title: Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol).
abstract: BACKGROUND
  Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited.
  
  
  METHODS
  This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form.
  
  
  CONCLUSIONS
  Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care.
  
  
  BACKGROUND
  PROSPERO CRD42014008853.
authors.affiliation: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon S7N 5A2, Canada. lawal.kazeem@usask.ca.
authors.forename: Adegboyega K
authors.initials: AK
authors.lastname: Lawal
authors.forename: Thomas
authors.initials: T
authors.lastname: Rotter
authors.forename: Leigh
authors.initials: L
authors.lastname: Kinsman
authors.forename: Nazmi
authors.initials: N
authors.lastname: Sari
authors.forename: Liz
authors.initials: L
authors.lastname: Harrison
authors.forename: Cathy
authors.initials: C
authors.lastname: Jeffery
authors.forename: Mareike
authors.initials: M
authors.lastname: Kutz
authors.forename: Mohammad F
authors.initials: MF
authors.lastname: Khan
authors.forename: Rachel
authors.initials: R
authors.lastname: Flynn
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D006282:Health Personnel; D006801:Humans; D007588:Job Satisfaction; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D058996:Quality Improvement; D012107:Research Design; D000078202:Systematic Reviews as Topic; D013997:Time Factors; D017749:Total Quality Management