Table 2 Perception of leagility in health research

1

Vries et al. (1999) [40]

Decoupling point in a production flow in healthcare sector can be used as the split between urgent admissions versus elective admission, the split between outpatient care and inpatient care, and the split between diagnostic phase and treatment phase (not used to its fullest potential yet). It is noted that different from manufacturing production, in the third example, the highest variability is upstream in the diagnostic phase rather than downstream in the treatment phase.

2

Toussaint et al. (2004) [41]

The main benefit of applying decoupling in a healthcare organization is that it decreases the interdependency of participants in a joint activity and thus makes the work of each participant more efficient.

3

Towill & Christopher (2005) [42]

A Time-Space Matrix covering the majority of healthcare activities is proposed and the de-coupling point of each pipeline is identified. The de-coupling point intends to lessen the interference between the four healthcare pipelines hence reduces disturbance and sequential falling-off in healthcare supply chain performance.

4

Rahimnia & Moghadasian (2010) [33]

Lean strategy affords markets with predictable demand, low variety and long product life cycle, agility acts best in a volatile environment with high variety and short product life cycle. Combining lean and agility within a healthcare supply chain will help

reduce overall lead time and cost of healthcare services. The key challenge in leagile supply chain is to determine the location of the decoupling point, which is used to separate these two paradigms.

5

Aronsson et al. (2011) [7]

The main focus of lean strategy in healthcare is to reduce waste and cost while the one of agile strategy is to ensure fast response to patients, greater flexibility of the system and shorter lead time. It is found that being lean before the decoupling point and being agile after this point is not applicable in a healthcare setting.

6

Saghafian et al. (2012) [22]

Simulation models are used to segment patients into streams for more efficient health care delivery.

7

Guimarães & de Carvalho (2012) [26]

Agile is a post-Lean paradigm leaving to Lean a ″foundational” role. The difference between lean and agile falls mainly on their emphasis on responsiveness to market demand. The combination of lean and agile is called for as individual different care is not addressed when the guidelines shift from mass production to healthcare sector.

8

Guimarães & de Carvalho (2013) [27]

Strategic outsourcing can provide a solution for a flexible, lean and agile healthcare supply chain to deliver better value to the customer.

9

Guven et al. (2014) [32]

Decoupling point (DP) divides the make-to-stock (i.e. push) portion and make-to-order (i.e. pull) portion of a supply chain. There was observed difficulty in locating the DP in a healthcare system thus modelling the process by in-depth study provides a reference to apply the hybrid strategy.

10

Olsson & Aronsson (2015) [28]

Instead of applying lean upstream before the decoupling point and agile downstream after the decoupling point, selecting a strategy for every sub-process based on characteristics such as volume and variety is considered more appropriate in the healthcare sector.

11

Tolf et al. (2015) [29]

Agility prioritizes responsiveness and market sensitiveness to deliver healthcare services based on demand in order to achieve high availability. While Lean prioritize cost optimization by reducing waste to achieve high productivity.

12

Pérez et al. (2015) [21]

Lean improves the operability and efficiency of a clinical laboratory by applying techniques such as zero defects, waste reduction and continuous improvement. An agile methodology enables the flexibility and adaptability to cope with changing needs from physicians to obtain analytical information under specific challenges such as certification and accreditation of the laboratory.

13

Kuupiel et al. (2017) [43]

A lean and agile supply chain management framework helps to improve the accessibility and efficiency of point of care (POC) diagnosis services in low- and middle-income countries.

14

Nabelsi & Gagnon (2017) [35]

A patient-oriented, lean and agile (POLA) approach is proposed for hospitals to integrate healthcare processes and reconcile efficiency imperatives in the supply chain with the adoption of IT technology. Agility helps hospitals respond fastly to patient needs and unexpected risk events, while lean contributes to continuous quality improvement and cost control in the healthcare system.

15

Wikner et al. (2017) [34]

A flow-based decoupling thinking framework combining the back- and front- office distinction and five decision categories for service design is built to introduce the concept of standardization versus customization in a service context. The framework can be applied to healthcare service through patient flow differentiation.

16

Dixit et al. (2019) [1]

Lean operation in healthcare supply chain (HSC) provides high efficiency with low cost while agile operation offers high responsiveness for low service time and quick availability of healthcare services. It is time to move on “leagile operation” by coupling these two for efficient, effective, quick responsive HSC with cheaper cost at the same time.

17

Mishra et al. (2019) [20]

The backend portion of a healthcare service operation such as medicines, equipment, nursing aids and food supplements for chronic disease operates much like a factory, and it could adopt leagility from the manufacturing sector for better management. Besides demand variability, criticality, cost and perishability are characteristics of the product that should be considered when choosing a right strategy for the management of that product.

18

Pohjosenperä (2019) [44]

Modularization and standardization enable value creation in healthcare logistics management.

19

Ni et al. (2020) [36]

A lean and agile multi-dimensional process (LAMP) is developed to generate a minimum set of evidence (lean) relevant to manufacturer needs (agile). The joint execution of lean and agile, or le-agility, produces a process that is highly dynamic and outcome- driven with demonstrable results. Applied to healthcare evidence generation, leagility gives rise to a diffused and iterative approach for healthcare technology design and development.

20

Claudio et al. (2021) [45]

An agile standardized work procedure is proposed for minimizing turnover time and cost for operating room (OR) preparation with varying number of staff available to clean the room.

21

Sen et al. (2021) [30]

Patient Order Decoupling Point (PODP) acts as a buffer to determine the upstream and downstream of the supply chain of healthcare products and services, which results in the synergy between the healthcare service provider and patient through collaboration-co-ordination-cooperation.

22

Fannah et al. (2022) [46]

Agile teams using lean methods streamline the workflow of a hospital under COVID-19 to respond fast to volatile patient demand such as the unexpected inflow of infected patients and elective services resumption. Information system is also adopted for adaptation in order to fulfill healthcare needs during the pandemic.

23

Yadav & Kumar (2022) [31]

Leagility is the integration of lean and agile paradigms. Leanness in a healthcare supply chain increases profits by cutting costs and reducing waste, while agility optimizes profit by supplying exactly what the patient wants. The agile management practices are used where demand is unpredictable, and the lean paradigm is applied where demand is steady.

24

Saraji et al. (2023) [47]

Lean strategy aims at creating a waste-free flow to produce products with less cost and add value to end users. While agility of an organization refers its capacity to produce and deliver unique goods to its customer in a timely and cost-effective way.