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Healthcare organizations have been facing challenges due to high costs and low efficiency in health services. The growth of costs and losses caused by avoidable mistakes lead to the search for solutions, and Health Lean Management appears as a potential solution to help in solving service quality problems, as well as reducing risks. This study aims to analyse the state of the art in the literature centred on the Lean approach in the context of risk management in healthcare organizations, and to identify new research opportunities, highlighting possible lines of future research.

Following a systematic literature review approach, 51 papers were considered relevant for this research, and reviewed to explore the development of literature in this area.

Based on the results, five main research streams were identified: (1) risk management oriented towards patient safety; (2) risk management oriented towards employee safety; (3) importance of attitudes and behaviours in risk reduction projects; (4) Lean tools used in healthcare risk management and (5) Integration of approaches. Moreover, several shortcomings were identified in literature.

Identified shortcomings represent significant opportunities for further research development.

Quality improvement has developed and spread, and today, all Swedish Regions emphasize that their strategies are based on systematic improvement. This paper aims to describe and illuminate the development of Quality Improvement (QI) in Swedish healthcare and welfare organizations by using publications in a Swedish context.

The overview synthesis is inspired by a scoping literature review approach of relevant literature. All publications relevant to Swedish healthcare and welfare settings between 1992 until 2020 were included.

In all, 213 papers, 29 books and chapters and 34 dissertations related to QI and research in Swedish healthcare and welfare context were identified. From 2011 to 2020, the publication rate increased rapidly. Six different focus areas emerged: systematic and value-creating improvement work; collaboration between organizations and healthcare providers; use of improvement methods and (theoretical) models; leadership and learning; measurements, quality registers and follow-up; and involvement and patient safety. Further QI development in Swedish healthcare and welfare points to an increased importance of collaboration between organizations and coproduction with beneficiaries for the healthcare and welfare services.

This paper is one of the first to describe and illuminate the QI development in the healthcare and welfare sector in a country. The trajectory also points to a need for coproduction to handle future challenges.

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 purpose of this paper is to examine patient engagement in remote consultation services, an increasingly important issue facing Healthcare Operations Management (HOM) given the significant expansion in this and other forms of telehealth worldwide over the last decade. We use our analysis of the literature to develop a comprehensive framework that incorporates the patient journey, multidimensionality, antecedents and consequences, interventions and improvement options, as well as the cyclic nature of patient engagement. We also propose measures suitable for empirical assessment of different aspects of our framework.

We undertook a comprehensive review of the extant literature using a systematic review approach. We identified and analysed 63 articles published in peer-reviewed scientific journals between 2003 and 2022.

We conceptualise patient engagement with remote consultation across three key aspects: dimensions, process, and the antecedents and consequences of engagement. We identify nine contextual categories that influence such engagement. We propose several possible metrics for measuring patient engagement during three stages (before service, at/during service and after service) of remote consultation, as well as interventions and possible options for improving patient engagement therein.

The primary contribution of our research is the development of a comprehensive framework for patient engagement in remote consultation that draws on insights from literature in several disciplines. In addition, we have linked the three dimensions of engagement with the clinical process to create a structure for future engagement assessment. Furthermore, we have identified impact factors and outcomes of engagement in remote consultation by understanding which can help to improve levels of adoption, application and satisfaction, and reduce healthcare inequality. Finally, we have adopted a “cyclic” perspective and identified potential interventions that can be combined to further improve patient engagement in remote consultation.

In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes.

Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature.

ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised.

This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as “agents”, “stewards” or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems.

The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance.

The purpose of this study is to identify important strategies and practices supporting inter-organizational learning (IOL) in integrated care. The two research questions ask how organizational network architectures can help involved organizations overcome the barriers of IOL in integrated care (RQ1) and what design recommendations can strengthen the processes of IOL in integrated care (RQ2).

This study applies a qualitative design to analyze an improvement initiative in a regional, integrated care service for elderly patients with multiple illnesses in Norway. An inductive thematic analysis for the triangulating of qualitative data from different sources was applied. Patterns within the data were organized into themes, categories and subcategories. No software was applied.

The identified characteristics of the organizational network architectures supporting IOL in integrated care in the case under study were: equality of the involved parties, shared goals, recognition of expertise and the abilities to coordinate, design IOL processes and make joint decisions (RQ1). The categories of practices supporting the process of IOL were: insight into complex realities, contradictions, iteration, motivation and prototypes (RQ2).

