Do Lean Practices Lead to More Time at the Bedside?

Abstract

The aim of this review is to evaluate the application of value-added processes in healthcare, with an emphasis on their effects on bedside nursing. Literature relevant to Lean methodology and inpatient care was reviewed, excluding all research related to other service lines (i.e., surgical services, emergency services, laboratory, radiology, etc.). Increased value is also an important tenet of transforming care at the bedside (TCAB), an initiative launched by the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF). Therefore, articles concerning TCAB were also included in this review. A systematic study of the literature revealed varied applications of Lean principles in practice, ranging from the implementation of a single tool, to full organizational restructuring. All articles reviewed reported positive results, although the majority lacked strong supporting evidence for claims of improvement. Even though there is some indication that the application of Lean principles to nursing processes is successful in improving specific outcomes, the authors cannot conclude that the implementation of Lean methodology or TCAB greatly influences direct patient care, or increases time spent at the bedside.

Effects of organizational context on Lean implementation in five hospital systems

“…These covered external and intraorganizational setting of the reported organization-wide initiative and noted details on one or more Lean projectsVincluding the aims and methods used in these focused improvement efforts, supporting implementation processes, and results. After this survey, we examined published syntheses of peer-reviewed research on Lean through 2013 (Brackett, Comer, & Whichello, 2013;DelliFraine, Langabeer, & Nembhard, 2010;Glasgow, ScottCaziewell, & Kaboli, 2010;Holden, 2011;Mazzocato, Savage, Brommels, Aronsson, & Thor, 2010;Nicolay, 2012;Vest & Gamm, 2009) and individual papers with abstracts indicating that the paper contained details on implementation setting and processes, as well as outcomes.…”

Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol)

“…We will categorize articles based on three types of studies as suggested by a previously published literature review on lean management in hospitals [29]. The three article types are as follows: (1) articles that discuss the application of lean principles and are based only on the experience or general knowledge of the authors, (2) empirical articles based on actual case studies or research related to the application of lean principles and (3) literature reviews related to lean processes [29]. The reason for excluding retrieved full text studies will be stated in the final review.…”

Efficient, Compassionate, and Fractured:Contemporary Care in the ICU

“…Churchill and Schenck's second healing skill involves taking time. However, for physicians to be present and take a certain block of time to form a relationship with patients or their families, would take precious time away from the curative focus on technically complex cases, and, according to a disconcerting 2011 report by Tiffany Brackett and colleagues, the drive to maximize efficiency and save time in the ICU does not seem to translate into more time spent with families and patients or into compassionate care . As noted, the drive to make the ICU more streamlined and efficient for the purposes of time and cost savings has been influenced by modern management strategies developed in the automotive manufacturing industry.…”

“…Several recent studies have questioned whether lean approaches add any value at all along this domain of care. Turning again to the work of Brackett and colleagues, we have some evidence about the impact of lean practices in the clinical context . After a thorough review of the literature discussing lean practices and bedside patient care—2,105 articles—the authors reported that “value‐stream mapping” (that is, detailed evaluation of processes to distinguish value‐added steps and wasteful steps), as well as significant relocation and reorganization of supplies, had resulted in increased productivity and improved patient safety.…”