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The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.

The purpose of this paper is to examine the characteristics and functions of images in scientific practices and how scientific images differ to other types of representation (e.g. textual, numerical or artistic images). To address these questions, the study looks into the illustration practice of the Swedish researcher Gaston Backman, who wrote several books on the origin of the human species, human anatomy, physical anthropology and race biology in the beginning of the twentieth century.

A comparative and functional analytical method is applied to show how the images act in his writings and how rhetorical and technical circumstances affect the way the images communicate and document scientific facts and ideas. Theoretically, the study relates to ideas suggesting: images to be serious partakers and vehicles of representation in the practice of science; and the need for images to be schematic and more abstract in comparison to an iconic image in order to work in this practice.

The findings of this study show that Backman used both schematic and iconic images in his research writings, and that these different image expressions had different functions: where the former was based on facts and had an informative and scientific function, the latter was based on fantasy/myth and used to promote ideological values and ideas.

This study stresses the importance of images in the practice of science, i.e. how images alongside verbal or numerical expressions act as important information and knowledge carriers in the work of science. Even though images intermingle with verbal and numerical expression, they also have a unique and specific, a role that needs to be taken seriously and investigated further in the realm of information studies and document studies. The authors also need to be aware that images can have different functions in the scientific practice, and are not always there to carry scientific facts or ideas, but ideologies and fantasies.