Emergency department (ED) overcrowding and long wait times are major concerns in health systems the world over. Many ED-focused innovations – such as revising staff mix, improving internal processes and exploiting decision-support software – have been implemented to address these complex problems, often with limited success. Beginning in 2008, St. Michael's Hospital in Toronto, which had some of the most challenging ED overcrowding and longest wait times in Ontario, has charted a different course. By taking an organization-wide corporate approach to the challenge of patient flow throughout the hospital, St. Michael's has significantly improved key ED flow metrics for both its admitted and non-admitted patients.