Lean bundles in health care: a scoping review

Leveraging Kaizen with Process Mining in Healthcare Settings: A Conceptual Framework for Data-Driven Continuous Improvement

Background/Objectives: Healthcare systems face persistent challenges in improving efficiency, optimizing resources, and delivering high-quality care. Traditional continuous improvement methodologies often rely on subjective assessments, while data-driven approaches typically lack human-centered adaptability. This study aims to develop an integrated framework combining Kaizen principles with Process Mining capabilities to address these limitations in healthcare process optimization. Methods: This research employed a structured literature review approach to identify key concepts, methodologies, and applications of both Kaizen and Process Mining in healthcare settings. The study synthesized insights from the peer-reviewed literature published in the last two decades to develop a conceptual framework integrating these approaches for healthcare process improvement. Results: The proposed framework combines Kaizen's employee-driven approach to eliminating inefficiencies with Process Mining's ability to analyze workflow data and identify process deviations. The integration is structured into four key phases: data collection, process analysis, Kaizen events, and continuous monitoring. This structure creates a feedback loop where data-driven insights inform collaborative problem-solving, resulting in sustained improvements validated through objective process analysis. Conclusions: The integration of Kaizen and Process Mining offers a promising approach to enhancing workflow efficiency, reducing operational errors, and improving resource utilization in healthcare settings. While challenges such as data quality concerns, resource constraints, and potential resistance to change must be addressed, the framework provides a foundation for more effective process optimization. Future research should focus on empirical validation, AI-enhanced analytics, and assessing adaptability across diverse healthcare contexts.

What are barriers and facilitators in sustaining lean management in healthcare? A qualitative literature review

BACKGROUND

Lean management (LM) is a continuous improvement methodology originating from manufacturing and is widely adopted in healthcare to improve processes. LM shows promising results in healthcare and research on the topic is increasing. However, it can be difficult to sustain LM over time, and an overview of facilitators or barriers that influence the sustainment of LM in a healthcare context is unavailable.

METHODS

Prior to search, five inclusion and exclusion criteria were defined to establish suitability of identified articles for our research question. This study was based on 24 selected peer-reviewed studies that reported on the sustainment of LM in healthcare organisations, published in the last five years. Following the Preferred Reporting Items for Systemtic Reviews and Meta-Analyses (PRISMA) guidelines, all articles were scanned, retrieved for full-text and analysed thematically.

RESULTS

Following thematic analysis, we identified four overarching themes: Mobilising Employees, Guiding Change Efforts, Methods, and Local Context. Key facilitators for supporting LM are fostering an improvement culture and learning culture, providing professional development opportunities, assigning more responsibilities to employees in decision making processes and appointing change agents to act as local LM leaders. Key barriers for sustaining LM include overburdening employees with responsibilities, omitting staff involvement during LM implementation, lack of patient engagement, lack of resources to engage with LM, a lack of leadership commitment and follow-up on projects, and a lack of knowledge of LM among leaders.

CONCLUSION

Overall, studies emphasise the importance of actively involving and engaging the workforce to embed LM into organisational culture. Reflecting on the origins of LM, healthcare organisations can find inspiration in the virtue of respecting people in their journey to sustain and cultivate an improvement culture. LM provides potential to change healthcare for the better and could help healthcare organisations to cope with increasing external pressures.

Large scale healthcare facility redevelopment: A scoping review

Internationally, organisations are undertaking large scale facility redevelopment as a strategy for the transformation of care systems. Redeveloping facilities provides a once in a generation opportunity to transform health service delivery, typically, however, system level changes are poorly understood. To address this gap, our aim was to investigate the empirical knowledge base regarding large scale redevelopment of healthcare facilities. A scoping review was undertaken, guided by the redeveloped health service management (HSM) scoping review framework (HSM-SRF). Across 17 articles, five key concepts were identified, and they form the principles for successful redevelopment. First, establish a strong governance framework integrating diverse expertise and evidence base. Second, engage with internal and external stakeholders to build effectual relationships. Third, consult with end users, including clinicians and patients, to encourage the acceptance of the redevelopment and actively manage stakeholder dynamics, including politics and power undercurrents. Fourth, commit appropriate resources, including time, workforce, technology and finance to ensure redevelopment success. Finally, reimagine workflows through consultation with end users, including staff and consumers, allowing them to conceptualise how the space will be utilised. This scoping review is the first to synthesise the empirical knowledge base of the redevelopment of healthcare facilities.

