Lean Management Approach In Hospital Processes: Literature Review

Öz

This study provides a comprehensive examination the applications and impacts of lean methodologies in hospitals. Lean methodology, widely implemented across various industries, aims to optimize processes, reduce waste, lower costs, and enhance service quality. In complex and multi-stakeholder organizations such as hospitals, these methodologies provide significant contributions to operational and strategic improvements. Based on studies conducted between 2014 and 2024, the effectiveness of lean tools in processes such as patient registration, laboratory workflows, medication procurement and distribution, patient transfers, and discharge procedures has been analyzed in detail. Commonly utilized tools include 5S, Value Stream Mapping, A3 Reporting, and DMAIC. These tools significantly contribute to accelerating processes, improving patient satisfaction, and optimizing resource utilization. The findings indicate that lean methodologies shorten patient waiting times, expedite service processes, reduce medical errors, and create safer environments in healthcare settings. By minimizing waste, these approaches enable more efficient hospital resource management and reduce the workload on healthcare professionals. Moreover, lean methodologies support organizational change and foster a culture of continuous improvement, enhancing staff motivation and contributing to patient safety. In conclusion, this study emphasizes the need for broader evaluations of lean methodologies in hospitals, particularly in terms of expanding the related literature in Turkey. Increasing research on the application of lean methodologies in healthcare can significantly contribute to process improvements and heightened patient satisfaction.

Anahtar Kelimeler

• Hospital
• Waste
• Improvement
• Healthcare
• Lean

Hastane Süreçlerinde Yalın Yönetim Yaklaşımı: Türkiye Odaklı Literatür İncelemesi

Öz

Bu çalışma, yalın metodolojilerin hastanelerdeki uygulamalarını kapsamlı bir şekilde ele almakta ve sağlık hizmetlerinde süreç optimizasyonu, israfın azaltılması, maliyet minimizasyonu ve hizmet kalitesinin artırılmasındaki etkinliğini değerlendirmeyi amaçlamaktadır. Yalın metodoloji, süreçlerin optimize edilmesi, israfın azaltılması, maliyetlerin düşürülmesi ve hizmet kalitesinin artırılması amacıyla birçok sektörde başarıyla uygulanmaktadır. Hastaneler gibi karmaşık ve çok paydaşlı organizasyonlarda, bu metodolojiler süreçleri daha etkin hale getirerek hem operasyonel hem de stratejik düzeyde önemli katkılar sağlamaktadır. 2014-2024 yılları arasında yapılan çalışmalara dayanarak, hasta kayıt işlemleri, laboratuvar süreçleri, ilaç tedarik ve sevkiyatı, hasta sevkleri ve taburculuk gibi süreçlerde kullanılan yalın araçların etkinliği detaylı olarak incelenmiştir. Literatürde en sık kullanılan araçlar arasında 5S, Değer Akış Haritalama, A3 raporlama ve DMAIC yer almaktadır. Bu araçların süreçlerin hızlanmasına, hasta memnuniyetinin artmasına ve kaynakların daha verimli kullanılmasına önemli ölçüde katkı sağladığı tespit edilmiştir. Analizler, yalın metodolojilerin hasta bekleme sürelerini kısaltarak hizmet süreçlerini hızlandırdığını, tıbbi hataları azalttığını ve sağlık hizmetlerinde daha güvenli bir ortam oluşturduğunu göstermektedir. Ayrıca, israfı en aza indiren bu yaklaşımlar, hastane kaynaklarının daha etkin yönetilmesini ve sağlık çalışanlarının iş yükünün azaltılmasını sağlamaktadır. Bunun yanında, organizasyonel değişim ve sürekli iyileştirme kültürünü destekleyerek çalışanların motivasyonunu artırdığı ve hasta güvenliğine katkı sunduğu vurgulanmıştır. Sonuç olarak, bu çalışma, yalın metodolojilerin hastanelerdeki potansiyelinin daha geniş bir perspektifle değerlendirilmesi gerektiğini ve özellikle Türkiye'deki literatürün bu alanda gelişime açık olduğunu ortaya koymaktadır. Yalın metodolojilerin sağlık hizmetlerinde kullanımına yönelik araştırmaların artırılması, süreçlerin iyileştirilmesine ve hasta memnuniyetinin yükseltilmesine yönelik önemli katkılar sağlayabilir.

