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Lean Management, Waiting Time, Door-to-Doctor Process, Door-to-Doctor Time, Quality Improvement, Map Process, Observational Study


Emergency Medicine | Public Health


Lean management, when adopted in health care settings, will influence clinicians to find better ways for providing health care services to patients. In ED’s everyday processes, lean focuses on improving the ED process flow through facilitating communication among ED staff and eliminating any unnecessary steps (wastes) along the process. An observational cross-sectional study has been conducted at the Emergency Department (ED) of the American University of Beirut- Medical Center (AUBMC), to assess the extent upon which AUBMC-ED is lean. The time it takes the patient to be examined by an attending doctor, from the moment s/he hits the ED door, denoted as Door-to Doctor (D2D), was measured. A sample size (n) of 135 D2D timings was collected over a period of twenty nine days (October 28th till November 21st, and November 29th till December 2nd, 2013). Average D2D timing was found to be 25 minutes. The current process map of AUBMC-ED was also assessed and analyzed to identify any non-value added steps and obstacles that contributed to such D2D timings. These are increasing the crowding in ED and hindering the ED staff from performing their duties efficiently. These include: ED door being utilized by individuals not directly heading to ED, entrance of more than two relatives per patient in to the different ED units, security guards performing duties not inherent to their jobs such as greeting, and patients and/or relatives being unaware of steps to do after they are done with registration. The paper then proposes multiple feasible recommendations that would redesign the current process map of AUBMC-ED for it to become leaner. These recommendations can serve as a point of reference to promote lean thinking in EDs of other academic hospitals in Lebanon and the region.

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AASCIT Journal of Health


American Association for Science and Technology





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