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This article has been cited by other articles in PMC. Abstract Background Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits.
Research on the application and implementation of lean principles in health care has been limited.
The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases.
All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed.
In addition, we will also include cohort, case—control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality low- versus high-quality studies and the reported types of implementation in the primary studies.
We will present the results of studies in a tabular form. Discussion Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol.
As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. Systematic review registration Keywords: Lean, Systematic review, Health care, Toyota management system Background Lean is a set of operating philosophies and methods that help create maximum value for patients by reducing waste and waits [ 1 ].
It aims to fundamentally change organization thinking and value, which ultimately leads to the transformation of organization behaviour and culture over time [ 2 ]. Recently, the health care industry has demonstrated success in applying these principles in the United States, United Kingdom, Australia and now Canada [ 4 ].
Despite indications that lean is prevalent in health care, many authors regard its implementation to be pragmatic, patchy and fragmented [ 5 ]. The application of lean management in health care can also be holistic such as the transformation of an overall business strategy [ 26 ].
Although lean thinking originated from car making, research on its application and sustainability in health care is still limited [ 7 ].
Primary studies often lack appropriate concepts explicitly stated, research designs, appropriate analysis and outcome measures [ 7 ].
The majority of studies also reported on successful lean interventions, whereas little has been documented about the failed attempts or barriers to its implementation in health care [ 7 ]. It is therefore imperative to catalogue and synthesize the existing literature via a systematic review on the effects of lean implementation especially the potential effects on professional practice and health care outcomes in various settings.
Review questions and objectives The primary review question is as follows: What are the effects of lean management in health care on professional practice and health care outcomes? The secondary review questions are as follows: What can we learn from the existing evidence on lean to better understand the various methodologies used and the experience in evaluating the impact?
What are the differences in lean implementation, and can we explain how those differences might lead to different outcomes? Criteria for considering existing publications for this review The systematic review will include all relevant studies according to the review questions and objectives. We will apply the electronic search strategy to identify all primary studies reporting on the effectiveness of lean and the different strategies used for implementation.
We will extract and collate all of the concepts used to describe lean, how it is applied and the activities involved in the implementation process. We will not include editorial reports, animal studies, lean applications in other industries, teaching and investigations using self-reported outcomes.
In addition, we will also consider cohort or panel longitudinal studies, case—control studies and relevant non-comparative publications such as case reports.
A case report is a document that provides details about how a study was conducted and its subsequent findings. A panel study is a longitudinal study in which variables are measured on the same units over time. The approach was originally derived from the Toyota car company production line system: The majority of lean investigations published in the international literature refer to the Toyota management system as applied to health care [ 11 - 18 ].
Lean application in Saskatchewan In Saskatchewan, the Toyota lean management system is used in combination with a strategic management and policy deployment system, called Hoshin Kanri [ 25 ], and daily visual management.
Daily visual management is an approach where staff members take the time each day to evaluate their progress using the key elements of daily huddles and visibility walls.
Types of implementation strategy reported Varying terms and Japanese terminologies are used to describe the lean implementation strategies.Lean thinking begins with driving out waste so that all work adds value and serves the customer’s needs.
Identifying value-added and non-value-added steps in every process is the beginning of the Going Lean in Health Care IN. 5 IN IN. Aug 19, · Development, theory and application of lean thinking to health care. Lean thinking evolved from a tool designed to improve operational shop-floor performance at an automotive manufacturer to a management approach with both operational and sociotechnical aspects.
By combining Lean thinking and six sigma (SS), lean six sigma (LSS) is a well-known methodology for providing a powerful process improvement solution. Thinking Lean in a hospital setting involves considering the definition of value from a patient's perspective and putting in place efficient clinical changes to provide valuable care.
A Lean Discharge Case Study. Waiting to be discharged from the hospital is frustrating for patients and costly for hospitals. At the University of Michigan Medical Center in Ann Arbor, the discharge process was taking too long, according to Christopher Kim, MD, a hospitalist there. The paper also delves into the five steps of Lean and describes each step in-depth and includes techniques, example worksheets, and materials that can be used during the overall analysis and implementation process.