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Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
Limits of Lean Manufacturing & Service Practices
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Limits of Lean Manufacturing & Service Practices

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Lean thinking minimized the level of waste and caused positive radical changes in the industrial sector. On the other hand, there are limits that make lean inapplicable and is not worth it.

Lean thinking minimized the level of waste and caused positive radical changes in the industrial sector. On the other hand, there are limits that make lean inapplicable and is not worth it.

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  • 1. LIMITS OF LEAN MANUFACTURING & SERVICE PRACTICES Written by Hafez Shurrab
  • 2. ABSTRACT Lean thinking proved its excellence through its techniques and practices. Manyorganizations – including first lean introducers and practitioners - couldn‘t get the desiredoutcomes due to different external and internal concerns. This article addresses somerelevant limitations and impediments arise when lean practices and techniques areconsidered for implementation into manufacturing and service contexts, leanmanufacturing and lean service, respectively. Lean thinking was born in manufacturingenvironment but has been brought to the service sector lately, during last two decades.The objective of this article is to discuss and expose some relevant limitations andbarriers of lean management system for both manufacturing and service contexts. Methodology: The methodology applied to better understand lean limitationswithin different contexts was a systematic review of literature, as described basically byCusumano, M. (1994); and Brandão L. and Pidd M. (2011). Findings: This article has synthesized and categorized the limitations of leaninto different management contexts, in an effort to discuss how significant is to considerthe customization of lean practices and techniques to the adopters. In total, fourlimitations for lean manufacturing (automobiles) and eight barriers for lean service(health care) have been discussed. Research Limitations: Publications have exposed some examples ofmanagement contexts that may not generalize the limitations and barriers to the otherindustries. There may be other special-oriented limitations that either fit the discussedexamples solely or could be found exclusively in other management contexts. Future Study: It is highly recommended to consider change management whenlean practices and techniques are transformed to other culture and context. Much ofresearching effort required to design appropriate lean style suits different cases. Common Terms: Just-in-time (JIT); continuous improvement (CI); total qualitymanagement (TQM); world class manufacturing; theory of constraints (TOC); and SixSigma. Article Type: Literature review I
  • 3. TABLE OF CONTENTSABSTRACT ................................................................................................................................ ITABLE OF CONTENTS ...........................................................................................................IILIST OF TABLES & FIGURES ............................................................................................. III1. INTRODUCTION ..........................................................................................................- 1 - 1.1. Historical Review ................................................................................................................ - 1 - 1.2. Terminology ........................................................................................................................ - 2 - 1.2.1. Pull and Push Systems .............................................................................................................. - 2 - 1.2.2. Lean .......................................................................................................................................... - 2 - 1.2.3. JIT ............................................................................................................................................. - 3 - 1.2.4. Continuous Improvement Process ............................................................................................ - 3 - 1.2.5. Blue- & White-collar workers................................................................................................... - 3 - 1.2.6. New Product Development ....................................................................................................... - 4 -2. LEAN UNDER DIFFERENT MANAGEMENT CONTEXTS .....................................