Anahtar Kelimeler

• Hastane
• İsraf
• İyileştirme
• Sağlık
• Yalın

Kaynakça

1. Abbes N., Sejri N., Xu J., Cheikhrouhou M. New lean six sigma readiness assessment model using fuzzy logic: Case study within clothing industry. Alexandria Engineering Journal 2022; 61(11): 9079-9094.
2. Adeodu A., Maladzhi R., Kana-Kana Katumba MG., Daniyan I. Development of an improvement framework for warehouse processes using lean six sigma (DMAIC) approach. A case of third party logistics (3PL) services. Heliyon 2023; 9(4): e14915.
3. Afsar-manesh N., Lonowski S., Namavar AA. Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative. Healthcare 2017; 5(4): 194-8.
4. Alexander G., Williams JH. The impact of an accelerated improvement workshop on ordering and receiving. Library Collections, Acquisitions, & Technical Services 2005; 29(3): 283-294.
5. Alukal VG., Manos A. Lean kaizen. Quality Press; 2006.
6. Arora S., Tsang F., Kekecs Z., Shah N., Archer S., Smith J., Darzi A. Patient safety education 20 years after the institute of medicine report: Results from a cross-sectional national survey. Journal of Patient Safety 2021; 17(8): 1884-1888.
7. Aydın Ş., Kara H., Can E., İltar MR. FRAM ile fizik tedavi hastanelerinde psikososyal ve ergonomik risklerin analizi. Ofis Academy 2022; 5: 165-174.
8. Azevedo J., Sá JC., Ferreira LP., Santos G., Cruz FM., Jimenez G., Silva FJG. Improvement of production line in the automotive industry through lean philosophy. Procedia Manufacturing 2019; 41: 1023-1030.

9. Belayutham S., González VA., Yiu TW. Clean–lean administrative processes: A case study on sediment pollution during construction. Journal of Cleaner Production 2016; 126: 134-147.
10. Berte B., Kobza R., Toggweiler S., Schüpfer G., Duytschaever M., Hoop V. Improved procedural efficiency of atrial fibrillation ablation using a dedicated ablation protocol and lean management. JACC Clin Electrophysiol 2021; 7(3): 321-332.
11. Birgün S., Kulaklı A. Scientific publication analysis on lean management in healthcare sector: the period of 2010-2019. İstanbul Ticaret Üniversitesi Sosyal Bilimler Dergisi 2020; 19: 478-500.
12. Bittencourt VL., Alves AC., Leão CP. Lean Thinking contributions for Industry 4.0: A systematic literature review. IFAC-PapersOnLine 2019; 52(13): 904-909.
13. Boronat F., Budia A., Broseta E., Ruiz-Cerdá JL., Vivas-Consuelo D. Application of lean healthcare methodology in a urology department of a tertiary hospital as a tool for improving efficiency. Actas Urológicas Españolas 2018; 42(1): 42-48.
14. Bossone E., Majolo M., D’Ambrosio S., Raiola E., Sparano M., Russo G., Longo G., Triassi M., Rosa A. Lean management approach for reengineering the hospital cardiology consultation process: a report from aorn “a. Cardarelli” of naples. International Journal of Environmental Research and Public Health 2022; 19(8): 4475.
15. Bowe CM., Gurney B., Sloane J., Newlands C. Process mapping and Lean principles applied to orthognathic surgery. British Journal of Oral and Maxillofacial Surgery 2021; 59(2): 157-162.
16. Burroni L., Bianciardi C., Romagnolo C., Cottignoli C., Palucci A., Massimo Fringuelli F. Lean approach to improving performance and efficiency in a nuclear medicine department. Clinical and Translational Imaging 2021; 9(2): 129-39.
17. Camgöz-Akdağ H., Çalışkan E., Toma S. Lean process design for a radiology department. Business Process Management Journal 2017; 23(4): 779-791.
18. Castro C., Pereira T., Sá JC., Santos G. Logistics reorganization and management of the ambulatory pharmacy of a local health unit in Portugal. Evaluation and Program Planning 2020; 80: 101801.
