A healthy dose of lean Hotel Dieu Grace Hospital used value stream mapping and other lean techniques to transform its emergency room, and now it is looking for even deeper changes, as Keith Regan reports. Not long ago, the emergency room at Hotel Dieu Grace Hospital (HDGH) in Windsor, Ontario, was a study in inefficiency. Given its downtown location and proximity to the border, the ER can be a very chaotic place. Patients endured long waits to be seen by doctors and nurses and often became angry as a result.