- 4 - 2.1. Lean Manufacturing ............................................................................................................ - 4 - 2.1.1. Urban Congestion ..................................................................................................................... - 4 - 2.1.2. Supplier Management ............................................................................................................... - 5 - 2.1.3. Blue-collar Workers .................................................................................................................. - 6 - 2.1.4. Product Variety ......................................................................................................................... - 6 - 2.2. Lean Service ........................................................................................................................ - 7 - Lean in Health Care ......................................................................................................................... - 8 - 2.2.1. Perception Barriers ................................................................................................................... - 8 - 2.2.2. Terminology Barriers ................................................................................................................ - 9 - 2.2.3. Personal/ Professional Skills of Health Care Professional Difference Barrier ........................ - 10 - 2.2.4. Organizational Momentum ..................................................................................................... - 10 - 2.2.5. Hierarchy & Management Roles Barrier ................................................................................ - 10 - 2.2.6. Professional & Functional Silos Barrier ................................................................................. - 11 - 2.2.7. Data Collection & Performance Measurement Barrier ........................................................... - 12 - 2.2.8. Resistance Change/Skepticisms Barrier.................................................................................. - 12 -3. CONCLUSION .............................................................................................................- 13 -4. REFERENCES .............................................................................................................- 14 - II
  • 4. LIST OF TABLES & FIGURESTable 1: Limitations of Lean: Japan 1990s ............................................................................- 7 -Figure 1: Top-down versus bottom-up flow of ideas ...........................................................- 11 - III
  • 5. 1. INTRODUCTION After the revolution of lean production and its tool, which had been introducedfirst time by Japanese companies in 1970s, most of researches concluded after addressedthe transitional phases of how to apply lean thinking whatever is the context. Leanapproach with its tools could change the waste levels radically for many differentindustries inside, as well as, outside Japan. As the lean philosophy is very powerful andrepresent the perfection, very few researchers those who were quite courageous tocriticize the philosophy, and not only to support deploying it with new tailor-madeadditions that make it more applicable for different conditions and context. This report addresses the limits of lean approach for different managementcontexts, generally for manufacturing and service industries.1.1. Historical Review Lean practices came from the Japanese manufacturing area. John Krafcikintroduced lean as it‘s known in 1988. (Holweg et al., 2007) Before doing MBA studiesin MIT, Krafcik worked as a quality engineer for one of Toyota businesses. TheInternational Motor Vehicle Program has continued Krafciks research. Jim Womack,Daniel Roos, and Daniel Jones produced the international book ―The Machine ThatChanged the World‖. For many practitioners, Lean is the group of "tools" that enable identifying andeliminating wastes (muda). The elimination of wastes facilitates improving the qualitywhile reducing cost and time of production. Examples of such practices, techniques ortools are Kanban, six S, Value Stream Mapping, and poka-yoke. Toyota supported another approach to Lean Manufacturing, in which the focusis on improving the "flow" of work, herewith constantly eliminating mura ("unevenness")not on waste to be reduced per se but through the system. Techniques to support flowinvolve production leveling, "pull" production and the Heijunka box. Both TPS and Lean could be seen as an insufficiently connected group ofcompeting principles that target to reduce the cost by eliminating the wastes. (TaiichiOhno, 1988) These principles involve: Perfect first-time quality, Pull processing, Wasteminimization, Flexibility, Continuous improvement, Building and sustaining a long term -1-
  • 6. relationship with suppliers, Visual control, Autonomation and Load leveling and Production flow. Some of these principles have disconnected nature that may affect the fact that the TPS has grown to be more practically since 1948 as it could respond to the problems it saw within the production facilities. Therefore what it seen today is the outcomes of a need tracked learning to develop where each stage has built on previous ideas and not something depended upon a theoretical formation.1.2. Terminology1.2.1. Pull and Push Systems (Peter & Donnelly, 2002) (Dowling, 2004) A push–pull system describes the way of information or product movement between two entities. On markets, the supplier usually pushes the goods or information, while the consumer pulls them according the