Purpose -The purpose of this paper is to discuss the current state of implementation of Lean production in healthcare. The study focuses on Lean definition in healthcare, implementation process, barriers, challenges, enablers and outcomes of implementing lean production methods in healthcare.Design/methodology/approach -A comprehensive search of the literature concerning the implementation of Lean production in healthcare was used to generate a synthesis of the literature around the chosen research questions.Findings -Lean production in healthcare is mostly used as a process improvement approach and focuses on three main areas: defining value from the patient point of view, mapping value streams and eliminating waste in an attempt to create continuous flow. Value Stream Mapping is the most frequently applied Lean tool in healthcare. The usual implementation steps include conducting Lean training, initiating pilot projects and implementing improvements using interdisciplinary teams.One of the barriers is lack of educators and consultants who have their roots in the healthcare sector and can provide support by sharing experience and giving examples from real-life applications of Lean in healthcare. The enablers of Lean in healthcare seem not to be different from enablers of any other change initiative. The outcomes can be divided into two broad areas: the performance of the healthcare system and the development of employees and work environment.

ISO 14000 is based on the concept that better environmental performance can be achieved when environmental aspects are systematically identified and managed. Despite the growing interest in voluntary environmental management standards, little empirical information exists and only a few survey studies have been made. This paper contains an evaluation of results from a survey on ISO 14000 and ISO 9000 companies. The study presents experiences from the standards implementation processes in Sweden. It focuses on motives for implementation, perceived benefits and key implementation factors. Further, comparisons are made between ISO 14000 and ISO 9000 systems. Swedish companies mainly use the standard to demonstrate their commitment to environmental protection. Most benefits are also perceived in the improved relations with stakeholders and in marketing advantages. Since the standard requires companies to set their environmental policy and objectives themselves, the identification of environmental aspects was stated as most important and also as the factor requiring most effort. Organizations require their suppliers to implement ISO 9000 to a greater extent than ISO 14000.

Purpose -This article aims to contribute towards a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations.Design/methodology/approach -The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data was collected by methods including interviews, observations, and document studies. Findings -The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers.Practical implications -Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance.Originality/value -In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

The aim of this paper is to contribute to a better understanding of managerial practices and leadership in Lean organisations. The results presented here are based on five case studies. The manager's role changed radically with the implementation of Lean production. The focus in managerial tasks changed from managing processes to developing and coaching people. Supporting structures were developed to empower employees and give them more responsibility for daily management activities. These supporting structures included visual control, goal deployment, short daily meetings, two-way communication flow, and a system of continuous improvement. Many leadership behaviours exhibited by Lean managers can be classified as transformational leadership behaviours. However, the need for transformational leadership behaviours was smaller, if the supporting management structure was strong

Purpose -The purpose of this study is to develop and evaluate a model for patient co-creation and learning based on diaries for use in health-care service development. In particular, the study aims to investigate the process of patient co-creation and different mechanisms through which health-care service providers can learn from the patient. Design/methodology/approach -The study is based on an action research approach. First, a development phase for patient co-creation and learning leading to a proposed model was conducted. Second, a test phase of the diary-based method was performed on 53 patients in three cases: orthopaedic care, rehabilitation care and gastroenterology care. Findings -The study suggests a model for co-creation and learning in health-care service development through three learning methods. First, the model may be used as a means for generating and collecting patient ideas; second, a single patient's story can be illustrated and can serve as incentive for health-care service development and creation of patient-centred care; finally, a larger number of diaries can be analysed and combined with patient surveys to provide a deeper understanding of how the patient experiences health care services. Originality/value -This study extends the research on diary-based methods as an operationalisation of co-creation in two ways. First, the study offers new and more diverse ways of using the rich material provided by customer diaries in the development of services. Second, the study suggests a co-creation approach of involving patients in health-care service development through patient diaries.