Lean Efforts Research Articles

SYSTEMATIC LITERATURE REVIEW: LEAN ERGONOMICS ANALYSIS IN SMALL & MEDIUM ENTERPRISES (SMEs) MANUFACTURING SECTOR

Ergonomics has emerged as a significant workplace issue, negatively impacting finances due to worker absence and reduced productivity. Small and Medium Enterprises (SMEs) are particularly prone to occupational accidents, contributing to over 80% of such incidents. This review delves into the perspective of lean ergonomics within SMEs. The study followed a structured review protocol,formulating research questions and systematically searching the Scopus and WoS databases. The findings reveal several key points: (1) SMEs commonly implement ergonomics principles addressing awkward postures, repetitive movements, manual material handling, hand-wrist postures, excessive reach, grip strength, and prolonged standing; (2) Lean principles such as SMED, 5S, standardized work,TPM, VSM, and kanban positively impact ergonomics; (3) Various ergonomics assessment methods, including REBA, RULA, HFE, JSI, KIM, OCRA, and Shoaf’s model, are recommended for future research and practical application; (4) Ergonomics can underpin lean transformation efforts, with Lean Manufacturing (LM) contributing to reduced ergonomics risks. However, the review identified alimitation in the scope of databases used (WoS and Scopus), suggesting that expanding the range of databases and research keywords could improve future article searches. The study's primary focus serves as a reference point for future researchers and manufacturers interested in lean ergonomics, emphasizing the need for comprehensive approaches to enhance worker safety and productivity through ergonomic and lean practices.

Performance analysis of supply chain for construction materials at high rise building project based on Supply Chain Operations Reference Method: A case study

Abstract Supply chain management is an approach to implementing lean construction efforts to minimize construction project problems, such as cost overruns, project delays, and disputes. Implementation of supply chain management is necessary, especially in the procurement of materials. However, there is a need to measure performance during the implementation. Results of measurement can show the extent to which the project operates and use it as a benchmark to determine the end impact of a project. This study’s purpose is to measure of supply chain performance with the supply chain operation reference (SCOR) method and use the analytical hierarchy process (AHP). Compile data using an observation with scoring form based on standards adoption, categories, and SCOR metrics through key performance indicators (KPI) and structured interviews with the contractor to validate. Limited to the study is the supply chain of ready-mix concrete materials. The AHP method give the weight of the output value of the KPI. The results of the KPI measurements from the contractor’s perspective are that one indicator is still at a low value, which is a cycle time for fulfilling orders. An overall result of 84.83 from the measurement KPI suggests a “good” performance category.

Guiding the Lean Design of a Hospital's New Laboratory: A Case Study.

To present the process used by a clinical laboratory to guide the design of their new facility, part of a major campus expansion at a pediatric hospital. The primary objective was to generate information about arrangement and allocation of laboratory space and functional flows in the early phases of the expansion project. Seattle Children's Hospital has increased the capacity of their primary campus in response to growing demand for specialized services. The clinical laboratory was identified as one of the functional groups that would move their operations to the new building. The clinical laboratory team agreed on a three-stage process to guide the development of their initial design specifications: formulate the concept, develop design alternatives, and evaluate those alternatives. The different tasks were executed successfully. The process defined-based on Plan, Do, Check, Act (PDCA)-provided a context for collaboration among sections of the clinical laboratory, reducing silo thinking, so common in the specialized sections within a large clinical laboratory. The process was developed to guide the lean design efforts, even when initial space and location parameters had not yet been decided and was sufficiently flexible to accommodate changes in the project constraints and emergent information generated by the concurrent design activities of other hospital functional groups to be included in the campus expansion. The three-stage process allowed the team to review each laboratory section's complexity, create multiple conceptual designs for review, and ultimately increase the likelihood of an efficient physical configuration that would satisfy a diverse group of stakeholders.

