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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.

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 is focused to support an ongoing development project of the case company's current state and the challenges of the order-to-cash (O2C) process. The O2C process is the most visible process to the customer, and therefore, its punctual and fluent order management is vital. It is observed that the high degree of manual work in the O2C process causes mistakes, delays and rework in the process. The purpose of this article is therefore to analyze the case company's current state of the O2C process as well as to identify the areas of development in this process by deploying the means of Lean Six Sigma tools such as value stream mapping (VSM).

The study was conducted as a mix of quantitative and qualitative analysis. Based on both the quantitative and qualitative data, a workshop on VSM was organized to analyze the current state of the O2C process of a case company, engaged in the energy and environment sector in Finland.

The results found that excessive manual work was highly connected to inadequate or incorrect data in pricing and invoicing activities, which resulted in canceled invoices. Canceled invoices are visible to the customer and have a negative impact on the customer experience. This study found that by improving the performance of the O2C process activities and improving communication among the internal and external stakeholders, the whole O2C process can perform more effectively and provide better customer value.

The O2C process is the most visible process to the customer and therefore its punctual and fluent order management is vital. To ensure that the O2C process is operating as desired, suitable process performance metrics need to be aligned and followed. The results gathered from the case company's data, questionnaire interviews, and the VSM workshop are all highlighted in this study. The main practical and managerial implications were to understand the real-time O2C process performance, which is necessary to ensure strong performance and enhance continuous improvement of the O2C process that leads to operational excellence and commercial competitiveness of the studied case company.

Both technological and human-centric perspectives need to be acknowledged when combining lean production practices and Industry 4.0 (I4.0) technologies. This study aims to explore and explain how lean production practices and I4.0 technologies may coexist to enhance the human-centric perspective of manufacturing operations in the era of Industry 5.0 (I5.0).

The research approach is an explorative and longitudinal case study. The qualitative data collection encompasses respondents from different job functions and organizational levels to cover the entire organization. In total, 18 interviews with 19 interviewees and five focus groups with a total of 25 participants are included.

Identified challenges bring forth that manufacturing organizations must have the ability to see beyond lean production philosophy and I4.0 to meet the demand for a human-centric perspective in socially sustainable manufacturing in the era of Industry 5.0.

The study suggests that while lean production practices and I4.0 practices may be considered separately, they need to be integrated as complementary approaches. This underscores the complexity of managing simultaneous organizational changes and new digital initiatives.

The research presented illuminates the elusive phenomena comprising the combined aspects of a human-centric perspective, specifically bringing forth implications for the co-existence of lean production practices and I4.0 technologies, in the transformation towards I5.0.

The study contributes to new avenues of research within the field of socially sustainable manufacturing. The study provides an in-depth analysis of the human-centric perspective when transforming organizations towards Industry 5.0.

This paper presents a new and well-structured framework that aims to assess the current environmental impact from a Greenhouse Gas (GHG) emissions perspective. This tool includes a new set of Lean Key Performance Indicators (KPIs), which translates the well-known logic of Overall Equipment Effectiveness in the field of GHG emissions, that can progressively detect industrial losses that cause GHG emissions and support decision-making for implementing improvements.

The new metrics are presented with reference to two different perspectives: (1) to highlight the deviation of the current value of emissions from the target; (2) to adopt a diagnostic orientation not only to provide an assessment of current performance but also to search for the main causes of inefficiencies and to direct improvement implementations.

The proposed framework was applied to a major company operating in the plywood production sector. It identified emission-related losses at each stage of the production process, providing an overall performance evaluation of 53.1%. The industrial application shows how the indicators work in practice, and the framework as a whole, to assess GHG emissions related to industrial losses and to proper address improvement actions.

This paper scrutinizes a new set of Lean KPIs to assess the industrial losses causing GHG emissions and identifies some significant drawbacks. Then it proposes a new structure of losses and KPIs that not only quantify efficiency but also allow to identify viable countermeasures.

In the multilayered capability framework the authors integrate two layers, namely functional level production capabilities and shop floor-level production routines (PRs). The authors examine how these two layers are interlinked, and additionally, they explore how these layers contribute to firm performance.