The influence of soft and hard TQM on quality performance and patient satisfaction in health care: investigating direct and indirect effects

PURPOSE

The present study conceptualizes total quality management (TQM) in terms of soft and hard aspects and examines their effects on quality performance and patient satisfaction. The indirect effects of soft and hard TQM on patient satisfaction through quality performance are also investigated.

DESIGN/METHODOLOGY/APPROACH

A multi-item questionnaire was prepared to gather primary data from a sample of 312 medical employees in private hospitals in Jordan. The measurement model was evaluated for validity and reliability and determined to be acceptable. Structural equation modeling (SEM) was applied to test the research hypotheses.

FINDINGS

The results revealed that soft TQM has a strong positive effect on quality performance and patient satisfaction. Hard TQM was found to positively affect quality performance but to a lesser extent compared to soft TQM. The effect of hard TQM on patient satisfaction, meanwhile, was not significant. Quality performance positively mediated the relationship between TQM - both soft and hard - and patient satisfaction.

ORIGINALITY/VALUE

This study is one of the first to conceptualize TQM in terms of soft and hard aspects in a health care context. It offers valuable insights for managers of private hospitals looking to enhance quality performance and patient satisfaction. The results reveal that soft TQM is the primary driver of quality performance and patient satisfaction in the health care context, which is in stark contrast to the manufacturing sector.

A framework to guide the implementation of lean management in emergency department

PURPOSE

The paper aims at enriching the knowledge of the application of lean management (LM) in emergency department (ED), structuring the methodology for implementing LM projects and summarizing the relevant dimensions of LM adoption in ED.

DESIGN/METHODOLOGY/APPROACH

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature review has been performed, extracting a database of 34 papers. To answer the research purpose, a descriptive and content analyses have been carried out.

FINDINGS

The descriptive analysis demonstrates that the dealt topic is worldwide emerging and multidisciplinary as it arouses interest by medical and engineering communities. Despite the heterogeneity in the adopted methodology, a framework can be grasped from the literature review. It points out the phases and activities, the tools and techniques and the enablers to be considered for guiding the developing of LM project in ED.

ORIGINALITY/VALUE

This paper provides a comprehensive overview on how to adopt LM in ED, contributing to fill in the gap emerged in the literature. From a practical perspective, this paper provides healthcare managers with a synthesis of the best managerial practices and guidelines in developing a LM project in ED.

Sustainable human resource planning for hospitals in tier 2/3 cities: evidence from India

Purpose

To evolve sustainable practices for human resource planning (HRP) for hospitals being set up in Tier 2/3 cities in India. The purpose of this study is to determine the strategic challenges are faced by hospitals in Tier 2/3 cities. To align HRP/workforce planning to departmental strategic/business planning of the hospital in the defined context. To address the dilemmas of the prospective health-care workforce in Tier 2/3 cities.

Design/methodology/approach

The integrated methodology adopted uses the grounded approach for building theory from practice. Due to the lack of research in the identified context, the study relies on a review of literature related to health-care practices, HRP and general management inputs to evolve the exact interview questionnaire. The subsequent empirical analysis is based on interviews of niche human resource experts in private hospitals.

Findings

The traditional and successful model of private hospitals in the metro cities cannot be transplanted to the Tier 2/3 cities. The thumb rule on a ratio between the doctors, paramedic staff, nurses and other support staff requires to be modified as necessary. Uncertainty in the new context requires the outlook to be basic, uncomplicated, flexible and agile. Attracting and recruitment strategies require adopting an innovative and multipronged approach. Sourcing high-end specialists need not follow the retainership model of employment.

Practical implications

The need to penetrate health-care services to the Tier 2/3 cities within India cannot be disputed. With the increase in disposable income and standard of living in these cities, access to quality and affordable health care is also imperative. The study is a pioneering effort to suggest a practicable and uncomplicated model for hospital setup in the identified context, with a focus on HRP.

Originality/value

This paper offers novel perspectives to the HRP of health-care personnel for a hospital setup in Tier 2/3 cities in India. For the success of private hospitals and their financial viability, this planning is of utmost importance. There is an attempt to fill the knowledge gap in the context which has been rarely explored or ventured. In addition, the policy initiatives suggested are expected to encourage the growth of private hospitals within the Tier 2/3 cities in India.

Pharmacy service factors and pharmacy performance: the role of patient satisfaction in community pharmacies

Purpose

This study aims to examine the effects of pharmacy service factors (namely, medication teaching, service promptness, pharmacist attitudes, medication supply and pharmacy location) on patient satisfaction with community pharmacies in Jordan and to explore the effect of patient satisfaction on pharmacy performance.

