Background -Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. Methods -This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Results -Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary care centres working with Lean healthcare compared to those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Conclusions -Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients.

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An overview of the work under development within the EU-funded collaborative project MAESTRI is presented in this chapter. The project provides a framework of new Industrial methodology, integrating several tools and methods, to help industries facing the fourth industrial revolution. This concept, called the MAESTRI Total Efficiency Framework (MTEF), aims to advance the sustainability of manufacturing and process industries by providing a management system in the form of a flexible and scalable platform and methodology. The MTEF is based on four pillars: a) an effective management system targeted at continuous process improvement; b) Efficiency assessment tools to support improvements, optimization strategies and decision-making support; c) Industrial Symbiosis paradigm to gain value from waste and energy exchange; d) an Internet-of-Things infrastructure to support easy integration and data exchange among shop-floor, business systems and MAESTRI tools.

An overview of the work under development within the EU-funded collaborative project MAESTRI is presented in this chapter. The project provides a framework of new Industrial methodology, integrating several tools and methods, to help industries facing the fourth industrial revolution. This concept, called the MAESTRI Total Efficiency Framework (MTEF), aims to advance the sustainability of manufacturing and process industries by providing a management system in the form of a flexible and scalable platform and methodology. The MTEF is based on four pillars: a) an effective management system targeted at continuous process improvement; b) Efficiency assessment tools to support improvements, optimization strategies and decision-making support; c) Industrial Symbiosis paradigm to gain value from waste and energy exchange; d) an Internet-of-Things infrastructure to support easy integration and data exchange among shop-floor, business systems and MAESTRI tools.