Lean in healthcare: A comprehensive review

Purpose




The purpose of this paper is to highlight the importance of Lean methodology through an exhaustive literature review, and its implications and application in the service industry right from its initiation in 1990s till date.




Design/methodology/approach




The paper summarises the evolution of Lean in services and has systematically classified the reviewed literature in four dimensions, namely time, publisher, region and content. Further under “time” dimension, the literature is classified into Pre-Lean era, Lean awareness era, Lean Exploration era and Lean implementation era. Under the “content” dimension, the categories include theoretical foundation, frameworks/models and application/case studies.




Findings




The analysis inferred; Lean is gaining roads in services, though the research is still at nascent stage. Lean is applicable in services though transfer of Lean manufacturing principles to services has certain limitations because of the characteristics of services. The need is to focus on process difference between services and manufacturing. Respect for people and employment engagement is critical to Lean in service. The authors identified the necessity to standardise the Lean service definition, principles, and tools and to develop guidelines for structured implementation in service industry.




Research limitations/implications




Though multiple databases have been taken-up but that does not assume that the literature presented in this paper is by any means comprehensive. Development of a standard model/framework for Lean services is critical for future research. Rigorous industry-specific studies, specifically in developing nations are another area for future research. Future studies could analyse the impact of join applications and possible links between Lean service and other approaches like TQM, Six Sigma, etc., with an aim of process improvement.




Practical implications




This paper would serve as a resource for Lean practitioners as well as researchers as a fundamental platform, contributing to Lean body of knowledge.




Social implications




Service industry has special significance to the society in large. Many services including governments, public interest services, non-profit organisations, healthcare, banking, consulting, etc., has a significant share across markets. Lean being a proven methodology for successful process improvements has to be looked at from a services perspective. This paper helps in such interest.




Originality/value




Publications reviewing the adoption of Lean in services is scarce in literature. This paper serves as an excellent resource for research on the subject and will facilitate academicians and practitioners to objectively understand Lean in service sector.

Lean services: a systematic review

The purpose of this paper is to review the existing literature on Lean Six Sigma (LSS) for services, construct a morphological analysis (MA) framework and identify research gaps to point to future research possibilities and priorities.,The MA framework is based on literature review of 175 papers published from 2003 to 2015, across 67 journals recognised by Scopus or ABS Academic Journal Quality Guide 2015. A three-phased methodology is used by the authors, with Phase1 featuring a five-stage systematic review protocol to identify relevant journal papers for review; Phase2 presenting a framework for classifying the reviewed papers in terms of their fundamental, methodological, chronological and sector-wise orientations; and Phase3 constructing an MA framework on the classified papers and identifying the research gaps.,The MA framework constructed based on six dimensions, namely, organizational context of applications, desired outcomes, implementation systems, LSS tools and techniques, integration with other management philosophies and evaluation methods, involving 40 focused themes, has revealed 355 distinct research gaps as opportunities for future research.,This paper confirms the existence of substantial scope and points to specific topics for further research in the area of LSS for services. The findings demonstrate the gaps in academic research on the subject. In addition, the study also helps organisational leaders and practitioners to look at LSS from a holistic perspective in the services context.,The MA framework of the existing literature on LSS for services presents a unique, systematic effort to identify research opportunities. In addition, a five-stage systematic review protocol is proposed in this paper. This could be valuable to researchers and practitioners in enabling them to systematically review the literature on research subjects of interest to them.

A morphological analysis of research literature on Lean Six Sigma for services

Fostered by a rapid spread beyond the manufacturing sector, Lean philosophy for continuous improvement has been widely used in service organizations, primarily in the healthcare sector. However, there is a limited research on the motivating factors, challenges and benefits of implementing Lean in healthcare. Taking this as a valuable opportunity, the purpose of this paper is to present the key motivating factors, limitations or challenges of Lean deployment, benefits of Lean in healthcare and key gaps in the literature as an agenda for future research.,The authors used the secondary data from the literature (peer-reviewed journal articles) published between 2000 and 2016 to understand the state of the art. The systematic review identified 101 articles across 88 journals recognized by the Association of Business Schools ranking guide 2015.,The systematic review helped the authors to identify the evolution, current trends, research gaps and an agenda for future research for Lean in healthcare. A bouquet of motivating factors, challenges/limitations and benefits of Lean in healthcare are presented.,The implications of this work include directions for managers and healthcare professionals in healthcare organizations to embark on a focused Lean journey aligned with the strategic objectives. This work could serve as a valuable resource to both practitioners and researchers for learning, investigating and rightly adapting the Lean in the healthcare sector.,This study is perhaps one of the comprehensive systematic literature reviews covering an important agenda of Lean in Healthcare. All the text, figures and tables featured here are original work carried by five authors in collaboration (from three countries, namely, India, the USA and the UK).

