A large community hospital with over 100,000 emergency visits annually was challenged with reducing their patient waiting times, and decided to make some critical changes to their process in order to care for their patients. The hospital was certain that the lack of space was the primary cause of the problem, as all exam rooms and the waiting areas were occupied during peak times. This study was conducted to understand the relationships between current operational practices, patient volumes and flow of patients through the different areas of the emergency department. The team first approached the study by understanding the operational processes in the emergency department. Through the use of Lean design principles, observational study, and other methods such as data analysis and operational modeling, the research team identified opportunities that would improve operations and flow with minimal construction costs.