Healthcare efficiency and healthcare staff well-being: A systematic review of lean management in hospital emergency services
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Abstract
The implementation of Lean Management in hospital emergency services has expanded as a strategy to optimize processes, reduce waste, and improve healthcare efficiency. However, its effects on working conditions and the well-being of healthcare staff remain a matter of debate, particularly in settings characterized by high pressure, work overload, urgent decision-making, and constant exposure to critical situations. The objective of this article was to analyze the available scientific evidence on the effects of Lean Management implementation on the working conditions and physical and psychological well-being of staff in hospital emergency services. A systematic review article was developed, following methodological guidelines aimed at the identification, selection, and critical analysis of scientific studies related to Lean Management, Lean Healthcare, Lean Thinking, continuous improvement, and emergency services. The review made it possible to organize the evidence around four main areas: psychological well-being, working conditions, mediating or moderating factors, and mitigation strategies. The findings show that Lean may generate positive effects when it reduces waiting times, improves patient flow, organizes tasks, strengthens communication, and promotes staff participation. Nevertheless, adverse effects were also identified when the methodology is implemented instrumentally, focused solely on efficiency indicators, without considering workload, autonomy, privacy, fatigue, and the emotional exhaustion of the team. It is concluded that Lean Management should not be understood merely as an operational tool, but rather as an organizational intervention that requires leadership, institutional support, and explicit protection of healthcare staff well-being.
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