Implementation of lean in health care environments: an update of systematic reviews

Purpose – Even though the implementation of Lean in healthcare environments is relatively recent, it has been receiving a lot of attention in recent years. Partly due to the fact that it is a recent field of practice and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this article aims to systematically review the implementation of Lean tools and techniques applied to hospital organizational areas in a 5-year period, between 2014 to 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified. Methodology - As starting point for this systematic literature review, a set of selected pre-existing review publications was used to support the current work and as the ground base for the expansion of the studies about Lean Healthcare. The current study contemplated 114 articles from a 5-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas. Findings - The thorough analysis of selected articles show a lack of works in Continuous Improvement approaches when compared to the application of work organization, visual management, and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations, are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives, and strive to promote cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement. Originality – The current work develops a new perspective of the articles published under the thematic of Lean Healthcare, published in a recent period of 5 years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of Lean Healthcare, exposing the current trends, improvements and also the main gaps.This work has been supported by FCT–Fundação para a Ciência e Tecnologia within the R&D Units Project Scope UIDB/00319/2020 and project POCI-01-0145-FEDER-03029