International Journal of Mechanical Engineering and Technology (IJMET)

Volume 9, Issue 7, July 2018, pp. 303–312, Article ID: IJMET_09_07_035

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ISSN Print: 0976-6340 and ISSN Online: 0976-6359

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ANALYZING THE ROLE OF LEAN

MANAGEMENT IN HEALTH CARE:
A SYSTEMATIC LITERATURE REVIEW
Vinodhini A
Assistant Professor/Research Scholar, Department of commerce
Cauvery College for Women-Tiruchirappalli, Tamil Nadu, India

Dr. Seethalakshmi R
Assistant Professor, Department of Commerce
Cauvery College for Women-Tiruchirapplai, Tamil Nadu, India

Dr. Sowdamini T
Assistant Professor, GITAM Institute of Management
Visakhapatnam, Andhra Pradesh, India

ABSTRACT
Purpose- The purpose of this paper is to do a study of lean management tools and
practices in health carethrough a systematic literature review. The effective tools of
lean management such as six sigma, Lean strategy and other methods which improve
the quality in health care are identified through the review of literature.
Design/methodology/approach-Content Analysis is used to analyses the literature
collected from 50 articles from a reputed journal from 2012-2017, literature body is
followed by the pattern of content analysis, and the subcategories were formed to do a
typical research.
Findings-The result of lean implementation in the health care service has created
a positive impact for many health care issues like reducing the waiting time,
addressing the professionals jobs satisfaction and it has paved a way for an improved
quality service in health care through lean principals and tools.
Paper type: Literature review
Key words: Content analysis, lean tools and techniques,Lean safety, lean six sigma,
Lean quality improvement, Literature review.
Cite this Article: Vinodhini A, Dr. Seethalakshmi R and Dr. Sowdamini T, Analyzing
the Role of Lean Management in Health Care: A Systematic Literature Review,
International Journal of Mechanical Engineering and Technology 9(7), 2018, pp.
303–312.
http://iaeme.com/Home/issue/IJMET?Volume=9&Issue=7

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 Vinodhini A, Dr. Seethalakshmi R and Dr. Sowdamini T

1. INTRODUCTION
Lean is a set of operating philosophies, which was first invented by Womack, Jones and Roos
to define the Toyota Production system. Later Lean manufacturing practices were adopted by
many manufacturing industries to improve their product quality with a low cost and with
more flexibility which also improved their competitiveness in the market, with a long term
approach to improve the efficiency and quality which was possible only by implementing lean
practices as it works on a systematic manner by identifying and eliminating waste through the
concept of continuous improvement. After a continued success in the manufacturing sector,
lean has also been adopted by the health care sector as patient care looking for hassle free,
world-class healthcare services from Indian hospitals and at the same time India is emerging
as a preferred destination for Medical Tourism, which is opening a new growth opportunity
for Indian health care organizations. Implementation of Lean in healthcare will enhance the
confidence of domestic as well as foreign customers in the hospitals, which can assure world-
class healthcare quality at competitive cost. In India implementation of lean in health care is
less compared to other countries in the world. Since the last few years' cost of health care is
continuously rising along with increasing complexity and sophistication in clinical processes.
Due to increased sophistication in healthcare operations, it requires a large number of people
with special skills, expensive diagnostic machines and complex processes to enhance quality
and safety issues which can be addressed through the implementation of lean management.
The waiting time is a major problem faced by the patients in condition of sickness which can
be addressed by Lean. There are lean tools to overcome the waiting time problem. Now days
the healthcare sector is working under increasing pressure to deploy resources more
efficiently to reduce costs and improve service quality. The principles of Lean Thinking have
been developed to tackle such problems. Lean Thinking in health care is not just about cost
reduction, nor about 'efficiency' improvements or staff cuts. It is about improving the safety
and quality of healthcare by applying a series of continuous incremental improvements in
processes, people and organizational culture. Interest in applying lean thinking to healthcare
processes has grown across the world. Many hospitals have begun to see how lean processes
can deliver better quality outcomes, increased patient’s satisfaction and improved working
conditions for staff while treating a number of patients with the same resources. In a global
context, countries like Sweden, Japan, Canada, America, and Russia implemented lean in
healthcare and are very successful in the overview of value stream mapping; while the lean
management is implemented only in very few health care services in India.
Successful Lean health care efforts result in the measurable improvements in patient
outcomes, such as improved quality, less harm due to preventable errors, better access, shorter
waiting times, and better service. Implementing Lean management in health care has gained
an advantage in global health care. The researcher has done a detailed study of lean in the
health care industry through a systematic literature review.