Critical Success Factors of Lean Implementation in the Construction Industry

Lean implementation aims to maximize customer satisfaction while minimizing waste. However, the Lean philosophy has not yet been well understood in the construction industry due to complex and dynamic nature of construction projects. Even though Lean efforts in construction have recently gained popularity, there are still problems with the implementation processes. Therefore, it is essential to identify critical success factors (CSFs) in Lean implementation for conducting projects more effectively. Due to lack of studies in revealing CSFs in Lean implementation and the need for an up-to-date Lean implementation roadmap, this article provides an extensive set of CSFs for construction practitioners to benefit in their projects. Within this context, 27 variables were identified through an in-depth literature review. Moreover, a survey is designed and given to Lean practitioners to rank the variables based on their importance. The findings of the survey indicate that management commitment is ranked as the most important driver of Lean implementation, whereas the supportive nature of governmental regulations in Lean is ranked as the least important. A factor analysis of CSFs result in six factor groups, namely motivational factors, project factors, strategic and policy factors, company factors, technical factors, and workforce and resource factors.

A preliminary framework for assessing lean implementation in higher education

PurposeThis study aims to develop and implement an initial framework for assessing progress in lean implementation within an higher education institution (HEI). It includes developing preliminary findings regarding the impacts of lean implementation in the HEI case organization and comparing outcomes from this assessment to outcomes from other published sources.Design/methodology/approachExisting literature on lean, particularly in an HEI context, was used to develop a preliminary lean assessment framework for HEIs. Quality and continuous improvement literature were also compared to the proposed assessment framework to further validate the approach. This assessment framework was then utilized to evaluate lean implementation at a large public university (LPU) in the U.S.FindingsThe paper presents the framework as well as the major findings from the Large Public University (LPU)’s assessment. The assessment findings are further compared to other HEI quality measures and lean assessments done in other industries. Overall, the findings suggest that the assessment framework provides valuable insight to HEI organizations implementing lean.Originality/valueThe research intends to support lean assessment standardization efforts by proposing a preliminary lean assessment framework for the HEI, grounded in research trends, research findings, identified gaps in the research, and case study outcomes. To the research team's knowledge, this is the first lean assessment framework proposed for HEIs and also contributes to research gaps related to service industry frameworks and those containing both practices and outcomes. The framework can be used by other researchers as a foundation for additional conceptual and empirical developments on the topic and by researchers and practitioners seeking to understand and assess lean implementation progress in the HEI.

Using Programme Theory to evaluate Lean interventions in healthcare

Lean in healthcare has continued to attract practitioner and research interest over the past two decades yet lacks evidence of sustained application. This longitudinal case study examines Lean healthcare interventions through the lens of Programme Theory, to provide an understanding of the design and implementation of a Lean programme. Through a qualitative single case study of an NHS organisation implementing Lean, content analysis of 70 reports from a 6-year period was undertaken and supported by interview data from 12 respondents involved in Lean initiatives. Through Programme Theory, we identify contextual moderators, internal and external, informing the design and development of Lean efforts. The key to successful and sustained Lean efforts is staff acceptance of the Programme Theory for delivering and maintaining outcomes. This has been identified as a key social determinant for Lean sustainability. Results from the research provide practical implications for designing a programme that accommodates resource challenges while incorporating multiple contextual drivers. The case study highlights an organisation’s Lean journey and the best practices that evolved; however, further longitudinal investigations are required to validate the findings.

Context of Digital Divide in the New Normal: Implication for the Schools of the Future

Digital divide becomes a vital and salient term in the field of education especially in this time of pandemic. Reviewed studies revealed a dearth of studies on the context of digital divide brought the paradigm shift in education during the new normal education. In such light, this case study was conducted to describe what it is like to be learning using the new learning modalities amidst the digital divide that the pandemic has brought to the learners and the teachers. In achieving this objective, the researchers interviewed six (6) students followed by member checking procedures. The cool and warm analyses of interview transcripts revealed their challenges, coping mechanisms, and views on the new learning modalities amidst the digital divide they are facing. The challenges are lack of digital skills, lack of devices, and lagging to poor internet connection. To cope with these challenges, they employ the two L’s: look of assistance and lean efforts in learning. With these challenges and coping, they view learning in the new normal as difficult and technology-driven. This study concludes that students remain steadfast and determined in learning despite being confronted with the challenges in the light of the digital divide during the new normal education. As such, studies should be conducted to formulate an intervention program that shall address the challenges of the students in the new normal learning and beyond.

Engaging Patients in the Veterans Health Administration's Lean Enterprise Transformation: A Qualitative Study.

