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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.

Acknowledging, on the one hand, the increasing fragility of supply chains and the number of risks involved in supply chain operations and, on the other hand, the role of small- and medium-sized enterprises (SMEs) in supply chains and the high exposure of these firms to risks of different types, this study aims to examine the relationship between supply chain risk management (SCRM) and innovation performance in SMEs. Furthermore, the impact of technological turbulence on this relationship was studied to take into account recent technological changes.

Structural equation modelling was carried out on a sample of Turkish SMEs to test the hypotheses developed.

The findings presented allow the authors to better understand the link between SCRM and innovation performance in SMEs. More precisely, empirical evidence is provided about the impact of SCRM components such as maturity and ability on innovation performance. Furthermore, the findings show the impact of technological turbulence on both SCRM and innovation performance.

By focusing on SCRM in SMEs, this paper contributes to the body of knowledge with regard to SCRM in general and with regard to SMEs in particular; research on the latter has only started recently. Moreover, by having studied SMEs from a developing country (other than China), this paper helps to develop a broader and more diverse perspective of SCRM.

Intellectual capital (IC) plays a crucial role in today’s volatile business landscape, yet its measurement remains complex. To better navigate these challenges, the authors propose the Integrated Intellectual Capital Measurement (IICM) model, an innovative, robust and comprehensive framework designed to capture IC amid business uncertainty. This study focuses on IC measurement models, typically reliant on secondary data, thus distinguishing it from conventional IC studies.

The authors conducted a systematic literature review (SLR) and bibliometric analysis across Web of Science, Scopus and EBSCO Business Source Ultimate in February 2023. This yielded 2,709 IC measurement studies, from which the authors selected 27 quantitative papers published from 1985 to 2023.

The analysis revealed no single, universally accepted approach for measuring IC, with company attributes such as size, industry and location significantly influencing IC measurement methods. A key finding is human capital’s critical yet underrepresented role in firm competitiveness, which the IICM model aims to elevate.

This is the first SLR focused on IC measurement amid business uncertainty, providing insights for better management and navigating turbulence. The authors envisage future research exploring the interplay between IC components, technology, innovation and network-building strategies for business resilience. Additionally, there is a need to understand better the IC’s impact on specific industries (automotive, transportation and hospitality), Social Development Goals and digital transformation performance.

This study aims to deepen the understanding of the challenges and implications entailed by deploying mobile clinics in conflict zones to reach populations affected by violence and cut off from health-care services.

This research combines an integrated literature review and an instrumental case study. The literature review comprises two targeted reviews to provide insights: one on conflict zones and one on mobile clinics. The case study describes the process and challenges faced throughout a mobile clinic deployment during and after the Iraq War. The data was gathered using mixed methods over a two-year period (2017–2018).

Armed conflicts directly impact the populations’ health and access to health care. Mobile clinic deployments are often used and recommended to provide health-care access to vulnerable populations cut off from health-care services. However, there is a dearth of peer-reviewed literature documenting decision support tools for mobile clinic deployments.

This study highlights the gaps in the literature and provides direction for future research to support the development of valuable insights and decision support tools for practitioners.

Vehicle allocation problems (VAPs), which are frequently confronted in many transportation activities, primarily including but not limited to full truckload freight transportation operations, induce a significant economic impact. Despite the increasing academic attention to the field, literature still fails to match the needs of and opportunities in the growing industrial practices. In particular, the literature can grow upon the ideas on sustainability, Industry 4.0 and collaboration, which shape future practices not only in logistics but also in many other industries. This review has the potential to enhance and accelerate the development of relevant literature that matches the challenges confronted in industrial problems. Furthermore, this review can help to explore the existing methods, algorithms and techniques employed to address this problem, reveal directions and generate inspiration for potential improvements.

This study provides a literature review on VAPs, focusing on quantitative models that incorporate any of the following emerging logistics trends: sustainability, Industry 4.0 and logistics collaboration.

In the literature, sustainability interactions have been limited to environmental externalities (mostly reducing operational-level emissions) and economic considerations; however, emissions generated throughout the supply chain, other environmental externalities such as waste and product deterioration, or the level of stakeholder engagement, etc., are to be monitored in order to achieve overall climate-neutral services to the society. Moreover, even though there are many types of collaboration (such as co-opetition and vertical collaboration) and Industry 4.0 opportunities (such as sharing information and comanaging distribution operations) that could improve vehicle allocation operations, these topics have not yet received sufficient attention from researchers.

The scientific contribution of this study is twofold: (1) This study analyses decision models of each reviewed article in terms of decision variable, constraint and assumption sets, objectives, modeling and solving approaches, the contribution of the article and the way that any of sustainability, Industry 4.0 and collaboration aspects are incorporated into the model. (2) The authors provide a discussion on the gaps in the related literature, particularly focusing on practical opportunities and serving climate-neutrality targets, carried out under four main streams: logistics collaboration possibilities, supply chain risks, smart solutions and various other potential practices. As a result, the review provides several gaps in the literature and/or potential research ideas that can improve the literature and may provide positive industrial impacts, particularly on how logistics collaboration may be further engaged, which supply chain risks are to be incorporated into decision models, and how smart solutions can be employed to cope with uncertainty and improve the effectiveness and efficiency of operations.