The authors tested the hypotheses using structural equation modeling (SEM) on a sample of manufacturing firms.

Regarding the capability layers, the authors found that at the functional level, production dynamic capabilities (PDCs) drive the renewal of production ordinary capabilities (POCs), and that at the shop floor level, deployment of Industry 4.0 (I4.0) is influenced by lean production. Regarding the direct links between capability layers, the authors showed that PDCs and POCs have different roles in shaping shop floor PRs: PDCs is linked to I4.0, and lean methods is impacted by POCs. Concerning performance implications, only PDC and POC have significant impact on firm performance (the latter is negative), while PRs do not.

Although, contextual factors (e.g. technology intensity, size) do not influence our findings, the potential country-effect and the dominance of medium-sized firms offer future research directions.

If production managers want to contribute to business performance, they should be more susceptible to resource renewal (PDCs) than to their general (POCs) or specific (PRs) exploitation efforts. As they exploit current resource stocks, they face a trade-off: they must consider that beyond their positive impacts on operational performance, their implications on business performance will be controversial.

Scholars usually examine one layer of capabilities, either capabilities or routines, and associate that with one dimension of performance, either financial and market measures or operational indicators. The authors propose a multilayered capability framework with a complex view on performance implications.

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.

The purpose of this paper is to advance the understanding of paradoxes, underlying tensions and potential management strategies when integrating digital technologies into existing lean-based production systems (LPSs), with the aim of achieving synergies and fostering the development of production systems.

This study adopts a collaborative management research (CMR) approach to identify patterns of organisational tensions and paradoxes and explore management strategies to overcome them. The data were collected through interviews and focus group interviews with experts on lean and/or digital technologies from the companies, from documents and from workshops with the in-case researchers.

The findings of this paper provide insights into the salient organisational paradoxes embraced in the integration of digital technologies in LPS by identifying different aspects of the performing, organising, learning and belonging paradoxes. Furthermore, the findings demonstrate the intricacies and relatedness between different paradoxes and their resolutions, and more specifically, how a resolution strategy adopted to manage one paradox might unintentionally generate new tensions. This, in turn, calls for either re-contextualising actions to counteract the drift or the adoption of new resolution strategies.

This paper adds perspective to operations management (OM) research through the use of paradox theory, and we (1) provide a fine-grained perspective on why integration sometimes “fails” and label the forces of internal drift as mechanisms of imbalances and (2) provide detailed insights into how different management and resolution strategies are adopted, especially by identifying re-contextualising actions as a key to rebalancing organisational paradoxes in favour of the integration of digital technologies in LPSs.

We studied the relationship between job engagement and systematic problem solving (SPS) among shop-floor employees and how lean production (LP) and Internet of Things (IoT) systems moderate this relationship.

We collected data from a sample of 440 shop floor workers in 101 manufacturing work units across 33 plants. Because our data is nested, we employed a series of multilevel regression models to test the hypotheses. The application of IoT systems within work units was evaluated by our research team through direct observations from on-site visits.

Our findings indicate a positive association between job engagement and SPS. Additionally, we found that the adoption of lean bundles positively moderates this relationship, while, surprisingly, the adoption of IoT systems negatively moderates this relationship. Interestingly, we found that, when the adoption of IoT systems is complemented by a lean management system, workers tend to experience a higher effect on the SPS of their engagement.

One limitation of this research is the reliance on the self-reported data collected from both workers (job engagement, SPS and control variables) and supervisors (lean bundles). Furthermore, our study was conducted in a specific country, Italy, which might have limitations on the generalizability of the results since cross-cultural differences in job engagement and SPS have been documented.

Our findings highlight that employees’ strong engagement in SPS behaviors is shaped by the managerial and technological systems implemented on the shop floor. Specifically, we point out that implementing IoT systems without the appropriate managerial practices can pose challenges to fostering employee engagement and SPS.

This paper provides new insights on how lean and new technologies contribute to the development of learning-to-learn capabilities at the individual level by empirically analyzing the moderating effects of IoT systems and LP on the relationship between job engagement and SPS.

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.