Exploring the use of operational excellence methodologies in the era of COVID-19: perspectives from leading academics and practitioners

A structured model for continuous improvement methodology deployment and sustainment: A case study

This research focuses on designing a clear methodology for problem-solving. It investigates the application of a defined 'Lean' methodology for the proactive application of process improvement activities using a phased digitized measurement and monitoring system. This case study in a Medtech organisation utilized the Plan, Do, Check, Act (PDCA) model to develop a Lean system and structure to support managing the process improvement or project management element of a Continuous Improvement (CI) framework. The results from the pilot of this study delivered financial gains and demonstrated how a robust structure and methodology to measure improvement activity and success provided a strong, sustainable foundation for customer satisfaction, efficiency, cost reduction and employee engagement improvement. It also highlighted the importance of focusing on proactive process improvement as part of a CI framework. The study provides valuable insights into the effective implementation of Lean principles and process improvement via a sustainable model, thereby contributing to the body of knowledge in this field. This study demonstrated how the developed model supported process improvement activity underpinning the development of a wider continuous improvement culture to support Lean deployment and sustainment and that systems can drive behaviour. Additionally, this application in the healthcare manufacturing sector adds to the sparse application in the literature from this sector.

The response of the Irish pharmaceutical manufacturing sector to the COVID-19 pandemic with a focus on Lean and JIT

Background

Just in Time (JIT) and Lean manufacturing are concepts that originated in the automotive industry and were then adopted by pharmaceutical and biopharmaceutical companies during the 1990s. However, the Covid-19 pandemic and the urgent demand for pharmaceutical treatment challenged JIT and Lean manufacturing processes. Production of Covid-19-related medicines increased, putting pressure on global supply chains and operations. This also hindered the production of medicines using the same or similar materials. Thus, questions are raised concerning JIT and Lean supply chains in the pharmaceutical industry.

Objectives

The present study aimed to explore (1) if material and supply constraints occurred due to the Covid-19 pandemic, (2) how companies were impacted and managed and (3) if changes are required to future proof the JIT supply chain approach for future global events.

Design

A mixed-method cross-sectional survey design was used and focused on material supply, qualification and validation in Irish pharmaceutical manufacturing sites.

Methods

Employees working in the Irish pharmaceutical manufacturing industry were recruited using convenience sampling through online advertisement using the social media platform 'LinkedIn'. Quantitative data was analysed using percentages and qualitative data from free-text responses were used to add context to the quantitative survey questions.

Results

A total of 41 participants were recruited. The results suggested that the pandemic had a negative effect on material availability according to 81% of participants. This translated to delays or stoppage of production activity and was mainly handled by sourcing new materials (70%). To cope with future global crises, 60% of participants recommended more flexibility in future validation processes while 78% of participants acknowledged the importance of validating additional suppliers. A hybrid model of manufacturing and supply chain management was also a preferred approach to exclusive Lean and JIT (42%).

Conclusions

The production of non-Covid-19 medicines was adversely affected by the Covid-19 pandemic, but the pharmaceutical industry in Ireland demonstrated resilience and collaboration in response to these challenges. This study suggests that the JIT and Lean manufacturing model should be adjusted to ensure medicine supply chains are not disrupted during future global events.

A cross-organizational Lean deployment in an Italian regional healthcare system

PURPOSE

This study explores how Lean was deployed in several hospitals in the Apulia region in Italy over 3.5 years.

DESIGN/METHODOLOGY/APPROACH

An exploratory qualitative design was drawn up based on semi-structured interviews.

FINDINGS

The drivers of Lean in hospitals were to increase patient satisfaction and improve workplace well-being by eliminating non-value-add waste. The participants highlighted three key elements of the pivotal implementation stages of Lean: introduction, spontaneous and informal dissemination and strategic level implementation and highlighted critical success and failure factors that emerged for each of these stages. During the introduction, training and coaching from an external consultant were among the most impactful factors in the success of pilot projects, while time constraints and the adoption of process analysis tools were the main barriers to implementation. The experiences of the Lean teams strongly influence the process of spontaneous dissemination aided by the celebration of project results and the commitment of the departmental hospital heads.

