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Introduction
Since the 1970s, competition on factors such as zero defects, process time reduction, cost reduction and relevant customization has increased. This scenario is the opposite of the so-called mass production , in which there is a huge demand for services and products, and services are provided with low-cost resources and with poor personalization and quality (Chiarini, 2013a).
In the past decades, many industries, including public healthcare, have embraced strategies which stem from the Japanese industry, in particular total quality management (TQM) and Lean thinking. Since the introduction of TQM in the 1990s in healthcare (Marszalek-Gaucher and Coffey, 1993), process performance has improved, in particular customer satisfaction and error reduction (Baccarani and Castellani, 2008; Chiarini, 2013b; Garengo and Biazzo, 2013). TQM is based on the involvement of all the staff, including physicians, nurses and senior management. TQM has also introduced to healthcare the principle of kaizen , which is translated as continuous improvement (Imai, 1986; Bhuiyan and Baghel, 2005). As discussed in the next section, in the past few years, healthcare has incorporated Lean thinking with the aim of integrating it with TQM initiatives.
Lean is the term which Womack et al. (1990) coined in the 1990s through their famous book, The Machine That Changed the World: The Story of Lean Production . In this well-quoted book, the authors investigated different production systems within the automotive sector, including the Toyota Production System. The latter originated along with total quality control and management in the 1960s. The Toyota Production System proposes that companies have to avoid seven wastes that lead to a loss of efficiency and efficacy:
1. overproduction;
2. inventory;
3. transport;
4. motion;
5. defectiveness;
6. waiting; and
7. over-processing (Chiarini, 2013a).
Teeuwen (2010) introduced an eighth waste specifically for the public sector. According to the author, underutilization of human skills is a waste that has to be taken into account when public organizations, including healthcare, deal with Lean implementation.
When it comes to deploying TQM and Lean strategy, these two systems generally bring to processes and the organization, a legacy of specific tools and principles used for reducing the above-mentioned wastes, including errors.
TQM and Lean stem directly from production and manufacturing management, in particular from the Japanese production system, but over time,...