Barriers for lean healthcare implementation: a systematic literature review
Keywords:Lean Production, Health Services, Barriers.
AbstractThe literature has shown that some barriers can hinder the implementation of lean healthcare, negatively impacting the sustainability of this production system. Therefore, this paper aims to identify barriers to implementing lean healthcare, proposing principles and tools to deal with such barriers through a systematic literature review. Most of the papers focus only on the improvements provided by the implementation of lean healthcare. The analyses also showed that the papers focus on necessary factors for implementation, principles, methods, and implementation benefits. Tools, principles, and barriers to lean healthcare implementation were also identified. The barriers were grouped into five categories: (i) complexity of health systems; (ii) human factors; (iii) lack of a methodology; (iv) supply chain; and (v) lack of culture and a long-term vision. Recognizing lean implementation barriers allowed identifying problems and suggesting tools and principles dealing with barriers' challenges regarding lean production implementation. The paper contributes to lean healthcare practice, recognizing barriers that hinder this process, enabling managers to direct their efforts to deal with these challenges.
Abdallah, A. B., & Alkhaldi, R. Z. (2019). Lean bundles in health care: a scoping review. Journal of Health Organization and Management, 33(4), 488–510. https://doi.org/10.1108/JHOM-09-2018-0263
Aij, K. H., & Teunissen, M. (2017). Lean leadership attributes: a systematic review of the literature. Journal of Health, Organisation and Management, 31(7–8), 713–729. https://doi.org/10.1108/JHOM-12-2016-0245
Al-Balushi, S., Sohal, A. S., Singh, P. J., Hajri, A. Al, Farsi, Y. M. A., & Abri, R. Al. (2014). Readiness factors for lean implementation in healthcare settings: a literature review. Journal of Health, Organisation and Management, 28(2), 135–153. https://doi.org/10.1108/JHOM-04-2013-0083
Alkhaldi, R. Z., & Abdallah, A. B. (2019). Lean management and operational performance in health care: Implications for business performance in private hospitals. International Journal of Productivity and Performance Management, 69(1), 1–21. https://doi.org/10.1108/IJPPM-09-2018-0342
Baccei, S. J., Henderson, S. R., Lo, H. S., & Reynolds, K. (2020). Using Quality Improvement Methodology to Reduce Costs while Improving Efficiency and Provider Satisfaction in a Busy, Academic Musculoskeletal Radiology Division. Journal of Medical Systems, 44(6), 1–12. https://doi.org/10.1007/s10916-020-01569-8
Borges, G. A., Tortorella, G., Rossini, M., & Portioli-Staudacher, A. (2019). Lean implementation in healthcare supply chain: a scoping review. Journal of Health Organization and Management, 33(3), 304–322. https://doi.org/10.1108/JHOM-06-2018-0176
Brito, T. C., Karla Oliveira Regis, T., Santos, L. C., Gohr, C. F., & Sarmento, M. C. (2018). Produção enxuta em operações de serviços: uma revisão sistemática. Revista Produção Online, 18(3), 1016–1042. https://doi.org/10.14488/1676-1901.v18i3.3092
Bucci, S., De Belvis, A. G., Marventano, S., De Leva, A. C., Tanzariello, M., Specchia, M. L., Ricciardi, W., & Franceschi, F. (2016). Emergency Department crowding and hospital bed shortage: Is Lean a smart answer? A systematic review. European Review for Medical and Pharmacological Sciences, 20(20), 4209–4219.
Burns, Nancy; Grove, S. K. (2005). Study guide for the practice of nursing research: conduct, critique, and utilization. Saunders.
Cavalcante, N. G. L., Gohr, C. F., Morioka, S. N., & Santos, L. C. (2020). Implementação da produção enxuta em saúde: uma revisão sistemática de redes. Produção Online, 20(1), 172–201.
