Byline: Sue S. Feldman, Department of Health Service Administration (Drs Feldman, Hearld, and Hall, Mr Orewa, and Ms Kpomblekou-Ademawou), UAB Hospital Medicine (Dr Kennedy), University of Alabama at Birmingham; Department of Emergency Medicine, University of Alabama at Birmingham Medical Center (Dr Nafziger); and Tenet Healthcare, Dallas, Texas (Ms Kpomblekou-Ademawou).; Kierstin Cates Kennedy; Sarah M. Nafziger; Gregory N. Orewa; Enyonam Kpomblekou-Ademawou; Kristine Ria Hearld; Allyson G. Hall Abstract 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.