Table 3 Overview of types of redesign interventions and methods used in included studies

1. Pennell, et al. (2005) USA

To produce substantiated practice changes in glycemic management and improved outcomes for coronary artery bypass surgery patients

NP-led practice redesign

Before-and-after study

N = 103 (Before group = 41; After group = 62).

1. New cardiothoracic team established, including advanced practice nurses;

2. 2. Implementation of new tools and guidelines

Not mentioned

2. King, Ben-Tovim, Bassham (2006) Australia

Streamlining patient care at the ED to reduce overcrowding

Lean thinking

Before-and-after study

Before: N = 49075 presentations to the ED; After: N = 50337 presentations to the ED.

1. Process mapping (incl. value stream map);

2. Restructuring of patient flow; streamlining in relation to predicted outcome

12 months

3. Raab, Andrew-JaJA, Condel, et al. (2006) USA

Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods

Toyota production system

Non-concurrent cohort study with control-group and comparison of retrospective consecutive case data from previous year for same time frame

Women with ASC US (atypical squamous cells of undetermined significance) diagnosis

1. Choosing a target for improvement;

2. Problem

Analysis;

3. Intervention design;

4. Pretest;

5. Implementation;

6. Evaluation

Not mentioned

4. Raab, et al. (2006) USA

Determine whether the Toyota production system process redesign resulted in diagnostic error reduction for patients who underwent cytologic evaluation of thyroid nodules

Toyota production system

Longitudinal before-and-after, non-concurrent cohort study

2,424 patients with thyroid gland nodule

1. Development and use of a standardized diagnostic terminology scheme;

2. Expansion of an immediate interpretation service

Not mentioned

5. Shannon, et al. (2006) USA

Eliminating central line-associated bloodstream (CLAB) infections in ICUs by employing the principles of Toyota production system adapted to health care

(Lean thinking) Toyota production system

Before-and-after study

49 patients with CLAB admitted to medical intensive care unit and coronary care unit between July 2002 and June 2003. 10 residents, 10 fellows, 8 attending physicians, 16 nurses, 6 nurse aides and 5 personnel

Real-time problem-solving with help of the Toyota production system

34 months

6. Kelly, Bryant, Cox, et al. (2007) Australia

Analyze ED patient flow processes using task analysis and lean thinking; re-engineer these processes to improve flow through the ED for all groups of patients

Lean thinking

Before-and-after study

31570 patients admitted to emergency department

Choosing a target for improvement; problem analysis; intervention design; pretest; implementation; and evaluation

Not mentioned

7. Kim, et al. (2007) USA

Implement a lean project to improve patient care access and reduce excess work in providing palliative radiation therapy to patients referred for bone or brain metastases

Lean thinking

Before-and-after study

1600 patients in total/year, 15 % have bone or brain metastases

Applied the principles and tools of lean thinking

Not mentioned

8. Raab, Grzybicki, Condel, et al. (2007) USA

To measure the effect of implementation of a lean quality improvement process on the efficiency and quality of a histopathology lab section

Lean thinking

Non-concurrent interventional cohort study with control group and pre-post measurement

One histopathology section of anatomical pathology laboratory

1. Education of staff;

2. Determining current condition;

3. Designing and implementing multiple (200) interventions;

4. Sustaining the “perfecting patient care” learning line

Not mentioned

9. Shendel-Falik, Feinson, Mohr (2007) USA

Develop and implement a standardized approach to “hand-off” communications, including an opportunity to ask and respond to questions

Appreciative inquiry

Before-and-after study

Patients being transitioned from the ED to the telemetry unit and the associated care providers involved in the handoff

A 5D cycle of appreciative inquiry (definition, discover, dream, design, destiny) with 5 improvement projects:

1. A welcome script,;

2. Safety assessments;

3. Standardized transfer report;

4. Low-risk cardiac transport protocol;

5. Interpersonal relationships

6 months

10. Wood, Brennan, Chaudhry, et al. (2008) USA

To improve the quality and safety of patient care and to improve the efficiency and satisfaction of all team members, including physicians

Lean thinking

Before-and-after study

1157 consecutive clinical notes before and 257 clinical notes after implementation;

137 physicians and 12 allied health staff members

Standardized process of patient care that included collaborative work between physicians and appropriately trained clinical assistants; the rooming process

