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Numerous and diverse organizations have implemented lean principles and practices, which concentrate on improving the efficiency of business processes by reducing cost, waste, consumptions and effort. However, previous assessments have not focused on the leanness of the supply chain in a health-care setting. This paper aims to introduce a method for assessing the successful implementation of lean principles and tools in a supply chain. Furthermore, this paper validates the method in a health-care organization.

This paper starts with an extensive literature review on assessing leanness and using multi-grade fuzzy logic. Then, a conceptual model was developed to measure leanness. The conceptual model was validated by discussing the initial version with select academic experts, especially those who deal with leanness in health-care organizations. After responding to the experts’ valuable comments, the health-care organization that is the focus of this case study was chosen based on two criteria. The first criterion was the organization’s ability to participate in the study, and the second was the organization’s commitment to implementing lean principles. These criteria were important to ensure the organization had the necessary foundation for implementing change initiatives such as lean process improvements. Next, a multi-grade (multi-attributes) fuzzy logic was used for leanness measurement. A leanness index was calculated, and the results were validated using experts from the case study organization. Finally, the weaker areas of the organization’s processes were identified to point the way for further improvements.

The assessment indicated that the case study organization is not lean. The organization’s weaker attributes were identified, and improvements have been suggested.

This study focused on a single health-care organization, which was selected from a limited pool of potential organizations, namely, organizations which are accredited by both the Saudi Central Board for Accreditation of Healthcare Institutions and the Joint Commission International. The scope of future research should be extended to multi-case studies to enhance the findings presented in this paper. This paper’s findings can be used to help decision-makers at health-care providers to implement lean thinking in supply chain processes.

This research may be interest to practicing supply chain managers, as it proposes what enablers, factors and attributes should be emphasized in lean implementation. The proposed model can work as an assessment tool to identify the gap between the present level of leanness and the desired leanness state so the health-care organization can identify what can be improved. This model enables decision-makers in hospital supply chain to take suitable actions for improving lean implementation level.

This study makes an original contribution to the body of research concerning lean principles; the study developed a conceptual model for leanness assessment that can be applied to the supply chain of health-care organizations. Indeed, the conceptual model is likely to be useful for assessing leanness outside of the health-care field, which suggests avenues for future research.

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 aims to examine lean thinking in medical commodities supply chains by considering its applications and success factors. It determines the drivers and wastes of medical commodity supply chain, and the existing lean tools and practices together with their application in the supply chain processes. The paper also examined the challenges and success factors for effective lean application in the medical commodities supply chains.

The study used qualitative approaches, in-depth interviews and focus group discussions with key informants to form the basis for data collection. Through thematic analysis, the collected data were analyzed by developing themes reflecting the objectives of the study.

The main drivers for waste associated with the supply chain were demand management, supplier development, institutional framework and governance. The wastes were observed at the level of inventory, operation costs, transaction costs, delays in terms of service, commodity delivery time and quality. Digitalization, information technology and standardization were the tools for medical supply chain. Poor infrastructure, unreliable internet supply, environmental uncertainty and poor management support were challenges to realizing an effective supply chain.

Although the qualitative approach used in the study provides detailed information, a quantitative study covers a larger sample for generalization.

Capacity building and professionalism should be given a priority because the philosophy of lean focuses on waste removal and continuous improvement, which highly depends on the quality of human resource (Brito et al., 2020). Limited human resource capabilities in supply chain management will, therefore, result into poor operational efficiency, which are wasted. Moreover, systems interoperability is key waste minimization and, therefore, demands interventions.

The government under the Ministry of Health and other key sector ministries such as local and regional governments should better understand the role of the waste drivers and adopt system-wide reforms to support improvements to remove waste in the medical supply chain. For example, the current institutional framework creates an administrative block and hence leads to wastes. This bureaucratic procedure should be removed to minimize wastes along the chain.

This study is among the first studies to determine applicability and implementation of lean in a resource-constrained context. The paper identifies contextual factors for lean implementation. This paper focused on a holistic view of the entire supply chains to enhance a well-functioning supply chain in delivering health commodities.

This study aims to investigate the mediating role of lean management on the relationship between workforce management and value-added time in private hospitals. This study also investigates the direct influences of workforce management and lean management on the value-added time of the hospitals.

This study applied a quantitative approach to obtain data from the private hospitals’ staff in Peninsular Malaysia. A self-administered survey questionnaire was used to collect data from 287 hospital staff using a stratified random sampling method. The partial least squares structural equation modeling (PLS-SEM) approach was used to determine the internal consistency, reliability, validity of the constructs. The PLS-SEM method was also used to test the hypothesised research model via SmartPLS 3.3.4 version.

The findings of the study indicate that lean management has a direct and significant effect on the value-added time of private hospitals. The findings also revealed that lean management significantly mediates the relationship between workforce management and value-added time in private hospitals. The analysis of the results indicates that both workforce and lean management have a significant impact on the value-added time of the hospitals.

This study provides empirical contributions to enhance the quality of workforce management, lean management and value-added time. The findings of this study provide valuable insights into how effectively managing the workforce and providing guidelines to augment the lean management practices can ensure value-added time in Malaysian hospitals and the overall health-care industry. The lean management framework provides useful insights for the policymakers to understand the significance of workforce management, lean management on ensuring value-added time through reducing waiting times, unnecessary delays, generating a higher degree of patient safety, satisfaction and loyalty.

The research findings provide some essential indications for the health-care service providers to understand how the lean management approach can be implemented to enhance value-added time and how lean management can play a mediating role in creating a link between workforce management and value-added time in hospitals. This study also contributes to the theoretical and practical perspectives. The present study contributes to a better understanding of workforce management and lean management in health-care sectors from theoretical and practical perspectives.

