Lean healthcare: review,classification and analysis of literature

This study presents a literature review of 107 papers on lean healthcare to evaluate its evolution by updating previous literature reviews and to propose a classification and analysis of the papers reviewed. The literature classification was performed based on six parameters: research method, country, healthcare area, implementation, lean tools and methods and results. From the analysis performed, this paper presents a quantitative analysis of the state of the art concerning lean healthcare and indicates current research trends, based on the stage of evolution of the area, that may guide further studies on the subject. An example is lean healthcare expansion to other countries, such as Brazil and the Netherlands. Another aspect is the application of lean healthcare in hospital as a whole, not limited to a specific setting. Finally, a few studies detail the lean implementation process and use infrequently applied tools, present the barriers and main critical factors found in the lean implementation.     

Improvement culture in the public mental healthcare sector: evaluation of implementation efforts

Abstract

The Danish public healthcare system has been forced to improve performance in terms of better service and lower costs. One regional Danish public healthcare organization has systematically implemented an improvement culture in its psychiatry sector. This research paper contains an evaluation of the organization’s transformation journey towards continuous improvement in psychiatry. The study was based on twenty-five personal interviews, two group interviews and four focus group interviews with centre managers, doctors, psychologists, psychiatrists, nurses and medical personnel in two of the ten psychiatry centres in the region. The objectives of implementing an improvement culture were to create better service for patients and to improve efficiency. Findings indicate that a number of critical success factors and barriers exist in mental healthcare and that even though a number of resources was invested up front, adjustments of the implementation process were needed from centre to centre. Furthermore, the implementation of a lean culture had some positive effects on treatments. In particular, internally, efficiency improved in some areas, creating a common view of what creates value and how to make improvements. Involving different groups of specialists in the implementation of an improvement culture is important. However, the achievement of continuous improvement efforts could be challenging, as results can be difficult to quantify. The novelty of the paper lies in the fact that data is collected from different groups of employees (from both managers’ and employees’ perspectives) on the effects of a full-scale implementation of an improvement culture in public mental healthcare.     

Six Sigma to reduce claims processing errors in a healthcare payer firm

Abstract

As a continuous improvement practice, Six Sigma has been accepted globally across the service industry. In the past decade, the application and success of Six Sigma in healthcare services has been remarkable. Despite the fact that several papers on Six Sigma have appeared in the erstwhile literature related to healthcare operations, there is a dearth of field studies highlighting the application of Six Sigma in healthcare outsourced firms, in specific to healthcare payers that engage in a non-clinical setup. The aim of this paper is to explore the role of Six Sigma within the healthcare payer outsourced firms, where error-free delivery becomes critical. The article contributes to the literature of Six Sigma in healthcare outsourcing highlighting how ‘Six Sigma as a methodology’ could help reduce claims adjudication errors in a healthcare payer firm. The Six Sigma DMAIC project case study presented as part of the paper delivered a saving of USD 0.53 million and is a classic example of how Six Sigma can bring bottom-line impact to healthcare outsourced organizations. Managerial implications and lessons learned are discussed alongside the concluding notes.     

Managerial challenges of Industry 4.0: an empirically backed research agenda for a nascent field

The increasing intelligence of products and systems, their intra-company cross-linking and their cross-company integration into value creation networks is referred to as Industry 4.0. Academics and practitioners, largely agreeing on the global importance of this proclaimed industrial revolution, have published many contributions on the topic. Research, however, is rather focused on investigating single technologies in quite specific application domains and largely neglects the profound managerial challenges underlying Industry 4.0. Given the recent plea for a more active contribution from the management science community, we strive to establish Industry 4.0 as a challenging but promising field for management research, and aim to assist scholars in engaging with the topic. Therefore, we first gather and analyze extant contributions by means of a systematic literature review and synthesize the information gained into 18 managerial challenges of Industry 4.0 falling into six interrelated clusters: (1) strategy and analysis, (2) planning and implementation, (3) cooperation and networks, (4) business models, (5) human resources and (6) change and leadership. Considering that Industry 4.0 is still an emerging topic and publications may therefore not always be found in highly ranked journals, we aimed to increase the confidence in our findings and triangulated our data by conducting an online survey of industry experts and academics that allows us to qualify the identified challenges in terms of importance and future research need. On this basis, we present an empirically backed research agenda and suggest fruitful avenues for future research in three basic categories: practice-enhancing research, knowledge-enhancing research, and high-impact research.     

