{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T17:02:11Z","timestamp":1753894931373,"version":"3.41.2"},"reference-count":102,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2012,1,1]],"date-time":"2012-01-01T00:00:00Z","timestamp":1325376000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Engineering Business Management"],"published-print":{"date-parts":[[2012,1,1]]},"abstract":"<jats:p> Looking for efficiency, quality and profitability gains, healthcare organizations are adopting outsourcing solutions in the attempt of \u201cdoing more with less\u201d. Seeking for cost reduction, risk mitigation, adapting to quick changes without compromising internal resources, these organizations also take big risks in control and flexibility variables. In order to understand how healthcare organizations find the best value equation combining internal and external resources in a modular service conception, a case study on a start-up Long-term Care unit with innovative format, great levels of customization and following an outsourcing strategy, was carried out. <\/jats:p><jats:p> The main conclusion, among others, is that in ambitious start-ups, having speed of entrance as the conditioning factor, a process orientation and management approach may offer a clear view of the gains related with trade-off decisions regarding time and cost (agility) and cost and quality (Leanness) ie, decisions under the \u201cleagile\u201d paradigm. <\/jats:p><jats:p> This study contributes for a wider understanding of the \u201cleagile\u201d concept associated to an outsourcing operational strategy. Additionally, it also provides new insights to the concept of modularity in services settings in a complex service as healthcare. <\/jats:p>","DOI":"10.5772\/51886","type":"journal-article","created":{"date-parts":[[2012,12,20]],"date-time":"2012-12-20T13:25:47Z","timestamp":1356009947000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Outsourcing in Healthcare through Process Modularization \u2013 A Lean Perspective"],"prefix":"10.1177","volume":"4","author":[{"given":"Cristina Machado","family":"Guimar\u00e3es","sequence":"first","affiliation":[{"name":"Lisbon University Institute, Lisbon, Portugal"}]},{"given":"Jos\u00e9 Crespo","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"Lisbon University Institute, Lisbon, Portugal"}]}],"member":"179","published-online":{"date-parts":[[2012,1,1]]},"reference":[{"volume-title":"Marketing Logistics","year":"1997","author":"Christopher M","key":"bibr1-51886"},{"key":"bibr2-51886","first-page":"5","volume":"7","author":"Marcus I","year":"2010","journal-title":"Journal of Global Strategic Management"},{"key":"bibr3-51886","doi-asserted-by":"publisher","DOI":"10.2307\/258154"},{"key":"bibr4-51886","doi-asserted-by":"publisher","DOI":"10.1080\/16258312.2011.11517267"},{"key":"bibr5-51886","doi-asserted-by":"publisher","DOI":"10.1002\/smj.4250160921"},{"key":"bibr6-51886","doi-asserted-by":"publisher","DOI":"10.1108\/09574099810805807"},{"volume-title":"Lean Thinking, Banish Waste and Create Wealth in Your Corporation","year":"1996","author":"Womack JP","key":"bibr7-51886"},{"key":"bibr8-51886","doi-asserted-by":"publisher","DOI":"10.1080\/09613210500285106"},{"key":"bibr9-51886","doi-asserted-by":"publisher","DOI":"10.1108\/02621710010377508"},{"key":"bibr10-51886","doi-asserted-by":"publisher","DOI":"10.1016\/S0925-5273(98)00223-0"},{"key":"bibr11-51886","unstructured":"Naim MM, Gosling J (2010) On Leanness, agility and leagile supply chains. International Journal of Production Economics. DOI: 10.1016\/j,ijpe.2010.04.045."