Purpose -During the last decades, different quality management concepts, including total quality management (TQM), six sigma and lean, have been applied by many different organisations. Although much important work has been documented regarding TQM, six sigma and lean, a number of questions remain concerning the applicability of these concepts in various organisations and contexts. Hence, the purpose of this paper is to describe the similarities and differences between the concepts, including an evaluation and criticism of each concept. Design/methodology/approach -Within a case study, a literature review and face-to-face interviews in typical TQM, six sigma and lean organisations have been carried out. Findings -While TQM, six sigma and lean have many similarities, especially concerning origin, methodologies, tools and effects, they differ in some areas, in particular concerning the main theory, approach and the main criticism. The lean concept is slightly different from TQM and six sigma. However, there is a lot to gain if organisations are able to combine these three concepts, as they are complementary. Six sigma and lean are excellent road-maps, which could be used one by one or combined, together with the values in TQM. Originality/value -The paper provides guidance to organisations regarding the applicability and properties of quality concepts. Organisations need to work continuously with customer-orientated activities in order to survive; irrespective of how these activities are labelled. The paper will also serve as a basis for further research in this area, focusing on practical experience of these concepts.

BackgroundCardiovascular Magnetic Resonance (CMR) enables non-invasive quantification of cardiac output (CO) and thereby cardiac index (CI, CO indexed to body surface area). The aim of this study was to establish if CI decreases with age and compare the values to CI for athletes and for patients with congestive heart failure (CHF).MethodsCI was measured in 144 healthy volunteers (39 ± 16 years, range 21–81 years, 68 females), in 60 athletes (29 ± 6 years, 30 females) and in 157 CHF patients with ejection fraction (EF) below 40% (60 ± 13 years, 33 females). CI was calculated using aortic flow by velocity-encoded CMR and is presented as mean ± SD. Flow was validated in vitro using a flow phantom and in 25 subjects with aorta and pulmonary flow measurements.ResultsThere was a slight decrease of CI with age in healthy subjects (8 ml/min/m2 per year, r2 = 0.07, p = 0.001). CI in males (3.2 ± 0.5 l/min/m2) and females (3.1 ± 0.4 l/min/m2) did not differ (p = 0.64). The mean ± SD of CI in healthy subjects in the age range of 20–29 was 3.3 ± 0.4 l/min/m2, in 30–39 years 3.3 ± 0.5 l/min/m2, in 40–49 years 3.1 ± 0.5 l/min/m2, 50–59 years 3.0 ± 0.4 l/min/m2 and >60 years 3.0 ± 0.4 l/min/m2. There was no difference in CI between athletes and age-controlled healthy subjects but HR was lower and indexed SV higher in athletes. CI in CHF patients (2.3 ± 0.6 l/min/m2) was lower compared to the healthy population (p < 0.001). There was a weak correlation between CI and EF in CHF patients (r2 = 0.07, p < 0.001) but CI did not differ between patients with NYHA-classes I-II compared to III-IV (n = 97, p = 0.16) or patients with or without hospitalization in the previous year (n = 100, p = 0.72). In vitro phantom validation showed low bias (−0.8 ± 19.8 ml/s) and in vivo validation in 25 subjects also showed low bias (0.26 ± 0.61 l/min, QP/QS 1.04 ± 0.09) between pulmonary and aortic flow.ConclusionsCI decreases in healthy subjects with age but does not differ between males and females. We found no difference in CI between athletes and healthy subjects at rest but CI was lower in patients with congestive heart failure. The presented values can be used as reference values for flow velocity mapping CMR.

Purpose – The purpose of this paper is to elaborate, how the use of a joint-use strategy of Lean and Six Sigma can improve flexibility, robustness, and agility. Telecom manufacturing has been under tremendous change after dot.com bubble burst in the early 2000, and new competition has originated from Asia. Being successful requires now more than before, and joint-use of strategies is one option to survive. Design/methodology/approach – A single case study from a Swedish company operating in the telecom manufacturing was conducted. In particular, a Six Sigma project was followed and analyzed during 2002. However, the outcome of the Six Sigma project has been studied in longitudinal manner until 2014. Findings – The Lean Six Sigma strategy ensures flexible, robust, and efficient processes. However, to make them more agile in order to sustain in today's highly competitive environment, something more is required. This could include staff training, strengthening company culture and collaborating with key partners in the supply chain. Research limitations/implications – This study is limited to large company that usually has a lot of resources and choices where to put the strategic emphasis as well as has level of control of the supply chain operations. The situation could be very different in small and medium-sized companies and thus it may be more difficult to realize the Lean Six Sigma strategy in such environment. On the other hand, the processes in these companies are often less complex. Practical implications – This research provides guidance on how to manage the Lean Six Sigma strategy in order to ensure more flexible, robust, and efficient processes as well as how to perform a Six Sigma project in Lean environment, in a proper manner. Originality/value – This research provides guidance to companies regarding the applicability and properties of the Lean Six Sigma strategy. The paper will also serve as a basis for other companies and industries, on how to survive in difficult times.

Many universities have experienced an increase in the intake of students and at the same time cuts in the budgets for teaching. Many teachers have discovered, for a number of reasons, that they have to adjust their teaching or even a course with short notice. These facts pose a challenge to the teachers' agility in adapting to changes-and in doing it in a cost-efficient way.We propose eXtreme Teaching as a framework that allows teachers to focus on experimenting with and improving their teaching techniques without compromising quality. The framework and the associated practices provide quick, accurate feedback that teachers can act on. eXtreme Teaching will allow better student learning, stronger relationships with the students, increased interaction and development of the staff involved, less risk-and probably happier staff members.In this paper, we will describe the eXtreme Teaching framework and discuss and motivate its background.