Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems
Appendices
Appendix 1. MEDLINE search strategy
NOTE on strategy: The following search strategy will be edited and updated for our review, to ensure all lean concepts are included. We will also add methodological filters.
Ovid MEDLINE(R) In‐Process & Other Non‐Indexed Citations and Ovid MEDLINE(R) <1946 to Present> Run 2014
1 ((total quality or quality assurance or quality improvement) adj3 lean).ti,ab. (23)
2 (think lean or lean thinking).ti,ab. (83)
3 (lean adj3 (workflow? or efficienc$ or efficient$)).ti,ab. (92)
4 (lean and (approach or business model? or care or collaborat$ or design$ or enterpri?e or healthcare or health care or implementation? or industry or initiative? or intervention$ or leader$ or management or methodolog$ or method? or organi?ation$ or plan or planning or philosophy or practice or practices or principles or principle or process improvement? or production or program? or programme or programmes or quality or redesign$ or reengineer$ or restructur$ or reorgani$ or safety or sigma or strategy or strategies or thinking or tool or tools or workshop$)).ti. (509)
5 (organi?ation$ adj5 lean).ab. (39)
6 (lean adj2 (approach or business model? or care or collaborat$ or design$ or enterpri?e or healthcare or health care or implementation? or industry or initiative? or intervention$ or leader$ or management or methodolog$ or plan or planning or philosophy or practice or practices or principles or principle or process improvement? or production or program? or programme or programmes or quality or redesign$ or reengineer$ or restructur$ or safety or sigma or strategy or strategies or thinking or tool or tools or workshop$)).ab. (568)
7 (lean and (admitting or clinic or clinics or emergency department? or emergency medicine or emergency room? or emergency service? or family practice? or general practice? or healthcare or health care or hospital? or hospitali?ed or inpatient? or intensive care or ICU or "length of stay or nursing" or oncology or outpatient? or patient care or pharmacist? or pharmacy or practitioner? or physician? or readmission? or surgeon? or surgery or surgical or trauma center? or trauma centre? or trauma service? or trauma care or ward or wards)).ti. (221)
8 (lean adj4 (admitting or clinic or clinics or emergency department? or emergency medicine or emergency room? or emergency service? or family practice? or general practice? or healthcare or health care or hospital? or hospitali?ed or inpatient? or intensive care or ICU or "length of stay or nursing" or oncology or outpatient? or patient care or pharmacist? or pharmacy or practitioner? or physician? or readmission? or surgeon? or surgery or surgical or trauma center? or trauma centre? or trauma service? or trauma care or ward or wards)).ab. (176)
9 (((PDSA or PDCA or TQIS) adj3 (cycle or process or processes or intervention or quality or lean or improv$)) or ("plan do study" or "plan do check")).ti,ab. (418)
10 (Lean and waste).ti. or (lean adj3 waste).ab. (18)
11 ((wait$ time? or reduc$ wait$) and lean).ti. or ((wait$ time? or reduc$ wait$) adj4 lean).ab. (6)
12 (lean and (overcrowd$ or patient$ flow? or wait time?)).ti,ab. (53)
13 (lean technique? or lean manufacturing).ti,ab. (55)
14 (lean basics or lean training).ti,ab. [added Feb 20] (3)
15 ((lean adj7 5s) or (5s adj3 (event? or method? or methodolog$ or model? or process or processes or safety or waste or quality))).ti,ab. (102)
16 ((a3 adj3 (healthcare or health care or problem solving or quality improv$ or workflow? or method? or methodology or process or processes)) or A3 thinking or (a3 adj3 lean)).ti,ab. (65)
17 toyota.ti,ab. (182)
18 (gemba or Kaizen or kanban).ti,ab. (64)
19 (innovation? adj2 collaborat$).ti,ab. (95)
20 (PROCESS MAP? or process mapping).ti,ab. (213)
21 (mistake proofing or value‐stream map? or incident learning).ti,ab. (43)
22 Pareto diagram?.ti,ab. (18)
23 ((shewhart or shewart or deming) adj3 (cycle or method$)).ti,ab. (90)
24 process failure‐mode‐and‐effects‐analysis.ti,ab. (2)
25 (breakthrough adj3 (series or project or collaborative?)).ti,ab. (148)
26 rapid process improvement?.ti,ab. (8)
27 (rapid cycle adj3 (improvement or quality or process or processes)).ti,ab. (76)
28 quality improvement? tool?.ti,ab. (225)
29 (six sigma or 6 sigma).ti,ab. (398)
30 or/1‐29 [Set 1] (2964)
31 (bibliography or biography or editorial or lectures or news or newspaper article).pt. (737304)
32 animals/ not (animals/ and humans/) (3909440)
33 30 not (or/31‐32) [Set 1] (2687)
34 remove duplicates from 33 (2660)
| 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. | |
