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This study aims to explore the involvement of middle management in forming strategies to manage variable acute patient flows at a hospital.

Empirical evidence from a university hospital was gathered via interviews, internal documents, observation and participation in meetings. The role of middle management in the development of strategies was analyzed using literature on middle management involvement.

In managing variable acute patient flows, middle management adopts a number of roles and behavioral characteristics that have been previously described in research. The role of facilitator is the most prominent, with middle managers prioritizing individual goals and strategies for the clinical departments that they manage before their collective responsibility for hospital performance. Unclear responsibilities and mandates within the organization, together with a lack of hospital-wide strategies concerning how the acute patient flow should be managed, are contributing factors to this behavior.

The research is based on an explorative, single case study methodology. Future research assessing the extent of different middle management roles in health care, in which more empirical data and quantitative analysis is conducted, is encouraged.

There is a need for top management to establish long-term goals to enhance middle management roles when developing strategies for managing variable patient flows.

Middle management involvement in developing strategies for managing variable patient flows is a novel topic for research. The interface and division of tasks between top and middle management is crucial for successful strategies in managing variable patient flows.

This paper aims to explore if actions used at a hospital to manage a variable acute patient flow can be categorised using the concepts of lean, agile and leagile.

Empirical evidence from a university hospital was gathered by interviews, internal documents, shadowing and participation in meetings. Identified actions used at both hospital level and departmental level are categorised as lean or agile, while combinations of actions are compared with different leagile approaches.

Actions from every lean and agile category derived from literature are used at the hospital, however in varying extent. Many agile actions are reactive, indicating a lack of proactive measures. Actions that directly manage external variation are also few in numbers. Leagile approaches of all three combinations derived from literature are also used at the hospital.

As a single-case study is used, empirical generalisation to other hospitals cannot be deduced. Future research assessing the appropriateness of different actions for managing a variable acute patient flow is encouraged.

The use of actions within both lean and agile categories indicate the possibility of combining these process strategies in hospitals, and not only focusing on implementing lean. By cleverly combining lean and agile actions, leagile approaches can be formed.

The use of lean in health care has been a topic of research, while the use of agile has been sparsely researched, as well as the combination of the two.

The objective of this exploratory paper is to find out what is important to consider when developing a supply chain in health care, what is required in order to establish a supply chain orientation and how lean and agile can be used as process strategies in order to improve supply chain performance.

In order to build an empirical framework for using both lean and agile strategies in health care supply chain management illustrative examples are provided from a Swedish health care setting describing the patient flow and planning processes.

Supply chain management has potential to work well as a philosophy for patient flow in the health care sector. However, it should not only be about the use of the concept of lean in health care, as in fact is the case in practice today. It is rather about organizing for quick response and flexibility in a hybrid strategy through combining lean and agile process strategies. This can only be done if a systems approach is applied together with a strategic orientation, where cooperative efforts by the supply chain members should synchronize and converge operational as well as strategic capabilities into a unified whole.

The analysis in the paper underlines the importance of focusing on both agility and leanness combined. Hospitals or health care systems that introduce such an approach, as opposed to only relying on lean strategies, could gain both competitive advantages and improved performance.

In health care, even more so than in the manufacturing industry, containment of costs without sacrificing quality is important. This paper applies SCM techniques, tools and concepts that have not been used previously for patient flow in a health care setting, combining lean and agile in one and the same analysis.

This paper seeks to address how firms may contribute to environmental improvement through structural changes of their logistics systems.

A comprehensive literature review discloses the low interest that has been directed to environmental issues in logistics, and findings relevant for structural issues at a firm level are described. Three cases where firms have implemented different types of structural changes to their logistics systems support the analysis.

A range of different measures to succeed in environmental as well as logistics performance are presented, comprising types of consolidation, logistics standardisation, and IS/IT solutions allowing a vast restructuring of logistics systems.

The discussion about logistics and the environment has mostly revolved around more environmental friendly technological solutions, concerning single firms as well as governmental support for technology development. The structural, more organisational issues, have been addressed on a societal level, where solutions concern infrastructure. There is a need to reduce the amount of transport in general. The paper discusses how logistics systems' environmental performance can be improved simultaneously with a non‐reduction of logistics performance in terms of costs and delivery service.

The outcome of product development, i.e. the product design, together with the packaging solution, has a great impact on the logistics performance of supply chains. Despite this, packaging has traditionally been given a very modest role in the product development literature as well as in the logistics literature. The aim of this paper is to show how logistics performance and product design can be affected, and improved, by the packaging organization within a company.

A single case study has been conducted at IKEA, including on‐site interviews and review of internal documents. Along with the case study, a literature study has been conducted within the areas of product development, packaging and logistics.

