Lean Methodology Cuts Surgical Waste in the Preoperative Phase, Review Finds

A scoping review published in BMC Health Services Research has systematically mapped how Lean methodology—a management philosophy born on the factory floors of postwar Japan—is being used to strip waste and delay out of the surgical patient journey, with a particular spotlight on the often chaotic hours and days before an operation. The analysis, led by Rui Cortes with Marília Silva Paulo and Paulo Sousa at NOVA National School of Public Health in Lisbon, synthesized 27 studies published between 2010 and 2024 and found that Lean interventions consistently improved process efficiency and resource utilization in surgical care, with some studies also reporting better patient outcomes.

Lean methodology originated in the Toyota Production System, where engineers developed a disciplined approach to eliminating muda, the Japanese term for waste. Its core logic is deceptively simple: any step that consumes resources without adding value from the customer’s perspective should be removed, reduced, or redesigned. In manufacturing, this translated into tools such as value stream mapping, which diagrams every step of a process to expose bottlenecks; 5S, a workplace organization method; kanban systems for just-in-time inventory; and continuous improvement cycles known as kaizen. When transplanted into hospitals, the customer becomes the patient, and the product becomes the flow of care itself.

The preoperative phase is a natural target for this kind of thinking because it is where surgical systems leak the most time and money. Before a patient ever reaches the operating room, they typically pass through referral, outpatient consultation, anesthesia assessment, laboratory and imaging workup, and scheduling. Each handoff is an opportunity for redundancy: tests repeated because results cannot be located, appointments rescheduled because information arrived incomplete, and cancellations on the day of surgery because preassessment was never finished. These failures are not merely administrative annoyances. Redundant testing exposes patients to unnecessary venipuncture and radiation, and day-of-surgery cancellations carry measurable psychological and financial costs.

To capture this landscape, the reviewers searched PubMed, Web of Science, and Scopus for English-language studies published between 2010 and 2024, applying the Joanna Briggs Institute framework for scoping reviews. They included studies of surgical patients in which Lean principles were applied to improve efficiency in any phase of the surgical process, and they excluded non-surgical and purely administrative studies. Data were extracted and analyzed according to the JBI methodology, allowing the team to chart where Lean had been deployed, in which surgical specialties, and with what reported effects.

The 27 included studies revealed a consistent catalog of inefficiencies that Lean teams set out to attack. Redundant testing emerged as a recurring theme, with patients undergoing duplicate laboratory work or imaging because results were unavailable at the point of care. Scheduling delays appeared across many settings, driven by poor coordination between preassessment clinics and operating theaters. Communication gaps between departments—surgeons, anesthesiologists, ward nurses, and administrative staff—surfaced as a third major source of waste, often manifesting as incomplete handoffs and last-minute cancellations. Lean interventions addressed these problems through redesigned workflows, standardized checklists, and restructured preassessment pathways.

Most studies in the review reported improvements in process efficiency and resource utilization after Lean implementation. Operating theaters ran with fewer delays, preassessment visits were consolidated, and staff time was used more productively. Some studies went further and documented enhanced patient outcomes, suggesting that smoother preoperative processes can ripple forward into the surgical experience itself. The reviewers also observed notable variation in how Lean was applied across different surgical specialties, reflecting the fact that orthopedics, general surgery, oncology, and other fields each face distinct logistical constraints and patient flows.

The technical appeal of Lean in the preoperative setting lies in its emphasis on value stream mapping applied to the patient rather than the product. When a hospital maps the surgical patient journey, it traces every step from referral to operating room entry, annotating where value is added and where time stagnates. This exposes what Lean practitioners call the eight wastes: defects, overproduction, waiting, non-utilized talent, transportation, inventory, motion, and extra processing. In a preassessment clinic, waiting might dominate; in a laboratory pathway, extra processing in the form of duplicate tests; in scheduling, defects in the form of incomplete information. The discipline of mapping forces teams to quantify these losses rather than argue about them anecdotally.

Standardization is another pillar that Lean brings to surgical care. By creating consistent preoperative protocols—uniform checklists, standardized preassessment forms, agreed criteria for when tests are actually needed—hospitals reduce the variability that breeds error. The review’s findings align with broader evidence that standardized pathways reduce day-of-surgery cancellations and improve first-case on-time starts. Yet the reviewers caution that the field lacks consistent metrics. Key performance indicators, or KPIs, varied widely across the included studies, making it difficult to compare results across specialties or to build a unified evidence base for what works best.

This heterogeneity is the review’s central limitation and its most important finding. Because Lean interventions were tailored to local contexts, and because the studies measured different outcomes with different tools, the reviewers could not pool results quantitatively. A scoping review maps the terrain rather than measuring the altitude, and this one reveals a landscape rich with activity but sparse with standardization. The authors conclude that Lean methodology has proven effective in reducing inefficiencies in surgical care, particularly in the preoperative phase, but they call for further research to standardize interventions and develop consistent metrics across surgical specialties to improve evaluation and outcomes.

For hospital administrators and clinicians watching this space, the message is pragmatic. Lean is not a magic bullet, and its success depends on sustained leadership commitment, frontline engagement, and a willingness to measure honestly. But the evidence assembled in this review suggests that when hospitals apply Lean thinking to the preoperative journey—eliminating redundant tests, tightening scheduling, and closing communication gaps—they can reclaim time and resources that would otherwise be lost to waste. As health systems worldwide grapple with surgical backlogs and constrained budgets, the factory floor’s most famous export may prove one of surgery’s most valuable imports.

Subject of Research: Health Services Research

Article Title: The application of lean methodology in the preoperative phase: a scoping review

Article References: Cortes, R., Paulo, M. S., & Sousa, P. (2026). The application of lean methodology in the preoperative phase: a scoping review. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15410-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15410-4

Keywords: application, lean, methodology, preoperative, phase, scoping, review, scientific research