Lean management is a strategy for improving health care experiences of patients. While best practices for engaging patients in quality improvement have solidified in recent years, few reports specifically address patient engagement in Lean activities. This study examines the benefits and challenges of incorporating patient engagement strategies into the Veterans Health Administration's (VA) Lean transformation. We conducted a multisite, mixed-methods evaluation of Lean deployment at 10 VA medical facilities, including 227 semistructured interviews with stakeholders, including patients. Interviewees noted that a patient-engaged Lean approach is mutually beneficial to patients and health care employees. Benefits included understanding the veteran's point of view, uncovering inefficient aspects of care processes, improved employee participation in Lean events, increased transparency, and improved reputation for the organization. Challenges included a need for focused time and resources to optimize veteran participation, difficulty recruiting a diverse group of veteran stakeholders, and a lack of specific instructions to encourage meaningful participation of veterans. As the first study to focus on patient engagement in Lean transformation efforts at the VA, this study highlights ways to effectively partner with patients in Lean-based improvement efforts. Lessons learned may also help optimize patient input into quality improvement more generally.

Lean implementation in healthcare: offsetting Physicians’ resistance to change

Physicians’ resistance towards Lean is often viewed as an important barrier to its successful implementation in healthcare organisations. However, there exists a dearth of knowledge regarding what influences reactions from physicians towards Lean and what organisations can do about it. This study adopts a behavioural perspective and focuses on the triggers of physicians’ resistance towards Lean. Using longitudinal qualitative data from multiple case studies of Canadian hospitals, 15 behavioural triggers are identified. A cross-case analysis reveals that core-technical and efficiency-driven changes clash with medical professionalism and generate active resistance from physicians, while leadership and familiarity with Lean are linked to championing behaviours that mitigate it. This study provides a deeper understanding of physicians’ behaviours during Lean transformations and the factors that drive resistance. It also provides insight into how organisations can better engage their medical staff in their Lean efforts by focussing on the process of change to offset resistance.

COMPLEMENTS OR CONFLICTS: R&D AND LEAN INNOVATION APPROACHES

The purpose of this research is to explore the relationship between research and development (R&D)-funded innovation efforts and operational-level lean improvement efforts through the lens of the Resource-Based View (RBV), with a focus on the relationship between them. Does the “leaning” of a firm’s operations create barriers to change and inhibit the success of R&D-led innovation investment? Or, does the “leaning” of operations help organisations focus on priorities and simplify routines so that new R&D efforts are more effective? Our analysis of more than 850 firm-years’ worth of data showed that the relationship between lean and R&D productivity is nonlinear, specifically an inverted U-shape (concave). Leanness provides some early R&D productivity improvement benefits, but R&D productivity levelled then declined over time. In a follow-up industry-level analysis, we found that the effects of leanness on firm-level R&D productivity differed by industry, with some industries seeing evidence of positive effects from lean practices and others experiencing negative effects on R&D productivity from lean.

A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on sustainability of a lean intervention in pediatric healthcare

BackgroundIn 2012, the Saskatchewan Ministry for Health mandated a system-wide Lean transformation. Research has been conducted on the implementation processes of this system-wide Lean implementation. However, no research has been done on the sustainability of these Lean efforts. We conducted a realist evaluation on the sustainability of Lean in pediatric healthcare. We used the context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic to explain under what contexts, for whom, how and why Lean efforts are sustained or not sustained in pediatric healthcare.MethodsWe employed a case study research design. Guided by a realist evaluation framework, we conducted qualitative realist interviews with various stakeholder groups across four pediatric hospital units ‘cases’ at one acute hospital. Interview data was analyzed using an integrated approach of CMOc categorization coding, CMOc connecting and pattern matching.ResultsWe conducted thirty-two interviews across the four cases. Five CMOcs emerged from our realist interview data. These configurations illustrated a ‘ripple-effect’ from implementation outcomes to contexts for sustainability. Sense-making and staff engagement were prominent mechanisms to the sustainment of Lean efforts. Failure to trigger these mechanisms resulted in resistance. The implementation approach used influenced mechanisms and outcomes for sustainability, more so than Lean itself. Specifically, the language, messaging and training approaches used triggered mechanisms of innovation fatigue, poor ‘sense-making’ and a lack of engagement for frontline staff. The mandated, top-down, externally led nature of implementation and lack of customization to context served as potential pitfalls. Overall, there was variation between leadership and frontline staff’s perceptions on how embedded Lean was in their contexts, and the degree to which participants supported Lean sustainability.ConclusionsThis research illuminates important contextual factors and mechanisms to the process of Lean sustainment that can be applicable to those implementing systems changes. Future work is needed to continue to develop the science on the sustainability of interventions for healthcare improvement.

