Lean management approach in hospitals: a systematic review

Purpose: In the recent few years, the Lean management has made significant improvements in providing quality service to patients in many health-care centers. Thus, this study aims to systematically review features and results of conducted studies using a lean management approach in hospitals. Design/methodology/approach: In this systematic review, eight databases, including PubMed, Web of Knowledge, Google Scholar, Scopus, Iranmedex, SID, Magiran and Medlib, were searched using keywords including “Lean principles,” “Lean Six Sigma,” “Lean Process SID,” “Lean thinking,” “Lean Methodology,” “Toyota Production System lean processing,” “lean techniques” and “hospital,” as well as their Persian equivalents. Required data were extracted using an extraction table and were analyzed using content analysis method. Findings: Out of 967 identified articles, 48 articles were included in the study. Most of the studies have been conducted in developed countries such as America, Britain, The Netherlands and Canada. The highest number of studies has been conducted in the overall hospital and emergency departments. Lean Six Sigma and Lean methodology were the most frequent terms used for lean management. The five-phase Six Sigma methodology was one of the most important methods used for the implementation of the Lean management. Performing the process at the first time (timing) and length of stay had the highest frequencies among indicators assessed in the studies. All indicators assessed in the studies have improved after the implementation of Lean management. Among 150 assessed indicators, 69 were meaningfully improved (p< 0.05) and 12 indicators did not have a meaningful improvement (p> 0.05) and 69 indicators did not show any meaningful changes. Practical implications: A number of implications are drawn out to aid academics, practitioners and policymakers in improving knowledge and skills. The elimination of production wastes is the most important principle of Lean thinking and paying attention to the clients and increasing the value. This will significantly improve quality of services to the patients and reduce costs and losses through preventing wastes. Suitable metrics in Lean management need to be established. A move to placing greater emphasis on understanding the contexts in which theory is implemented is another application. Research/limitation: The limitation of this study is selection of studies in English and Persian language, excluding gray literatures and unpublished studies and relying on a relatively limited number of databases for the identification of potentially eligible studies. In addition, because of the enormous heterogeneity in the methods and results of the studies, performing a meta-analysis in this study was not possible. Originality/value: The results of this study show that there were many dispersions and heterogeneities in the way of implementation and content of Lean management in hospitals.