Pull processes in health care: a systematic literature review

Abstract

The lean production paradigm was first adopted by the automobile industry and has been progressively adapted and adopted by several other sectors. Health services are, in general, co-created by users. This poses a logical challenge when applying one of the principles of the lean production paradigm: the establishment of pulled processes. This article investigates how pull processes have been adapted for lean production in healthcare (lean healthcare). A bibliometric analysis of 267 articles on lean healthcare research, published between 2004 and 2021, is presented in this article. A qualitative review of 233 articles is also presented. Most articles presented in this study were published after 2012, and publications and citations are primarily from the US, Brazil, and the UK. 39 articles pertain to an application of the concept, but most of the articles refer to pulling intermediate products, which are not subject to the aforementioned logical challenge. Only 8 articles effectively discuss the pulling of the flow of users. The main conclusion is that pulling has a distinct objective when applied to health care: the goal is not exactly the elimination of queues (the equivalents of intermediate stocks) but the elimination of idleness in downstream resources with limited capacity.