A Systematic Review of Lean Implementation Frameworks and Roadmaps: Lessons Learned the Way Forward

Purpose: The purpose of this study is to carry out a comprehensive systematic review of Lean implementation frameworks and roadmaps developed over the past decade and report the key findings along with the limitations and the way forward. Methodology: A systematic review methodology proposed by Tranfield (2003) was followed to identify the relevant works on the research topic. Articles were searched using a set of inclusion criteria in various databases including Google Scholar, Web of Science and Science Direct over a period of thirty years. Findings: The high failure rate of Lean system implementation, reaching a range between 70-90% in almost all industries, is a matter of concern. This failure rate is still high even though numerous frameworks and roadmap models exist to streamline Lean implementation. There is no standard framework or roadmap identified in the literature and many organisations are implementing lean in their unique ways. However it would be desirable to develop a practical and systematic roadmap on Lean looking into the cultural and leadership dimensions rather than focusing on a set of tools. Moreover, most frameworks and roadmaps lack the sustianance aspects of Lean implementation. Limitation: This research only identifies the fundamental gaps with the existing frameworks and roadmaps on lean implementation. The next phase of the research is to develop a roadmap and validate it with a number of organisations in different cultural contexts and leadership styles. Originality: The authors argue that this is one of the most comprehensive systematic review on lean frameworks and roadmaps ever produced in the literature to date

Agronomic characteristics of the spring forms of the wheat landraces (einkorn, emmer, spelt, intermediate bread wheat) grown in organic farming

Organic farmers look to the possibilities of growing neglected crops, such as the spring forms of hulled wheat – einkorn, emmer and spelt – for support in developing the organic farming system. In 2008, 169 landraces from the gene bank at the Crop Research Institute in Prague were tested on certifi ed organic plots. The experiment was aimed at fi nding suitable varieties for the organic farming system. In summary, our fi ndings show that einkorn (Triticum monococcum L.) and emmer wheat [Triticum dicoccum Schrank (Schuebl)] are resistant to powdery mildew and brown rust, spelt wheat (Triticum spelta L.) is less resistant to these two diseases, and the intermediate forms of bread wheat are very sensitive to such infestation. The varieties evaluated incline to lodging, as they have long and weak stems. Einkorn and emmer wheat have short and dense spikes and a low thousand grains weight, whereas spelt wheat has long and lax spikes. The level of the harvest index is low. Potentially useful varieties were found during the fi eld experiment and evaluation, and our future efforts will therefore focus on improving resistance to lodging and increasing the productivity of the spike

Healthcare 4.0 digital technologies impact on quality of care: A systematic literature review

The healthcare industry is transforming into Healthcare 4.0 (H4.0), an era characterized by smart and connected healthcare systems. This study presents a conceptual framework that classifies H4.0 digital technologies into information and communication technology bundles within the healthcare value chain. It also identifies barriers and evaluates digital technologies’ impact on quality measures through a systematic literature review and meta-analysis approach following the PRISMA protocol. The analysis reveals that digital technologies in the healthcare sector traditionally consist of sensing-communication and processing-actuation technologies. The findings highlight the significant influence of H4.0 digital technologies on three quality measures: patient safety, patient experience/ satisfaction, and clinical effectiveness. While these technologies offer potential benefits, they pose challenges for patients and clinicians, including intellectual property and significance concerns, especially in North America. The proposed framework addresses these issues and enables stakeholders to prioritize, review, and analyze H4.0 digital technologies to enhance patient safety, experience, and clinical effectiveness. This research contributes to the existing literature by being the first comprehensive analysis of the impact of H4.0 technologies on the quality of care. The framework provided in this study offers valuable guidance for stakeholders in selecting appropriate technologies to improve patient outcomes and support the healthcare value chain

Techno-Economic Feasibility Analysis of a Fully Mobile Radiation Oncology System using Monte Carlo Simulation

PURPOSEDisparities in radiation oncology (RO) can be attributed to geographic location, socioeconomic status, race, sex, and other societal factors. One potential solution is to implement a fully mobile (FM) RO system to bring radiotherapy to rural areas and reduce barriers to access. We use Monte Carlo simulation to quantify techno-economic feasibility with uncertainty, using two rural Missouri scenarios.METHODSRecently, a semimobile RO system has been developed by building an o-ring linear accelerator (linac) into a mobile coach that is used for temporary care, months at a time. Transitioning to a more FM-RO system, which changes location within a given day, presents technical challenges including logistics and quality assurance. This simulation includes cancer census in both northern and southeastern Missouri, multiple treatment locations within a given day, and associated expenditures and revenues. A subset of patients with lung, breast, and rectal diseases, treated with five fractions, was simulated in the FM-RO system.RESULTSThe FM-RO can perform all necessary quality assurance tests as suggested in national medical physics guidelines within 1.5 hours, thus demonstrating technological feasibility. In northern and southeastern Missouri, five-fraction simulations\u27 net incomes were, in US dollars (USD), $1.55 ± 0.17 million (approximately 74 patients/year) and$3.65 USD ± 0.25 million (approximately 98 patients/year), respectively. The number of patients seen had the highest correlation with net income as well as the ability to break-even within the simulation. The model does not account for disruptions in care or other commonly used treatment paradigms, which may lead to differences in estimated economic return. Overall, the mobile system achieved a net benefit, even for the most negative simulation scenarios.CONCLUSIONOur simulations suggest technologic success and economic viability for a FM-RO system within rural Missouri and present an interesting solution to address other geographic disparities in access to radiotherapy

