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Article
Publication date: 1 May 2009

Luciano Brandao de Souza

The aim of this paper is to provide a review of the existing literature on lean healthcare. It seeks to describe how this concept has being applied and to assess how trends and…

24482

Abstract

Purpose

The aim of this paper is to provide a review of the existing literature on lean healthcare. It seeks to describe how this concept has being applied and to assess how trends and methods of approach in lean healthcare have evolved over the years.

Design/methodology/approach

The paper surveys the applications of lean healthcare in the current literature and classifies over 90 works according to a taxonomy suggested.

Findings

Though there seems to exist an agreement about the potential of lean healthcare, it remains a challenge for academics and practitioners to evaluate lean healthcare under a more critical perspective.

Practical implications

This work is helpful not only for healthcare practitioners and for researchers in private and public organisations, but also for journal editors and reviewers because it offers ready access to an up to date comprehensive review.

Originality/value

Since lean started being applied in healthcare, no effort to provide a complete resource surveying the existing literature has been done.

Details

Leadership in Health Services, vol. 22 no. 2
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 17 February 2021

Francisco Elder Escossio de Barros, Ruan Carlos dos Santos, Lidinei Eder Orso and Antonia Márcia Rodrigues Sousa

From the agency theory’s point of view, this paper aims to analyze corporate governance mechanisms about the characteristics of the companies quoted in the segments Bovespa Mais…

1550

Abstract

Purpose

From the agency theory’s point of view, this paper aims to analyze corporate governance mechanisms about the characteristics of the companies quoted in the segments Bovespa Mais and Bovespa Mais 2 and their influence on the creation of value in preparation for the opening of the initial public offering (IPO).

Design/methodology/approach

A quantitative approach was adopted to achieve the proposed objective using the panel data with fixed effects and secondary data collected on the Comissão de Valores Mobiliários website, using statistical software Stata® 13.0 for statistical tests. The population comprises non-financial companies belonging to the Bovespa Mais and Bovespa Mais Level 2 groups, as the survey sample took into account the period of adhesion of the companies, totaled in 15 companies, which cover the period from 2008 to 2019. The selected variables correspond to the ownership structure’s characteristics, then the board’s composition and the fiscal council as the body responsible for supervising the administrators’ acts.

Findings

The main results indicate that the number of independent members on the board of directors and the supervisory board’s participation positively influence market performance. However, it also reveals that the concentration of ownership brings fundraising for other companies’ acquisitions, risk reduction concerning information asymmetry between investing powers.

Research limitations/implications

The main results indicate that the number of independent members on the board of directors and the supervisory board’s participation positively influence market performance. Despite this, it also reveals that the concentration of ownership brings fundraising for other companies’ acquisitions, risk reduction concerning information asymmetry between investing powers.

Practical implications

This paper advances a comparative institutional perspective to explain capital market choice by firms making an IPO in a foreign market. This paper finds that internal governance characteristics (founder-chief executive officer, executive incentives and board independence) and external network characteristics (prestigious underwriters, degree of venture capitalist syndication and board interlocks) are significant predictors of foreign capital market choice by foreign IPO firms.

Social implications

While product market choices have been central to strategy formulation for firms in the past, financial markets’ integration makes capital markets an equally crucial strategic decision. This paper advances a comparative institutional perspective to explain capital market choice by firms making an IPO in a foreign market.

Originality/value

This situation generates value to shareholders and is perceived by the market and, ultimately, generates a direct relationship with the market performance of companies. While product market choices have been central to strategy formulation for firms in the past, financial markets’ integration makes capital markets an equally major strategic decision.

Details

Corporate Governance: The International Journal of Business in Society, vol. 21 no. 5
Type: Research Article
ISSN: 1472-0701

Keywords

Article
Publication date: 6 June 2016

Matloub Hussain, Mohsin Malik and Hamda S. Al Neyadi

The purpose of this paper is to introduce lean concept to the field of healthcare management, expands the conceptualization of lean management beyond the manufacturing companies…

1296

Abstract

Purpose

The purpose of this paper is to introduce lean concept to the field of healthcare management, expands the conceptualization of lean management beyond the manufacturing companies to consider key waste reduction opportunities which are posited to be requisites to lean practices and implements the proposed framework in the three public hospitals in Abu Dhabi.

Design/methodology/approach

This research is designed by decomposing complex and unstructured issue into a set of components organized in a multi-level hierarchical form. To deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research.