PRACTICAL IMPLICATIONS

Lean culture can spread to allow many projects be conducted spontaneously, but the Lean paradigm can struggle to be adopted strategically. Lean in healthcare can fail because of the lack of alignment of Lean with leadership in healthcare and with their strategic vision, a lack of employees' project management skills and crucially the absence of a Lean steering committee.

ORIGINALITY/VALUE

The absence of managerial expertise and a will to support Lean implementation do not allow for systemic adoption of Lean. This is one of the first and largest long-term case studies on a Lean cross-regional multi-hospital application in healthcare.

A balanced approach involving hard and soft factors for internalizing Lean Management and Six Sigma in hospitals

Purpose

This study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.

Design/methodology/approach

A cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.

Findings

A systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.

Research limitations/implications

This study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.

Practical implications

In their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.

Originality/value

This is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.

Application of six sigma and the system thinking approach in COVID-19 operation management: a case study of the victorian aged care response centre (VACRC) in Australia

COVID-19 has posed many unique and critical challenges in various contexts and circumstances. This often led the stakeholders and decision-makers to depart from traditional thinking and the business-as-usual processes and to come up with innovative approaches to tackle various mission-critical situations within a short time frame. In this paper, a real-life case study of COVID-19 operation management following a multi-disciplinary, multi-stakeholder novel integrated approach in aged care facilities in Victoria, Australia, is presented which yielded significant and positive outcomes. The purpose of the intervention was to develop an integrated system performance approach through the application of various quality management tools and techniques to achieve organizational excellence at the aged care centers. The case involved the use of mathematical models along with statistical tools and techniques to address the specific problem scenario. A system-wide management plan was proposed, involving various agencies across several residential aged care facilities during the pandemic. A three-step methodological framework was developed, where Six Sigma, a system thinking approach, and a holistic metric were proposed to manage the value chain of the pandemic management system. The experimental result analyses showed significant improvement in the management process, suggesting the validity and potential of this holistic approach to stabilize the situation and subsequently set the conditions for operations excellence within the sectors. The model offers new insight into the existing body of knowledge and offers an efficient approach to achieving operational excellence in any organization or business regardless of its type, shape and complexity, which can help practitioners in managing complex, mission-critical situations like a pandemic.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors

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.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Motivations and Benefits

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.

Digital technologies and circular economy practices: vital enablers to support sustainable and resilient supply chain management in the post-COVID-19 era

Purpose

The COVID-19 pandemic has caused major disruptions and revealed the fragilities in supply chains. This crisis has re-opened the debate on supply chain resilience and sustainability. This paper aims to investigate distinct impacts of COVID-19 on supply chains. It identifies both short- and medium-to-long-term measures taken to mitigate the different effects of the pandemic and highlights potential transformations and their impacts on supply chain sustainability and resilience.

Design/methodology/approach

To address the purpose of the study, a qualitative research approach based on case studies and semi-structured interviews with 15 practitioners from various supply chain types and sectors was conducted. Studied organizations included necessary and non-necessary supply chain sectors, which are differently impacted by the COVID-19 pandemic.

Findings

This study reveals five main challenges facing supply chains during COVID-19, including uncertain demand and supply, suppliers' concentration in specific regions, globalized supply chains, reduced visibility in the supply network, and limited supplier capacity. To help mitigate these challenges and develop both sustainability and resilience, this paper identifies some mitigating actions focusing on the promotion of the health and wellbeing of employees and supply chain stabilization. Further, in the post-COVID era, sustainable and resilient supply chains should consider regionalization of the supply chain, diversification of the supply network, agility, collaboration, visibility, and transparency; and should accelerate the use of smart technologies and circular economy practices as dynamic capabilities to improve supply chain resilience and sustainability.

Originality/value

This study contributes to exploring the sustainability- and resilience-related challenges posed by the COVID-19 pandemic. Its findings can be used by researchers and supply chains decision-makers to limit disruptions and improve responsiveness, resilience, sustainability, and restoration of supply chains. The results support benchmarking through sharing of the best practices and organizations can also integrate the different capabilities discussed in this study into the processes of selection and auditing of their suppliers.

