• Leahora Rotteau, Fiona Webster, Erin Salkeld, Chelsea Hellings, Astrid Guttmann, Marian J Vermeulen, Robert S Bell, Merrick Zwarenstein, Brian H Rowe, Amit Nigam, Michael J Schull, and ED Investigator Team.
• The Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.
• Acad Emerg Med. 2015 Jun 1;22(6):720-9.

ObjectivesIn recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure.MethodsA qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed.ResultsTwenty-four interviews were coded and analyzed. The results are organized according to participants' experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project.ConclusionsSeveral key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the development and implementation of future similar interventions in health care settings could be useful.© 2015 by the Society for Academic Emergency Medicine.

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