19. Chan H., Lo S., Lee L., Lo W., Yu W., Wu Y. Lean techniques for the improvement of patients’ flow in emergency department. World Journal of Emergency Medicine 2014; 5(1): 24-28.
20. Chen T., Ma X., Zhou S., Wang H., Pan Y., Chen L. Establishing a standardized FUO emergency department: design and practice in dealing with COVID-19. Annals Of Translational Medicine 2020; 8(12): 749.
21. Chiarini A. Sustainable manufacturing-greening processes using specific Lean Production tools: An empirical observation from European motorcycle component manufacturers. Journal of Cleaner Production 2014; 85: 226-233.
22. Chronéer D., Wallström P. Exploring waste and value in a lean context. International Journal of Business and Management 2016; 11(10): 282.
23. Costa R., Resende T., Dias A., Pereira L., Santos J. Public sector shared services and the lean methodology: implications on military organizations. Journal of Open Innovation: Technology, Market, and Complexity 2020; 6(3): 78.
24. Cox A., Chicksand D. The limits of lean management thinking: multiple retailers and food and farming supply chains. European Management Journal 2005; 23(6): 648-662.
25. Crema M., Verbano C. How to combine lean and safety management in health care processes: A case from Spain. Safety Science 2015; 79: 63-71.
26. Dağcı A., Aslan E. Sağlık sektöründe yalın üretim uygulaması: Tokat ilinde bir devlet hastanesi örneği. Hacettepe Sağlık İdaresi Dergisi 2020; 23(4): 4.
27. De Barros LB., Caldas LP., Bohomol E., Sarantopoulos A., Minatogawa V., Gasparino RC. Evaluation of waste related to the admission process of low-complexity patients in emergency services, in light of the lean healthcare philosophy. International Journal Of Environmental Research and Public Health 2022; 19(12): 7044.
28. Erdmann MA., Paramel IS., Marshall C., LeHew K., Kee A., Soliman S., Monica Vuong M., Sydney Spillane S., Joshua Baer J., Shania Do S., Tiffany Jones T., Derek McGuire D. Reduced time to admit emergency department patients to inpatient beds using outflow barrier analysis and process improvement. The Western Journal of Emergency Medicine 2024; 25(5): 748-757.
29. Digioia AM., Greenhouse PK., Chermak T., Hayden MAA. Case for integrating the patient and family centered care methodology and practice in lean healthcare organizations. Healthcare 2015; 3(4): 225-230. Dörner A., Pirkl G., Simon M., Bures M. Use of lean management methods based on eye-tracking information to make user interfaces in production more human-centered. Procedia CIRP 2024; 128: 514-519.
30. Drei SM., Ignácio PS de A. Lean healthcare applied systematically in the accommodation of medical clinic’s beds in a medium-sized hospital. IFAC-PapersOnLine 2022; 55(10): 910-915.
31. Durgun A. Yeşil hastane ve yeşil sosyal hizmet. İksad Yayınevi; 2022.
32. Dyas SR. Practitioner application: using time-driven activity-based costing to model the costs of various process improvement strategies in acute pain management. Journal of Healthcare Management 2018; 63(4): 86-87.
33. Efe ÖF., Şen H. Türkiye’de yalın üretim alanında yapılan lisansüstü tezlerin incelenmesi. Osmaniye Korkut Ata University Journal of The Institute of Science and Techn 2025; 8(2): 906-928.
34. El Sayed MJ., El-Eid GR., Saliba M., Jabbour R., Hitti EA. Improving emergency department door to doctor time and process reliability: a successful implementation of lean methodology. Medicine (Baltimore) 2015; 94(42): e1679.
35. Esaki RK., Macario A. Wastage of supplies and drugs in the operating room. Medscape Anesthesiology 2009. Ewnetu M., Gzate Y. Assembly operation productivity improvement for garment production industry through the integration of lean and work-study, a case study on Bahir Dar textile share company in garment, Ethiopia. Heliyon 2023; 9(7).
36. Feld WM. Lean manufacturing: tools, techniques, and how to use them. CRC Press; 2000.
37. Fisher AM., Ding MQ., Hochheiser H., Douglas GP. Measuring time utilization of pharmacists in the Birmingham Free Clinic dispensary. BMC Health Services Research 2016; 16: 1-7.
