In extreme circumstances such as pandemics, the presence of patients in hospital emergency departments becomes untenable. Healthcare professionals and organizations worldwide are leaning on technology as a crucial ally to deal with the COVID-19 outbreak. This article focuses on the positive impact of telemedicine for helping service provision, from enabling virtual triage to mitigating the negative psychological effects of social isolation. The authors discuss the challenges and opportunities to telemedicine practices. IMPACTThis article explains how telemedicine and other e-healthcare technologies can benefit people, medical staff and healthcare systems. One of the main challenges for telemedicine in many countries is the lack of regulations. The authors call on policy-makers to facilitate wider implementation of e-healthcare technologies, while considering issues of inclusiveness, privacy and data protection. The article informs managers about the use of new technologies. Examples are provided of e-healthcare technologies implemented during the COVID-19 pandemic, for example in terms of healthcare capacity and providing support to people affected by quarantine.

PurposeThe COVID-19 pandemic is considered a major disruptive event of this decade, raising unforeseen socio-economic implications worldwide. This novel virus has increased the influx of patients in hospitals, and healthcare organisations are facing unprecedented constraints in their operations to deal with increased demand and pressed capacity. Thus, this article evaluates the impact of the COVID-19 pandemic on healthcare systems' demand, resources and capacity and provides research directions.Design/methodology/approachThis is a viewpoint article and uses timely information on healthcare operations from both scholars and managers, published by diverse sources during the COVID-19 outbreak.FindingsThe authors discuss the focus on “flattening the curve of infection” as a measure to protect healthcare, delay the impact of increased demand and reorientate healthcare supply chain practices. Furthermore, the authors evaluate the role of lean practices on managing demand and capacity and improving quality across healthcare operations and supply chain. Finally, the authors suggest research directions on modern operational issues that emerged during this pandemic, such as discussions around the sustainability of lean post-pandemic, “just in time” practices, inventory trade-offs and lack of organisational responsiveness during untenable events.Originality/valueIn this article, the authors provide a contemporary assessment of the implications of the COVID-19 pandemic on healthcare operations, underscoring main economic and operational elements that can be affected, such as unforeseen demand, resources and capacity shortage. Therefore, the authors assess that healthcare organisations, practitioners and governments have to anticipate operational and economic impacts and, ultimately, to reassess their plans to deal with such adverse events.

This article presents an in-depth bibliographic study about the creation, principles, evolution, and practices of the lean philosophy oriented to the services sector. More than 70 papers about "lean thinking" -specially with focus on services -have been carefully reviewed. It presents the principles of lean service in an organized way, companies applying lean service, and best practices and tools in the implementation of lean service. It shows that lean service does not have a single or specific model of tools, practices or standards. In fact, it is a mix of tools and practices that must be applied according the situation found to be improved. Despite the lack of a standards and methodology for use in services, its best practices, inherited from manufacturing, when applied to services can generate large economic and financial results, as well as improvement of workers' behavior. But, like any change process, this study shows that the application of lean in services also suffers resistance. There might be limitations when evaluating lean practices and principles to services, specially those that have not yet been well defined and reported. Other limitations are due to the scarce articles in the literature. However, this research showed that the use of the lean philosophy in services proved to be effective and quite worthwhile. Several cases analyzed presented significant gains and confirmed an increasing and promising future for service companies "thinking lean".

The barriers to implement lean have been well researched and have generated consistent results; this study identifies these as ostensible barriers. There is a dearth of research that focuses on understanding the causes of these ostensible barriers. Thus, this study aims to empirically investigate the deeper causes that produce ostensible barriers to implement lean in emergency areas of healthcare. To achieve this aim, the paper draws on rich, qualitative data from four different sources of data, using exploratory case studies as the main approach. Undertaking thematic analysis, six main underlying barriers emerge as the root cause of ostensible barriers. The results suggest that addressing each of the underlying barriers in healthcare is likely to support lean implementation and sustainability, by reducing the impact of restraining forces that come from stakeholders and the public healthcare system.

