Sustainable care quality improvement: a scoping literature review of performance measurement in lean healthcare implementations

Abstract

Background: The phenomenon of demographic changes and the aging population requires Territorial Ambulatory Healthcare (TAH) to provide increasingly high-quality and sustainable care to a growing number of individuals with chronic diseases. In this context, Healthcare Lean Management (HLM) can support sustainable care quality, increasing patient satisfaction and process performance. According to the literature, a significant barrier to sustainability is the limitation of monitoring systems for process performance. For this reason, this study aims to provide a comprehensive overview of the most pursued improvement objectives, performance measurement indicators, and data collection tools and techniques of HLM implementations within TAH.

Methods: Following the PRISMA protocol, a scoping literature review was conducted to investigate the linkages among improvement objectives, performance measurement indicators, and data collection tools and techniques.

Results: The current study provides valuable insights into the performance measurement indicators that should be adopted according to the specific improvement objectives. It highlights that measuring and monitoring are essential activities but often overlooked in HLM projects, negatively affecting the effectiveness of this managerial approach in terms of sustainability over time.

Conclusions: The final results demonstrate how research about performance measurement systems in HLM projects is still in its early stages, both from a theoretical and empirical perspective. The current research enriches the knowledge about the theme and provides managerial support to the journey of territorial care services toward sustainable care quality.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-025-13598-5.

Fig. 1

Research protocol

Fig. 2

Descriptive analysis of the literature

Fig. 3

Quality improvement objectives

Fig. 4

Ambulatory visit time indicators definition

Fig. 5

Care quality improvement objectives and data collection tools