What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review

Abstract

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization’s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

Why industrial methods do not work in healthcare: an analytical approach

“…For example, it is proposed that lean management techniques from Toyota will improve the efficiency of healthcare provision, and that the crew resource management from the aviation industry may lead to improvement of safety. 2,3 In healthcare, lean is expected to result in decreased costs, enhanced safety and improved quality of care. 1 The original aim of lean was to ensure defect-free manufacturing while minimising waste and addressing customer needs.…”

“…It is believed that the similarities between car industry and aviation on the one hand and healthcare on the other hand are sufficiently large to justify cross learning. 2 The aviation industry is known for its high safety standards. 2 Nowadays, lean is defined most frequently as 'an integrated socio-technical system, whose main objective is to eliminate waste by concurrently reducing or minimising, supplier, customer and internal variability'.…”

“…2 The aviation industry is known for its high safety standards. 2,10,11 As possible reasons for this evidence gap, it is argued that though there are several similarities, there are also essential differences between healthcare organisations and other industries and businesses, such as providing a service that directly affects life and death, and legal requirements to stabilise patients and provide charity care. 4 Nowadays, the application of aviation-based team training and simulation training has been applied in various healthcare disciplines and settings.…”

“…1 The original aim of lean was to ensure defect-free manufacturing while minimising waste and addressing customer needs. 2 Nowadays, lean is defined most frequently as 'an integrated socio-technical system, whose main objective is to eliminate waste by concurrently reducing or minimising, supplier, customer and internal variability'. 2,3 In healthcare, lean is expected to result in decreased costs, enhanced safety and improved quality of care.…”

“…2 Nowadays, lean is defined most frequently as 'an integrated socio-technical system, whose main objective is to eliminate waste by concurrently reducing or minimising, supplier, customer and internal variability'. 2,3 In healthcare, lean is expected to result in decreased costs, enhanced safety and improved quality of care. 2 The aviation industry is known for its high safety standards.…”