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Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care
  1. Bozena Bonnie Poksinska1,
  2. Malgorzata Fialkowska-Filipek2,
  3. Jon Engström1
  1. 1Department of Management and Engineering, Linköping University, Linköping, Sweden
  2. 2Department of Computer Science and Management, Wroclaw University of Technology, Wroclaw, Poland
  1. Correspondence to Dr Bozena Bonnie Poksinska, Quality Technology and Management, Department of Management and Engineering, Linköping University, Linköping 581 83, Sweden; bonnie.poksinska{at}


Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction.

Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time.

Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time.

Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.

  • Lean management
  • Primary care
  • Patient satisfaction

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  • Contributors All authors participated in the study design, interpretation of the results and critical revision of the manuscript. BBP and JE developed the first draft of the manuscript. BBP and MF acquired the quantitative data and carried out the statistical analyses. BBP takes responsibility for the paper as a whole.

  • Funding The Swedish Institute.

  • Competing interests None declared.

  • Ethics approval The current study is exempt from ethical approval according to the Swedish legislation on research ethics [Ministry of Education and Research. SFS (2008:192). Ethical Approval Act of Research Involving Humans. Stockholm].

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

  • Data sharing statement The data from the National Patient Survey used in this paper were obtained from the Swedish Association of Local Authorities and Regions and can be accessed at

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