2. PURPOSE OF THE STUDY

The main motto of the research is to do a systematic literature review on lean management by
applying content analysis.

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 Analyzing the Role of Lean Management in Health Care: A Systematic Literature Review

3. METHODOLOGY
Qualitative Study Content Analysis Conceptual Content Analysis

Inductive Method

(Creating data out of existing data)

3.1. Data Collection

A unit of analysis is done for the literature sample of the peer reviewed literature review
papers on lean management for the past five years with 50 articles which highlights the main
mode of communication among researchers. For compiling the paper sample, a literature
search was carried out based on the pair of key words “literature review” and “lean
management in health care” and title, keywords or abstract. The structured keywords search
was conducted in major databases and library services: Emerald (www.emeraldinsight.com),
Scopus (www.scopus), Pub med (www.pubmed).

3.2. Analyzing the collected data:

The collected data are analyzed and tabulated according to various sub fields in lean
management. The table indicates the title, aim, author, year, journal name, country, sampling
methods and findings.
Developing themes of the analyzed data: The sub-fields of lean management are created
accordingly to the concept as lean six sigma, lean tools and practices in healthcare, lean total
quality management, clinical risk management, lean safety, literature analysis, lean strategy,
professionals in lean, analytical hierarchy process approach in lean, waste elimination,
improving health care, value stream mapping.

3.3. Text Accordingly to the Themes of Reviewed Paper

Reviewed Papers
Sub Field 1 : Lean Six Sigma
R.J.de Koejier et.al, (2014)
AlirezaShokiri (2015)
Pauline Stanton et.al, (2014)
Abraham Zhang et.al, (2015)
Shri Ashok Sarkar et.al, (2013)
Journal
International Journal of Human
Resource Management
International Journal of Quality and
Reliability Management
International Journal of Human
Resource Management
International Journal of Operations
and Production Management
The Total Quality Management
Journal
Aim
To understand the direct and
indirect effect of lean
management and six sigma
in health care.
To extend previous studies to a
hybrid analysis of business
improvement practices of lean six
sigma LSS within last two decades
and identify the research gap.
An analysis of process improvement
project based on lean
six sigma techniques in emergency
department of a large Australian
Hospital
The purpose of this paper is to
investigate the implementation
of lean six sigma for improving
logistic operations
In implementing Six Sigma
how to select the subset
root cause developing methodology
for validation of
potential causes to root causes to aid

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 Vinodhini A, Dr. Seethalakshmi R and Dr. Sowdamini T
Charles R et.al, (2015)
Deepak et.al, (2016)
Sub Field 2 : Lean Tools and
Pernilla Lindskog et.al, (2015)
Horaciosorianomeier et.al, (2011)
Bryanmaltosh et.al, (2014)
Pauline Hwang et.al, (2014)
Oscar Roemeling et.al, (2017)
Mialjungblom (2014)
Maltloubhussain Malik (2016)
Tapanijorma et.al, (2016)
Yashdaultani et.al, (2016)
Sarellavy et.al,
Gabriela Souza Assis et.al, (2016)
Gustaf Kastberg et.al, (2017)
Beata Kollberg et.al, (2014)
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American Journal of Business
Practices
International Journal of Lean Six
Sigma
International Journal of Health Care
Quality Assurance
International Journal of Health Care
Quality Assurance
International Journal of Operation
and Production Management
International Journal of Quality and
Service Science
Journal of Health Organization and
Management
Leadership in health services
Business process management
Qualitative research in accounting
and management
International journal of productivity
and performance management
306
practitioners
To examine how
initiatives mediate the effect
of medical error sources to
enhance three hospital
outcomes
Implementing Six Sigma
combined with lean can help
the hospital to deliver world-
class quality care and
simultaneously bring down the co st
The study expands upon
lean tools and innovations enabling
job resources
Impact of layout configuration
in a hospital on implementation
of lean management
Implementation of practices
imported from manufacturing into
health care as a solution to rise in
health spending and disappointing
patient staffing indicators
Health care providers are
implementing lean practices
to achieve results to present
a model that identifies and
defines lean implementation
key success factors in health
care organization
The role that employees
initiate lean improvement
project play in health care
To research the practices of
ethics in Swedish health care
To manage health care waste in
public and private hospitals
To evaluate lean thinking used in
health care in the environment of
finish health care
Implementing lean in different
departments of health care
organization with various lean tools
To overcome the unfavorable
conditions of the hospital staffs and
patients in construction of
health care organizations
Focuses on complex and
difficulties in health care, to
analyses the study of promotion in
BPM lean in health care
The study is to expand our
understanding of process
oriented of HC organization in
the shape of Lean management &to
investigation what measures a
taken to reframe the HC
organization.
To discuss how a performance
measure system called
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 Analyzing the Role of Lean Management in Health Care: A Systematic Literature Review

