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This paper explores Lean Six Sigma principles and the DMAIC (define, measure, analyze, improve, control) methodology to propose a new Lean Six Sigma 4.0 (LSS 4.0) framework for employee occupational exams and address the real-world issue of high-variability exams that may arise.

This study uses mixed methods, combining qualitative and quantitative data collection. A detailed case study assesses the impact of LSS interventions on the exam management process and tests the applicability of the proposed LSS 4.0 framework for employee occupational exams.

The results reveal that changing the health service supplier in the explored organization caused a substantial raise in occupational exams, leading to increased costs. By using syntactic interoperability, lean, six sigma and DMAIC approaches, improvements were identified, addressing process deviations and information requirements. Implementing corrective actions improved the exam process, reducing the number of exams and associated expenses.

It is important to acknowledge certain limitations, such as the specific context of the case study and the exclusion of certain exam categories.

The practical implications of this research are substantial, providing organizations with valuable managerial insights into improving efficiency, reducing costs and ensuring regulatory compliance while managing occupational exams.

This study fills a research gap by applying LSS 4.0 to occupational exam management, offering a practical framework for organizations. It contributes to the existing knowledge base by addressing a relatively novel context and providing a detailed roadmap for process optimization.

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

The aim of this study is to empirically explore and analyze the concrete tasks of output measurement and the inherent challenges related to these tasks in a traditional and autonomous professional public work setting – the judicial system.

The analysis of the tasks is based on a categorization of general performance measurement motives (control-motivate-learn) and main stakeholder levels (society-organization-professionals). The analysis is exploratory and conducted as an empirical content analysis on materials and reports produced in two performance improvement projects conducted in European justice organizations.

The identified main tasks in the different categories are related to managing resources, controlling performance deviations, and encouraging improvement and development of performance. Based on the results, key improvement areas connected to output measurement in professional public organizations are connected to the improvement of objectivity and fairness in budgeting and work allocation practices, improvement of output measures' versatility and informativeness to highlight motivational and learning purposes, improvement of professional self-management in setting output targets and producing outputs, as well as improvement of organizational learning from the output measurement.

The paper presents empirically founded practical examples of challenges and improvement opportunities related to the tasks of output measurement in professional public organization.

This paper fulfils an identified need to study how general performance management motives realize as concrete tasks of output measurement in justice organizations.

This study is focused to support an ongoing development project of the case company's current state and the challenges of the order-to-cash (O2C) process. The O2C process is the most visible process to the customer, and therefore, its punctual and fluent order management is vital. It is observed that the high degree of manual work in the O2C process causes mistakes, delays and rework in the process. The purpose of this article is therefore to analyze the case company's current state of the O2C process as well as to identify the areas of development in this process by deploying the means of Lean Six Sigma tools such as value stream mapping (VSM).

The study was conducted as a mix of quantitative and qualitative analysis. Based on both the quantitative and qualitative data, a workshop on VSM was organized to analyze the current state of the O2C process of a case company, engaged in the energy and environment sector in Finland.

The results found that excessive manual work was highly connected to inadequate or incorrect data in pricing and invoicing activities, which resulted in canceled invoices. Canceled invoices are visible to the customer and have a negative impact on the customer experience. This study found that by improving the performance of the O2C process activities and improving communication among the internal and external stakeholders, the whole O2C process can perform more effectively and provide better customer value.

The O2C process is the most visible process to the customer and therefore its punctual and fluent order management is vital. To ensure that the O2C process is operating as desired, suitable process performance metrics need to be aligned and followed. The results gathered from the case company's data, questionnaire interviews, and the VSM workshop are all highlighted in this study. The main practical and managerial implications were to understand the real-time O2C process performance, which is necessary to ensure strong performance and enhance continuous improvement of the O2C process that leads to operational excellence and commercial competitiveness of the studied case company.

This study aims to analyze how the interplay between hard and soft elements of total quality management (TQM) produces the conditions for sustaining success in the quest for quality.

A qualitative analysis (Gioia method) was carried out on an original dataset collected through both direct and indirect methods (i.e. archival sources, interviews and observations) to generate a new interpretive framework.

The interpretative framework identifies four categories of elements: trigger elements create the starting conditions for a quality virtuous cycle; benchmarking tools set the standards of performance; improvement tools enable exploration of the space of possible alternative practices and finally, catalytic forces allow the institutionalization of effective techniques discovered in this search process into new standards.

The findings the authors present in this paper are derived by a single case study, limiting the generalizability of our results in other settings.

This study has three implications: first, the design of trigger elements is critical for the success of any TQM initiative; second, the interplay of improvement and benchmarking tools at several levels should be coherent and third, to exploit the potential of TQM, efforts should be devoted to the dissemination of new effective practices by means of catalyzing elements.

