Lean thinking in healthcare services: learning from case studies

JEL: D22, I12Healthcare organisations, especially in public sector, have been adopting Lean management practices with increasing outcomes’ evidences in several parts of the world, since the beginning of this century. However, Lean deployment in Healthcare services has been addressed in the literature in a surgical way by an array of case reports addressing the “hard” side of Lean deployment, sometimes with no result’s consistency or even follow-up analysis. This thesis seek to add to the operational side of Lean deployment in Healthcare, a complementary understanding of Lean deployment approaches, addressing both “hard” and “soft” sides, identifying the real constraints of Lean in Healthcare sector and the sustainability factors. Supported by two main literature reviews and a multi-case approach, a deep research on the eligible Portuguese cases was conducted answering the questions: (i) What are the different outcomes from Lean deployment in Healthcare?; (ii) What are the barriers to Lean implementation in Healthcare?; (iii) What enables Lean implementation in Healthcare?; (iv) What are the risks of Lean in Healthcare?; (v) How to measure Lean achievements in Healthcare services?; and (vi) How to develop a sustainable Lean culture? This contribution to the academic debate on Lean deployment in Healthcare creates clarity on what can be called Lean practices in Healthcare settings under the light of the concept’s founders; what pattern of a Lean deployment journey was followed by Healthcare organisations; and how different cultural (organisational and national) contexts can influence the pace in pursuing that pattern.As organizações de saúde, nomeadamente públicas, têm vindo a adoptar práticas de gestão Lean com crescente evidência de resultados em várias partes do mundo, desde o início deste século. Contudo, a aplicação do Lean em serviços de saúde tem tido um tratamento cirúrgico na literatura, recaindo apenas nos aspectos “hard” e sem grande consistência ou seguimento de resultados . Esta tese pretende acrescentar aos aspectos “hard” do Lean, um entendimento complementar juntando os aspectos “hard” e “soft”, identificando as restrições e factores de sustentabilidade da aplicação do Lean no sector da saúde. Tendo por base duas revisões bibliográficas primordiais e uma abordagem empírica multi-caso a partir de casos portugueses elegíveis, esta tese fornece respostas às questões: (i) Quais os diferentes resultados da aplicação do Lean na Saúde?; (ii) Quais as barreiras à aplicação do Lean na Saúde?; (iii) Quais os facilitadores da implementação do Lean na Saúde?; (iv) Quais os riscos do Lean na Saúde?; (v) Como medir a implementação do Lean na Saúde; e (vi) como desenvolver uma cultura Lean sustentável? Este contributo para o debate académico sobre a aplicação do Lean na Saúde introduz clareza sobre o que pode ou não ser chamado de práticas Lean na Saúde tendo como referência os conceitos dos fundadores; que padrão de implementação é seguido pelas organizações; e de que forma diferentes contextos culturais (nacionais e organizacionais) influenciam o ritmo desse padrão de implementação

Modelling lean and green supply chain

Dissertação para obtenção do Grau de Doutor em Engenharia IndustrialThe success of an organization depends on the effective control of its supply chain. It is important to recognize new opportunities for organization and its supply chain. In the last few years the approach to lean, agile, resilient and green supply chain paradigms has been addressed in the scientific literature. Research in this field shows that the integration of these concepts revealed some contradictions among so many paradigms. This thesis is mainly focused on the lean and green approaches. Thirteen different management frameworks, embodied in awards, standards and tools were studied to understand if they could contribute for the modelling process of a lean and green approach. The study reveals a number of categories that are common in most management frameworks, providing adequate conditions for a lean and green supply chain transformation. A conceptual framework for the evaluation of a lean and green organization`s supply chain was proposed. The framework considers six key criteria, namely, leadership, people, strategic planning, stakeholders, processes and results. It was proposed an assessment method considering a criteria score for each criterion. The purpose is to understand how lean and green supply chain can be compatible, using principles, practices, techniques or tools (i.e. elements) that support both, a lean and a green approach, in all key criteria. A case study in the automotive upstream supply chain was performed to understand more deeply if the elements proposed for the conceptual framework could be implemented in a real-scenario. Based on the conceptual framework and the case study, a roadmap to achieve a lean-green transformation is presented. The proposed roadmap revealed its contribution to the understanding on how and when an organization`s supply chain should apply the lean and green elements. This study is relevant to practice, as it may assist managers in the adoption of a lean and green supply chain approach, giving insights for the implementation of a hybrid supply chain.Fundação para a Ciência e a Tecnologia - (PhD fellowship: SFRH/BD/60969/2009); Project entitled "Lean, agile, resilient and green supply chain management" (LARG_SCM) which facilitated the development of case study and make possible the submission of papers at several International Meetings and Conference

