Lean interventions in healthcare: do they actually work? A systematic literature review

Abstract

PurposeLean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs.Data sourcesWe conducted a systematic literature review of Medline, PubMed, Cochrane Library, CINAHL, Web of Science, ABI/Inform, ERIC, EMBASE and SCOPUS.Study selectionPeer reviewed articles were included if they examined a Lean intervention and included quantitative data. Methodological quality was assessed using validated critical appraisal checklists. Publically available data collected by the Saskatchewan Health Quality Council and the Saskatchewan Union of Nurses were also analysed and reported separately.Data extractionData on design, methods, interventions and key outcomes were extracted and collated.Results of data synthesisOur electronic search identified 22 articles that passed methodological quality review. Among the accepted studies, 4 were exclusively concerned with health outcomes, 3 included both health and process outcomes and 15 included process outcomes. Our study found that Lean interventions have: (i) no statistically significant association with patient satisfaction and health outcomes; (ii) a negative association with financial costs and worker satisfaction and (iii) potential, yet inconsistent, benefits on process outcomes like patient flow and safety.ConclusionWhile some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings.

Rolling-out Lean in the Saskatchewan Health Care System: Politics Derailing Policy

“…A recent systematic review of Lean initiatives in health found little evidence of quality improvement overall and singled out Saskatchewan's experience as costing far more to implement than was achieved in savings (Moraros, Lemstra and Nwankwo 2016).…”

Pharmacist Clinical Process Improvement: Applying Lean Principles in a Tertiary Care Setting

“…A systematic review of 22 studies using Lean processes, with quantitative data for health outcomes, process outcomes, or both health and process outcomes, did not show statistically significant results, although the data were too diverse for a meta-analysis. 17 Nonetheless, the authors found that there was no association between Lean methods and patient satisfaction or health outcomes. 17 Also, there might have been a negative association with costs and employee satisfaction.…”

“…17 Nonetheless, the authors found that there was no association between Lean methods and patient satisfaction or health outcomes. 17 Also, there might have been a negative association with costs and employee satisfaction. 17 Finally, the review showed inconsistent benefits in terms of patient flow and safety.…”

“…17 Also, there might have been a negative association with costs and employee satisfaction. 17 Finally, the review showed inconsistent benefits in terms of patient flow and safety. 17 Another systematic review of 7 literature reviews summarized the implementation of Lean methods in acute care and their impact, 18 suggesting that Lean principles are better suited to linear processes.…”

“…17 Finally, the review showed inconsistent benefits in terms of patient flow and safety. 17 Another systematic review of 7 literature reviews summarized the implementation of Lean methods in acute care and their impact, 18 suggesting that Lean principles are better suited to linear processes. Of note, the quality of the evidence included was rated as poor to fair, which is a common limitation in studying the impact of Lean projects.…”