Assessing performance and value-creation capabilities in Lean healthcare: insights from a case study

ABSTRACT

Lean thinking is increasingly being applied worldwide. Yet its actual impact is still a puzzle, particularly when a ‘full-implementation approach’—which entails the adoption of a strategic approach to Lean dissemination on policy deployment procedures—is used. Focusing on the healthcare sector, this paper presents and tests a comprehensive measurement framework for Lean interventions. The paper explains how Lean testing can help decision-makers to solve managerial issues related to Lean initiatives.     

Farm size,land yields and the agricultural production function: An analysis for fifteen developing countries

The paper analyzes the relationship between factor inputs, land yields and labor productivity for farms of different size on the basis of FAO farm management data for 15 developing countries. For all but three countries a strong negative correlation is found between farm size on the one side, and factor inputs and yields per hectare on the other. The fitting of unconstrained production functions to the above data suggests that in only few cases the decline in yields for increasing farm size can be attributed to decreasing returns to scale. The higher yields observed in small farms are mainly to be ascribed to higher factor inputs and to a more intensive use of land. Therefore, where conspicuous labor surpluses exist, the superiority of small farming provides solid arguments in favor of land redistribution. Such an agrarian reform would determine higher output, higher labor absorption and a more equitable income distribution, thus contributing in a decisive manner to the alleviation of rural poverty. The paper also provides estimates of cross-sectional production functions for the 15 countries analyzed. Empirical relations are found between the output elasticities of land, labor and intermediate inputs and physical indicators of their scarcity. The paper concludes by proposing a simple method for deriving a long-term production function for agriculture.     

MACROECONOMIC STABILIZATION POLICIES IN THE EMU: SPILLOVERS, ASYMMETRIES AND INSTITUTIONS

This paper studies the institutional design of the coordination of macroeconomic stabilization policies within a monetary union in the framework of linear quadratic differential games. A central role in the analysis plays the partitioned game approach of the endogenous coalition formation literature. The specific policy recommendations in the European Economic and Monetary Union (EMU) context depend on the particular characteristics of the shocks and the economic structure. In the case of a common shock, fiscal coordination or full policy coordination is desirable. When anti‐symmetric shocks are considered, fiscal coordination improves the performance but full policy coordination does not produce further gains in policymakers' welfare.     

Uncertainty and the Cost of Reversal

For standard irreversibility theory the prospect of acquiring better information in the future should induce more flexible decisions: the “irreversibility effect”. This result relies on the definition of an irreversible position as one that would be technically or economically impossible to reverse. In practice, many positions can be reversed at an affordable cost. In this case an increase in informativeness alone is not enough to bias decisions in favour of more flexibility. We look for restrictions on decision sets, information structures and preferences that make possible to study the effect of information on flexibility. JEL Classification No: D81, D9     

VRP revisited: The impact of behavioural costs in balancing standardisation and variety

The objective of this paper is to bring a new element to the academic (and industrial) debate concerning the optimum level of variety in component design in mass production companies. Many authors have explored the trade-off between functional and variety costs, and this could be considered as a well-acknowledged management issue, at least from an engineering perspective. Nevertheless, while defining the theoretically optimal level of component variety, there are other elements, more related to operators’ attitude or to operative conditions, which may intervene and prevent effective exploitation of the existing variety. These elements have been given scant attention in literature, while they may play a relevant role in real organisations.In this paper, we will present a case study and an analytic model for these “behavioural costs” in manufacturing environments, so as to show how the theoretically optimal amount of variety changes if one takes into account these aspects. Researchers (and practitioners) might leverage on this contribution in order to rejuvenate the Variety Reduction paradigm, and to increase their awareness in designing and managing mass production manufacturing processes.     

