Lean Manufacturing | Literature Review

Lean Manufacturing Literature Re rivalSince the 1980s, numerous businesses in various sectors of industry exhaust continu on the wholey been introducing programs intended to improve both w beivity and whole step. Several authors have posited little(a) manufacturing or angle returnion as the best possible production transcription and one that foot be implemented in any industry and any procedure (Bonavia and Marin, 2006 and Lee-Mor sentencer, 2006). Doolen and navvy (2005) mentioned that antithetic researchers have explored the portability of guide practices both at heart and in the midst of assorted manufacturing sectors. In accordance, a renewing of surveys conducted in different types of industry (Soriano-Meier and Forrester, 2002, Bonavia and Marin, 2006, Doolen and Hacker, 2005, Snchez and Prez, 2001 and Taj, 2008) turn divulge that bend is widely successful in a variety of industrial sectors.However, in that location ar two problematic issues regarding angle of inclination manufacturing have been addressed in several studies. First, Shah and Ward (2007) claimed that any backchat of operate production denominates to an absence of reciprocal definition of the apprehension. Likewise, Pettersen (2009) tot onlyyeged that there is no h r ar upon definition of inclining that could be found in the literary works. Papadopoulou and -zbayrak (2005) decl bed that there is no consensus in different researchers perceptions to the concept of lean which hunts to conflicting results in identifying and classifying its practices and techniques.Second, there is conflict in using scathe such as elements, principles, causes, techniques and practices. Papadopoulou and -zbayrak (2005) mentioned that somewhat of the elements of lean ar actually referring to the goals and objectives or else than techniques or lances (e.g. elimination of pine, lead time reduction) and, in increase, a pattern of early(a) best manufacturing practices (suc h as agile manufacturing) were utilize in literature as lean practices. Moreover, Shah and Ward (2007) unders officed that identical items argon using up to consummationalize immensely different concepts and different items argon used to operationalize the akin construct. Thus, Shah and Ward (2007) argued that a great source of confusion and inconsistency associated with lean is the more than all important(p) ine fictional character about what em automobile trunks lean production and how it base be calculated operationally.Statement of the problemThe above mentioned issues shoped three confusions surrounding the lean concept in literature, which ar (1) the lack of a consistent definition of lean, (2) the dis sympathy about the elements that comprise lean manufacturing and (3) the lack of a measurement tool for esteeming changes towards lean death penalty.With the aim to clarify and resolve these confusions, this chapter has three principal(prenominal) objectives (1) to train a conceptual definition of the term lean manufacturing that captures all its of import facets, (2) to provide a framework that identifies its major elements and practices, and (3) to develop an operationalized case to assess changes towards lean manufacturing death penalty. To get through these objectives, an in-depth literature review is conducted regarding the report of lean manufacturing. At first, the concept of Lean and its main principles ar introduced. Next, the elements of lean manufacturing and the practices for lean implementation exit be investigated. Finally, different powers that measure the hop on achieved towards lean are explored.The concept of LeanLean was associated with the practice of deciphering the shelter added activities from those that are take in in an organization and its issue chain (Comm and Mathaisel, 2005). Motwani (2003) declared that companies subscribe to reduce on each product and its honor stream in found to distinguish mingled with counterbalanced activities and that actually create abide by. Moreover, Papadopoulou and -zbayrak (2005) stated that sparseness was introduced as an approach to manufacturing that was aiming at the elimination of waste succession filtering the make for perpetual improvement.However, lean manufacturing is much more than a technique, it is, in addition, a re origination of thought (Taj, 2008). The issue of lean thinking was widely discussed in different researches. Comm and Mathaisel (2005) believed that lean thinking removes the traditional way good deal think about regions and responsibilities by dint of remaining revolve arounded on the guest and the core competencies that the customer values from an organization. Therefore, Bhasin and Burcher (2006) claimed that for a successful implementation, numerous cultural changes are needful for embracing empowerment and disseminating the lean principles through-out the value chain. Similarly, Taj (2008) confirm ed that lean as a way of thinking creates a culture in which everyone in the organization perpetually improve operations. In accordance, Comm and Mathaisel (2000) introduced leanness as a philosophical schema that intended to signifi deposetly reduce cost and musical rhythm time throughout the inherent value chain while proceed to improve product performance.Hence, lean should be described from two points of view the philosophical post and the practical perspective (Shah and Ward, 2007). From the philosophical perspective, lean is viewed as an overall organizational ism that should affect the mint way of thinking and behaving (Papadopoulou and -zbayrak, 2005 and Bhasin and Burcher, 2006). This philosophy drives the guiding principles and the overarching goals of lean (Shah and Ward, 2007). On the other tidy sum, the practical perspective see lean as a set of solicitude practices, tools and techniques (Shah and Ward, 2007) that are used to apply the philosophy and to achie ve the goals (Bhasin and Burcher, 2006).This two-perspective view of lean is back up by the definition of lean as a socio- technical frame. much(prenominal) system agrees both technical system i.e. technology and social system i.e. people and organizational structure (Bhasin and Burcher, 2006). In the same condition, Shah and Ward (2007) asserted that to practise lean production, firms have to effectively manage their social and technical systems simultaneously. Moreover, Cua et al. (2001) proved that joint optimization of both socially- and technically-oriented policies or practices is necessary for achieving good results.Regarding its implementation, Panizzolo (1998) demonstrate that the wide range of lean practices are link to interventions in the manufacturing area, actions interpreted in other areas of the firm (design, HR, strategy, etc.) and relationships with both suppliers and customers. Likewise, Shah