38. Fong AJ., Smith M., Langerman A. Efficiency improvement in the operating room. Journal of Surgical Research 2016; 204(2): 371-83.
39. Forgia D., Paparella G., Signorile R., Arezzo F., Comes MC., Cormio G. Lean perspectives in an organizational change in a scientific direction of an Italian research institute: experience of the cancer institute of Bari. International Journal Of Environmental Research and Public Health 2022; 20(1): 239.
40. Frank L., Rader A. Using lean healthcare techniques to reduce appointment times. The Journal for Nurse Practitioners 2023; 19(3): 104508.
41. Freitas PS., de Mendonça GS., Resende ES. Implementation of the lean healthcare system in the emergency room of the clinical hospital of the federal university of Uberlandia: a case study. International Journal of Environmental Research and Public Health 2023; 20(24): 7184.
42. Fu S., Wu XG., Zhang L., Wu LF., Luo ZM., Hu QL. Service quality improvement of outpatient blood collection by lean management. Patient Prefer Adherence 2021; 15: 1537-1543.
43. Gomez CR., Cardonell B., Pfeiffer K., Pond D., Ingebritson D., French BR., Siddiq F., Qureshi AI. Optimizing workflow of urgent stroke endovascular intervention: A focused lean six sigma project. Journal of Stroke and Cerebrovascular Diseases 2024; 33(3): 107559.
44. Görener A., Akkurt M., Çınar S. Statistical analysis about perception of concurrent engineering and lean manufacturing approaches through manufacturing industry. Sigma Journal of Engineering and Natural Sciences 2008; 26(2): 138.
45. Graban M. Lean hospitals: improving quality, patient safety, and employee engagement. CRC Press; 2016.
46. Gupta R., Tat Q., O’Brien J., Shaw M., Cumbler E., McPherson R., de la Cruz D., Dua A., Yi JA. Utilization of lean project management principles and health informatics to reduce operating room delays in a vascular surgery practice. The American Journal of Surgery 2022; 223(1): 176-181.
47. Gupta S., Jain SK. The 5S and kaizen concept for overall improvement of the organisation: A case study. International Journal of Lean Enterprise Research 2014; 1(1): 22.
48. Hitti EA., El-Eid GR., Tamim H., Saleh R., Saliba M., Naffaa L. Improving emergency department radiology transportation time: a successful implementation of lean methodology. BMC Health Servıces Research 2017; 17(1): 625.
49. Huang WL., Liao SL., Huang HL., Su YX., Jerng JS., Lu CY., Ho WS., Xu JR. A case study of lean digital transformation through robotic process automation in healthcare. Scientific Reports 2024; 14(1): 14626.
50. İlkim NŞ., Deri̇n N. Dünyadan ve Türkiye’den örneklerle sağlık hizmetlerinde yalın yönetim. Hacettepe Sağlık İdaresi Dergisi 2016; 19(4): 465-479.
51. Işıkçelik F., Özkan O., Ağırbaş İ. Hastane ilaç stoklarının ABC, VED ve ABC-VED yöntemleri ile analizi. Hacettepe Sağlık İdaresi Dergisi 2019; 22(2): 305-318.
52. Kanchan BK., Chandan GK., Kumari R., Rajenthirakumar D., Gautom O. Implication of lean practices in enhancing public trust: An empirical study. Materials Today: Proceedings 2021; 47: 3358-3363.
53. Khalil V., Foo S. A lean approach for improving medicines management in Australia’s first cardiac hospital inventory system. The International Journal of Health Planning and Management 2024; 39(5): 1642-1651.
54. Kılıçarslan M. Reduction of lean in the health and lean application in the emergency of x hospital. Elektronik Sosyal Bilimler Dergisi 2019; 18(69): 454-465.
55. Küçük B., Arıcan G., Arıkan H., Aral M. Yalın üretim sistemlerinin hasta antimikrobiyal duyarlılık testlerine uygulanması. Sakarya Tıp Dergisi 2021; 11(4): 873-878.
56. Lakshmanan R., Nyamekye P., Virolainen VM., Piili H. The convergence of lean management and additive manufacturing: Case of manufacturing industries. Cleaner Engineering and Technology 2023; 13: 100620.
