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This study aims to identify the “should have” and “must have” capabilities required to boost a supply chain’s robustness and operational performance. Research on supply chain capabilities and their impact has long been central to the supply chain discipline. However, empirical studies continue to report mixed results regarding the relationship between integration and performance or agility and robustness. Using a novel methodological approach, this study explores how supply chain integration, agility and supply chain risk management activities influence the operational performance and robustness of supply chains.

Data was collected through surveys and analyzed using SmartPLS 4 and necessary condition analysis (NCA). This combined approach shifts focus from average trends to identifying the required levels of capabilities, offering insights into the necessity logic of supply chain strategies.

The study reveals that supply chain risk management and internal integration significantly influence operational performance and robustness. It also supports agility as a precursor to enhancing supply chain robustness, aligning with contemporary theoretical perspectives.

The findings suggest the importance of integrating risk management and internal processes to enhance supply chain performance and robustness. Additionally, agility emerges as a critical strategy in navigating disruptions, emphasizing the need to prioritize it in supply chain management.

By adopting a holistic approach grounded in dynamic capability theory, this study contributes to understanding the interplay of supply chain strategies amid unprecedented challenges. The combined use of SmartPLS 4 and NCA offers a novel perspective, shedding light on the necessary logic of supply chain capabilities.

Overall equipment effectiveness (OEE) is a performance indicator that is been used to measure manufacturing productivity. The purpose of this paper is to propose the operating room effectiveness for hospital operating rooms (ORs), adapted from the OEE, to measure performance and identify losses based on lean health-care principles.

The present study is an exploratory, descriptive and applied research work. Literature review, documents of the hospital, observation and interviews with employees of a large university hospital in southern Brazil were analyzed to organize the proposed effectiveness indicator. After that, historical data of the ORs was collected and the usefulness of the indicator was analyzed. The indicator was applied for 10 months and validated with an expert committee from the hospital.

The present study describes an adaptation of a performance indicator to ORs of hospitals, allowing to classify its types of operational losses in a lean health-care context. The application of this indicator and the development of improvement actions to a university hospital, resulted in operational efficiency gains of 12 per cent and estimated annual savings of US$400,000.

ORs are a critical service for hospitals. This paper presents a new way to measure the performance of ORs and identify their main types of wastes. It also shows how to implement it and the potential gains of its application. The main research limitations are related to technical analysis of care data from doctors and nurses involved.

This paper fulfills the need to study how ORs performance can be measured and its operational wastes can be identified. In addition, this paper classifies the planning, performance and quality related losses, which can be used by researchers and practitioners to improve the performance of operation rooms.