Evidence map›Paper›PMID 33607988›Full record

SynthesisBMC health services research2021

Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda.

Elina Reponen, Thomas G Rundall, Stephen M Shortell, Janet C Blodgett, Angelica Juarez, Ritva Jokela, Markku Mäkijärvi, Paulus Torkki

Abstract readSystematic Review
In one paragraph

Synthesis in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed.

  1. Trial
  2. Comparative Policy Analysis of Healthcare Healthy Eating Policies in Canada.Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals · 2026
    Review
  3. Article
  4. The outcomes of Lean management in a large academic hospital in Finland in 2018-2023: a qualitative study.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026
    Article
  5. Article
  6. Article
  7. Article
  8. Review
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Observational
  15. Article
  16. Article
  17. The cross-national applicability of lean implementation measures and hospital performance measures: a case study of Finland and the USA.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2021
    Article
  18. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Elina ReponenCenter for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA. elina.reponen@hus.fi.
Thomas G RundallCenter for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA.
Stephen M ShortellCenter for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA.
Janet C BlodgettCenter for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA.
Angelica JuarezCenter for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA.
Ritva JokelaHUS Helsinki University Hospital, P.O.Box 760, 00029, Helsinki, Finland.
Markku MäkijärviHUS Helsinki University Hospital, P.O.Box 760, 00029, Helsinki, Finland.
Paulus TorkkiDepartment of Public Health, University of Helsinki, Helsinki, Finland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundReliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists.

methodsWe systematically searched the Pubmed, Scopus, and Web of Science databases to identify original articles reporting benchmarking on different contextual levels in Lean healthcare and critically appraised the articles. Scarcity and heterogeneity of articles prevented quantitative meta-analyses. We developed a new, widely applicable conceptual framework for benchmarking drawing on the principles of ten commonly used healthcare quality frameworks and four value statements, and suggest an agenda for future research on benchmarking in Lean healthcare.

resultsWe identified 22 articles on benchmarking in Lean healthcare on 4 contextual levels: intra-organizational (6 articles), regional (4), national (10), and international (2). We further categorized the articles by the domains in the proposed conceptual framework: patients (6), employed and affiliated staff (2), costs (2), and service provision (16). After critical appraisal, only one fifth of the articles were categorized as high quality.

conclusionsWhen making evidence-informed decisions based on current scarce literature on benchmarking in healthcare, leaders and managers should carefully consider the influence of context. The proposed conceptual framework may facilitate performance benchmarking and spreading best practices in Lean healthcare. Future research on benchmarking in Lean healthcare should include international benchmarking, defining essential factors influencing Lean initiatives on different levels of context; patient-centered benchmarking; and system-level benchmarking with a balanced set of outcomes and quality measures.

Indexed as

BenchmarkingDelivery of Health CareQuality of Health CareHealth FacilitiesHumansBenchmarkingContextLean healthcareLean managementOutcomes

Identifiers

PMID33607988
PMCPMC7893761

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.