The State of Lean and Quality Improvement Methodologies in the South African Healthcare Sector: A Systematic Literature Review

Even though South Africa has developed a policy document on quality in the healthcare sector, the quality of service delivery continues to deteriorate. This study aimed to explore the application of lean and quality improvement (QI) methodologies in South African healthcare organisations, focusing on the periods before and after the introduction of the policy document. Using a systematic literature review (SLR) guided by the preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart, 17 relevant studies were analysed from a total of 1,233 retrieved records. The results of the study show a strong focus on QI methodologies, particularly in preventive HIV care among health professionals, in contrast with lean methodologies, which mainly target patients’ waiting times. The most frequently used tools were the plan-do-study-act (PDSA) and plan-do-check-act (PDCA) cycles, although their use often lacked clarity in distinguishing between lean and QI methodologies. To address these gaps, this study recommends appointing quality assurance personnel and developing a comprehensive framework to sustain lean healthcare and QI initiatives. These efforts aim to enhance the implementation of quality improvement practices and overall healthcare delivery in South Africa.