},{"issue":"2","key":"bibr12-51886","first-page":"1","volume":"21","author":"Bowersox DJ","year":"2000","journal-title":"Journal of Business Logistics"},{"key":"bibr13-51886","doi-asserted-by":"publisher","DOI":"10.1258\/095148407779614990"},{"key":"bibr14-51886","doi-asserted-by":"publisher","DOI":"10.1080\/07421222.1995.11518070"},{"key":"bibr15-51886","doi-asserted-by":"publisher","DOI":"10.1108\/14637151011017985"},{"key":"bibr16-51886","doi-asserted-by":"publisher","DOI":"10.1108\/17542730810857390"},{"key":"bibr17-51886","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2370.2009.00260.x"},{"key":"bibr18-51886","first-page":"84","volume":"75","author":"Baldwin CY","year":"1997","journal-title":"Harvard Business Review"},{"key":"bibr19-51886","doi-asserted-by":"publisher","DOI":"10.1002\/smj.4250171107"},{"key":"bibr20-51886","doi-asserted-by":"publisher","DOI":"10.1007\/s11782-008-0034-3"},{"volume-title":"Production and Supplier Systems discussion paper","year":"2001","author":"Takaeishi A","key":"bibr21-51886"},{"key":"bibr22-51886","doi-asserted-by":"publisher","DOI":"10.1108\/01443570710820620"},{"key":"bibr23-51886","doi-asserted-by":"publisher","DOI":"10.5465\/amr.2006.22528166"},{"key":"bibr24-51886","doi-asserted-by":"publisher","DOI":"10.1002\/smj.528"},{"key":"bibr25-51886","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-5915.2009.00241.x"},{"key":"bibr26-51886","doi-asserted-by":"publisher","DOI":"10.1002\/smj.547"},{"volume-title":"Proceedings from DRUID Summer Conference 2000","year":"2000","author":"Mikkola JH","key":"bibr26a-51886"},{"key":"bibr27-51886","doi-asserted-by":"publisher","DOI":"10.1108\/17410381011024331"},{"key":"bibr28-51886","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-278"},{"key":"bibr29-51886","doi-asserted-by":"publisher","DOI":"10.1108\/09604520710720656"},{"key":"bibr30-51886","volume-title":"Logistics and supply chain management: creating value-adding networks","author":"Christopher M","year":"2011","edition":"4"},{"volume-title":"The Machine That Changed the World","year":"1990","author":"Womack JP","key":"bibr31-51886"},{"volume-title":"The Toyota Way-14 management principles from the world's greatest manufacturer","year":"2004","author":"Liker JK","key":"bibr32-51886"},{"key":"bibr33-51886","doi-asserted-by":"publisher","DOI":"10.1108\/01443570410558049"},{"key":"bibr34-51886","doi-asserted-by":"publisher","DOI":"10.1002\/npr.10019"},{"key":"bibr35-51886","doi-asserted-by":"publisher","DOI":"10.1108\/09684880410561596"},{"key":"bibr36-51886","doi-asserted-by":"publisher","DOI":"10.1108\/01443570910925361"},{"key":"bibr37-51886","doi-asserted-by":"publisher","DOI":"10.1108\/17511870710829346"},{"issue":"1","key":"bibr38-51886","first-page":"2","volume":"56","author":"Kollberg B","year":"2007","journal-title":"International Journal of Productivity and Performance Management"},{"issue":"7","key":"bibr39-51886","first-page":"24","volume":"39","author":"Manos A","year":"2006","journal-title":"Quality Progress"},{"key":"bibr40-51886","doi-asserted-by":"publisher","DOI":"10.1108\/17511870910953788"},{"key":"bibr41-51886","doi-asserted-by":"publisher","DOI":"10.1080\/002075498193291"},{"key":"bibr42-51886","doi-asserted-by":"publisher","DOI":"10.1016\/S0925-5273(98)00222-9"},{"key":"bibr43-51886","doi-asserted-by":"publisher","DOI":"10.1108\/14654659910280893"},{"key":"bibr44-51886","doi-asserted-by":"publisher","DOI":"10.1108\/13598540010347334"},{"key":"bibr45-51886","doi-asserted-by":"publisher","DOI":"10.1016\/S0925-5273(98)00219-9"},{"key":"bibr46-51886","first-page":"73","volume":"39","author":"Ulrich