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Health-care organisations face many challenges in delivering safe, high-quality services while experiencing significant pressure to increase productivity and reduce costs. In this context, hospitals have implemented lean six sigma (LSS) programmes to improve their performance. This study aims to explore the application of LSS in three different non-profit Ecuadorian hospitals to comprehend the effectiveness of the methodology under this context.

A multiple-case analysis was performed in four phases: selecting the cases, defining a data collection protocol, performing a within-case analysis of each case and performing a cross-case analysis.

This research found that the LSS application positively impacts hospital performance indicators by reducing service time. The most frequently used tools include the supplier input process output customer diagram, value stream mapping, cause-and-effect diagram, five-why analysis, Gemba walk and paired two-sample test. Lastly, the results show that the most common challenges faced were lack of top management engagement, technical training and data availability.

The study is limited by the constraint of a single Latin American country from which the cases were analysed. Collaboration with external partners, like universities, and government policies promoting training in continuous improvement methodologies are crucial for success. Academic implications stress the importance of integrating soft skills in LSS implementation and engineering education.

This study shows a multiple-case analysis of LSS in a Latin American country highlighting the most commonly used tools, their impact on performance and the challenges of implementing LSS in health-care organisations in non-profit Ecuadorian hospitals.

Recognizing novel entrepreneurial opportunities arising from a crisis is of paramount importance for firms. Hence, understanding the pivotal factors that facilitate firms in this endeavor holds significant value. This study delves into such factors within a representative empirical context impacted by a crisis, drawing insights from existing literature on opportunity recognition during such tumultuous periods.

The authors conducted a qualitative inspection of 14 Italian firms during the COVID-19 pandemic crisis. The authors collected a rich body of multi-source qualitative data, including 34 interviews (with senior managers and entrepreneurs) and secondary data (press releases, videos, web interviews, newspapers, reports and academic articles) in two phases (March–August 2020 and September–December 2020).

The results suggest the existence of a process model of opportunity recognition during crises based on five entrepreneurial influencing factors (entrepreneurial knowledge, entrepreneurial alertness, entrepreneurial proclivity, entrepreneurial personality and entrepreneurial purpose).

Various scholars have highlighted that, in times of crises, it is not easy and indeed very challenging for entrepreneurs to identify novel entrepreneurial opportunities. However, recent research has shown that crises can also positively impact entrepreneurs and their capacity to identify new entrepreneurial opportunities. Given these findings, not much research has analyzed the process by which entrepreneurs identify novel entrepreneurial opportunities during crises. This study shows that some entrepreneurial influencing factors are very important to identify new entrepreneurial opportunities during crises.

The purpose of this paper is to provide an integrative picture of the state of the art of the literature on digitalisation of small and medium-sized enterprises (SMEs) as an enabler for their internationalisation process and as a comprehensive view of the specific domains impacted by digital technologies as well as their repercussions on the international outreach.

A systematic review which leverages a descriptive analysis of extant literature and an axial coding technique has been conducted to shed light on the current knowledge and to identify primary research areas and future research lines.

The research indicates that digitalisation impacts the internationalisation of SMEs in three specific domains: (1) internationalisation through the adoption of information and communication technologies (ICT) technologies and e-commerce platforms; (2) international expansion through the digitalisation of value chain activities and (3) international outreach through knowledge acquisition on digital platforms.

The value of this study is threefold. First, the authors attempt to systematically review the literature on SMEs digitalisation and internationalisation and provide a holistic perspective on the intertwining of these two research streams. Second, the authors propose a novel conceptualisation on the dimensions of SMEs digitalisation as enablers to internationalisation. Third, the authors put forward promising future lines of research.

1. Digitalisation represents a pivotal strategy that allows companies to build new strategic capabilities and is a propeller for SMEs internationalisation.

2. Through e-commerce, SMEs could compete at the same level of multinational companies but enduring lower costs of expansion.

3. Digital platforms allow SMEs to enhance the learning processes about international markets through an immediate access to relevant information.

4. Digital entrepreneurship has enabled SMEs to develop new configurations of value chain activities, evolving their business model or reaching new markets.

5. SMEs are changing the “business as usual” paradigm offering digital tools to build modular architectures that are scalable and agile in their evolution ability.

Digitalisation represents a pivotal strategy that allows companies to build new strategic capabilities and is a propeller for SMEs internationalisation.

Through e-commerce, SMEs could compete at the same level of multinational companies but enduring lower costs of expansion.

Digital platforms allow SMEs to enhance the learning processes about international markets through an immediate access to relevant information.

Digital entrepreneurship has enabled SMEs to develop new configurations of value chain activities, evolving their business model or reaching new markets.

SMEs are changing the “business as usual” paradigm offering digital tools to build modular architectures that are scalable and agile in their evolution ability.