The healthcare supply network: current state of the literature and research opportunities

Abstract

This literature review maps recent studies addressing supply chain management (SCM) in the healthcare sector through a systematic approach that synthesises 74 empirical studies (2006–2016). Our approach adopts a network lens to map the literature and offers key contributions to the field. First, we show that there is a lack of network level studies. Second, there is an imbalance of research attention regarding the various types of supply, namely health services, medicines, medical supplies and blood supply. Third, we underline the advantages of the network lens, indicating network actors and flows between those actors that need further research. Fourth, we show an alarming lack of theoretical lens in healthcare SCM studies and draw attention to the fact that even when explicitly adopting a theory, some studies show inconsistencies between theoretical lens and level of analysis. Ultimately, we offer a map of future research for healthcare SCM through a network lens in order to improve the understanding the complexities of the healthcare sector.     

全球视角下跨境医疗服务研究述评与展望

本文从跨境医疗研究现状出发,对跨境医疗新趋势进行分析。研究发现关于跨境医疗的研究成果较多基于传统的医疗管理和公共卫生理论与模式。互联网时代跨境医疗的特征和医疗服务模式发生了变革,在这一背景下的相关研究较少。本文系统分析了跨境医疗整体概况及测度研究、驱动机制与服务模式研究成果,有针对性地提炼跨境医疗研究的理论框架,探讨跨境医疗带来的全球医疗资源均等化配置问题,提出新趋势下跨境医疗研究的关键科学问题与相关研究建议。研究成果对于推动国内外学者开展跨境医疗前沿领域研究,贡献全球健康事业有着重要的理论价值和实践意义。     

A new value stream mapping approach for healthcare environments

Hospitals worldwide are giving a growing emphasis to the application of lean concepts in the healthcare sector, commonly known as ‘lean healthcare’. A fundamental tool that allows such implementations is the value stream mapping (VSM). The problem is that VSM models used in implementations of lean healthcare are simple adaptations of the original VSM model, which was initially directed towards manufacturing and may not always represent important support activities for the patient flow that directly impact treatment time. Within this context, this paper presents a new VSM approach for healthcare environments. This new VSM model, specifically designed for healthcare environments, contemplates all activities that directly affect the treatment time. In addition, the present paper also presents an action research in a Brazilian hospital where the proposed VSM model is compared to other VSM models found in the literature. The results shown that the proposed VSM model was able to identify some operational bottlenecks and wastes that interfere in the patient’s treatment that could not be identified by other mapping models studied.     

The Evolution of Korean corporate HRD: launching,growing pains,and transforming

Enthusiasm and greater attention from the international HRD community to Korea has motivated us to conduct research on the evolution of Korean corporate HRD in order to explore where we are now and where we are heading. Research literature on the topic, however, was minimal. The purpose of this study was to examine the evolution of Korean corporate HRD through interviews with 18 HRD researchers and practitioners who have witnessed the field’s growth. In addition, we reviewed the literature and company archives of HRD activities. We identified three major historical milestones of Korean corporate HRD including: the launching period in the 1980s, the growing pains period in the 1990s, and the transforming period from the 2000s to the present. We addressed major trends and issues of Korean corporate HRD in an attempt to generate a future research agenda.     

Prioritizing lean supply chain management initiatives in healthcare service operations: a fuzzy AHP approach

The objective of this study is to investigate the perceptions of practitioners/experts about the prioritisation of healthcare performance measures and their relationship with lean supply chain management (LSCM) practices. The study will also prioritise the drivers and resources required to implement LSCM in a healthcare operations context. The prioritisation is based on the relative weights of various initiatives on a range of performance measures. Twenty-four LSCM initiatives were identified using a comprehensive literature review. Q-sort method was used to divide those initiatives into four categories. Fuzzy AHP was then used to prioritise the four categories based on relative weight of importance of each category on three different performance dimensions. The result shows that continuous improvement is a dominating LSCM initiative in increasing operational and financial performance, while enterprise alignment/integration is a dominating initiative in enhancing organisational image and operational performance. However, lack of homogeneity among LSCM initiatives suggests that there is a need for careful consideration when implementing them in healthcare organisations. Furthermore, customer needs and the influence of competitor’s actions are the most important drivers to encourage hospitals to adopt an LSCM strategy. This is one of the first studies to examine the prioritisation and ranking of LSCM constructs on performance within the context of the healthcare industry.     

