title: Lean interventions in healthcare: do they actually work? A systematic literature review.
abstract: OBJECTIVE
  Lean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs.
  
  
  METHODS
  We conducted a systematic literature review of Medline, PubMed, Cochrane Library, CINAHL, Web of Science, ABI/Inform, ERIC, EMBASE and SCOPUS.
  
  
  METHODS
  Peer reviewed articles were included if they examined a Lean intervention and included quantitative data. Methodological quality was assessed using validated critical appraisal checklists. Publically available data collected by the Saskatchewan Health Quality Council and the Saskatchewan Union of Nurses were also analysed and reported separately.
  
  
  METHODS
  Data on design, methods, interventions and key outcomes were extracted and collated.
  
  
  RESULTS
  Our electronic search identified 22 articles that passed methodological quality review. Among the accepted studies, 4 were exclusively concerned with health outcomes, 3 included both health and process outcomes and 15 included process outcomes. Our study found that Lean interventions have: (i) no statistically significant association with patient satisfaction and health outcomes; (ii) a negative association with financial costs and worker satisfaction and (iii) potential, yet inconsistent, benefits on process outcomes like patient flow and safety.
  
  
  CONCLUSIONS
  While some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings.
authors.affiliation: School of Public Health, University of Saskatchewan, Saskatoon, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Moraros
authors.affiliation: College of Medicine, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Lemstra
authors.affiliation: School of Public Health, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Chijioke
authors.initials: C
authors.lastname: Nwankwo
mesh_terms: D006801:Humans; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration
keywords: Lean; Lean interventions; Lean thinking; healthcare; quality improvement
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