Criteria For Allocation Of Resources Research Articles

Ethical prioritization of critical care resources during COVID-19: perspectives from Italy and the United States.

This article examines some of the ethical challenges of prioritizing intensive care resources during the Covid-19 pandemic by comparing the Italian and United States contexts. After presenting an overview to the clinical, ethical, and public debates in Italy, the article will discuss the development of triage allocation protocols in United States hospitals. Resource allocation criteria underwent increased scrutiny and critique in both countries, which resulted in modified professional and expert guidance regarding healthcare ethics during times of emergency and resource scarcity.

Impacts of neoliberal school reforms policy on students with disabilities in Nepal

This article argues that special and inclusive education policies in Nepal have been influenced by neoliberal policy reforms. The study employs discourse analysis as a theoretical perspective to analyse the effects of market-based schooling practices on students with disabilities in Nepal. The findings of this study are informed to some extent by the outcomes of the doctoral research project (Thapaliya, 2018). Data was collected through policies and documents. A selection of key education policies and documents between 1990 to 2020 were examined and analysed. One core theme and five sub-themes were identified from the data analysis. Disability as a resource management issue was a main theme. (i) Managing resources; (ii) resource allocation criteria; (iii) professional experts deciding resource funds; (iv) competing for limited resources; and (v) competition and school choice were sub-themes. The available evidence signals that the marketisation model of education does not assist students with disabilities adequately. The findings of this study reveal that the current policy and practice signal changes in government structure rather than working to fulfil these commitments in the everyday practice of students with disabilities. The limitations of the study and recommendations of this research are also discussed.

Public preferences in healthcare resource allocation: A discrete choice experiment in South Korea

ObjectivesThis study aimed to explore the public view on priority-setting criteria for healthcare resource allocation. Specifically, it investigates how the value of a quality-adjusted life year (QALY) varies depending on patient characteristics. MethodsA discrete choice experiment was conducted using an online sample of the general South Korean population. Respondents were presented with two competing treatment scenarios. The attributes of the scenarios were age at disease onset, life expectancy without treatment, life-years gain with treatment, health-related quality of life (HRQoL) without treatment, and HRQoL gains with treatment.Two hundred choice sets were generated and randomly allocated into 20 blocks. A conditional logit model was used to estimate the factors affecting the respondents' choices. ResultsA total of 3,482 respondents completed the survey. The larger the QALY gain, the more likely it was that the scenario would be chosen but with a diminishing marginal value. Respondents prioritized 40-year-old patients over 5-year-olds and 5-year-olds over 70-year-olds and prioritized baseline HRQoL of 40% and 60% over 20%. Patients at the end of life were not preferred to those with a longer life expectancy. ConclusionOverall, respondents preferred health-maximizing options without explicit consideration for end-of-life patients or those with poor health. In addition, they revealed a kinked preference for patient age, prioritizing middle-aged patients over children and older people

Could negative outcomes of psychotherapies be contributing to the lack of an overall population effect from the Australian Better Access initiative?

We examine deterioration in psychotherapies, as reported in the recent evaluation of the Australian Medicare Better Access initiative. A focus on patients who experience poor clinical outcomes helps programs minimise harm and improve quality of care. The Better Access evaluation found the mental health of 20-40% of patients deteriorated. This may partly explain why population distress and suicide rates were not reduced by the introduction of the Better Access initiative. Deterioration was more likely for milder conditions, and less likely for severe conditions, which also improved the most. Using severity as a criterion for priority setting and resource allocation may minimise patient risk and maximise benefits. Patients with severe conditions may require considerably more sessions than the current average for Better Access psychotherapies.