need. In supply chains, the stages for both push- and pull-systems are operating normally. (Harrison et al. 2003) In push production the demand is forecasted, while the actual demand is based on for pull production. The transitional phase between these stages is called the decoupling point or push–pull boundary.1.2.2. Lean Lean is a set of production practices that focus on the expenditure of resources don‘t add a value for the consumer or end customer and deployed to eliminate non-value added activities associated with these resources. According to the customer point of view that benefits from a service or product, "value" is perceived as any process or activity a customer is ready to pay for (Womack et al. 1990).The original seven types of wastes are: Transport Inventory Unnecessary Motion Waiting Overproduction Over Processing Defects -2-
  • 7. The eighth waste was added later by Womack et al. (2003); it was discussed asthe case when the customer demand or specifications aren‘t met by the provided goods orservices. The waste of unused talents has been integrated on the seven types wastes bymany others. These wastes were found to be useful additions in practice, even thoughthey were not originally a part of the seven catastrophic wastes defined by Taiichi Ohnoin TPS (Bicheno & Holweg, 2009).1.2.3. JIT Just in time (JIT) is a production procedures set that struggles to improve abusiness return on investment by reducing in-process inventory and associated carryingcosts. The process relies on Kanban between different process points to meet JITobjectives, which inform production when to make the next component. Kanban areusually tickets or cards but could be just simple signals, such as the full or empty part ona shelf. JIT, implemented correctly, when continuous improvement is on focuses and canimprove the return on investment of a manufacturing organization, efficiency, andquality. To achieve continuous improvement key areas of concern could be quality, flowand employee involvement (Shingo S. 1989).1.2.4. Continuous Improvement Process A continual improvement process is an ongoing effort to improve processes,services, or products. These efforts can seek "incremental" improvement over time or"breakthrough" improvement all at once. (ASQ 2012) Delivery (customer valued)processes are steadily evaluated and improved in terms of their efficiency, effectivenessand flexibility.1.2.5. Blue- & White-collar workers A blue-collar worker is a working class member who practices manual labor.Blue-collar work may involve manufacturing, skilled or unskilled, technical installation,mining, mechanical, maintenance, construction and many other sorts of physical work.Often physical maintenance or building is on board. On the other hand, the white-collar worker takes the responsibility of officework, and the work environment includes desk and computer. -3-
  • 8. Blue-collar worker is usually paid by different types of payment methods including hourly wage-labor, project or salaried. The payscales are widely ranged and work depends upon the experience and field of specialty (Wickman, 2012). 1.2.6. New Product Development In business and engineering, new product development (NPD) is the complete process of bringing a new product to market. A product is a set of benefits offered for exchange and can be tangible (that is, something physical you can touch) or intangible (like a service, experience, or belief). There are two parallel paths involved in the NPD process: one involves the idea generation, product design and detail engineering; the other involves market research and marketing analysis. Companies typically see new product development as the first stage in generating and commercializing new product within the overall strategic process of product life cycle management used to maintain or grow their market share (Ulrich et al. 2004).2. LEAN UNDER DIFFERENT MANAGEMENT CONTEXTS 2.1. Lean Manufacturing As the idea of lean came from a production context, it‘s highly important to consider the obstacles hindered those who wanted to import lean manufacturing as a holistic approach, which should be stuck to literally. Cusumano M. (1994) criticized some practices of lean manufacturing and gave examples of other Japanese companies when tried to adopt Toyota‘s philosophy. He went further to spot the light on Toyota itself, when it started to export its automobiles across the world or in different parts of it. The general and most serious impediments the pioneers of lean confronted were as the following: 2.1.1. Urban Congestion Most Japanese producers in general and automakers in particular were obsessed of JIT, which in turn made the physical exchanges of Kanban cards or ―Production Orders‖ between suppliers, branches, factories, exhibitions, and customers very intensive. This affected severely the traffic congestion that the Japanese government had organized media campaigns to recommend the reduction of deliveries frequency. Besides, the levels -4-
