Search results

During the past few decades, Lean Six Sigma (LSS) in the health-care sector has received increasing attention from both researchers and practitioners because it plays an imperative role in quality improvement and cost reduction initiatives. Although researchers have often focussed on evidence of model effectiveness through the study of performance indicators, too little attention has been given to the factors that lead to implementation failure and the causal relationships among them. This study aims to investigate the factors that may inhibit the successful implementation of the method by focussing on Italian public hospitals.

Through the use of the Delphi technique and fuzzy cognitive maps, this paper derives new and relevant results for researchers, hospital managers and policymakers.

The results show the factors with the greatest impact on LSS implementation and provide insight into the causal links and degrees of influence between critical failure factors and performance variables.

The findings could be considered useful, in particular, to hospital managers and policymakers, who could leverage the suggestions derived from the study to address LSS implementation.

This work overcomes a gap in the literature related to the absence of studies on the causal relationships between factors that determine the success or failure of LSS implementation.

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.

This study aims to fully assess the readiness for Lean Six Sigma (LSS) and Quality Performance Improvement (QPI) in an Italian Public Healthcare ecosystem.

Drawing from previously established survey development and adaptation protocols, a replication study was carried out; Lean, Six Sigma and QPI were extracted and validated through confirmatory factor analysis in an Italian Public Healthcare setting, with a sample of health professionals from the Campania region.

This study reports the adaptation of an existing scale for measuring LSS and QPI in an Italian public healthcare organisation. This analysis extracts six conceptual domains and constitutes an original adaptation of an existing scale to assess the readiness to adopt Lean, Six Sigma and Quality Performance in Italian Public Health Organizations. The constructs show strong levels of internal consistency, as demonstrated by each item factor loading and each subscale reliability.

Managers, policymakers and academics can employ the proposed tool to assess the public healthcare ecosystem’s capability to implement LSS initiatives and strategies to improve quality performance.

This is one of the first studies to assess cross-regional organisational readiness for LSS and QPI in an Italian Public Healthcare environment at this scope and level.

The current paper aims to discuss the implementation of Green Lean Six Sigma (GLSS) in the food industry to improve sustainable practices. The focus is more specifically on dairy processors to ascertain the current state of the literature and aid future research direction.

Utilising a systematic literature review (SLR), the paper addresses various terms and different written forms in the literature. The study characterises the current deployment of GLSS in the food industry and explains the reported benefits of this approach.

GLSS, a concept that has yet to be fully explored in the food industry, as in other sectors, holds significant potential to enhance the food industry’s sustainability practices. The dairy sector, a subsector of the food industry known for its high greenhouse gas emissions, is a prime candidate for the application of GLSS. In instances where it has been applied, GLSS has demonstrated its effectiveness in improving sustainability, reducing waste, lowering greenhouse gas emissions and minimising water usage. However, the specific tools used and the model for GLSS implementation are areas that require further study, as they have the potential to revolutionise food industry operations and reduce their environmental impacts.

Benchmarking of this research by the food industry sector and by academics can aid understanding of the practical application of GLSS tools and aid implementation of these practices to evolve the dairy processing sector in the next decade as sustainability champions in the sector.

This study extensively analyses GLSS in the food industry, with a particular focus on dairy processors.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

This study aims to improve a construction company's overall project delivery by utilising lean six sigma (LSS) methods combined with building information modelling (BIM) to design, modularise and manufacture various building elements in a controlled factory environment off-site.

A case study in a construction company utilised lean six sigma (LSS) methodology and BIM to identify non-value add waste in the construction process and improve sustainability.

An Irish-based construction company manufacturing modular pipe racks for the pharmaceutical industry utilised LSS to optimise and standardise their off-site manufacturing (OSM) partners process and leverage BIM to design skids which could be manufactured offsite and transported easily with minimal on-site installation and rework required. Productivity was improved, waste was reduced, less energy was consumed, defects were reduced and the project schedule for completion was reduced.

The case study was carried out on one construction company and one construction product type. Further case studies would ensure more generalisability. However, the implementation was tested on a modular construction company, and the methods used indicate that the generic framework could be applied and customized to any offsite company.

This is one of the few studies on implementing offsite manufacturing (OSM) utilising LSS and BIM in an Irish construction company. The detailed quantitative benefits and cost savings calculations presented as well as the use of the LSM methods and BIM in designing an OSM process can be leveraged by other construction organisations to understand the benefits of OSM. This study can help demonstrate how LSS and BIM can aid the construction industry to be more environmentally friendly.

The purpose of this study is to investigate how the emotion expressed by a fictitious proposer influences the responder’s decision to accept or reject a severely unfair deal, represented by the splitting of a predetermined sum of money between the two players during an ultimatum game (UG). Rejection leads both parts to dissipate that sum. Critically the authors consider the situation in which both players have the best alternative to negotiation agreement (BATNA), which simulates a backup plan to rely on in case of no agreement.