Understanding Determinants of Sustainability Through a Realist Investigation of a Large-Scale Quality Improvement Initiative (Lean): A Refined Program Theory.

Implementation science research seeks to understand ways to best ensure uptake of research-based initiatives to health care; however, there is little research done on how to sustain such efforts. Sustainability is the degree to which an initiative continues to be used in practice after efforts of implementation have ended. Sustainability research is a growing field of implementation science that needs further research to understand how to predict and measure the long-term use of effective initiatives to improve health care. The question of what influences the sustainability of research-based initiatives to improve health care remains unknown. The purpose of this article was to present a refined program theory on the contextual factors and mechanisms that influence the sustainability of one large-scale quality management initiative (Lean) in pediatric health care. We conducted a multiphase realist investigation to explain under what contexts, for whom, how, and why Lean efforts are sustained or not sustained in pediatric health care through the generation of an explanatory program theory. This article presents the theoretical triangulation of our multiphase realist investigation, resulting in a refined program theory. We integrated the initial program theories (IPTs) from each research phase to form a refined program theory. It involved going back and forth from the initial IPT to the findings from each phase and our middle-range theories and examining the most substantiated IPTs on the contextual factors and mechanisms that influenced the sustainability of Lean efforts. The refined program theory depicts the complex nature to sustaining Lean efforts and that sustainability as a small, often unrepresentative portion of something much larger or more complex that cannot yet be seen or understood. The approach and nature of implementation is critical to shaping contexts for sustainability. Outcomes from implementation become facilitating or hindering contexts for sustainability. Customization to context is an important contextual factor for sustainability. Sense making, value congruency, and staff engagement are critical aspects from early implementation that enable or hinder processes of sustainment. Such mechanisms can trigger staff empowerment that can lead to a greater likelihood of sustainability. These findings have important implications for sustainability research, in understanding the determinants of sustainability of research-based initiatives in health care. It is important to understand and explain determinants of sustainability through theory-driven evaluative research in order to assist key stakeholders in sustaining the effective research-based initiatives made to improve healthcare services, patient care, and outcomes.

Evaluation of critical success factors (CSFs) to lean implementation in SMEs using AHP

PurposeIn an attempt to promote the implementation of lean in small and medium sized enterprises (SMEs), the purpose of this paper is to determine and to evaluate success factors critical to the implementation of lean in SMEs. This will help SMEs to redirect and stepwise strategies for implementing lean and overcome the financial and technical limitations that are hindering smaller companies to address a large set of factors at the same time.Design/methodology/approachThis research proposes the use of a two-phase research methodology. First, 28 critical success factors (CSFs) were identified and grouped into five categories: policy, leadership and management, funding, technic and process, culture, humans and competencies, market, customers and suppliers and understanding, methodology and implementation. Second, a structural model based on the analytical hierarchy process (AHP) was proposed to prioritize the identified CSFs. A practical case study is conducted in a small automotive supplier to validate the proposed model, take inputs and solve the problem under study.FindingsThe results show that CSFs related to “Policy, leadership and management” are found to be the most significant for SMEs to successfully implement lean production. This is followed closely by CSFs from the category of “Understanding, methodology and implementation”. CSFs of “Culture, humans and competencies” and “Funding, technique and process” are the third and fourth prominent categories. At the end of the priority list come CSFs of “Market, customers and suppliers”.Originality/valueThe present study has a twofold contribution that complete the existing literature. First, the study is focused on small companies which have not received sufficient attention. Second, it provides a more accurate, effective and systematic decision support tool for selecting the most prominent CSFs to redirect lean efforts in SMEs in a stepwise manner.

Transferring lean knowledge within multinational networks

Transferring lean knowledge is crucial for multinational companies; however, it is very difficult. Nevertheless, our knowledge in the area is limited. This paper investigates (a) how lean knowledge is transferred within multinational networks and (b) the type of organizational context that supports it. We use four case studies with 18 interviews in our exploratory study. Our results indicate that companies use a sophisticated knowledge transfer system with a fine web of practices that serve to transfer both explicit and tacit knowledge. The revealed organizational contexts show different patterns of division of labour (and responsibilities) between a central lean office and the particular subsidiary’s lean office. Our findings highlight the importance of transfer coalition, which consists of the cooperation of lean experts and top management during the knowledge transfer process. Top managers play a key role with their weak inter-unit ties, and they provide guidance for lean efforts and allocate sufficient resources to them. Further findings show that the evolution of lean transitions is not linear, and each of our case companies has witnessed turnaround during their journey.

