Purpose

Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that it is a recent field of practise and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this study aims to review the implementation of lean tools and techniques applied to hospital organizational areas in a five-year period, between 2014 and 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified.

Design/methodology/approach

As starting point for this systematic literature review (SLR), a set of selected pre-existing review publications was used to support the current study and as the ground base for the expansion of the studies about lean health care. The current study contemplated 114 articles from a five-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas.

Findings

The thorough analysis of selected articles show a lack of works in continuous improvement approaches when compared to the application of production organization methods, visual management and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives and strive to promote the cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement.

Originality/value

The current study develops a new perspective of the articles published under the thematic of lean health care, published in a recent period of five years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of lean health care, exposing the current trends, improvements and also the main gaps.

中文翻译：

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在医疗保健环境中实施精益：系统评价的更新

目的

尽管在医疗保健环境中实施精益生产是相对较新的，但近年来它已引起了很多关注。部分原因是因为它是最近的实践和研究领域，部分原因是该领域开发的作品数量迅速增长，因此重要的是经常更新有关该研究领域的观点。因此，本研究旨在回顾在2014年至2018年的五年期间，将精益工具和技术应用于医院组织领域的实施情况，以补充一些已经发表的最相关的评论。评估和量化了最重要的标准，例如工具，方法和原则，干预的医院区域，改进和困难。

设计/方法/方法

作为此系统文献综述（SLR）的起点，使用了一系列选定的既有综述出版物来支持当前的研究，并为扩展有关精益医疗保健的研究奠定了基础。本研究从2014年至2018年的五年期间共纳入114篇文章。对其中58篇文章的一部分进行了严格评估，以了解精益工具和方法在不同医院领域的应用。

发现

与生产组织方法，视觉管理以及诊断和问题解决工具的应用相比，对选定文章的透彻分析表明，在持续改进方法方面缺乏工作。报告的改进结果表明符合精益哲学的原理和基础，但是这些结果是单独提出的，并且没有长期维护的有力证据。此外，该研究表明，涉及医院区域精益实施的文章数量在不断发展，但在绝大多数情况下，此类文章报告了在不同领域中孤立的实施情况，并未向全球组织推广。因此，一些主要建议是需要对患者，药物和材料的完整流动进行研究，

创意/价值

当前的研究为最近五年出版的以精益医疗为主题的文章开辟了新的视角，但其他著作并未完全涵盖这些文章。此外，它以创新的方式明确应用了一种方法，该方法使用一组先前的评论作为此SLR的起点。通过这种方式，它整合了来自不同SLR的方法和类别，从而创建了可供未来研究人员使用的分析框架。最后，它显示了精益医疗的最新实施方式，揭示了当前的趋势，改进以及主要的不足。