The iconic universal sign that indicates urgent medical care.

Utilizing Lean Six Sigma in the Emergency Department of Hospitals

Jaime McHugh


What exactly is “Lean Six Sigma”? Lean Six Sigma is a team-focused managerial approach that seeks to improve performance by eliminating waste and defects. The entire concept strives to eliminate waste of physical resources, time, effort, and talent while assuring quality in production and organizational processes. The “lean” concept of management lends its focus on the reduction and elimination of eight kinds of waste known as “DOWNTIME,” which is an abbreviation of defects, overproduction, waiting, non-utilized talent, transportation, inventory, motion, and extra-processing. “Lean” refers to any method, measure or tool that helps in the identification and elimination of waste. Six Sigma’s DMAIC phases are utilized in Lean Six Sigma. The acronym stands for define, measure, analyze, improve, and control and refers to a data-driven method for improving, optimizing, and stabilizing business and manufacturing processes. This method has been used in many different professional, business, and corporate settings but how could the ideas of Lean Six Sigma be utilized to increase the efficiency of a Hospital Emergency Department and reduce patient wait times? While a long wait time can indicate a non-serious health problem, emergency rooms need to streamline patient intake and care operations because patient care and satisfaction suffers with excessive wait times, can negatively affect health outcomes, and patients sometimes defer definitive care instead of waiting.

Efficiency is desperately needed for overwhelmed and exhausted ED staff and first responders.

Patient care is hands-on, the possibility for a variance is larger than in other process-driven industries. Variables may be small and difficult to quantify, but Six Sigma’s data-driven approach can result in measurable improvement. The big question is how can Lean Six Sigma help to streamline patient care in the emergency department and reduce emergency room wait times? We need to first address why it is important to streamline patient care and reduce wait times. Reducing patient waiting times influences how people feel about their doctors, nursing staff, and the overall patient care experience. Improving efficiency means eliminating unnecessary patient delays, managing, and coordinating patient care before, during, and after the visit, and safeguarding the physician-patient interaction so it remains dedicated to care delivery. It has absolutely been shown that patient care and satisfaction suffer with excessive wait times. Improving the efficiency of an emergency room can literally mean life or death in specific medical or traumatic situations. This can be a challenge in many situations because of chronic overcrowding of emergency rooms and lack of public education as to what exactly provokes an emergency room visit versus scheduling and appointment with their primary care physician. Long wait times can sometimes negatively impact the health outcomes of patients if they had been evaluated sooner. Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish. In certain instances, they can also result in poorer medical outcomes — transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities. What is even worse is that many patients will sometimes leave the Emergency Department instead of waiting for long periods which could potentially have catastrophic consequences for those patients who really needed to be evaluated and treated just because the wait time is too long. Lean principles provide EDs with an excellent approach to continuous process improvement. Implementation of Lean principles in healthcare can improve care capacity by as much as 30% and reduce patient waiting time by 50%. However, the interaction between working groups with Lean is variable, which indicates that the successful implementation of Lean depends on the leaders’ commitment. Other elements for the success of Lean methodology in an ED is the ability to change, developing a clear mapping of processes and the introduction of small improvements that are sustainable in the long term.

Streamlining patient care will improve patient satisfaction and staff satisfaction.

Lean six sigma would be excellent in an emergency department because it would improve efficiency, increase accuracy in results improved due to error elimination caused by laboratory test repetition, improve patient safety and satisfaction, and boost moral and productive shifts for staff member. There is also strong evidence that by improving and streamlining emergency room efficiency that is could also reduce the overall hospitalization time for those patients being admitted, and overall costs for all patients.


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