K","year":"1991","journal-title":"Issues in Design Manufacture\/Integration"},{"issue":"1","key":"bibr47-51886","first-page":"2","volume":"6","author":"Piller F T","year":"2003","journal-title":"Mass Customization News"},{"key":"bibr48-51886","doi-asserted-by":"crossref","unstructured":"Stump B, Badurdeen F (2009) Integrating Lean and other strategies for mass customization manufacturing: a case study, Journal of Intelligent Manufacturing. DOI: 10.1007\/s10845\u2013009\u20130289\u20133.","DOI":"10.1007\/s10845-009-0289-3"},{"key":"bibr49-51886","doi-asserted-by":"publisher","DOI":"10.1016\/j.ergon.2007.01.007"},{"key":"bibr50-51886","doi-asserted-by":"publisher","DOI":"10.1080\/00207540802230462"},{"key":"bibr51-51886","doi-asserted-by":"publisher","DOI":"10.1108\/09513550710740616"},{"key":"bibr52-51886","doi-asserted-by":"publisher","DOI":"10.1023\/A:1009634706576"},{"key":"bibr53-51886","doi-asserted-by":"publisher","DOI":"10.1016\/S0925-5273(98)00129-7"},{"key":"bibr54-51886","doi-asserted-by":"publisher","DOI":"10.1108\/14654650010312606"},{"key":"bibr55-51886","doi-asserted-by":"publisher","DOI":"10.1108\/14635770110389843"},{"key":"bibr56-51886","doi-asserted-by":"publisher","DOI":"10.1108\/01443570710750277"},{"key":"bibr57-51886","doi-asserted-by":"publisher","DOI":"10.1080\/00207540110118370"},{"key":"bibr58-51886","doi-asserted-by":"publisher","DOI":"10.1016\/j.jom.2005.11.011"},{"key":"bibr59-51886","doi-asserted-by":"publisher","DOI":"10.1108\/13598549610799040"},{"issue":"5","key":"bibr60-51886","first-page":"3","volume":"44","author":"Christopher M","year":"2002","journal-title":"PPI, May"},{"key":"bibr61-51886","doi-asserted-by":"publisher","DOI":"10.1016\/j.emj.2005.10.010"},{"key":"bibr62-51886","doi-asserted-by":"publisher","DOI":"10.1016\/S0925-5273(02)00254-2"},{"key":"bibr63-51886","doi-asserted-by":"publisher","DOI":"10.1108\/14654650010356103"},{"key":"bibr64-51886","doi-asserted-by":"publisher","DOI":"10.1016\/S0925-5273(03)00109-9"},{"issue":"2","key":"bibr65-51886","first-page":"130","volume":"19","author":"Towill DR","year":"2005","journal-title":"An evolutionary approach to the architecture of effective healthcare delivery systems"},{"key":"bibr66-51886","unstructured":"Fisher M (1997) What is the right supply chain for your product? Harvard Business Review. March\/April:105\u2013116."},{"key":"bibr67-51886","doi-asserted-by":"publisher","DOI":"10.1007\/s10696-005-5169-3"},{"key":"bibr68-51886","doi-asserted-by":"publisher","DOI":"10.1097\/01974520-200907000-00006"},{"volume-title":"Strategic Outsourcing","year":"1999","author":"Greaver MF","key":"bibr69-51886"},{"volume-title":"Business Logistics\/Supply Chain Management","year":"2003","author":"Ballou R H","key":"bibr70-51886"},{"key":"bibr71-51886","doi-asserted-by":"publisher","DOI":"10.1108\/14635770310477771"},{"key":"bibr72-51886","doi-asserted-by":"publisher","DOI":"10.1111\/j.1745-493X.2007.00037.x"},{"volume-title":"The Firm, the Market and the Law","year":"1988","author":"Coase R H","key":"bibr73-51886"},{"key":"bibr74-51886","doi-asserted-by":"publisher","DOI":"10.1086\/466942"},{"key":"bibr75-51886","doi-asserted-by":"publisher","DOI":"10.2307\/258191"},{"key":"bibr76-51886","unstructured":"Prahalad CK, Hamel G (1990) The Core Competence of the Corporation. Harvard Business Review. May-June: 79\u201391."