"the flow model" is designed

Sub Field : 3 Total Quantity
Natalia Yuri Eiro et.al, (2015)
Bozen Poksinska et.al, (2013)
Hisahiro Ishijima et.al, (2014)
Abdallah Abdallah et.al, (2014)
Pascal Bacoup et.al, (2018)
Total quantity management and
business excellence
Clinical governance An international
Journal
International journal of health care
Quality Assurance
The total quantity management
journal
To achieve efficient identification,
control and management of
cost by promoting a better
quality of service
Better understanding of
managerial practices and
leadership in lean organization
To identify factors the
influence the implementation
of roll out of the 5S approach
in public hospitals
A study of literature to understand
drivers and challenges facing quality
initiatives in health care
organizations
To purpose a comprehensive
methodology which combines the
benefit of both International
Organization for Standardization and
lean management

Sub Field : 4 Improving Lean Health Care

(2016)
To balance the conflict between cost
cutting efficiency and providing
value for money for customer in
organization
Gabrielas et.al, IFAC IOM says at least one medical error
is done per day to reduce its system
needed

Sub Field : 5 Waste Elimination

Richard J.Schonderger (2017)
Hisohiro Ishijima et.al, (2016)
Sub Field : 6 Values Stream GuilhermeLuz
Tortorella et.al, (2015)
Cristina Machado et.al, (2013)
Sub Field : 7 Lean Safety
Maria Crema et.al, (2015)
Science Direct
The total quality management
journal
Mapping
Total quality management and
business excellence
Strategic outsourcing: An
international journal
International journal of Quality and
Service
Health care to pursue Lean
in its own way rather than
follow the often wayward lean
principles
To assess causal relationship
between implementation of
the 5 S approach reduction of
patients waiting time
This paper reports the
application of one such new
management technique named value
stream mapping in public health care
organization
Vendor managed benefits serve lean
purpose in health care why outcomes
are difficult
Significant features that
characterize these projects
i)Organizational aspect
ii)Phases and activities
iii)Tools
iv)Techniques
v)Practices

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 Vinodhini A, Dr. Seethalakshmi R and Dr. Sowdamini T

vi)Key factors for successful

Maria Crema et.al, (2014)
Sub Field : 8 APH
Dotun Adedanjo et.al, (2014)
Matloub Hussain (et.al, 2016)
Sub Field : 9 Lean Professional
Federico Barnabe et.al, (2017)
Richard J. Holder et.al, (2014)
Sub Field : 10 Lean Strategy
Federico Barnabe et.al, (2017)
Kurthozak et.al, (2015)
Federico Barnabe et.al, (2016)
Cristina Machado et.al, (2013)
Sub Field : 11 Clinical Risk Management
Maria Crema et.al, (2015)
Sub Field : 12 Lean a Literature Review
Thomas Bortolotti et.al, (2017)
Luana Bonome et.al, (2016)
Shradha Gupta et.al, (2016)
International journal of quality and
reliability management
Production planning and control
Business Process management
journal
Development in organization: An
International journal
Applied Ergonomics
The total quantity management
International journal of lean six
sigma
Journal of health organization and
management
Strategic outsourcing: An
international journal
Business process Management
Journal
International Journal of Operations
and Production Management
Production Planning and Control
International Journal of Productivity
implementation
To study the significant features in
health lean management obtaining
patient safety
To investigate the perception
of practitioners/experts in
Lean supply chain practice, Lean
supply chain performance measure
& Drivers to improve
Lean supply chain practice
To introduce lean concept to
the field of health care
management To consider key waste
reduction opportunity which are
posted in lean practice
To stimulate interest in the
potential of serious games
and provide information
about their design and
implementation in practice.
To study the role of context
in shaping lean and how health care
workers perceive lean.
The application of lean
strategy principles and tools in
modern organization health care
sector
To develop insight about the
psychological factors contribute to
leans success
Potentials of role-playing in
training health care professionals to
implement lean practices and tools
Paper aims to fill a literature gap
between outsourcing practices and
establishing a development
evolution
To describe the Italian state of
art of health lean management
that connect with clinical risk
management
To identify the most influential
determinants of health care
employee’s problem solving
capabilities towards kaizen
initiatives in social outcome.
To evaluate its evolution by
updating previous literature
reviews
Highlighting the importance of 1990

