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. 2023 Sep 7;11(18):2488.
doi: 10.3390/healthcare11182488.

How to Use Lean Thinking for the Optimization of Clinical Pathways: A Systematic Review and a Proposed Framework to Analyze Pathways on a System Level

Joanna R G Vijverberg  1   2   3 , Marc B V Rouppe van der Voort  4 , Paul B van der Nat  3   5 , Machteld J Mosselman  4 , Sander Rigter  6 , Douwe H Biesma  7   8 , Frits van Merode  1   2
Affiliations

How to Use Lean Thinking for the Optimization of Clinical Pathways: A Systematic Review and a Proposed Framework to Analyze Pathways on a System Level

Joanna R G Vijverberg et al. Healthcare (Basel). .

Abstract

Lean Thinking and clinical pathways are commonly used concepts to improve healthcare. However, little is known on how to use Lean Thinking for the optimization of pathways or the quantification of both concepts. This study aims to create a framework to analyze pathways with Lean Thinking on a system level, by quantifying the seven wastes, flow and pull. A systematic literature review was performed. Inclusion criteria were the focus of the article on a well-defined group of patients and studied a pathway optimization with Lean Thinking. Data were extracted on measured outcomes, type of intervention and type of researched pathway. Thirty-six articles were included. No articles described the implementation of the Lean Thinking philosophy or studied the development of their people and partners ("4 P" model). Most articles used process optimization tools or problem-solving tools. The majority of the studies focused on process measures. The measures found in the review were used as input for our suggested framework to identify and quantify wastes, flow, and pull in a clinical pathway. The proposed framework can be used to create an overview of the improvement potential of a pathway or to analyze the level of improvement after an enhancement is introduced to a pathway. Further research is needed to study the use of the suggested quantifications.

Keywords: clinical pathway; improvement potential; lean thinking; quantification.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram with review decision process [15].
Figure 2
Figure 2
Total number of published articles per year.
Figure 3
Figure 3
Example of a clinical pathway with different trajectories and steps.
Figure 4
Figure 4
Zoom of Figure 3 with three steps as an example of variables measured per step.
Figure 5
Figure 5
Legend of symbols used in Figure 3 and Figure 4.
See this image and copyright information in PMC

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