Heating, ventilating, air-conditioning and cooling (HVAC) systems are crucial in daily health-care facility services. Design-related defects can lead to maintenance issues, causing service disruptions and cost overruns. These defects can be avoided if a link between the early design stages and maintenance feedback is established. This study aims to use experts’ experience in HVAC maintenance in health-care facilities to list and evaluate the risk of each maintenance issue caused by a design defect, supported by the literature.

Following semistructured interviews with experts, 41 maintenance issues were identified as the most encountered issues. Subsequently, a survey was conducted in which 44 participants evaluated the probability and impact of each design-caused issue.

Chillers were identified as the HVAC components most prone to design defects and cost impact. However, air distribution ducts and air handling units are the most critical HVAC components for maintaining healthy conditions inside health-care facilities.

The unavailability of comprehensive data on the cost impacts of all design-related defects from multiple health-care facilities limits the ability of HVAC designers to furnish case studies and quantitative approaches.

This study helps HVAC designers acquire prior knowledge of decisions that may have led to unnecessary and avoidable maintenance. These design-related maintenance issues may cause unfavorable health and cost consequences.

This study aims to facilitate access to vascular disease screening for low-income individuals living in remote and conflict areas based on the results of a pilot trial in Colombia. Also, to increase the amount of diagnosis training of vascular surgery (VS) in civilians.

The operation method includes five stages: strategy development and adjustment; translation of the strategy into a real-world setting; operation logistics planning; strategy analysis and adoption. The operation plan worked efficiently in this study’s sample. It demonstrated high sensibility, efficiency and safety in a real-world setting.

The authors developed and implemented a flow model operating plan for screening vascular pathologies in low-income patients pro bono without proper access to vascular health care. A total of 140 patients from rural areas in Colombia were recruited to a controlled screening session where they underwent serial noninvasive ultrasound assessments conducted by health professionals of different training stages in VS.

The plan was designed to be implemented in remote, conflict areas with limited access to VS care. Vascular injuries are critically important and common among civilians and military forces in regions with active armed conflicts. As this strategy can be modified and adapted to different medical specialties and geographic areas, the authors recommend checking the related legislation and legal aspects of the intended areas where we will implement this tool.

Different sub-specialties can implement the described method to be translated into significant areas of medicine, as the authors can adjust the deployment and execution for the assessment in peripheral areas, conflict zones and other public health crises that require a faster response. This is necessary, as the amount of training to which VS trainees are exposed is low. A simulated exercise offers a novel opportunity to enhance their current diagnostic skills using ultrasound in a controlled environment.

Evaluating and assessing patients with limited access to vascular medicine and other specialties can decrease the burden of vascular disease and related complications and increase the number of treatments available for remote communities.

It is essential to assess the most significant number of patients and treat them according to their triage designation. This management is similar to assessment in remote areas without access to a proper VS consult. The authors were able to determine, classify and redirect to therapeutic interventions the patients with positive findings in remote areas with a fast deployment methodology in VS.

Access to health care is limited due to multiple barriers and the assessment and response, especially in peripheral areas that require a highly skilled team of medical professionals and related equipment. The authors tested a novel mobile assessment tool for remote and conflict areas in a rural zone of Colombia.

People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality.

This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health).

A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool.

To the best of the authors’ knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths.

Railways are a well-known example of complex critical infrastructure, incorporating socio-technical systems with humans such as drivers, signallers, maintainers and passengers at the core. The technological evolution including interconnectedness and new ways of interaction lead to new security and safety risks that can be realised, both in terms of human error, and malicious and non-malicious behaviour. This study aims to identify the human factors (HF) and cyber-security risks relating to the role of signallers on the railways and explores strategies for the improvement of “Digital Resilience” – for the concept of a resilient railway.

Overall, 26 interviews were conducted with 21 participants from industry and academia.

The results showed that due to increased automation, both cyber-related threats and human error can impact signallers’ day-to-day operations – directly or indirectly (e.g. workload and safety-critical communications) – which could disrupt the railway services and potentially lead to safety-related catastrophic consequences. This study identifies cyber-related problems, including external threats; engineers not considering the human element in designs when specifying security controls; lack of security awareness among the rail industry; training gaps; organisational issues; and many unknown “unknowns”.

The authors discuss socio-technical principles through a hexagonal socio-technical framework and training needs analysis to mitigate against cyber-security issues and identify the predictive training needs of the signallers. This is supported by a systematic approach which considers both, safety and security factors, rather than waiting to learn from a cyber-attack retrospectively.