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 Analyzing the Role of Lean Management in Health Care: A Systematic Literature Review

and Performance Management till date

Kyle et.al, (2012)
Simon Deblois et.al, (2016)
Jijuantony et.al, (2017)
Kjeldharald Aij et.al, (2017)
Thomas Rotter
Kjeldarald Aij et.al, (2017)
International Journal of Lean Six
Sigma
International Journal of Health Care
Quality Assurance
International Journal of Quality and
Reliability Management
Journal of Health Organization and
Management
Journal of Health Care Leadership
To present a systematic review
of four decades of lean
Systematic review of literature
reviews summarizing how lean and
six sigma management techniques
impact
Systematic role played by six sigma
methodology in improving the
quality health care
Emphasis on quality and
reducing cost in health care to
reconfigure their management
process and quality control,
infrastructure.
This article outlines the process
utilized to develop an operational
definition of lean in health care
Specific similarities and
differences between lean
and servant leadership

4. FINDINGS
Content analysis is an effective tool for conducting a literature review in a transparent way.
The research focuses on many problems faced in health care in improving the quality and the
efficiency, the researcher found the following results of lean six sigma which is implemented
in many countries like UK, USA, India and Singapore to solve the major health service issues
like medical errors. In order to improve the service quality the 5s method is adopted to solve
the problem. The 5S are Sorting, Simplifying, Safety, Standard and Sustainability which leads
to quality delivery of service to the patients in health care. Lean tools are implemented for the
benefit of three dimensional successful outcomes such as for the Patient, Professionals and
Health system improvement. It reduces patient waiting time and medical errors through 5S
approach. With regards to professionals, lean drives a quality working environment through
the factors of job control, job clarity, decision making and time spend with the patients to
avoid staff overtime. For the improvement in the outcome of the health system, lean adopted a
strategy in physical layout design, NGH layout modeling which gives a complete design
model for the physical layout which is desirable in health care. The main issues addressed by
lean management in health care is waste reduction, waste elimination and to reduce the
waiting time of the patients which leads to the quality health care by Just In Time, Value
Stream Mapping for an enhanced quality service in health care. Clinical risk is avoided by
lean management in health care by the methods of lean quality care, reduce risk, and reduce
cost method patient safety method. Lean implementation in Indian hospitals is very less in
number; the researcher has collected 50peer reviewed journal articles in which only 5article
address the issues of lean health care in Indian context. Hence the researcher focuses on
“study on the impact of lean implementation in Indian health care”.

5. CONCLUSIONS
This paper contributes to the identification of the research gap between lean in global
healthcare and lean in Indian health care system. The key factors enabling a successful lean
management in health care are brought forward through content analysis .The Findings of this
paper leads to understand the concept of lean management in health care.

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 Vinodhini A, Dr. Seethalakshmi R and Dr. Sowdamini T

