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Review
. 2021 Jul 10;18(14):7389.
doi: 10.3390/ijerph18147389.

Lean Healthcare Tools for Processes Evaluation: An Integrative Review

Letícia Bianchini de Barros  1 , Letícia de Camargo Bassi  1 , Laura Passos Caldas  1 , Alice Sarantopoulos  2 , Eliete Boaventura Bargas Zeferino  3 , Vinicius Minatogawa  4 , Renata Cristina Gasparino  1
Affiliations
Review

Lean Healthcare Tools for Processes Evaluation: An Integrative Review

Letícia Bianchini de Barros et al. Int J Environ Res Public Health. .

Abstract

Several health services have used lean healthcare to seek continuous improvement of their processes. Therefore, it is important to investigate the evidence available in the literature about the most used lean tools in the health area to review processes and the main results achieved by the researchers. As an integrative literature review methodology was used, it was conducted in five databases, using the descriptor "quality improvement" and the keyword "Lean Healthcare". A total of 33 complete articles were selected for analysis. The most recurrent tools were: define, measure, analyze, improve and control (DMAIC); value stream map (VSM); suppliers, inputs, process, outputs, customers analysis (SIPOC), Ishikawa Diagram and 5S. Through the analysis of waste, different interventions were implemented and the main results achieved were reduction in times (processing, waiting, cycle and total), costs, workload and increase in the number of calls. The findings enabled the identification of the main lean tools used in the health area to achieve better results. In particular, we highlight recent studies that have explored the lean six sigma healthcare approach. The results, in addition to contributing to the literature, will also assist managers in choosing the best tool to achieve continuous improvement in hospitals and other health services.

Keywords: health care; health services; process assessment; quality improvement; total quality management; workflow.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the data collection process adapted from the PRISMA recommendations [18].
Figure 2
Figure 2
Countries where the articles were produced.
Figure 3
Figure 3
Academic fields.
Figure 4
Figure 4
Locations where tools were applied.
Figure 5
Figure 5
Study designs adopted by researchers.
Figure 6
Figure 6
Main tools used by the articles included.
Figure 7
Figure 7
Graph of the main results obtained from the included studies.
See this image and copyright information in PMC

References

    1. Arruda N.M., Maia A.G., Alves L.C. Inequality in access to health services between urban and rural areas in Brazil: A disaggregation of factors from 1998 to 2008. Cad. Saude Publica. 2018;34 doi: 10.1590/0102-311X00213816. - DOI - PubMed
    1. Malta D.C., Bernal R.T.I., Lima M.G., de Araújo S.S.C., da Silva M.M.A., de Freitas M.I.F., de Barros M.B.A. Noncommunicable diseases and the use of health services: Analysis of the National Health Survey in Brazil. Rev. Saude Publica. 2017;51:1S–10S. doi: 10.1590/s1518-8787.2017051000090. - DOI - PMC - PubMed
    1. Radnor Z.J., Holweg M., Waring J. Lean in healthcare: The unfilled promise? Soc. Sci. Med. 2012;74:364–371. doi: 10.1016/j.socscimed.2011.02.011. - DOI - PubMed
    1. Henrique D.B., Godinho Filho M. A systematic literature review of empirical research in Lean and Six Sigma in healthcare. Total Qual. Manag. Bus. Excell. 2020;31:429–449. doi: 10.1080/14783363.2018.1429259. - DOI
    1. Marodin G., Frank A.G., Tortorella G.L., Netland T. Lean product development and lean manufacturing: Testing moderation effects. Int. J. Prod. Econ. 2018;203:301–310. doi: 10.1016/j.ijpe.2018.07.009. - DOI

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