This study offers much-needed insight into a successful approach for IOL in integrated care. The results offer strategies to be considered when building organizational networks for the improvement of integrated care and relevant practices useful when designing IOL processes in such care services. We believe such knowledge has important implications for policymakers, frontline personnel, education, research and leaders.

The objective of this study is to systematically identify, categorize and assess the driving factors and interdependencies associated with various types of healthcare waste. The study specifically focuses on waste that has been managed or is recommended for treatment through the application of Lean Six Sigma (LSS) methodologies.

To accomplish the study’s objectives, interpretive structural modeling (ISM) was utilized. This analytical tool aided in quantifying the driving power and dependencies of each form of healthcare waste, referred to as “enablers,” as well as their related variables. As a result, these enablers were classified into four distinct categories: autonomous, dependent, linkage and drivers or independents.

In the healthcare sector, the “high cost” (HC) emerges as an autonomous variable, operating with substantial independence. Conversely, variables such as skill wastage, poor service quality and low patient satisfaction are identified as dependent variables. These are distinguished by their low driving power and high dependency. On the flip side, variables related to transportation, production, processing and defect waste manifest strong driving forces and minimal dependencies, categorizing them as independent factors. Notably, inventory waste (IW) is highlighted as a salient issue within the healthcare domain, given its propensity to engender additional forms of waste.

Employing the ISM model, along with comprehensive case study analyses, provides a detailed framework for examining the complex hierarchies of waste existing within the healthcare sector. This methodological approach equips healthcare leaders with the tools to accurately pinpoint and eliminate unnecessary expenditures, thereby optimizing operational efficiency and enhancing patient satisfaction. Of particular significance, the study calls attention to the key role of IW, which often acts as a trigger for other forms of waste in the sector, thus identifying a crucial area requiring focused intervention and improvement.

This research reveals new insights into how waste variables are structured in healthcare, offering a useful guide for managers looking to make their waste-reduction strategies more efficient. These insights are highly relevant not just for healthcare providers but also for the administrators and researchers who are helping to shape the industry. Using the classification and ranking model developed in this study, healthcare organizations can more easily spot and address common types of waste. In addition, the model serves as a useful tool for practitioners, helping them gain a deeper, more detailed understanding of how different factors are connected in efforts to reduce waste.

This paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes.

In their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review (N = 68), qualitative interviews (N = 16) and a Delphi study (N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders.

The authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept.

The authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool.

Digital lean implementation can solve the dual problem of stagnating quality and rising costs in healthcare. Although technology adoption in healthcare has increased in the post-COVID world, value unlocking using technology needs a well-thought-out approach to achieve success. This paper provides a prescriptive framework for successfully implementing digital lean in healthcare.

This study uses a mixed-method approach to achieve three research objectives. Whilst it uses a narrative review to identify the enablers, it uses qualitative thematic analysis techniques to categorise them into factors. The study utilises the delphi method for the thematic grouping of the enablers in the broader groups. The study used an advanced ordinal priority approach (OPA) to prioritise these factors. Finally, the study uses concordance analysis to assess the reliability of group decision-making.

The study found that 20 identified enablers are rooted in practice factors, followed by human resource management (HRM) factors, customer factors, leadership factors and technology factors. These results further counter the myth that technology holds the utmost significance in implementing digital lean in healthcare and found the equal importance of factors related to people, customers, leadership and best practices such as benchmarking, continuous improvement and change management.

The study is the first of its kind, providing the prescriptive framework for implementing digital lean in healthcare. The findings are useful for healthcare professionals and health policymakers.

The main objective of the study is to address the lack of sustainability assessments of smart connected health systems in the academic literature by presenting an assessment model to determine the alignment of these systems with the 17 Sustainable Development Goals (SDGs) proposed in the 2030 Agenda.

An evaluation model based on decision analysis is proposed that includes three phases: alignment framework, information gathering and assessment. This model measures the alignment of the connected health system with each of the 17 SDGs, identifying the goals and criteria associated with each SDG that the system achieves to satisfy.

The analysis reveals that the system has achieved more than 24% of the targets among the 17 SDGs. In addition, it identifies four sustainability challenges that the system potentially addresses in relation to the SDGs, providing valuable guidance for researchers and practitioners interested in sustainable health technology development.

The study's results have significant implications for policymakers and stakeholders in the health and technology sectors.

The originality of this study lies in its comprehensive approach to assessing the sustainability of connected health systems in the context of the SDGs, filling an important gap in the existing literature.