Identifying design criteria for urban system ‘last-mile’ solutions – a multi-stakeholder perspective

Abstract

This study presents a novel approach to design and evaluate ‘last-mile’ solutions – encompassing the social and economic perspectives of key stakeholders. While urban system initiatives have been implemented in practice, theoretical gaps remain at the operational design level. A theoretical framework is developed, based on design criteria identified from a critical synthesis of supply chain and operations management literature, and ‘operationalised’ using an in-depth case study demonstrating implementation of a Consumer Choice Portal-Package Consolidation Centre solution, within a densely populated urban geography. Findings suggest that there is a need to re-define the role of institutional actors beyond that of the traditional governance task, to one of being able to facilitate performance outcomes. Similarly, industrial efficiency dimensions need to be reorientated to include consumer participation, social considerations and multi-stakeholder service outcomes. Finally, implications for operations theory and practising managers in city logistics are highlighted, with suggested directions for future research.     

Material logistics in hospitals: A literature review

Hospital material management has been identified as one key cost containment lever to cope with steadily increasing healthcare costs in industrialized countries. The purpose of this work is to present the state-of-the-art of research on material logistics management in hospitals. Particular focus is given to articles that apply quantitative methods. Our contribution is threefold: First, we provide research guidance through categorizing literature and identifying major research streams. Second, we discuss applied methodologies and third, we identify future research directions. A systematic approach is undertaken in order to identify the relevant literature from 1998 to 2014. Applicable publications are categorized thematically and methodologically and future research opportunities are worked out. In total, 145 publications are identified and discussed in this work. The literature is categorized into four streams, i.e., (1) Supply and procurement, (2) Inventory management, (3) Distribution and scheduling, and (4) Holistic supply chain management. The use of optimization techniques is constantly gaining importance. The number of respective publications has continually grown and has peaked over the last three years. Optimization has been successfully applied in research streams (1), (2), and (3). Category (4) comprises a rather qualitative research field of literature dealing with supply chain management issues.     

Do makerspaces represent scalable production models of community-based redistributed manufacturing?

Abstract

This research explores the development of local community-based ‘makerspaces’ as potential scalable forms of redistributed manufacturing (RDM). Makerspaces are rapidly emerging in post-industrial economies and have been identified as a catalyst of local regeneration in urban areas. However, their role in local production systems is limited. There is a gap in the literature, with respect to the evolution of makerspaces and their productive contribution. The purpose of this paper therefore is to identify, classify and examine the different types of makerspaces. Our focus is on the implementation characteristics that enable industrial production activity to take place. First, we used Leximancer (to identify from the literature) three types of makerspace. Second, we then identify five RDM implementation characteristics. The characteristics were integrated together to form the RDM-makerspace implementation model. Third, case studies were purposively selected to test and advance this model. They were subsequently classified as a Type 1 (educational), Type 2 (design) or Type 3 (production) makerspace. Only one of the case studies was classified as a fully evolved Type 3 production space. The findings concur with the literature that makerspaces tend to be primarily Type 1 or Type 2. Finally, the contribution to local production theory is emphasized.     

A systematic literature review of mining weak signals and trends for corporate foresight

Due to the ever-growing amount of data, computer-aided methods and systems to detect weak signals and trends for corporate foresight are in increasing demand. To this day, many papers on this topic have been published. However, research so far has only dealt with specific aspects, but it has failed to provide a comprehensive overview of the research domain. In this paper, we conduct a systematic literature review to organize existing insights and knowledge. The 91 relevant papers, published between 1997 and 2017, are analyzed for their distribution over time and research outlets. Classifying them by their distinct properties, we study the data sources exploited and the data mining techniques applied. We also consider eight different purposes of analysis, namely weak signals and trends concerning political, economic, social and technological factors. The results of our systematic review show that the research domain has indeed been attracting growing attention over time. Furthermore, we observe a great variety of data mining and visualization techniques, and present insights on the efficacy and effectiveness of the data mining techniques applied. Our results reveal that a stronger emphasis on search strategies, data quality and automation is required to greatly reduce the human actor bias in the early stages of the corporate foresight process, thus supporting human experts more effectively in later stages such as strategic decision making and implementation. Moreover, systems for detecting weak signals and trends need to be able to learn and accumulate knowledge over time, attaining a holistic view on weak signals and trends, and incorporating multiple source types to provide a solid foundation for strategic decision making. The findings presented in this paper point to future research opportunities, and they can help practitioners decide which sources to exploit and which data mining techniques to apply when trying to detect weak signals and trends.     

