Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany.
Syst Rev. 2017 Aug 24;6(1):170. doi: 10.1186/s13643-017-0563-y.
Quality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients' value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities.
A systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian's model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered.
Of the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing.
For a final conclusion about Value Stream Mapping's effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review's conclusion, the limitation of including heterogeneous and potentially biased results has to be considered.
医疗保健设施需要进行质量改进，并且必须基于证据和以患者为中心。价值流映射是精益管理的一种方法，旨在通过可视化和量化护理流程来提高患者的价值和护理质量。本研究旨在检验价值流映射在护理设施的结构、过程和结果质量方面的有效性。
进行系统评价。2016 年 2 月，在 PubMed、EBSCOhost（包括 Business Source Complete、Academic Search Complete、PSYCInfo、PSYNDX、SocINDEX with Full Text、Web of Knowledge 和 EMBASE ScienceDirect）上进行了搜索。纳入评估价值流映射并以英文或德文发表的 2000 年 1 月以来的所有同行评审论文。为了进行数据综合，将所有研究结果归入 Donabedian 的结构、过程和结果质量模型。为了评估和解释价值流映射的有效性，统计检查了结果的频率。
从 903 篇文章中检索到 22 项研究符合纳入标准。其中 11 项研究用于回答研究问题。价值流映射对过程和结果质量的时间维度有积极影响。它似乎可以减少非增值时间（例如等待时间）和住院时间。所有研究设计都是前后没有对照的研究，并且缺乏方法学上复杂的研究。
为了对价值流映射的有效性得出最终结论，需要进行更多具有改进方法学的研究。尽管缺乏证据，但价值流映射有可能改善护理质量的时间维度。需要调查背景影响，以在应用价值流映射时对不同质量领域之间的关系得出结论。但是，为了使用本综述的结论，必须考虑纳入异质和潜在有偏差的结果的局限性。
