Is Lean sustainable in today's NHS hospitals? A systematic literature review using the meta-narrative and integrative methods
Is Lean sustainable in today's NHS hospitals? A systematic literature review using the meta-narrative and integrative methods
Purpose
Methodological variance and quality, heterogeneity of value and divergent approaches are reasons for the varied results of Lean interventions in healthcare despite ongoing global popularity. However, there is piecemeal evidence addressing the sustainability of initiatives—the aim of this review is to use an integrative approach to consider Lean’s sustainability and the quality of available evidence in today’s National Health Service (NHS).
Data sources
A literature review of AMED, CINAHL, Cochrane, JBI, SCOPUS, DelphiS, MEDLINE, EMBASE, MIDIRS, Web of Science and PsycINFO electronic databases was conducted.
Study selection
Peer-reviewed studies in NHS hospitals/trusts that concerned undiluted, service-wide Lean adoption and contained quantitative data were included. Reference lists were consulted for evidence via a snowball approach. Methodological quality was assessed using an adapted critical appraisal tool.
Data extraction
Research design, method of intervention, outcome measures and sustainability were extracted.
Results of data synthesis
Electronic searches identified 12 studies eligible for inclusion. This comprised of five quasi-experimental designs (one mixed-method), three multi-site analyses, one action research, one failure mode and effects analysis, one content analysis of annual reports and one systematic review. Six articles considered sustainability with two of these providing measured successes. Despite diverse and positive outcomes studies lacked scientific rigour, failed to consider confounding issues, were at risk of positive bias and did not demonstrate sustainability with any statistical significance.
Conclusion
Lean has ostensible value but it is difficult to draw a conclusion on efficacy or sustainability. Higher quality scientific research into Lean and the effect of staffing cultures on initiatives are needed to ascertain the extent that Lean can affect healthcare quality and subsequently be sustained.
578-586
Woodnutt, Samuel
dbb6678a-2b2b-4e7c-9a12-f9d838555116
October 2018
Woodnutt, Samuel
dbb6678a-2b2b-4e7c-9a12-f9d838555116
Woodnutt, Samuel
(2018)
Is Lean sustainable in today's NHS hospitals? A systematic literature review using the meta-narrative and integrative methods.
International Journal for Quality in Health Care, 30 (8), .
(doi:10.1093/intqhc/mzy070).
Abstract
Purpose
Methodological variance and quality, heterogeneity of value and divergent approaches are reasons for the varied results of Lean interventions in healthcare despite ongoing global popularity. However, there is piecemeal evidence addressing the sustainability of initiatives—the aim of this review is to use an integrative approach to consider Lean’s sustainability and the quality of available evidence in today’s National Health Service (NHS).
Data sources
A literature review of AMED, CINAHL, Cochrane, JBI, SCOPUS, DelphiS, MEDLINE, EMBASE, MIDIRS, Web of Science and PsycINFO electronic databases was conducted.
Study selection
Peer-reviewed studies in NHS hospitals/trusts that concerned undiluted, service-wide Lean adoption and contained quantitative data were included. Reference lists were consulted for evidence via a snowball approach. Methodological quality was assessed using an adapted critical appraisal tool.
Data extraction
Research design, method of intervention, outcome measures and sustainability were extracted.
Results of data synthesis
Electronic searches identified 12 studies eligible for inclusion. This comprised of five quasi-experimental designs (one mixed-method), three multi-site analyses, one action research, one failure mode and effects analysis, one content analysis of annual reports and one systematic review. Six articles considered sustainability with two of these providing measured successes. Despite diverse and positive outcomes studies lacked scientific rigour, failed to consider confounding issues, were at risk of positive bias and did not demonstrate sustainability with any statistical significance.
Conclusion
Lean has ostensible value but it is difficult to draw a conclusion on efficacy or sustainability. Higher quality scientific research into Lean and the effect of staffing cultures on initiatives are needed to ascertain the extent that Lean can affect healthcare quality and subsequently be sustained.
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More information
Accepted/In Press date: 22 March 2018
e-pub ahead of print date: 10 April 2018
Published date: October 2018
Identifiers
Local EPrints ID: 443081
URI: http://eprints.soton.ac.uk/id/eprint/443081
ISSN: 1353-4505
PURE UUID: b39d3640-2dfd-46a4-8de0-1f24fcb0443c
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Date deposited: 10 Aug 2020 16:30
Last modified: 17 Mar 2024 03:56
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