57. Langer R., Tröhler A., Schnüriger B., Trippel M., Blank A., Banz Y., Candinas D., Perren A., Lugli A. Implementation of modern tools in autopsy practice-the way towards contemporary postmortal diagnostics. Virchows Archiv: An International Journal of Pathology 2019; 474(2): 149-158.
58. Le DX., Do HT., Bui KT., Hoang TQ., Nguyen GH., Nguyen AV., Nguyen QT., Gorgui-Naguib H., Naguib RNG. Lean management for improving hospital waiting times-Case study of a Vietnamese public/general hospital emergency department. The International Journal of Health Planning and Management 2022; 37(1): 156-170.
59. Letelier P., Guzmán N., Medina G., Calcumil L., Huencho P., Mora J. Workflow optimization in a clinical laboratory using Lean management principles in the pre-analytical phase. Journal Of Medical Biochemistry 2021; 40(1): 26-32.
60. Liker JK. Becoming lean: inside stories of U.S. manufacturers. CRC Press; 1997.
61. Lima E de S., de Oliveira UR., Costa M de C., Fernandes VA., Teodoro P. Sustainability in public Universities through lean evaluation and future improvement for administrative processes. Journal of Cleaner Production 2023; 382: 135318.
62. Lin CC., Chueh JW., Chen HM., Chiu YH., Chu D. Applying the Toyota production system to decrease the time required to transport patients undergoing surgery from the general ward to the operating room and reviewing the essence of lean thinking. Frontiers in Medicine 2022; 9: 1054583.
63. Lukrafka TO., Silva DS., Echeveste MA. Geographic picture of Lean adoption in the public sector: Cases, approaches, and a refreshed agenda. European Management Journal 2020; 38(3): 506-517.
64. Mamede HS., Gonçalves Martins CM., Mira da Silva MA. Lean approach to robotic process automation in banking. Heliyon 2023; 9(7): e18041.
65. Mancosu P., Nicolini G., Goretti G., De Rose F., Franceschini D., Ferrari C., Reggiori G., Tomatis S., Scorsetti M. Applying lean-six-sigma methodology in radiotherapy: Lessons learned by the breast daily repositioning case. Radiotherapy and Oncology 2018; 127(2): 326-331.
66. Manning MW., Bean EW., Miller AC., Templer SJ., Mackenzie RS., Richardson DM., Bresnan KA., Greenberg MR. Using medical student quality improvement projects to promote evidence-based care in the emergency department. The Western Journal of Emergency Medicine 2018; 19(1): 148-157.
67. Mogini V., Campanella P., Moraca E., Makishti O., Ricciardi W., Specchia M. Improving quality and efficiency in healthcare. The Lean Thinking strategy: Paolo Campanella. European Journal of Public Health 2017; 27: 187-272.
68. Mohan Prasad M., Dhiyaneswari JM., Ridzwanul Jamaan J., Mythreyan S., Sutharsan SMA. Framework for lean manufacturing implementation in Indian textile industry. Materials Today: Proceedings 2020; 33: 2986-2995.
69. Morell-Santandreu O., Santandreu-Mascarell C., Garcia-Sabater JJ. A model for the ımplementation of lean improvements in healthcare environments as applied in a primary care center. Internatıonal Journal Of Environmental Research And Public Health 2021; 18(6): 2876.
70. Moreno-Fergusson ME., Guerrero Rueda WJ., Ortiz Basto GA., Arevalo Sandoval IAL., Sanchez–Herrera B. Analytics and lean health care to address nurse care management challenges for inpatients in emerging economies. Journal of Nursing Scholarship 2021; 53(6): 803-814.
71. Muharam R., Firman F. Lean management improves the process efficiency of controlled ovarian stimulation monitoring in IVF treatment. Journal of Healthcare Engineering 2022; 2022: 6229181.
72. Narayanamurthy G., Gurumurthy A. Is the hospital lean? A mathematical model for assessing the implementation of lean thinking in healthcare institutions. Operations Research for Health Care 2018; 18: 84-98.
73. Ouyang L., Zhu Y., Zheng W., Yan L. An information fusion FMEA method to assess the risk of healthcare waste. Journal of Management Science and Engineering 2021; 6(1): 111-124.
