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The purpose of this paper is to assess causal relations between the implementation of the 5S approach and the reduction of patients’ waiting time at out patient departments (OPDs) of hospitals in Tanzania.

Patients’ waiting time was measured under the cluster randomized control trial (c-RCT). In all, 16 hospitals were chosen and divided into treatment and control groups using block randomization. Before the intervention, a baseline study was conducted at OPDs in all 16 hospitals. After one year of the intervention, the end-line study was carried out in both the groups. A comparison of the average waiting time reduction and Difference-in-Difference (DID) analysis was carried out to see the effect of the 5S approach on the reduction of patients’ waiting time.

Statistical significance in reduction of patients’ waiting time was seen in the medical records sections (p=0.002) and consultation rooms (p=0.020) in the intervention group. The same trend was also seen using DID analysis (−15.66 min in medical record, −41.90 min in consultation rooms).

This study has the following limitations in terms of the data. The data were collected for only three days at the time of baseline survey, and again for three days at the time of the end-line survey from 16 hospitals. Moreover, piloted areas for the implementation of the 5S approach vary from hospital to hospital. There might be a bias in the measurement of a patient’s waiting time. Caveats are therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for implementing quality improvement programs in Tanzania and in other African countries for improvement of time factors.

This study used c-RCT, and has proven the effectiveness of the 5S approach in improving the working environment and reducing patients’ waiting time at OPDs in several hospitals at district level in Tanzania.

Building on the routine dynamics literature, this paper aims to expand our philosophical, practical and infrastructural understanding of implementing lean production. The authors provide a process view on the interplay between lean operating routines and continuous improvement (CI) routines and the roles of different actors in initiating and establishing these routines.

Using data from interviews, observations and document analysis, retrospective comparative analyses of three embedded case studies on lean implementations provide a process understanding of enacting and patterning lean operating and CI routines in manufacturing SMEs.

Incorporating the “who” and “how” next to the “what” of practices and routines helps explain that rather than being implemented in isolation or even in conjunction with each other, sustainable lean practices and routines come about through team leader and employee enactment of the CI practices and routines. Neglecting these patterns aligned with unsustainable implementations.

The proposed process model provides a valuable way to integrate variance and process streams of literature to better understand lean production implementations.

The process model helps manufacturing managers, policy makers, consultants and educators to reconsider their approach to implementing lean production or teaching how to do so.

Nuancing the existing lean implementation literature, the proposed process model shows that CI routines do not stem from implementing lean operating routines. Rather, the model highlights the importance of active engagement of actors at multiple organizational levels and strong connections between and across levels to change routines and work practices for implementing lean production.

Lean management is a suitable methodology for companies that want to improve their productive performance and competitiveness. This study aims to research levels of implementation and internalisation of Lean production tools in Spanish manufacturing companies, and explores differences in behaviour between SMEs and large companies based on data gathered over three time periods. The correlation between Lean adoption and company performance is also analysed.

Company survey data for the years 2012, 2015 and 2018 collected from 354 respondents were used to conduct a longitudinal study on the level of lean tool adoption and internalisation in manufacturing companies.

Over the years, the use of Lean tools has increased, whereas levels of internalisation have remained stable. Lean tool use in SMEs and large companies show significant differences in 2012 and 2015, but this is no longer the case 2018. Results also show that higher Lean tool use helps increase return on sales (ROS), and higher levels of internalisation of tools helps reduce the number of products rejected.

To date, there are no known studies on the use and internalisation of Lean tools or their correlations with business performance indicators in Spanish manufacturing companies.