Mazzocato Pamela, Savage Carl, Brommels Mats, Aronsson Håkan, Thor Johan
Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Qual Saf Health Care. 2010 Oct;19(5):376-82. doi: 10.1136/qshc.2009.037986. Epub 2010 Aug 19.
To understand how lean thinking has been put into practice in healthcare and how it has worked.
A realist literature review. Data sources The authors systematically searched for articles in PubMed, Web of Science and Business Source Premier (January 1998 to February 2008) and then added articles through a snowball approach.
The authors included empirical studies of lean thinking applications in healthcare and excluded those articles that did not influence patient care, or reported hybrid approaches. The authors conducted a thematic analysis based on data collected using an original abstraction form. Based on this, they articulated interactions between context, lean interventions, mechanisms and outcomes.
The authors reviewed 33 articles and found a wide range of lean applications. The articles describe initial implementation stages and emphasise technical aspects. All articles report positive results. The authors found common contextual aspects which interact with different components of the lean interventions and trigger four different change mechanisms: understand processes to generate shared understanding; organise and design for effectiveness and efficiency; improve error detection to increase awareness and process reliability; and collaborate to systematically solve problems to enhance continual improvement.
Lean thinking has been applied successfully in a wide variety of healthcare settings. While lean theory emphasises a holistic view, most cases report narrower technical applications with limited organisational reach. To better realise the potential benefits, healthcare organisations need to directly involve senior management, work across functional divides, pursue value creation for patients and other customers, and nurture a long-term view of continual improvement.
了解精益思维如何在医疗保健领域付诸实践及其成效。
一项现实主义文献综述。数据来源 作者系统检索了PubMed、科学网和商业资源全文数据库（1998年1月至2008年2月）中的文章，然后通过滚雪球的方法补充文章。
作者纳入了精益思维在医疗保健领域应用的实证研究，排除了那些对患者护理没有影响或报告混合方法的文章。作者基于使用原始摘要形式收集的数据进行了主题分析。在此基础上，阐明了背景、精益干预措施、机制和结果之间的相互作用。
作者回顾了33篇文章，发现了广泛的精益应用。这些文章描述了初始实施阶段，并强调技术方面。所有文章均报告了积极的结果。作者发现了与精益干预措施的不同组成部分相互作用并触发四种不同变革机制的常见背景因素：理解流程以产生共同理解；为有效性和效率进行组织和设计；改进错误检测以提高意识和流程可靠性；以及协作系统地解决问题以加强持续改进。
精益思维已在各种医疗保健环境中成功应用。虽然精益理论强调整体观，但大多数案例报告的是范围较窄的技术应用，组织影响有限。为了更好地实现潜在利益，医疗保健组织需要让高级管理层直接参与，跨越职能部门开展工作，为患者和其他客户追求价值创造，并培养持续改进的长期观念。
