The proceedings contain 24 papers. The special focus in this conference is on Challenging the Future with Lean. The topics include: A Confrontation Between Lean Thinking and Postmetaphysical Philosophy; barriers and Enablers of Lean Industry 4.0; how Organizations Can Harness Continuous Improvement Practices to Develop Their Data Analytic Capability: A Conceptual Paper; Introducing DACAR: A Process Mapping Tool to Uncover Robotization Implications in Manufacturing; toward 1+1 = 3 with Lean Robotics: The Introduction of a Human-Centered Robotization Method; digital Tools Supporting Lean Program in a Multinational Enterprise; lean Planning & Control in a High-Variety/Low-Volume Environment; sustainability Struggles: Investigating the Interactions of Lean Practices and Barriers to Environmental Performance in Manufacturing; Investigating the Relationship Among Lean Manufacturing Practices to Improved Eco-Efficiency Performance: A Fuzzy DEMATEL Analysis; The Contribution of SMED to the Sustainability of Organizations; hoshin Kanri for Social Enterprises - Co-visualizing Values-Based Strategic Plans; integration of a Robot Solution in a Manufacturing Environment: A Serious Gaming Approach; using Games and Simulations to Facilitate Generative Conflict; the Influence of Learning Styles on the Perception of Lean Implementation Effectiveness by Employees; current State of Practice in Developing Lean Six Sigma Training and Certification Programs -an Irish Perspective; improving the Success Rate of Lean-Themed Internships; serious Games as a Lean Construction Teaching Method - A Conceptual Framework; The Impact of SMED on Productivity and Safety; a Systematic Literature Review on the Use of Lean Methodologies in Enterprise Sales Processes; the First Chapter of a Regional Deployment of a Continuous Improvement Program in a Medical Device Company.
LINK
This paper presents work aimed at improved organization and performance of production in housing renovation projects. The purpose is to explore and demonstrate the potential of lean work organization and industrialized product technology to improve workflow and productive time. The research included selected case studies that have been found to implement lean work organization and industrialized product technology in an experimental setting. Adjustments to the work organization and construction technology have been implemented on site. The effects of the adjustments have been measured and were reviewed with operatives and managers. The data have been collected and analyzed, in comparison to traditional settings. Two projects were studied. The first case implied am application of lean work organization in which labor was reorganized redistributing and balancing operations among operatives of different trades. In the second case industrialized solution for prefabricated installation of prefabricated roofs. In both cases the labor productivity increased substantially compared to traditional situations. Although the limited number of cases, both situations appeared to be representative for other housing projects. This has led to conclusions extrapolated from both cases applicable to other projects, and contribution to the knowledge to improve production in construction. Vrijhoef, R. (2016). “Effects of Lean Work Organization and Industrialization on Workflow and Productive Time in Housing Renovation Projects.” In: Proc. 24 th Ann. Conf. of the Int’l. Group for Lean Construction, Boston, MA, USA, sect.2 pp. 63–72. Available at: .
MULTIFILE
Lean Production (LP) can be regarded as a design approach in search of a theoretical foundation. In this paper we show that Lowlands’ Sociotechnical Design Theory (STSL) could function as such a foundation. To reach this goal, we first describe STSL as a system theoretical reformulation of Original Sociotechnical Theory (OSTS). Then, we introduce the Toyota Production System as the origin of LP and the challenge it poses for the academic field of organization design. This academic field should (1) assess LP’s success, (2) generalize it by embedding it in more abstract concepts and theories in order to be able to (3) re-specify it for different manufacturing and non-manufacturing contexts. Next, we give an exposition of STSL as a structural design approach based on developments in system theory. At last, we reformulate lean production in STSL terms and so show that LP is a subcase within the more general theory of STSL. We discuss the merits of both approaches and clarify some misunderstandings of lean both outside and inside the lean community. Embedding LP in the more general language of STSL should enable us to discover similarities and differences, to start a process of mutual learning, to integrate diverse design approaches in a theory of organizational design and to add content to redesign proposals of for example the health care system as proposed by Porter and Teisberg (2006) and Christensen et al. (2009). We quote extensively from the lean literature (to convince our sociotechnical friends) and embed both STSL and LP in the broader literature on organization design. We hope this adds a new perspective to the one given in the Operations Management literature on LP. Again, mutual learning is the goal.