Enablers and Barriers of Lean Implementation in Construction Projects

Lean aims to maximize customer satisfaction while minimizing waste. However, Lean philosophy has not been well understood yet in the construction industry for the fact that the complexity and dynamic nature of construction projects bring up uncertainties that may be hardly handled by construction practitioners. Moreover, project-based nature of construction business makes Lean implementation even more challenging for construction people. Even though Lean efforts in construction have recently increased, there are problems with the implementation processes. It is undeniable that successful Lean implementation strongly affects project performance. Therefore, it is essential to reveal enablers and barriers in Lean implementation so that the construction industry practitioners might conduct projects more effectively and satisfy project requirements (i.e. schedule, budget, safety). This study aims to provide a set of core enablers and barriers of Lean implementation in construction projects and guide construction professionals to better satisfy project requirements. Within this context, the study proposes seven major enabler and barrier groups, namely the financial, managerial, technical, workforce, culture, government, and communication and twenty-seven components for each group. Moreover, a survey was designed and administered to Lean practitioners to rank the enablers and barriers based on importance level. Clear understanding of technical requirements in Lean practices was ranked as the most important enabler of Lean implementation whereas lack of top management support was ranked as the most important barrier in the Lean implementation. However, the average rankings were not found to be diverging indicating that selected components of enabler and barrier groups are properly chosen. The study is expected to lead Lean practitioners with creating value to customers while preventing them from experiencing waste.

The sustainability of Lean in pediatric healthcare: a realist review

BackgroundLean is a quality improvement management system from the Toyota manufacturing industry. Since the early 2000’s, Lean has been used as an intervention for healthcare improvement. Lean is intended to reduce costs and improve customer value through continuous improvement. Despite its extensive use, the contextual factors and mechanisms that influence the sustainability of Lean in healthcare have not been well studied. Realist synthesis is one approach to “unpack” the causal explanations of how and why Lean is sustained or not in healthcare. We conducted a realist synthesis using the context (C) + mechanim (M) = outcome (O) heuristic, to further develop and refine an initial program theory with seven CMO hypotheses, on the sustainability of Lean efforts across pediatric healthcare.MethodsOur search strategy was multi-pronged, iterative, and purposeful in nature, consisting of database, gray literature, and contact with three healthcare organizations known for Lean implementation. We included primary research studies, published and unpublished case studies or reports, if they included Lean implementation with a pediatric focus and sustainability outcome. We used the Normalization Process Theory and the National Health Services Sustainability Model, an operational definition for Lean and a comprehensive definition for sustainability as guidance for data extraction and analysis. Our initial program theory with was refined using a blend of abductive and retroductive analytical processes.ResultsWe identified six published primary research studies, two published quality improvement case studies, and three unpublished quality improvement case reports. Five CMO hypotheses from our initial program theory were substantially supported after synthesis, “sense-making and value congruency,” “staff engagement and empowerment,” and the “ripple effect” or causal pathway between Lean implementation outcomes that served as facilitating or hindering contexts for sustainability. Overall, there was variation with the conceptualization and measurement of sustainability.ConclusionsThis study is the first to examine Lean sustainability in pediatric healthcare using realist methods. Future research should examine whether the predictors of implementation are the same or different to sustainability and evaluate the underlying mechanisms that influence the sustainability of Lean. There is also a need for research to develop and test conceptual models and frameworks on sustainability.Systematic review registrationPROSPERO-CRD42015032252.