  • 9. of air pollution increased significantly as well as the wasted time, the most importantfactor for lean (Cusumano, 1994). Outside Japan, it was absolutely impractical to deliver very small lots for longdistance. This is one of the most controversial points to discuss the lean manufacturing asan effective approach that could suit all cases. Some of Toyota‘s competitors such as Nissan figured out that their bodies aremore dispersed than Toyota. Nissan believed that it‘s more practical to increase the levelsof inventory to one or a couple of days, but not a couple of hours that Toyota did. Thephysical exchanges of Kanban became impractical and obsolete after the revolution ofinternet and signal science.2.1.2. Supplier Management Lean manufacturing application requires cooperative and reliable suppliers,which account for about %75 of manufacturing work in automobile industry, and %50 ofproduct development, measured by costs. (Cusumano, 1994) The Japanese companiesfaced much trouble relying on suppliers outside Japan, where culture, mentality, costs,rules and other were partially or totally different. Non-Japanese suppliers have notcomplied literally with Japanese quality and pricing requirements, nor were they trustedby the Japanese. As a result of production and market expansion around the world, Japan sufferedfrom severe shortage of factory labor. The Japanese government allowed foreign workersto work in Japan or in Japanese companies to cover the shortage. But this introducedanother problem of the training needs to the workforce for those who miss the Japaneseliteracy. The companies reported many quality issues and lack of workers flexibility as aresult of using less-skilled foreigners. So the companies have been enforced to reduce theproductivity to provide longer time to the inspection and other quality activities. -5-
  • 10. 2.1.3. Blue-collar Workers Ohno Taiichi, the inventor of kanban system and former brilliant manager ofToyota, relied on well-trained workers instead of the automation. He was convinced thatthe automation can be relayed on when it becomes reliable, reprogrammable, easilyadjustable in terms of product variations and volume fluctuations, and inexpensivecompared with human. For being responsive to the developed manufacturing demand,managers needed skilled workers to be flexible with their working times. There weremore factories than demanded blue-collar workers (women were not permitted to work inauto assembly factories that time). Moreover, young Japanese tended more to white-collar work instead. Employee turnover rates reached 30% annually. (Cusumano, 1994)The problem would have been worsened if Japanese economy covered. Any change inthe strategy could likely reduce the productivity advantage Toyota had been enjoying athome.2.1.4. Product Variety Toyota and other companies had high flexible production systems that let themproduce too many models and features of products and maximize their competitivecustomizations. The parts maker and assembly plants had to be responsive with too smalland very rare orders too frequently. The variety requires constant equipment setups,kanban exchanges, and small lots – just when the total sales are stagnant and workers,suppliers, and traffic system have reached to sort of practical level (maturity).Environmental concerns came to mind after the product life cycle started to be narrower.But the most pressing concern is that the cost of new model development and modelreplacement is very high, and money became very expensive while interest rates in Japanreached international levels. Banks could no longer offer cheap loans, as their portfoliosof stocks and real estate and their customers‘ portfolios had declined. Companies couldno longer raise capitals from stock market because of Japanese investors‘ reluctance tobuy securities in the market that had dropped %50 in value during the several yearsbefore. The operating profits were the only ―free‖ money, which had also declineddramatically. Japanese companies changed their scheduling and control systems in the shortterm. They reduced products variety to %20 of the products that achieve %80 of overallprofits. (Cusumano, 1994) They relied on electronic forms of moving information, such -6-
  • 11. as bar-code readers, rather than exchanging kanban cards physically. Exporting used- products to other places of world was an effective temporary solution to the environmental concerns. They considered recycling product‘s materials more effectively. Japanese have realized that they had to reduce their overall investment in new product development. They are now reducing unique parts and product variety and increasing interchangeability by %30 to %50 or more for new models. (Cusumano, 1994) They determined to reconsider heavyweight manager by limiting their discretion and budgets. Establishing platform manager and chief engineers to facilitate sharing more key component and manufacturing facilities (this could ease assembly activities, simplify supplier relationship, and reduce engineering and manufacturing-preparation costs). The risk: The total sales could likely decline as the options and variety the customer used to enjoy is no longer on table. Sales may even decline, although profits may rise as a percentage of sales if the Japanese learn how to generate more profits from each product development effort, rather than simply look for expansion of sales and market share (Cusumano, 1994).Table 1: Limitations of Lean: Japan 1990s 2.2. Lean Service During the economic crisis invaded the world in 2000s, many organizations started to conduct cost-reductive procedures to the most possible extent. Many researches addressed lean philosophy that succeeded radically in cost reduction for many cases of industrial contexts. Considering lean techniques in service context came before the -7-
