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  1. Feldman, Sue S. PhD, MEd, RN
  2. Kennedy, Kierstin Cates MD, MSHA, FACP, SFHM
  3. Nafziger, Sarah M. MD, MSHA
  4. Orewa, Gregory N. MSc, MBA, LNHA
  5. Kpomblekou-Ademawou, Enyonam LSSGB
  6. Hearld, Kristine Ria PhD
  7. Hall, Allyson G. PhD


Background: Delayed discharges can be a systemic issue. Understanding the systemic factors that contribute to discharge inefficiencies is essential to addressing discharge inefficiencies.


Purpose: This article reports on a Lean Six Sigma approach and the process to identifying inefficiencies and systemic barriers to early discharge in a large US academic medical center.


Methods: A qualitative methodology guided this project. In particular, direct observation methods were used to help the project team identify factors contributing to discharge inefficiencies.


Results: Overall, findings suggest that establishing consistent multidisciplinary team communication processes was a contributing factor to reducing the inefficiencies around discharges. On a more granular level, key barriers included disparate communication systems, disruptors (specifically Kaizen bursts), and unique role challenges.


Conclusions: This article provides a framework for addressing discharge inefficiencies. Because the output of the process, a critical contributor to the overall outcome, is often not analyzed, this analysis provides value to others contemplating the same or similar process toward discharge efficiency.