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As the demand for efficiency and quality in the health-care industry has increased over the past few years, adoption of Lean principles and tools in the medical laboratory industry has become increasingly crucial. The purpose of this study is to explore the level of adoption, barriers and enablers of Lean principles and tools in the Namibian medical laboratory industry.

A descriptive cross-sectional study was carried out to examine the level of usage, barriers and enablers, impact of Lean tools and to suggest appropriate strategies for adopting Lean in the Namibian medical laboratory services.

Research findings reveal that Lean tools are moderately implemented in most laboratories. Standard operating procedures, root cause analysis, overall equipment effectiveness and visual management are the important Lean tools used in the industry. Results of the survey also show that Lean tools had a positive impact on operational performance, employee motivation, turnaround time and cost reduction. Furthermore, top management involvement, adequate training and proper planning emerged as important enablers, while lack of support from the management, financial constraint and staff resistant to change are major barriers to the adoption of Lean principles in the Namibian medical laboratory industry.

The paper has inherent limitations of survey research, which the authors will overcome by using case studies with medical laboratories.

The findings of the authors’ work will help in widening the application of Lean principles in more medical laboratories in Namibia and in other parts of the world.

The paper is based on numerous health-care studies on Lean. This is one of the few papers investigating the adoption of Lean principles, specifically in medical laboratories, from an emerging economy such as Namibia.

In early 2014, recent Stanford University graduate Tyler Shultz was in a quandary. He had been working at Theranos, a blood-diagnostic company founded by Elizabeth Holmes, a Stanford-dropout wunderkind, for almost a year. Shultz had learned enough about the company to realize that its practices and the efficacy of its much-touted finger-prick blood-testing technology were questionable and that the company was going to great lengths to hide this fact from the public and from regulators.

Theranos and Holmes were Silicon Valley darlings, enjoying positive press and lavish attention from potential investors and technology titans alike. Just as companies like PayPal had revolutionized the stagnant payments industry and Uber had upended the for-hire transportation sector, Theranos had been positioned as the latest technology firm to substantially disrupt yet another mature sector: the medical laboratory business. By the start of 2014, the company had raised more than $400 million in funding, and had an estimated market valuation of $9 billion.

Shultz's situation was exacerbated by the fact that his grandfather, the highly respected former US Secretary of State George Shultz, was on the Theranos board and was one of Elizabeth Holmes's biggest supporters.

But Tyler Shultz worried about the customers he was convinced were receiving highly unreliable and often inaccurate blood-test results. With so much at stake, Shultz wondered how he should proceed. Should he raise his concerns with the firm's investors? Blow the whistle externally? Report to industry regulators? Go away quietly?

This case and its subsequent four brief follow-up cases are based largely on interviews with Tyler Shultz, and outline the dilemma he faced and the various steps he would take both to extricate himself from his unsavory position and let the public know the full extent of the deception at Theranos.

Five optional handouts are available to instructors to further discussion after the case has been debriefed. The handouts serve as additional decision points for the students if your class time permits.

The aim of this study is to determine the effect of the application of the lean methodoloy in the pathology laboratory and to evaluate the results on the turnaround time.

This study was a prospective intervention study formed of the three stages of pre-intervention, determination of problem areas and the application of lean techniques and quality improvement. The study was conducted between February 2019 and August 2020. In the first stage, research was made through interviews, observations, questionnaires and seminars; in the second stage, observations, brain-storming, process flowcharts and fishbone diagram were used; and in the third stage, Kaizen, A3 method and spaghetti diagram were applied.

Following the application of lean techniques, turnaround time in the pathology laboratory was decreased, and the changes made in the working methods and placement of the units in the laboratory were found to have prevented unnecessary steps. The lean method was also determined to have had positive effects on the workplace satisfaction of the laboratory employees and of the physicians working with the laboratory.

The results showed that applying lean techniques could reduce waste and increase participation in processes. This article demonstrates its originality and relevance by proving that the lean techniques can be applied in the hospital laboratory. Actions to improve turnaround time are also crucial for the efficient use of resources.

