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Updated: Apr 12, 2026
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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
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Ontario's emergency department process improvement program: the experience of implementation.
Leahora Rotteau1, Fiona Webster2, Erin Salkeld3
1The Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.
Summary
Lean healthcare initiatives improve emergency department (ED) wait times by focusing on implementation context, staff engagement, and strong communication. Successful strategies require careful planning and executive support for sustainability.
Area of Science:
- Healthcare Management
- Operations Research
- Quality Improvement
Background:
- Lean manufacturing principles are increasingly applied to healthcare to enhance quality and efficiency.
- Ontario's Ministry of Health and Long-Term Care implemented an ED process improvement program using Lean principles to reduce ED length of stay (LOS) and improve patient flow.
Purpose of the Study:
- To describe hospital-based teams' experiences during an ED process improvement program implementation.
- To identify key factors influencing the success or failure of Lean-based ED process improvement initiatives.
Main Methods:
- A qualitative evaluation using semistructured interviews with 24 hospital implementation team members (team leads, medical leads, executive sponsors) across 10 Ontario hospitals.
- Thematic framework approach applied to interview data with a developed thematic coding framework.
- Hospitals were purposively selected based on changes in median ED LOS post-implementation.
Main Results:
- Four major themes significantly impacted implementation: local contextual factors, team-support relationships, staff engagement, and sustainability.
- Effective implementation requires attention to the specific context, strong relationships and communication, and proactive planning for sustainability.
Conclusions:
- Key success factors include thorough preparation, robust executive support, task-oriented team creation, and diverse communication strategies.
- Incorporating these factors into future healthcare interventions can enhance the success of similar quality improvement programs.
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