Costa, L. B. M., & Godinho Filho, M. (2016). Lean healthcare: review, classification and analysis of literature. Production Planning and Control, 27(10), 823–836. https://doi.org/10.1080/09537287.2016.1143131
Crema, M., & Verbano, C. (2013). Guidelines for overcoming hospital managerial challenges: A systematic literature review. Therapeutics and Clinical Risk Management, 9(1), 427–441. https://doi.org/10.2147/TCRM.S54178
D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: A comprehensive review. Health Policy, 119(9), 1197–1209. https://doi.org/10.1016/j.healthpol.2015.02.002
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Gabutti, I., Mascia, D., & Cicchetti, A. (2017). Exploring “patient-centered” hospitals: a systematic review to understand change. BMC Health Services Research, 17(1), 1–16. https://doi.org/10.1186/s12913-017-2306-0
Gohr, C. F., Cabral, N. G. C., & Santos, L. C. (2019). Success factors for lean healthcare implementation: Exploratory case study in a Brazilian hospital. Rahis, 16(2), 126–138.
Gohr, C. F.,Régis, T. K. O., Santos, L. C., Taíse C. Brito, & Marcella C. Sarmento. (2017). A produção científica sobre lean healthcare : revisão e análise crítica. Rahis, 14(1), 68–90.
Hallam, C. R. A., & Contreras, C. (2018). Lean healthcare: scale, scope and sustainability. International Journal of Health Care Quality Assurance, 31(7), 684–696. https://doi.org/10.1108/IJHCQA-02-2017-0023
Hasle, P., Nielsen, A. P., & Edwards, K. (2016). Application of Lean Manufacturing in Hospitals—the Need to Consider Maturity, Complexity, and the Value Concept. Human Factors and Ergonomics In Manufacturing, 26(4), 430–442. https://doi.org/10.1002/hfm.20668
Henrique, D. B., Filho, M. G., Marodin, G., Jabbour, A. B. L. de S., & Chiappetta Jabbour, C. J. (2020). A framework to assess sustaining continuous improvement in lean healthcare. International Journal of Production Research, 1, 1–20. https://doi.org/10.1080/00207543.2020.1743892
Henrique, D. B., & Godinho Filho, M. (2020). A systematic literature review of empirical research in Lean and Six Sigma in healthcare. Total Quality Management and Business Excellence, 31(3–4), 429–449. https://doi.org/10.1080/14783363.2018.1429259
Khorasani, S. T., Cross, J., & Maghazei, O. (2020). Lean supply chain management in healthcare: a systematic review and meta-study. International Journal of Lean Six Sigma, 11(1), 1–34. https://doi.org/10.1108/IJLSS-07-2018-0069
Leite, H., Bateman, N., & Radnor, Z. (2020). Beyond the ostensible: an exploration of barriers to lean implementation and sustainability in healthcare. Production Planning and Control, 31(1), 1–18. https://doi.org/10.1080/09537287.2019.1623426
Liker, J. K., & Meier, D. (2006). The Toyota Way: a Practical Guide for Implementing Toyota’s 4Ps (1st ed.). McGraw-Hill.
Maijala, R., Eloranta, S., Reunanen, T., & Ikonen, T. S. (2018). Successful Implementation of Lean As A Managerial Principle in Health Care: A Conceptual Analysis from Systematic Literature Review. International Journal of Technology Assessment in Health Care, 34(2), 134–146. https://doi.org/10.1017/S0266462318000193
Mazzocato, P., Holden, R. J., Brommels, M., Aronsson, H., Bäckman, U., Elg, M., & Thor, J. (2012). How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s hospital, Stockholm, Sweden. BMC Health Services Research, 12(1). https://doi.org/10.1186/1472-6963-12-28
Mazzocato, P., Savage, C., Brommels, M., Aronsson, H., & Thor, J. (2010). Lean thinking in healthcare: A realist review of the literature. Quality and Safety in Health Care, 19(5), 376–382. https://doi.org/10.1136/qshc.2009.037986
Moraros, J., Lemstra, M., & Nwankwo, C. (2016). Lean interventions in healthcare: Do they actually work? A systematic literature review. International Journal for Quality in Health Care, 28(2), 150–165. https://doi.org/10.1093/intqhc/mzv123
Mousavi Isfahani, H., Tourani, S., & Seyedin, H. (2019). Lean management approach in hospitals: a systematic review. International Journal of Lean Six Sigma, 10(1), 161–188. https://doi.org/10.1108/IJLSS-05-2017-0051
Naidoo, L., & Fields, Z. (2019). 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, 17(1), 1–9. https://doi.org/10.1186/s12960-019-0405-1