The purpose of this paper is to make a lean assessment of a chemical analyst training laboratory in a higher education institution and identify the main types of waste on a daily basis and understand the lean maturity of the laboratory and establish priority areas of intervention to make the laboratory leanest.

A single descriptive case study methodology was used to carry out the lean laboratory evaluation. The lean manufacturing waste terminology was adapted to a lean analytical laboratory environment, and a lean waste assessment step-by-step procedure was developed to reach the study goal.

Three types of waste (i.e. transport, waiting and defects) were the main contributors of the problem. The Pareto analysis results showed that 37.5% of the different types of waste contributed to almost 51.4% of the problems. The case study allowed on diagnosing wastes, understanding the lean maturity in a teaching laboratory setting and priority areas of intervention

Some data collection methods were used, and tools were developed to answer the research questions. A waste measurement instrument was created to evaluate lean waste in a chemical analytical laboratory, and a lean classification scheme was built to understand the lean maturity of the laboratory. The lessons learnt of the lean assessment in a teaching laboratory and the developed tools will be helpful for future research and for practitioners in a teaching chemical analytical laboratory setting.

The number of lean assessment studies in teaching laboratories is not very significant, and this work contributes to overcome this gap illustrating the lean waste assessment foundation with a step-by-step procedure and tools used in a teaching laboratory to perform a lean assessment and identify opportunities for improvement. A generic roadmap to lean laboratory waste assessment and continuous improvement is proposed with the key elements to take into consideration.

With the application and development of intelligent clothing and wearable technology, the term “micro-interaction” has gradually entered people’s lives. The paper aims to discuss this issue.

The paper takes the concept of “micro-interaction” as the design principle, starting from the consumer demand, combing the realization mode of the intelligent safety clothing in recent years, and finds out the existing problems in the design of the intelligent safety clothing.

Under the concept of micro-interaction, a new theoretical model has been proposed to study intelligent safety clothing. Finally, the paper also emphasizes the importance of the industrialization of the proposed model.

The paper proposes a new research and development mode for intelligent clothing in safety protection area which is a pioneering study and can be valuable for safety clothing manufacturers to produce more functional and attractive products.

The success rate of Lean Six Sigma (LSS) in the service industries is dismally poor, and most organisations discontinue LSS initiatives prematurely. This paper aims to identify the LSS barriers (LSSBs) and analyse their interaction via a hierarchical model developed by using interpretive structural modelling (ISM) and Fuzzy Matriced Impacts Croise’s Multiplication Appliqué à un Classement (MICMAC). These allow the LSS execution and implementation to be much more effective and avoid the high cost of implementation.

A structural review of the literature and interviews with experts and professionals from the service industries in the UAE supplied data wherewith to identify LSSBs. Sixteen LSSBs were determined and analysed using ISM and the MICMAC approach to discover the strong drivers and highly dependent barriers. The Fuzzy set was included in the MICMAC analysis to obtain a more precise output and create an effective hierarchical model of the barriers.

The research findings suggest that the top barriers to LSS implementation in service industries are lack of top management commitment, lack of customer focus, resistance to change management and lack of alignment between the LSS and organisational strategy. A deeper analysis using the Fuzzy-MICMAC approach categorises these barriers on the basis of their driving power and dependency.

The relationships between paired LSSBs were obtained through an experts’ interpretations of limited numbers in one country. Conducting a large-scale survey with a more comprehensive demographic or deep focus in one service industry might deepen our understanding of the interactions of LSSBs and models.

The developed ISM that model suggests that the dependencies and relationships among the barriers must be accurately determined so as to remove the collaborative effect of barriers on the implementation process is at the earliest opportunity. This would improve service companies’ competitive advantage and profitability, drive out waste and reduce the cost associated with poor quality. Similarly, academicians may advocate ways in various issues can contribute to improve LSSBs for amended LSS implementation now that business services are booming in the fourth industrial revolution.

The structural model was developed holistically on the basis of the inputs from practitioners and academicians to ensure its practical validity. Though the model has theoretical foundations, its practical applicability is a key factor in its development, so this approach was helpful for practitioner wanted to focus on removing the key dominant barriers and be able to deploy LSS concepts smoothly in service industries. The results support the proposition that top management is a crucial factor for LSS project implementation, whatever the complexity of the research methodology and the nature of the service industries.

