SynthesisBMJ open2014
Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews.
Synthesis in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review.International journal of environmental research and public health · 2020Pooled it
- Organizational issues for the lean success in China: exploring a change strategy for lean success.BMC health services research · 2019Pooled it
- Lean Adoption in Healthcare: Between Promise and Practice.Healthcare (Basel, Switzerland) · 2026Review
- Operational inefficiency and perceived quality in a paediatric day hospital: a lean-informed study of patient flow, caregiver and staff perceptions.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Observational
- Patient-centered lean healthcare management from a humanistic perspective.BMC health services research · 2024Article
- Studying the implementation of Zero Suicide in a large health system: Challenges, adaptations, and lessons learned.Contemporary clinical trials communications · 2022Article
- What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System.BMC health services research · 2022Article
- Exploring emergency physicians' knowledge, attitudes, and behaviour towards Choosing Wisely in Taiwan.PloS one · 2022Article
- A novel conceptual approach to lean: value, psychological conditions for engagement with work and perceived organizational support in hospital care.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2021Review
- A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice.International journal of environmental research and public health · 2021Article
- A Realist Inquiry to Identify the Contribution of Lean Six Sigma to Person-Centred Care and Cultures.International journal of environmental research and public health · 2021Article
- Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare.Journal of healthcare leadership · 2021Review
- Promoting health equity through social capital in deprived communities: a natural policy experiment in Trieste, Italy.SSM - population health · 2020Article
- Increasing Operating Room Efficiency with Shop Floor Management: an Empirical, Code-Based, Retrospective Analysis.Journal of medical systems · 2020Article
- Adapting Lean methods to facilitate stakeholder engagement and co-design in healthcare.BMJ (Clinical research ed.) · 2020Article
- A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on sustainability of a lean intervention in pediatric healthcare.BMC health services research · 2019Article
- Standards as applied in reality: a case study on the translation of standards in eHealth evaluation practice.BMC medical informatics and decision making · 2019Article
- Critical success factors for the successful initiation of Lean in public hospitals in KwaZulu-Natal: a factor analysis and structural equation modelling study.Human resources for health · 2019Observational
- Features and Results of Conducted Studies Using a Lean Management Approach in Emergency Department in Hospital: A Systematic Review.Bulletin of emergency and trauma · 2019Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveLean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute.
designA two-dimensional conceptual framework was developed by combining Shortell's Dimensions of capability with Walshes' Domains of an intervention. We then conducted a systematic review of lean review articles concerning hospitals, published in the period 2000-2012. The identified lean facilitators were categorised according to the intervention domains and dimensions of capability provided by the framework.
resultsWe provide a framework emphasising context by relating facilitators to domains and dimensions of capability. 23 factors enabling a successful lean intervention in hospitals were identified in the systematic review, where management and a supportive culture, training, accurate data, physicians and team involvement were most frequent.
conclusionsIn the absence of evidence, the two-dimensional framework, incorporating the context, may prove useful for future research on variation in outcomes from lean interventions. Findings from the review suggest that characteristics and local application of lean, in addition to strategic and cultural capability, should be given further attention in healthcare quality improvement.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.