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The various quality improvement (QI) frameworks and maturity models described in the health services literature consider some aspects of QI while excluding others. This paper aims to present a concerted attempt to create a quality improvement maturity model (QIMM) derived from holistic principles underlying the successful implementation of system-wide QI programmes.

A hybrid methodology involving a systematic review (Phase 1) of over 270 empirical research articles and books developed the basis for the proposed QIMM. It was followed by expert interviews to refine the core constructs and ground the proposed QIMM in contemporary QI practice (Phase 2). The experts included academics in two academic conferences and 59 QI managers from the New Zealand health-care system. In-depth interviews were conducted with QI managers to ascertain their views on the QIMM and its applicability in their respective health organisations (HOs).

The QIMM consists of four dimensions of organisational maturity, namely, strategic, process, supply chain and philosophical maturity. These dimensions progress through six stages, namely, identification, ad-hoc, formal, process-driven, optimised enterprise and finally a way of life. The application of the QIMM by the QI managers revealed that the scope of QI and the breadth of the principles adopted by the QI managers and their HOs in New Zealand is limited.

The importance of QI in health systems cannot be overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality.

This paper contributes new knowledge by presenting a maturity model with an integrated set of quality principles for HOs and their extended supply networks.

This study aims to deepen the understanding of the challenges and implications entailed by deploying mobile clinics in conflict zones to reach populations affected by violence and cut off from health-care services.

This research combines an integrated literature review and an instrumental case study. The literature review comprises two targeted reviews to provide insights: one on conflict zones and one on mobile clinics. The case study describes the process and challenges faced throughout a mobile clinic deployment during and after the Iraq War. The data was gathered using mixed methods over a two-year period (2017–2018).

Armed conflicts directly impact the populations’ health and access to health care. Mobile clinic deployments are often used and recommended to provide health-care access to vulnerable populations cut off from health-care services. However, there is a dearth of peer-reviewed literature documenting decision support tools for mobile clinic deployments.

This study highlights the gaps in the literature and provides direction for future research to support the development of valuable insights and decision support tools for practitioners.

The application of integrated project delivery (IPD) in conjunction with building information modeling (BIM) and Lean Construction (LC) as the efficient method for improving collaboration and delivering construction projects has been acknowledged by construction academics and professionals. Once organizations have fully embraced BIM, IPD and LC integration, a measurement tool such as a maturity model (MM) for benchmarking their progress and setting realistic goals for continuous improvement will be required. In the context of MMs literature, however, no comprehensive analysis of these three construction management methods has been published to reveal the current trends and common themes in which the models have approached each other.

Therefore, this study integrates systematic literature review (SLR) and thematic analysis techniques to review and categorize the related MMs; the key themes in which the interrelationship between BIM, IPD and LC MMs has been discussed and conceptualized in the attributes; the shared characteristics of the existing BIM, IPD and LC MMs, as well as their strengths and limitations. The Preferred Reporting Items for Systematic Reviews (PRISMA) method has been used as the primary procedure for article screening and reviewing published papers between 2007 and 2022.

Despite the growth of BIM, IPD and LC integration publications and acknowledgment in the literature, no MM has been established that holistically measures BIM, IPD and LC integration in an organization. This study identifies five interrelated and overlapping themes indicative of the collaboration of BIM, IPD and LC in existing MMs' structure, including customer satisfaction, waste minimization, Lean practices and cultural and legal aspects. Furthermore, the MMs' common characteristics, strengths and limitations are evaluated to provide a foundation for developing future BIM, IPD and LC-related MMs.

This paper examines the current status of research and the knowledge gaps around BIM, IPD and LC MMs. In addition, the highlighted major themes serve as a foundation for academics who intend to develop integrated BIM, IPD, and LC MMs. This will enable researchers to build upon these themes and establish a comprehensive list of maturity attributes fulfilling the BIM, IPD and LC requirements and principles. In addition, the MMs' BIM, IPD and LC compatibility themes, which go beyond themes' intended characteristics in silos, increase industry practitioners' awareness of the underlying factors of BIM, IPD and LC integration.

