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Practicing Lean strategy: Hoshin Kanri and X-Matrix in a healthcare-centered simulation

Federico Barnabè (Department of Business Studies and Law, University of Siena, Siena, Italy)
Maria Cleofe Giorgino (Department of Business Administration, Finance, Management and Law, University of Milano-Bicocca, Milano, Italy)

The TQM Journal

ISSN: 1754-2731

Article publication date: 12 June 2017




This paper builds on the debate regarding the application of Lean strategy principles and tools in modern organizations, specifically focusing on the healthcare (HC) sector. The purpose of this paper is threefold: first, to highlight the potential role played by Lean strategy tools for strategic planning and management, particularly in reference to the Hoshin Kanri policy deployment system and the “focus, alignment, integration, and review” (FAIR) method; second, to discuss how Lean strategy can be operationalized, specifically relying on the X-Matrix reporting tool; and third, to explore how simulation techniques, in the form of role-playing (RP), may support the aforementioned operationalization of Lean strategy while at the same time promoting policymaking and knowledge sharing.


This research adopts a case study approach. Specifically, the paper relies on the use of a RP Lean strategy project developed in a HC setting.


The paper highlights the potential for the Hoshin Kanri policy deployment process in HC, also emphasizing the main strengths of X-Matrix reporting and the usefulness of the RP technique to support learning acquisition and decision making.

Practical implications

The paper demonstrates how a Lean strategy simulation project may be effectively used for strategic planning/management and to train professionals in HC. To achieve these aims, a methodology to design and implement simulation-based Lean strategy projects in HC is presented and discussed.


A review of the academic literature indicates that Lean strategy is still an emerging research topic addressed by only a limited number of articles. The paper contributes to a deeper understanding of the fundamentals of Lean strategy (particularly Hoshin Kanri and X-Matrix) with particular reference to the HC sector.



Barnabè, F. and Giorgino, M.C. (2017), "Practicing Lean strategy: Hoshin Kanri and X-Matrix in a healthcare-centered simulation", The TQM Journal, Vol. 29 No. 4, pp. 590-609.



Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

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