Rapid Effects of Marine Reserves via Larval Dispersal

Marine reserves have been advocated worldwide as conservation and fishery management tools. It is argued that they can protect ecosystems and also benefit fisheries via density-dependent spillover of adults and enhanced larval dispersal into fishing areas. However, while evidence has shown that marine reserves can meet conservation targets, their effects on fisheries are less understood. In particular, the basic question of if and over what temporal and spatial scales reserves can benefit fished populations via larval dispersal remains unanswered. We tested predictions of a larval transport model for a marine reserve network in the Gulf of California, Mexico, via field oceanography and repeated density counts of recently settled juvenile commercial mollusks before and after reserve establishment. We show that local retention of larvae within a reserve network can take place with enhanced, but spatially-explicit, recruitment to local fisheries. Enhancement occurred rapidly (2 yrs), with up to a three-fold increase in density of juveniles found in fished areas at the downstream edge of the reserve network, but other fishing areas within the network were unaffected. These findings were consistent with our model predictions. Our findings underscore the potential benefits of protecting larval sources and show that enhancement in recruitment can be manifested rapidly. However, benefits can be markedly variable within a local seascape. Hence, effects of marine reserve networks, positive or negative, may be overlooked when only focusing on overall responses and not considering finer spatially-explicit responses within a reserve network and its adjacent fishing grounds. Our results therefore call for future research on marine reserves that addresses this variability in order to help frame appropriate scenarios for the spatial management scales of interest

Quantifying the Spatial Ecology of Wide-Ranging Marine Species in the Gulf of California: Implications for Marine Conservation Planning

There is growing interest in systematic establishment of marine protected area (MPA) networks and representative conservation sites. This movement toward networks of no-take zones requires that reserves are deliberately and adequately spaced for connectivity. Here, we test the network functionality of an ecoregional assessment configuration of marine conservation areas by evaluating the habitat protection and connectivity offered to wide-ranging fauna in the Gulf of California (GOC, Mexico). We first use expert opinion to identify representative species of wide-ranging fauna of the GOC. These include leopard grouper, hammerhead sharks, California brown pelicans and green sea turtles. Analyzing habitat models with both structural and functional connectivity indexes, our results indicate that the configuration includes large proportions of biologically important habitat for the four species considered (25–40%), particularly, the best quality habitats (46–57%). Our results also show that connectivity levels offered by the conservation area design for these four species may be similar to connectivity levels offered by the entire Gulf of California, thus indicating that connectivity offered by the areas may resemble natural connectivity. The selected focal species comprise different life histories among marine or marine-related vertebrates and are associated with those habitats holding the most biodiversity values (i.e. coastal habitats); our results thus suggest that the proposed configuration may function as a network for connectivity and may adequately represent the marine megafauna in the GOC, including the potential connectivity among habitat patches. This work highlights the range of approaches that can be used to quantify habitat protection and connectivity for wide-ranging marine species in marine reserve networks

Larval Connectivity in an Effective Network of Marine Protected Areas

Acceptance of marine protected areas (MPAs) as fishery and conservation tools has been hampered by lack of direct evidence that MPAs successfully seed unprotected areas with larvae of targeted species. For the first time, we present direct evidence of large-scale population connectivity within an existing and effective network of MPAs. A new parentage analysis identified four parent-offspring pairs from a large, exploited population of the coral-reef fish Zebrasoma flavescens in Hawai'i, revealing larval dispersal distances ranging from 15 to 184 km. In two cases, successful dispersal was from an MPA to unprotected sites. Given high adult abundances, the documentation of any parent-offspring pairs demonstrates that ecologically-relevant larval connectivity between reefs is substantial. All offspring settled at sites to the north of where they were spawned. Satellite altimetry and oceanographic models from relevant time periods indicated a cyclonic eddy that created prevailing northward currents between sites where parents and offspring were found. These findings empirically demonstrate the effectiveness of MPAs as useful conservation and management tools and further highlight the importance of coupling oceanographic, genetic, and ecological data to predict, validate and quantify larval connectivity among marine populations