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This book is written by a seasoned physician, teacher, and scientist who was the CEO of a large integrated system for 20 years. It is a complete how-to book on implementing a Lean transformation in a health care system that includes not only a hospital but also HMO, CHC, and paramedics. Providing an accessible explanation of the Lean philosophy and tools, the book outlines a detailed approach to Lean implementation. It includes exercises and examples of Lean applications that go beyond the hospital to include CHC, paramedics, and poison centers. - Provided by publisher

The dimensions -- Think systemically -- Create constancy of purpose -- Results : create value for the customer -- Lean prescription at Denver health : the enterprise alignment workshop case study -- Assessing the enterprise alignment and results dimensions -- Summary -- Bibliography.

Critical studies of 'lean' work regimes have tended to focus on the factory shop floor or public and healthcare sectors, despite its recent revival and wider deployment in neoliberal service economies. This paper investigates the politics of the workplace in a United Kingdom automotive dealership group subject to an intervention inspired by lean methods. We develop Foucauldian studies of governmentality by addressing lean as a technology of power deployed to act on the conduct of workers, examining how they debunk, distance themselves from and enact its imperatives. Our findings support critiques of lean work regimes that raise concerns about work intensification and poor worker health. Discourses of professional autonomy allow workers to distance themselves from lean prescriptions, yet they are reaffirmed in their actions. More significantly, we illustrate the exercise of a more encompassing form of power, showing how lean harnesses the inherently exploitable desire for recognition among hitherto marginalised workers, and its role as a form of 'human capital'. The paper contributes to critical studies of lean by illustrating its subtle, deleterious and persistent effects within the analytical frame of neoliberal governmentality. We also demonstrate how studies of governmentality can be advanced through the analysis of contested social relations on the ground, highlighting the ethico-political potential of Foucauldian work.

Critical studies of 'lean' work regimes have tended to focus on the factory shop floor or public and healthcare sectors, despite its recent revival and wider deployment in neoliberal service economies. This paper investigates the politics of the workplace in a United Kingdom automotive dealership group subject to an intervention inspired by lean methods. We develop Foucauldian studies of governmentality by addressing lean as a technology of power deployed to act on the conduct of workers, examining how they debunk, distance themselves from and enact its imperatives. Our findings support critiques of lean work regimes that raise concerns about work intensification and poor worker health. Discourses of professional autonomy allow workers to distance themselves from lean prescriptions, yet they are reaffirmed in their actions. More significantly, we illustrate the exercise of a more encompassing form of power, showing how lean harnesses the inherently exploitable desire for recognition among hitherto marginalised workers, and its role as a form of 'human capital'. The paper contributes to critical studies of lean by illustrating its subtle, deleterious and persistent effects within the analytical frame of neoliberal governmentality. We also demonstrate how studies of governmentality can be advanced through the analysis of contested social relations on the ground, highlighting the ethico-political potential of Foucauldian work.

The Biden 2024 re-election campaign says it will highlight more generous Affordable Care Act (ACA) subsidies and federally set limits on prescription drug prices as its major first-term achievements. Playing it safe on health care seems to be the operating principle.
The post Most State-Run Health Reforms Lean Towards Rate-Setting, Not Markets appeared first on American Enterprise Institute - AEI.

Purpose
The purpose of this paper is to understand how the association between leadership styles (task or relation orientation) and lean manufacturing (LM) implementation changes due to two contextual variables, team size and the leader's age.


Design/methodology/approach
The authors carried out a survey with 225 leaders from different Brazilian companies that are implementing LM. Research constructs were validated through rigorous procedures using confirmatory factor analysis. Hypotheses were tested using ordinary linear least squares regression.


Findings
The results suggest that larger teams and more senior managers were negatively associated with LM implementation. Task-orientation style makes leaders more likely to achieve higher levels of LM than relation-orientation style leaders. Finally, the influence of relation-oriented leaders on LM implementation is contingent upon the size of the team.


Research limitations/implications
Regarding study's limitations, sample size and respondents' location restrict results to this contextual condition, indicating that increasing the sample would help provide wider and more generalizable results. It is also worth noting that results are based on respondents' (leaders) perspective. Hence, future studies may collect data from multiple perspectives, such as leaders and their followers, in order to compare results so as to verify the convergence or divergence among different respondents.


