Lean thinking in healthcare - Findings from a systematic literature network and bibliometric analysis.

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.