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This study aimed to bridge the gap between the financial measurement of process improvement ideas and Lean Six Sigma measurements. It was required to increase employee engagement in process improvement initiatives.

Through both a practical and theoretical application of the Design for Lean Six Sigma methodology, the researcher was able to design a process and a benefit measuring methodology that was acceptable by finance and aligns with the benefits expected from the elimination of the Lean wastes.

The project found that benefit measurement methodology is not understood by most employees, which leads to a lack of engagement in working on improvements. The result of the study was a model for employees to identify and quantify these benefits. This has resulted in a model for cost-benefit analysis aligning financial costs with non-value add waste costs and cost of poor-quality costs resulting in increased process improvement ideas and activity.

While this study was limited to one company, applying this methodology could benefit any company experiencing the same difficulties.

This is one of the first studies to try and cost the benefits of LSS projects both from an organisational and generic viewpoint.

Agile methods are increasingly being applied in the contexts of innovation beyond traditional information technology (IT) and physical product development projects, such as when process improvements are being implemented. Nevertheless, this phenomenon is still recent and little addressed in the literature, with few descriptions of empirical cases. This study aims to address this gap.

This multiple case study aims to present and discuss the application of Agile practices embedded in large companies’ innovation value chains, focusing on improvements of business processes. The following research question is pursued: How are large companies applying elements of Agile methods to their innovation processes when implementing incremental improvements in their operational processes? Based on the idea that the Agile-Stage-Gate model is an alternative to this challenge, this study investigates the application of this hybrid model in two large Brazilian companies by presenting their idiosyncrasies, lessons learned, adaptations, challenges and benefits.

Overall, it was observed that the experience with the application of the Agile-Stage-Gate model is positive for these companies, with better customer engagement, easier project control and increased productivity of the project team.

For those aiming to implement the Agile-Stage-Gate model, this paper identifies the main adaptations made in order to combine the purist approaches and critical success factors for its 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.

The increasing complexity of civil engineering projects necessitates focusing on new competencies of project participants. Based on the research on team performance and design processes that are more closely linked to the relevance of the project context, it is hypothesised that empathic abilities could play an important role in the performance of civil engineering projects. Therefore, this study aims to investigate whether performance can be improved by focusing on empathic abilities during the integrated design phase.

Semi-structured in-depth interviews with experts were conducted to explore the relevance of empathic abilities and their interaction with performance in a real-life infrastructure project. The project team’s empathy level was measured by means of a survey using Davis’ Interpersonal Reactivity Index method. Finally, differences between expected and measured levels of empathy were analysed.

The results provide insights into how empathic abilities interact with performance. The measurement indicates that, on average, professionals in the civil engineering industry score relatively low on empathy. In addition, differences were identified between the expected distribution and the measured empathy levels of the team, implying a potential for improvement, in particular by increasing the empathic abilities of the project management and increasing gender diversity.

To the best of the authors’ knowledge, this study is the first to investigate a relationship between empathy and the performance of civil engineering projects. The results provide initial insights into the empathic ability of civil engineering project teams and the potential of empathy to improve performance. Furthermore, from an empathy perspective, this study advocates increasing the gender diversity of project teams to improve performance.

By adopting the “hard” and “soft” project management (PM) approaches from the PM-literature, this paper aims to problematize the expected role of client organizations in driving innovation in the transport infrastructure sector.

Addressing a large public client in Sweden, a case study design was initially applied to provide in-depth insights and perspectives of client project managers’ views and experiences of managing projects expected to drive innovation. In this paper, the concepts of “hard” and “soft” are used to discuss empirical findings on challenges associated with adopting a PM-approach for driving innovation in projects. The empirical material consists of interview data, complemented with observations and archival data.

Findings reveal challenges associated with combining hard and soft approaches, frequently demonstrating difficulties in balancing short-term project expectations with the promotion of innovation. In line with the literature, project managers note that there is a need for soft approaches to promote development and drive innovation. Yet, findings reflect a situation in which operational success criteria predominate, whereas soft approaches are not sufficiently used to create the grounds required for fostering innovation.

