Lean Initiatives Research Articles

Transforming the Patient Experience through Lean Initiatives: Improving Care for Our Brachytherapy Patients

Transforming the Patient Experience through Lean Initiatives: Improving Care for Our Brachytherapy Patients

The integration of lean, green and best practice business principles

Background: Whilst there are separate streams of established research on lean, green and best practice initiatives, the intersection of these three strategic principles has not been addressed extensively in the past.Objectives: In this study a framework to integrate lean, green and best practice principles into an integrated business model was developed as a strategy for businesses to develop sustainable competitive advantages.Method: A descriptive case study was conducted on Toyota South Africa Motors (TSAM) to understand whether a clear link between the company’s environmental approach, lean principles and established best practice culture could be determined. In addition, the case study tested the view that the implementation of these three principles concurrently resulted in improved business results.Results: The main findings of the study revealed that TSAM’s commitment to lean, green and best practice business principles contributed and was directly linked to its business success in terms of sales and market position.Conclusion: It is recommended that businesses implement an integrated lean, green and best practice business model as a strategy to reduce costs and sustainably enhance profitably and competitiveness.

The rhetoric and reality of Lean: a multiple case study

In this paper, we analyse the similarities and differences between the descriptions of Lean found in the extant literature and how it is applied in practice. Using a multiple case study with seven cases from different sectors, we offer seven propositions about Lean as applied in reality and its relation to descriptions in literature. Our results indicate that organisations adopt the general rhetoric, and repeat the message conveyed by Lean proponents, in terms of the rationale for, and expected outcomes of, applying Lean. Furthermore, we see that the decision to implement Lean often precedes the identification of problems in the organisation, which causes a risk of an unfocused change process. Lean initiatives also tend to have a rather narrow scope, which contradicts the holistic view advocated in the literature. This, together with the variation in operationalisation, makes it difficult to predict the outcomes of a Lean initiative. Our study suggests that our findings do not depend on organisation size, sector or industry.

Inclusive versus exclusive learning: the secret ingredient to creating a truly “lean” and “learning” culture

Purpose – The purpose of this paper is a first-hand study of lean improvement programs that has led the authors to distinguish two different forms of learning intent: exclusive learning versus inclusive learning. These two forms of learning reflect two different attitudes to learning. With exclusive learning, the executives expect to learn by themselves and then apply this learning to the organization – and then reap the benefits. With inclusive learning, the executives intend to learn with others and from their own learning efforts – and share the benefits. The authors argue that these learning attitudes account for a large part of the difference between the success and failure of lean initiatives. Design/methodology/approach – The paper is based on over 25 years of research studying Toyota – where the term “lean” was first used to describe their particular way of working – together with working with hundreds of other organizations around the world across all sectors. Findings – To implement a lean strategy that brings long-term, effective change requires senior executives to start with their own personal learning journey and to create an inclusive learning culture within their organization. Originality/value – The paper provides a succinct summary of how a different mindset is required from senior executives if they are to create and implement a truly lean strategy for their organization. Their behaviors enable or inhibit what the authors describe as an “inclusive” learning environment which will create and maintain a sustainable shift to a lean culture.

Productivity improvement through lean initiative in a surgical equipment manufacturing company: a case study

The paper presents a case study conducted at a surgical equipment manufacturing company, where productivity improvement can be achieved by reducing the lead time required to manufacture their product. Using an important lean tool value stream mapping (VSM) the various wastes that are held up at each stage of manufacturing is identified, from which the most critical waste has been selected using a cost-time profile (CTP). Then a model is developed and solved using regression analysis. Based on the values obtained a cost-time profile is drawn again and compared, which reveals that there is nearly a 50% increase in the overall productivity.

The critical success factors for successful lean implementation in hospitals

Lean initiatives have been widely used to improve productivity. Several factors should be addressed while implementing lean initiatives in hospitals. In the present work, critical success factors (CSFs) of lean implementation in hospitals were investigated. Published lean CSFs were reviewed and grouped into five categories, i.e., strategic orientation, organisation culture, management system, implementation process, and implementation team. The contribution of the proposed model is twofold: 1) it demonstrates the critical success factors of lean implementation in hospital services; 2) it investigates CSF effects on lean success via structural equation modelling (SEM). The results explore and demonstrate evidence for significant relationships between those factors and lean success which support the proposed hypotheses. The findings are discussed and further researches are offered.

