PDF(Pubmed)
Abstract：
Lean Thinking and clinical pathways are commonly used concepts to improve healthcare. However, little is known on how to use Lean Thinking for the optimization of pathways or the quantification of both concepts. This study aims to create a framework to analyze pathways with Lean Thinking on a system level, by quantifying the seven wastes, flow and pull. A systematic literature review was performed. Inclusion criteria were the focus of the article on a well-defined group of patients and studied a pathway optimization with Lean Thinking. Data were extracted on measured outcomes, type of intervention and type of researched pathway. Thirty-six articles were included. No articles described the implementation of the Lean Thinking philosophy or studied the development of their people and partners (\"4 P\" model). Most articles used process optimization tools or problem-solving tools. The majority of the studies focused on process measures. The measures found in the review were used as input for our suggested framework to identify and quantify wastes, flow, and pull in a clinical pathway. The proposed framework can be used to create an overview of the improvement potential of a pathway or to analyze the level of improvement after an enhancement is introduced to a pathway. Further research is needed to study the use of the suggested quantifications.
摘要：
精益思维和临床路径是改善医疗保健的常用概念。然而,人们对如何使用精益思维来优化路径或量化这两个概念知之甚少。本研究旨在创建一个框架，在系统层面上分析精益思维的路径，通过量化七种浪费，流动和拉动。进行了系统的文献综述。纳入标准是本文针对定义明确的患者组的重点，并研究了精益思维的途径优化。数据是根据测量结果提取的，干预类型和研究路径类型。包括36篇文章。没有文章描述精益思维哲学的实施或研究他们的人和合作伙伴的发展（“4P”模型）。大多数文章使用流程优化工具或解决问题的工具。大多数研究都集中在过程措施上。审查中发现的措施被用作我们建议的识别和量化废物框架的投入，流量,并引入临床路径。所提出的框架可用于创建途径的改善潜力的概述或分析在对途径引入增强后的改善水平。需要进一步的研究来研究建议的量化的使用。
