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Healthcare provision is costly, and patient expectations are increasing. Lean implemented within healthcare settings is one possible solution for dealing with this issue, with much of the current research in this respect mostly focused on developed countries. The research examines the applicability of lean in the healthcare sector of a developing country, specifically Oman.

Interviews were conducted with 32 individuals representing four public sector hospitals, along with two major hospital suppliers and the Ministry of Health. The readiness of lean thinking was assessed against seven criteria. Data were then analyzed thematically.

The authors found that Oman's healthcare sector is strong on leadership support, understanding value and customer groups, ability to undertake an end-to-end process view and engaging in the required training for lean. Interviewees showed awareness of the challenges, including aligning lean with the strategic agenda of healthcare settings, aligning measurement and reward systems to lean thinking and matching demand and capacity levels. The authors conclude that Oman's healthcare sector is ready for widespread application of lean, and if executed successfully, will generate strong strategic and operational outcomes.

This paper provides evidence of the applicability of lean in a very different context to the one that has been generally reported in the literature. The authors propose that lean thinking can be applied in countries and regions with similar cultural contexts such as the Middle East.

The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature.

A comprehensive review of literature focussing on lean and lean healthcare was conducted.

Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings.

The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study.

The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed.

To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

This paper aims to assess the nexus between green human resource management (GHRM) practices, green culture, environmental responsibility and environmental performance (EP).

Using a supervisor-subordinated nested design and multi-time data collection approach through convenience sampling, the authors obtained 330 responses from 15 hotels operating in the metropolitan cities of Pakistan.

The study results indicate the prominence of GHRM practices toward enhancing hotels’ EP. The authors also found green culture and environmental responsibility as potential mediators in the direct association between GHRM and EP. In addition, the findings suggest that the GHRM and environmental association can be deeper when individuals exhibit green values and showcase green responsibility about their environment. Taken together, the findings of the present study found support for all direct and indirect hypothesized relationships hence, forwarding notable implications for theory and practice.

This paper forwards both theoretical and practical implications. Drawing upon ability-motivation-opportunity (AMO) theory, this paper asserts that GHRM practices shall be used to improve EP through green values and environmental responsibility. The authors specifically suggest that pro-environment personnel practices can nourish green culture and a pro-environment sense of responsibility that facilitates in robust pro-environment results.

The study advances and addresses gaps found in prior studies to help support organizational scholars, practitioners and pro-environment enthusiasts to understand the interplay of GHRM, culture, responsibility and EP.

Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that it is a recent field of practise and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this study aims to review the implementation of lean tools and techniques applied to hospital organizational areas in a five-year period, between 2014 and 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified.

As starting point for this systematic literature review (SLR), a set of selected pre-existing review publications was used to support the current study and as the ground base for the expansion of the studies about lean health care. The current study contemplated 114 articles from a five-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas.

The thorough analysis of selected articles show a lack of works in continuous improvement approaches when compared to the application of production organization methods, visual management and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives and strive to promote the cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement.

The current study develops a new perspective of the articles published under the thematic of lean health care, published in a recent period of five years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of lean health care, exposing the current trends, improvements and also the main gaps.

This study aims to analyze the determinants influencing Chinese manufacturing companies in implementing lean manufacturing (LM).

The determinants to be explored in this study consist of technological, organizational and environmental (TOE) dimensions. A questionnaire survey was conducted on Chinese manufacturing companies, and 208 samples were analyzed.

The findings show that the relative advantage of LM and organizational support have significantly positive effects on Chinese manufacturing firms’ adoption of LM. The complexity of LM, quality of human resources, organizational readiness, customer pressure, international situation, governmental support and environmental uncertainty do not have significant effects.

This paper contributes to the literature by using the TOE model to explore the factors influencing LM adoption in the Chinese manufacturing industry.

This study explores how Lean was deployed in several hospitals in the Apulia region in Italy over 3.5 years.

An exploratory qualitative design was drawn up based on semi-structured interviews.

The drivers of Lean in hospitals were to increase patient satisfaction and improve workplace well-being by eliminating non-value-add waste. The participants highlighted three key elements of the pivotal implementation stages of Lean: introduction, spontaneous and informal dissemination and strategic level implementation and highlighted critical success and failure factors that emerged for each of these stages. During the introduction, training and coaching from an external consultant were among the most impactful factors in the success of pilot projects, while time constraints and the adoption of process analysis tools were the main barriers to implementation. The experiences of the Lean teams strongly influence the process of spontaneous dissemination aided by the celebration of project results and the commitment of the departmental hospital heads.