The IKEA case suggests that the packaging function should have a strong link to both the logistics function and the product development function within a product‐developing company to be able to improve the logistics performance.

As the evidence is collected through a single case study, the results are not to be seen as generalizable but should be regarded as a first step to future research within the interface of product development, packaging and logistics.

Packaging and logistics are usually considered late in the product development process with the result that possible logistics solutions are constrained. Through considering “the whole package” – i.e. the product, the packaging and the supply chain characteristics – at an early stage in the product development process, savings can be made.

This paper includes the aspects of product development, logistics and packaging, an interface with very limited research contributions.

Aims to examine the value of manufacturer access to downstream demand information in managing product introductions and to Identify factors affecting this value.

Simulation based on actual data on 19 product introductions is used for comparing different types of demand information and their usefulness to a manufacturer. Two metrics are introduced. Bias indicates if there is a consistent difference between demand information from two sources. Delay in demand synchronization measures how long it takes for demand information from two sources to start conveying demand similarly in a transient situation.

Finds that, in the supply chain examined, demand variability is mainly induced by distributors, whereas bias and delay in demand synchronization are mainly induced by retail outlets, especially for products with large wholesale packages compared with their sales.

The simulation model is simple and does not enable realistic examination of how a manufacturer could best use downstream demand data in managing its operations. Further research including such mechanisms as forecasts and stock‐outs is needed.

Provides a means for manufacturers to assess when they should invest in gaining access to downstream demand information and to estimate when their traditional information sources start to accurately convey end‐customer demand for new products.

Although it has been suggested that the value of access to downstream demand information could be greatest in situations with transient or irregular demand, such as product introductions, this claim has not yet been thoroughly examined. This study is a first attempt at filling this gap in the theory.

To provide empirical evidence of benefits from IT in supply chain management.

Data in this qualitative study were collected through multiple enquiries. SCM consultant interviews gave an understanding of the current state of practice. A survey of 48 progressive companies was conducted to identify what IT solutions they have implemented in SCM. This was followed by 18 in‐depth case studies to identify the mechanisms for achieving benefits of IT in SCM.

Based on the empirical studies five propositions are presented on the use and benefits of IT. First, successful companies have developed focused e‐business solutions for improving customer service elements that are most important in their business. Second, improved efficiency allows company personnel to focus more on critical business activities. Third, the use of e‐business solutions improves information quality. Fourth, e‐business solutions support planning collaboration and improved agility of the supply network. Finally, to gain strategic benefits, the use of IT has to be coupled with process redesign.

The sample of companies used in the study was selected by expert assessment and is biased towards companies willing to discuss and share results openly. Additionally, the focus of the paper was on single companies and not on the entire supply network. However, the findings of this study present an opportunity to further develop understanding of the underlying mechanisms of how IT investments benefit supply chain management.

The paper fulfils an identified need for in‐depth case studies that analyze the possible mechanisms behind the practical benefits of IT in supply chain management.

To construct a framework for exploring and discussing the use of different research approaches – deductive, inductive and abductive – in logistics.

A review of research articles in three major logistics journals (International Journal of Logistics Management, International Journal of Physical Distribution & Logistics Management and Journal of Business Logistics) from 1998 to 2002.

Recognizes the dominance of deductive research in logistics, and the need for more inductive and, in particular, abductive research for theory development. Discusses the use of the abductive research approach in logistics.

Keywords searches led to a small sample size; more thorough content analysis is needed to apply the findings from the constructed framework.

Useful source of information on the three different research approaches, their possibilities and implications for research.

The abductive research approach has not yet been discussed in logistics.

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.

The purpose of this paper is to focus on the associations of employees’ attitudes and human resource arrangements to sickness absence from the perspective of absence culture and work ability.

The study was conducted in one of the largest food industry companies in Finland. Sickness absence register data were obtained from the years 2003 to 2005 and a survey from 2005. This survey included single propositions about work arrangements (five propositions) and attitudes (three propositions) during sickness absence. These were analysed by absence days and short (1‐7 days) and long spells (>7 days).

The attitude of blue‐collar workers who agreed that it is a matter of course that someone is absent was statistically significant regarding sickness absence. They had increased risk for sickness absence days and for short spells. From work arrangements during absence the fact that jobs will wait returning to the workplace decreased the risk for short and long sickness absence spells in both groups. In addition, the fact that the employer will take a substitute during workmates’ absence increased the risk for all measured sickness absence rates among white‐collar workers.

These findings should be noted in enterprises’ human resource management and occupational health services to manage and understand sickness absence.

Although sickness absence has been widely studied, very little is known about sickness absence related work arrangements and attitudes associated with sickness absence. This study increases knowledge about these issues.