DOCUMENT
Background The gait modification strategies Trunk Lean and Medial Thrust have been shown to reduce the external knee adduction moment (EKAM) in patients with knee osteoarthritis which could contribute to reduced progression of the disease. Which strategy is most optimal differs between individuals, but the underlying mechanism that causes this remains unknown. Research question Which gait parameters determine the optimal gait modification strategy for individual patients with knee osteoarthritis? Methods Forty-seven participants with symptomatic medial knee osteoarthritis underwent 3-dimensional motion analysis during comfortable gait and with two gait modification strategies: Medial Thrust and Trunk Lean. Kinematic and kinetic variables were calculated. Participants were then categorized into one of the two subgroups, based on the modification strategy that reduced the EKAM the most for them. Multiple logistic regression analysis with backward elimination was used to investigate the predictive nature of dynamic parameters obtained during comfortable walking on the optimal modification gait strategy. Results For 68.1 % of the participants, Trunk Lean was the optimal strategy in reducing the EKAM. Baseline characteristics, kinematics and kinetics did not differ significantly between subgroups during comfortable walking. Changes to frontal trunk and tibia angles correlated significantly with EKAM reduction during the Trunk Lean and Medial Thrust strategies, respectively. Regression analysis showed that MT is likely optimal when the frontal tibia angle range of motion and peak knee flexion angle in early stance during comfortable walking are high (R2Nagelkerke = 0.12). Significance Our regression model based solely on kinematic parameters from comfortable walking contained characteristics of the frontal tibia angle and knee flexion angle. As the model explains only 12.3 % of variance, clinical application does not seem feasible. Direct assessment of kinetics seems to be the most optimal strategy for selecting the most optimal gait modification strategy for individual patients with knee osteoarthritis.
MULTIFILE
Purpose: Continuous improvement initiatives such as Lean in Higher Education (HE) institutes are an emerging topic for research. Under pressure to do more with less, institutes of HE are increasingly adopting the tools and methods of lean to improve their quality practices. Nevertheless, institutes of HE differ significantly from business organizations. The purpose of this study was to examine the critical success factors (CSFs) of continuous improvement in this homogeneous industry. Two other contextual factors, implementation approach and national culture, are examined. Design/methodology/approach: A mixed methods approach, combining Q-methodology, online surveys and interviews, was used to investigate the CSFs of lean implementation in HE. Participants were recruited from an international network of lean practitioners in HE. Using Q-methodology, three perspectives of CSFs in HE were identified. Findings: Lean implementation at institutes of HE is characterized by a bottom-up approach, involving mostly supporting processes. Contrary to business organizations, the role of management in the implementation of Lean in HE is limited and attention should instead be directed to employee empowerment and customer focus. The findings also showed that, at least for institutes of HE, organizational culture is more influential than national culture. Practical implications: When management involvement is limited, a bottom-up implementation of lean is recommended, centered on improving university-wide supporting processes, promoting cross-departmental cooperation and overcoming the silo mentality. This approach requires an emphasis on a specific set of CSFs, namely, employee empowerment, sharing success stories and training. Originality/value: The study findings enrich conceptually based lean implementation frameworks for HE that advocate a top-down implementation approach.
LINK
Rationale: Lean body mass, including muscle, is known to decrease with age, which may contribute to loss of physical function, an indicator of frailty. Moreover, low muscle thickness is considered an indicator of frailty in critically ill patients. However, little is known about the relationship between muscle thickness and frailty in community dwelling adults. Therefore, we studied the association between frailty and whole body lean body mass index (LBMi) and muscle thickness of the rectus femoris (RF) in community dwelling older adults. Methods: In older adults aged ≥55y, who participated in the Hanze Health and Ageing Study, frailty status was assessed with a multidimensional instrument, measuring frailty on a cognitive, psychosocial en physical level, i.e., the Groningen Frailty Indicator (GFI), using ≥4 as cut-off score for frailty. LBMi (kg/m2) was estimated with BIA (Quadscan 4000©, Bodystat), using the build-in equation. Muscle thickness (mm) of the RF was measured with ultrasound, using the Bodymetrix© (Intelametrix). Univariate and multivariate binary logistic regression analyses were performed for LBMi and for RF thickness. Multivariate analysis corrected for age, sex, body mass index (kg/m2), and handgrip strength (handgrip dynamometer; kg). A p-level of <0.05 was considered significant and Odds Ratios (OR; [95% CI]) were presented. Results: 93 participants (age 65.2±7.7 years; male 46 %; LBMi 17.2±2.6 kg/m2; RF 14.6±4.4 mm; median GFI =1 (interquartile range=0-3; frail: n=18) were included in the analysis. In both the univariate and multivariate analysis, LBMi (p=0.082, OR=0.82 [0.66-1.03]; p=0.077, OR=0.55 [0.28-1.07] respectively) and muscle thickness of RF (p=0.436, OR=0.95 [0.84-1.08]; p=0.796, OR= 1.02 [0.88-1.18] respectively) were not significantly associated with frailty. None of the co-variables were significantly associated with frailty either. Conclusion: In this sample of older adults aged ≥55 years, LBMi and RF thickness are not associated with frailty. However, frail participants scored at cut-off or just above, and measurements in a population with higher scores for frailty may provide further insight in the association between lean body mass and muscle thickness and frailty.