Lean culture can spread to allow many projects be conducted spontaneously, but the Lean paradigm can struggle to be adopted strategically. Lean in healthcare can fail because of the lack of alignment of Lean with leadership in healthcare and with their strategic vision, a lack of employees' project management skills and crucially the absence of a Lean steering committee.

The absence of managerial expertise and a will to support Lean implementation do not allow for systemic adoption of Lean. This is one of the first and largest long-term case studies on a Lean cross-regional multi-hospital application in healthcare.

Maintaining a healthy and productive workforce is a challenge for most organizations. This is even truer for health organization, facing staff shortages and work overload. The aim of this study is to identify the resources and constraints that influence managers' mental health and better understand how they are affected by them.

A qualitative approach was chosen to document the resources, the constraints as well as their consequences on managers in their day-to-day realities. The sample included executive-, intermediate- and first-level managers from a Canadian healthcare facility. A total of 62 semi-structured interviews were conducted. The coding process was based on the IGLOO model of Nielsen et al. (2018) to which an employee-related level was added (IGELOO).

Results highlight the importance of considering both resources as well as constraints in examining managers' mental health. Overarching context, organizational constraints and the management of difficult employees played important roles in the stress experienced by managers.

The results offer a better understanding of the importance of intervening at different levels to promote better organizational health. Results also highlight the importance of setting up organizational resources and act on the various constraints to reduce them. Different individual strategies used by managers to deal with the various constraints and maintain their mental health also emerge from those results.

In addition to addressing the reality of healthcare managers, this study supplements a theoretical model and suggests avenues for interventions promoting more sustainable organizational health.

This study aims to investigate the mediating role of lean management on the relationship between workforce management and value-added time in private hospitals. This study also investigates the direct influences of workforce management and lean management on the value-added time of the hospitals.

This study applied a quantitative approach to obtain data from the private hospitals’ staff in Peninsular Malaysia. A self-administered survey questionnaire was used to collect data from 287 hospital staff using a stratified random sampling method. The partial least squares structural equation modeling (PLS-SEM) approach was used to determine the internal consistency, reliability, validity of the constructs. The PLS-SEM method was also used to test the hypothesised research model via SmartPLS 3.3.4 version.

The findings of the study indicate that lean management has a direct and significant effect on the value-added time of private hospitals. The findings also revealed that lean management significantly mediates the relationship between workforce management and value-added time in private hospitals. The analysis of the results indicates that both workforce and lean management have a significant impact on the value-added time of the hospitals.

This study provides empirical contributions to enhance the quality of workforce management, lean management and value-added time. The findings of this study provide valuable insights into how effectively managing the workforce and providing guidelines to augment the lean management practices can ensure value-added time in Malaysian hospitals and the overall health-care industry. The lean management framework provides useful insights for the policymakers to understand the significance of workforce management, lean management on ensuring value-added time through reducing waiting times, unnecessary delays, generating a higher degree of patient safety, satisfaction and loyalty.

The research findings provide some essential indications for the health-care service providers to understand how the lean management approach can be implemented to enhance value-added time and how lean management can play a mediating role in creating a link between workforce management and value-added time in hospitals. This study also contributes to the theoretical and practical perspectives. The present study contributes to a better understanding of workforce management and lean management in health-care sectors from theoretical and practical perspectives.

The purpose of this study is to propose a Lean Six Sigma (LSS) roadmap to guide healthcare practitioners in the implementation of LSS along with a customized LSS tool kit for reducing medication errors.

The authors initially critically reviewed several frameworks/roadmaps of Lean, Six Sigma and LSS which have been proposed in healthcare sector from the existing literature. This review has led to an understanding of key characteristics, limitations and reasons behind the development of such frameworks/roadmaps. A conceptual roadmap was developed and then validated by a number of LSS experts and a healthcare practitioner. Based on the previous studies and taking LSS experts’ opinions into account, a revised roadmap for reducing medication is presented.

The roadmap for LSS in reducing medication errors is developed. This roadmap includes three phases: Phase 1 cultural readiness for LSS employment in reducing medication errors; Phase 2 preparation, initialization and implementation; and Phase 3 sustainability.

The roadmap has been tested with only a handful of practitioners of LSS. Moreover, only two case studies have been carried out in a Thai hospital setting which followed the roadmap. In order to improve the validity of research, more case studies need to be executed and more people should be used for testing the roadmap with varied cultures.

This is the first attempt in the development of a LSS roadmap that healthcare practitioners can follow to reduce medication errors using LSS methodology and sustaining LSS in their organizations.