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The aim of this paper is to support public decision‐makers in a local healthcare agency (LHA) in evaluating the effects of different de‐hospitalization strategies and the potential for outsourcing clinical services.

The approach adopted is based on the “patient pathway” perspective. Starting from the identification of specific care pathways, all the feasible care paths in a given LHA in Italy are investigated in order to evaluate the practicability of the de‐hospitalization of some phases with a particular focus on co‐ordination of hospitals and territorial services. A heuristic approach based on discrete‐event simulation modelling is proposed. The methodology and the simulation model have been validated with reference to field data derived from a full‐scale case study carried out within a LHA in southern Italy.

The results show where, in terms of care pathways, de‐hospitalization is practicable, valuable in terms of better resource utilization, and eligible for outsourcing. The outsourcing option appears to be more sustainable from a social point of view. It specifies that there would be no dismissal of employees, and that there would be recruitment of specialized workers such as nurses and doctors, employed under more flexible conditions. Savings in overheads would be achieved by means of patient de‐hospitalization.

The existing scientific literature, to the best of the authors' knowledge, deals with patient flow management at the hospital level. However, in the European countries, the public healthcare system is generally organized in terms of the territorially based allocation of service centres. Given the scarcity of public resources, the main difficulty seems to be a mismatch among actions needed to improve territorial and residential care for outsourcing, and the interventions needed to contain hospital costs.

Even though the integration of Lean Supply Chain Management (LSCM) and Industry 4.0 (I4.0) technologies is relatively recent, it has been receiving a lot of attention. Partly because 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 integration between LSCM and I4.0 analysing relationship at operative, tactical and strategic levels.

Systematic literature review was conducted to identify and explain the integration of LSCM and I4.0 from scientific sources that were published before March 2021.

The analysis of the literature revealed the level of integration of LSCM and I4.0 is present at different managerial levels. Moreover, when the integration is detailed at different managerial levels, it appears that LSCM paves the way for the adoption of I4.0 at a strategic level, while I4.0 technologies promise to enhance LSCM practices at the operational level.

The main contribution of this study is the framework which shows that LSCM paves the way for the adoption of I4.0 at a strategic level, while I4.0 technologies promise to enhance LSCM practices at the operational level.

This study develops a new perspective of the articles published under the thematic of LSCM and I4.0. Additionally, it proposes a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of LSCM and I4.0, exposing the current trends, improvements and also the main gaps.