Leaders’ behavioural change throughout a hospital’s lean implementation

This article empirically examines the relationship between leadership behaviours and the implementation level of Lean Healthcare (LH). At three points in time, with a six-month interval between each point, we surveyed and interviewed 12 leaders from a Brazilian public hospital adopting LH. Our findings indicate that leaders who actively adopt LH practices also demonstrate more task- and relations-oriented behaviours, whereas low LH adopters may drop their display of those behaviours over time. This finding parallels with Kübler-Ross’s change curve that describes how an individual’s confidence, morale and effectiveness levels may vary as a change process, such as LH implementation, unfolds

Professional competence and its effect on the implementation of healthcare 4.0 technologies: scoping review and future research directions

Background: The implementation of Healthcare 4.0 technologies faces a number of barriers that have been increasingly discussed in the literature. One of the barriers presented is the lack of professionals trained in the required competencies. Such competencies can be technical, methodological, social, and personal, contributing to healthcare professionals managing and adapting to technological changes. This study aims to analyse the previous research related to the competence requirements when adopting Healthcare 4.0 technologies. Methods: To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the most important databases and retrieved 4976 (2011–present) publications from all the databases. After removing duplicates and performing further screening processes, we ended up with 121 articles, from which 51 were selected following an in-depth analysis to compose the final publication portfolio. Results: Our results show that the competence requirements for adopting Healthcare 4.0 are widely discussed in non-clinical implementations of Industry 4.0 (I4.0) applications. Based on the citation frequency and overall relevance score, the competence requirement for adopting applications of the Internet of Things (IoT) along with technical competence is a prominent contributor to the literature. Conclusions: Healthcare organisations are in a technological transition stage and widely incorporate various technologies. Organisations seem to prioritise technologies for ‘sensing’ and ‘communication’ applications. The requirements for competence to handle the technologies used for ‘processing’ and ‘actuation’ are not prevalent in the literature portfolio

A lean six sigma framework for continuous and incremental improvement in the oil and gas sector

This article aims to explore synergies between Lean Production (LP) and Six Sigma principles in order to propose a Lean Six Sigma (LSS) framework for continuous and incremental improvement in the oil and gas sector. The Three-Dimensional LSS Framework seeks to provide various combinations about the integration between LP principles, DMAIC cycle and PDCA cycle to support operations management needs. Design/methodology/approach - The research method is composed of two main steps: (i) diagnostic of current problems and proposition of a conceptual framework that qualitatively integrates synergistic aspects of LP and Six Sigma; and (ii) analysis of the application of the construct through semi-structured interviews with leaders from oil and gas companies to assess and validate the proposed framework. Findings - As a result, a conceptual framework of LSS is developed contemplating the integration of LP and Six Sigma and providing a systemic and holistic approach to problemsolving through continuous and incremental improvement in the oil and gas sector. Originality/value - This research is different from previous studies because it integrates LP principles, DMAIC and PDCA cycles into a unique framework that fulfils a specific need of oil and gas sector. It presents a customized LSS framework that guides wastes and costs reduction, while enhances quality and reduces process variability to elevate efficiency in operations management of this sector. The paper type is an original research that present new and original scientific findings.N/

The moderating role of just-in-time on sociotechnical practices' effect over quality and workers' health

Sociotechnical (ST) theory emphasizes the notion that the design and performance of new systems can be improved, and can only work satisfactorily within an organization if the social and the technical aspects are brought together and treated as interdependent aspects of a work system. The implementation of lean manufacturing (LM) principles and practices has become popular, despite increasing demand on the current and emerging workforce to achieve higher levels of quality and flexibility with lower costs. Exploratory studies that investigate how LM practices influence the effect of ST practices on performance are still scarce, and a holistic view of such a relationship is needed. In this context, this study aims at verifying the moderating effect of just-in-time (JIT) practices on the relationship between ST practices and the performance of quality and workers' health. We carried out a survey with 144 different companies from Southern Brazil that are undergoing a lean implementation. Results indicate that ST practices have a positive significant relationship with such performance, and the concurrent adoption of JIT does not undermine quality and workers' health

Effects of Lean Healthcare on Patient Flow: A Systematic Review

Objectives: To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. Methods: A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. Results: Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. Conclusions: According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/ staff satisfaction and the translation of the obtained benefits into savings is scarce among studies