International Journal of Environmental Research and Public Health Review Lean Healthcare Tools for Processes Evaluation: An Integrative Review Letícia Bianchini de Barros 1, * , Letícia de Camargo Bassi 1 , Laura Passos Caldas 1 , Alice Sarantopoulos 2,† , Eliete Boaventura Bargas Zeferino 3 , Vinicius Minatogawa 4 and Renata Cristina Gasparino 1   Citation: de Barros, L.B.; Bassi, L.d.C.; Caldas, L.P.; Sarantopoulos, A.; Zeferino, E.B.B.; Minatogawa, V.; Gasparino, R.C. Lean Healthcare Tools for Processes Evaluation: An Integrative Review. Int. J. Environ. Res. Public Health 2021, 18, 7389. https://doi.org/10.3390/ ijerph18147389 Academic Editors: Giovanni Improta, Massimo Martorelli, Alfonso Maria Ponsiglione and Antonio Gloria Received: 29 April 2021 Accepted: 7 July 2021 Published: 10 July 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 School of Nursing, University of Campinas, Campinas 13083-887, Brazil; lehbassi6@gmail.com (L.d.C.B.); la.passos@outlook.com (L.P.C.); grenata@unicamp.br (R.C.G.) 2 Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; alice_sarantopoulos@hotmail.com 3 Hospital de Clínicas, University of Campinas, Campinas 13083-888, Brazil; elietebb@hc.unicamp.br 4 Escuela de Ingeniería en Construcción, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340000, Chile; vinicius.minatogawa@pucv.cl * Correspondence: lebarros377@gmail.com † Current Address: Atos Inova Saúde, Campinas 13085-055, Brazil. Abstract: Several health services have used lean healthcare to seek continuous improvement of their processes. Therefore, it is important to investigate the evidence available in the literature about the most used lean tools in the health area to review processes and the main results achieved by the researchers. As an integrative literature review methodology was used, it was conducted in five databases, using the descriptor “quality improvement” and the keyword “Lean Healthcare”. A total of 33 complete articles were selected for analysis. The most recurrent tools were: define, measure, analyze, improve and control (DMAIC); value stream map (VSM); suppliers, inputs, process, outputs, customers analysis (SIPOC), Ishikawa Diagram and 5S. Through the analysis of waste, different interventions were implemented and the main results achieved were reduction in times (processing, waiting, cycle and total), costs, workload and increase in the number of calls. The findings enabled the identification of the main lean tools used in the health area to achieve better results. In particular, we highlight recent studies that have explored the lean six sigma healthcare approach. The results, in addition to contributing to the literature, will also assist managers in choosing the best tool to achieve continuous improvement in hospitals and other health services. Keywords: quality improvement; process assessment; health care; health services; workflow; total quality management 1. Introduction Quality care in health services guarantees an increase in the quality of life for the population, resulting in greater socioeconomic development [1]. The difficulty in maintain- ing effective and efficient processes constitutes an important barrier to the prevention of diseases and to minimize the suffering of those who are already ill. Therefore, dealing with this problem involves governance and public policy actions that ensure the patient’s entry to the health service, as well as the continuity of their treatment by this service [2]. In order to resolve procedural problems, we have a health management philosophy called lean healthcare (LH), which enables the removal of rework, waste and unnecessary procedures. The LH is a healthcare adaptation of the lean philosophy created by Eiji Toyoda, founder of Toyota Motor Company, a Japanese car company [3]. These tools have been applied in several processes in the healthcare area, helping performance and facing challenges such as staff shortages, rising costs and providing high quality services, considering current financial constraints [4]. Lean six sigma, as well as lean healthcare, has also been applied in healthcare services and has shown to be very promising due to its character of addressing operational problems in complex environments [4]. Int. J. Environ. Res. Public Health 2021, 18, 7389. https://doi.org/10.3390/ijerph18147389 https://www.mdpi.com/journal/ijerph