Abstract
Understanding how VMI benefits serve lean purposes in healthcare and why its outcomes can be difficult to achieve in healthcare settings is the main purpose of this study. An in?depth case study of VMI is presented in the perspective of the downstream member, a public general multi?site hospital, operating as a small scale consolidated service centre in terms of material management, exploring such dimensions as: VMI benefits, risks, barriers and enablers. Despite some unawareness of VMI benefits in healthcare, it can present a waste reduction solution not only in costs but in the quality of care for freeing clinical professionals to clinical tasks, among other savings. The multiple benefits are better explored, as in any relationship building, by investing in partnership creation and overcoming the idiosyncratic barriers of the healthcare sector. Although findings of a single case study are difficult to generalize, the protocol and methodology presented allow replication in other units of analysis with the same inclusion criteria. This paper brings the lean deployment discussion out of the organization's boundaries, showing the interconnections and pointing to the need for future work that would allow healthcare managers to build a lean supply chain. By considering VMI an outsourcing alternative, this paper identifies the lean thinking intent behind such options and enhances the idiosyncratic difficulties in full deployment in the healthcare sector, a less studied setting. © 2013, Emerald Group Publishing Limited

Abstract
Considering lean thinking inside and beyond the organisation's boundaries, in the extended supply chain, this paper aims to fill a literature gap clearly stating some outsourcing practices as lean practices and establishing a deployment evolution parallel between both practices. A literature review was carried out collecting cases of lean deployment in healthcare, from both scientific and grey literature. Cases were classified according to lean deployment taxonomy in healthcare settings, showing some differences in lean journey stages in 15 countries. There is an alignment between SCM thinking in healthcare and lean thinking that places a SCM decision as outsourcing as a lean practice serving not only strategic intent but solving operational efficiency. There is a match between different outsourcing drivers (transactional, strategic and transformational) and lean maturity levels. The main constraint to deployment of both lean and outsourcing practices are cultural differences. Understanding lean and outsourcing different deployment maturity levels under the national cultural umbrella can open new perspectives to study lean sustainability factors and better outsourcing relationships in healthcare organisations. This paper presents a merger between the state?of?the art of both lean and outsourcing practices in healthcare settings and suggests an outsourcing and lean evolving pathway. © 2013, Emerald Group Publishing Limited

Abstract

Abstract
This article presents a critical review of lean assessment in manufacturing and service settings as a base for development of a lean assessment framework for healthcare organizations, aiming to help them throughout a long journey. Having as starting point lean projects’ failures in four public hospitals, the authors discover the lack of monitoring (among other reasons) as the main issue. This article proposes a monitoring instrument for preventing returns to the comfort zone and guiding the lean journey. The healthcare lean assessment (HLA) can be used as an “as is” diagnosis tool, assessing whether each process should be improved, disrupted, or eliminated and also as an ongoing implementation assessment, providing control measures and correction actions. Although the framework proposed requires empirical testing in further research for universal application, it can help healthcare organizations by providing a transformation roadmap and monitoring instrument and also contributes to the growing stream of academic research in this area. © IIE, INCOSE.

Abstract
Senior entrepreneurship is getting increasing prominence in research, academia, and business. Given the demographic shifts occurring in Western Europe, it is also becoming a nuclear topic of interest for policymakers. Still, existing literature overlooked the emergent trend encompassing older individuals which, with different leitmotifs, starting-up new enterprises after decades as employees. In doing so, they convey formal and informal knowledge, networks, experience, savoir faire, and financial endowments, nurtured along the years, which is an evident advantage compared to the younger counterparts. Due to the raising number of negative experiences in the job market, either in getting or maintaining a position, senior workers look up for alternatives. Sometimes being pushed by necessity, other times pulled by opportunity identification and independence, seniors are increasingly making their best to overcome unsatisfying or insufficient conditions as employees. Enhancing entrepreneurial initiative across older individuals is urgent for policy makers due to the need to find occupation for an aging population and their contribution to income generation, at the same time, social and human capital will be leveraged, multiplying the effects of other policy actions such as education. Using the GEM database, this article aims to offer an overview on the role of age in entrepreneurial intention and its nature, addressing the nonlinearities of the effect. This new methodological framework can be used as a basis for future empirical research on the topic of senior entrepreneurship; additionally, it aims contributing to a better understanding of the role of age in shifting the individual reasons for starting a business, controlling for other individual characteristics. The identification of the particular features of the different age cohorts along with gender, education, social context or macro-economic contexts will shed some light on the specific policy packages needed to reinforce the entrepreneurial initiative as a vehicle to promote sustainable and inclusive growth along the European Countries.

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.