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Cochrane Database of Systematic Reviews

Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems

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Information

DOI:
https://doi.org/10.1002/14651858.CD012831Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 03 November 2017see what's new
Type:
  1. Intervention
Stage:
  1. Protocol
Cochrane Editorial Group:
  1. Cochrane Effective Practice and Organisation of Care Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Thomas Rotter

    Healthcare Quality Programs, School of Nursing, Queen's University, Kingston, Ontario, Canada

    Healthcare Quality Programs, Queen’s University School of Nursing, Kingston, Canada

  • Christopher T Plishka

    Correspondence to: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada

    [email protected]

  • Lawal Adegboyega

    College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada

  • Michelle Fiander

    Information Specialist, Consultant, Ottawa, Canada

  • Elizabeth L Harrison

    School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Canada

  • Rachel Flynn

    Faculty of Nursing, University of Alberta, Edmonton, Canada

  • James G Chan

    School of Health Sciences, University of Northern British Columbia, Prince George, Canada

  • Leigh Kinsman

    Health, University of Tasmania, Hobart, Australia

Contributions of authors

Conceiving the protocol: TR, CP.

Designing the protocol: TR, CP.

Co‐ordinating the protocol: CP.

Designing search strategies: MF.

Writing the protocol: TR, CP.

Providing general advice on the protocol: LA, MF, EH, RF, JC, LK.

Securing funding for the protocol: TR, LK.

Performing previous work that was the foundation of the current study: TR, LA, MF, EH, RF, JC, LK.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Saskatchewan Health Quality Council, Canada.

    Contract C7036

Declarations of interest

TR: none known.

CP: none known.

LA: none known.

MF: none known.

EH: none known.

RF: none known.

JC: none known.

LK: none known.

Acknowledgements

We acknowledge the help and support of the Cochrane Effective Practice and Organisation of Care Group (EPOC). The review authors would like to thank Julia Worswick (Managing Editor) for continued support and patience. The review authors would also like to thank the following editors and peer referees, who provided comments to improve the protocol: Bonnie Poksinska (External Referee), Christopher Nicolay (External Referee), Jemma Hudson (Statistician), Paul Miller (Information Specialist), and Atle Fretheim (Contact Editor).

National Institute for Health Research support provided via Cochrane Infrastructure funding to the Effective Practice and Organisation of Care Group. The views and opinions expressed therein are those of the review authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS, or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2020 Jan 15

Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems

Protocol

Thomas Rotter, Christopher Plishka, Adegboyega Lawal, Michelle Fiander, Elizabeth L Harrison, Rachel Flynn, James G Chan, Leigh Kinsman

https://doi.org/10.1002/14651858.CD012831.pub2

2017 Nov 03

Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems

Protocol

Thomas Rotter, Christopher T Plishka, Lawal Adegboyega, Michelle Fiander, Elizabeth L Harrison, Rachel Flynn, James G Chan, Leigh Kinsman

https://doi.org/10.1002/14651858.CD012831

Notes

The methods section of this protocol is based on a standard template used by the Cochrane Effective Practice and Organisation of Care Group (EPOC).

Table 1. Names and definitions of frequently used Lean activities

Lean activity

Description

Value stream mapping (VSM)

Visual tool plotting all processes required to deliver a healthcare service. VSM facilitates enhanced understanding of the flow of patients, supplies, or information through a healthcare process (RQHR 2015).

Rapid process improvement workshop (RPIW)

Generally a week‐long event during which teams of patients and their families, staff, and clinicians focus on a single problem, identify the root cause, create solutions, and implement sustainable changes (SHR 2015)

5S events

Stands for ‘Sort, Sweep, Simplify, Standardise, Sustain/Self‐Discipline’; represents a set of concepts that ensure a clean and well‐organised workplace (RQHR 2015)

A3 problem solving

Standardised method of addressing problems utilising an A3 report ‐ a standardised form for planning and report writing. Content follows the plan‐do‐study‐act (PDSA) cycle (A3 Thinking 2015).

Gemba walk

Japanese term that means ‘the workplace’. This term simply refers to the ‘work floor’ or unit where necessary patient care is provided (SHR 2015). Refers to the action of a manager or CEO spending time on the hospital floor and speaking to front‐line staff who understand problems and shortcomings of the organisation (Black 2008)

'Stop the Line' techniques

Derived from manufacturing (specifically, the assembly line); term refers to the act of enabling all healthcare professionals to immediately stop the line (a process of care) when a defect or error is realised. This prevents errors from being passed on and makes causes of errors more salient (JBA 2014).

Levelled production

Refers to elimination of unnecessary variation (unevenness) in health care to avoid bottlenecks and backups, which can lead to patient wait times and wasted time for healthcare professionals (Black 2008). Requires rigorous study of organisational processes and scheduling of patients and clients according to actual or forecasted demand (Black 2008)

Daily visual management (DVM)

System aimed at improving communication and ensuring that information is available when needed. Achieved by displaying objectives, metrics, and progress transparently and using measures (e.g. staff injuries, patient falls) to manage change (RQHR 2015). Closely linked to the wider strategic management system or policy deployment system of an organisation (Black 2008)

Kanban

Just‐In‐Time inventory management system which utilizes visual indicators to limit excess inventory and trigger the acquisition or production of specified goods (Black 2008)

Standard work

Details the steps in a course of treatment or health care in a multi‐disciplinary care plan. Prescribes a uniform way to achieve a desired service or patient outcome based on best available evidence. Serves as the basis for any kind of improvement (RQHR 2015)

DVM: daily visual management.

PDSA: plan‐do‐study‐act cycle.

RPIW: rapid process improvement workshop.

VSM: value stream mapping.

Figures and Tables -
Table 1. Names and definitions of frequently used Lean activities