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Earthquake usually causes death, injury, disability and destruction of buildings and infrastructure, and people with disabilities are usually affected more than healthy people. As undesirable experiences may also have positive outcomes, this study aims to investigate the experiences of PWD and identify the positive effects of earthquakes on them in Iran, as an earthquake-prone country.

In this qualitative study, 20 participants were selected purposively among those having physical disability, aged 23-55 years and with experience of an earthquake. Their opinions were collected using semi-structured interviews. Analysis was performed using thematic approach and MAXQDA software was used to organize the data.

The positive effects of earthquake were categorized into five main themes: promotion of preparedness, knowledge enhancement, improvement of structures, socio-economic improvement (economic situation enhancement and social cohesion promotion) and outstanding role of national and international non-governmental organizations.

Although disasters are generally unpleasant, in the long term, they can result in positive effects and may be considered as opportunities to improve the situation and eliminate certain limitations. It is also important to learn from experiences of people with disabilities and apply the lessons learned, for enhancing preparedness and providing better services in the response phase of disaster management. Additionally, paying attention to the positive attitudes of such people, with special conditions and limitations, indicates their enhanced resilience to cope with disasters and emergencies, including COVID-19, which should be taken into consideration by policymakers and planners in future programs.

In the recent few years, the Lean management has made significant improvements in providing quality service to patients in many health-care centers. Thus, this study aims to systematically review features and results of conducted studies using a lean management approach in hospitals.

In this systematic review, eight databases, including PubMed, Web of Knowledge, Google Scholar, Scopus, Iranmedex, SID, Magiran and Medlib, were searched using keywords including “Lean principles,” “Lean Six Sigma,” “Lean Process SID,” “Lean thinking,” “Lean Methodology,” “Toyota Production System lean processing,” “lean techniques” and “hospital,” as well as their Persian equivalents. Required data were extracted using an extraction table and were analyzed using content analysis method.

Out of 967 identified articles, 48 articles were included in the study. Most of the studies have been conducted in developed countries such as America, Britain, The Netherlands and Canada. The highest number of studies has been conducted in the overall hospital and emergency departments. Lean Six Sigma and Lean methodology were the most frequent terms used for lean management. The five-phase Six Sigma methodology was one of the most important methods used for the implementation of the Lean management. Performing the process at the first time (timing) and length of stay had the highest frequencies among indicators assessed in the studies. All indicators assessed in the studies have improved after the implementation of Lean management. Among 150 assessed indicators, 69 were meaningfully improved (p < 0.05) and 12 indicators did not have a meaningful improvement (p > 0.05) and 69 indicators did not show any meaningful changes.

A number of implications are drawn out to aid academics, practitioners and policymakers in improving knowledge and skills. The elimination of production wastes is the most important principle of Lean thinking and paying attention to the clients and increasing the value. This will significantly improve quality of services to the patients and reduce costs and losses through preventing wastes. Suitable metrics in Lean management need to be established. A move to placing greater emphasis on understanding the contexts in which theory is implemented is another application.

The limitation of this study is selection of studies in English and Persian language, excluding gray literatures and unpublished studies and relying on a relatively limited number of databases for the identification of potentially eligible studies. In addition, because of the enormous heterogeneity in the methods and results of the studies, performing a meta-analysis in this study was not possible.

The results of this study show that there were many dispersions and heterogeneities in the way of implementation and content of Lean management in hospitals.