74. Özkan O. Özel hastane yöneticilerinin yalın sağlık yönetimi hakkında görüşlerinin incelenmesi; Ankara ili örneği. Gazi Üniversitesi Sağlık Yönetimi Anabilim Dalı Yüksek Lisans Tezi, sayfa no: 103, Ankara, Türkiye, 2018.
75. Pellini F., Di Filippo G., Mirandola S., Deguidi G., Filippi E., Pollini GP. Effects of lean thinking and emerging technologies on breast cancer patients’ therapeutic process during covid-19 pandemic: a case-control matched study. Frontiers In Surgery 2023; 8: 582980.
76. Perdomo-Verdecia V., Sacristán-Díaz M., Garrido-Vega P. Lean management in hotels: Where we are and where we might go. International Journal of Hospitality Management 2022; 104: 103250.
77. Prado-Prado JC., García-Arca J., Fernández-González AJ., Mosteiro-Añón M. Increasing competitiveness through the implementation of lean management in healthcare. International Journal of Environmental Research and Public Health 2020; 17(14): 4981.
78. Rahani AR., Al-Ashraf M. Production flow analysis through value stream mapping: A lean manufacturing process case study. Procedia Engineering 2012; 41: 1727-1734.
79. Rao PK., Cunningham AJ., Kenron D., Mshelbwala P., Ameh EA., Krishnaswami S. Applying lean healthcare in lean settings: launching quality improvement in resource-limited regions. Journal of Surgical Research 2021; 266: 398-404.
80. Régis TKO., Santos LC., Gohr CFA. A case-based methodology for lean implementation in hospital operations. Journal of Health Organization and Management 2019; 33(6): 656-676.
81. Roosen TJ., Pons DJ. Environmentally lean production: the development and incorporation of an environmental impact index into Value Stream Mapping. Journal of Industrial Engineering 2013; (1): 298103.
82. Rosso CB., Saurin TA. The joint use of resilience engineering and lean production for work system design: A study in healthcare. Applied Ergonomics 2018; 71: 45-56.
83. Safi M., Clay-Williams R., Ursin Grau T., Brandt F., Ravnborg Thude B. FRAM and LEAN as tools for describing and improving the referral process between outpatient clinics in a Danish Hospital: Complementary or conflicting? Safety Science 2023; 166: 106230.
84. Sales Coll M., De Castro R., Ochoa de Echagüen A., Martínez Ibáñez V. Economic impact of lean healthcare implementation on the surgical process. Healthcare 2024; 12(5): 512.
85. Salinas B., Villamin C., Gallardo LD. Integration of lean visual management tools into quality improvement practices in the hospital setting. Journal of Nursing Care Quality 2022; 37(1): 61-67.
86. Scala A., Ponsiglione AM., Loperto I., Della Vecchia A., Borrelli A., Russo G., Triassi M., Improta G. Lean six sigma approach for reducing length of hospital stay for patients with femur fracture in a university hospital. International Journal of Environmental Research and Public Health 2021; 18(6).
87. Seth D., Gupta V. Application of value stream mapping for lean operations and cycle time reduction: An Indian case study. Production Planning & Control 2005; 16(1): 44-59.
88. Sethi R., Yanamadala V., Burton DC., Bess RS. Using lean process improvement to enhance safety and value in orthopaedic surgery: The case of spine surgery. JAAOS-Journal of the American Academy of Orthopaedic Surgeons 2017; 25(11): e244-e250.
89. Simons FE., Aij KH., Widdershoven GAM., Visse M. Patient safety in the operating theatre: How A3 thinking can help reduce door movement. International Journal for Quality in Health Care 2014; 26(4): 366-371.
90. Soyuer H. Tam zamanında üretim sistemlerinin küçük ve orta ölçekli işletmelerde uygulanma koşulları. Gazi Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi 1999; 1(2): 155-166.
91. Su CT., Chou CJA systematic methodology for the creation of Six Sigma projects: A case study of semiconductor foundry. Expert Systems with Applications 2008; 34(4): 2693-2703.
92. Syltevik S., Karamperidis S., Antony J., Taheri B. Lean for airport services: A systematic literature review and agenda for future research. International Journal of Quality & Reliability Management 2018; 35(1): 34-49.
