Objectives: To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. Methods: A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. Results: Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. Conclusions: According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/ staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.

Purpose The purpose of this paper is to empirically investigate the effect of a set of contextual variables on the implementation of lean supply chain (LSC) practices. The authors do that by investigating one main research question: “how do the contextual variables (i.e. plant size, supply chain level, level of onshore suppliers and age of the LM initiative) influence on the degree of adoption of LSC practices?” Design/methodology/approach To this end, the authors collected data from 115 companies from different sectors located in Southern Brazil. Data collected was analyzed by means of multivariate techniques. The authors tested if the frequency of observations for each contextual variable was associated to the implementation levels of the LSC practices. Findings The evidences suggest that supply chain context significantly impacts the likelihood of implementing LSC practices. In particular, the influence of tier level, plant size and larger experience in implementing LM seems to be substantial across a wide mix of practices. On the other hand, results indicate that contexts in which companies are still beginners at the lean journey and their level of onshore suppliers appear to be less pervasive than previous empirical researches imply. Originality/value The implementation of LSC practices entails a different business model, in which improved profits arise from the cooperation rather than bargaining or imposing power over supply chain partners. However, not all organizations should implement the same set of practices, since the adoption of any specific management practice depends upon a set of contextual variables. The understanding of the relationship between the level of adoption of LSC practices and the contextual variables helps to anticipate occasional difficulties and sets the proper expectations along the implementation.

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Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.

PurposeThe objective of this research is twofold. First, we aim at identifying the pairwise relationships between Lean Production (LP) practices and Industry 4.0 (I4.0) technologies. Second, based on these results, we propose a framework for Lean Automation (LA) implementation, in which I4.0 technologies are integrated into LP practices.Design/methodology/approachTo achieve that, a cross-sector survey was performed with 147 manufacturers that are undergoing a LP implementation aided by novel information and communication technologies from I4.0. Multivariate data analysis was applied in order to underpin the proposed framework for LA.FindingsFindings indicate that I4.0 technologies are positively correlated with LP practices, providing evidence to bear the proposition of a LA framework that can potentially overcome traditional barriers and challenges of a LP implementation.Originality/valueAs previous studies have approached LA implementation from a narrow perspective or including a limited set of LP practices and I4.0 technologies, the proposition of an integrated framework unfolds a wider range of synergistic implementations that may corroborate to a holistic approach for continuous improvement in the Fourth Industrial Revolution era.