Abstract
BackgroundReliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists.MethodsWe systematically searched the Pubmed, Scopus, and Web of Science databases to identify original articles reporting benchmarking on different contextual levels in Lean healthcare and critically appraised the articles. Scarcity and heterogeneity of articles prevented quantitative meta-analyses. We developed a new, widely applicable conceptual framework for benchmarking drawing on the principles of ten commonly used healthcare quality frameworks and four value statements, and suggest an agenda for future research on benchmarking in Lean healthcare.ResultsWe identified 22 articles on benchmarking in Lean healthcare on 4 contextual levels: intra-organizational (6 articles), regional (4), national (10), and international (2). We further categorized the articles by the domains in the proposed conceptual framework: patients (6), employed and affiliated staff (2), costs (2), and service provision (16). After critical appraisal, only one fifth of the articles were categorized as high quality.ConclusionsWhen making evidence-informed decisions based on current scarce literature on benchmarking in healthcare, leaders and managers should carefully consider the influence of context. The proposed conceptual framework may facilitate performance benchmarking and spreading best practices in Lean healthcare. Future research on benchmarking in Lean healthcare should include international benchmarking, defining essential factors influencing Lean initiatives on different levels of context; patient-centered benchmarking; and system-level benchmarking with a balanced set of outcomes and quality measures.
Highlights
Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels
Uncovering the similarities in widely used healthcare quality frameworks and value statements, we address the second question by developing a conceptual framework with a widely applicable and balanced set of outcome and quality domains and examine the articles identified through the systematic review using this novel framework
Informed by the contextual levels and outcome domains used in the articles identified through the systematic review, we identify major gaps in the existing research and propose a future research agenda that would fill those gaps and provide actionable results to the international Lean healthcare audience
Summary
Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists. In an attempt to address the above challenges, many healthcare organizations have adopted transformational performance improvement initiatives such as the Lean management system. We define Lean in healthcare as a management philosophy emphasizing patient focus, respect for people, eliminating waste and striving for excellence by engaging staff in continuous improvement and problem solving through a set of practices and tools such as A3 thinking, daily huddles, visual management, 5S (sort, set in order, shine, standardize, and sustain), and the PDSA (plan-do-study-act) cycle
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