The basic principles and practices of the Toyota production system (TPS) have been discussed for decades. Sugimori et al.[1] published one of the first scientific papers on this topic.The practice now known as lean production (LP) has been changing and developing from a simple set of practices to the complexity of an entire lean business system [2] and [3]. As a result, knowledge and understanding about the theory behind LP is also evolving in [2] and [4].In this research paper [5] the authors identify four key main factors that are critical for the implementation of lean manufacturing within small and medium-sized enterprises (SMEs), which are: leadership and management, finance, skills and expertise, and the culture of the recipient organisation. These four factors are defined, but least had been improved on the field of management support.Pay [6] stated that there are four major reasons companies fail to achieve benefits through lean implementation. The first is that senior management is not committed to and/or doesn't understand the real impact of 'lean.' The second reason is that senior management is unwilling to accept that cultural change is required for lean to be a success. The third reason is that the company lacks the right people in the right positions, and the last reason is that the company has chosen lean as their process improvement methodology when a different process improvement program -or none at all -would have been the better choice. Based on Pay [6] these four major reasons for failure needs to be avoided or detected soon enough to prevent damage and LP failure.Papers [7] to [9] identified a lack of senior leadership focus and complacency as barriers to lean manufacturing implementation.A methodology for implementing lean manufacturing strategies was proposed which is able to systematically identify manufacturing waste, select appropriate lean tools, identify relevant performance indicators, achieve significant performance improvement, and establish lean culture in the organisation [10]. A management commitment transformation plan and the formation of a lean team should be enough to initiate a lean culture. But initiation of a lean culture is not sufficient, management needs to consistently stay supportive and not only at the start of LP implementation. A lean team cannot implement LP if management support is not absolute. Detection of unsupportive management should be done soon enough.The creation of a lean culture is one of the greatest challenges awaiting the prospective lean implementers, since a considerable degree of organisational learning skills are needed [11]. This is why the LP implementation progress should be measured, and all employees have to be educated regarding LP. Methodology to Facilitate Successful Lean Implementation

Kurzfassung Zunehmende Marktvolatilität und steigende Unsicherheit zwingen Produktionsunternehmen, ihr Produktionskonzept an sich stark verändernde Umweltbedingungen anzupassen. Dazu ist es notwendig, Volatilität zu antizipieren und proaktiv damit umzugehen. Die Ausrichtung nach dem Konzept der agilen Produktion kann der Schlüssel zum Erfolg in diesem Umfeld sein. Im vorliegenden Beitrag werden Grundzüge dieses Konzepts erläutert und Anwendungsbeispiele aus der Praxis aufgezeigt.

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Atrial burst pacing is an effective method of terminating supraventricular tachycardia. In the patient presented in this report, a Symbios 7008 pacemaker (Medtronic Inc., Minneapolis, MN, USA) was implanted for two reasons: (1) severe AV conduction defect (AH, 230 msec; HV, 150 msec) and bifascicular block following anterior myocardial infarction; and (2) paroxysmal atrial flutter. The conduction defect ruled out programming other than atrial burst in DDD mode. Activation of burst pacing required appropriate programming of the "tachycardia detection window" on the basis of the cycle length of the flutter waves. In the case reviewed, episodes of atrial flutter with variable cycle lengths of 230 to 280 msec necessitated reprogramming of the AV interval, the refractory period, and the upper rate interval. The use of an antitachycardia device in automatic mode may be limited by variations in tachycardia cycle length.