Criteria for Ethical Allocation of Scarce Healthcare Resources: Rationing vs. Rationalizing in the Treatment for the Elderly

This paper stems from the current global worsening of the scarcity of resources for healthcare, which will deepen even more in future public emergencies. This justifies strengthening the reflection on the allocation of resources which, in addition to considering technical issues, should also involve ethical concerns. The two plans in which the allocation of resources develops—macro and micro—are then systematized, both requiring the identification of ethical criteria for the respective complex decision-making. Then, we describe how the complexity at the macro level focuses on the joint consideration of the rectitude of the principles, the goodness of the ends, and the integrity—respectively the deontological, teleological, and procedural perspectives; and at the micro level, it focuses in prioritizing people, which can result in the exclusion of some, as happened with the elderly during peaks of COVID-19. The main objective of this article is to show that, in public health emergency situations, in which the daily criteria for prioritizing access to health care are not efficient, it is possible not only to ration the available means but also to rationalize them. We argue that rationing and rationalization are different concepts, entail different consequences, have different ethical foundations, and draw different guidelines for patient care. We apply them to the distribution of intensive care and vaccines to the elderly thus demonstrating the ethically legitimate domain of implementation of each of these two prioritization criteria. We conclude that rationalization respects more strictly the core ethical principles of our common morality.

Effective or predatory funding? Evaluating the hidden costs of grant applications.

Researchers are spending an increasing fraction of their time on applying for funding; however, the current funding system has considerable deficiencies in reliably evaluating the merit of research proposals, despite extensive efforts on the sides of applicants, grant reviewers and decision committees. For some funding schemes, the systemic costs of the application process as a whole can even outweigh the granted resources-a phenomenon that could be considered as predatory funding. We present five recommendations to remedy this unsatisfactory situation.

Priority Criteria for Community-Based Care Resource Allocation for Health Equity: Socioeconomic Status and Demographic Characteristics in the Multicriteria Decision-Making Method.

SDG 10 stipulates that inequality within and between countries can be reduced by governmental policies that focus on the allocation of fiscal resources and social protection strategies to improve equity. The sustainability of community-based care stations is a crucial support network for achieving the goal of active aging. Unequal allocation would occur only if the populations of administrative districts are considered. Comprehensive policies, in accordance with data and sustainable goals, must consider multiple factors. Hence, this study used multicriteria decision making (MCDM) to investigate how nine criteria-related socioeconomic statuses (SES) and demographic characteristics are prioritized in community resource and funding allocation. Thirty-four community care and aging experts were invited to complete a questionnaire based on the modified Delphi method and the analytical hierarchy process (AHP) method. The assessment criteria for the allocation of community resources are prioritized in the following order: disability level, age, household composition, identity of social welfare, family income, ethnicity, marital status, educational attainment, and gender. Quantitative indices can be used to determine the importance of resource allocation policymaking. The benefit of this study lies in decision makers’ application of ranking and weighting values in public funding allocation ratios for community-based care resources for health equity in Taiwan.

Resource scarcity and allocation criteria during the Covid-19 pandemic: Ethical issues

The increase in cases of patients needing to be admitted to intensive care, due to Covid-19 infection, has led to a strong imbalance between available resources and healthcare requirements. Therefore, the determination of further criteria, in addition to those of clinical appropriateness and proportionality of care, to define the allocation of the limited resources available was necessary. For these reasons, in March 2020, the SIAARTI (Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care) published a document containing the “Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments, in exceptional, resource-limited circumstances,” to relieve clinicians from a part of the responsibility in the decision-making process, which can be emotionally burdensome, carried out in individual cases and to make the allocation criteria for healthcare resources explicit in a condition of their own extraordinary scarcity.

Equity, justice, and social values in priority setting: a qualitative study of resource allocation criteria for global donor organizations working in low-income countries