REFERENCES
[1] S.Alireza, (2017) "Quantitative analysis of Six Sigma, Lean and Lean Six Sigma research
publications in last two decades", International Journal of Quality &Reliability
Management, Vol. 34Issue: 5, pp.598-625,
[2] A. Zhang, W. Luo, Y. Shi, Song Ting Chia, ZhiHao Xavier Sim, (2016) "Lean and Six
Sigma in logistics: a pilot survey study in Singapore", International Journal of Operations
& Production Management, Vol. 36 Issue: 11, pp.1625-1643,
[3] S. Ashok Sarkar, A. Ranjan Mukhopadhyay, S. Kumar Ghosh, (2013) "Root cause
analysis, Lean Six Sigma and test of hypothesis", The TQM Journal, Vol. 25 Issue: 2,
pp.170-185,
[4] Charles R. Gowen III, Kathleen L. McFadden, S.Settaluri, (2012) "Contrasting continuous
quality improvement, Six Sigma, and lean management for enhanced outcomes in US
hospitals", American Journal of Business, Vol. 27 Issue: 2, pp.133-153,
[5] H. Soriano‐Meier, Paul L. Forrester, S. Markose, J. Arturo Garza‐ Reyes, (2011) "The role
of the physical layout in the implementation of lean management initiatives", International
Journal of Lean Six Sigma, Vol. 2 Issue: 3, pp.254-269,
[6] B. McIntosh, B. Sheppy, I. Cohen, (2014) "Illusion or delusion – Lean management in the
health sector", International Journal of Health Care Quality Assurance, Vol. 27 Issue: 6,
pp.482-492,
[7] P. Hwang, D. Hwang, P. Hong, (2014) "Lean practices for quality results: a case
illustration", International Journal of Health Care Quality Assurance, Vol. 27 Issue: 8,
pp.729-741,
[8] O. Roemeling, M. Land, K.Ahaus, (2017) "Does lean cure variability in health care?",
[9] International Journal of Operations & Production Management, Vol. 37 Issue: 9, pp.1229-
1245,
[10] M.Ljungblom, (2014) "Ethics and Lean Management – a paradox?", International Journal
of Quality and Service Sciences, Vol. 6 Issue: 2/3, pp.191-202,
[11] M. Hussain, M. Malik, (2016) "Prioritizing lean management practices in public and
private hospitals", Journal of Health Organization and Management, Vol. 30 Issue: 3,
pp.457-474,
[12] T.Jorma, H.Tiirinki, R.Bloigu, L.Turkki, (2016) "LEAN thinking in Finnish Healthcare",
Leadership in Health Services, Vol. 29 Issue: 1, pp.9-36,
[13] G.SouzaAssis Ferreira, U.Rezende Silva, A.Lucirton Costa, S.InêsDallavallede
DallavallePádua, (2018) "The promotion of BPM and lean in the health sector: main
results",Business Process Management Journal, Vol. 24 Issue: 2, pp.400-424,
[14] G. Kastberg, S.Siverbo, (2017) "Lean and process-orienting health care – linking and
disentangling activities", Qualitative Research in Accounting & Management, Vol. 14
Issue: 4, pp.390-406,
[15] B.Kollberg, Jens J. Dahlgaard, P.Brehmer, (2006) "Measuring lean initiatives in health
care services: issues and findings", International Journal of Productivity and Performance
Management, Vol. 56 Issue: 1, pp.7-24,
[16] H.Ishijima, EliudiEliakimu, S.Takahashi, N.Miyamoto, (2014) "Factors influencing
national rollout of quality improvement approaches to public hospitals in Tanzania",
Clinical Governance: An International Journal, Vol. 19 Issue: 2, pp.137-152,

http://iaeme.com/Home/journal/IJMET 310 editor@iaeme.com

 Analyzing the Role of Lean Management in Health Care: A Systematic Literature Review

[17] A.Abdallah, (2014) "Implementing quality initiatives in healthcare organizations: drivers