The participants played a UG and, to foster the ecological validity of the paradigm, the parts could both rely on a more or less generous BATNA. The critical manipulation was the emotion expressed by the proposer while their BATNA was either hidden (Exp. 1) or communicated (Exp. 2).

The proposer’s emotions influenced participants’ own emotions, affected their social evaluations about the proposer, the desire for future interactions with the proposer and were used to infer the proposer’s BATNA when it was unknown. In this latter case, proposers’ emotions and in particular his/her happiness, decreased dramatically the participants’ tendency to reject even severely unfair offers.

Past research on UG has been predominantly aimed to investigate the effect of responders’ emotions or the effects of responders’ emotions on the proposer, devoting little attention to how the critical responder’s acceptance/rejection decision might be affected by the proposer’s emotion. Especially in the ecological situation where the parts have a BATNA in case of non-agreement.

The main purpose of this study is to investigate Ishikawa’s statement that “95% of problems in processes can be accomplished using the 7 Quality Control (QC) tools” and explore its validity within the health-care sector. The study will analyze the usage of the 7 QC tools in the health-care service sector and the benefits, challenges and critical success factors (CSFs) for the application of the 7 QC tools in this sector.

In order to evaluate Ishikawa’s statement and how valid his statement is for the health-care sector, an online survey instrument was developed, and data collection was performed utilizing a stratified random sampling strategy. The main strata/clusters were formed by health-care professionals working in all aspects of health-care organizations and functions. A total of 168 participants from European health-care facilities responded to the survey.

The main finding of this study is that 62% of respondents were trained in the 7 QC tools. Only 3% of participants in the health-care sector perceived that the seven tools of QC can solve above 90% of quality problems as originally claimed by Dr Ishikawa. Another relevant finding presented in this paper is that Histograms, Cause and Effect diagrams and check sheets are the most used tools in the health-care sector. The least used tools are Stratification and Scatter diagrams. This paper also revealed that the 7 QC tools proposed by Dr Ishikawa were most used in hospital wards and in administration functions. This work also presents a list of CSFs required for the proper application of the 7 QC tools in healthcare.

This research was carried out in European health-care facilities – and there is an opportunity to expand the study across global health-care facilities. There is also an opportunity to study the use of the tools and their impact on hospital performance using the Action Research methodology in a health-care organization.

To the best of the authors’ knowledge, this is the very first research within the health-care sector that focused on investigating the usage of all the 7 basic tools and challenging Dr Ishikawa’s statement: “95% of problems in processes can be accomplished using the 7 Quality Control (QC) tools” from his book “What is Quality Control?” The results of this study represent an important first step toward a full understanding of the applicability of these tools in the health-care sector.

The current study makes two main contributions: one theoretical and one methodological. First, it investigated the theoretical prepositions of career sustainability perspective, which appears particularly suitable for examining project managers' careers' dynamics and patterns, featured by explicit and recursive interactions between individual, temporal and contextual factors. Second, the study aimed to adopt a qualitative approach to this topic as to allow a deeper understanding of individual narratives about careers, highlighting underexplored issues and peculiarities that future research could further examine through quantitative methodologies.

Project managers' careers are still an under-researched topic, especially through qualitative methods. The study applied career sustainability theory to the realm of project management, moreover, adopting a socio-constructivist perspective. Participants were 50 Italian project managers who were involved through a narrative in-depth interview that focused on career and career success. Their answers were analyzed through thematic analysis of contents and diatextual analysis.

Results showed that project managers' career could be a prototypical example of sustainable career, basically described in terms of four basic constitutive dimensions as follows: time frame, social space, agency and meaning. Implications for both future theoretical expansion of career sustainability theory and project managers' career management interventions were also discussed.

The originality of the paper could be found in the effort to adopt a socio-constructivist perspective to investigate the topic of career sustainability taking the exemplary case of project managers' career.

This article on Messedaglia might start with Schumpeter's words: “I have chosen him for mention because of the strategic position he holds in the history of Italian economics and statistics”. In fact the Italian history of economics in the nineteenth century is populated by many authors who were rather famous during their lifetime but less and less appreciated later. Generally speaking it can be said, again with Schumpeter, that “the economic research which was done during this period in the various centres of national life … was not on the same level with the achievements of either the earlier times of Beccaria and Verri or the later times of Pantaleoni and Pareto…. And if it is true that “the political and administrative structure of every nation reflects itself in the organisation of its scientific work” (ibid.) the difficulties faced by Italy, trying first to get rid of foreign domination and, secondly, to build national unity, can explain the trouble Italian economists have had in disentangling themselves from foreign influence and in avoiding divisions into regional schools of thought. Angelo Messedaglia is one of the few able to be original and not provincial, as will be shown later; instead, at this point it would seem useful to give a brief account of the historical situation of Italy in the nineteenth century.