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Improving patient flow through applying lean concepts to emergency department

Hossam Elamir (Department of Quality and Accreditation, Ministry of Health, Kuwait)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 30 May 2018

Issue publication date: 18 July 2018




This paper aims to propose lean-based interventions that address the main causes of emergency department overcrowding. Emergency department overcrowding (EDOC) and increased length of stay (LOS) have been key global issues for more than 20 years, as they have serious repercussions. No measurements have been done to assess the situation nationally. Expanding emergency departments (EDs) and adding more beds have never succeeded in eliminating wastes and targeting the root causes of the problem.


This paper is a quantitative analytical applied research. The paper used direct observation for seven days to collect patient flow data on ED patients at a secondary care hospital in Kuwait. It calculated wait times and services to identify the major causes of EDOC and increased LOS.


Around one-third of the ED design capacity was used by 12 per cent of the patients who stayed >6 h each. The wasted waiting time represents 56.2 per cent of the aggregated LOS, which puts lean management (LM) on the top of the process reengineering approaches suitable for improving overcrowding by reducing waste. Guided by the LM concepts, the paper proposes solutions that fall into three themes. The selected solutions address the vital few causes of the EDOC and prolonged EDLOS.


This paper is the first study of its kind in Kuwait, and one of the most outstanding studies in the Gulf region, in terms of the number of the daily ED visits and the comprehensive multi-level proposed interventions.



This work could not have been completed successfully without the contribution and support of a range of individuals. Among those are the hospital quality staff, the ED staff and the staff development unit. The author would like to show gratitude to Jumana Al-Amir who edited and proofread the work.


Elamir, H. (2018), "Improving patient flow through applying lean concepts to emergency department", Leadership in Health Services, Vol. 31 No. 3, pp. 293-309.



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