Not mentioned

11. Reid, et al. (2009) USA

1. Maintain or enhance patient care experiences;

2. Reduce physician and care team burnout;

3. Improve clinical quality scores;

4. Reduce emergency, specialty and avoidable hospitalization use and costs

Patient-centered medical home

Before-and-after study

One intervention clinic and 19 control clinics; 8094 patients were included at the PCMH clinic and 228,510 patients were included at the control clinics

1. Structural changes;

2. Point-of-care process changes;

3. Patient outreach changes;

4. Management process changes

12 months

12. Auerbach, et al. (2010) USA

The co-management neurosurgery service (CNS) was implemented in response to changes in care—primarily reducing availability of physicians for ward patients—which resulted from resident duty hour reductions

Hospitalist-led co-management neurosurgery service (CNS)

Before-and-after study with control group

A total of 7596 patients were admitted to the neurosurgery service during the study period: 4203 (55.3 %) before July 1, 2007, and 3393 (44.7 %) after CNS implementation

Co-management: shared management of surgical patients between surgeons and hospitalists

18 months

13. Ravikumar, et al. (2010) USA

Reduce mortality by enhancing continuity and co-management throughout hospital stay; minimize errors at transition points; increase throughput; reduce length of stay

Continuum of care

Before-and-after study with control group

Pilot study: one intervention and one control hospital. Validation study: one hospital department as intervention group and the entire hospital as control cohort

CoC study: one hospital

1. Surgical Continuum of Care (SCoC);

2. Continuum of Care (CoC)

Pilot study: 3 years; Validation study: 3 years;

CoC study: 6 months

14. Hwang, Lee, Shin (2011) South Korea

To shorten processing time and improve service quality

Structure redesign vs. process redesign

Before-and-after study

Two teaching hospitals. At Guro hospital (layout redesign) the final sample sizes were 291 patients at baseline and 170 patients at follow-up. At Anam hospital (critical pathway implementation) the final sample sizes were 273 patients at baseline and 125 patients at follow-up

1. Structure-oriented approach: improvement of the physical structure of the ER operations by remodeling the hospital’s layout;

2. Process-oriented approach: implementation of critical pathways and protocols

12 months

15. Collar, et al. (2012) USA

To determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities; all staff working at one surgeon’s operating room

Lean thinking

Before-and-after study (18-month prospective quasi-experimental study)

144 cases were included in the baseline period and 55 cases in the intervention period (follow-up)

1. Visualization of the current state of the perioperative work process in the form of a swim lane diagram;

2. Identification of waste;

3. Root cause analysis for key waste items;

4. Creation of new swim lanes and a standard work matrix

6 months

16. Krening, Rehling-Anthony, Garko (2012) USA

To decrease risk exposure in the use of oxytocin administration hospitals of Centura Health

A process improvement project; standardized evidence-based protocol and processes across the healthcare system

Before-and-after study

Nine hospitals of Centura Health, delivering obstetric care

1. A standardized oxytocin mixture;

2. Low-dose administration guidelines;

3. Utilization of safety checklists to assure fetal and maternal well-being before initiation of oxytocin and increases in oxytocin dosages;

4. A standardized order set;

5. An educational handout for pregnant woman on oxytocin usage

12 months

17. Murray, Christen, Marsh, et al. (2012) Scotland

Redesign of the new-patient fracture clinic, with the objective of: improving patient care, trainee education, interprofessional relations and clinic efficiency

Evidence-based redesign

Not mentioned

301 consecutive patients attending the new-patient fracture clinic over a 3-week period in the summer of 2010, compared to 346 consecutive patients during a 3-week period exactly one year previously. Adequate data available for 240 patients (80 %) in 2010 and 296 patients (86 %) in 2009

1. Investigate existing conditions before introducing the new clinic model;

2. identify problems and delineate potential improvements;

3. Redesigned the new-patient fracture clinic;

4. Implemented change;

5. Documented outcomes

3 months

18. Liss, et al. (2013) USA

Providing patients with a continuous source of whole-person primary care; increasing patient access and satisfaction with care and reducing total costs

Patient-centered medical home

Controlled before-and-after study

One Group Health clinic as intervention site and 19 Group Health Clinics as controls. The final study population included 37,930 adults with diabetes, hypertension and/or CHD, with 1181 patients paneled to the PCMH prototype clinic and 36,757 patients paneled to other clinics

1. Increased primary care staffing;

2. Physicians paired in dyads with medical assistants;

3. Standard in-person primary care office visits lengthened to 30 min;

4. Virtual medicine contacts;

5. Rerouting patients’ calls;

6. Creation of collaborative care plans;

7. Provider outreach to manage monitoring tests

21 months