  • 12. economic crisis by years. Many researchers studied the transition of lean techniques tothe service context for both private and public sectors within various industries. Due tothat some common barriers and limitations have arisen while applying lean in serviceorganizations. This report reviews some of those barriers limited the results of leanapplication in health care sector as a representative example of service industry.Lean in Health Care Many countries consider lean philosophy and techniques in the health caresector. The cost pressure led the majority to adopt lean techniques to improve their bothefficiency and effectiveness. And another objective is to minimize non-value-addedactivity level. As expected, it isn‘t that simple to understand and adapt the uniquecharacteristics of health care industry to the lean frame. Many impediments and barriershave shown up. Radnor et al. (2006) suggests the following implementation barriers:  People: mainly referring to skepticism about change programs in general.  Lack of ownership: either of current activities or of proposed processes.  Identity of improvement team members: often made up of those willing to get involved, rather than those who should do so.  Leadership failure.  Compartmentalization: functional and professional silos.  Weak link between improvement programs and strategy.  Lack of resources.  Poor communication: the over-use of jargon and the lack of a clear message to staff. Brandão L. and Pidd M, (2011) identified the implementation barriers in healthcare. It is always difficult to introduce new things in an organization as employees wantto stick to the old system. The common problem is that everybody knows lean as amanufacturing system which may only applicable to Japan. It is also true that manythings of lean has improved or developed due to the unique nature of Japanese people andtheir working style. There are some common barriers while implementing lean in healthcare.2.2.1. Perception Barriers Manufacturing myths and lack of understanding of lean principles among healthcare professionals is seen as a barrier. Some health care professionals argue that everypatient is different, unlike every manufactured product in a factory. A common -8-
  • 13. misbelieve among professionals that a patient might be treated as a ‗piece of metal‘—humanity would disappear from health care. It is important to emphasis that lean focuseson reducing non-value-adding activities, which usually means those activities that do notinvolve patient contact such as ‗paperwork‘. There is no intention in lean to reducehuman contact between patients and clinicians, there may, instead, be an increase in theproportion of touch time.2.2.2. Terminology Barriers Introduction of new language is a common issue for implementing lean in anysetting. In general, health care professionals responded well to the introduction of newvocabulary and it helped them to shift from old to new practices. Any organization usinglean thinking as its main improvement philosophy needs to integrate new terminologyinto its vocabulary (LEI, 2003). Some regard the introduction of new terminology as animplementation barrier for lean health care. The idea of eliminating waste is to review allorganizational levels and entities, detect where the non-value added cost to be reduced oreliminated. Seven types of wastes are in healthcare:  Transport- movement of patients and equipment  Inventory- unneeded stocks and supplies  Motion- movement of staff and supplies  Waiting- delays in diagnosis and treatment  Over production- unnecessary tests  Over burden- stressed, overworked staff  Defects – e. g. medications errors, infections It is extremely important, though, to develop a common vocabulary to be usedacross the whole organization for lean implementation. Inconsistencies in terminologybetween different departments can lead to serious misunderstandings. The important issueis the idea and not the name, though some terms do need to be adapted. In a patient-related application for instance, it would be inappropriate to refer to lead time or work-inprogress if terms such as waiting time or waiting lists are already in use. -9-