Total quality management in Peruvian goods companies during the COVID-19 pandemic

Purpose

The aim of this research is to empirically assess the nine dimensions of the Total Quality Management (TQM) model, which have been categorized into four blocks: the top management block, the supplier block, the process management block and the customer block. The nine dimensions represent key strategic activities of company performance. A comparative analysis of companies with ISO 9001 certification and those without certification in a developing country during the COVID-19 pandemic is carried out.

Design/methodology/approach

A survey was administered to the management of 259 Peruvian goods companies (in the mining, repair and manufacturing sectors) during the COVID-19 pandemic. The survey consisted of 35 Likert-scale items, which were grouped into the following nine TQM dimensions: Top management (leadership), quality planning, quality audit and assessment, product design, suppliers' quality management, process control and improvement, education and training, quality circles and focus on customer satisfaction. Then, Cronbach's alpha, the Kolmogorov–Smirnov test, the Mann–Whitney U test and means were computed for each of the dimensions. This analysis made it possible to estimate significant differences between ISO 9001 certified and non-certified goods companies in terms of the dimensions.

Findings

The results showed that, for ISO 9001 certified companies, the averages for all of the dimensions were significantly different from those of non-certified companies, except for the education and training dimension. ISO 9001 certified companies scored higher than non-certified companies in the TQM dimensions. For both certified and non-certified companies, the leadership dimension had the highest average and the quality circles dimension had the lowest average.

Originality/value

This study addresses two main gaps highlighted in the research on quality management: the application of Quality Management Systems (QMS) in developing countries like Peru, and the impact of ISO 9001 on the performance of goods companies during the COVID-19 pandemic.

Lean six-sigma (LSS) applications in hospitals: a decade (2011–2020) bibliometric analysis

Purpose

This study examines the research landscape of Lean Six-Sigma (LSS) applications in hospitals for the period of the last decade (2011–2020) to derive answers to the research questions RQ 1: What are the current publication trends for the application of LSS in hospitals concerning document type, Journal (Source), active authors and country-wise publications and their comparison in the two most reputed scientific databases, i.e. Scopus and Web of Science (WoS), RQ2: What are the clusters based on the authors and keywords? RQ3: What are the research trends and author's productivity in LSS applications in Hospitals? RQ4: What are the future research areas?

Design/methodology/approach

This article compares these two databases (Scopus and WoS) based on publication pattern, document type, active authors and co-citation analysis. This article analyzes the core sources, author's productivity, globally cited articles, word growth analysis, thematic map and world collaboration map on the WoS and Scopus dataset. The software used are Vosviewer, Biblioshiny (R Package for Bibliometric) and M.S. Excel.

Findings

The application of LSS in hospitals is a niche theme. In the WoS database International Journal of Lean Six-Sigma and in Scopus database International Journal of Health Care Quality Assurance are the most relevant sources publishing research articles in this field. The USA has the highest scientific production in this field. Among the authors, Antony J is the most active author in this area, with the highest contribution over the years.

Originality/value

This study fills the literature gap by mapping the field of LSS in hospitals.

Critical failure factors for continuous improvement methodologies in the Irish MedTech industry

Purpose

The main objective of this study is to investigate what are the critical success factors that exist for continuous improvement (CI) methodology deployment in the Irish medical technology (MedTech) industry. The research will, in particular, seek to establish if the highly regulated nature of the global MedTech industry is an additional critical failure factor (CFF) for the deployment of CI methodology. The study involves the analysis of the benefits, challenges, CFFs and tools most utilised for the application to the deployment of CI methodologies in the Irish medical device (MD) industry.

Design/methodology/approach

A quantitative survey was utilised in this study. The main participants were made up of senior quality professionals working in operational excellence, quality consultants, quality directors, quality engineers, quality managers and quality supervisors working in both manufacturing and service sectors from Irish MD companies. A total of 94 participants from the Irish MedTech industry responded to the survey.

Findings

The main finding of this study is that 42% of participants perceived that a highly regulated environment was a CFF to CI, whilst 79% of respondents utilised Lean Six Sigma in their organisations, and productivity and financial factors were found to be the highest reasons for CI deployment amongst the Irish MedTech industry. The top CFFs highlighted for CI in regulated industries were fear of extra validation activity, compliance versus quality culture and a regulatory culture of being “safe”. Another relevant finding presented in this paper is that just over 48% of participants felt that CI tools are very strongly integrated into the industries quality management systems (QMSs) such as the corrective and preventative action system, non-conformance and audit systems.

