How Florida Hospital Orlando Used Lean Process to Save Millions of Dollars and Decreased ED Door-to-Door Time

Rationale / Objectives

Long waiting times in an Emergency Department can result in life-threatening risks as well as dissatisfaction for patients. Therefore, the Florida Hospital Orlando wanted to decrease emergency department (ED) door-to-doctor time by 25 percent by December 2008.

Project/Program Description & Major Achievements

Florida Hospital Orlando teamed up with The Institute for Healthcare Improvement’s (IHI’s) Emergency Department Learning and Innovation Community to investigate the current process and implement a better approach by utilizing Lean process. This approach has had a significant impact on the hospital key metrics and has been adopted as their culture. Two years following the implementation of Lean, the hospital saved 5.3 million dollars and increased patient satisfaction by 10%.

Lessons Learned

Florida Hospital Orlando learned that they need to keep track of the process constantly or they would tend to go back to their previous, inefficient approach. Positive results ensued from monitoring the results frequently and making small, regular changes rather than rare, multiple changes. Moreover, communication between staff and senior leadership is very important for reflection during the process and to make future modifications.

Further Description

Florida Hospital Orlando, part of 7 Florida’s hospital system, “is one of the country’s largest not-for-profit health care providers with 22 campuses serving communities throughout Florida” 2. Specifically, the Hospital has one of the largest emergency rooms in the country. Their 62,000-square-foot facility is designed to accommodate 90,000 visits per year. With the large number of patients in ED, the hospital implements the LEAN tracking process to shorten the time for patients to wait in the Emergency Department. This allows patients to move seamlessly from the emergency room to the patient-care area to further checkup 3. In order to apply the change, they initiated the predictive model between ED and staff based on historical statistics of patient visits in four weeks. By doing so, they:

  • Could have more staff for busy days and fewer for days with lower demand.
  • Decreased the lab process to one hour or sooner from order to result.
  • Investigated and eliminated non-valued steps and waste by observing and videotaping processes.
  • Redesigned the staff room and stocking process to eliminate wasted time.
  • Incorporated lean tools into their daily process.
  • Developed a monthly process council to review and discuss among different units regarding action plan and achievement. 4

Major Achievements

Adopting the lean process saved Florida hospital Orlando 5.3 million dollars 5. The result is comparing the metrics before and after implementation Lean process.

Metric Result Additional Detail
Length of stay

Decreased by 2% after 1st ​implementation year

Decreased by 3% after 2nd implementation year

US National Library of Medicine – 
National Institute of Health
(as cited by Dickson et al. 2009)
Patients visits per month

Increased by 9% after 1st implementation year

Increased by 22% after 2nd implementation year

Percent of patients ranking 
overall ED care as “very good"

Increased by 8% after 1st implementation year

Increased by 10% after 2nd implementation year

Admission per month

Increased by 14% after 1st implementation year

Increased by 28% after 2nd implementation year