“…Various healthcare practices are highlighted in literature, nevertheless they focus on hard factors, such as SS, or soft ones, like Lean, and not on their combination. For example, in the sphere of SS, the application of the DMAIC, Value Stream Mapping (VSM) and Visual Management as hard factors has proven effective in improving patient care processes (dos Reis et al, 2022). Conversely, for Lean Management, the emphasis is placed on the impact of incorporating soft and human aspects in fostering hospital performance, such as continuous improvement, effective leadership, collaboration and communication (Waring and Bishop, 2010;Alkhaldi and Abdallah, 2020).…”