Review of 5S methodology and its contributions towards manufacturing performance

The paper systematically categorises the literature on 5S and presents a systematic review of literature methodically. The literature on classification of 5S has so far been very limited. The paper presents an overview of 5S implementation practices adopted by the manufacturing organisations and also highlights the contributions of 5S initiatives towards improving manufacturing performance. The paper reveals the important issues in 5S ranging from maintenance techniques, framework of 5S, the relationship of 5S with lean manufacturing initiatives, barriers and success factors in 5S implementation, etc. The contributions of strategic 5S programme towards improving manufacturing competencies of the organisations have also been highlighted. The paper highlights the significant enablers and success factors for eliminating barriers in successful 5S implementation. The study will be useful to industry professionals and researchers both and others concerned with organisation management to understand the significance of 5S and its contributions towards manufacturing performance.

Application of Value Stream Mapping in Pump Assembly Process: A Case Study

Over the decade, there has been increasing interest in the leaner and more responsive operations along with reduction in Cycle time to improve performance across the entire business network. “Process Improvement” means making things better. However, when we engage in true process improvement, we seek to learn what causes things to happen in a process and to use better technology to reduce product variation, remove activities that contribute no value to the product or service produced, and improve customer satisfaction. To examine all of the factors affecting the process in related with men, machine and materials are main responsible for the transformation of materials in to a product or service. Lean manufacturing is originated and developed in Japan which is considered as a business strategy to reduce and eliminate wastes occurred during manufacturing process, thus it leads to improve the productivity by giving quality products with higher accuracy especially for small and medium scale enterprises (SMEs) To implementing lean approach, VSM (value stream mapping) and kaizen principles are most effective in nature among all other lean practices. In this research work, a case study on implementing VSM and kaizen as the lean manufacturing initiative is clearly reported. And the same lean tools are implemented in pump assembly of medium scale enterprises to identify and reduce the wastes during this case study. Here initially process path is visualized by drawn current value stream mapping (CVSM), after tracking the entire process wastes affecting the cycle time are identified and analyzed. In the next stage, the application of Kaizen principle to reduce the wastes in the process, then future state map is developed to analyze the previous cause for the waste development. This capability will definitely enable the considering enterprise to achieve cycle time reduction, competitive strength and productivity.

Pain Outcomes in a US Children's Hospital: A Prospective Cross-Sectional Survey.

Pain in hospitalized children may be underrecognized and undertreated. The objective of this survey was to benchmark pain prevalence, intensity, assessment, and pharmacologic as well as integrative treatment of pain in inpatients in a US children's hospital. This was a single-day, cross-sectional survey and electronic medical record review of inpatients who received medical care at a pediatric hospital. Inpatients and emergency department patients were asked to report their experience with pain and its management during the previous 24 hours. Of 279 inpatients listed on the morning census, 178 children and parents were located and completed the survey. Seventy-six percent had experienced pain during the previous 24 hours, usually acute or procedural pain, 12% of whom possibly suffered from chronic pain. Twenty percent of all children surveyed experienced moderate and 30% severe pain in that time period. The worst pain reported by patients was caused by needle pokes (40%), followed by trauma/injury (34%). Children and their parents rated 5 integrative, nonpharmacologic modalities as more effective than medications. Pain assessments and management were documented in the medical record for 58% of patients covering the 24-hour period before the morning census. The most commonly prescribed analgesics were acetaminophen, morphine, and ibuprofen. Despite existing hospital policies and a pain consult team, significant room for improvement in pain management was identified. A hospital-wide, 3-year Lean quality improvement initiative on reducing pain was commenced as a result of this survey.

