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Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the “toolbox lean” toward an actual transformation to lean healthcare.

A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow.

The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare.

With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization’s change capacity as crucial success factor for a sustainable transformation to lean healthcare.

Focuses on two key aspects of the rule of law – equality before the law and the universal application of the same system of law to all people – and examines these requirements in the context of the European Works Council (EWC) Directive, aimed at establishing a European‐wide legal framework for transnational information and consultation. Looks at the philosophy behind the EWC concept, discussing its historical context, the rationale for its adoption, its provisions and certain implementation problems, and considers the implications and consequences of the Directive for the UK, which is in the process of adopting it. Spotlights three problematic areas relating to recognition and employee representation, the potential consequences of late implementation and uniting different employee representative arrangements, and identifies three aspects of inequality relating to both employers and employees that appear to breach the rule of law. Concludes that the Directive represents a first step towards achieving true employee participation and a transnational industrial relations system.

This study investigates labour market fluctuations and gender issues in the health and care sector. A large data set from public registers has allowed us to compile a comprehensive picture of the job categories that particularly attract men. We find a polarisation of men in the upper and lower positions in the job hierarchy. In the metropolitan area, men tend to be discouraged from taking jobs in the health and care sector, as opposed to the peripheral region, where alternative job offers may be more scarce. A logistic regression analysis shows that (young) age is the major explanatory factor for leaving the health and care sector to find occupation elsewhere. However, gender (male), wage levels (low), marital status (single) and education (none) are also significant. The study discusses seven theoretical perspectives for male and female careers in the health and care sector: The need for flexibility. Destandardising of jobs. Devaluation of feminised work areas. Human capital as a stabiliser. Feminisation. The prospects of boundaryless careers. The spatial dimension.

States that advertisers on the World Wide Webb (WWW) rely on a traditional mass communication model, which may be inappropriate for electronic commerce. Sets out to explore how marketing could happen on the WWW. Explains the WWW, its origins, its phenomenal growth, and the opportunities it opens up for commercial transactions, particularly in the USA. Refers to literature which indicates that conventional marketing activities need to be revisited and turned into virtual marketing if there is to be any success in electronic commerce. Cites five phases in this evolutionary process. Focuses on interactivity between the consumer and the marketing organization, predicting that good marketing will be based on good conversation, customer satisfaction and consumer access to the company.

The research presented in this paper aims at understanding the views of European food risk management experts on food traceability implementation, implementation of the general food law, and the advantages the system can offer for effective risk mitigation.

Delphi methodology was applied to understand experts ' views on the efficiency of existing traceability systems in Europe following the implementation of the General Food Law. An internet survey was administered in two rounds, in order to elicit expert views on changes needed to current traceability practices, if traceability systems are to contribute to improved food safety.

Traceability was considered to be an effective safety- and quality-monitoring system with potential to improve safety within food chains, as well as increasing consumer confidence in food safety and consumer protection. However, the results underlined the need for further improvements, particularly regarding the definition of food chain traceability, enforcement of regulations, and harmonisation of practice.

Expert opinion regarding food traceability and its implementation was confined to Europe and the impact of European legislation. Further research at a global level is needed, given the need to trace food and food ingredients across the regional boundaries imposed by European legislation, the increased globalisation of food chains, and the need for pan-global harmonisation of food traceability legislation.

The results provide important insights into the advantages and shortcomings of the present European traceability approach enshrined in the European General Food Law.

The purpose of this paper is to analyse through ethnographic fieldwork the social and cultural context and (unintended) consequences of introducing a management concept from the private sector (LEAN) into the public sector.

Ethnographic fieldwork combined with reading of reports and material.

The major findings are: first, Lean is seen in a cultural context, it is argued that the persuasiveness of Lean depends on building a metaphorical connection between organizational aims and individual experiences and bodily ideals; second, Lean purports to be a win-win game and road to eliminating “waste” through worker participation, empowerment and enthusiasm. The research points to the contrary. Lean was met with scepticism and was seen by the social workers as a waste of time.

As demonstrated in the paper, the vast majority of research published about Lean is hortatory in nature. It is recipe books trying to convince readers of the benefits of introducing Lean. This paper, on the contrary, attempts an open ethnographic exploration of the Lean process and its social and cultural ramifications.

Increased evidence for the health benefits of probiotics for health restoration coupled with the consumer's inclination towards a safe, natural and cost-effective substitute for drugs have led application of probiotics as a pharmaceutical agent and are rapidly moving in clinical usage. In this context, this article attempts to highlight the potential of probiotics as a pharmaceutical agent.

Endeavor has been made to explore the significance of probiotics for the modulation of gut ecology and their action. Potentiality of probiotics for their exploitation as a pharmaceutical agent has also been justified. Limitations of probiotic therapy and the various considerations for probiotic therapy have also been delineated.

Probiotic organisms influence the physiological and pathological process of the host by modifying the intestinal microbiota, thereby affecting human health. Beneficial effects of probiotics as a pharmaceutical agent seem to be strain and dose dependent and more efficacious with their early introduction. Combination of various probiotics proved to be more efficacious than single strain for exhibiting prophylactic activities.

Reviewed literature indicated that it is difficult to generalize for the beneficial effect of all probiotics for all types of diseases as efficacy of probiotics is strain-dependent and dose-dependent and its clinical application needs long-term investigations.

Clinical trials have displayed that probiotics may alleviate certain disorders or diseases in humans especially those related to gastro-intestinal tract.

Ingestion of fermented dairy products containing probiotic cultures may provide health benefits in certain clinical conditions such as antibiotic-associated diarrhoea, rotavirus-associated diarrhoea, inflammatory bowel disease, inflammatory bowel syndrome, allergenic diseases, cancer, Helicobacter pylori infection and lactose-intolerance. Application of probiotics as a pharmaceutical agent is recommended.

This chapter uses new data sets to analyze labor market integration between 1882 and 1936 in an area of Asia stretching from South India to Southeastern China and encompassing the three Southeast Asian countries of Burma, Malaya, and Thailand. We find that by the late nineteenth century, globalization, of which a principal feature was the mass migration of Indians and Chinese to Southeast Asia, gave rise to both an integrated Asian labor market and a period of real wage convergence. Integration did not, however, extend beyond Asia to include core industrial countries. Asian and core areas, in contrast to globally integrated commodity markets, showed divergent trends in unskilled real wages.