DOCUMENT
Purpose of reviewTo help guide metabolic support in critical care, an understanding of patients’ nutritional status and risk is important. Several methods to monitor lean body mass are increasingly used in the ICU and knowledge about their advantages and limitations is essential.Recent findingsComputed tomography scan analysis, musculoskeletal ultrasound, and bioelectrical impedance analysis are emerging as powerful clinical tools to monitor lean body mass during ICU stay. Accuracy, expertise, ease of use at the bedside, and costs are important factors, which play a role in determining, which method is most suitable. Exciting new research provides an insight into not only quantitative measurements, but also qualitative measurements of lean body mass, such as infiltration of adipose tissue and intramuscular glycogen storage.SummaryMethods to monitor lean body mass in the ICU are under constant development, improving upon bedside usability and offering new modalities to measure. This provides clinicians with valuable markers with which to identify patients at high nutritional risk and to evaluate metabolic support during critical illness.
DOCUMENT
Background: The diagnosis of sarcopenia is essential for early treatment of sarcopenia in older adults, for which assessment of appendicular lean mass (ALM) is needed. Multi-frequency bio-electrical impedance analysis (MF-BIA) may be a valid assessment tool to assess ALM in older adults, but the evidences are limited. Therefore, we validated the BIA to diagnose low ALM in older adults.Methods: ALM was assessed by a standing-posture 8 electrode MF-BIA (Tanita MC-780) in 202 community-dwelling older adults (age ≥ 55 years), and compared with dual-energy X-ray absorptiometry (DXA) (Hologic Inc., Marlborough, MA, United States; DXA). The validity for assessing the absolute values of ALM was evaluated by: (1) bias (mean difference), (2) percentage of accurate predictions (within 5% of DXA values), (3) the mean absolute error (MAE), and (4) limits of agreement (Bland-Altman analysis). The lowest quintile of ALM by DXA was used as proxy for low ALM (< 22.8 kg for men, < 16.1 kg for women). Sensitivity and specificity of diagnosing low ALM by BIA were assessed.Results: The mean age of the subjects was 72.1 ± 6.4 years, with a BMI of 25.4 ± 3.6 kg/m2, and 71% were women. BIA slightly underestimated ALM compared to DXA with a mean bias of -0.6 ± 1.2 kg. The percentage of accurate predictions was 54% with a MAE of 1.1 kg, and limits of agreement were -3.0 to + 1.8 kg. The sensitivity for ALM was 80%, indicating that 80% of subjects who were diagnosed as low ALM according to DXA were also diagnosed low ALM by BIA. The specificity was 90%, indicating that 90% of subjects who were diagnosed as normal ALM by DXA were also diagnosed as normal ALM by the BIA.Conclusion: This comparison showed a poor validity of MF-BIA to assess the absolute values of ALM, but a reasonable sensitivity and specificity to recognize the community-dwelling older adults with the lowest muscle mass.
DOCUMENT
De laatste decennia is tijd een strategische concurrentiefactor geworden in de maakindustrie (Demeter, 2013; Godinho Filho et al., 2017a; Gromova, 2020). Naast tijdige levering verwacht de klant ook keuze, maatwerk, hoge kwaliteit en een lage prijs (Siong et al., 2018; Suri, 2020). Om de door de klant gewenste korte doorlooptijd te kunnen realiseren en daarbij ook te voldoen aan zijn andere eisen, zijn flexibiliteit en aanpassingsvermogen essentieel geworden (Godinho Filho et al., 2017b; Siong et al., 2018). Quick Response Manufacturing (QRM) heeft als doel de doorlooptijd te verkorten in productieomgevingen die gekenmerkt worden door een hoge variëteit in producten en maatwerk (Suri, 2020; Siong et al., 2018). QRM kent zijn oorsprong begin jaren negentig van de vorige eeuw (Suri, 2020) en vertoont sterke gelijkenis met lean manufacturing. Het verschil met lean manufacturing is echter dat QRM zich richt op bedrijven in een omgeving met veel productvariatie. Daarnaast heeft QRM nieuwe elementen toegevoegd, zoals Paired-cell Overlapping Loops of Cards with Authorization (POLCA) en Manufacturing Critical Path Time’ (MCT)’ (Godinho Filho et al., 2017b).
DOCUMENT
To deal with an increasingly competitive environment, organizations are combining continuous improvement (CI) practices with digitalization to accrue their benefits on operational performance and achieve operational excellence. Using a mixed-methods approach consisting of an online survey and semi-structured interviews, we examined how digitalization technologies have been incorporated in CI projects by organizations. Besides significant relationships between the nature of CI initiative and the use of digitalization tools, we found key enablers for organizations to be system compatibility, room to experiment, data-driven decision-making and step-by-step introduction with involvement of stakeholders. These enablers were found to be interlinked through knowledge of digitalization.
DOCUMENT