Relationship between lean and safety

To remain profitable, organisations must continue to lower costs while maintaining quality and productivity. Many companies have turned to the lean philosophy for help in achieving this goal. The basic principle of lean is to identify and eliminate all forms of waste. During the focus on lean implementation there is a potential of introducing hazards and changing a process in ways that can result in non-compliance of health and safety regulations. The relationship between lean and safety is not clear; however, they should work in harmony. Money and time spent on accidents and workers' compensation is classified as a waste, which is something that should be avoided based on the lean philosophy. Both lean and safety should have the common goal of reducing accidents and minimising hazards. If lean and safety issues are addressed simultaneously, the result is a more productive and safe working environment. However, anecdotal evidence shows that changes are made to improve productivity at the expense of safety during lean implementation. An online survey was conducted to gauge the affects of lean initiatives on safety. The results show a positive relationship with significant room for improvement. Based on the survey findings, recommendations for improvement are also presented.

Lean Healthcare and Ontario Case Costing - An Examination of Strategic Change and Management Control Systems

In this paper we examine how two different strategic changes influence the Management Control Systems in six Ontario based hospitals. These changes are: 1. new funding regimes based on Ontario Case Costing and, 2. Lean Healthcare initiatives in Ontario Hospitals.The Ontario Case Costing (OCC) approach is based on the traditional MAS assumption that more accurate costs will lead to lower costs through better management decisions of some sort. In contrast, Lean Healthcare is premised on the assumption that the primary path to better performance is realized by individual employees, who serve as the leading actors in a daily process of waste removal and efficiency improvement.Based on the MA literature and on information about both the OCC and Lean Healthcare initiatives, we expect there to be significant frictions inside the financial management staff as well as between the Lean initiative and the financial management staff related to the OCC mandate. This study examines this set of interactions to learn how these issues impact the employees involved. In particular, the Ontario context allows us to examine the variety of responses to the interaction of Lean healthcare strategy and a traditional MAS such as OCC.We find that the MASs of hospitals in our sample are too loosely coupled to develop the frictions indicated by traditional MAS theory and propose modifications in application of the theory to accommodate this observation.

Investigating lean and green supply chain linkages through a balanced scorecard framework

This paper investigates how to evaluate lean and green supply chain performance through a traditional Balanced Scorecard (BSC). To attain the paper's objective, in a first stage a literature review was carried out to provide a comprehensive understanding of how lean and green can be compatible in a supply chain, how the performance should be evaluated, and how the BSC can evaluate the lean and green supply chain performance. Next, a conceptual framework was developed to investigate how lean and green initiatives can affect supply chain performance. A causal diagram was used to represent the relationships between each lean and green measure through the traditional four BSC perspectives: financial, customer, internal business process and learning and growth. It is possible to recognize that lean and green initiatives influence the linkages between performance measures. These linkages were established by anecdotal evidence derived from the literature review; they are an example of how to evaluate the organization's supply chain. The proposed diagram can be the basis for further research in lean and green supply chain performance. To the author's knowledge, this study is the first to attempt to understand how to apply BSCs to evaluate the integration of lean and green paradigms on supply chain performance.

Lean Cooperation: A Framework

<p><em>While both concepts lean management and cooperation not only have received considerable attention in management literature but also have been combined e.g. in the field of supply chain literature, a comprehensive definition of lean cooperation is still missing. Whereas lean supply chain cooperation is only one aspect in a growing field, we aim at considering further forms of cooperation coming up and having consequences for the management of lean initiatives. </em><em></em></p> <p><em>Based on an extensive literature review, we develop a framework addressing lean cooperation and thus, allowing for systematization. Furthermore we find out that current literature mainly focusses on lean cooperation along the supply chain. This paper presents other forms of cooperation focused on lean management. With a case study of lean cooperation within an industry cluster we will show the potential of knowledge-transfer on lean practices for individual firm´s implementation. </em><em></em></p> <p><em>This paper provides a definition and a research framework for lean cooperation. Insights will be useful for further analysis of lean management roll-out within outlined forms of cooperation. Practitioners will learn about benefits and restrictions of lean cooperation. The paper also is of value for researchers giving a structured outline of lean cooperation and stating fields for further research.</em></p>