This study aims to present an overview of leading research trends in the lean six sigma domain published in the International Journal of Lean Six Sigma (IJLSS) since its inception.

The study analyses articles published between 2010 and 2019 in IJLSS using the bibliometric technique. The results of data analysis identify the most prolific authors, their affiliation, citation trends and highly cited articles from the journal. Further, a graphical analysis involving bibliographic coupling and co-citation analysis of the corpus enriches the investigation.

The results of the bibliometric analysis suggest that the number of IJLSS’s publications and citations grew markedly over time (from 4 citations in 2010 to nearly 1,324 in 2019). The organizational diversity and collaboration among authors publishing in IJLSS are trending upwards. Case study and focus group are the two most common research designs in publications. In the study, three major themes emerged: implementation of lean on business, integration of lean and six sigma and the effects of lean six sigma on businesses.

The study finding informs and educates practitioners and scholars about various qualitative research tools, applications and methods of implementing lean six sigma tools in different industry sectors.

The study uses bibliometric analysis to propose a novel categorization of research published in IJLSS and to report on the utilization of various lean tools in the journal. The study provides guidance for new future research besides offering a thorough introspection of the lean and six sigma domains.

Increased demand and the pressure to reduce health-care costs have led to longer waiting time for patients to make appointments and during the day of hospital visits. The purpose of this study is to identify opportunities to reduce waiting time using lean techniques and discrete-event simulation (DES).

A five-step procedure is proposed to facilitate the effective utilization of lean and DES to improve the performance of the Otolaryngology Head and Neck Surgery Outpatient Clinic at Cleveland Clinic Abu Dhabi. While lean techniques were applied to reduce the potential sources of waste by aligning processes, a DES model was developed to validate the proposed solutions and plan patient arrivals under dynamic conditions and different scenarios.

Aligning processes resulted in an efficient patient flow reducing both waiting times. DES played a complementary role in verifying lean solutions under dynamic conditions, helping to plan the patient arrivals and striking a balance between the waiting times. The proposed solutions offered flexibility to improve the clinic capacity from the current 176 patients up to 479 (without violating the 30 min waiting time policy) or to reduce the patient waiting time during the visit from the current 33 min to 4.5 min (without violating the capacity goal of 333 patients).

Proposing and validating lean solutions require reliable data to be collected from the clinic and such a process could be laborious as data collection require patient and resource tracing without interfering with the regular functions of the clinic.

The work enables health-care managers to conveniently conduct a trade-off analysis and choose a suitable inter-arrival time – for every physician – that would satisfy their objectives between resource utilization (clinic capacity) and average patient waiting time.

Successful implementation of lean requires a supportive and cooperative culture from all stakeholders involved.

This study presents an original and detailed application of lean techniques with DES to reduce patient waiting times. The adopted approach in this study could be generalized to other health-care settings with similar objectives.

Several authors have examined the lean healthcare literature, but besides all efforts made, articles comparing conceptual and analytical studies were not found. Thus, a systematic review is conducted aiming to understand the state of the art of lean healthcare by investigating and comparing how conceptual and analytical articles address tools/methods, application fields, implementation barriers and facilitators and positive and negative impacts.

Articles in English about lean healthcare, published in journals in the last ten years (2009–2018) and indexed in Web of Science (WoS) or Scopus were examined and assessed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) protocol. A qualitative content analysis on the eligible articles was conducted, and results from the conceptual and analytical studies were compared.

There is a literature gap regarding tools/methods in both conceptual and analytical approaches once they prioritize for different items. Barriers, facilitators and negative impacts are perceived differently within both categories and might require more extensive analysis. The same items prevail in both conceptual and analytical categories when analyzing healthcare fields and positive impacts.

There is a lack of articles comparing conceptual and analytical studies concerning lean healthcare. So, this study's relevance is in identifying theoretical and applied research gaps to strengthen the lean healthcare state of the art and to integrate theoretical-applied knowledge. For healthcare professionals, it might provide an overview of the key factors that can promote lean implementation.