This review article is the first of a kind to analyze the interaction of IPD, BIM and LC in the context of MMs in current AEC literature. This study concludes that BIM, IPD and LC share several joint cornerstones according to the existing MMs.

This paper explores Lean Six Sigma principles and the DMAIC (define, measure, analyze, improve, control) methodology to propose a new Lean Six Sigma 4.0 (LSS 4.0) framework for employee occupational exams and address the real-world issue of high-variability exams that may arise.

This study uses mixed methods, combining qualitative and quantitative data collection. A detailed case study assesses the impact of LSS interventions on the exam management process and tests the applicability of the proposed LSS 4.0 framework for employee occupational exams.

The results reveal that changing the health service supplier in the explored organization caused a substantial raise in occupational exams, leading to increased costs. By using syntactic interoperability, lean, six sigma and DMAIC approaches, improvements were identified, addressing process deviations and information requirements. Implementing corrective actions improved the exam process, reducing the number of exams and associated expenses.

It is important to acknowledge certain limitations, such as the specific context of the case study and the exclusion of certain exam categories.

The practical implications of this research are substantial, providing organizations with valuable managerial insights into improving efficiency, reducing costs and ensuring regulatory compliance while managing occupational exams.

This study fills a research gap by applying LSS 4.0 to occupational exam management, offering a practical framework for organizations. It contributes to the existing knowledge base by addressing a relatively novel context and providing a detailed roadmap for process optimization.

This study aims to analyze lean wastes for the poultry sector in Turkey and link lean tools to this study, focusing on identifying each lean waste that affects poultry production and proposing solutions for preventing these lean wastes in the sector. The proposed solutions aim to improve processes by suggesting different lean tools and their applications for the poultry sector.

The study consists of two different applications. First, the waste relationship matrix (WRM) was created to reveal the relationship between seven lean wastes and their importance order. Then, after determining lean tools for eliminating lean wastes, the optimum weight ranking and consistency ratio of the most suitable lean tools were calculated for these wastes and ranked with the best-worst method (BWM).

Results showed that overproduction is the most critical waste that impacts other wastes, followed by defect waste. Due to the nature of the sector, these wastes not only result in economic loss for the company but also in food waste and loss and issues related to animal welfare. Furthermore, the Kaizen approach and 5S implementation are the methods to eliminate these wastes. Detailed discussion on the link between lean tools and lean wastes is provided for the poultry sector.

This is the first study that theoretically and empirically identifies the potential lean waste affecting the poultry sector and provides lean tools for eliminating these wastes. Sector-specific explanations and discussions are presented in the study to show the applicability of lean approaches in the poultry sector to eliminate waste. In addition, this study is the first to integrate the WRM and BWM.

Small and medium-scale enterprises (SMEs) that operate with modest financial investments and commodities face numerous challenges to remain in business. One major philosophy used by SMEs these days is the implementation of lean manufacturing to get solutions for various issues they encounter. But is lean getting sustained over time? The purpose of this research is to design a Sustainable Lean Performance Index (SLPI) to assess the sustainability of lean systems and to pinpoint the variables that might be present as potential lean system inhibitors which hinder the sustainability of leanness.

A multi-level sustainable lean performance model is constructed and presented based on the literature research, field investigation and survey conducted by administering a questionnaire. Fuzzy logic approach is used to analyse the multi-level model.

SLPI for the SMEs is found using fuzzy logic approach. Additionally, the ranking score system is applied to categorise attributes into weak and strong categories. The performance of the current lean system is determined to be “fair” based on the Euclidean distance approach and the SLPI for SMEs.

This work is concentrated only in South India because of the country’s vast geographical area and rich and wide diversity in industrial culture of the nation. Hence, more work can be done incorporating the other parts of the country and can analyse the lean behaviour in a comparative manner.

The generalised sustainable lean model analysed using fuzzy logic identifies the inhibitors and level of performance of SMEs in South India. This can be implemented to find out the level of performance in the SMEs after a deeper study and analysis around the SMEs of the country.

The sustainable assessment of lean parameters in the SMEs of India is found to be very less in literature, and it lacks profundity. The model established in this study assesses the sustainability of the lean methodology adopted in SMEs by considering the lean and sustainability attributes along with enablers like technology, ethics, customer satisfaction and innovation with the aid of fuzzy logic.

