Improving quality and efficiency in healthcare. The Lean Thinking strategy [Pitch Presentation]

Background Lean Thinking is a philosophy originated from Toyota Production Systems that emphasize eliminating non-value added activities while delivering quality products on time at least cost with greater efficiency. It has been adapted and expanded by a wide range of industries, including logistics and distribution, services, retail, government, construction, maintenance and even healthcare. The first hospital that implemented the Lean Thinking was Virginia Mason Hospital. Some successful examples of Lean implementation in health care settings are: Johns Hopkins – Baltimore, John Radcliffe – Oxford, Mount Sinai - New York, New Karolinska Solna – Stockholm and Erasmus Medical Centre – Rotterdam. Methods To assess the impact of Lean Thinking implementation in healthcare in terms of volume of services, time, personnel, quality, safety and costs we conducted a systematic review. PubMed, Scopus and Cochrane CINAHL databases were searched to identify studies that evaluate the impact of Lean Thinking implementation. Two reviewers screened all identified citations and extracted data according to the MOOSE guidelines. Quality of the studies was evaluated using the New Castle – Ottawa scale. Results Of the 635 articles identified, 27 studies were included. All included studies showed a positive impact of Lean Thinking implementation. For example, following the adoption of Lean principles and tools in an Emergency Department, it was found a statistically significant reduction (p < 0.05) for the waiting time, triage and waiting for the medical examination. In operating rooms, it has been reported a better management of stocks of materials within the warehouse with a reduction in inventories and the order process time. Other studies have showed also a statistically significant reduction (p < 0.05) in 30-day mortality and in 3-day mortality, as well as improvement in other clinical outcomes. Conclusions Lean methodology seems an appropriate strategy of management in healthcare. Key messages: Lean Thinking is a methodology that can be widely adapted to health services reorganization. Lean Thinking implementation is generally associated with outcome improvement.