Lean healthcare aims to manage and improve the processes in the healthcare sector by eliminating everything that adds no value by improving quality of services, ensuring patient safety and facilitating health professionals’ work to achieve a flexible and reliable organization. Value Stream Mapping (VSM) is considered the starting point of any lean implementation. Some papers report applications of VSM in healthcare services, but there has been less attention paid to their contribution on sustainability indicators. The purpose of this work is to analyze the role of VSM in this context. To do so, a scoping review of works from recent years (2015 to 2019) was done. The results show that most applications of VSM reported are in the tertiary level of care, and the United States of America (USA) is the country which leads most of the applications published. In relation with the development of VSM, a heterogeneity in the maps and the sustainability indicators is remarkable. Moreover, only operational and social sustainability indicators are commonly included. We can conclude that more standardization is required in the development of the VSM in the healthcare sector, also including the environmental indicators.

Improving the delivery of patient care is an ongoing challenge in the National Health Service (NHS). This challenge is not insignificant in the process of chemotherapy administration for oncology patients. The present research is motivated by a public Spanish hospital in which oncology patients receive medical care in the Oncology Day Hospital (ODH). At the ODH, oncology patients receive different health services by different specialists on a single day. Any discoordination in patient flow will contribute to longer waiting times and stays in the ODH. As oncology patients tend to have special health conditions, any extra time in the hospital is a source of risk and discomfort. This study applies value stream mapping methodology in a Spanish ODH to improve this situation, reducing hospital waiting times and shorting the length of stay. For that purpose, the path of the oncology patients is mapped and the current state of the system is analyzed. Working at takt time and levelling the workload are proposed for improving the working conditions for healthcare personnel. As a result, the quality of service for oncology patients who need a well-defined care profile is improved. The singular characteristics of the Spanish NHS make it challenging to implement new ways of working, so this study has significant theoretical and managerial implications offering directions in which improvement is possible.

Until 2016, very few works had investigated the use of the VSM. With this research, we will discover if the situation has changed in the last 3 years. In the lean manufacturing context, different techniques that help the continuous improvement process can be used (Marin-Garcia & Bonavia, 2011; Marin-Garcia & Carneiro, 2010; Marin-Garcia et al., 2012; Scott, 2001). One is the Value Stream Map (VSM) (Coetzee et al., 2016; Marin-Garcia & Mateo Martínez, 2013; Vidal-Carreras et al., 2015). This publication is a protocol (Marin-Garcia, 2015; Marin-Garcia, 2019) that aims to promote research transparency and replication. The concepts investigated in it are defined (VSM and health services sector), a research niche is justified, and the search and codification procedure of the systematic literature review is established. Although there are different versions of the VSM (Dinis-Carvalho et al., 2018; Hines & Rich, 1997; Shou et al., 2017), we will focus on that proposed by Rother and Shook (1998). The main peculiarity of the version by Rother and Shook (1998) is that it graphically shows the flow of information and the flow of materials in the same diagram (Lucherini & Rapaccini, 2017; Shou et al., 2017; Vidal-Carreras et al., 2015), which is necessary to complete a project, a product or a service (Bevilacqua et al., 2014; Lucherini & Rapaccini, 2017). It is also very intuitive and easy to understand, even by non-technical people (Lucherini & Rapaccini, 2017).The VSM version that we have chosen is usually applied via standardized symbols (Lucherini & Rapaccini, 2017; Vidal-Carreras et al., 2015) following a 4-stage procedure (Rother & Shook, 1998; Shou et al., 2017): 1) select a product family (each VSM represents a family of sufficiently homogeneous products to represent the process); 2) draw the current VSM; 3) model the improved process by drawing the desirable future VSM; 4) implement actions to obtain a similar process to the future VSM. These four stages can be split into eight in other implementation versions (Tapping, 2007; Tapping et al., 2002; Tapping & Shuker, 2003). The above procedure allows value-added (VA) and nonvalue-added (NVA) activities and initiating actions to be identified to improve the proportion of VA versus NVA (Bevilacqua et al., 2014; Shou et al., 2017; Vidal-Carreras et al., 2015). Our goal is to include any healthcare level (primary care, secondary care - medical specialists, hospitals, referral centers for rare diseases, and geriatric or disability care). We wish to explore the use in organizations of any country worldwide whose ownership is public, private or a nonprofit foundation. We will focus on patient health services. We will not include the pharmaceutical industry or the operation of governmental or nongovernmental public health structures (e.g. ministries, the Red Cross or similar). Different literature reviews on the VSM have been published. Some focus on analyzing several sectors, predominantly manufacturing. Previous research seems to indicate that the VSM allows the transparency of the process to improve by making it much more understandable for the agents involved in it (Shou et al., 2017; Vidal-Carreras et al., 2015); reduce process times (lead times) (Shou et al., 2017) and inventories (Shou et al., 2017). However, these results come mostly from repetitive manufacturing contexts (linked to the automotive or consumer electronics sectors, or their auxiliary industries), and normally from Anglo-Saxon countries. There do not seem to be enough publications in order to generalize these results to all kinds of contexts. Some publications reveal that the barriers from using such tools can overcome facilitators in public service contexts (Marin-Garcia et al., 2018b).Very few reviews have focused specifically on the VSM and the health services sector (Nowak et al., 2017; Vidal-Carreras et al., 2015). Both conclude that there is not enough material to provide evidence for and a conclusive answer to our research questions. The systematic review that we propose in this protocol intends to answer (in a future publication) the following questions: 1) what is the VSM research gap that applies to the health services sector that currently exists?; 2) is the VSM being used in hospitals or other health centers?; 3) what VSM version is common in health sector publications?; 4) collect examples of the VSM in hospitals/heath centers; 5) how was the VSM used in the hospitals/health centers that have applied it?; 6) what problems and/or difficulties have arisen while drawing the VSM or after drawing it? Different programs will be used for the bibliometric analysis (see details in Marin-Garcia and Alfalla-Luque (2019)). First, the R Bibliometrix package (Aria & Cuccurullo, 2017; Garfield, 2004; Wulff Barreiro, 2007) and also the suitability of SciMAT (Cobo et al., 2012; Santana & Lopez-Cabrales, 2019) to visualize thematic maps and strategic maps will be tested.

