Abstract
•This paper draws on 299 published articles from six databases.•A new methodology called Systematic Literature Network and Bibliometric Analysis.•After 20 years, Lean thinking in health settings is still in its infancy.•Silo mentality is deeply rooted in the healthcare literature at multiple levels.•A lack of systems thinking suggests extending the scope of lean implementations.
This paper draws on 299 published articles from six databases, and utilizes a novel methodology combining elements of a systematic literature review, citation network analysis, and bibliometric analysis, to track the development of Lean Thinking (LT) in healthcare—a popular improvement methodology increasingly being adopted by healthcare organizations.
A review of the LT literature in healthcare identifies that a piecemeal approach appears to have been taken regarding LT in health, with departmental focused implementations rather than LT’s intended systems approach. In addition, tool-myopic thinking tends to be a prevalent practice and often governs implementations, with less attention provided to soft practices such as continuous improvement and employee empowerment, undermining the long-term sustainability of LT’s improvements.
To fully explore the scope of LT, a parallel analysis of the Healthcare Supply Chain Management (HSCM) literature was also undertaken to determine whether these same tendencies were present. This paper identified a substantial gap between the LT and the HSCM literatures as mirrored by the citation network analysis by uncovering almost no inter-disciplinary cross-citations. Bibliometric analysis identified the same divide in terms of authors, with only three publishing in both fields.
It is crucial that LT is considered a system-wide approach and implementations move beyond departmental/functional boundaries and incorporate extended supply chains to ensure waste elimination rather than waste transference to other entities in supply chains.