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Worldwide, healthcare systems struggle to sustain the delivery of services at a time of increasing demand, limited resources and growing expectations from users, coupled with dealing with the aftermath of the Covid-19 pandemic and the threat of other outbreaks. There has never been a more important time to sustain innovation and improvements. Using an illustrative case, the authors assess the application of two existing frameworks to identify the key propositions and dimensions required to deliver sustainable services.

This illustrative case study focuses on a service provided by a chronic disease, multidisciplinary community healthcare team in the UK. Experienced-based interviews were conducted with health professionals, patients and relatives to provide a rich account of a care pathway design. A high-level process map is used to visualise the key touch points.

The authors identify all seven propositions of the SERVICE framework being present along with additional dimensions relating to sustaining innovation and improvement.

This research is limited to a chronic disease care pathway. However, the authors believe the results could be applicable to other medical conditions, which are supported by a similar multi-disciplinary service delivery model.

The authors provide a sustainable public service operations SERVICES framework for health professionals and managers to consider when (re)designing care pathways.

This research contributes to the emerging discipline of public service operations research by empirically testing for the first time the SERVICE framework within healthcare. The authors have included additional factors associated with innovation and improvement and recommended further development of the framework to include factors, such as economic sustainability, highly relevant to the context of universal healthcare systems.

Many organizations are embarking upon knowledge management initiatives to enhance their competitiveness. While there has been a significant amount of multidisciplinary research in this area, the evidence from surveys of practitioners indicate that a large proportion of company projects focus on the implementation of technology‐based solutions without consideration of the structural and contextual issues. Many academic authors have presented a variety of different models for knowledge management but have often failed to relate these to the requirements of practitioners. This paper presents a model of knowledge management derived from a synthesis of current literature. The model emphasizes the need for knowledge evaluation within a knowledge management approach and describes, using a case study, how this might be achieved.

The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature.

A comprehensive review of literature focussing on lean and lean healthcare was conducted.

Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings.

The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study.

The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed.

To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

This paper seeks to take a historic perspective on performance measurement and management (PMM) within operations management (OM) across all sectors (manufacturing, service and public) in order to reflect on and undercover relevant lessons and issues about PMM in OM.

Drawing from a range of documents and experts, three historic phases were identified which reflected changing aspects of PMM in OM from the early twentieth century until today.

The analysis shows that most of PMM within OM derives from work study and productivity measurement within manufacturing during the industrial revolution. The general trend shows a movement away from performance measurement towards performance management. The paper illustrates how views of PMM have moved in three directions: the broadening of the unit of analysis; the deepening of performance measures; and the increasing range of performance measures.

The paper concludes by presenting four reflections and challenges including the fact that the drive for productivity still exists and there is a need to continue to develop measures across organisations which are also predictive. Finally, that lessons between private and public sectors regarding PMM are shared.

The paper argues that in order to evaluate the movement in the three directions effectively it is necessary to differentiate between the terms performance measurement, performance reporting and performance management.

The paper examines change programmes based around the introduction of regulatory practices, both voluntary and involuntary (imposed form outside). These are essentially of two kinds: work critical (attempting to improve the effectiveness or efficiency of work) and safety critical (attempting to improve the health and well‐being of the workforce, customers or other stakeholders). The paper discusses the effect that regulatory practices have on individual and organisational behaviour and attempts to understand why some change programmes succeed and others fail. Evidence is provided from a review of the current literature and an initial qualitative case study.

“Lean working”, “leanness” or “lean” are terms that can be used to describe “doing more with less” i.e. improved utilisation of an organisation's resources. This paper outlines the concept of leanness before developing thinking to describe a state of “corporate anorexia” – the inability to utilise or balance effectively the facets/resources of the organisation. There may be a variety of causes of this state of anorexia; this paper will not however consider all of them in detail, since its main focus is around identifying the characteristics of an anorexic organisation. The case study analysis presented focuses on the process of change undergone by an organisation when becoming lean and the extent to which this may result in corporate anorexia. A review of literature is used to develop a set of questions that can be used to consider the impact of the process of change to a state of leanness on various facets of the organisation, and in particular the way in which they balance with each other. These questions are then applied to some case studies in order to assess how lean an organisation is, and conclusions drawn about what the cases show in relation to both leanness and anorexia.

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.

This purpose of this paper is to examine the application and outcomes of applying all of the seven lean flows to pathology laboratory remodelling as part of a lean rapid improvement event (RIE).

Longitudinal case study of a lean RIE linking emergency and pathology departments focusing on the systematic application of lean's seven flows to the physical environment.

Following the lean RIE, changes improving patient specimen, technician, supplies and information flows avoided 187 km and eight days of unnecessary walking each year.

The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged.

This research provides evidence that applying lean design concepts in a laboratory can make substantial improvements, particularly if the expertise of the people working in the laboratory is trusted to determine the most appropriate changes. Significant amounts of time and motion were saved by just one, easily quantifiable change.

The laboratory staff is processing increased numbers of time-critical tests, yet report a calmer working environment, without any increase in the pace of work. Laboratory personnel also experienced satisfaction in exercising control over their work environment.

To the best of the authors’ knowledge this is the first comprehensive report applying lean flows to pathology laboratory remodelling and one of the few applications of Lean Systems Thinking between departments and between separate health services organisations.

The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.

The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies.

The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.

Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations’ working environment, staff development, and organizational performance.

In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.