This study aims to examine the impact of Lean 4.0 practices on value co-creation in the dairy ecosystem.

Data collection were carried out through a questionary application with 126 professionals linked to the dairy ecosystem, including milk producers, milk cooperatives and milk transporters. The data were analyzed using Cluster Analysis, Mann-Whitney test and Chi-Square test.

A strong relation was found between the use of Lean 4.0 tools and the increase in operational performance, in addition to milk quality. Moreover, it can be noted that the use of digital technologies from Industry 4.0 has a strong relation with dairy production optimization, in other words, it is possible to be more efficient in the dairy process via Lean 4.0 adoption.

The study is limited to analyzing the Brazilian dairy ecosystem. The results presented may not reflect the characteristics of the other countries.

Once the potential empirical impacts of the relation between Lean 4.0 and value co-creation are elucidated, it is possible to direct strategies for decision-making and guide efforts by researchers and professionals to deal with the waste mitigation present in the dairy sector.

Lean 4.0 proves to be a potential solution to improve the operational performance of the dairy production system. Lean 4.0, linked to value co-creation, allows the integration of the production sector with consumers, through smart technologies, so new services and experiences can be provided to the consumer market. Additionally, the consumer experience can be stimulated based on Lean 4.0, once the quality specification is highlighted based on data science and smart management control.

To the best of the authors’ knowledge, this is the first study that analyzes the interrelationship between the Lean 4.0 philosophy and the value co-creation in the dairy ecosystem. In this sense, the study reveals the main contributions of this interrelation to the dairy sector via value co-creation, which demonstrates a new perspective on the complementarity of resources, elimination of process losses and new experiences for the user through digital technologies integrated with the Lean Thinking approach.

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.

Lean management tools are becoming increasingly applied in different types of organizations around the world. These tools have shown their significant contribution to improving business performance. In this vein, the purpose of this paper is to examine the influence of lean management on both occupational safety and operational excellence in Tunisian companies.

A survey was conducted among Tunisian companies, and it resulted in the collection of 62 responses that were analyzed using the software SPSS. In addition, a conceptual model linking the practices of the three basic concepts was designed to highlight the hypotheses of the research. Subsequently, factor analysis and structural equation method analysis were conducted to assess the validation of the assumptions.

The results obtained have shown that lean management has a significant impact on occupational safety. Similarly, occupational safety has a significant impact on operational excellence. However, lean management does not have a significant impact on operational excellence.

This work highlighted the involvement of small and medium-sized enterprise’s managers from emerging economies in the studied concepts’ practices. Likewise, it testified to the impacts of lean management on occupational safety and operational excellence in the Tunisian context.

High levels of child obesity alongside rising stunting and the absence of a coherent food policy have deemed UK’s food system to be broken. The National Food Strategy (NFS) was debated intensely in media, with discussions on how and who should fix the food system.

Using a mixed methods approach, the authors conduct framing analysis on traditional media and sentiment analysis of twitter reactions to the NFS to identify frames used to shape food system policy interventions.

The study finds evidence that the media coverage of the NFS often utilised the tropes of “culture wars” shaping the debate of who is responsible to fix the food system – the government, the public or the industry. NFS recommendations were portrayed as issues of free choice to shift the debate away from government action correcting for market failure. In contrast, the industry was showcased as equipped to intervene on its own accord. Dietary recommendations made by the NFS were depicted as hurting the poor, painting a picture of helplessness and loss of control, while their voices were omitted and not represented in traditional media.

British media’s alignment with free market economic thinking has implications for food systems reform, as it deters the government from acting and relies on the invisible hand of the market to fix the system. Media firms should move beyond tropes of culture wars to discuss interventions that reform the structural causes of the UK’s broken food systems.

As traditional media coverage struggles to capture the diversity of public perception; the authors supplement framing analysis with sentiment analysis of Twitter data. To the best of our knowledge, no such media (and social media) analysis of the NFS has been conducted. The paper is also original as it extends our understanding of how media alignment with free market economic thinking has implications for food systems reform, as it deters the government from acting and relies on the invisible hand of the market to fix the system.