Metodologías Lean en salud. Propuesta de mapa analítico-conceptual para sistematizar su impacto y resultados
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dic 20, 2024
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Objetivo: Diseñar una propuesta teórico-metodológica para sistematizar los resultados del uso de metodologías Lean en salud y aplicar dicho modelo en el ámbito sanitario occidental. Metodología: Se diseñó una herramienta teórico-metodológica que combina los sistemas de indicadores del modelo de Donabedian, el Sistema Nacional de Salud y el modelo de Atención Sanitaria Basada en el Valor. El mapa analítico-conceptual creado se aplicó en una revisión sistemática de estudios empíricos cuantitativos y mixtos publicados en los últimos cinco años sobre el impacto de Lean en salud. Resultados: Los 33 estudios analizados, principalmente diseños cuantitativos pre-post, describen y evalúan el impacto de diversas intervenciones Lean (flujo de valor, ciclo PDSA/PDCA, Lean Six Sigma y eventos Kaizen) orientadas a mejorar la eficiencia y la calidad asistencial. La mayoría de los estudios se concentran en contextos hospitalarios (quirófanos, cuidados intensivos y farmacia) y en mediciones centradas en el eje organizacional (oferta de servicios, accesibilidad, gestión del tiempo y organización del trabajo, reducción de costos, eficiencia y seguridad), con menor atención a los aspectos centrados en el valor para los pacientes (resultados en salud, satisfacción y efectos a largo plazo). Conclusiones: El análisis estructurado basado en el mapa analítico-conceptual permitió dimensionar los resultados de Lean en salud, identificar las áreas de gestión y calidad con mayor aplicación e impacto Lean, y señalar la necesidad de ampliar las investigaciones en torno al valor para los pacientes.
Keywords
Sector de Atención de Salud, Indicadores de Calidad de la Atención de Salud, Calidad de la Atención de Salud, Calidad, Acceso y Evaluación de la Atención de Salud, Revisión sistemáticaSetor de Atenção à Saúde, Indicadores de Qualidade da Atenção à Saúde, Qualidade da Atenção à Saúde, Qualidade, Acesso e Avaliação da Atenção à Saúde, Revisão SistemáticaHealthcare Sector, Healthcare Quality Indicators, Healthcare Quality, Quality, Access, and Healthcare Evaluation, Systematic Review
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2. Graban M. Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. Boca Ratón: CRC Press; 2016.
3. Souza DL, Korzenowski AL, Alvarado M, Sperafico JH, Friedl Ackermann AE, Mareth T et al. A Systematic Review on Lean Applications' in Emergency Departments. Healthcare. 2019;9(6):e763. doi:10.3390/healthcare9060763
4. Magalhães ALP, Erdmann AL, da Silva EL y Dos Santos JLG. Lean thinking in health and nursing: An integrative literature review. Rev Lat Am Enfermagem. 2016; 24:e2734. doi:10.1590/1518-8345.0979.2734
5. Johnson JE, Smith AL y Mastro KA. From Toyota to the bedside: nurses can lead the lean way in health care reform. Nurs. Adm. Q. 2012;36:234-242. doi:10.1097/NAQ.0b013e318258c3d5
6. Filser L, Da Silva F y De Oliveira O. State of research and future research tendencies in lean healthcare: a bibliometric analysis. Scientometrics. 2017;112(2): 1-18.
7. Miller R, Chalapati N. Utilizing lean tools to improve value and reduce outpatient wait times in an Indian hospital. Leadersh Health Serv (Bradf Engl). 2015;28(1):57-69. doi:10.1108/LHS-01-2014-0001.
8. Menachemi N, Tinsley T, Johnston A y Schulhof A. Implementation of lean in a health system: Lessons learned from a meta-analysis of rapid improvement events, 2013-2017. J Healthc Manag. 2020;65(6):407-417. doi:10.1097/JHM-D-19-00097
9. Anonimizado
10. D'Andreamatteo A, Ianni L, Lega F y Sargiacomo M. Lean in healthcare: A comprehensive review. Health Policy. 2015;119(9):1197-1209. doi:10.1016/j.healthpol.2015.02.002
11. Akmal A, Greatbanks R y Foote J. Lean thinking in healthcare – findings from a systematic literature network and bibliometric analysis. Health Policy. 2020; 124(6):615-627. doi:10.1016/j.healthpol.2020.04.008
12. Reponen E, Rundall TG, Shortell SM, Blodgett JC, Juarez A, Jokela R et al. Benchmarking outcomes on multiple contextual levels in lean healthcare: A systematic review, development of a conceptual framework, and a research agenda. BMC Health Services Research. 2021;21(1). doi:10.1186/s12913-021-06160-6
13. Marsilio M y Pisarra M. Lean management in health care: A review of reviews of socio-technical components for effective impact. J Health Organ Manag. 2020;35(4):475-491. doi:10.1108/JHOM-06-2020-0241
14. Donobedian A. La Calidad de la atención médica, definición y métodos de evaluación. Ciudad de México: Editorial La Prensa Médica Mexicana; 1984.
15. Ministerio de Sanidad y Consumo. Indicadores clave del Sistema Nacional de Salud. Consejo Interterritorial del SNS-SbC de Sistemas de Información. Plan de Calidad para el Sistema Nacional de Salud; 2007. https://www.sanidad.gob.es/estadEstudios/estadisticas/sisInfSanSNS/pdf/indicadoresClaveCISNS.pdf
16. Porter ME y Teisberg EO. Redefining health care: creating value-based competition on results. Boston: Harvard Business School Press; 2006.
