Leadership Requirements for Successful Implementation of Lean Management in Health Care: A Systematic Review of the Literature

Lean is a management philosophy aimed at increasing value for end users by controlling waste. As such, it is a promising approach for health-care organizations to improve quality and control costs. Yet the transition to Lean management often fails in health-care organizations, commonly due to a lack of specific Lean leadership skills. This research addresses a gap in the knowledge about leadership requirements for successful Lean implementation in health-care organizations. A systematic literature search was performed using the MEDLINE, EMBASE and Emerald databases, resulting in the selection of 23 articles. Analysis of these articles confirmed the five Lean leadership principles identified in the manufacturing literature--improvement culture, self-development, employee training, going to the gemba, and hoshin kanri--and identified specific leadership behaviors, skills, characteristics, and attitudes for each principle. A sixth leadership principle, that of customer value, was also identified. This research contributes to existing Lean literature by providing new insights into leadership requirements for Lean transitions in health care. A new leadership framework is suggested for Lean leadership requirements during Lean implementation. In practice, this research provides health-care leaders with a practical framework and guidance with which to successfully implement Lean in a health-care institution.