  • 14. 2.2.3. Personal/ Professional Skills of Health Care Professional Difference Barrier There are intrinsic differences in personal and professional skills between healthand manufacturing professionals, and there differences are seen as a barrier. It becomesclear that the fire –fighting mentality acts as a practical barrier in the introduction of lean.Ben-Tovim et al. (2007a) argues that health care managers are generally chosen for theirproblem-solving skills, particularly ‗firefighting‘, and usually enjoy the dramainvolved—an observation confirmed in the case studies. However, lean practice is notbased on finding quick, temporary solution to problems, but on understanding the rootcauses of delays and other hindrances to flow. To shift the focus of health care managersfrom a problem-solving and fire-fighting approach to careful analysis, and to change theirdecision processes from experience-based to data/evidence-based will always be achallenge and is a real implementation barrier.2.2.4. Organizational Momentum The constant change of strategy for improvement (locally) and governmentalpolicy (nationally) inhibits the continuity of potentially successful programs. Lean is nota quick fix, but a continuously evolving program of work. This is not always recognizedin practice (Esain et al., 2008 & Proud et al., 2008). A continuous improvement programrequires substantial effort at the start, including training, piloting and overcoming someof the barriers described here. The rate of change in a typical lean program may beinitially slow until organizational momentum is acquired. At this point, a culture ofimprovement is created and improvement becomes a ‗day job‘ rather than a series ofconceptual events that happen in discrete points of time (Brandão L. & Pidd M, 2011).2.2.5. Hierarchy & Management Roles Barrier Cultural issues based on the hierarchy of health care staff and the waymanagement roles are allocated typically becomes a barrier for any improvement but thisis especially important when lean is introduced. Ben-Tovim et al. (2007b) discusses another barrier to lean health care caused byhierarchical and cultural issues: health care managers see their role as having to come upwith a solution once a problem is identified. By contrast, lean thinking implies an - 10 -
  • 15. inverted flow of solutions/ ideas (from top-down to bottom-up, figure 1), recognizing thatfront-line staff understand the most about the problems they face each day. Figure 1: Top-down versus bottom-up flow of ideas2.2.6. Professional & Functional Silos Barrier The fragmentation of health care into silos (professional or functional) imposesa major barrier to the flow of patients, goods and information and consequently to theimplementation of lean techniques in hospitals. Some of the main barriers to lean health care stem from the current structure offragmented care and professional practice, seen in many hospitals as professional andfunctional silos. A professional silo occurs when health care practitioners are separatedinto professional groups. A typical hospital may have over 100 such that can be classifiedinto two main groups:  Care providers (for example doctors, nurses and physiotherapists).  Non-care providers (for example managers, secretaries and cleaners). Functional silos lead to fragmented care (Mann, 2005), which may mean thatpressure to improve performance results in sub optimization (in single silos) that may notresult in overall improvement of care provided to patients. Lean health care principles - 11 -
  • 16. support the improvement of the complete care process, from arrival to discharge, ratherthan a series of disconnected steps. The medical records case provides a good example ofthree functional silos in the flow of medical files, namely medical records, medicalsecretaries and outpatient clinics. Lean was used to improve the flow of medical files,which led to better care in outpatient clinics.2.2.7. Data Collection & Performance Measurement Barrier Lean implementation usually reveals problems in data collection and poorperformance measures in most aspects of patient care. This often amplifies the need forcultural change in health care settings. Performance measurement is a key component forsuccessful implementation of lean approaches (Kollberg et al., 2007). Great care isrequired if performance measurement is not to lead to undesirable side-effects. Many years ago, Ridgway (1956) argued that measurement, once introduced, isoften interpreted by staff as defining the important aspects of the job or activity in whichthey are engaged. Hence, it is important to understand the motivational and behavioralconsequences of any performance measurement. Smith (1995) extended this argument toconsider the effects of publishing performance data, which can lead to many differenttypes of dysfunctional behavior if not carefully planned.2.2.8. Resistance Change/Skepticisms Barrier Resistance to change is a significant problem in any improvement program inany organization. It deserves special attention from those attempting to implement lean,since staff empowerment, which is a key issue in the lean theory, is needed for engaginghealth care professionals. Resistance to change is a problem in many, possibly all,organizations and there is a vast academic literature on this topic. Val D. and Fuentes(2003) offer a thorough review, pointing to many sources of resistance within a broadcontext. - 12 -