Given the complexity and difficulties of the health sector, the question that this study attempts to answer is as follows: what are the main results of studies on business process management (BPM) and lean in the health sector? The purpose of this paper is to analyze the results of studies that address the promotion of BPM and lean in the health sector.

To conduct a survey of published studies using the BPM and lean approach in healthcare, a search was performed in the Scopus, Web of Science, and PubMed databases in two steps. The first step consisted of the collection and analysis of data related to the BPM approach in the health sector, based on a survey of published articles on this topic. The second step consisted of the collection and analysis of data related to the use of lean in the same sector, based on the survey of systematic reviews published in major databases.

The main results of the studies that address the promotion of BPM and lean in the health sector are as follows: a reduced length of hospitalization, increased patient satisfaction, increased patient efficiency and safety, a reduction in the time of notification of infection, help with organizational change, understanding the end-to-end process, increased motivation, understanding the importance of some handoffs for patient safety, improvements in quality indicators in the emergency department, and improvements in the organization’s focus on high-level processes. By contrast, a single study showed difficulties in promoting management focused on processes in which decisions are unique and difficult to model.

The results may help in the identification of research gaps in the promotion of BPM and lean healthcare and in the development of relevant research. In addition, by understanding how health organizations are promoting management focused on processes and the results obtained with this approach, managers from other organizations, especially in this sector, can reflect and develop similar actions that seek to improve the quality of services offered, increase productivity and customer satisfaction, and reduce costs, errors, and waiting times.

The purpose of this paper is to discuss how a performance measurement system called “the flow model” is designed to measure changes towards lean thinking in health care services.

The paper integrates literature from the health care sector and the lean production movement in order to understand whether lean thinking is applicable in healthcare and thereby identify key performance indicators that measure changes towards lean thinking in health care. The flow model is discussed in relation to this measurement framework.

The paper finds that lean thinking is applicable in health care settings, and that the flow model is a suitable tool for following up these initiatives. However, it is argued that the flow model needs to be balanced with other measurements in order to receive a complete picture of lean performance.

The paper shows that the framework of measurements may be used in empirical research of assessing changes towards lean thinking in health care settings.

The paper shows that health care practitioners may use the findings to develop measurements of the outcome of lean initiatives on existing care processes.

The paper shows analysis and discussion of the application of an industrial concept – Lean Production – in health care services.

The purpose of this paper is to research the practice of ethics in Swedish health care organizations using Lean Management.

A qualitative study was conducted.

Findings indicate that ethics is not a consideration when hospitals are implementing Lean Management.

Organizations generally have diverse value systems when building their codes of professional ethics for examining ethical principles, whereas Lean Management has established base principles with different codes of professional ethics differing from the intrinsic values humans create according to moral philosophy. It could be said that Lean Management relies on minimalistic ethic. While hospitals implement Lean Management, there are still many barriers to resolve to achieve useful implementation. Managing change while emphasizing ethical values could be a success factor for those organizations and their customers.

Studying ethical values in Lean Management implementation.

This paper aims to present a method for strategic planning and implementation processes in health care based on lean management.

Within the framework of the action research methodology, the authors present the ten steps of a kaizen project, which enable lean transformation over a period of time. The study is underpinned by a literature review of enablers and barriers and an implementation case in a tertiary care hospital.

Key points and possible contingency issues are presented for each of the steps, and a successful lean tools intervention is illustrated by examples of improvement projects of the surgical process. Conclusions of the implementation establish a roadmap for improvement projects in hospital environments based on lean management, thus bridging the existing gap between the large number of theoretical projects (much of the projects described are not sustainable over time as the hospital sector is very particular) that have failed to be implemented, or been paused mid-term, and the self-sustaining projects developed by improvement teams in the hospital.

The study details knowledge gleaned from a three-year project entailing various stages: forming improvement teams; training health-care professionals in lean management; drawing up a process map to identify value stream mapping improvement opportunities; implanting projects and verifying the results obtained; and finally, laying the cornerstones, which would make the project self-sustaining and open to long-term continuous improvement.

Lean practices are one of the fundamental practices adopted by health-care organizations to improve service quality and to reduce cost. In this context, the measurement of leanness in health-care organizations has become imperative. The purpose of this study is to measure the leanness of a hospital using fuzzy logic.

The design of the research includes two major steps. First, the identification of enablers, criteria and attributes of leanness constitutes the measures of assessment. Second, the above measures in the case hospital are assessed by using fuzzy logic approach.

This study suggests that leanness assessment is essential to identify the current lean capability of a health-care organization. This would help the health-care organizations to improve their lean performance further. The findings of the study suggest that the leanness of the case hospital is “Lean” (fuzzy range: 5.61, 7.24 and 8.91).

This study brings in three important implications from managerial point of view. First, it helps the management to assess the current level of leanness of the hospital. Second, it identifies the attributes that prevent the organization from being more lean. Third, it provides suggestive measures to address the weaker attributes and enables the enhancement of lean performance further.

The leanness assessment framework developed in the hospital operations is found to be original, and it adds value to the leanness assessment in health-care operations.

The purpose of this paper is to present management techniques in the healthcare sector through lean office.

A case study approach is adopted, with data collected in the Brazilian military organization.

The findings identify several ways to apply lean concepts outside manufacturing. From this, a future lean office health state design will be proposed.

The lean office health proposal has to be tested in other organizations to confirm this case study. While this may limit the generalization of the findings, there is value in demonstrating the benefits modern lean office techniques can bring to the developing world healthcare.

The paper shows that lean office health techniques can provide benefits to healthcare in developing countries' hospitals and others.

The value of the paper arises from providing a detailed analysis of a healthcare lean office in the developing world. There have been only a small number of other studies published in the literature about lean office health.