Design and implementation of a Drum-Buffer-Rope pull-system

Purpose: This paper investigates the selection, design and implementation of a Drum-Buffer-Rope (DBR) type of production pull-system in a panel fabrication plant characterised by extensive shared, batch resource resources within a low volume UK manufacturer of large vehicles. This was the second of a series of two related research projects conducted under the aegis of a Lean initiative at this case firm.Design/methodology/approach: A purposively selected longitudinal case study conducted over 24 months and organised around a two phase research design. The initial body of evidence included a detailed map constructed by a project team of eight managers and accountants during a two day structured workshop; numerous unstructured interviews and observation of shop floor practices; document and archival analysis, and 140 photographs of the focal operation. Supplemented by extensive financial and operational data extracted from the firm’s accounting and MRP systems, including all data necessary to construct and implement bespoke capacity planning, work in progress (WIP) monitoring and simulation modelling tools. The case firm is anonymised.Findings: The Lean manufacturing literature ignores the real-world issue of shared resources, and this gap is attributable to the concept of ‘rightsizing’ tools and equipment that is widely promoted within the Lean community. The case panel plant is characterised by extensive shared resources; many of which are also batch processes. The most appropriate pull-system method for this production environment is DBR. The detailed design of the DBR mechanism required a controlled transfer buffer of overhead conveyance capacity after the Drum because the extent of downstream process variability risked it being unable to offload panels, hence compromising throughput.Research limitations/implications: The study is based upon a single case. This consequently has implications for the ability to generalise from the results.Practical Implications: When the DBR pull-system design was implemented it reduced the number of panels in WIP by 60%. This equated to a 56% (18 days worth) reduction of manufacturing lead time and more than doubled the plant’s inventory turns (from 9.1 to 21.2). It also significantly improved delivery schedule adherence, with downstream jig stoppages in the Final Assembly falling from an average of six to less than one per week. The financial benefit was independently audited to equate to an annualised value of $850 K. Consequently, this project was awarded the first prize at its parent enterprise’s annual worldwide process improvement competition.Originality/value: This paper details a novel technique that permits the routings of multiple value streams to be mapped and is useful for highlighting the identity and location of shared resources. It also contributes significantly to the literature that is available on the relationship between the Lean paradigm and the management of shared production resources, and adds to the literature on the detailed design and implementation of a DBR pull-system in a jobbing-type of environment.

Performance evaluation of lean manufacturing implementation in Brazil

Purpose – Manufacturing companies worldwide have been replacing traditional mass-production practices by lean initiatives. This translation process is progressive and may vary depending on several factors. Hence, it could be expected that the degree of adoption of the lean practices could vary significantly among industries, regions and even countries. The purpose of this paper is to explore the implementation performance of lean principles in Brazil, the paper developed a survey in the Sao Paulo Metropolitan Area, which considered 51 industries of different sizes, from several industrial segments, nationals and multinationals. Design/methodology/approach – The proposed survey was developed using as a normative framework the SAE J4000 standard – identification and measurement of the best practice in implementation of lean operation and the SAE J4001 – implementation of lean operation user manual. To measure the implementation degree of the lean practices in the researched industries, the paper proposed the utilization of two concepts: the degree of leanness (DOL) of an element of J4000 and DOL of a company. Also three hypotheses were tested, trying to establish the relationship among the DOL and firm ownership, their size and respective industrial sector. Findings – The results obtained in the survey demonstrated that the performance of lean initiative implementation is not uniform among the companies located in the researched area. Outcomes also showed that the degree of implementation of the lean practices by multinational companies was higher than that for the national firms. However, it was not possible to establish a relationship between the DOL and the size of the firms. Neither a clear and definite association between DOL and industrial sector was possible to be identified. Practical implications – For the practitioners and managers dealing with the lean implementation, this paper gives a relevant contribution because it shows how they can effectively use an existing tool to measure the implementation of the lean practices in their respective firms. Furthermore, the DOL calculation for each individual element of the J4000 standard could also be used by practitioners and managers to identify specific problems and opportunity areas where practical actions could be identified to improve the lean implementation. Originality/value – This paper contributes to the lean manufacturing theory because it proposes a theoretical way to measure the degree of implementation of the lean initiatives in the manufacturing companies. Also the survey results generate additional research material that could be used by other researchers to further explore the subject in the area.