A systematic review of Lean in healthcare: a global prospective

It is commonly agreed that the success of Lean management is not only determined by its technical practices, but also by the so-called soft practices such as behavior and actions of employees and management. Lean Management behavior is in itself paradoxical in nature as it incorporates technical aspects (e.g., fact-based management, analysis and adhering to the standard operating procedures for sake of efficiency) and social, follower-related aspects (e.g., promotion of employee responsibility to continuously improve their work processes). In this paper, we investigate the (moderating) effect of some important Lean related management actions on the relationship between Lean and the level of process improvement: i) envisioning and communicating the meaning of Lean, ii) setting goals and active steering on improvement performance metrics and ii) encouraging continuous improvement. Survey data of 178 responses from Dutch organizations, shows that these management actions have a positive effect on both Lean and the level of process improvement. In addition, active steering on performance improvement has a reinforcing effect on the relationship between Lean and process improvement. For respondents with a low level of steering on performance improvement Lean does not lead to process improvement, while it does for respondents with average and high levels of steering on performance improvement. The more management operates on performance improvement, the more Lean will result in a higher level of process improvement.

/pdf/the-moderating-effect-of-management-behavior-for-lean-and-2odhk0tv82.pdf

The moderating effect of management behavior for Lean and process improvement

Hospital operating theatres are a critical but costly resource in healthcare processes Their efficiency and utilisation impact upon hospital finances, clinical effectiveness and patient outcomes Operations management techniques have now been applied widely to optimise flow An important challenge is to balance the needs of process flexibility, efficiency and work standardisation with clinical requirements This paper applies operations management methods to analyse elective orthopaedic surgery at five international hospitals to describe the issues that affect operating theatre productivity It utilises an innovative method of video analysis to observe patient changeovers over 29 days of surgery and data is analysed to understand the causes of variability and waste The findings suggest that processes which are standardised via operations management methodologies can improve productivity in a process that exhibits wide variation in practice There are apparent trade-offs associated with efficiency and clinical concerns such infection control, that lead to different standard process archetypes being utilised Recommendations for standardising patient changeovers are provided

Are we operating effectively? A lean analysis of operating theatre changeovers

Running gait assessment has traditionally been performed using subjective observation or expensive laboratory-based objective technologies, such as three-dimensional motion capture or force plates. However, recent developments in wearable devices allow for continuous monitoring and analysis of running mechanics in any environment. Objective measurement of running gait is an important (clinical) tool for injury assessment and provides measures that can be used to enhance performance.We aimed to systematically review the available literature investigating how wearable technology is being used for running gait analysis in adults.A systematic search of the literature was conducted in the following scientific databases: PubMed, Scopus, Web of Science and SPORTDiscus. Information was extracted from each included article regarding the type of study, participants, protocol, wearable device(s), main outcomes/measures, analysis and key findings.A total of 131 articles were reviewed: 56 investigated the validity of wearable technology, 22 examined the reliability and 77 focused on applied use. Most studies used inertial measurement units (n = 62) [i.e. a combination of accelerometers, gyroscopes and magnetometers in a single unit] or solely accelerometers (n = 40), with one using gyroscopes alone and 31 using pressure sensors. On average, studies used one wearable device to examine running gait. Wearable locations were distributed among the shank, shoe and waist. The mean number of participants was 26 (± 27), with an average age of 28.3 (± 7.0) years. Most studies took place indoors (n = 93), using a treadmill (n = 62), with the main aims seeking to identify running gait outcomes or investigate the effects of injury, fatigue, intrinsic factors (e.g. age, sex, morphology) or footwear on running gait outcomes. Generally, wearables were found to be valid and reliable tools for assessing running gait compared to reference standards.This comprehensive review highlighted that most studies that have examined running gait using wearable sensors have done so with young adult recreational runners, using one inertial measurement unit sensor, with participants running on a treadmill and reporting outcomes of ground contact time, stride length, stride frequency and tibial acceleration. Future studies are required to obtain consensus regarding terminology, protocols for testing validity and the reliability of devices and suitability of gait outcomes.CRD42021235527. 

