Lean healthcare: scale, scope and sustainability

Abstract

Purpose Lean healthcare is highlighted in the literature as an approach to quality improvement and operational efficiency. The purpose of this paper is to study how Lean healthcare has been implemented by analyzing empirical outcomes. Design/methodology/approach The authors used a literature review as the primary research method, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses process. Peer-reviewed journals were analyzed – searching for Lean healthcare implementation, tools used, wastes addressed, outcomes and sustainability. Findings Evidence suggests that Lean can improve healthcare operational effectiveness. However, empirical studies show implementation is still highly localized with small successes. Most transformations are focused on implementing one or two Lean tools that primarily target patient waiting times and there is minimal evidence about sustainability. Establishing clear definitions for healthcare-related Lean terminology may improve practice, especially episodic care and service quality. Originality/value This work provides a Lean healthcare case review. The research makes a significant contribution to Lean healthcare by increasing understanding (scale, scope and sustainability). From a theory building perspective, the authors suggest that barriers to adoption include a common healthcare-specific Lean terminology, and a need to expand implementation beyond small successes. This understanding will help identify key areas for further research in Lean healthcare management.

Lean thinking in total nursing care for mechanically ventilated patients: A new concept in ICU

“…Tool 2: Critical care nurses' self-report about waste during total care of mechanically ventilated patients This tool was developed by the researchers after reviewing the related literature. [3,19] This tool allows critical care nurses to report wastes in the following care categories; direct, indirect, personal and unit related care activities while caring for MVPs. A scale of 'Yes' or 'No' was utilized by nurses.…”

“…The indirect patients' care practices performed away from them, including giving reports, communication with the team, gathering supplies, preparing equipment, and seeking consultation. [2,3] Direct and indirect care together with other practices such as unit related practices and personal practices are occupying the time the critical care nurses spend with MVPs. [3] Therefore, it is necessary to assign all the resources within the care process according to time and demand [4] and exclude any intervention provides no-value for MVPs to get the optimum value of all care practices, decreasing the mechanical ventilation and intensive care units (ICUs) beds occupation rate and the total cost of ICU stay.…”

“…[2,3] Direct and indirect care together with other practices such as unit related practices and personal practices are occupying the time the critical care nurses spend with MVPs. [3] Therefore, it is necessary to assign all the resources within the care process according to time and demand [4] and exclude any intervention provides no-value for MVPs to get the optimum value of all care practices, decreasing the mechanical ventilation and intensive care units (ICUs) beds occupation rate and the total cost of ICU stay. [5,6] In an effort to standardize competency of the care for MVPs, new care concepts have been proposed to ICU community to maximize the value of technical and non-technical components of patients' care.…”

“…Excessive stocks; related to increasing cost, due to use of spaces, stocks, or supplies, over-processing; is the efforts that have no contribution in achieving the outcomes of the health care services to MVPs, such as unnecessary duplication of certain procedures and wasted talent; in which the waste is presented as inappropriate use of human abilities (physical, cognitive, or creative). [3,11] Mura is another type of waste which means unevenness. Unevenness is presented when there is more work than the staff or equipment can handle, or when there is a lack of work.…”

Lean task boards in healthcare, an improvement tool for tidying up the local chaos and promote professionalism

“…According to a review by de Souzas [12], we lack studies that have a critical perspective on the use of lean tools in healthcare. There is also a lack of qualitative case studies that investigate how lean tools, such as the lean task board are implemented and used [13]. In addition, we need to understand how the use of these tools may promote action learning among line managers and employees that will result in new practices [2].…”