Abstract
Healthcare organisations, especially in public sector, have been adopting Lean management practices with increasing outcomes’ evidences in several parts of the world, since the beginning of this century. However, Lean deployment in Healthcare services has been addressed in the literature in a surgical way by an array of case reports addressing the “hard” side of Lean deployment, sometimes with no result’s consistency or even follow-up analysis. This thesis seek to add to the operational side of Lean deployment in Healthcare, a complementary understanding of Lean deployment approaches, addressing both “hard” and “soft” sides, identifying the real constraints of Lean in Healthcare sector and the sustainability factors. Supported by two main literature reviews and a multi-case approach, a deep research on the eligible Portuguese cases was conducted answering the questions: (i) What are the different outcomes from Lean deployment in Healthcare?; (ii) What are the barriers to Lean implementation in Healthcare?; (iii) What enables Lean implementation in Healthcare?; (iv) What are the risks of Lean in Healthcare?; (v) How to measure Lean achievements in Healthcare services?; and (vi) How to develop a sustainable Lean culture? This contribution to the academic debate on Lean deployment in Healthcare creates clarity on what can be called Lean practices in Healthcare settings under the light of the concept’s founders; what pattern of a Lean deployment journey was followed by Healthcare organisations; and how different cultural (organisational and national) contexts can influence the pace in pursuing that pattern.;As organizações de saúde, nomeadamente públicas, têm vindo a adoptar práticas de gestão Lean com crescente evidência de resultados em várias partes do mundo, desde o início deste século. Contudo, a aplicação do Lean em serviços de saúde tem tido um tratamento cirúrgico na literatura, recaindo apenas nos aspectos “hard” e sem grande consistência ou seguimento de resultados . Esta tese pretende acrescentar aos aspectos “hard” do Lean, um entendimento complementar juntando os aspectos “hard” e “soft”, identificando as restrições e factores de sustentabilidade da aplicação do Lean no sector da saúde. Tendo por base duas revisões bibliográficas primordiais e uma abordagem empírica multi-caso a partir de casos portugueses elegíveis, esta tese fornece respostas às questões: (i) Quais os diferentes resultados da aplicação do Lean na Saúde?; (ii) Quais as barreiras à aplicação do Lean na Saúde?; (iii) Quais os facilitadores da implementação do Lean na Saúde?; (iv) Quais os riscos do Lean na Saúde?; (v) Como medir a implementação do Lean na Saúde; e (vi) como desenvolver uma cultura Lean sustentável? Este contributo para o debate académico sobre a aplicação do Lean na Saúde introduz clareza sobre o que pode ou não ser chamado de práticas Lean na Saúde tendo como referência os conceitos dos fundadores; que padrão de implementação é seguido pelas organizações; e de que forma diferentes contextos culturais (nacionais e organizacionais) influenciam o ritmo desse padrão de implementação.

Abstract

Abstract
This study adopts an integrative review approach to explore the differences and similarities between smart cities and sustainable cities. The research starts by performing two systematic literature reviews about both paradigms and, after that, employs a thematic analysis to identify key themes, definitions, and characteristics that differentiate and connect these two urban development concepts. The findings reveal more similarities than differences between the two paradigms. Despite this, some key differences are identified. Smart cities are characterized by their use of advanced information and communication technologies to enhance urban infrastructure, improve public services, and optimize resource management. In contrast, sustainable cities focus on environmental conservation, social equity, and economic viability to ensure long-term urban resilience and quality of life. This study is important because it clarifies both concepts and highlights the potential for integrating smart and sustainable city strategies to address contemporary urban challenges more holistically. The findings also suggest a convergence towards the concept of 'smart sustainable cities', which leverage technology to achieve sustainability goals. Finally, this study concludes by identifying research gaps and proposing a future research agenda to further understand and optimize the synergy between smart and sustainable urban development paradigms.

Abstract
When taking a broader view, ‘leanness’ can be conceptualized in terms of a quest for structural flexibility involving restructuring, downsizing and outsourcing. Looking for efficiency, quality and profitability gains, healthcare organizations adopt outsourcing solutions in the attempt of “doing more with less” seeking for benefits such as cost reduction, risk mitigation, adapting to quick changes without compromising internal resources (value mapping and value chain reconstruction) but also taking big risks as loss of control and flexibility. In order to understand how healthcare organizations find the best value equation combining internal and external resources, a case study on a start-up Long-term Care unit with innovative format, great levels of customization and following an outsourcing strategy, was carried out. The main conclusion, among others, is that in ambitious start-ups, when the speed of entrance is a conditioning factor, trade-offs between cost and quality gains (leanness) and between cost and time gains (agility) can be combined through outsourcing strategies in a so called “leagile” paradigm. This study contributes for a wider understanding of the “leagile” concept associated to an outsourcing strategy as a way of coping with market and services volatility, uncertainty and complexity, hyper competition and market share/sped of entrance goals. © Springer-Verlag Berlin Heidelberg 2012.

Abstract

Abstract
This article seeks to investigate outsourcing decisions in supply chain management of healthcare organizations, namely the motives and constraints behind the decision, the selection criteria for activities to be outsourced to third parties, the type of possible agreements, and the impact of this decision on the organization per se. A case study of the start-up phase of a Longterm Care unit with an innovative approach and high levels of customization was conducted to understand the outsourcing process in a start-up context (not in the standard context of organizational change) and a risk evaluation matrix was created for outsourcing activities in order to define and implement a performance monitoring process. This study seeks to understand how to evaluate and assess the risks of an outsourcing strategy and proposes a monitoring model using risk management tools. It was shown that the risk management approach can be a solution for monitoring outsourcing in the organizational start-up phase. Conclusions concerning dissatisfaction with the results of outsourcing strategies adopted are also presented.