and challenges", International Journal of Health Care Quality Assurance, Vol. 27 Issue: 3,
pp.166-181,
[18] P.Bacoup, C.Michel, G.Habchi, M.Pralus, (2018) "From a Quality Management System
(QMS) to a Lean Quality Management System (LQMS)", the TQM Journal, Vol. 30 Issue:
1,pp.20-42,
[19] Hisahiro Ishijima, EliudiEliakimu, Jonathan McharoMshana, (2016) "The “5S” approach
to improve a working environment can reduce waiting time: Findings from hospitals in
Northern Tanzania", TheTQM Journal, Vol. 28 Issue: 4, pp.664-680,
[20] M.Crema, C.Verbano, (2015) "Mapping lean experiences and emerging connections with
clinical risk management in Italian context", Business Process Management Journal, Vol.
21 Issue: 5,pp.1091-1116,
[21] M.Crema, C.Verbano, M.LauraChiozza, (2015) "First evidences from “lean & safety”
projects", International Journal of Quality and Service Sciences, Vol. 7 Issue: 2/3, pp.245-
259,
[22] M.Crema, Chiara Verbano, (2016) "Safety improvements from health lean management
implementation: Evidences from three cases", International Journal of Quality &
Reliability Management, Vol. 33 Issue: 8, pp.1150-1178,
[23] L.Bonome Message Costa & M.GodinhoFilho (2016) Lean healthcare: review,
classification and analysis of literature, Production Planning & Control, 27:10, 823-836,
[24] S.Gupta, M.Sharma, Vijaya Sunder M., (2016) "Lean services: a systematic review",
International Journal of Productivity and Performance Management, Vol. 65 Issue: 8,
pp.1025-1056,
[25] Kyle B. Stone, (2012) "Four decades of lean: a systematic literature review", International
Journal of Lean Six Sigma, Vol. 3 Issue: 2, pp.112-132,
[26] S.Deblois, L.Lepanto, (2016) "Lean and Six Sigma in acute care: a systematic review of
reviews", International Journal of Health Care Quality Assurance, Vol. 29 Issue: 2,
pp.192-208,
[27] J.Antony, P.Palsuk, S.Gupta, D.Mishra, P.Barach, (2018) "Six Sigma in healthcare: a
systematic review of the literature", International Journal of Quality & Reliability
Management, Vol. 35 Issue: 5, pp.1075-1092,
[28] K.Aij, M.Teunissen, (2017) "Lean leadership attributes: a systematic review of the
literature", Journal of Health Organization and Management, Vol. 31 Issue: 7/8, pp.713-
729,
[29] T.Bortolotti, S.Boscari, P. Danese, H.Suni, N.Rich,P.Romano, (2018) "The social benefits
of kaizen initiatives in healthcare: an empirical study", International Journal of Operations
& Production Management, Vol. 38 Issue: 2, pp.554-578
[30] F.Barnabè, M.CleofeGiorgino, (2017) "Practicing Lean strategy: HoshinKanri and
XMatrixin a healthcare-centered simulation", The TQM Journal, Vol. 29 Issue: 4, pp.590-
609,
[31] Kurt Hozak, Eric O. Olsen, (2015) "Lean psychology and the theories of “Thinking, Fast
and Slow”",International Journal of Lean Six Sigma, Vol. 6 Issue: 3, pp.206-225,
[32] F.Barnabè, M.CleofeGiorgino, J.Guercini, Caterina Bianciardi, Vincenzo Mezzatesta,
(2018) "Management simulations for Lean healthcare: exploiting the potentials of
roleplaying",
[33] Journal of Health Organization and Management, Vol. 32 Issue: 2, pp.298-320,

http://iaeme.com/Home/journal/IJMET 311 editor@iaeme.com

 Vinodhini A, Dr. Seethalakshmi R and Dr. Sowdamini T

[34] C.Guimarães, José Crespo de Carvalho, (2013) "Strategic outsourcing: a lean tool of
healthcare supply chain management", Strategic Outsourcing: An International Journal,
Vol. 6 Issue: 2, pp.138-166,
[35] F.Barnabè, Maria Cleofe Giorgino, Jacopo Guercini, Caterina Bianciardi, Vincenzo
Mezzatesta, (2017) "Engaging professionals with serious games: the Lean Healthcare Lab
at Siena University Hospital", Development and Learning in Organizations: An
International Journal, Vol. 31 Issue: 3, pp.7-10,
[36] D.Adebanjo, T.Laosirihongthong & P.Samaranayake (2016)Prioritizing lean supply chain
management initiatives in healthcare service operations: a fuzzy AHP approach,
Production Planning & Control, 27:12, 953-966,
[37] M.Hussain, M.Malik, Hamda S. Al Neyadi, (2016) "AHP framework to assist lean
deployment in Abu Dhabi public healthcare delivery system", Business Process
Management Journal,Vol. 22 Issue: 3, pp.546-565,
[38] G.Tortorella, FlávioSansonFogliatto, Michel Anzanello, Giuliano
[39] Almeida Marodin, Mayara Garcia & Rafael Reis Esteves (2017) Making the value flow:
applicationof value stream mapping in a Brazilian public healthcare organisation, Total
Quality Management &Business Excellence, 28:13-14, 1544-1558
[40] C.Guimarães, J.Carvalho, A.Maia, (2013) "Vendor managed inventory (VMI): evidences
from lean deployment in healthcare", Strategic Outsourcing: An International Journal,
Vol. 6 Issue: 1, pp.8-24.

http://iaeme.com/Home/journal/IJMET 312 editor@iaeme.com