Ortíz-Barrios, M. A., & Alfaro-Saíz, J. J. (2020). Methodological approaches to support process improvement in emergency departments: A systematic review. International Journal of Environmental Research and Public Health, 17(8). https://doi.org/10.3390/ijerph17082664
Parkhi, S. S. (2019). Lean management practices in healthcare sector: a literature review. Benchmarking: An International Journal, 26(4), 1275–1289. https://doi.org/10.1108/BIJ-06-2018-0166
Radnor, Z. J., Holweg, M., & Waring, J. (2012). Lean in healthcare: The unfilled promise? Social Science and Medicine, 74(3), 364–371. https://doi.org/10.1016/j.socscimed.2011.02.011
Ramori, K. A., Cudney, E. A., Elrod, C. C., & Antony, J. (2019). Lean business models in healthcare: a systematic review. Total Quality Management and Business Excellence, 0(0), 1–16. https://doi.org/10.1080/14783363.2019.1601995
Régis, T. K. O., Gohr, C. F., & Santos, L. C. (2018). Implementação do lean healthcare: experiências e lições aprendidas em hospitais brasileiros. Revista de Administração de Empresas, 58(1), 30–43. https://doi.org/10.1590/s0034-759020180104
Régis, T. K. O., Santos, L. C., & Gohr, C. F. (2019). A case-based methodology for lean implementation in hospital operations. Journal of Health Organization and Management, 33(6), 656–676. https://doi.org/10.1108/JHOM-09-2018-0267
Senna, P., Gomes, A., Monteiro, A., & Pinha, D. (2016). Study on techniques and tools used in lean healthcare implementation: a literature review. Brazilian Journal of Operations & Production Management, 13(4), 406. https://doi.org/10.14488/bjopm.2016.v13.n4.a1
Sharma, G. V. S. S., Prasad, C. L. V. R. S. V., & Srinivasa Rao, M. (2020). Industrial engineering into healthcare: A comprehensive review. International Journal of Healthcare Management, 1, 1–15. https://doi.org/10.1080/20479700.2020.1757874
Soliman, M., & Saurin, T. A. (2017). Lean production in complex socio-technical systems: A systematic literature review. Journal of Manufacturing Systems, 45, 135–148. https://doi.org/10.1016/j.jmsy.2017.09.002
Stelson, P., Hille, J., Eseonu, C., & Doolen, T. (2017). What drives continuous improvement project success in healthcare? International Journal of Health Care Quality Assurance, 30(1), 43–57. https://doi.org/10.1108/IJHCQA-03-2016-0035
Tlapa, D., Zepeda-Lugo, C. A., Tortorella, G. L., Baez-Lopez, Y. A., Limon-Romero, J., Alvarado-Iniesta, A., & Rodriguez-Borbon, M. I. (2020). Effects of Lean Healthcare on Patient Flow: A Systematic Review. Value in Health, 23(2), 260–273.
Tortorella, G., van Dun, D. H., & de Almeida, A. G. (2020). Leadership behaviors during lean healthcare implementation: a review and longitudinal study. Journal of Manufacturing Technology Management, 31(1), 193–215. https://doi.org/10.1108/JMTM-02-2019-0070
Tranfield, D., Denyer, D., & Smart, P. (2003). Towards a Methodology for Developing Evidence-Informed Management Knowledge by Means of Systematic Review. British Journal of Management, 14(3), 207–222. https://doi.org/10.1111/1467-8551.00375
Ullah, M. F., Fleming, C., Fox, C., Tewary, T., & Tormey, S. (2020). Patient experience in a surgical assessment unit following a closed-loop audit using a Kaizen Lean system. Irish Journal of Medical Science, 189(2), 641–647. https://doi.org/10.1007/s11845-019-02105-5
Wang, Q., & Waltman, L. (2016). Large-scale analysis of the accuracy of the journal classification systems of Web of Science and Scopus. Journal of Informetrics, 10(2), 347–364. https://doi.org/10.1016/j.joi.2016.02.003
The Journal reserves the right to make normative, spelling and grammatical changes in the published article, aiming at maintaining the proper standard of the language, while respecting the personal style of the authors.
Author (s) are fully responsible for the published article. Journal of Lean Systems is not responsible for any violations of Copyright.
Journal of Lean Systems allows the author to retain the copyright of articles accepted for publication without restriction.
Plagiarism constitutes unethical behavior and is inconceivable. This journal reserves the right to use any methods of detecting plagiarism to analyze the submitted works.
This journal is licensed under a Creative Commons License.