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Presents a model for clinical governance developed from the work of Sutherland, Dawson and Mintzberg. The model relates existing quality assurance processes to three key components of quality maintenance, namely skills, outcomes and processes. Argues that from such a model the relevant actions for clinicians are easier to identify and the respective needs for corporate and clinical service level actions become easier to understand. In addition four generic questions are presented which allow detailed examination of a clinical service while addressing broad principles of clinician behaviour, continuous improvement of services, patient expectations and appropriateness of interventions. This approach of using simple generic models which can be easily adapted to a specific setting provides usable tools for understanding, enquiry and change, and encourages the continuing appropriate exercise of well‐maintained skills.

Considers the nature of rationing, examining legal and ethical aspects in the context of current political resistance to admitting that rationing exists in the NHS. Considers the inherent contradictions in the two main ethical models (deontological and utilitarian) in relation to the tensions between the needs of individual patients and the wider needs of society. Argues that allocation of resources is inevitable and consideration is given to the merits of different ways of achieving this rationing. Considers the role of the National Institute of Clinical Excellence and concludes that it would be honest to admit that rationing exists and that it is difficult to implement.

Manufacturing industries are facing dynamic challenges in today’s highly competitive world. In the recent past, integrating Industry 4.0 with the lean six sigma improvement methodologies has emerged as a popular approach for organizational excellence. The research aims to explore and analyze critical success factors of lean six sigma integrated Industry 4.0 (LSSI).

This research study explores and analyzes the critical success factors (CSFs) of LSSI. A three-phase study framework is employed. At first, the CSFs are identified through an extensive literature review and validated through experts’ feedback. Then, in the second phase, the initial list of CSFs is finalized using the fuzzy DELPHI technique. In the third phase, the cause-effect relationship among CFSs is established using the fuzzy DEMATEL technique.

A dyadic relationship among cause-and-effect category CSFs is established. Under the cause category, top management commitment toward integrating LSSI, systematic methodology for LSSI and organizational culture for adopting changes while adopting LSSI are found to be topmost CSFs. Also, under the effect category, organizational readiness toward LSSI and adaptability and agility are found to be the uppermost CSFs.

The study offers a framework to understand the significant CSFs for LSSI implementation. Insights from the study will help industry managers and practitioners to implement LSSI and achieve organizational excellence.

To the best of the authors’ knowledge, CSFs of LSSI are not much explored in the past by researchers. Findings will be of great value for professionals in developing long-term operations strategies.

Industry 4.0 (I 4.0) consists of numerous digital technologies applied in organizations strategically to add value to the customer. Different organizations have varying degrees of technological capability and strategic flexibility. This paper aims to explore the relationship between technological capability and strategic flexibility on successful implementation of I 4.0.

A qualitative study using a grounded theory approach is conducted on 34 senior managers from Europe and North America who have implemented I 4.0 participated in this study through a theoretical sampling frame.

This study finds that technological capability and strategic flexibility have an impact on the successful implementation of I 4.0. The study also finds that different dimensions of technological capability also impact I 4.0. The interactive effect of strategic flexibility and technological capability is also noted. The study also develops a framework for successful implementation of I 4.0.

This study can be used by managers while implementing I 4.0 to devise a strategic roadmap for acquiring technological capability with I 4.0 technologies. Besides, it will help the managers to consider the bidirectional relationship between technological capability and strategic flexibility while formulating I 4.0 strategy for successful implementation of I 4.0 in their organizations.

Previous studies have examined the importance of I 4.0 technologies. However, this study extends the previous works by suggesting how technological capability and strategic flexibility can help in the successful implementation of I 4.0.

The purpose of this paper is to examine the digitalization of operational processes and activities in lean manufacturing firms and explore the associated learning implications through the lens of cumulative capability theory.

Adopting a multiple-case design, we examine four cases of digitalization initiatives within lean manufacturing firms. We collected data through semi-structured interviews and direct observations during site visits.

The study uncovers the development of learning capabilities as a result of integrating lean and digitalization. We find that digitalization in lean manufacturing firms contributes to the development of both routinized and evolutionary learning capabilities in a cumulative fashion.

The study adds nuance to the limited theoretical understanding of the integration of lean and digitalization by showing how it cumulatively develops the learning capabilities of lean manufacturing firms. As such, the study supports the robustness of cumulative capability theory. We further contribute to research by offering empirical support for the cumulative nature of learning.

There is increasing interest in the connection between Industry 4.0 (I4.0) and operational excellence approaches; however, studies on the integration between Six Sigma (SS) and I4.0 have been absent from the literature. Integration with I4.0 technologies can maximize the positive effects of SS. The purpose of this study is to understand what types of relationships exist between SS and I4.0 and with I4.0's technologies, as well as the benefits derived from this integration and future directions for this field of study.

A Systematic Literature Review (SLR) was carried out to analyze studies about connections between I4.0 technologies and SS. SLR analyzed 59 articles from 2013 to 2021 extracted from the Web of Science and Scopus databases, including documents from journals and conferences.

