Table 6.

Framework for measuring Lean Thinking in a clinical pathway. Suggested variable or formula linked to the Lean elements.

Lean Element	Description	Variable or Formula
Overproduction	Number of people waiting for step (x) per day.	n_step(x)
Waiting	Average waiting time of patients before step (x) in days for chosen period.	t_wait(x)
Conveyance	Physical distance to step x from step x-1, categorized as e.g., zero (for same location or digital), at department, in building, outside building.	d(x)
Overprocessing	Steps that deviate from the desired clinical pathway established by healthcare professionals.	s_repeat s_added s_skipped
Inventory	Total number of patients waiting in a certain trajectory per day.	n_trajectory(x)
Defects	E.g., patient satisfaction of the entire pathway, complications, mortality, and functional recovery.	defect_satisfaction defect_complication defect_mortality defect_PROM defect_PREM
Flow	Ratio between total waiting time and cycle time (time between first meeting to end of trajectory) per patient.	$\frac{t_{wait,1}+t_{wait,2}+t_{wait,x}}{t_{end}-t_{first}}$
Pull	Total number of patients waiting in clinical pathway per day.	${\displaystyle \sum _{i=1}^n}n\_step\left(x_i\right)$