  • 17. 3. CONCLUSION Lean was running smoothly at the beginning of its practice when it developed in Toyota production system (TPS). The growth of Toyota made it difficult to keep the fundamental principal of lean. The main attraction of lean manufacturing is its capability of reducing waste and the continuous development of the product/service. When the system is getting large, it is difficult for lean to perform smoothly, which means its scalability is insufficient. The main advantage of lean is the reduction of inventory levels, which emphasizes other relevant benefits of quality issues particularly and other areas of interest in general. It‘s cost effective in many senses but it‘s very stressful for the suppliers and employees in the assembly line. For the service sector like health the practices has developed in a very different way under lean. It‘s not easy for many countries to adopt the system in health sector because of the hierarchal structures and management practices that have been developed over years. It is very significant to understand the consequences follow applying lean system literally - copying the system to all kind of organization without understanding the philosophical meaning of lean. Every organizational context has its distinct aspects and considerations. Every field of concern has its dimensions and constraints that may affect the behavior of system under lean practices. It‘s highly important for those willing to import lean for their industries to study the limitations of lean under which context it‘s intended to operate on. The cultural differences between the culture lean has been introduced in first time for a certain industry and the other culture lean would be brought to are very controversial and significant for future studies. It‘s recommended to go further the integration of change management to the transitional phases of lean application. - 13 -
  • 18. 4. REFERENCES ASQ (2012). Learn About Quality. Available: http://www.asq.org/learn-about- quality/continuous-improvement/overview/overview.html [2012-09-20]. Ben-Tovim, D. I. (2007a), ‗Lean thinking across a hospital: redesigning care at the Flinders Medical Centre‘ Australian Health Review, 31, 10–15. Ben- Tovim, D. I. (2007 b), ‗Seeing the picture through ‗lean thinking‘ British Medical Journal, 334, 169. Bicheno, John; Holweg, Matthias (2009). The Lean Toolbox. PICSIE. De Souza, L, & Pidd, M2011, ‗Exploring the barriers to lean health care implementation‘ Public Money& Management, 32,1, 59-66. Del Val, M. P. & Fuentes, C. M. (2003), ‗Resistance to change: a literature review and empirical study‘ Management Decision, 41, 2, pp. 148–155. Dowling, Grahame Robert (2004). The Art and Science of Marketing. Oxford University Press. pp. 266. Esain, A., Williams, S. & Massey, L. (2008), ‗Combining planned and emergent change in a health care lean transformation‘ Public Money & Management, 28, 1, pp. 21–26. Edward G. Hinkelman & Sibylla Putzi (2005). Dictionary of International Trade – Handbook of the Global Trade Community. World Trade Press. Holweg, Matthias (2007). "The genealogy of lean production". Journal of Operations Management, 25, 2, 420–437. Kollberg, B., Dahlgaard, J. & Brehmer, P. O. (2007), ‗Measuring lean initiatives in health care services‘ International Journal of Productivity and Performance Management, 56, 1, 7–24. Kyle B. Stone, (2012), ‗Four decades of lean: a systematic literature review‘, International Journal of Lean Six Sigma, 3, 2, 112 – 132. Krafcik, John F. (1988). "Triumph of the lean production system". Sloan Management Review, 30, 1, 41–52. - 14 -
  • 19. Michael A. Cusumano 1994, ―The Limits of Lean‖, Sloan Management Review, 35, 4, 27-32.Mann, L. (2005). ‗From ‗silos‘ to seamless health care: bringing hospitals and GPs backtogether again‘ Medical Journal of Australia, 182, 34–37.Ohno, Taiichi (1988). Toyota Production System. Productivity Press. p. 8.Peter, J. Paul; James H. Donnelly (2002). A Preface to Marketing Management. McGraw-Hill Professional. p. 132.Putnik, G, & Putnik, Z 2012, ‗lean vs. agile in the context of complexity management inorganizations‘, Learning Organization, 19, 3, 248-266.Radnor, Z., Walley, P., Stephens, A. and Bucci, G. (2006), ‗Evaluation of the LeanApproach to Business Management and its Use in the Public Sector‘, The ScottishGovernment, Edinburgh.Ridgway, V. F. (1956), ‗Dysfunctional consequences of performance measurements‘Administrative Science Quarterly, 1, 2, pp. 240–247.Smith, P. C. (1995), ‗On the unintended consequences of publishing performance data inthe public sector‘ International Journal of Public Administration, 18, 2, 3, 277–310.Shigeo Shingo, (1989) , A study of the Toyota Production System, Productivity Press, pp.187Terry P. Harrison, Hau L. Lee & John J. Neale (2003). The Practice of Supply ChainManagement. Springer.Wickman, Forrest (May 2012). "Working Mans Blues: Why do we call manual laborersblue collar?‖ Available: http:// Slate.com, [2012-09-18].Womack, James P.; Daniel T. Jones, & Daniel Roos (1990). The Machine That Changedthe World, Harper Perennial.Womack, James P. & Daniel T. Jones (2003). Lean Thinking. Free Press. p. 352.Ulrich, Karl T. & Eppinger, Steven D (2004) Product Design and Development, NewYork: McGraw-Hill, 3rd Edition. - 15 -

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