Quality Function Deployment and operational design decisions – a healthcare infrastructure development case study

The purpose of this paper is to demonstrate how QFD can enhance a healthcare organisation’s strategic operational alignment, by synchronising the infrastructure design with the service intention. In this empirical paper, a case study of a £15 million infrastructure development has been used as the unique context to assess and test the experimental findings. QFD was utilised in order to capture and transform the requirements of decision-makers, providers, patients and local communities into both service and building design for Project K, a healthcare infrastructure, in the U.K. Two full iterations of the QFD results are presented. Using QFD generated effectiveness and efficiency by creating an information exchange platform and providing the stakeholders with a framework to optimise the decision-making. This paper makes a practical contribution by empirically testing the QFD modelling and providing evidence of its implementation within the complex, dynamic and evolving nature of the healthcare built environment sector.     

Improving patients’ satisfaction in a mobile hospital using Lean Six Sigma – a design-thinking intervention

Abstract

Lean Six Sigma (LSS) that offers a unique integration of Lean and Six Sigma has been accepted globally across services sectors. Previous studies that examined the application of LSS in healthcare were steered in traditional hospital settings. Apparently, there are no studies that highlight the application of LSS in mobile hospitals, an emerging trend in the healthcare sector. The aim of this article is to explore the applicability of LSS in a mobile hospital. The authors present a case study of improving patients’ satisfaction in a mobile hospital, through reducing turnaround time. Design-thinking intervention to LSS helped resolve a real-time problem using Define-Measure-Analyze-Design-Verify roadmap. This article contributes to the ‘healthcare quality” body of knowledge and is novel as it is the first of its kind of LSS application in a mobile hospital underpinning Design thinking. This study is unique as it demonstrates academia–industry collaboration in solving an organizational problem.     

How to reconsider risk management in SMEs? An Advanced,Reasoned and Organised Literature Review

The purpose of this paper is two-fold: to reconsider the fundamental role of risk management (RM) in small and medium enterprises (SMEs) by identifying and critically analysing the most important international works; and to define opportunities for further studies by suggesting a different approach to study the topic. This research is based on a new hybrid method developed by the authors, called Advanced, Reasoned and Organised (ARO) literature review, which improves the quality of literature reviews by integrating the systematic review for quantitative papers, the meta-synthesis for qualitative research and the critical interpretative analysis. Forty-eight articles were included in the literature review. Bibliometric and cluster analyses were carried out. Two hypotheses were applied as filters in the interpretative synthesis of the content and guided the analysis to answer two research questions. The findings underline that RM in SMEs is still a ‘spot’ subject as they put little effort into the risk identification, assessment and monitoring. The lack of procedures and strategies is due to the lack of risk mindfulness and knowledge, and it is related to the managers’ and owners’ risk attitudes. It is fundamental to understand why risk procedures are not implemented and to find a way to raise awareness of the potential benefits of risk and control measures. The topic is current, and the multidisciplinary perspective and mixed-method approach enhance both theoretical and practical contributions for academics and SME owners.     

Defining and assessing industry 4.0 maturity levels – case of the defence sector

Abstract

Firms do not currently fully appreciate the complex characteristics of Industry 4.0 and as a result are uncertain about what it represents for them. In this study, an assessment model is developed to measure the level of implementation of Industry 4.0 technologies, around three dimensions: ‘Factory of the Future’, ‘People and Culture’, and ‘Strategy’. The ‘Factory of the Future’ is the main dimension and is composed of eight attributes: Additive Manufacturing, Cloud, Manufacturing Execution System, Internet of Things and Cyber Physical Systems, Big Data, Sensors, e-Value Chains, and Autonomous Robots. The study uses a defence manufacturing firm to develop, test and validate the model and report on 12 partners. We concluded that the focal firm has an Industry 4.0 maturity level of 59.35, above the sector average of 55.58. This research contributes by empirically developing a model and providing an analysis of major firms in the Defence supply network.     

Looking at the IPO from the “top floor”: a literature review

This article aims to assess the current situation and the evolution of the literature on the role of top level decision-makers in initial public offerings. The article combines bibliometric and qualitative reviews of 147 articles published in 57 journals until 2015. Findings show that the debate on the role of top-level decision-makers in initial public offerings has followed an irregular pathway. Research attention has moved from studies on the actors and the dynamics of going public to a focus on the strategic implications of initial public offerings. The paper is a good starting point for future policy-making interventions designed to support top-level decision-making. By enhancing awareness of the strategic role of initial public offerings, we hope to improve the governance practices associated with them. The paper also sheds light on the importance of fostering the corporate transparency of top-level decision-making in firms going public, as an additional tool to increase investors’ trust and attract financial resources. Finally, the paper provides a comprehensive overview of the academic field, examining research trends and the evolutionary pattern. It also suggests future research avenues by identifying un(der)explored issues to advance knowledge on the topic.