BackgroundThere is increasing acceptance of the importance of social values such as equity and fairness in health care priority setting (PS). However, equity is difficult to define: the term means different things to different people, and the ways it is understood in theory often may not align with how it is operationalized. There is limited literature on how development assistance partner organizations (DAP) conceptualize and operationalize equity in their health care prioritization decisions that affect low-income countries (LIC). This paper explores whether and how equity is a consideration in DAP priority setting processes.MethodsThis was a qualitative study involving 38 in-depth interviews with DAPs involved in health-system PS for LICs and a review of their respective webpages.ResultsWhile several PS criteria were identified, direct articulation of equity as an explicit criterion was lacking. However, the criterion was implied in some of the responses in terms of prioritizing vulnerable populations. Where mentioned, respondents discussed the difficulties of operationalizing equity as a PS criterion since vulnerability is associated with several varying and competing factors including gender, age, geography, and income. Some respondents also suggested that equity could be operationalized in terms of an organization not supporting the pre-existing inequities.Although several organizations’ webpages identify addressing inequities as a guiding principle, there were variations in how they spoke about its operationalization. While intersectionalities in vulnerabilities complicate its operationalization, if organizations explicitly articulate their equity focus the other organizations who also have equity as a guiding principle may, instead of focusing on the same aspect, concentrate on other dimensions of vulnerability. That way, all organizations will contribute to achieving equity in all the relevant dimensions.ConclusionsSince most development organizations support some form of equity, this paper highlights a need for an internationally recognized framework that recognizes the intersectionalities of vulnerability, for mainstreaming and operationalizing equity in DAP priority setting and resource allocation. Such a framework will support consistency in the conceptualization of and operationalization of equity in global health programs. There is a need for studies which to assess the degree to which equity is actually integrated in these programs.

Radio Resource Allocation Improvements in Cognitive Radio Sensor Network for Smart Grid: Investigative Study and Solutions

Background: A cognitive radio sensor network (CRSN)-based Smart Grid (SG) is a new paradigm for a modern SG. It is totally different from the traditional power grid and conventional SG. Currently, an SG uses a static resource allocation technique to allocate resources to sensor nodes in the SG network. Static resource allocation is not efficient due to the heterogeneous nature of CRSN-based SGs. Hence, an appropriate mechanism such as dynamic radio resource allocation (RRA) is required for efficient resource allocation in CRSNs for SGs. Objective: The objective of this paper is to investigate and propose suitable dynamic RRA for efficient resource allocation in CRSNs-based SGs. This involves a proposal for appropriate strategy that will address poor throughput and excessive errors in resource allocation. Methods: In this paper, the dynamic RRA approach is used to allocate resources such as frequency, energy, channels and spectrum to the sensor nodes. This is because of the heterogeneity in a CRSN which differs for SG applications. The dynamic RRA approach is based on optimization of resource allocation criteria such as energy efficiency, throughput maximization, QoS guarantee, etc. The methods include an introduced model called “guaranteed network connectivity channel allocation for throughput maximization” (GNC-TM). Also used, is an optimal spectrum-band determination in RRA for improved throughput. Results: The results show that the model outperforms the existing protocol of channel allocation in terms of throughput and error probability. Conclusion: This study explores RRA schemes for CRSNs for SGs. The paper proposed a GNC-TM model, including demonstration of suitable spectrum band operation in CRSNs for SGs.

PROYECTO DE INCLUSIÓN DE LA EVALUACIÓN AMBIENTAL ESTRATÉGICA EN LA PLANIFICACIÓN DEL TRANSPORTE EN MATANZAS

Transport constitutes a fundamental tool for the development of society, and has in turn generated a series of collateral environmental problems. In consequence, it is necessary for urban management to direct its projects to improve the environment through policies that imply improvement of the environment associated with transport. The general objective of the research was to propose a project for the inclusion of the Strategic Environmental Assessment in transportation planning in the province of Matanzas. A set of tools and techniques were integrated such as: Gantt Chart, PERT Critical Path Method, resource allocation, observation, individual interview and expert criteria. As a fundamental result of the research, the following were obtained: the programming of the activities of the process with a project approach, identification of the critical activities and their assignment by the clock method, as well as the optimal compression of the process.

