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IntroductionThe provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysisIn a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and disseminationApproved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.Trial registration number NCT03180606.

This study aimed to explore the potential impact of the Lean Manufacturing methodology on the implementation and functioning of the BRC Standard for Packaging. The study highlighted many issues where the Lean Manufacturing concept supports and opposes the BRC Standard for Packaging. A framework for the coexistence of both approaches was determined. The study was of a conceptual nature; it adopted an analytical approach. The approach was based on in-depth consideration of each requirement in the BRC Standard for Packaging s and an assessment of the coherence with the Lean Manufacturing methodology. As a result, many conclusions, clues and challenges were found. The article indicates several areas, in which Lean Manufacturing supports the BRC Standard for Packaging, attributing a special positive role to Lean Tools & Techniques. Also, it indicates six areas, in which the BRC Standard for Packaging contradicts the Lean Manufacturing approach. A comprehensive analysis of the coexistence of both management systems allows a better understanding of challenges while implementing both of them in an organisation. The presented concept of the coexistence of both systems is valuable for management.

Many improvement programmes often fail to sustain over an extended period of time. Previous research suggests that a similar set of factors influence the success and sustainability of an improvement programme. The purpose of this paper is to make a distinction between the success and sustainability of improvement programmes, and to identify mechanisms that specifically contribute to the sustainability. In this paper, we study a sustainable improvement programme from the perspective of complexity theories that stress the importance of studying change as a dynamic process of interacting elements and events unfolding in time. We conducted a longitudinal, indepth case study of a Swedish Lean Prize Award Winner where a Lean improvement programme was studied over 9 years. An improvement programme is successful if goals are achieved and the targeted problems are resolved. Furthermore, the first-order sustainability means the ability to sustain results and the second-order sustainability means the ability to keep an improvement programme alive. The lessons identified from complexity theories, such as destabilising the organisation, ensuring novelty and constant flow of change or self-organisation at the team level, are examples of mechanisms important to achieve the sustainability of the improvement programme.