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How can independent organizations, in a supply chain, coordinate and collaborate in a process improvement endeavor, in the absence of financial or contractual mechanisms to enforce compliance among the organizations? This paper provides an example using a health care supply chain for delivering patient care services, where the demand is extremely variable and unpredictable and the work is distributed among independent organizations. Using lean principles as a lens, this paper describes how process improvement is achieved in such a supply chain and the related implications for work design. Focus of the paper is to examine how management can effectively coordinate work and process improvement across independent organizations (the "hierarchy problem") rather than how work can be divided into self-contained modules for distribution across independent organizations.
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