Critical success factors for Lean implementation in IT outsourcing relationships

PurposeFollowing positive results of Lean implementation in manufacturing environments, Lean has become an emerging philosophy for clients and suppliers of information technology (IT) services. However, how to implement Lean in IT outsourcing relationships has been addressed sparsely in academic literature. The purpose of this paper is to investigate critical success factors (CSFs) for implementing Lean in IT outsourcing relationships. Key findings, implications and avenues for future research are discussed.Design/methodology/approachSix IT outsourcing relationships were qualitatively investigated by means of 36 semi-structured interviews. CSFs were identified based on interview transcription analyses, selection techniques and expert reviews.FindingsIn total, 16 CSFs for Lean implementation in IT outsourcing relationships are identified and described.Practical implicationsThe CSFs presented in this paper indicate key areas that deserve managerial attention to steer Lean implementation efforts in IT outsourcing relationships in a favorable direction.Originality/valueThis study is the first to describe the phenomenon of “Lean IT outsourcing” and provides researchers and practitioners with a foundation to further examine Lean implementation in IT outsourcing relationships.

Validation of qualitative aspects of the Lean Assessment Tool (LAT)

PurposeThe purpose of this paper is to test the reliability and validity of the qualitative section of Lean Assessment Tool (LAT) starting from the point where a reliable and valid tool is needed to measure increasing leanness level of business organizations.Design/methodology/approachThe questionnaire used in this study included the qualitative component of LAT developed by Pakdil and Leonard (2014). The unit of the study was individual employees who work in manufacturing firms participating in this study. This study focused on the data collected from three firms that operate in Turkey and two firms that operate in the USA. The total respondents from Turkish firms were 263 employees, while the 205 employees responded from US firms.FindingsExploratory factor analysis and confirmatory factor analysis were completed to determine valid and reliable factors that compose LAT’s qualitative component. The statistical analysis showed five distinct factors, namely process, delivery, quality, customer satisfaction and human resource. In addition, the fuzzy logic showed appropriate loadings to make the argument for its use in analysis of the LAT.Research limitations/implicationsThis study moves the debate about the success or failure of lean efforts forward. With the debates about lean and its potential, it is necessary to have a scientific determination of success and the areas where further work in the firm is needed. Such measurement is the backbone of management progress, and the authors believe that this paper is useful. Second, the necessity of reliable and valid tools of lean assessment is obvious in the literature and practice. The findings of this study help academicians find reliable and valid tools to measure lean success both in the literature and practice.Practical implicationsManagerial implications include the development of a way to assess the areas of success and areas requiring further work. Failure to measure success and needs for further work has been the reason for the questionable results found in investigating lean implementation efforts. If there is no way to determine what is needed to improve lean efforts, they will be seen as failure, even if part of the implementation has been successful. This tool has been found to be potentially useful for evaluation of these crucial and time-consuming efforts.Originality/valueIn this study, the qualitative section of LAT has been validated. The results demonstrated that, based on two countries’ data sets, the scale was found to be reliable and valid within itself and across sociocultural boundaries.

The relationship between lean manufacturing, environmental damage, and firm performance

Prior research has found mixed results of leanness, with a counter idea being that slack allows flexibility to improve firm financial performance. We first seek to confirm empirically that leanness in manufacturing does in fact contribute to both lower environmental damage and to improve firm financial performance. With increased awareness of global environmental issues, we incorporate environmental damage measures from Trucost to assess how they may affect firm performance and are affected by leanness. The measures of leanness are calculated based on publically available financial data from Compustat. Based on a final sample of 406 manufacturing firms representing 3594 firm-year observations from 2002 to 2013, the proposed relationships of leanness to firm outcomes and environmental damaged are investigated. A key finding of this study is that a firm should aim its lean efforts to reducing environmental damage, which in turn has more of an effect on improving financial performance than other lean initiatives.

Reconstituting lean in healthcare: From waste elimination toward ‘queue-less’ patient-focused care

With ultra-short sightlines to its patient-customers, healthcare should pursue lean in its own way rather than follow the often wayward lean practices of manufacturing, a sector in which few people ever see real customers. Because of the distance in manufacturing from end customers, this sector’s lean practices usually focus inward on operational efficiency through waste elimination. The nature of healthcare—with customers up close and immediate—calls for elevating its lean efforts toward customer-focused lean effectiveness: flexibly quick response along the multiple flow paths leading to and involving patients. This article illustrates that approach to lean by drawing from a case study in which widely scattered heart attack patients were transported to a central treatment hospital in a system-wide, highly coordinated program of quick response. This article shows that the keys to success—including high rates of saving lives and lean healthcare in general—boil down to just five lean methodologies, each focused on quick response. Lean healthcare, when practiced in this way, becomes deserving of status as a fixture in strategic management of the enterprise.