Practical implications
The results suggest that leaders should have different behaviors according to the context in which they are inserted. Therefore, such behavioral prescriptions are useful for managers since they are pressured to achieve high operational performance in short time periods and with few resources. Further, companies undergoing lean implementation may also be able to stimulate proper leadership behaviors and promote development programs accordingly, which is extremely relevant since behavioral changes usually take time.


Originality/value
The evolutionary process for achieving a successful lean enterprise requires different leadership styles according to the context in which leaders are inserted. This research provides arguments to help better understand the recommended leadership behaviors for lean implementation, complementing existing roadmaps by considering the proper leadership style as a contingency issue during lean implementation. Moreover, identifying the effect of contextual variables helps specify the contexts in which lean practices are more likely to be implemented.

One way to make efficiency, improve service quality and improve patient safety in America is by using the Lean Thinking concept that is applied in hospitals to become Lean Hospital. In RSUD Sijunjung, which is a government-owned hospital, this research analyzes the flow of prescription services at the Outpatient Pharmacy Installation as repair data. By using Value Strem Mapping (VSM), in-depth observations and interviews were carried out showing that non-value add activities were 57% and value added activities were 43% in preparation of non-concocted drugs. These data indicate that there is waste (waste). Proposals for improvements to reduce waste include increasing 5S, scheduling work and improving, rearranging the arrangement of the work table. It is hoped that there will be an increase in efficiency at the Outpatient Pharmacy Installation and reduce long queues.

In this study, we assessed the acute kinematic effects of different sled load conditions (unloaded and at 10%, 20%, 30% decrement from maximum velocity (Vdec)) in different sporting populations. It is well-known that an athlete's kinematics change with increasing sled load. However, to our knowledge, the relationship between the different loads in resisted sled sprinting (RSS) and kinematic characteristics is unknown. Thirty-three athletes (sprinters n = 10; team sport athletes n = 23) performed a familiarization session (day 1), and 12 sprints at different loads (day 2) over a distance of 40 m. Sprint time and average velocity were measured. Sagittal-plane high-speed video data was recorded for early acceleration and maximum velocity phase and joint angles computed. Loading introduced significant changes to hip, knee, ankle, and trunk angle for touch-down and toe-off for the acceleration and maximum velocity phase (p < 0.05). Knee, hip, and ankle angles became more flexed with increasing load for all groups and trunk lean increased linearly with increasing loading conditions. The results of this study provide coaches with important information that may influence how RSS is employed as a training tool to improve sprint performance for acceleration and maximal velocity running and that prescription may not change based on sporting population, as there were only minimal differences observed between groups. The trunk lean increase was related to the heavy loads and appeared to prevent athletes to reach mechanics that were truly reflective of maximum velocity sprinting. Lighter loads seem to be more adequate to not provoke changes in maxV kinematics. However, heavy loading extended the distance over which it is possible to train acceleration.

How has the experience of managerial work changed in the digital age? This two-phase (2002–2006, 2015–2019) study addresses this question by examining how middle managers perceive the spatio-temporal boundaries of their work to have shifted. Typically, such managers report change occurring in two directions: (i) the contractual employment boundary becoming stretched as hours completed inside the workplace increase; and (ii) this boundary becoming breached as managers conduct additional work voluntarily from locations outside corporate premises. Although such trends can be explained deterministically – the former stemming from corporate acceptance of consultancy-influenced organizational prescriptions (business process reengineering, lean management, agile management etc.), and the latter from widespread adoption of digital communication innovations (BlackBerry, email, WhatsApp etc.) – we argue that to achieve a more rounded appreciation of such work 'extensification' attention must also be paid to agentic forces of strategic and political choice. Developing this argument, and acknowledging paradox when theorizing spatio-temporal change, we suggest future research on managerial employment must entail documenting not only factors influencing the stretching and breaching of work boundaries, but also – given incipient political regulations and innovative surveillance technologies – others serving to strengthen and protect them, notably those directed at improving work–life balance and physical/psychological health.