Allocation of limited resources in intensive and emergency medical care

HintergrundDurch demographischen Wandel und medizinischen Fortschritt kann es zu einem stetigen, durch Pandemien oder andere Großschadenslagen zu einem akuten Mehrbedarf an intensiv- und notfallmedizinischen Ressourcen kommen, der die verfügbaren Mittel übersteigt. Es werden daher zwangsläufig Kriterien zur gerechten Verteilung der vorhandenen Ressourcen benötigt.Ziel der ArbeitHintergrund, Struktur und Kriterien verteilungsethischer Entscheidungen bei knappen Ressourcen in der Intensiv- und Notfallmedizin werden dargestellt und diskutiert.Material und MethodenDie deutschsprachige Literatur zum Thema wird analysiert und erörtert.Ergebnisse und DiskussionEntscheidungen über knappe Ressourcen werden auf unterschiedlichen Ebenen (Mikro‑, Meso- und Makroebene) getroffen und verantwortet und sollen verschiedenen prozeduralen und inhaltlichen Mindeststandards gerecht werden. Bereits unter konsequenter sorgfältiger Prüfung von Therapieindikationen, vorhandener oder fehlender Evidenz sowie des mutmaßlichen, vorausverfügten oder geäußerten Patientenwillen lässt sich der Verantwortung, ethisch verantwortliche Verteilungsentscheidungen zu treffen, gerecht werden.

Recomendaciones de la Sociedad Uruguaya de Medicina Intensiva sobre los aspectos bioéticos en la pandemia Covid-19

Introduction: the pandemic caused by SARS-CoV2 constitutes a significant challenge for the health system, and especially for Critical Care Units, so we need to prepare in many aspects. Likewise, we need to consider there could be an extraordinary demand for beds in critical care units, what would lead to an imbalance between clinical needs and the effective availability of health resources. Objectives: the study aims to perform a bioethical analysis that could provide guidelines for the assistance of patients in critical care. Specific objectives: 1) to analyse the main bioethical principles in this context, 2) to support clinicians in the making of difficult decisions, 3) to make the resource allocation criteria specific, 4) to define action lines upon a potential “health’s disastrous” scenarioMethod: the Uruguayan Society of Intensive Care has generated a space for collective work based on discussion processes. Documents include a bibliographic review and the existing protocols. Results: the study presents a theoretical analysis that is backed up by the bioethical principles involved in the pandemic context on the scenarios of demand for assistance and, by the arguments calling for a change in the ethical criteria upon the saturation of the health system. Conclusion: practical recommendations are made: 1) for the making of decisions about admission and discharge in a controlled demand. 2) to define action criteria upon an increase in demand, clearly defining the different scenarios, 3) to apply upon the saturation of the health system.

The Prohibition of Riba in Islam

A number of objections have been raised against the prohibition ofriba (interest) in Islam and it has been alleged that a riba-free economywill face so many problems that it may not be able to survive. This paperevaluates the nature and significance of some of the major objectionsand, in the process, also indicates the rationale behind the prohibition ofriba.I. ALLOCATION OF RESOURCESOne of the objections raised against an interest-free economy is that itwill not be able to bring about an optimum allocation of resources. Thereason given for this is that interest is a price and like all prices itperforms the function of allocating 'scarce' loanable funds among the'infinite' users of such funds in an objective manner on the basisof abilityto pay the price. If the demand for, or supply of, loanable funds changes,a new equilibrium is reached at a different rate of interest.This objection is based on two assumptions. The first assumption isthat in the absence of interest loanable funds will be available ‘free’ toborrowers, the demand will thus be infinitely large and there will be nomechanism for equating demand with supply. This implies that interestis the only objective criterion for allocation of resources and, in itsabsence, scarce financial resources will be used inefficiently to thedetriment of society. The second assumption is that the money rate ofinterest has been a successful mechanism in allocqting resourcesoptimally and that profit cannot perform the function efficiently.The first asumption is baseless because funds will not be available‘free’ in the Islamic system. They will be available at a cost, and the costwill be the ‘share’ in profit. The rate of profit will hence become acriterion for allocation of resources as well as the mechanism forequating demand with supply. The greater the expected or ex-ante rateof profit in any business, the greater may be the supply of funds to thatbusiness. If the actual or ex-post profit for certain businesses isconsistently lower than the ex-ante profit such businesses may facedifficulty in raising funds in the future. Therefore, while ex-ante profitwill be immediately important in determining the flow of investment,the ex-post performance will be crucial for the future success of thebusiness in raising funds. This should help enforce a greater discipline ininvestments through a more careful evaluation of projects, weeding outall inefficient and unproductive projects. This is not the same in interestbasedinvestment. The interest-oriented lender does not share in the riskof the business financed. He shifts the entire risk of busines to theentrepreneur and assures himself of a predetermined rate of returnirrepwtive of the ultimate net outcome of the borrower’s business. Hethus does not have to undertake as thorough an evaluation as the sahib al-mal(financier) would have to undertake in a riba-free economy, eitherby himself or with the help of a bank or consulting firm. Because of a twosidedevaluation of projects, the rate of profit in the Islamic systemshould be a more efficient mechanism for allocation of resources thaninterest can ever be in the capitalist system ...

