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Originally developed by the Japanese firm Toyota in the 1950s, the core innovation of lean production is to reorient all organizational activity around continuous improvement and the elimination of waste. We use the case of lean production in two healthcare organizations to explore the process of translating management models into new environments (Czarniawska & Sevón, 1996; Mohr, 1998). We draw on insights from organizational sociology and social movement theory to understand the strategies of actors as they attempt to overcome opposition to model transfer (Battilana, Leca, & Boxenbaum, 2009; Friedland & Alford, 1991; Snow, Rochford, Worden, & Benford, 1986). We examine two attempts to export lean production to healthcare organizations: Riverside Hospital, a research and teaching institution, and Lakeview Associations, a managed health provider. We use these cases to illustrate two ways that management models can get lost in the process of institutional translation: model attenuation, and model decoupling.

This chapter covers total quality management (TQM) with respect to the Lean and Six Sigma methods used to improve the effectiveness and efficiency of hospitality operations. In the first section, TQM is discussed. In the second section, Lean and Six Sigma techniques are examined individually. Then, Lean and Six Sigma are connected with an example of a housekeeping case study that applies both methodologies. In the third section, business analytics are explored and statistical process control analysis is demonstrated using a hotel room cleanliness example. The fourth section summarizes the concepts of change management, which is critical for embracing the philosophies of TQM. Finally, project management is discussed in the fifth and last section.

This study investigates the relationship between lean manufacturing practices, management accounting and performance measurement (MAC & PM) practices, organizational strategy, structure, and culture, and facility performance. We extended past research by examining the relationships between lean manufacturing, MAC & PM practices and performance in a broader organizational context. Our study was performed using survey data provided by managers and executives at 368 facilities that had contacted the Shingo Institute for information or that had entered a Shingo Prize competition. Consistent with past research we found a significant positive association between lean manufacturing practices and lean MAC & PM practices. We found that greater employee empowerment, use of process performance measures, and use of lean accounting practices were driven primarily by lean strategy and secondarily by the extent of lean manufacturing practices. We also found that changes in organization structure to support lean are driven primarily by lean strategy and secondarily by lean manufacturing practices. Change toward lean culture, on the other hand, is driven by the extent of lean manufacturing practices. Further, we found that emphasizing process performance measures does not reduce emphasis on results performance measures and emphasizing results performance measures leads to improved financial performance. Process and results measures are being used in tandem and value stream costing has not replaced traditional accounting. The results of our study provide important insights for managers of companies engaged in lean transformation and for academics who teach or research lean accounting.

The Government of Eswatini (GoE) civil service wage bill has continued to rise in recent years. The personnel budget is still the largest single recurrent expenditure item in the budget in Eswatini. To control the civil service wage bill, the GoE introduced Lean Service Principle through Management Services Division (MSD). The civil service wage bill continues to rise despite the implementation of the Lean Service Principle. So far, there are no tangible outcomes that indicate that the principles applied have been effective in the reduction of the wage bill. Thus, this research aims to examine the question of why the Lean Service Principle failed to effectively slow the rampant growth of the civil service wage bill in the Kingdom of Eswatini. This study used the quantitative research approach to collect data on amounts spent on wages, the percentage increase of the wage bill for the period 2010–2017, and the percentage increase in the number of civil servants as per the Establishment Registers, 2010–2017. The study investigated the wage bill push factors, the shortcomings of the Lean Service Principle, and the Just-In-Time (JIT) Technique in the management and reduction of the GoE civil service wage bill. The study found the MSD has been applying the wrong methodologies in wage bill control, which has been evident in the continued yearly increase of the wage bill. The study recommends that the MSD should consider the utilisation of Human Resources Forecasting and Planning Techniques instead of using the Lean Service Principle and the JIT technique. This study will enable the Cabinet to make an appropriate decision on the mandate and future of the MSD, as there have been growing calls to disband the division due to the failure to reduce and/or control the wage bills as that is the core mandate of the division.

In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.