Implementation of lean in health care environments: an update of systematic reviews

Abstract

Purpose Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that it is a recent field of practise and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this study aims to review the implementation of lean tools and techniques applied to hospital organizational areas in a five-year period, between 2014 and 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified. Design/methodology/approach As starting point for this systematic literature review (SLR), a set of selected pre-existing review publications was used to support the current study and as the ground base for the expansion of the studies about lean health care. The current study contemplated 114 articles from a five-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas. Findings The thorough analysis of selected articles show a lack of works in continuous improvement approaches when compared to the application of production organization methods, visual management and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives and strive to promote the cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement. Originality/value The current study develops a new perspective of the articles published under the thematic of lean health care, published in a recent period of five years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of lean health care, exposing the current trends, improvements and also the main gaps.

Improving hospital operations management to reduce ineffective medical appointments

“…The intention of using the Lean approach on all organization sectors emerged on the 1990s with the term "Lean enterprise" (LE), and this concept encompasses the use of Lean approaches from the manufacturing sector to the whole organization, including service processes (Womack & Jones, 1994, p. 93). Womack & Jones (1994) Lean philosophy can provide vast benefits when implemented holistically and instructed as a mutually beneficial strategy (Hallam & Contreras, 2018;Waring & Bishop, 2010); however, such approaches are missing in hospital operations management (Lima et al, 2020). Anyhow, the waste reduction approach can be applied independently in order to make progress in terms of organizational culture with the aim of implementing the Lean philosophy or even with the intention of maximizing the use of available resources.…”

A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center

“…These and other authors [ 10 , 20 , 22 ], have also indicated that the application of each tool depends on the real situation in which the organization or company finds itself, as experts in the field do not agree when it comes to identifying them, classifying them, and proposing their scope of application. These tools can be used independently or in conjunction with other tools (e.g., process diagram, Ishikawa diagram, spaghetti diagram) not necessarily related to production process improvement in themselves, but that are equally useful for the development of the Lean philosophy and that serve the continuous improvement of the organization.…”

Modeling, Assessment and Design of an Emergency Department of a Public Hospital through Discrete-Event Simulation

“…Both labour law codes, as well as the potential conflict between management and workers, may make it impossible to adopt lean government policies [8]. Nevertheless, the health sector has been demonstrating a great capacity to adapt to the principles of the philosophy originated in Toyota in what can called lean healthcare, which is a very recent concept [9]. To advocate a management policy based on lean healthcare concepts means a constant search to provide improved patient services using a lower number of resources.…”

“…The exact beginning of the application of the lean healthcare concept is somewhat diffuse, however pioneering work stands out [11], where the author transports productive technology to the hospital context in order to reduce inventories. Since then, multiple publications have appeared in the scientific community [9], addressing several applications of different Lean tools in healthcare services, such as the application of SMED techniques to reduce the setup time of an operating room [12], the application of performance indicators such as the overall equipment effectiveness of operating rooms [13], or the application of the methodology 5S in a hospital establishment [14]. Research in lean healthcare has been growing almost exponentially; however, according to Proudlove et at.…”

“…Research in lean healthcare has been growing almost exponentially; however, according to Proudlove et at. [15] and D'Andreamatteo et al [16], lean healthcare is still in an early stage of development, with countless opportunities yet to be explored [9].…”