https://link.springer.com/content/pdf/10.1007/s40279-022-01760-6.pdf

Wearables for Running Gait Analysis: A Systematic Review

Running gait assessment is essential for the development of technical optimization strategies as well as to inform injury prevention and rehabilitation. Currently, running gait assessment relies on (i) visual assessment, exhibiting subjectivity and limited reliability, or (ii) use of instrumented approaches, which often carry high costs and can be intrusive due to the attachment of equipment to the body. Here, the use of an IoT-enabled markerless computer vision smartphone application based upon Google’s pose estimation model BlazePose was evaluated for running gait assessment for use in low-resource settings. That human pose estimation architecture was used to extract contact time, swing time, step time, knee flexion angle, and foot strike location from a large cohort of runners. The gold-standard Vicon 3D motion capture system was used as a reference. The proposed approach performs robustly, demonstrating good (ICC(2,1) > 0.75) to excellent (ICC(2,1) > 0.90) agreement in all running gait outcomes. Additionally, temporal outcomes exhibit low mean error (0.01–0.014 s) in left foot outcomes. However, there are some discrepancies in right foot outcomes, due to occlusion. This study demonstrates that the proposed low-cost and markerless system provides accurate running gait assessment outcomes. The approach may help routine running gait assessment in low-resource environments.

https://www.mdpi.com/1424-8220/23/2/696/pdf?version=1674008164

Internet-of-Things-Enabled Markerless Running Gait Assessment from a Single Smartphone Camera

Contemporary approaches to gait assessment use wearable within free-living environments to capture habitual information, which is more informative compared to data capture in the lab. Wearables range from inertial to camera-based technologies but pragmatic challenges such as analysis of big data from heterogenous environments exist. For example, wearable camera data often requires manual time-consuming subjective contextualization, such as labelling of terrain type. There is a need for the application of automated approaches such as those suggested by artificial intelligence (AI) based methods. This pilot study investigates multiple segmentation models and proposes use of the PSPNet deep learning network to automate a binary indoor floor segmentation mask for use with wearable camera-based data (i.e., video frames). To inform the development of the AI method, a unique approach of mining heterogenous data from a video sharing platform (YouTube) was adopted to provide independent training data. The dataset contains 1973 image frames and accompanying segmentation masks. When trained on the dataset the proposed model achieved an Instance over Union score of 0.73 over 25 epochs in complex environments. The proposed method will inform future work within the field of habitual free-living gait assessment to provide automated contextual information when used in conjunction with wearable inertial derived gait characteristics.Clinical Relevance—Processes developed here will aid automated video-based free-living gait assessment

Deep learning semantic segmentation for indoor terrain extraction: Toward better informing free-living wearable gait assessment

Running gait assessment and running shoe recommendation is important for the injury prevention of runners who exhibit different skill-levels and running styles. Traditionally, running gait assessment for shoe recommendation relies upon a combination of trained professionals (e.g., sports-therapists, physiotherapists) and complex equipment such as motion or pressure sensors, often incurring a high-cost to the consumer. Despite this, assessments are still prone to subjectivity, and may differ between assessors. Alternatively, methods to provide low-cost, reproduceable gait assessment has become a necessity, especially within a habitual (low-resource) context, with many traditional methods generally unavailable due to the need of professional assistance and more recently the COVID-19 pandemic. Fuzzy logic has shown to be an effective tool in the assessment and identification of gait by providing the potential for a high-accuracy methodology, while retaining a low computational cost; ideal for applications within embedded systems. Here, we present a novel shoe recommendation fuzzy inference system from the classification of two key running gait parameters, foot strike and pronation from a single foot mounted internet of thing (IoT) enabled wearable inertial measurement unit. The fuzzy approach provides excellent (ICC > 0.9) accuracy, while significantly increasing the resolution of the gait assessment technique, providing a more detailed running gait analysis.

Fraser Young

Papers

Are we operating effectively? A lean analysis of operating theatre changeovers

Wearables for Running Gait Analysis: A Systematic Review

Internet-of-Things-Enabled Markerless Running Gait Assessment from a Single Smartphone Camera

Deep learning semantic segmentation for indoor terrain extraction: Toward better informing free-living wearable gait assessment

Bespoke Fuzzy Logic Design to Automate a Better Understanding of Running Gait Analysis