Purpose The purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process. Design/methodology/approach A survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED. Findings The results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times. Research limitations/implications The research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process. Originality/value This research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.

中文翻译：

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使用精益策略来增强急诊室（ED）的患者流量-客户的综合声音和过程视角的声音

目的本文的目的是从客户的声音（VOC）和过程的声音（VOP）的角度系统地研究医院急诊科（ED）的患者流量和等待时间问题，并提出一种新的ED精益框架处理。设计/方法/方法进行了一项调查以更好地了解患者对ED服务的看法，使用精益工具（例如过程映射和A3问题解决表）来识别隐藏的过程废物，并进行了根本原因分析以确定原因。在ED中等待时间长。结果结果表明，急诊的漫长等待时间是患者的主要问题，并影响急诊服务的质量。据透露，床位有限，无法提供必要的人员，急诊室的布局，患者之间对紧急服务性质的了解不足是造成延误的主要原因。使用精益工具结合VOC和VOP观点解决这些问题，可以改善患者流量，提高患者满意度并提高ED能力。提出了未来价值流图，以简化ED活动并最大程度地减少等待时间。研究的局限性/含意该研究涉及单个案例中相对较小的样本。提议的方法将使ED管理员能够避免ED过度拥挤并简化整个ED过程。原创性/价值这项研究从VOC和VOP的角度确定了ED质量问题，并提出了合适的精益工具来克服这些问题。