A Systematic Review of Lean Implementation in Hospitals: Impact on Efficiency, Quality, Cost, and Satisfaction

Articles in Press

Document Type : Review Article

Authors

1 Institutes of Health Central Plains, Henan Medical University, Xinxiang, China

2 The Second Affiliated Hospital of Henan Medical University, Xinxiang, China

3 The First Affiliated Hospital of Henan Medical University, Xinxiang, China

4 School of Public Health, Henan Medical University, Xinxiang, China

Abstract

Background 
Lean healthcare practices are widely used to enhance efficiency, quality, cost-effectiveness, and satisfaction in hospitals. However, no studies have synthesized their effectiveness across these dimensions. This review aims to address this gap by evaluating the impact of Lean implementation on four key themes: Efficiency, quality, cost, and satisfaction.
 
Methods 
Four online databases were selected for the targeted articles: Scopus, Medline, PubMed, and Web of Science. Additionally, a comprehensive search was conducted using the Google Search Engine, along with a review of the citation list from the retrieved articles, to identify related grey literature and acquire additional articles. The search covered only the period from January 2019 to October 2024. The quality and research methodology of the articles reviewed were evaluated to determine the reliability of these findings.
 
Results 
A total of 6021 articles were screened, and 60 were included in this study. Our findings were grouped into four themes: (1) Efficiency: 49 studies identified 12 sub-dimensions of efficiency, with the most common variables being waiting time, length of stay (LOS), and patient volumes. (2) Quality: 12 studies reported quality improvements, covering 12 variables, with 30-day readmission rates, counselling sessions, and drug-related indicators being most prominent. (3) Cost: 17 studies examined Lean-driven cost reductions, with operating costs being the most frequently addressed variable, appearing in seven studies. (4) Satisfaction: Key satisfaction indicators included patient satisfaction, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, complaint rates, and nurse satisfaction.
 
Conclusion 
This is the first review to synthesize the literature on the impacts of Lean implementation across four key themes, while also identifying existing gaps. It highlights the positive outcomes of Lean in hospitals and outlines the primary areas of improvement emphasized by healthcare institutions within each theme. 

Keywords

References

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International Journal of Health Policy and Management

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Available Online from 03 August 2025

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  • Received Date: 04 January 2025
  • Revised Date: 05 May 2025
  • Accepted Date: 02 August 2025
  • First Published Date: 03 August 2025

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