Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda

Abstract

Background Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists. Methods We systematically searched the Pubmed, Scopus, and Web of Science databases to identify original articles reporting benchmarking on different contextual levels in Lean healthcare and critically appraised the articles. Scarcity and heterogeneity of articles prevented quantitative meta-analyses. We developed a new, widely applicable conceptual framework for benchmarking drawing on the principles of ten commonly used healthcare quality frameworks and four value statements, and suggest an agenda for future research on benchmarking in Lean healthcare. Results We identified 22 articles on benchmarking in Lean healthcare on 4 contextual levels: intra-organizational (6 articles), regional (4), national (10), and international (2). We further categorized the articles by the domains in the proposed conceptual framework: patients (6), employed and affiliated staff (2), costs (2), and service provision (16). After critical appraisal, only one fifth of the articles were categorized as high quality. Conclusions When making evidence-informed decisions based on current scarce literature on benchmarking in healthcare, leaders and managers should carefully consider the influence of context. The proposed conceptual framework may facilitate performance benchmarking and spreading best practices in Lean healthcare. Future research on benchmarking in Lean healthcare should include international benchmarking, defining essential factors influencing Lean initiatives on different levels of context; patient-centered benchmarking; and system-level benchmarking with a balanced set of outcomes and quality measures.

Lean adoption, implementation, and outcomes in public hospitals: benchmarking the US and Italy health systems

“…There is growing interest in cross-national comparative benchmarking studies of Lean [ 14 , 28 ] that also recognize differences in each countries healthcare systems. This work is among the first to meet this need.…”

“…This paper provides a theoretical framework based on three main dimensions aiming to investigate the relationship of a system-wide approach to the adoption and implementation of Lean with its achievements. These include: the maturity of adoption (concerning how much Lean management is diffused within hospital units, the timing since it has been implemented by the hospital and Lean self-reported maturity); the implementation approach (concerning the methodologies, principles and techniques used, the people involved and the operations mechanisms), identifying both strategic and operational activities and tools; and the Lean performance, investigated through 15 self-reported achievements grouped in four main areas [ 14 ]: patients, employed and affiliated staff, costs and service provision . …”

“…the Lean performance, investigated through 15 self-reported achievements grouped in four main areas [ 14 ]: patients, employed and affiliated staff, costs and service provision .…”

“…Despite the growing interest in transformational performance improvement among nearly all countries [ 1 ], benchmarking has rarely been used at an international level, even though it could be useful to expand knowledge in the field [ 14 ]. Cross-comparative research could allow an appreciation of the extent of Lean’s use in healthcare and a better evaluation of possible cultural influences on Lean adoption and implementation [ 15 ].…”

Building learning organizational culture during COVID-19 outbreak: a national study

“…As the government is under heavy transition periods by the new health leadership, it is expected the funding portion is flipped within decades [5,28]. As a result of each provision having different entities and priorities, a chasm now may exist between knowledge and practice within each entity [29].…”