Issues and challenges in the implementation of lean healthcare in hospitals: a systematic review

Abstract

Lean healthcare has emerged as a transformative approach to enhance efficiency, reduce waste, and improve patient outcomes in hospital settings. This systematic review aims to identify the key issues and challenges in implementing Lean initiatives in hospitals. Guided by the PRISMA framework, an extensive literature search was conducted across PubMed, Scopus, and Web of Science for literature published between January 2015 and December 2023, ultimately including 15 studies. The review categorises challenges into seven primary themes: resource limitations, organisational resistance, knowledge and training gaps, operational inefficiencies, communication barriers, sustainability concerns, and patient-centric obstacles. Study quality and risk of bias were independently assessed using the Joanna Briggs Institute (JBI) and the Center for Evidence-Based Management (CEBMa) critical appraisal tools. Resource constraints, encompassing financial, infrastructural, and human resource shortages, emerged as the most prominent barrier, reported in 66.7% of studies. Organisational resistance, driven by scepticism, fear of job losses, and insufficient leadership support, was the second most frequent challenge, found in 46.7% of studies. Additionally, gaps in staff knowledge and training regarding Lean principles, alongside workflow inefficiencies, further hindered implementation. Communication and coordination issues, often exacerbated by hierarchical decision-making, and challenges sustaining Lean practices due to high staff turnover and shifting priorities were also highlighted. Balancing Lean’s efficiency goals with the need for personalised patient care posed additional complexities. The findings underscore the necessity for comprehensive strategies to address these barriers. Strong leadership commitment, tailored training programs, and resource optimisation are critical for successful and sustainable Lean implementation. While Lean offers significant potential to enhance hospital operations and patient care, overcoming these multifaceted challenges is essential for realising its full benefits. This review provides actionable insights for policymakers and healthcare administrators, aiming to foster effective, context-sensitive strategies to mitigate barriers and promote Lean healthcare adoption.