Agile Supply Chain Management in the UK Fashion Sector

More demanding customers and the globalisation of both markets and production have led to companies nowadays facing a highly volatile and uncertain environment. In this environment, the ability to react to environmental uncertainty is key for competitiveness. Long lead times and high levels of stock have higher and higher risks associated with and, as a result, producing just-in-time to customer specifications has become the key to succeeding in the market place. Efficient supply chains often become uncompetitive because they don’t adapt to changes in the structures of markets. In this context, the area of agile supply chain management has gained increasing attention over the past few decades. It focuses on increasing the speed and flexibility of a network of interconnected businesses involved in the ultimate provision of product and service packages required by end customers.If extensive research has been previously conducted on various aspects of agility, the majority of previous studies focus on consumer acceptance of the strategy and not on operational issues. Building on this weakness, this thesis aims to construct a framework of agile supply chain management practices and, through two case studies, investigate the interactions between its components. The UK fashion sector was chosen as the focus of this research, due to its high levels of demand volatility. It also presents a set of challenges, as the high levels of globalization that characterises the sector and the complexity of the supply networks operated by fashion retailers, have previously been identified as barriers to responsiveness.The thesis’ main findings are threefold. First, due to the fact that traditional supply chains are either too complex and cost-laden to distribute low-cost products effectively or too asset-intensive and inflexible to quickly harness and deploy innovation, companies need to build ‘fit-for-purpose’ supply chain networks. This involves configuring supply networks in a tailored fashion to deliver innovation and responsiveness for premium brands and high efficiency for mass value products. Second, through high levels of process integration companies should accelerate the innovation process so that new products and promotions can be introduced into stores more cheaply and quickly. They should also reinvent the value chain by reconfiguring operations to radically cut costs and proactively meet customer demands. Third, to enable high levels of agility in a global sourcing context through rapid supply systems reconfiguration, new supply chain structures and actors, such as trade agents / intermediaries, need to be involved

The role, design and operation of distribution centres in agile supply chains

The aim of this research is to explore the role of distribution centres (DCs) in agile supply chains, together with how they should be designed, operated and their performances measured within this context. The research is based, first of all, on a survey to ascertain the current situation, and then a series of case studies of international supply chains, DC designs, DC operations, and warehouse automation projects. The techniques used include questionnaires, semi-structured interviews, quantitative measures where appropriate and qualitative measures based on 5-point Likert scales. A number of constructs are used, particularly from supply chain agility and manufacturing agility literature, and these are refined and extended to form the basis for the research. The findings indicate that a prime role of distribution centres, particularly in terms of inventory-holding, is consistent with the decoupling point concept. Further roles for distribution centres in agile supply chains include cross-docking, postponement activities, and returns. The research identifies five types of agility, namely volume, time, unit quantity, presentation and information. The responses to these different types can then be categorised according to the combination of levels (i.e. supply chain, business unit, distribution network, and distribution centre), by the type of resource used (i.e. land / building, equipment, staff, and process / systems), and by how these are deployed (i.e. extra capacity, additional resources when needed, and flexible resources). Agility measurement can be undertaken using the categories of range, mobility and uniformity. With markets becoming more volatile, agility can offer a key source of competitive advantage. However, warehouses are by their nature long-term fixed assets and therefore difficult to incorporate into an agile strategy. The series of frameworks developed during this research begins to address this important area and thus forms a basis for further research as well as providing some initial frameworks to assist practitioners.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Improving the manufacturing process of brick based products using FIT principles and Discrete Event Simulation

