The Definitive Guide to Emergency Department Operational Improvement

In a unique and integrated approach, The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the "No Wait" Department exposes you to the academics behind managing the complex service environment that is the ED. The book combines applied management science and ED experience to create a model of how to improve your emergency department operations.

After summarizing the current state of emergency medicine, the book offers an in-depth presentation of Lean tools used in the ED along with basic and advanced flow principles grounded in queuing theory and the theory of constraints. It then shows how these concepts are applied in the emergency department and why they work, supported by a comprehensive case study in which Lean principles were used to transform an underperforming ED into a world-class operation.

The authors highlight three commonly referenced intervals in the ED: door to doc (input), doc to disposition (throughput), and disposition to departure (output). After reviewing best practices, the authors explain how to achieve excellence in your own environment by discussing change management, leadership, dealing with resistance, and other critical elements of creating a culture of change. Under any scenario realized by healthcare reform, this book provides the tools and concepts to improve your ED for patients, staff, the organization, and ultimately, society.

About the Authors:

Joseph T. Crane, MD, MBA is one of the nation’s leading experts in emergency department (ED) operations. He is an emergency physician practicing at Mary Washington Hospital in Fredericksburg, Virginia. In addition to his clinical responsibilities, from 2002 to 2009, he served as the business director of his group, Fredericksburg Emergency Medical Alliance. In 2004, he graduated from the Physician Executive MBA Program (PEMBA) at the University of Tennessee, where he is currently an adjunct professor teaching physician-led operations improvement.

Dr. Crane’s work focuses on innovative approaches to ED and hospital-wide operational and patient flow improvement, specifically addressing the application of Lean manufacturing concepts within the healthcare environment. He also specializes in leadership and change management for operational and clinical improvement. Dr. Crane is an emergency medicine faculty member of The Institute for Healthcare Improvement. His company, X32 Healthcare, teaches and consults with organizations on process improvement using Lean applications. Through these engagements, Dr. Crane has worked with hundreds of EDs from around the world on adopting innovations in the delivery of emergency care. He has taught and worked in a wide variety of settings in the United States, Canada, Europe, South America, and the Middle East, including courses or sessions at The University of Tennessee, The University of Kansas, George Mason University, and Harvard University.

Charles E. Noon, PhD

is a professor of management science in the College of Business at the University of Tennessee. He is a founding member of the highly ranked Physician Executive MBA Program and continues to teach in the program. He holds a PhD in industrial and operations engineering from the University of Michigan. His teaching interests include operational improvement, business modeling, simulation, and decision analysis and support. His applied research concerns computer-based models and process improvement, and his papers in these areas have appeared in Interfaces, Journal of Healthcare Management, and Networks and Spatial Analysis.

Dr. Noon also teaches in the full-time MBA program, the Management Science PhD program, and various nondegree executive education programs, including a new offering entitled Lean for Healthcare. He is the recipient of numerous teaching awards and serves as a teaching mentor for junior faculty. To stay current, he periodically consults with hospitals on process improvement, capacity planning, and staff scheduling.