Background In the scientific literature, many studies describe the application of lean methodology in the hospital setting. Most of the articles focus on the results rather than on the approach adopted to introduce the lean methodology. In the absence of a clear view of the context and the introduction strategy, the first steps of the implementation process can take on an empirical, trial and error profile. Such implementation is time-consuming and resource-intensive and affects the adoption of the model at the organizational level. This research aims to outline the role contextual factors and introduction strategy play in supporting the operators introducing lean methodology in a hospital setting. Methodology The methodology is revealed in a case study of an important hospital in Southern Italy, where lean has been successfully introduced through a pilot project in the pathway of cancer patients. The originality of the research is seen in the detailed description of the contextual elements and the introduction strategy. Results The results show significant process improvements and highlight the spontaneous dissemination of the culture of change in the organization and the streamlined adoption at the micro level. Conclusion The case study shows the importance of the lean introduction strategy and contextual factors for successful lean implementation. Furthermore, it shows how both factors influence each other, underlining the dynamism of the organizational system.

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During the last decades, academic spin-offs have received increasing attention from both researchers and practitioners, mainly due to their ability to advance industrial application of scientific knowledge. In the past, scholars believed that these organisations were subjected to fast growth after their establishment. Only in the last decade, scholars realise that the fast-growing perspective hypothesised was an oversimplification, as the majority of high-tech academic spin-offs growth slowly or remain small in size for long time. The aim of our study is to investigate the reasons that inhibit the growth of established academic spin-offs, focusing on the Italian context. Through the implementation of the Delphi technique and of the fuzzy logic we derive new and relevant results, for scholars, spin-offs' managers and policy-makers. ARTICLE HISTORY

Lean Six Sigma (LSS) has been applied in many healthcare organisations, but there has been limited research on the evolution of LSS application in healthcare. This paper aims to present the challenges, critical success factors (CSFs), readiness factors and most common tools and techniques used for LSS deployment in healthcare. A systematic literature review (SLR) was utilised to research the study objectives. Peer-reviewed literature over a 16-year period was studied to understand the deliverables of LSS. The SLR process identified relevant articles and screened a final selection for those under study. The systematic literature review helped the authors to identify the challenges and tools/techniques used for LSS in healthcare. Several CSFs and readiness factors for LSS deployment in healthcare are also presented. This work informs healthcare managers and professionals on the important factors for successful LSS deployment before embarking on the LSS journey. In addition, this work is a valuable resource for healthcare LSS practitioners and academic researchers to learn about, investigate and deploy LSS in the healthcare sector. This study is one of the most comprehensive SLRs covering the importance and specificity of understanding challenges, CSFs and organisational readiness for LSS in healthcare. This study provides knowledge of the successful deployment of LSS in healthcare.

Purpose During the past few decades, Lean Six Sigma (LSS) in the health-care sector has received increasing attention from both researchers and practitioners because it plays an imperative role in quality improvement and cost reduction initiatives. Although researchers have often focussed on evidence of model effectiveness through the study of performance indicators, too little attention has been given to the factors that lead to implementation failure and the causal relationships among them. This study aims to investigate the factors that may inhibit the successful implementation of the method by focussing on Italian public hospitals. Design/methodology/approach Through the use of the Delphi technique and fuzzy cognitive maps, this paper derives new and relevant results for researchers, hospital managers and policymakers. Findings The results show the factors with the greatest impact on LSS implementation and provide insight into the causal links and degrees of influence between critical failure factors and performance variables. Practical implications The findings could be considered useful, in particular, to hospital managers and policymakers, who could leverage the suggestions derived from the study to address LSS implementation. Originality/value This work overcomes a gap in the literature related to the absence of studies on the causal relationships between factors that determine the success or failure of LSS implementation.

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While Lean Six Sigma (LSS) has been applied extensively in healthcare organisations, there has been limited research on the trends of LSS application in healthcare in recent years. This paper aims to present the key motivations and benefits of LSS in healthcare with a view to highlighting the types of problems that LSS in healthcare can aid in solving. The authors used a systematic literature review (SLR) approach to achieving the article’s purpose. Peer-reviewed journal articles published between 2011 and 2021 are considered to achieve the study objectives. The systematic review helped the authors to identify the evolution, benefits, and motivations for LSS in healthcare. This work includes directions for managers and healthcare professionals in healthcare organisations to embark on a focused LSS journey aligned with the strategic objectives. This study is perhaps one of the most comprehensive SLRs covering a vital agenda of LSS in healthcare. This study provides all the deliverables of LSS for its successful deployment in healthcare.

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