Research limitations/implications

All data collected in the survey came from professionals working for Irish indigenous and multinational MedTech companies. It is important to highlight that n = 94 is a low sample size, which is enough for a preliminary survey but reinforcing the limitation in terms of generalisation of the results. A further study on a wider European and global scale as well as a comparison with the highly regulated pharma industry would be informative.

Originality/value

The authors understand that this is the very first research focussed on the CFFs for CI in the MedTech/MD manufacturing industry with a specific focus on the highly regulated nature of the industry as a potential CFF. The results of this study represent an important first step towards a full understanding of the applicability and use of CI in the medical-device-manufacturing industries on a global scale.

A conceptual framework for a systemic understanding of barriers during lean implementation

Purpose

Multiple organisations which have attempted to implement lean production/manufacturing/thinking have failed to achieve significant benefits. Practitioners and researchers have identified the barriers that hinder successful implementation. This study first consolidates such lean implementation barriers that are common across all industry sectors. Further, a systemic understanding of lean barriers is attempted by determining causal relationships between barriers and their relative causal strength.

Design/methodology/approach

Barriers to lean implementation were first identified from extant literature and categorised into broad barrier groups. These barrier groups were classified into four categories as specified by Liker's 4P model of lean–philosophy, people and partnership, processes and problem-solving. Additionally, interrelations between barriers, both within and among these four categories were determined.

Findings

The barriers classified under philosophy were the most critical as it affects the barriers in other groups. Similarly, barriers such as lack of leadership and top management commitment, lack of resources, shortage of lean consultants and trainers, lack of systemic understanding of lean and the need for its implementation, lack of lean expertise and training were found to be the most critical causal barriers.

Research limitations/implications

Highly critical barriers in terms of causality should be addressed with high priority, as effective measures against them may eliminate or reduce the impact of other barriers.

Originality/value

This study addresses the confusion regarding the high number of lean barriers in extant literature by providing a systemic understanding of the same. By exploring the interrelations among barriers, the most important causal barriers and barrier types (4Ps) are identified, the knowledge of which could improve lean implementation success. This is a novel attempt in the domain of lean.

Quality 4.0 conceptualisation and theoretical understanding: a global exploratory qualitative study

Purpose

Quality 4.0 has a unique potential to create a competitive advantage for organisations by improving customer experience and enhancing profitability. The purpose of this study is to examine Quality 4.0, the9; benefits, motivating factors, critical success factors and the skills required by quality professionals in the successful implementation of Quality 4.0. The study also investigates the organisational readiness factors9 and challenges that need to be addressed before Quality 4.0 adoption and assess their importance.

Design/methodology/approach

A qualitative interview approach was utilised by interviewing a panel of senior management, engineering and continuous improvement (CI); professionals working in leading companies in Asia, Europe and America who are currently deploying Quality 4.0.

Findings

This study provides a theoretical base for the Quality 4.0 body of knowledge in terms of an organisation’s adoption and overcoming implementation challenges and providing examples of Quality 4.0 application. Organisations can use this study to understand what Quality 4.0 means to industry, the benefits and motivating factors for implementing, the Critical Success Factors, challenges, the organisational readiness factors and the role of leadership in a Quality 4.0 deployment. In addition, the study looks at the skills required by future Quality 4.0 professionals in terms of hard skills, soft skills and a curriculum for educating future quality management professionals. The respondents cited that predictive analytics, sensors and tracking, and electronic feedback loops are the most critical technologies for driving Quality 4.0.

Research limitations/implications

One of the limitations of this research was that as this area is a nascent area the researchers were limited in their literature review. The second limitation was that the study was based on 12 interviews. A more comprehensive longitudinal study would yield more data so that better and robust conclusions can be derived from the study.

Originality/value

This is the first empirical study on Quality 4.0, which captures the viewpoints of senior management professionals on a full range of topics related to Quality 4.0 motivation for deployment, implementation and readiness for its adoption.