"Preface Sustainability is an ability: the ability to endure. In ecology, sustainability describes how biological species survive. For the environment, it is assessing whether or not project outputs can be produced without permanent and unacceptable changes in the environment. For humans, it is our long-term physical and cultural well-being. For mechanical systems and structures, it is maximizing reliability while conserving required resources and reducing waste. For an entity or an enterprise, it is the ability of the enterprise, its products, and its systems to remain competitive and productive long term, without failure, while minimizing waste. Sustainability and sustainable development have become popular goals. They have also become wide-ranging terms that can be applied to any entity or enterprise on a local or a global scale for long time periods. Sustainability has many interpretations. Recently, the term has been used more in the context of "green," which refers to having no negative impact on the environment, community, society, or economy (Bromley 2008). However, the traditional meaning centers on the words "to endure" or "to maintain" or "to survive," which is the context for sustainability used in this book. Here, sustainability means to adopt a strategy or prescription to maintain the ability of an entity or enterprise and its systems or services to survive with established performance requirements in the most effective and efficient manner possible over the entity's life cycle. Engineering for Sustainability is the third volume in a series of manuscripts under the title Sustaining the Military Enterprise. The first volume, An Architecture for a Lean Transformation (Mathaisel 2007),"--

Product Name: Fat Decimator System Author Name: Kyle Cooper Bonus: Yes Official Website: CLICK HERE Add to Cart - Buy only on $17 ($20 OFF) - Click Here Fat Decimator System is a 131-page program that depends on over a time of research. Concentrating on how the human body functions, this guide will enable you to shed that obstinate stomach fat you just can't dispose of. Separated into three parts, you should center around eating routine, work out, and your inspirational mentality. As you get thinner, you'll enhance your wellbeing — it's a win-win. Fat Decimator System depends on long periods of research, more than 500 restorative investigations, and certifiable testing. Helping clients shed paunch fat rapidly and securely, this program is genuinely stand-out. For whatever length of time that you pursue the framework as guided, you will lose up to 20 pounds in only 3 weeks! The best part is that you will realize why you are doing what you're doing. WHAT IS THE FAT DECIMATOR SYSTEM? 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Do you remember the big stink in the U.S. a few years back surrounding McDonald's and their food, most notably French fries? It was the big trans-fat scare! That's right, we were being poisoned by the evil clown with deadly fat and something had to be done! Yeah, because we're not adults or anything… So the government stepped in and the burger giant was forced to change their frying oil. On the surface of it, it's nice of good old Uncle Sam to take care of us right? To watch out for we, the ignorant masses, and make sure that when we're shoving super-sized fries into our feed holes that they're not entirely unhealthy! Okay… but do you know that despite the choice you make to visit Mickey Dee's, there is in fact something found in virtually every can, box or bag of food in the grocery aisle that's incredibly addictive, almost immediately turns to fat when you eat it and is one of the leading causes of most of the ailments we suffer today? So what is this killer, which is not only ignored by the government but actually supported by it? SUGAR That's right, processed sugar in its many forms is one of the most used ingredients in all processed and packaged foods. That includes regular white sugar, brown sugar, corn syrup, maltodextrin and a host of others. Want proof? Try this experiment the next time you go shopping. Walk down the aisles and examine the stuff you normally buy. Including stuff you wouldn't even think they'd put sugar in – soup, salad dressing, instant potatoes, juice, frozen foods and even baby foods… Now, if you read the list of ingredients you'll find some of the sugars I mentioned above. Keep in mind that this list of ingredients is organized from the highest concentration to the lowest. So if some kind of sugar is listed in the first three ingredients – and it's often #1 or #2 – then you're eating a whole lot of it. Sugar is a killer and, while okay in small quantities, is extremely unhealthy, fattening and addictive. That's right – thousands of independent clinical studies have shown that sugar is more addictive than cocaine and even heroine… …and it's in virtually everything we eat! So is it any wonder why you might find it hard to drop the poundage? Here's something else to ponder before we say goodbye. There's actually a list of vegetables that are routinely served in restaurants and found in the produce section of the grocery store that are generally thought to be healthy… but are actually very bad for you and inhibit your ability to drop weight! Health, fitness and weight loss are complex issues and we've been fed a lot of myths over the years. That's why I've made it my goal in life to share the truth about foods, exercise and weight loss that we westerners have been denied for so long! If you're looking to lose weight, have ever struggled with your weight or are just sick and tired of paying for the next big fitness craze, diet or gizmo that never seems to work, then I'd like to invite you to learn more about the foods you eat and the way your body works. Click this link now and watch my presentation where I'll reveal some of the biggest weight loss myths and prove to you through hard science why they don't work and how we've all been bilked for billions!