The economic production quantity method is one of the simplest models to control production and inventory. However, the assumptions on which it is based make its application difficult in practical situations. In most companies, set-up and inventory costs are unknown, or may not even exist as such, although other data are known, such as available capacity in machining hours and limits set by the financing subsystem. The present work offers a multi-item inventory model that sets reference values using known values such as inventory investment limits and production capacity. In order to confer the proposed model’s larger practical content, a spreadsheet available to be downloaded has been implemented. Finally, the model dynamics is illustrated as a numerical example obtained from a real company.

In this paper we present some reflections about the process of evaluation of teaching as a starting point for an improvement. Without information there cannot be change. Any improvement in the classroom requires dealing with information coming from, first, the students as counterpart in the university learning teaching process; second, other colleagues who give their professional opinion and; third, of ourselves as lecturers, so that a complete evaluation is made from all points of view.

El concepto de estilos de aprendizaje (estilos cognitivos) aparece en la literatura en los años 50 del siglo XIX en el ámbito de la psicología cognitiva, siendo considerados como la expresión de las formas particulares de los individuos de percepción e información. Desde entonces, muchos autores han propuesto algunas definiciones, enfoques y métodos para analizar estos estilos. Entre los modelos cognitivos encontramos el modelo de aprendizaje de Kolb a través de las experiencias, que relaciona los estilos de aprendizaje con sus procesos. Según este autor, el aprendizaje se define como el proceso de creación de conocimiento a través de la transformación de la experiencia. El modelo sigue un proceso, basado en el ciclo experiencial de Lewin, en el cual una experiencia concreta o situación diaria activa el conocimiento de tal manera que la persona comienza a recolectar, almacenar, procesar y analizar información. Luego, el individuo generaliza los conceptos e internaliza y madura los conocimientos y habilidades adquiridos. Finalmente, el aprendizaje se contrasta para demostrar que puede ser útil en situaciones o experiencias nuevas. Kolb define cuatro estilos dominantes de estilos de aprendizaje basados en la forma en que se percibe la información (desde la experiencia directa hasta conceptos abstractos) y se procesa (desde el punto de vista práctico al teórico): divergente, convergente, asimilador o analítico y acomodador. El objetivo de este trabajo es reflexionar sobre la relación que existe entre el estilo de aprendizaje predominante en un docente y la forma en que se diseña la guía docente de las asignaturas que imparte, en particular en lo relativo a la aplicación de distintas metodologías de enseñanza-aprendizaje y/o a los sistemas de evaluación utilizados.