To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.

Foodborne diseases are a significant cause of morbidity and mortality worldwide. Studies have shown that the knowledge, attitude, and practices of food handlers are important factors in preventing foodborne illness. The purpose of this research is to assess the effects of training interventions on knowledge, attitude, and practice on food safety and hygiene among food handlers at different stages of the food supply chain. To this end, we conducted a systematic review and meta-analysis with close adherence to the PRISMA guidelines. We searched for training interventions among food handlers in five databases. Randomized control trials (RCT), quasi-RCTs, controlled before–after, and nonrandomized designs, including pre–post studies, were analyzed to allow a more comprehensive assessment. The meta-analysis was conducted using the random-effects model to calculate the effect sizes (Hedges’s g) and 95% confidence interval (CI). Out of 1094 studies, 31 were included. Results showed an effect size of 1.24 (CI = 0.89–1.58) for knowledge, an attitude effect size of 0.28 (CI = 0.07–0.48), and an overall practice effect size of 0.65 (CI = 0.24–1.06). In addition, subgroups of self-reported practices and observed practices presented effect sizes of 0.80 (CI = 0.13–1.48) and 0.45 (CI = 0.15–0.76) respectively.

Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.

Purpose: – The purpose of this paper is to extend the understanding of Six Sigma (SS) and the underlying dimensions of its critical success factors (CSF) via an analysis of the effects of top management support (TMS), implementation strategy (IS), and collaborative team (CT) on project performance (PP) in Mexican manufacturing companies.Design/methodology/approach: – Based on a SS literature review, a survey was conducted to capture practitioners’ viewpoints about CSFs for SS implementation and their impact on performance in manufacturing companies. A factor analysis and structural equation modeling were conducted in order to identify and analyze causal relationships.Findings: – The results suggest that CSFs grouped in the constructs TMS, IS, and CT have a positive impact on PP as measured by cost reduction, variation reduction, and quality improvement.Research limitations/implications: – Although the empirical data collected supported the proposed model, results might differ among organizations in different countries. In addition, the study did not analyze a unique performance metric; instead, general PP dimensions were used.Practical implications: – Boosting the TMS, IS, and CT enhances positive PP of SS in manufacturing companies.Originality/value: – IS as a construct has not been studied exhaustively; this work contributes to a better understanding of it and its impact on PP. Additionally, studies of SS in Latin America are limited, so this study gives a complementary vision to practitioners and researchers about it.

This paper presents a second-order structural equation model that analyzes three lean manufacturing tools associated with material flow, such as 5S, SMED, and continuous flow related to economic sustainability. The variables relate to each other through six hypotheses, tested with 169 responses to a questionnaire applied to the Mexican maquiladora industry, using the partial least squares technique and 95% confidence to estimate direct, the sum of indirect, and total effects. In addition, an analysis with conditional probabilities appears to determine how low and high implementation levels in independent variables affect the dependent variables’ occurrence. Findings indicate that 5S is a lean manufacturing tool with the most increased direct effects on SMED and continuous flow. Additionally, values indicate that SMED is essential to maintain continuous flow in production lines and is vital for economic sustainability due to the time reduction in setup.