the key goals of Lean Process Improvement is to reduce variability in workflows. In the ED, variability can significantly impact patient flow and wait times. Standardizing key processes—such as how quickly imaging or lab results must be communicated to the ED—ensures that staff are working consistently, even when the department is under stress. This type of standardization also allows hospitals to identify trends and problem areas more easily, leading to faster resolution and improvement.

   Example: Developing a standardized process where diagnostic tests for suspected critical conditions (e.g., stroke or heart attack) are given priority in radiology or lab departments ensures that critical patients move more rapidly through the ED, improving both patient outcomes and departmental efficiency.

Patient Experience and Its Connection to OP-18b
While the OP-18b measure focuses on the efficiency of the ED, it also has significant implications for patient experience. Long wait times in the ED are often cited as a source of frustration for patients and their families. Extended stays in the ED can increase patient anxiety, discomfort, and dissatisfaction, leading to lower patient satisfaction scores. Improving the median time patients spend in the ED can alleviate these concerns and improve the overall patient experience.

By using Lean to streamline workflows, hospitals can provide more timely and coordinated care, leading to improved patient outcomes and higher satisfaction scores. The synergy between people and process helps create a more seamless patient experience, where care is delivered efficiently, and unnecessary waiting is minimized.

A Holistic Approach to Emergency Care
Improving OP-18b is not just about making the ED more efficient—it’s about creating a holistic approach to emergency care that prioritizes both the patient and the staff. When people and processes work in harmony, hospitals can achieve measurable improvements in care delivery while creating a positive work environment for staff. Frontline staff feel empowered when they have a say in process improvement, and patients benefit from smoother, more coordinated care.

The Ripple Effect: Beyond the Emergency Department
The lessons learned from applying Lean to improve OP-18b in the ED can be applied across the entire hospital. For example, the same principles of cross-departmental collaboration, staff empowerment, and standardization can be used to improve patient flow in surgical departments, inpatient units, and outpatient clinics. Lean is not just about fixing isolated problems—it’s about creating a culture of continuous improvement that benefits every part of the organization.

Conclusion: Harnessing People and Process for Better Outcomes
The synergy between people and process is the key to improving the efficiency and quality of care in the emergency department. By focusing on both Lean Process Improvement and the collaboration of ED staff, radiology, lab, and other departments, hospitals can not only meet the CMS OP-18b standard but also provide a better patient experience.

In a healthcare environment where time is often of the essence, fostering a culture of collaboration and continuous improvement is essential. When healthcare professionals are empowered to contribute their insights, and when processes are streamlined to eliminate waste, both patients and staff benefit. Hospitals that embrace this synergy will find themselves well-equipped to deliver timely, patient-centered care that meets both clinical and operational goals.