The SLR identified relationships between SS and several I4.0 technologies, the most cited and with the greatest possibilities of relationships being Big Data/Big Data Analytics (BDA) and Internet of Things (IoT). Three main types of relationships were identified: (1) support of I4.0 technologies to SS; (2) assistance from the SS to the introduction of I4.0 technologies, and, to a lesser extent; (3) incompatibilities between SS and I4.0 technologies. The benefits are mainly related to availability of large data sets and real-time information, enabling better decision-making in less time.

In addition, the study can help managers to understand the integration relationships, which may encourage companies to adopt SS/Lean Six Sigma (LSS) in conjunction with I4.0 technologies. The results also drew attention to the incompatibilities between SS and I4.0 to anticipate potential barriers to implementation.

The study focuses on three previously unexplored subjects: the connection between SS and I4.0, the existing relationships with different technologies and the benefits resulting from the relationships. In addition, the study compiled and structured different types of relationships for SS and I4.0 and I4.0's technologies, identifying patterns and presenting evidence on how these relationships occur. Finally, exposes current trends and possible research directions.

The following classified, annotated list of titles is intended to provide reference librarians with a current checklist of new reference books, and is designed to supplement the RSR review column, “Recent Reference Books,” by Frances Neel Cheney. “Reference Books in Print” includes all additional books received prior to the inclusion deadline established for this issue. Appearance in this column does not preclude a later review in RSR. Publishers are urged to send a copy of all new reference books directly to RSR as soon as published, for immediate listing in “Reference Books in Print.” Reference books with imprints older than two years will not be included (with the exception of current reprints or older books newly acquired for distribution by another publisher). The column shall also occasionally include library science or other library related publications of other than a reference character.

Investigates the differences in protocols between arbitral tribunals and courts, with particular emphasis on US, Greek and English law. Gives examples of each country and its way of using the law in specific circumstances, and shows the variations therein. Sums up that arbitration is much the better way to gok as it avoids delays and expenses, plus the vexation/frustration of normal litigation. Concludes that the US and Greek constitutions and common law tradition in England appear to allow involved parties to choose their own judge, who can thus be an arbitrator. Discusses e‐commerce and speculates on this for the future.

The aim of this analysis is to review the Indian manufacturing organizations practicing Lean Six Sigma (LSS) tools/techniques with an objective of monitoring the performance of an organization and to develop recommendation for strategies to benchmark organizational operational efficiency.

This study offers insights of the LSS performance measurement aspects of the Indian manufacturing organizations based on Data envelopment analysis (DEA) approach. The five inputs and two outputs are considered on the basis of literature review and discussed with the practitioners.

In this analysis, the relative efficiency score of 18 Indian manufacturing organizations has been determined in order to assist evaluation of the impact of monetary investment on the outputs. The present analysis not only investigates the optimum level of input variables but also lays down a significant observation that an organization having higher profit and inventory turnover ratio is not necessarily an efficient organization.

The results assist to determine the best practice units, potential source of inefficiency and deliver beneficial data for the consistent enhancement of the operational efficiency. The DEA results assist managers and decision makers to derive appropriate strategies to enhance their performance with reference to the efficient organization and to regard it as their role model.

This analysis renders a DEA based framework of LSS practicing Indian manufacturing organizations. The framework is unique in terms of its input-outputs variable selection and measurement procedure.

Quality 4.0 incorporates the role of automation and digitization and provides competitive advantage for organizations by enhancing customer experience and increase profitability. The purpose of this study is to critically examine the organizational readiness factors for the successful implementation of Quality 4.0 implementation and assess their importance.

This study applies a quantitative research methodology to examine readiness factors of Quality 4.0 in organizations by 147 senior management professionals in various organizations including manufacturing and service companies in America, Asia and Europe participated through an online survey.

The readiness factors for Quality 4.0 were critically ranked amongst manufacturing and service organizations by senior management professionals from three continents. Five significant reasons for non-adoption of Quality 4.0 were lack of resources, inability to link Quality 4.0 with the corporate strategy and objectives, lack of understanding of benefits, high initial investment and the current quality management strategy and methods are already delivering good results hence unsure of the need for Quality 4.0. The handling of big data in quality management was the most important factor for adopting Quality 4.0, irrespective of the size and nature of the organization. More accuracy and less errors and improved decision-making the factors of adopting Quality 4.0 in service sector were not significant for manufacturing sector. Small and medium-sized enterprises (SMEs) reported that costs and time savings over the long run were not so significant.

This study is focussed on the significance of pros and cons of adopting Quality 4.0 in organizations. Senior managers in both large and SMEs can benefit immensely from understanding before investing heavily towards implementing Quality 4.0. The importance of identified organizational readiness factors for the successful adoption of Quality 4.0 can be used as indicators to understand how ready an organization is to implement Quality 4.0. The top three readiness factors for the successful adoption of Quality 4.0 were identified as: top management commitment, leadership and organizational culture. Improved understanding of the readiness factors can be highly beneficial to senior quality professionals in both manufacturing and service companies in the journey towards successful implementation of Quality 4.0.

This is the first empirical study on assessing Quality 4.0 readiness factors at an intercontinental level and therefore serves as a foundation for many future studies. The study provides a theoretical foundation for the Quality 4.0 in terms of organizational readiness for successful adoption and overcoming implementation challenges. During the planning, implementation and progress review of Quality 4.0, review the readiness factors while planning and resourcing a Quality 4.0 implementation strategy to ensure effective performance.