Lean Management, Discrete Event Simulation, and Virtual Reality in Hemodialysis Units: A Scoping Literature Review and Evidence Gap Analysis

The rising global incidence of kidney failure is increasing pressure on hemodialysis unit operations, with operational vulnerabilities further exposed by the COVID-19 pandemic. This scoping review mapped evidence on Lean management, discrete event simulation (DES), and virtual reality (VR) in hemodialysis units; compared reported outcome domains and performance indicators; identified barriers to Lean implementation; and assessed the empirical basis for a combined Lean–DES–VR framework. English-language peer-reviewed articles, conference papers, and book chapters addressing Lean, DES, VR, or their combination in dialysis settings were searched in Scopus, PubMed, SpringerLink, IEEE Xplore, ACM Digital Library, and Google Scholar to 30 June 2024; grey literature and opinion pieces were excluded. Structured data extraction and thematic narrative synthesis were applied. Twenty-seven studies were included (Lean n = 4, DES n = 9, VR n = 13, DES + VR n = 1). DES studies mainly reported operational outcomes, whereas VR studies focused predominantly on patient-centered rehabilitation and experience. Most studies examined methods in isolation, and integrated Lean–DES–VR applications were almost entirely absent. The literature suggests complementarity among these approaches but provides no robust empirical basis for a fully integrated framework. No protocol was prospectively registered.