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The purpose of this article is to increase the understanding of how improvements can be facilitated in a public service containing multiple actors in terms of identifying, aligning and prerequisites for the improvements.

The research utilizes an interactive research approach where data were gathered though a conference, workshop and a survey. The study alternately combines quality management methods such as affinity and interrelationship diagrams with computer aided text mining and latent semantic analysis.

The research shows that practitioners must consider interconnectedness between improvements and benefits that are crossing organizational levels of the public service system as well as professional borders. In public service systems, the complex reality can be better understood when improvements and benefits are classified into different organizational layers and an interconnectedness and sequence of improvement areas are acknowledged.

The research is set in the Swedish public service of the tax-paid sick leave insurance. Future research would benefit by investigating similar cases in other nations and other services.

The used methodology can be applied by practitioners to enhance a unified understanding of the system required to improve. The study also guides practitioners for how to support, relive hinders and prioritize improvements.

The research fills a gap of understanding of improvements in public services with multiple actors. As this area is difficult to improve, a novel combination of qualitative and quantitative methods paved the way for deeper and more unified understanding of the system.

Teachers of primary education experience high levels of stress but lack rational coping strategies to reduce their work stress. The paper develops a value stream mapping for education approach and examines its use as a rational coping strategy for teams of teachers and other employees to overcome work-related stressors.

The research process consists of two phases. First, a value stream mapping approach for education is developed, based on literature research. Next, the approach is validated in an action research study to reduce work stress of teachers in educational services. The processes that have been selected by the teachers relate to coping with increased variety, long and uncertain throughput times and unclear specifications.

Value stream mapping for education (VSM4EDU) is a well-structured improvement method based on principles of visualization, participation and process thinking, which helps teachers without background in lean thinking to analyse their processes. Using this method has enabled the team to develop rational coping strategies to reduce their work-related stress.

VSM4EDU has been validated using action research at a single school, which implicates deep insight, but further testing at other schools is welcome. Moreover, VSM4EDU has not been used to develop a future state map.

Value stream mapping is useful in educational settings as long as the educational context is respected in the approach.

VSM4EDU empowers teachers and helps to develop co-operation in teams.

The validation of value stream mapping for education is well-documented and original.

This paper examines whether and when improvement routines are critical for implementing lean practices in small- and medium-sized manufacturing enterprises (SMEs). Improvement routines such as “employees initiate and carry through improvement activities” are generally seen as an important means to achieve the full benefit of structural lean interventions. Womack and Jones (2003) suggest that these improvement routines should be developed as the company becomes more experienced in lean. The purpose of this paper is to explore the relative importance of individual improvement routines at various degrees of lean practice implementation.

A Between-Case Comparison Analysis (Dul and Hak, 2012) and a Necessary Condition Analysis (Dul, 2016) were performed on self-assessment data from 241 respondents at 38 Dutch manufacturing SMEs.

The importance of improvement routines depended on the degree of lean practice implementation. Lean practices could be implemented to some extend without developing specific improvement routines, yet certain routines were necessary for more advanced implementations of lean. These routines relate to employees conducting shared improvement activities and in the most advanced cases to aligning different improvement activities.

These findings question existing lean implementation models that neglect improvement routines and indicate the need to integrate improvement routines into every lean transformation for it to be sustainable.

The purpose of this paper is twofold: first, to describe Lean maturity in primary care using a questionnaire based on Liker’s description of Lean, complemented with observations; and second, to determine the extent to which Lean maturity is associated with quality of care measured as staff-rated satisfaction with care and adherence to national guidelines (NG). High Lean maturity indicates adoption of all Lean principles throughout the organization and by all staff.

Data were collected using a survey based on Liker’s four principles, divided into 16 items (n=298 staff in 45 units). Complementary observations (n=28 staff) were carried out at four units.

Lean maturity varied both between and within units. The highest Lean maturity was found for “adhering to routines” and the lowest for “having a change agent at the unit.” Lean maturity was positively associated with satisfaction with care and with adherence to NG to improve healthcare quality.

Quality of primary care may benefit from increasing Lean maturity. When implementing Lean, managers could benefit from measuring and adopting Lean maturity repeatedly, addressing all Liker’s principles and using the results as guidance for further development.

This is one of the first studies to evaluate Lean maturity in primary care, addressing all Liker’s principles from the perspective of quality of care. The results suggest that repeated actions based on evaluations of Lean maturity may help to improve quality of care.

The purpose of this paper is to analyse the effectiveness of a quality improvement method in driving innovation in the public sector. The study expands on the concept of innovation and analyses the types and usefulness of the innovations observed.

The study utilizes an action research approach. The aim of the quality improvement method introduced is to generate innovations enhancing efficiency. An interventionist research method is required to produce the findings. Data collection methods include a preliminary question sheet, interview, workshops, observation and the examination of other material concerning the case organization.

The study supports the notion that innovations created with a quality improvement method can be more oriented towards process improvement, particularly in the public sector. Further, when the method enables professionals from different functions to participate in the process, the innovations created can be more comprehensively designed. Innovations can be classified according to their degree of novelty, type, resource consumption and the projected outcome. A project follow-up makes it possible to compare the projected outcome of the innovation against its actual outcome.

The method applied could be a viable option for practitioners considering public sector quality improvement and innovation capacity building. The paper provides guidelines for prioritizing innovations in terms of their resource consumption and usefulness.

Integrating quality improvement with innovation generation as a potential efficiency source for public-sector organizations has received relatively little research attention. Further, the paper provides a categorization for innovations in the public sector that provides guidelines for prioritizing innovations.