Insights are provided into how PM-approaches may impact construction innovation in the infrastructure sector, demonstrating a need for further research on the challenges and implications of applying and combining hard and soft PM-approaches.

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

This study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.

A cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.

A systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.

This study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.

In their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.

This is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.

The purpose of this study is to investigate how professionals who are continuing their education rate a higher education quality management course with an emphasis on reflective learning and real problem-solving. The audited course consists of module-based teaching, while students work on an improvement project at their workplace between course sessions. This study has a twofold aim: to contribute to the design of quality improvement courses based on doing as we learn and to offer insight into the use of a final grading method that consist of a folder with reports from the intermediate work steps and a final report.

After completing the course, students received a survey with questions and statements about the course content, delivery and final grading methods. They answered these questions on a seven-point Likert scale and also answered open-ended questions.

It is clear that professional students value the interweaving of theory with real-life training, and they value module-based teaching in which theory is reviewed and applied to practical problems. Reflective learning was achieved through feedback from both teachers and fellow students on various interim reports. Students’ employers benefit from the course, as students gain experience with quality improvement. The grading of a final report on the improvement project based on three sub-assignments was highly appreciated.

Developers in courses in quality improvement benefit from learning how this course is structured, assessed and how participants perceived its components.

The course design with modules and intermediate work steps, where the students apply theory in quality improvement to a real project at their workplace, is an original concept. The modules correspond to the plan, do, check and act (PDCA) methodology.

The aim of this study is to empirically explore and analyze the concrete tasks of output measurement and the inherent challenges related to these tasks in a traditional and autonomous professional public work setting – the judicial system.

The analysis of the tasks is based on a categorization of general performance measurement motives (control-motivate-learn) and main stakeholder levels (society-organization-professionals). The analysis is exploratory and conducted as an empirical content analysis on materials and reports produced in two performance improvement projects conducted in European justice organizations.

The identified main tasks in the different categories are related to managing resources, controlling performance deviations, and encouraging improvement and development of performance. Based on the results, key improvement areas connected to output measurement in professional public organizations are connected to the improvement of objectivity and fairness in budgeting and work allocation practices, improvement of output measures' versatility and informativeness to highlight motivational and learning purposes, improvement of professional self-management in setting output targets and producing outputs, as well as improvement of organizational learning from the output measurement.

The paper presents empirically founded practical examples of challenges and improvement opportunities related to the tasks of output measurement in professional public organization.

This paper fulfils an identified need to study how general performance management motives realize as concrete tasks of output measurement in justice organizations.

Output from the Irish Dairy Industry has grown rapidly since the abolition of quotas in 2015, with processors investing heavily in capacity expansion to deal with the extra milk volumes. Further capacity gains may be achieved by extending the processing season into the winter, a key enabler for which being the reduction of duration of the winter maintenance overhaul period. This paper aims to investigate if Lean Six Sigma tools and techniques can be used to enhance operational maintenance performance, thereby releasing additional processing capacity.

Combining the Six-Sigma Define, Measure, Analyse, Improve, Control (DMAIC) methodology and the structured approach of Turnaround Maintenance (TAM) widely used in process industries creates a novel hybrid model that promises substantial improvement in maintenance overhaul execution. This paper presents a case study applying the DMAIC/TAM model to Ireland’s largest dairy processing site to optimise the annual maintenance shutdown. The objective was to deliver a 30% reduction in the duration of the overhaul, enabling an extension of the processing season.

Application of the DMAIC/TAM hybrid resulted in process enhancements, employee engagement and a clear roadmap for the operations team. Project goals were delivered, and original objectives exceeded, resulting in €8.9m additional value to the business and a reduction of 36% in the duration of the overhaul.

The results demonstrate that the model provides a structure that promotes systematic working and a continuous improvement focus that can have substantial benefits for wider industry. Opportunities for further model refinement were identified and will enhance performance in subsequent overhauls.

To the best of the authors’ knowledge, this is the first time that the structure and tools of DMAIC and TAM have been combined into a hybrid methodology and applied in an Irish industrial setting.