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Efficacy and efficiency of a lean cataract pathway: a comparative study
  1. Ellen Joan van Vliet1,2,
  2. Walter Sermeus1,
  3. Claudia M van Gaalen2,
  4. Johannes C A Sol2,
  5. Jan M H Vissers3
  1. 1School of Public Health, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
  2. 2Rotterdam Eye Hospital, Rotterdam, The Netherlands
  3. 3Institute of Health Policy and Management, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Ms Ellen Joan van Vliet, Rotterdam Eye Hospital, PO Box 70030, Rotterdam 3000LM, The Netherlands; ellen.vanvliet{at}


Background The demand for cataract surgery is rising, calling for pathways that have good access and are cost-effective. Lean thinking is a management strategy, aimed at improving quality while reducing costs. Lean production processes are designed to identify gaps between expected and actual performance.

Aim To analyse the efficacy and efficiency of a lean cataract pathway.

Methods Lean care delivered to a prospective cohort (616 cataract patients) was compared (1) with traditional care delivered to a historical cohort (591 cataract patients) and (2) with expected lean care in the prospective cohort. To evaluate efficacy, the authors analysed how many patients received care that adhered to the lean pathway's specifications. To evaluate efficiency, the authors analysed how often patients visited the hospital and how many additional patients could access the pathway.

Results In the lean pathway, patient visits decreased by 23%, and access to the cataract pathway increased with 42%. A 40% decrease in patient visits and a 76% increase in access could have been realised if healthcare staff would have adhered to the lean pathway's specifications.

Practice implications Lean pathways can realise large improvements, and still have a significant gap between expected and actual care delivery. The challenge for healthcare teams is not to improve care delivery by using lean pathways as opposed to using traditional pathways, but to strive for optimal performance by consistently adhering to the specifications of the lean pathway.

  • Care pathway
  • lean thinking
  • quality improvement
  • efficiency
  • healthcare quality improvement
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  • Funding The Rotterdam Eye Hospital Research Foundation.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Institutional Human Experimentation Committee of the Erasmus Medical Centre Rotterdam.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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