This technological article deals with a case study to implement an improvement to reduce the machine setup of an industrial process, in addition to the development of people using the A3 methodology for problem-solving.

As a research method, action research was used in a single-case study applied to a motorcycle production company, using the concept of the A3 report for problem-solving as the theoretical basis.

The implementation of the improvement in the process resulted in a reduction of 70.4% of the preparation time (setup) of the machines, thus eliminating the need to add a third production shift.

It has been applied to only one company, so it lacks a feasibility check to be implemented in other companies.

Regarding its practical contribution, the authors first consider that the proposed method can also be applied in small and medium-sized companies (SMEs), since the investment in this problem-solving approach is low without necessarily implementing the lean production system that, it is usually complex, time-consuming and requires the allocation of a substantial amount of resources by companies. The second practical contribution of this work is that the proposed A3 problem-solving methodology can serve as a guide for managers to implement or improve different industrial and service processes.

It has been applied to only one company, so it lacks a feasibility check to be implemented in other companies.

The aim of this study is to develop an in-depth case study on the implementation on Lean six sigma (LSS) in Schnell S.p.A., Italian company leader of an important multinational industrial group, highlighting the benefits that can be achieved from a careful application of this method, the main challenges and organizational learning from its implementation.

The study has been developed with a qualitative approach, creating a single in-depth case study, with the participant observation of researchers in the project which lasted 4 months. Periodic weekly meetings were done with the working group to exchange feedback on the development of the project to share opinions and data.

A project has been developed to stabilize the procurement process of a pull-type production cell, which experienced delays in supply lead times. The causes of the problems in their process of managing the supply of the production cell were found and some inefficiencies in the internal process of fulfillment of supply orders have been intercepted, the optimization of which has allowed the generation of an automatic system for sending supply orders, coming directly from the production line.

This study described the path and dynamics of the transformation process that business organizations undertake for optimizing their profitability and competitive advantage, placing emphasis on an innovative methodology for conducting business process improvement projects, which constitutes its operating philosophy on the effective and efficient use of company resources and skills, to guarantee to the company the achievement of a lasting and defensible competitive advantage over time.

Transport logistics systems in companies with additional public service roles are complex and could benefit from new approaches to performance management. Existing approaches tend to be fragmented; thus, the purpose of this paper is to integrate balanced performance measures, a dynamics model, and the problem-solving method into a new model.

An integrated framework is developed by reviewing literature and synthesising attributes of performance measurement systems, system dynamics and problem-solving methods. The framework is then applied to a multiple-role company’s sea transportation system. The study uses statistical methods to identify performance indicators, management interviews with document study to develop a dynamics model, and simulation methods to formulate an improvement plan.

The performance measurement design stage allowed for the identification of balanced, aligned performance indicators, while the system dynamics model illuminated the impact of the system components’ interrelationships on performance output. The problem-solving method allowed for analysis of system performance, identification of constraints and formulation of a performance improvement plan.

This framework can help transport logistics system stakeholders in multiple-role companies avoid silo thinking, misaligned performance objectives, local optima and short-term solutions.

This study contributes to the existing body of research by introducing a novel framework integrating performance measurement, system dynamics and the problem-solving method. It also addresses a theoretical gap by showing how interconnecting components of sea transportation systems affect transport logistics performance.

As a problem-solving tool, the kaizen event (KE) is underutilised in practice. Assuming this is due to a lack of group process quality during those events, the authors aimed to grasp what is needed during high-quality KE meetings. Guided by the phased approach for structured problem-solving, the authors built and explored a measure for enriching future KE research.

Six phases were used to code all verbal contributions (N = 5,442) in 21 diverse, videotaped KE meetings. Resembling state space grids, the authors visualised the course of each meeting with line graphs which were shown to ten individual kaizen experts as well as to the filmed kaizen groups.

From their reactions to the graphs the authors extracted high-quality KE process characteristics. At the end of each phase, that should be enacted sequentially, explicit group consensus appeared to be crucial. Some of the groups spent too little time on a group-shared understanding of the problem and its root causes. Surprisingly, the mixed-methods data suggested that small and infrequent deviations (“jumps”) to another phase might be necessary for a high-quality process. According to the newly developed quantitative process measure, when groups often jump from one phase to a distant, previous or next phase, this relates to low KE process quality.

A refined conceptual model and research agenda are offered for generating better solutions during KEs, and the authors urge examinations of the effects of well-crafted KE training.

To investigate the effects of payor–provider integration on the operational performance of health service provision. The research explores whether integration governs agency problems and tilts the incentives of diverse actors toward more systematic outcomes.

A two stage multimethod case study of occupational health services. A qualitative stage aimed to understand the reasons, mechanisms, and outcomes of payor–provider integration. A quantitative stage evaluated the performance of the integrated hospital against fee-for-service partner hospitals with a sample of 2,726 patients.

Payor–provider integration mitigates agency problems on multiple levels of the service system by complementing formal governance mechanisms with informal mechanisms. Compared to partner hospitals, the integrated hospital yielded 9% lower the total costs of occupational injuries achieved primarily by emphasizing conservative care and faster recovery.

Focuses on occupational health services in Finland. Provides initial evidence of the effects of payor–provider integration on the operational performance.

Vertical integration may provide systematic outcomes but requires mindful implementation of multiple mechanisms. Rigorous change management initiative is advised.

For patients, the research shows payor–provider integration of health services can be implemented in a manner that it reduces care costs while not compromising care quality and customer satisfaction.

This study provides a rare longitudinal analysis of payor–provider integration in health-care operations management. The study adds to the knowledge of operational performance improvement of health services.