Expanded Value Stream Mapping in Healthcare: From Efficiency to Sustainability

Value Stream Mapping (VSM) is a widely used lean tool that improves efficiency by identifying and eliminating wastes across various processes, including those in healthcare. In recent years, stakeholders have increasingly pressured organisations to integrate sustainability into their operations, underscoring the need to expand lean management practices by incorporating environmental and social considerations, such as the implementation of sustainable VSM. Unlike traditional VSM, which primarily focuses on customer (i.e., patient) value, sustainable VSM addresses the needs of a broader range of stakeholders, including patients, employees (healthcare staff), labour/professional unions, insurers, local communities, and regulatory bodies. This study aims to systematically identify the metrics used in VSM within the healthcare sector and propose an expanded metrics-based VSM that integrates economic, environmental, and social dimensions. A systematic literature review on sustainable VSM was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review indicates that current VSM practices in healthcare focus on metrics related to time, efficiency, capacity, cost, patient safety, and patient satisfaction. However, the healthcare sector also has significant implications for sustainability, including environmental aspects (e.g., resource consumption and healthcare waste management) and social aspects (e.g., occupational health and safety, and stakeholder satisfaction). To address these broader considerations, this study expands the existing application of VSM in healthcare by adapting multidimensional metrics commonly used in sustainable VSM in the manufacturing sector. This approach aims to achieve comprehensive outcomes by enhancing the quality of patient-centred care, while minimising resource consumption (materials, energy, and water), ensuring effective healthcare waste management, promoting health and safety, and improving the satisfaction of patients and other stakeholders. This study establishes a theoretical foundation for future research on integrating lean practices and sustainability. Additionally, it offers actionable insights for healthcare organisations seeking to implement a comprehensive approach to VSM that improves efficiency, care quality, and sustainability.