93. Tagge EP., Thirumoorthi AS., Lenart J., Garberoglio C., Mitchell KW. Improving operating room efficiency in academic children’s hospital using Lean Six Sigma methodology. Journal of Pediatric Surgery 2017; 52(6): 1040-1044.
94. Tekin M., Arslandere M., Etlioğlu M., Koyuncuoğlu Ö., Tekin E. An application of SMED and jidoka in lean production. Proceedings of the International Symposium for Production Research 2018; 2019 sayfa no: 530-545.
95. Tengilimoğlu D, Yiğit V. Sağlık işletmelerinde tedarik zinciri ve malzeme yönetimi. Nobel Akademik Yayıncılık; 2013.
96. Thakur V., Akerele OA., Randell E. Lean and six sigma as continuous quality improvement frameworks in the clinical diagnostic laboratory. Frontiers in Surgery 2023; 60(1): 63-81.
97. Tortorella G., Cómbita-Niño J., Monsalvo-Buelvas J., Vidal-Pacheco L., Herrera-Fontalvo Z. Design of a methodology to incorporate Lean Manufacturing tools in risk management, to reduce work accidents at service companies. Procedia Computer Science 2020; 177: 276-283.
98. Tresh A., Cohen AJ., Mmonu NA., Berdy S., Barnas K., Krombach J., Breyer BN. Resident-driven holistic lean daily management system to enhance care experience at a safety net hospital. Urology 2020; 140: 56-63.
99. Türkön BF., Toraman A. Sağlık kurumlarında yalın yönetim: Bursa ilinde bir uygulama örneği. Verimlilik Dergisi 2023; 57(1): 211-238.
100. Weigel WA. Redesigning an airway cart using lean methodology. Journal of Clinical Anesthesia 2016; 33: 273-282.
101. White SM. Needlestuck. Anaesthesia 2007; 62(12): 1199-1201.
102. Wongkrajang P., Reesukumal K., Pratumvinit B. Increased effectiveness of urinalysis testing via the integration of automated instrumentation, the lean management approach, and autoverification. Journal of Clinical Laboratory Analysis 2020; 34(1): e23029.
103. Xin X., Zheng X., Lu H., Yang Q., Sun Y., Qu K., Guo Y., He HA study on the management of needle-stick and sharps injuries based on total quality management in a tertiary hospital in western China. The Journal of Vascular Access 2021; 22(2): 273-279.
104. Yazıcı S., Ünal F., Çulhaoğlu Ö. Kalite süreçlerinde PUKÖ döngüsü: dış değerlendiricilerin görüşlerine göre Türk üniversitelerinin yeterlik düzeyleri. Pamukkale Üniversitesi Eğitim Fakültesi Dergisi 2023; 57: 281-305.
105. Yılmaz ÖF., Yeni FB., Gürsoy Yılmaz B., Özçelik G. An optimization-based methodology equipped with lean tools to strengthen medical supply chain resilience during a pandemic: A case study from Turkey. Transportation Research Part E: Logistics and Transportation Review 2023; 173: 103089.
106. Yücenur GN., Şenol K. Sequential SWARA and fuzzy VIKOR methods in elimination of waste and creation of lean construction processes. Journal of Building Engineering 2021; 44: 103196.
107. Zdęba-Mozoła A., Kozłowski R., Rybarczyk-Szwajkowska A., Czapla T., Marczak M. Implementation of lean management tools using an example of analysis of prolonged stays of patients in a multi-specialist hospital in Poland. International Journal of Environmental Research and Public Health 2023; 20(2).
108. Zdęba-Mozoła A., Rybarczyk-Szwajkowska A., Czapla T., Marczak M., Kozłowski R. Implementation of lean management in a multi-specialist hospital in poland and the analysis of waste. International Journal of Environmental Research and Public Health 2022; 19(2): 800.
109. Zhang MM., Yu XC., Lu FL., Lu KK. Lean management promotes compliance and satisfaction of rabies vaccines. Patient Prefer Adherence 2021; 15: 1207-1212.
110. Zhang X., Gu Y., Cui M., Stallones L., Xiang H. Needlestick and sharps injuries among nurses at a teaching hospital in China. Workplace Health & Safety 2015; 63(5): 219-225.