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Facing the burden of chronic diseases has become a priority for health-care systems’ economic and social sustainability. To this end, this paper aims to focus on adopting Health Lean Management (HLM), a widely used managerial approach, to improve the performance and quality of care provided in chronic care pathways. HLM addresses not only efficiency and timeliness issues but also care effectiveness and integration. Indeed, the lack of continuity and co-ordination of care constitutes a major challenge for chronic pathways. This research provides an innovative contribution, by extending the implementation of HLM to chronic pathways developed across hospital and territorial care. Indeed, HLM scope typically regards hospital units and departments; hence, analysing the interaction between different levels of care represents a novelty from an academic and practical perspective.

With the aim of understanding how to extend the adoption of HLM towards the territory, an action research project has been developed. In particular, an improvement project focused on breast cancer care pathways has been launched in a Spanish hospital. The research investigates which HLM activities, tools and practices need to be accomplished in this kind of project, grasping insights into emerging wastes. To this end, the HLM project followed the Define, Measure, Analyse, Improve and Control (DMAIC) cycle, supporting the project team in effectively conducting a preliminary context analysis, qualitative and quantitative data collection, the current state analysis and the countermeasure proposals.

The analysis conducted on the breast cancer care pathway highlighted major criticalities in managing the diagnosis of new patients. In particular, waiting times to obtain diagnostic imaging and breast specialist consultations highly impacted the care pathway effectiveness and efficiency. Specific wastes that caused these delays have been investigated, leading to the definition of specific countermeasures that could minimise the inefficiencies: an 85% reduction of the staging process lead time was estimated.

The achieved results contribute to enhancing the quality of care delivered to breast cancer patients. This paper enriches the theoretical knowledge about HLM, extending its typical field of application; provides practical support to health-care providers, managers and leaders with a case demonstrating how to develop HLM projects adopting the DMAIC cycle; and finally, it has valuable social implications, addressing the global threat of chronic disease.

This study aims to assess the effectiveness of Lean Six Sigma (LSS) training by investigating critical success factors (CSFs) categorized into the domains of people, processes and technology.

A survey methodology, information was used to collect information from a participant pool of 102 individuals. The collected data were analyzed using ANOVA to examine the relationship between CSF and LSS training.

Organizing CSF significantly enhances the effectiveness of LSS training. High ratings were consistently observed for experienced instructors, structured materials and interactive elements. However, challenges were identified in evaluating the impact of training and the integration of e-learning platforms. These findings shed light on areas where improvements can be made to further enhance the outcomes of LSS training programs.

The sample size of 102 participants may limit the generalizability of the findings to a broader population. This study primarily examined short-term outcomes, so additional exploration of the long-term effects of LSS training is warranted. This research acknowledges potential bias in self-reported survey data and recognizes that personal perspectives may influence participant responses.

This research contributes a nuanced perspective by categorizing CSFs into the domains of people, process and technology, offering a comprehensive understanding of their interplay. Acknowledging the challenges in training evaluation and e-learning platforms adds originality to the study and provides practical insights for organizations aiming to optimize their LSS training initiatives.

The accuracy of budgeting is important to fulfilling its various roles. The aim of this study is to examine perceptions of budgeting accuracy in UK universities and to identify and understand the factors that influence them.

A mixed methods research design comprising a questionnaire survey (84 responses, = 51.5%) and 42 semi-structured, qualitative interviews is employed.

The findings reveal that universities tend to be conservative in their budgeting, although previous financial difficulties, the attitude of the governing body and the need to convince lenders that finances are being managed competently might lead to a greater emphasis on a “realistic” rather than cautious budget. Stepwise multiple regression identified four significantly negative influences on perceived budgeting accuracy: the difficulty of forecasting student numbers; difficulties associated with allowing unspent balances to be carried forward; taking a relatively long time to prepare the budget; and the institution’s level of financial surplus. The interviews are drawn upon to both explain and elaborate on the statistical findings. Forecasting student numbers and associated fee income emerges as a particularly challenging and complex issue.

Our regression analysis is cross-sectional and therefore based on correlations. Furthermore, the research could be developed by investigating the views of other parties as well as repeating the study in both the UK and overseas.

Implications for university management follow from the four factors identified as significant influences upon budget accuracy. These include involving the finance department in estimating student numbers, removing or controlling the carry forward of unspent funds, and reducing the length of the budget cycle.

The first study to examine the factors that influence the perceived accuracy of universities’ budgeting, this paper also advances understanding of budgeting accuracy more generally.

This study explores the effect of language on service satisfaction among Finland-Swedes, a national minority language group in Finland, in the context of early childhood education. Models of public service satisfaction hold standard process and outcome related factors, such as availability and quality, as drivers of the satisfaction. However, although research has shown significant variation in satisfaction between different groups of citizens (race, ethnicity, age etc.), research has largely overlooked group specific factors as explanations for the satisfaction.

A randomized survey experiment with a 2 × 2 × 2 factorial design analyzed the impacts of language, service accessibility, and quality on service satisfaction. The data was analyzed with ANOVA.

The results revealed that language significantly impacts Swedish speakers’ satisfaction, suggesting that for minority groups, language may override typical satisfaction determinants like quality and accessibility. Interestingly, special linguistic needs are relatively more pertinent in low-quality services than in higher-quality ones.

The study shows how group related factors of public service, in our case language, in an important factor explaining satisfaction with the service. The findings have implications for the literature on citizens’ satisfaction with public services with demographic and identity facets, especially in a typical Nordic welfare state.