Allocation of intensive care resources during an infectious disease outbreak: a rapid review to inform practice

BackgroundThe COVID-19 pandemic has placed sustained demand on health systems globally, and the capacity to provide critical care has been overwhelmed in some jurisdictions. It is unknown which triage criteria for allocation of resources perform best to inform health system decision-making. We sought to summarize and describe existing triage tools and ethical frameworks to aid healthcare decision-making during infectious disease outbreaks.MethodsWe conducted a rapid review of triage criteria and ethical frameworks for the allocation of critical care resources during epidemics and pandemics. We searched Medline, EMBASE, and SCOPUS from inception to November 3, 2020. Full-text screening and data abstraction were conducted independently and in duplicate by three reviewers. Articles were included if they were primary research, an adult critical care setting, and the framework described was related to an infectious disease outbreak. We summarized each triage tool and ethical guidelines or framework including their elements and operating characteristics using descriptive statistics. We assessed the quality of each article with applicable checklists tailored to each study design.ResultsFrom 11,539 unique citations, 697 full-text articles were reviewed and 83 articles were included. Fifty-nine described critical care triage protocols and 25 described ethical frameworks. Of these, four articles described both a protocol and ethical framework. Sixty articles described 52 unique triage criteria (29 algorithm-based, 23 point-based). Few algorithmic- or point-based triage protocols were good predictors of mortality with AUCs ranging from 0.51 (PMEWS) to 0.85 (admitting SOFA > 11). Most published triage protocols included the substantive values of duty to provide care, equity, stewardship and trust, and the procedural value of reason.ConclusionsThis review summarizes available triage protocols and ethical guidelines to provide decision-makers with data to help select and tailor triage tools. Given the uncertainty about how the COVID-19 pandemic will progress and any future pandemics, jurisdictions should prepare by selecting and adapting a triage tool that works best for their circumstances.

Impact of the Programa Mais m\xe9dicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities

BackgroundInvesting in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality.MethodsDifference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008–2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction.ResultsAfter starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of − 1.06 per 100,000 (95%CI: − 1.78 to − 0.34) annually – with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation.ConclusionsPMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.

Restricted care for asylum seekers. An explorative study of rationing practices

Abstract Background Access to health care for refugees in many European countries is initially restricted. In Germany, during the first 18 months after arrival, any health services except for acute needs must be requested on a case-by-case basis. As the procedures and criteria applied by medical and state actors leading to provision or denial of services are intransparent, we explored ways to study them and derived first hypothesis about resource allocation criteria to identify possible factors leading to inequities. Methods A mixed-method-study was carried out, including six weeks of ethnographic exploration in two refugee outpatient clinics, documention of requests, a free-listing task and 20 in-depth interviews with public administrators, health workers, and translators. Results Of 101 requested services, 53 % were granted, 30% denied, 37 % not answered in time. Preliminary qualitative findings show that in dealing with restrictions, medical professionals develop enabling strategies as well as anticipatory obedience, the latter based on speculations about authorities' decision criteria. The effects of observed social classification e.g. of patient's behavior or reasons for migration need further exploration. Interviews suggest that in allocation decisions of authorities, structural and political considerations such as the prospect to remain in Germany, might play a role. Conclusions Procedures and strategies of care provision can be explored ethnographically. We found, that in addition to medical factors, individual, formal, social, structural and political factors might play a role in distribution decisions. Continuous documentation of requests is needed to gain further insights. To ensure equal care for all refugee patients information and training of care providers and officials is necessary as well as exchange between the involved actors. The lack of transparent rationing principles opens up opportunities for discriminiation and should be reduced via open discussion. Key messages Decision making criteria and procedures to grant or deny medical care for asylum seekers in Germany are intransparent and have not been sufficiently studied yet. Heterogenous local implementation of legal regulations – through medical actors and state officials – can lead to health care inequities within vulnerable populations.