Design/methodology/approach

Descriptive analytical methodology, with a quantitative approach using survey strategy was applied. The study population represented the whole population of Jordan (2.033 million households). Data were collected using an online questionnaire. A convenient quota sample of 1,000 respondents was targeted; 502 valid questionnaires were returned, representing an effective response rate of 50.2%. The study hypotheses were tested using path analysis.

Findings

The results showed that the service factors contributing most significantly to patient satisfaction in Jordan are medication supply, pharmacist attitudes, medication teaching and service promptness, in descending order of influence. Meanwhile, the effect of pharmacy location on patient satisfaction proved to be insignificant. In addition, patient satisfaction proved to have a highly positive impact on pharmacy performance.

Originality/value

This study addresses a debatable issue in the literature regarding the influence that pharmacy service factors can have on patient satisfaction. In addition, to the best of the researchers’ knowledge, this is the first study to explore the proposed effects in Jordan. It is also one of the first to investigate the effect of patient satisfaction on community pharmacy performance.

Access to surgical care as an efficiency issue: using lean management in French and Australian operating theatres

PURPOSE

Millions around the world still cannot access safe, timely and affordable surgery. Considering access as a function of efficiency, this paper examines how the latter can be improved within the context of operating theatres. Carried out in France and Australia, this study reveals different types of waste in operating theatres and a series of successful tactics used to increase efficiency and eliminate wastefulness.

DESIGN/METHODOLOGY/APPROACH

Data for this qualitative study were collected through 48 semi-structured interviews with operating theatre staff in France (n = 20) and Australia (n = 28). Transcripts were coded using a theory-driven thematic analysis to characterise sources of waste in operating theatres and the tactics used to address them.

FINDINGS

The study confirmed the prominence of seven types of waste in operating theatres commonly found in industry and originally identified by Ohno, the initiator of lean: (1) underutilised operating rooms; (2) premature or delayed arrival of patients, staff or equipment; (3) need for large onsite storage areas and inventory costs; (4) unnecessary transportation of equipment; (5) needless staff movements; (6) over-processing and (7) quality defects. The tactics used to address each of these types of waste included multiskilling staff, levelling production and implementing just-in-time principles.

ORIGINALITY/VALUE

The tactics identified in this study have the potential of addressing the chronic and structurally embedded problem of waste plaguing health systems' operating theatres, and thus potentially improve access to surgical care. In a global context of resource scarcity, it is increasingly necessary for hospitals to optimise the ways in which surgery is delivered.

The impact of lean management on frontline healthcare professionals: a scoping review of the literature

BACKGROUND

Lean management practices are increasingly used in hospitals. However, their impacts on staff have not been systematically synthesised. This scoping review aims to synthesise the evidence on the effects of Lean Management practices on frontline healthcare professionals.

METHODS

A search was conducted in February 2020 on multiple databases to identify relevant sources. Studies had to satisfy the following inclusion criteria to be considered: published in English or French, peer-reviewed, empirical, studied the use of Lean in a healthcare setting and focused on its impacts on frontline workers. The studies included were heterogeneous in terms of participants. Findings were coded and classified using a thematic analysis. The quality and methodological rigour of the reviewed articles were assessed to establish a level of confidence in their findings.

RESULTS

Of 998 identified articles, 17 were included in the review. The findings were coded into four themes: (1) Morale, motivation and job satisfaction (n = 9, 2) work intensification, job strain, anxiety, stress and dehumanisation (n = 7, 3) teamwork, communication and coordination (n = 6); and (4) learning, innovation and personal development (n = 3). Overall, the articles reported positive (n = 11), negative (n = 3) and mixed (n = 3) impacts of Lean on frontline healthcare professionals.

CONCLUSION

This review is the first to synthesise and highlight the gaps in the existing literature examining the impacts of Lean on frontline health professionals. The review revealed a range of both positive, negative and mixed effects, and points to the need for more empirical research to identify the underlying reasons leading to these outcomes.

Lean management in health care: a review of reviews of socio-technical components for effective impact

PURPOSE

The aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study is to contribute to the advancement of knowledge by investigating which main socio-technical factors are considered to be effective for the implementation and management of lean initiatives.

DESIGN/METHODOLOGY/APPROACH

A systematic review of literature reviews on lean management in health care was conducted. The components of the socio-technical system are identified by moving from the socio-technical drivers that support organization-wide quality improvement practices and the lean implementation process in health care. The impacts of lean management are classified using the internal processes, patient, learning and financial dimensions.