Fat Decimator Review – Are you the one who is hustling, working hard, skipping the lavishing parties, those tasty drinks and the bunch of other colourful stuff to lose that stubborn fat on your body? Are you the type of person who has tried all kinds of diets and exercises but didn't get to your final goals, not at least close to them? You eat what you hear from anyone else but finding ways to follow that ultimate diet which can work and the workout that will show you effect? Are you 40 years old or 20 years old? Well, ladies and gentlemen, this article is definitely for you. Follow the guideline and the process so you will understand what you have been doing wrong all your struggling life and how you can lose weight this time. This article can be the "Aladdin's Lamp" for you, you will read this carefully, and only then it will lead you the best path to success. So, without wasting any of your time let's begin with the Creator of the weight loss regime. Concise history: the creator of Fat Decimator In the Military, there is maximum nil room for mistake. You do something in error, and then you pay for that in punishment. The mistakes are intolerable in armed forces. In the military, you can never be a little overweight the reason is if the army personnel is out-of-shape he can put his as well as the lives of others in extreme danger. Kyle Cooper has learned this quite effectively in a hard way. He served in Afghanistan, and while he was serving during a combat operation where he lost one 43-year-old man who was under his command. That loss was a big tragedy, and Kyle learned this harsh lesson specifically about combat readiness. He learned that the adults who are in their late 30's and those who are older let's say 40 or 50, they all need an entirely different way to get in fit shape. Because here is the most straightforward recipe that no one can get healthy with the same diet plan. A lot of people nowadays buy the same diet plan that everyone is getting. If the person is 25 years old and the woman who is 35 years old, how possibly they can get fit on the same diet plan. Kyle is urging people to understand this simple thing, this simple common sense and the ultimate real way to get fit faster than ever before. What's in the Fat Decimator System? Fat Decimator System merely is like the open book of the secrets for fitness, overall human health and the deep mysteries of weight loss industries. If you take time to observe diet and weight of a lot of other people all around the world, you will quickly be able to realise that overweight and obesity epidemic is just a westernised one. But, it sure isn't the only one, because of all the preserved or fast/junk food that we consume in our daily diets. It has a lot to do with the foods we eat and the exercises we do daily at gym or home. WE HAVE BEEN TRICKED BAD. We are tricked to eat unhealthy food with the posture of healthy eating. The exercise we have been doing, we are convinced that these sets of activities are the only way to lose weight but, in fact, they are all lies. BUT, here when you will start reading through the multiple chapters of Kyle's system, which is backed by science, all of it will begin to make definite sense! How will the system help? For the beginners, The Fat Decimator System is probably the best online weight loss regime which is more than 100%. Scientific researches create this system. This system is not any gimmicky "do this two times a day, and you will lose 20 pounds" either. Instead, this system is foolproof, and an effective science-based diet which will teach you why all those exercises and diets you've been working on aren't working. This system will show you about all the ineffective diets and foods and what you can do about it. 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The Fat Decimator System is composed of all the information, techniques, tips and tools that you will need to make the practical changes within your diet regimes. To give you a better insight here is the sneak peek of the chapters inside the system: Rapid Weight LossWhy 3 Weeks?21 Days to make a HabitThe Truth About Weight LossHow We Get FatHow to Get ThinNutrientsFibreFruits and VegetablesThe Miracle FiberProtein, Fat and CarbohydratesWaterWays to Rapidly Accelerate Fat LossHow to Increase CatecholaminesReducing Calories the Right WayReduced Carbohydrate IntakeStarvation ModeStubborn Body FatFat Burning Supplementsbest fast weight loss program Want some cherries on top and for free? 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