Identifying Key Factors Related to the Resource Allocation in the Health Sector of the Iranian Oil Industry: Application of DEMATEL Method

Background: Resource allocation is one of the major challenges of health systems. Various criteria are used to allocate health resources worldwide. Objectives: The current study aimed to identify and prioritize key factors related to the resource allocation in the health sector of the Iranian Oil Industry using the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method. Methods: This cross-sectional case study was conducted in two main phases during 2017. In the first phase, the literature review and interviews with experts (n = 6) were used to identify initial criteria for resource allocation. Then, considering the views of high and middle managers in the health sector of the Iranian Oil Industry, the final criteria were selected. In the second phase, the DEMATEL technique was used to assess the interactions among the selected criteria. Results: A total of nine criteria were entered into the DEMATEL final questionnaire. Criteria were divided into two main groups of influencing and influenced factors. The high-level documents and general policies of the health system (C1), the burden of diseases (C2), the number of population covered (C4), the infrastructure of the covered regions (C5), and population health needs (C8) were among factors that influenced other factors. Factors such as current budget (C3), the expected benefits of people (C6), the expected benefits of policymakers (C7), and the financial returns of the resource allocation (C9) were among the factors that were influenced by other factors. The number of covered population (C4) and the infrastructure of the regions (C5) were not influenced by other factors but could affect other factors. High-level documents (C1) and the burden of diseases (C2) were identified as independent factors. Conclusions: While allocating resources, policymakers should pay particular attention to influencing factors. The number of population covered in each region and the infrastructure available in each region were identified as key and important criteria in the resource allocation process. It is suggested that these factors be considered while allocating resources to different regions of the country.

Do Multilateral Development Bank Trust Funds Allocate Climate Finance Efficiently?

The Paris Agreement has been celebrated as a breakthrough for international climate policy. However, relatively scant attention has been given to the emergent ecosystem of climate finance facilities that support it. We provide an overview of the rising number of climate-related trust funds at multilateral development banks (MDBs). These funds can be distinguished into mitigation funds and adaptation funds. Some funds have a focus on capacity building activities. To maximize their effect on sustainable development, the different types of funds should follow different resource allocation criteria: For adaptation funds, vulnerability should represent the primary criterion. For mitigation funds, the main criterion should be the emission reduction potential. Capacity building should primarily focus on countries with weak institutions. Using a novel dataset of disbursements of climate-related trust funds, available for the World Bank, we examine whether fund allocations correspond to these expectations, and compare them with those of bilateral donors. We find that while trust funds with a focus on mitigation generally allocate aid in line with efficiency considerations, trust funds with a focus on adaptation do not seem to prioritize the countries most strongly in need, contrary to bilateral aid. Furthermore, capacity building activities do not seem to focus on countries with weak institutions. These findings have important implications for the effectiveness and legitimacy of climate aid to developing countries.

A roadmap for a leanness company to emerge as a true lean organization

The problem this work aims to solve is the improvement of the leanness level of a company jeopardized by the lack of lean engagement. The objectives of the research are to present a method based on a lean self-assessment approach, consisted of a qualitative self-assessment method based on lean elements that drives an index definition associated with a roadmap. The method consists in providing a roadmap for the assessed enterprise composed by the company’s lean index, recommendations and countermeasures deriving from Delphi and Kendall Coefficient of Concordance ( W) application among lean experts, leading the assessed enterprise to achieve results in terms of lean engagement, autonomy, and decision support criteria for future resource allocation. The results demonstrated that method can highlight gaps where additional improvements and investments would be necessary in the assessed enterprise. Finally, the study concludes that the lean performance identification associated to a lean roadmap in a company can be a highly effective tool to improve lean adoption in a leanness organization.