Effects of Lean Healthcare on Patient Flow: A Systematic Review

To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/staff satisfaction and the translation of the obtained benefits into savings is scarce among studies. •Lean healthcare (LH) has been implemented and studied in multiple healthcare settings and for different purposes in both ambulatory and inpatient care. LH outcomes vary in terms of health, process, efficiency, and patient/staff satisfaction, among others. We identified more than 15 reviews of LH, all of which had different approaches and results. Research on the impact of LH on patient flow still remains in the early stages.•To contribute to the body of knowledge on LH, we selected studies that met the defined inclusion criteria and conducted a systematic review of LH to summarize patient flow outcomes within ambulatory care—such as the change in both length of stay (LOS) and waiting times—in hospitals worldwide. Some outcomes are organized according to measures evaluated by the US Centers for Medicare & Medicaid Services