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Background Many management tools, such as Discrete Event Simulation (DES) and Lean Healthcare, are efficient to support and assist health care quality. In this sense, the study aims at using Lean Thinking (LT) principles combined with DES to plan a Canadian emergency department (ED) expansion and at meeting the demand that comes from small care centers closed. The project‘s purpose is reducing the patients’ Length of Stay (LOS) in the ED. Additionally, they must be assisted as soon as possible after the triage process. Furthermore, the study aims at determining the ideal number of beds in the Short Stay Unit (SSU). The patients must not wait more than 180 min to be transferred. Methods For this purpose, the hospital decision-makers have suggested planning the expansion, and it was carried out by the simulation and modeling method. The emergency department was simulated by the software FlexSim Healthcare®, and, with the Design of Experiments (DoE), the optimal number of beds, seats, and resources for each shift was determined. Data collection and modeling were executed based on historical data (patients’ arrival) and from some databases that are in use by the hospital, from April 1st, 2017 to March 31st, 2018. The experiments were carried out by running 30 replicates for each scenario. Results The results show that the emergency department cannot meet expected demand in the initial planning scenario. Only 17.2% of the patients were completed treated, and LOS was 2213.7 (average), with a confidence interval of (2131.8–2295.6) min. However, after changing decision variables and applying LT techniques, the treated patients’ number increased to 95.7% (approximately 600%). Average LOS decreased to 461.2, with a confidence interval of (453.7–468.7) min, about 79.0%. The time to be attended after the triage decrease from 404.3 min to 20.8 (19.8–21.8) min, around 95.0%, while the time to be transferred from bed to the SSU decreased by 60.0%. Moreover, the ED reduced human resources downtime, according to Lean Thinking principles.

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This study presents the use of a serious game developed to teach Lean philosophy. The structure of this game was built from theoretical elements and predefined learning events. Learning outcomes and student motivation were considered in the evaluation of the efficacy of the game. This serious game was applied to four groups of students with different profiles. The evaluation results were compared among these groups of students. It can be concluded that the serious game developed showed positive results in learning and motivation demonstrated by the students, regardless of the group analyzed. The main contributions to the literature presented in this article were the serious game (named 3L) that was developed and the efficacy evaluation method, considering the learning and motivation demonstrated in different profiles of students.