A Cluster-Controlled Trial of a Lean Management System Redesign on Emergency Department Throughput and Clinician Burnout

Abstract

Background: Emergency departments frequently face operational inefficiencies such as overcrowding, prolonged patient waiting times, and workflow fragmentation. These pressures not only affect patient throughput but also contribute to psychological strain and burnout among clinicians. Lean management, a process improvement framework focused on eliminating waste and optimizing workflow, has increasingly been adopted in healthcare settings to address these challenges. However, evidence evaluating its simultaneous impact on operational efficiency and clinician well-being remains limited, particularly in real-world emergency department environments. Objective: To evaluate the effect of a Lean management system redesign on emergency department throughput indicators and clinician burnout levels. Methods: A randomized controlled trial with department-level allocation was conducted over four months in emergency departments within the Islamabad–Rawalpindi healthcare region. Departments were randomly assigned to either a Lean management intervention or standard operational practice. A total of 72 clinicians, including physicians, nurses, and clinical officers, participated in the study. Operational efficiency outcomes included waiting time to physician assessment, total emergency department length of stay, and rate of patients leaving without being seen. Clinician burnout was assessed using the Maslach Burnout Inventory–Human Services Survey. Data were collected at baseline and post-intervention, and statistical analyses were performed using independent and paired t-tests, analysis of variance, and Pearson correlation analysis. Results: Emergency departments implementing Lean-based workflow redesign demonstrated significant improvements in operational performance. Mean waiting time to physician assessment decreased from 41.6 ± 9.3 minutes to 28.7 ± 7.4 minutes, while average department length of stay declined from 196.4 ± 34.5 minutes to 158.2 ± 30.6 minutes. The proportion of patients leaving without being seen also decreased. Clinicians in intervention groups reported lower emotional exhaustion scores (22.6 ± 6.3) compared with those in control groups (26.4 ± 6.5). Shorter patient waiting times were moderately associated with reduced burnout levels. Conclusion: Lean management system redesign improved both operational efficiency and clinician well-being within emergency department settings, suggesting that structured workflow optimization may contribute to more sustainable and supportive healthcare environments. Keywords: Burnout, Emergency Service Hospital, Health Care Quality Improvement, Lean Management, Patient Flow, Professional Burnout, Workflow.