},{"issue":"4","key":"bibr77-51886","first-page":"54","volume":"8","author":"Linder JC","year":"2004","journal-title":"Supply Chain Management Review"},{"volume-title":"Strategic Management of the Health Care Supply Chain","year":"2006","author":"Schneller E S","key":"bibr78-51886"},{"key":"bibr79-51886","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0266(200010\/11)21:10\/11<1105::AID-SMJ133>3.0.CO;2-E"},{"issue":"4","key":"bibr80-51886","first-page":"43","volume":"35","author":"Quinn JB","year":"1994","journal-title":"Sloan Management Review"},{"key":"bibr81-51886","doi-asserted-by":"publisher","DOI":"10.1108\/01409170610674374"},{"key":"bibr82-51886","doi-asserted-by":"publisher","DOI":"10.1108\/13598540610703864"},{"volume-title":"Outsourcing for Radical Change: A Bold Approach to Enterprise Transformation","year":"2004","author":"Linder J C","key":"bibr83-51886"},{"key":"bibr84-51886","doi-asserted-by":"publisher","DOI":"10.1071\/AH070140"},{"key":"bibr85-51886","doi-asserted-by":"publisher","DOI":"10.1080\/10967490701515572"},{"key":"bibr86-51886","unstructured":"Gottfredson M, Puryear R, Phillips S (2005) Strategic sourcing: from periphery to the core. Harvard Business Review. February: 132\u2013139."},{"key":"bibr87-51886","doi-asserted-by":"publisher","DOI":"10.1108\/14637150910949461"},{"key":"bibr88-51886","doi-asserted-by":"publisher","DOI":"10.1097\/00115514-200107000-00007"},{"issue":"10","key":"bibr89-51886","first-page":"44","volume":"59","author":"Hazelwood S E","year":"2005","journal-title":"Healthcare Financial Management"},{"key":"bibr90-51886","first-page":"32","volume":"3","author":"Lonsdale C","year":"1997","journal-title":"Supply Management"},{"key":"bibr91-51886","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2006.07.024"},{"key":"bibr92-51886","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejor.2003.08.022"},{"key":"bibr93-51886","doi-asserted-by":"publisher","DOI":"10.1016\/j.pursup.2004.11.001"},{"key":"bibr94-51886","volume-title":"Case Study Research: Design and Methods","author":"Yin RK","year":"2009","edition":"4"},{"key":"bibr95-51886","doi-asserted-by":"publisher","DOI":"10.1177\/1077800405284363"},{"key":"bibr96-51886","doi-asserted-by":"publisher","DOI":"10.1108\/01443570210414329"},{"key":"bibr97-51886","first-page":"93","volume":"17","author":"Ellram L M","year":"1996","journal-title":"Journal of Business Logistics"},{"key":"bibr98-51886","doi-asserted-by":"publisher","DOI":"10.1108\/02689239910294655"},{"key":"bibr99-51886","volume-title":"Research Methods for Business Students","author":"Saunders M","year":"2007","edition":"4"},{"volume-title":"Qualitative Data Analysis","year":"1994","author":"Miles MB","key":"bibr100-51886"},{"key":"bibr101-51886","doi-asserted-by":"publisher","DOI":"10.1108\/09574099310804920"}],"container-title":["International Journal of Engineering Business Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.5772\/51886","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.5772\/51886","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.5772\/51886","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T14:29:20Z","timestamp":1741616960000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.5772\/51886"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,1,1]]},"references-count":102,"alternative-id":["10.5772\/51886"],"URL":"https:\/\/doi.org\/10.5772\/51886","relation":{},"ISSN":["1847-9790","1847-9790"],"issn-type":[{"type":"print","value":"1847-9790"},{"type":"electronic","value":"1847-9790"}],"subject":[],"published":{"date-parts":[[2012,1,1]]},"article-number":"45"}}