Exploring operational excellence in ophthalmic services: a scoping review and future research directions

Abstract

Purpose – This study examines the application of Operational Excellence (OPEX) methodologies in ophthalmology, a speciality facing growing service demands amidst increasing resource constraints. The objective is to evaluate OPEX intervention outcomes, identify OPEX applications within ophthalmology, analyse the OPEX tools employed for continuous improvement (CI), and investigate the barriers and enablers influencing their implementation. Design/methodology/approach – A scoping review methodology was adopted, and the review included 25 peer-reviewed case studies that implemented OPEX strategies in ophthalmology. A descriptive and thematic synthesis was conducted to interpret patterns and gaps. Findings – OPEX methodologies in ophthalmology primarily focus on reducing surgical complications (via Six Sigma) and optimising patient flow (via Lean). Lean is the dominant methodology, with significant geographical variations in adoption. Implementation faces critical barriers, including a lack of internal expertise and unsustainable improvements, while enablers include expert support and staff engagement. Research limitations/implications – The findings highlight implications for clinical practice and healthcare management in ophthalmology. It demonstrates the effectiveness of OPEX methodologies in improving surgical outcomes and patient flow. The outcome suggests these approaches should be widely adopted, particularly in high-volume ophthalmic services facing resource constraints. However, the identified barriers, especially the lack of internal expertise and sustainability challenges, highlight the need for structured training programs and leadership commitment to embed CI into organisational culture. Originality/value – As the first comprehensive scoping review focused on ophthalmology, it reveals speciality-specific patterns in OPEX adoption. The geographical disparities identified highlight previously undocumented gaps in OPEX implementation within ophthalmology. Unlike generic CI studies, we provide a detailed typology of ophthalmology-specific OPEX applications, distinguishing between standardisation and efficiency-focused approaches.