TH‐C‐9A‐01: Lean Tools and Methods

Lean thinking has revolutionized the manufacturing industry. Toyota has pioneered and leveraged this aspect of Lean thinking. Application of Lean thinking and Lean Six Sigma techniques into Healthcare and in particular in Radiation Oncology has its merits and challenges. To improve quality, safety and patient satisfaction with available resources or reducing cost in terms of time, staff and resources is demands of today's healthcare. Radiation oncology treatment involves many processes and steps, identifying and removing the non‐value added steps in a process can significantly improve the efficiency. Real projects undertaken in radiation oncology department in cutting down the procedure time for MRI guided brachytherapy to 40% less using lean thinking will be narrated. Simple Lean tools and techniques such as Gemba walk, visual control, daily huddles, standard work, value stream mapping, error‐proofing, etc. can be applied with existing resources and how that improved the operation in a Radiation Oncology department's two year experience will be discussed. Lean thinking focuses on identifying and solving the root‐cause of a problem by asking “Why” and not “Who” and this requires a culture change of no blame. Role of leadership in building lean culture, employee empowerment and trains and develops lean thinkers will be presented. Why Lean initiatives fail and how to implement lean successfully in your clinic will be discussed.Learning Objectives: Concepts of lean management or lean thinking. Lean tools and techniques applied in Radiation Oncology. Implement no blame culture and focus on system and processes. Leadership role in implementing lean culture. Challenges for Lean thinking in healthcare

Readiness factors for lean implementation in healthcare settings--a literature review.

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.

Lean Manufacturing Initiatives: Are Small & Medium Enterprises Missing Out?

The purpose of this research study is to analyze the factors that prevent small and medium size enterprises from implementing lean manufacturing processes and show, that by not implementing lean they are missing out on savings, efficient workforce, and new markets in the globalization arena. Globalization offers opportunities that have not been realized by SME’s yet still pose challenges and barriers that can be overcome by adoption and implementation of lean manufacturing.

Lean Methodology Improves Efficiency in Outpatient Academic Uro-oncology Clinics

To determine if lean methodology, an industrial engineering tool developed to optimize manufacturing efficiency, can successfully be applied to improve efficiencies and quality of care in a hospital-based high-volume uro-oncology clinic. Before the lean initiative, baseline data were collected on patient volumes, wait times, cycle times (patient arrival to discharge), nursing assessment time, patient teaching, and physician ergonomics (via spaghetti diagram). Value stream analysis and a rapid improvement event were carried out, and significant changes were made to patient check-in, work areas, and nursing face time. Follow-up data were obtained at 30, 60, and 90 days. The Student t test was used for analysis to compare performance metrics with baseline. The median cycle time before the lean initiative was 46 minutes. This remained stable at 46 minutes at 30 days but improved to 35 minutes at 60 days and 41 minutes at 90 days. Shorter wait times allowed for increased nursing and physician face time. The average length of the physician assessment increased from 7.5 minutes at baseline to 10.6 minutes at 90 days. The average proportion of value-added time compared with the entire clinic visit increased from 30.6% at baseline to 66.3% at 90 days. Using lean methodology, we were able to shorten the patient cycle time and the time to initial assessment as well as integrate both an initial registered nurse assessment and registered nurse teaching to each visit. Lean methodology can effectively be applied to improve efficiency and patient care in an academic outpatient uro-oncology clinic setting.

Commentary: The Role of the Clinical Laboratory in the Future of Health Care: Lean Microbiology

This commentary will introduce lean concepts into the clinical microbiology laboratory. The practice of lean in the clinical microbiology laboratory can remove waste, increase efficiency, and reduce costs. Lean, Six Sigma, and other such management initiatives are useful tools and can provide dividends but must be accompanied by organizational leadership commitment to sustaining the lean culture in the laboratory setting and providing resources and time to work through the process.