Findings

AHP framework for this study resulted in a ranking of 21 healthcare wastes based on the evaluations of local situations by experienced healthcare professionals. It has been found that management in healthcare systems of Abu Dhabi is putting more emphasis on the inventory waste.

Research limitations/implications

The future directions of the research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas.

Practical implications

This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations.

Originality/value

The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.

Details

Business Process Management Journal, vol. 22 no. 3
Type: Research Article
ISSN: 1463-7154

Keywords

Open Access
Article
Publication date: 4 February 2019

Grazielle Sucupira, Flávio Saab, Gisela Demo and Paulo Henrique Bermejo

The subject of innovation in public service has been gaining attention in Brazilian scientific practice and production. This paper aims to identify national studies on innovation…

5933

Abstract

Purpose

The subject of innovation in public service has been gaining attention in Brazilian scientific practice and production. This paper aims to identify national studies on innovation in public administration and increase the level of knowledge about the subject, as well as to inspire new research and promote advances in theoretical and practical knowledge about innovation in the public sector.

Design/methodology/approach

The present study has a descriptive purpose, quantitative nature and was performed through a bibliometric study based on the protocol proposed by Cronin et al. (2008). Documentary data were collected from scientific articles, and quantitative techniques for descriptive statistics were used to analyze the results. Were selected Brazilian scientific journals classified with Qualis equal to or higher than B1, in the area of Public Administration and Business, Accounting and Tourism, in the quadrennium 2013-2016; a total of 164 journals searched.

Findings

The results herein indicate a research gap that should be filled by more theoretical studies. Also, they point to the need for multimethod research studies that promote the evaluation of product and process innovation, especially related to the phases of invention and implementation.

Originality/value

Few studies have covered public administration and, especially, innovation reviews; none of these studies focused on innovation in the Brazilian public sector, as proposed by this research; the period of analysis and coverage of journals used as search criteria also differ from other reviews in the area of innovation and public sector.

Details

Innovation & Management Review, vol. 16 no. 1
Type: Research Article
ISSN: 2515-8961

Keywords

Article
Publication date: 1 July 2021

Rayra Brandão, M. Reza Hosseini, Alcebíades N. Macêdo, André C. Melo and Igor Martek

Reverse logistics (RL) is a waste revaluation process aimed at reintroducing once-used materials back into the production cycle. Public administration (PA) plays a strong role in…

555

Abstract

Purpose

Reverse logistics (RL) is a waste revaluation process aimed at reintroducing once-used materials back into the production cycle. Public administration (PA) plays a strong role in influencing the implementation of RL in the construction industry through policy and laws. While much research identifies PA as an important driver in RL, no research yet describes how this occurs.

Design/methodology/approach

A systematic literature review was conducted on the theme PA in RL with 93 relevant publications retrieved.

Findings

Six strategies used by PA to promote RL were extracted: (1) legislation, (2) government subsidies, (3) landfill disposal fee, (4) government inspection, (5) use in public construction works and (6) penalties and fines. Moreover, a typology built on these six strategies was developed, mapping 15 interactional relationships between strategies, according to three levels of influence: (1) encouragement (2) requirement and (3) regulation.

Practical implications

It was found that legislation and government subsidies prove to be the more effective strategies, with the remaining strategies greatly neglected. Importantly, however, this study reveals that a combination of strategies are most effective when appropriately combined.

Originality/value

This study confirms the importance of PA in RL, in construction, while documenting the extent of current research. The resulting proposed typology, along with 15 identified future research priorities, is expected to be of value to academics and policy makers looking to advance understanding in this domain.

Details

Engineering, Construction and Architectural Management, vol. 29 no. 8
Type: Research Article
ISSN: 0969-9988

Keywords

Article
Publication date: 14 December 2023

Ali Al Owad, Neeraj Yadav, Vimal Kumar, Vikas Swarnakar, K. Jayakrishna, Salah Haridy and Vishwas Yadav

Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency…

Abstract

Purpose

Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Design/methodology/approach

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

Findings

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

Research limitations/implications

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

Originality/value

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.

Details

Benchmarking: An International Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1463-5771

Keywords

Open Access
Article
Publication date: 17 January 2023

Angelo Rosa, Teresa Angela Trunfio, Giuliano Marolla, Antonietta Costantino, Davide Nardella and Olivia McDermott

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a…

1289

Abstract

Purpose

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

Design/methodology/approach

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Findings

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

Research limitations/implications

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

Practical implications

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

Originality/value

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

Details

The TQM Journal, vol. 35 no. 9
Type: Research Article
ISSN: 1754-2731

Keywords

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