17. Porter ME. What is value in health care. N Engl J Med. 2010;363:2477-2481.
18. Willke RJ, Burke LB, Erickson P. Measuring treatment impact: a review of patient-reported outcomes and other efficacy endpoints in approved product labels. Control Clin Trials. 2004;25:535–52.
19. Lindgren P y Althin R. Something borrowed, something new: measuring hospital performance in the context of value based health care. Eur J Health Econ. 2021;22:851-854.
20. Moher D, Liberati A, Tetzlaff J, Altman DG y PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine. 2009; 6(7):e1000097. doi:10.1371/journal. pmed.1000097
21. JBI (Joanna Briggs Institute). Checklist for Case Reports; 2020. https://jbi.global/critical-appraisal-tools
22. Ammanuel SG, Chan AK, Digiorgio AM, Alazzeh M, Nwachuku K, Robinson LC et al. Perioperative anesthesia lean implementation is associated with increased operative efficiency in posterior cervical surgeries at a high-volume spine center. Neurospine. 2020;17(2):390-397. doi:10.14245/ns.1938318.159
23. Ankrum AL, Neogi S, Morckel MA, Wilhite AW, Li Z y Schaffzin JK. Reduced isolation room turnover time using lean methodology. Infect Control Hosp Epidemiol. 2019;40(10):1151-1156. doi:10.1017/ice.2019.199
24. Blouin-Delisle CH, Drolet R, Gagnon S, Turcotte S, Boutet S, Coulombe M et al. Improving flow in the OR. Int J Health Care Qual Assur. 2018;31(2):150-161. doi:10.1108/IJHCQA-01-2017-0014
25. Boronat F, Budia A, Broseta E, Ruiz-Cerdá JL y Vivas-Consuelo D. Aplicación de la metodología Lean healthcare en un servicio de urología de un hospital terciario como herramienta de mejora de la eficiencia. Actas Urol. Esp. 2018;42(1):42-48. doi:10.1016/j.acuro.2017.03.009
26. Boyle S, Tyrrell O, Quigley A y Wall C. Improving ward level efficiency using a modified treatment room layout according to lean methodologies. Ir. J. Med. Sci. 2022;191(1):127-132. doi:10.1007/s11845-021-02590-7
27. Brunsman AC. Using lean methodology to optimize time to antibiotic administration in patients with sepsis. AJHP. 2018;75(5):S13-S23. doi:10.2146/ajhp161017
28. Burr KL, Stump AA, Bladen RC, O’brien PR, Lemon BJ, Tearl DK et al. Twice-daily huddles improves collaborative problem solving in the respiratory care department. Resp Care. 2021;66(5): 822-828. doi:10.4187/respcare.07717
29. Caro Teller, J.M, Pablos Bravo, S., Serrano Garrote, O. et al. (2020). Implementación Lean Six Sigma en la mejora del circuito de dispensación de medicación. JHQR. 35(6), 364-371.
30. Castro C, Pereira T y Santos G. Logistics reorganisation and management of the ambulatory pharmacy of a local health unit in Portugal. Eval Program Plann. 2020; 80. doi:10.1016/j.evaprogplan.2020.101801
31. Cichos KH, Hyde ZB, Mabry SE, Ghanem ES, Brabston EW, Hayes LW et al. Optimization of orthopedic surgical instrument trays: Lean principles to reduce fixed operating room expenses. J Arthroplasty. 2019;34(12); 2834-2840. doi:10.1016/j.arth.2019.07.040
32. Coffey C, Cho ES, Wei E, Luu A, Ho M, Amaya R et al. Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center. Am. J. Surg. 2018;216(2):194-201. doi:10.1016/j.amjsurg.2018.05.002
33. Davis T, Beste J, Batish S, Watford R y Farrell S. Eliminating patient identified barriers to decrease medicaid inpatient admission rates and improve quality of care. JABFM. 2020;33(2):220-229. doi:10.3122/jabfm.2020.02.190275
34. Eamranond PP, Bhukhen A, DiPalma D, Kunuakaphun S, Burke T, Rodis J et al. Interprofessional, multitiered daily rounding management in a high-acuity hospital. Int. J. Health Care Qual. 2020;33(6):447-461. doi:10.1108/IJHCQA-09-2019-0158
35. Elsasser EJ, White CA y Jones MR. Implementation of a transformational plan of care at a veterans affairs medical center. AJHP. 2018;75(17):S63-S71. doi:10.2146/ajhp170485
36. Ezezika J, Easton L, Chung H, Barbera L, Ravi A, Hill-Mugford D et al. Going lean to improve the patient experience in a high-throughput brachytherapy program. JMIRS. 2018;49(2):130-135. doi:10.1016/j.jmir.2018.03.001
37. Fields E, Neogi S, Schoettker PJ y Lail J. Using lean methodologies to streamline processing of requests for durable medical equipment and supplies for children with complex conditions. Healthcare. 2018;6(4):245-252. doi:10.1016/j.hjdsi.2017.11.00
38. Fiorillo A, Sorrentino A, Scala A, Abbate V, Orabona GD. Improving performance of the hospitalization process by applying the principles of Lean thinking. TQM Journal. 2021; 33(7):253-271.
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Danet, A., & Pérez Lázaro, J. J. (2024). Metodologías Lean en salud. Propuesta de mapa analítico-conceptual para sistematizar su impacto y resultados. Gerencia Y Políticas De Salud, 23, 1–22. https://doi.org/10.11144/Javeriana.rgps23.mlsp
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