The aim of the study was to improve the current manufacturing process through the application of FIT manufacturing principles with the aid of Discrete Event Simulation (DES) technique. FIT principles focus on making the manufacturing process lean, agile and sustainable while maintaining the productivity rates, profitability and waste at their optimum levels. Discrete Event Simulation (DES) is a powerful tool which can be used to build a model of the current manufacturing process and later utilised to study the effects on the process flow by simulating the model under different scenarios corresponding to different key process parameters. In this study, WITNESS software was used as a platform to build the DES model and run simulations. The simulations were carried out manually i.e. by an intuitive approach and later run automatically i.e. using the embedded optimising module within WITNESS to collect the necessary data for improving the current manufacturing process. This study has been conducted as part of a Knowledge Transfer Partnership (KTP) program within a traditional manufacturing industry. Data has been collected from the company, process flow was mapped for 3 different product categories, plant layout of existing manufacturing facility was created in CAD package and a DES model was created to test different methodologies suggested by FIT manufacturing. For the simulation model, specific rules and functions were created to mimic the process flow based on the extracted knowledge of current practice. Three different FIT scenarios were tested against measured outputs to see the potential benefits to the company. The results were validated by setting the process parameters to the values suggested by the optimised DES model. The fourth scenario was tested by modelling breakdown pattern of the machines in the simulation. In the first scenario, manual improvements were made intuitively using FIT principles to allow the process to be more lean, agile and sustainable by critical evaluation and analysis such as line balancing of existing processes. iv However, due to thresholds met by this approach in terms of improvements to the manufacturing process, the DES model was simulated for the second and third scenarios using the Experimenter module in WITNESS to capture the complex relationships that exist between the 3 FIT components considering the level of investment required as a constraint for decision making. The fourth scenario was used to study the effect of breakdowns of the machines on the production line and the effect of predictive maintenance on the overall manufacturing process. The study showed that, in general, resources such as machines and labour that are shared between production lines caused undue pressure on the production line. Also, maximum allocation of resources does not always lead to maximum increase in productivity. On the contrary, lesser but smarter investment on resources improved productivity by a higher margin. Employing people with multiple skills who can carry out multiple operations was found to improve productivity significantly. It was also found that increasing the efficiency of one production line did not always increase the overall efficiency due to cross-functional relationships within the manufacturing processes and increasing the efficiency of one production line is likely to cause a bottleneck on the other inter-dependent operations. Breakdown of machinery were found to impact the production process flow negatively. In contrary to the belief that preventive maintenance is the effective solution, it was found that a reactive maintenance strategy of having a spare machine is more cost effective, in this case. This option is viable in the current manufacturing model, but not always on all scenarios. Overall, the study showed that the application of FIT manufacturing principles applied with the help of a DES model could add significant value to the organisation and increase the operational efficiencies. This work can be easily adapted to other manufacturing industries to identify the inefficiencies in the manufacturing process and remedy the bottlenecks as well as remove non-value adding activities

The strategic importance of supply chain management in small and medium sized enterprises :a case study of the garment industry in Sri Lanka

PhD ThesisThis research concerns SMEs in the Sri Lankan garment manufacturing and export industry and explores success factors in managing their supply chains. The overall aim of the study is to better understand successful supply chain management (SCM) practices which have been implemented by SMEs in the Sri Lankan garment exporting industry and the obstacles faced in their implementation. Eight telephone interviews were followed by 20 in-depth, face-to-face interviews with senior managers in Sri Lanka. Documentary evidence was also collected and analysed. Combined with a literature review on manufacturing operations, the data collection led to the development of three criteria for the selection of cases for the research: 1) maintaining direct contacts with foreign buyers, 2) shorter lead times and 3) high value added of products. Based on these three criteria, a sample of six cases: three firms that exercised 'more successful‘ SCM strategies and three characterised by 'less successful‘ SCM strategies were selected. Data were analysed using NVivo10 software with a combination of theoretically derived codes and indigenous codes as the coding strategy. Successful SCM strategies and constraints on improving SCM performance were identified based on each factor considered: lead time, value added and direct contacts related. While both macro and micro-environmental factors influence SME performance, the micro-environmental ones (in particular the lack of strategic business thinking, a weak resource base, resistance to business risk and low profit marginal niches) were far more salient. Further to this, the lack of a fabric manufacturing base within Sri Lanka is a common barrier for both 'more‘ and 'less successful‘ companies while company-specific successful strategies and constrains also were evident. The absence of direct contact with foreign buyers is critical for 'less successful‘ companies as it has led these companies to work with intermediaries. Critical supply chain decisions have to be channelled via buying offices, which leave these companies at risk. The findings add to a growing body of literature on the role of international buying offices and their impact on the implementation of SCM strategies‘ by exporting SMEs

Harnessing Knowledge, Innovation and Competence in Engineering of Mission Critical Systems

This book explores the critical role of acquisition, application, enhancement, and management of knowledge and human competence in the context of the largely digital and data/information dominated modern world. Whilst humanity owes much of its achievements to the distinct capability to learn from observation, analyse data, gain insights, and perceive beyond original realities, the systematic treatment of knowledge as a core capability and driver of success has largely remained the forte of pedagogy. In an increasingly intertwined global community faced with existential challenges and risks, the significance of knowledge creation, innovation, and systematic understanding and treatment of human competence is likely to be humanity's greatest weapon against adversity. This book was conceived to inform the decision makers and practitioners about the best practice pertinent to many disciplines and sectors. The chapters fall into three broad categories to guide the readers to gain insight from generic fundamentals to discipline-specific case studies and of the latest practice in knowledge and competence management