BackgroundQuality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients’ value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities.MethodsA systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian’s model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered.ResultsOf the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing.ConclusionsFor a final conclusion about Value Stream Mapping’s effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review’s conclusion, the limitation of including heterogeneous and potentially biased results has to be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0563-y) contains supplementary material, which is available to authorized users.

ZusammenfassungDas Forschungsfeld der organisationsbezogenen Versorgungsforschung ist in Deutschland noch relativ jung und von zunehmendem Interesse. Das Deutsche Netzwerk Versorgungsforschung e. V. (DNVF e. V.) hat im Jahr 2009 – getragen von den im DNVF organisierten Fachgesellschaften und Mitgliedern – eine Vertiefung zu „Methoden der organisationsbezogenen Versorgungsforschung“ des Memorandums III, Teil 1 konsentiert [1]. Ausgehend von dieser Veröffentlichung und dem gegenwärtigen Bedeutungsgewinn des Forschungsfeldes ist eine Weiterentwicklung der konzeptionellen und methodischen Grundlage erforderlich. Die Neuauflage und Erweiterung der Veröffentlichung aus dem Jahr 2009 gliedert sich in 3 Kapitel: (1) Definition und Konzept der organisationsbezogenen Versorgungsforschung, (2) Methodische Ansätze der organisationsbezogenen Versorgungsforschung: Zielgrößen, Datenquellen, Datenerhebung, und Datenanalyse, (3) Methodische Ansätze zur Konzeption, Evaluation und Implementierung komplexer Interventionen in Versorgungsorganisationen. Ziel des dritten Kapitels ist es, Methoden für das Design von Interventionen, für die Wirkungs- und Wirksamkeitsforschung sowie für die Implementierungsforschung unter besonderer Berücksichtigung des organisationalen Kontextes, in dem Versorgungsinterventionen stattfinden, vorzustellen.

ZusammenfassungDas Forschungsfeld der organisationsbezogenen Versorgungforschung ist von zunehmender Bedeutung. Ausgehend von der Vertiefung zu Methoden der organisationsbezogenen Versorgungsforschung des Memorandums III, Teil 1 aus dem Jahr 2009 werden die weiterentwickelten Standards und Grundlagen zusammengefasst. Das Memorandum behandelt die theoretische Rahmung, grundlegende Methodenansätze und Methoden zur Konzeption, Evaluation und Implementierung komplexer Interventionen in Versorgungsorganisationen.

Background Discharge management is a central task in hospital management. Mitchell's quality health outcomes model offers a contextual framework to derive expectations about the relationship between indicators of hospital structures and processes with patient experiences of preparation for discharge. Purpose The aim is to analyze the association between hospital structures and processes with patient experiences of preparation for discharge in breast cancer centers. Methodology The data were collected between February 1 and July 31, 2014–2016, with annual cross-sectional postal surveys on patient experiences of preparation for discharge in breast cancer center hospitals in Germany. These data were combined with secondary data on hospital structures, obtained from structured quality reports 2014 and the accreditation institution certifying breast cancer centers, constituting a hierarchical data structure. A total of 10,750 newly diagnosed breast cancer patients from 67 hospitals were analyzed. Following listwise deletion, 9,762 patients could be included in linear hierarchical regression analyses. Results Patients felt better prepared for discharge in hospitals that communicate the discharge date timely to patients, with good coordinative processes, and which cooperate with two other breast cancer center hospitals. Hospital structures, size, teaching status, and ownership were not associated with the patient experiences of preparation for discharge. Conclusion The results suggest that timely and informative communication, well-organized care processes, and the network structure of centers allow for an improvement of preparation for discharge. Current and future approaches for the improvement of hospital discharge should consider the identified hospital resources. Practice Implications Hospital management should increase the focus on structured communication and coordination processes to improve the discharge process. Cooperating networks should be expanded to increase expertise and resources. Results can be generalized to other care domains with caution. Patients' characteristics should further be assessed in order to use resources efficiently.

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