The application of lean methodology in the preoperative phase: a scoping review

Lean methodology, initially developed in manufacturing, is increasingly applied in healthcare to reduce inefficiencies. Despite its growing use, its application in the preoperative phase of surgery remains underexplored, though it may offer substantial benefits in improving efficiency and patient outcomes. This scoping review aims to assess the application of Lean principles to address inefficiencies in the surgical patient journey, with a particular focus on the preoperative phase, and to identify key areas of waste across surgical phases. Searches were conducted in PubMed, Web of Science, and Scopus, focusing on English-language studies published between 2010 and 2024. Data were extracted and analysed according to the JBI framework. The review includes studies on surgical patients applying Lean principles to improve efficiency in any phase of the surgical process. Non-surgical and administrative studies were excluded. A total of 27 studies were included, with Lean interventions addressing inefficiencies such as redundant testing, scheduling delays, and communication gaps. Most studies reported improvements in process efficiency and resource utilization, with some also noting enhanced patient outcomes. Variations in the application of Lean across different surgical specialties were observed. Lean methodology has proven effective in reducing inefficiencies in surgical care, particularly in the preoperative phase. However, there is a need for further research to standardize interventions and develop consistent metrics across surgical specialties to improve evaluation and outcomes.