This study demonstrates that integration of the voice of the customer, the voice of the process and the A3 Problem Solving Sheets provides an effective Lean tool to identify and eliminate waste in EDs. The appropriate integration of fundamental factors, engaged frontline workers, long-term leadership obligations, an understanding of patients’ requirements and the implementation of Lean strategies could continuously improve patient flow, healthcare service and growth in the ED. This study illustrates the benefits of integrating the concept of Lean tools in the identification of areas that can be improved by eliminating waste in order to achieve superior healthcare operations in practice. Some critical success factors in installing a successful