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Case Study 1


Like many UK hospitals during the Winter months of 2009/10, intense operational pressure led to an urgent focus upon improving patient flow in A&E. A one day improvement event took place in February 2010 to look at patient flow in A&E and how it might be improved in line with the NHS target of 98% of patients to be treated or discharged within 4 hours.

SimLean Educate was used to assist the workshop in making informed decisions about how to structure resources to promote better patient flow. The intense pressure faced by medical consultants, doctors and nurses meant that many people had their own ideas about how the process should be changed and thus the simulation provided a vehicle for considering the impact of such changes in line with the principles of Lean Thinking thereby avoiding the application of 'knee jerk' changes to the system that may not have the desired impact.

SimLean Educate

SimLean Educate was used to demostrate the impact of three specific learning points:

  1. The impact of reduced staff availability (non-dedicated resources);

  2. The impact of prioritising certain patients upon patient flow.

  3. The impact of adding an additional decision making unit to the A&E process upon patient flow.

SimLean Educate employed the hospital's own patient arrival data however it was found that the data retreival process was problematic and the credibility of the data (even though it came from the hospital's own information systems), was a source of continuing distraction. Following this event it was decided that in order for the workshop to focus on improving patient flow, it would be far better to use a 'generalised' process i.e. using average or even hypothetical data that is credible but not precise, thus focussing attention on the principles of flow and how to improve it.

  • SimLean Educate was successful in engaging all workshop participants, particularly medical consultants were reportedly 'switched on' and a considered discussion around the nature of the process itself took place
  • As a result of these lessons the need to take a systems view of A&E was acknowledged by all.