The Open Innovation Journey: How firms dynamically implement the emerging innovation management paradigm

Open Innovation is currently one of the most debated topics in management literature. Nevertheless, there are still many unanswered questions in Open Innovation research. Especially two issues require further investigation: (i) understanding the relevance of Open Innovation beyond high-tech industries and (ii) studying how firms implement Open Innovation in practice. The paper addresses these topics by studying, through an in-depth case study, the journey that the Italian leading cement manufacturer, has undergone to move from a Closed to an Open Innovation paradigm.The paper shows that the Open Innovation paradigm is implemented along a three-phase process that comprises the stages of unfreezing, moving and institutionalising. Moreover, it emerges that the changes through which Open Innovation has been implemented involve four major dimensions, i.e. networks, organisational structures, evaluation processes and knowledge management systems. They should be therefore conceived as the managerial and organisational levers an innovating firm can act upon to streamline its journey toward Open Innovation. Theoretical and managerial implications of using these levers for implementing Open Innovation are discussed at length.     

Fitting dynamic factor models to non-stationary time series

Factor modelling of a large time series panel has widely proven useful to reduce its cross-sectional dimensionality. This is done by explaining common co-movements in the panel through the existence of a small number of common components, up to some idiosyncratic behaviour of each individual series. To capture serial correlation in the common components, a dynamic structure is used as in traditional (uni- or multivariate) time series analysis of second order structure, i.e. allowing for infinite-length filtering of the factors via dynamic loadings. In this paper, motivated from economic data observed over long time periods which show smooth transitions over time in their covariance structure, we allow the dynamic structure of the factor model to be non-stationary over time by proposing a deterministic time variation of its loadings. In this respect we generalize the existing recent work on static factor models with time-varying loadings as well as the classical, i.e. stationary, dynamic approximate factor model. Motivated from the stationary case, we estimate the common components of our dynamic factor model by the eigenvectors of a consistent estimator of the now time-varying spectral density matrix of the underlying data-generating process. This can be seen as a time-varying principal components approach in the frequency domain. We derive consistency of this estimator in a “double-asymptotic” framework of both cross-section and time dimension tending to infinity. The performance of the estimators is illustrated by a simulation study and an application to a macroeconomic data set.     

Nutrition and growth in Italy, 1861-1911: What macroeconomic data hide

We investigate how nutritional status responded to economic growth in Italy during 1861-1911. By combining household-level data on food consumption with population censuses, we estimate that the incidence of undernutrition decreased by at least 15% between 1881 and 1901. Income elasticity of calories in 1901 was in the range of 0.3-0.6, varying inversely with the level income. Overall, our findings do not support the pessimists’ view, ubiquitous in the Italian literature. On the contrary, the early phase of Italian industrialization was beneficial to the bulk of the population, and even more so for the poorest among the poor.     

Financial Supervision: Integrated or Specialized?The case of Latin America and the Caribbean

This paper discusses the relative merits of the two approaches of financial regulation and supervision for the case of Latin America and the Caribbean (LAC). In doing so, it reviews the main arguments advanced in the specialized literature in pro and against of each approach. All the theoretical arguments are contrasted with available country experiences from around the world and discussed with a focus on the Latin American and Caribbean countries. A methodology to analyze the efficacy and the efficiency of each approach in meeting the main objectives of financial regulation is also provided. The paper concludes that in the present circumstances, the net benefits of adopting an integrated approach probably exceed the net benefits stemming from the adoption of a specialized approach for most of the countries in the region.     

The effects of privatization on corporate R&D units: evidence from Italy and France

Over the last two decades privatization programmes in a variety of different countries have radically reduced the role of the state as a major owner of productive assets. While there is empirical evidence to show that the switch in ownership generally improves productive efficiency and profitability at company level, its effects on research and development (R&D) activities, which can impact strongly on long–term performance, have been largely ignored in the literature.
In this paper we address this issue by analyzing seven cases of privatization that have recently occurred in Italy and France in order to gauge how R&D activities may be affected by privatization in terms of objectives and organization. The organizations studied show that R&D units within privatized companies are subject to profound restructuring actions, generally designed to boost efficiency and to strengthen integration with the goals of the business units and of the final customers. A new role for R&D thus emerges: the aim is no longer to generate new knowledge in the broad national interest, but rather more directly to create value for the company and its clients, by emphasizing the assessment and integration of external knowledge.