FINDINGS

The 28 reviews retrieved confirm the current and increasing interest in lean management. While more than 60% of them call for a system-wide approach, system-wide implementations have rarely been observed, and, instead, adoption in isolated units or departments, or the use of single techniques and tools, prevails. The most commonly investigated socio-technical components are organizational structure, techniques and tools and organizational culture and strategic management. Significant impacts are reported for all the four dimensions. Nonetheless, the review reveals that there is still a lack of evidence on the sustainability of lean results and a need for a standardized impact measurement system.

ORIGINALITY/VALUE

This work stands out as the first review of reviews of how the socio-technical components of the lean management approach obtain positive impacts within the patient, internal processes, learning and financial dimensions.

The Role of Value Stream Mapping in Healthcare Services: A Scoping Review

Lean healthcare aims to manage and improve the processes in the healthcare sector by eliminating everything that adds no value by improving quality of services, ensuring patient safety and facilitating health professionals' work to achieve a flexible and reliable organization. Value Stream Mapping (VSM) is considered the starting point of any lean implementation. Some papers report applications of VSM in healthcare services, but there has been less attention paid to their contribution on sustainability indicators. The purpose of this work is to analyze the role of VSM in this context. To do so, a scoping review of works from recent years (2015 to 2019) was done. The results show that most applications of VSM reported are in the tertiary level of care, and the United States of America (USA) is the country which leads most of the applications published. In relation with the development of VSM, a heterogeneity in the maps and the sustainability indicators is remarkable. Moreover, only operational and social sustainability indicators are commonly included. We can conclude that more standardization is required in the development of the VSM in the healthcare sector, also including the environmental indicators.

Kaizen-Kata, a Problem-Solving Approach to Public Service Health Care in Mexico. A Multiple-Case Study

Purpose: Mexico's public hospitals are experiencing major operational problems which seriously affect the care of Mexican citizens. Some hospitals have initiated efforts to apply the Kaizen philosophy to improve this situation. Therefore, the purpose of this article is to analyze the methodological impact of Kaizen-Kata implementation in Mexican public hospitals that have tried to solve operational problems using this improvement approach. Design/Methodology/Approach: The service organization implemented Kaizen-Kata methodology in order to improve one operational problem-process in health care. A case-study approach was used in this research in order to understand the effects of the Kaizen-Kata methodology in solving problems in their operational procedures. Findings: Six specific drivers were identified when applying the Kaizen-Kata methodology. Furthermore, the impact on the levels of implementation of the Kaizen-Kata methodology in each of the improvement teams studied was also identified. Research Limitations: The main limitation of the research is that only three case-studies are presented thus it is not possible to generalize its results. Practical Implications (Where Possible): Other public hospitals can use this specific example as a working guide to solve the operational problems of health systems. Originality/Value: A methodology of continuous improvement in manufacturing was imported from the industry sector for application in an operational health care process. The Kaizen-Kata methodology contributed significantly to improving issues involving delays, customer complaints, process reworks and extra-cost, among other effects of operational problems.

The relationship between quality and governance mechanisms

Purpose

Recent literature has highlighted the importance of quality and governance in supply networks. Usually, the relationships between the actors are complex, comprising both formal and informal interactions. Despite recent advances in quality and governance in supply networks, extant literature highlights the lack of quality in healthcare supply-chain networks in relation to governance mechanisms. This paper aims to investigate the role of governance mechanisms and their influence on the quality of healthcare supply networks, and assumes that governance instruments can support quality performance.

Design/methodology/approach

A multiple-case research approach was employed. Six organisations in the Brazilian healthcare sector were analysed (four operate only with renal replacement therapy, one is a material supplier, and one operates with renal replacement therapy and collective procurement).

Findings

Findings showed that there is no formalised supply network structure in these organisations. A possible consequence of this is that the supply-network governance is dominated by informal relationships. In the quality dimension, managers' awareness is limited, but there are mechanisms in place to control the quality of the materials.

Practical implications

Healthcare managers can actively invest in the social aspects of the relationship between buyer and supplier, such as trust and commitment, thus increasing responsiveness in patient care. However, this informal procedure can lead to problems with tracking and reliability, ultimately leading to quality problems. Therefore, it is recommended that formal and informal governance instruments be used jointly to improve service quality.

Originality/value

This study suggests that the integration of formal and informal mechanisms of governance can improve the quality of supply networks. Additionally, if the administrative process is purely formal, network relationships and their efficiency will be impaired.