suggest that publication bias tends to highlight favourable
results [6]. Despite this, a recent review identified only a few
studies with a controlled before–after study design. To make
matters worse, a wide range of often non-comparable measures
was used, while some of the reported results were not even
mentioned in the objective of the study and vice versa [7].
While some believe that lean thinking can contribute to
health care improvement, much work has to be done to substantiate
this claim. The purpose of this perspective on
quality article is to describe an understanding of lean thinking
and its application in health care.