The model provides a more specific understanding of the nature and purpose of the hard and soft elements of TQM and the dynamic interaction between the two classes of elements over time.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

Although businesses continue to take up artificial intelligence (AI), concerns remain that companies are not realising the full value of their investments. The study aims to provide insights into how AI creates business value by investigating the mediating role of Business Process Management (BPM) capabilities.

The integrative model of IT Business Value was contextualised, and structural equation modelling was applied to validate the proposed serial multiple mediation model using a sample of 448 organisations based in the EU.

The results validate the proposed serial multiple mediation model according to which AI adoption increases organisational performance through decision-making and business process performance. Process automation, organisational learning and process innovation are significant complementary partial mediators, thereby shedding light on how AI creates business value.

In pursuing a complex nomological framework, multiple perspectives on realising business value from AI investments were incorporated. Several moderators presenting complementary organisational resources (e.g. culture, digital maturity, BPM maturity) could be included to identify behaviour in more complex relationships. The ethical and moral issues surrounding AI and its use could also be examined.

The provided insights can help guide organisations towards the most promising AI activities of process automation with AI-enabled decision-making, organisational learning and process innovation to yield business value.

While previous research assumed a moderated relationship, this study extends the growing literature on AI business value by empirically investigating a comprehensive nomological network that links AI adoption to organisational performance in a BPM setting.

Insufficient productivity development in the global and Finnish infrastructure sectors indicates that there are challenges in genuinely achieving the goals of resource efficiency and digitalization. This study adapts the approach of capability maturity model integration (CMMI) for examining the capabilities for productivity development that reveal the enablers of improving productivity in the infrastructure sector.

Civil engineering in Finland was selected as the study area, and a qualitative research approach was adopted. A novel maturity model was constructed deductively through a three-step analytical process. Previous research literature was adapted to form a framework with maturity levels and key process areas (KPAs). KPA attributes and their maturity criteria were formed through a thematic analysis of interview data from 12 semi-structured group interviews. Finally, validation and refinement of the model were performed with an expert panel.

This paper provides a novel maturity model for examining and enhancing the infrastructure sector’s maturity in productivity development. The model brings into discussion the current business logics, relevance of lifecycle-thinking, binding targets and outcomes of limited activities in the surrounding infrastructure system.

This paper provides a new approach for pursuing productivity development in the infrastructure sector by constructing a maturity model that adapts the concepts of CMMI and change management. The model and findings benefit all actors in the sector and provide an understanding of the required elements and means to achieve a more sustainable built environment and effective operations.

This paper aims to explore how leaders can develop value-based leadership for sustainable quality development in Lean manufacturing.

A qualitative meta-analysis was conducted using data from a three-year study of Lean manufacturing in Sweden using the Shingo business excellence model as an analytical framework.

This study demonstrates that leaders can develop value-based leadership to support Lean manufacturing by defining and articulating the organization’s values and accompanying behaviors that are needed to support the strategic direction; creating forums and time for leaders to identify the why behind decisions and reflect on their experiences to be able to lead a transformative process; and using storytelling to create a coaching culture to connect values and behaviors, to the processes and systems of work.

This paper contributes insights for developing value-based leadership to support a systemic approach to sustainable quality development in lean manufacturing. Findings are based on a limited case sample size of three manufacturing companies in Sweden.

The findings were derived using a unique methodological approach combining storytelling, appreciative inquiry and coaching with traditional data collection methods including surveys and interviews to identify, define and shape value-based leadership in Lean manufacturing.

Improving productivity and efficiency has always been crucial for industrial companies to remain competitive. In recent years, the topic of environmental impact has become increasingly important. Published research indicates that environmental and economic goals can enforce or rival each other. However, few papers have been published that address the interaction and integration of these two goals.

In this paper, we identify both, synergies and trade-offs based on a systematic review incorporating 66 publications issued between 1992 and 2021. We analyze, quantify and cluster examples of conjunctions of ecological and economic measures and thereby develop a framework for the combined improvement of performance and environmental compatibility.

Our findings indicate an increased significance of a combined consideration of these two dimensions of sustainability. We found that cases where enforcing synergies between economic and ecological effects were identified are by far more frequent than reports on trade-offs. For the individual categories, cost savings are uniformly considered as the most important economic aspect while, energy savings appear to be marginally more relevant than waste reduction in terms of environmental aspects.

No previous literature review provides a comparable graphical treatment of synergies and trade-offs between cost savings and ecological effects. For the first time, identified measures were classified in a 3 × 3 table considering type and principle.