Purpose This paper aims to discuss the strategic role of telehealth technologies in managing the COVID-19 pandemic. Design/methodology/approach This is a viewpoint paper, based on opportune information published and discussed by scholars and managers from different sources; the authors gathered this information to discuss the implications of telehealth during the outbreak. Findings Based on examples and benchmarking, the authors found that it is possible to lean on telehealth technologies as a frontline ally to avoid the spread of the virus by tracking, testing and treating (3T’s model). Research limitations/implications Together with information published on COVID-19, the authors present their critical observations on the use of telehealth. However, the authors acknowledge that there are restrictions on the use of new technologies in health-care practices that were not addressed by this paper, and they suggest further research to address this limitation. Practical implications Governments, health-care organizations and managers are encouraged to take advantage of the information published in this paper. One of the benefits of telehealth is the possibility of bringing patients and physicians together virtually, without the need for physical contact. Henceforth, the authors suggest a more comprehensive implementation of best practices from telehealth to relieve congested health-care facilities and to avoid the risk of further infection. Social implications The economic and social impacts of the virus are considered unprecedented by governments worldwide. Therefore, the authors advocate that telehealth practices embedded in health-care practices relieve the pressure that naturally arise during this type of critical event. Originality/value In this timely paper, the authors provide invaluable information related to the impact of telehealth technologies on flattening the infection curve of COVID-19.

Lean philosophy has been one of the most prominent methodologies of process improvement.Positive results from lean implementations have motivated managers to carry out lean transformations. However, the low success rates, linked to barriers to implement lean are still a challenge, and one of the reasons is the lack of understanding of these inhibitors. Scholars have investigated barriers that affect the lean journey, some of these barriers overlap and require a meaningful categorisation. Thus, the purpose of this paper is to fill in this gap by providing a review of more than 20 years of literature, and synthesising these barriers into meaningful organisational categories. To achieve this aim, we employed a systematic literature review. Our findings present six meaningful lean barriers, which we categorised into a framework. These barriers have mainly behavioural and organisational aspects (people-dependent), and technical aspects (tool-based). Finally, we derived eight propositions, contributing to knowledge and practice.

PurposeThe healthcare system has been under pressure to provide timely and quality healthcare. The influx of patients in the emergency departments (EDs) is testing the capacity of the system to its limit. In order to increase EDs' capacity and performance, healthcare managers and practitioners are adopting process improvement (PI) approaches in their operations. Thus, this study aims to identify the main PI approaches implemented in EDs, as well as the benefits and barriers to implement these approaches.Design/methodology/approachThe study is based on a rigorous systematic literature review of 115 papers. Furthermore, under the lens of thematic analysis, the authors present the descriptive and prescriptive findings.FindingsThe descriptive analysis found copious information related to PI approaches implemented in EDs, such as main PIs used in EDs, type of methodological procedures applied, as well as a set of barriers and benefits. Aiming to provide an in-depth analysis and prescriptive results, the authors carried out a thematic analysis that found underlying barriers (e.g. organisational, technical and behavioural) and benefits (e.g. for patients, the organisation and processes) of PI implementation in EDs.Originality/valueThe authors contribute to knowledge by providing a comprehensive review of the main PI methodologies applied in EDs, underscoring the most prominent ones. This study goes beyond descriptive studies that identify lists of barriers and benefits, and instead the authors categorize prescriptive elements that influence these barriers and benefits. Finally, this study raises discussions about the behavioural influence of patients and medical staff on the implementation of PI approaches.

COVID‐19 has presented significant challenges for public healthcare systems across the globe. The critical challenge for public healthcare organisations is to provide effective health care to patients, while simultaneously keeping frontline staff safe. Telemedicine has emerged as a prominent service intervention to this end. Telemedicine integrates technologies into medical practices to alleviate the need for face‐to‐face interactions through video consultations. The study explores how physicians and patients can, together, co‐create service value both within the telemedicine ecosystem and under crisis. Secondary qualitative data from physicians and patients active on Twitter and from across multiple countries are used to this end. Thematic analysis reveals seven themes that inform a new integrative telemedicine value co‐creation framework, which provides a platform for inclusive, equitable, and sustainable telemedicine services. The study provides a new understanding of the service triad ‒ telemedicine co‐design, value co‐creation, and service improvement ‒ highlighting the roles of co‐design and value co‐creation for public health care under crises.