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PurposeConsidering lean thinking inside and beyond the organisation's boundaries, in the extended supply chain, this paper aims to fill a literature gap clearly stating some outsourcing practices as lean practices and establishing a deployment evolution parallel between both practices.Design/methodology/approachA literature review was carried out collecting cases of lean deployment in healthcare, from both scientific and grey literature. Cases were classified according to lean deployment taxonomy in healthcare settings, showing some differences in lean journey stages in 15 countries.FindingsThere is an alignment between SCM thinking in healthcare and lean thinking that places a SCM decision as outsourcing as a lean practice serving not only strategic intent but solving operational efficiency. There is a match between different outsourcing drivers (transactional, strategic and transformational) and lean maturity levels. The main constraint to deployment of both lean and outsourcing practices are cultural differences.Practical implicationsUnderstanding lean and outsourcing different deployment maturity levels under the national cultural umbrella can open new perspectives to study lean sustainability factors and better outsourcing relationships in healthcare organisations.Originality/valueThis paper presents a merger between the state‐of‐the art of both lean and outsourcing practices in healthcare settings and suggests an outsourcing and lean evolving pathway.

Assessing service quality has become a major issue in the healthcare sector. Although direct evaluation has already taken place, literature is scarce in terms of the impact the distance covered by the user has on perceived service quality. The aim of this study was to assess the influence distance has on perceived service quality when no similar service alternatives are available. The Servperf instrument was used to collect data. All women who delivered babies in autumn 2011 were respondents to the questionnaire. Exploratory analysis was used to test research hypotheses. Cronbach's alphas were computed to assess internal consistency. Findings show that Assurance is the quality dimension that contributes the most to patients' perceived service quality and Tangibles is the one that contributes the least. It was also possible to conclude that the distance the patient has to cover to be served and its educational level influence patients' perception of the service provided.

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Purpose -Understanding how VMI benefits serve lean purposes in healthcare and why its outcomes can be difficult to achieve in healthcare settings is the main purpose of this study. Design/methodology/approach -An in-depth case study of VMI is presented in the perspective of the downstream member, a public general multi-site hospital, operating as a small scale consolidated service centre in terms of material management, exploring such dimensions as: VMI benefits, risks, barriers and enablers. Findings -Despite some unawareness of VMI benefits in healthcare, it can present a waste reduction solution not only in costs but in the quality of care for freeing clinical professionals to clinical tasks, among other savings. The multiple benefits are better explored, as in any relationship building, by investing in partnership creation and overcoming the idiosyncratic barriers of the healthcare sector. Research limitations/implications -Although findings of a single case study are difficult to generalize, the protocol and methodology presented allow replication in other units of analysis with the same inclusion criteria. Practical implications -This paper brings the lean deployment discussion out of the organization's boundaries, showing the interconnections and pointing to the need for future work that would allow healthcare managers to build a lean supply chain. Originality/value -By considering VMI an outsourcing alternative, this paper identifies the lean thinking intent behind such options and enhances the idiosyncratic difficulties in full deployment in the healthcare sector, a less studied setting.