and Ward (2003) stated that lean should be seen as a multi-dime nsional approach that encompasses a wide variety of focusing practices. This conceptualization of lean as flat strategy is back up by a wide range of researchers (Doolen and Hacker, 2005, Karlsson and hlstrm, 1996, Shah and Ward, 2007 and Papadopoulou and -zbayrak, 2005).However, it is well accepted among researchers that lean should be implemented as an integrated system (Shah and Ward, 2007, Bhasin and Burcher, 2006, Karlsson and hlstrm, 1996 and Papadopoulou and -zbayrak, 2005). Shah and Ward (2007) suggested that a well- demonstrable lean strategy implementation go out require firms to exert massive parkway along several dimensions simultaneously. Bonavia and Marin (2006) concluded that there are tho few relationships between the degree of use of lean production practices on an individual basis and operational performance (in terms of productivity, pure tone, lead time and inventory). In the same vein, Shah and Ward (2003) provide unambiguous evidence that the synergist ic effects of all lean practices are associated with go bad manufacturing performance. other feature of lean manufacturing that was punctuate in literature is its time-frame of implementation. Bhasin and Burcher (2006) and Doolen and Hacker (2005) believed that lean is a long multidimensional organizational strategy. Papadopoulou and -zbayrak (2005) corroborate that transformation to lean requires a wad of effort, time and billeticipation of all organization levels in addition to make changes in company culture and organizational structure. Thus, lean enterprises should consecutively find shipway to spend consumption of resources in their struggle to deliver value to their customers. In correspondence, the implementation of the lean program in the case reading discussed in (Lee-Mortimer, 2006) proved that lean is not just a project, it is a long-term continuous journey which is implemented as a sequence of stages or projects.In conclusion, lean manufacturing embraces dif ferent features that should be taken into consideration when shaping this concept. Lean should be viewed as a philosophy, affecting company culture, alternatively than a set of tools/techniques. This, in turn, reveals the brilliance of managing social system as well as technical system simultaneously. Moreover, lean implementation background knowledge is not confined to the manufacturing function of a company, rather it relates to all functions ranging from product development, procurement and manufacturing over to distribution. Since lean companies seek to deliver value to their customers, this value should be predefined and delivered, while waste, which customers are not willing to pay for, should continuously be eliminated. All the aforementioned features of lean manufacturing disregard be captured in the following proposed conceptual definition.Lean manufacturing is a philosophy and a long-term strategy that is applied through a socio-technical system integrating all functio ns within the organization with the aim of continuous waste elimination while delivering outcomes that meet continuously predefined customer value.Lean principlesLean philosophy is chiefly based on the principle of eliminating waste. Waste is anything other than the minimum heart of equipment, corporals, separate, and working time that are essential to add value (Taj, 2008, Bonavia and Marin, 2006 and Karlsson and hlstrm, 1996). Snchez and Prez (2001) cited that the main goal of lean is to eliminate all activities that do not add value to the product. Value should be specified as it is perceived by customers (Andersson et al., 2006 and Dahlgaard and Dahlgaard-Park, 2006). If the task does not add value from the customers point of view, it should be modified or eliminated from the attend to (Andersson et al., 2006). It is believed that by minimizing waste and zero-value added activities, companies skunk reduce production costs and the overall production system will be more effic ient (Comm and Mathaisel, 2005 and Karlsson and hlstrm, 1996).Since inventory is considered one of the critical sources of waste (Snchez and Prez, 2001 and Karlsson and hlstrm, 1996), Dahlgaard and Dahlgaard-Park (2006) declared that the traditional way of producing in batches is inefficient as it requires goods to wait in inventories before the next production step is started up. Thus, Motwani (2003) mentioned that the value mustiness play to the customer without interruptions. Andersson et al. (2006) confirmed that focus should be on organizing a continuous lean through the production or supply chain rather than moving commodities in en liberald batches.Closely related to the continuous flow is the principle of just-in-time (JIT), since the ultimate goal that every swear out should be provided with only one part at a time, simply when that part is needed (Karlsson and hlstrm, 1996). Moreover, if continuous flow is not possible (Lummus et al., 2006), the way of plan the flow of material should be trace instead of shake (Motwani, 2003 and Dahlgaard and Dahlgaard-Park, 2006). This means that customer demand should pull sinless products through the system with the aim of not carrying out any work unless the result of it is required downstream (Andersson et al., 2006).It is obvious that to succeed in the implementation of any young system, everyone from top commission to any lower level should make artless efforts, and set their goals jointly through active participation and understanding (Ahmed et al., 2004). fit in to (McKone et al., 1999), employees coffin nail contribute significantly to the organization when they are allowed to participate in decisions that impact their area of responsibility. As a result, stake from all employees allows companies to better use of its available resources (McKone et al., 1999). This principle reflects the conceptualization of lean manufacturing as a socio-technical system, since it highlights the grandness of managing social system as well as technical system.Since lean is viewed as a long-term strategy, lean philosophy emphasizes continuous improvement. Several researchers (Karlsson and hlstrm, 1996, Comm and Mathaisel, 2005 and Snchez and Prez, 2001) affirmed that one of the most unplumbed principles of lean is the search for continuous improvement in products and processes. Lummus et al. (2006) mentioned that processes should be managed towards ne plus ultra to continuously reduce the time needed to serve the customer. Likewise, Andersson et al. (2006) underscored that the elimination of non-value-adding elements (waste) is a process of continuous improvement. In this context, Snchez and Prez (2001) highlighted the importance of employees involvement and top worry support to create and train improvement teams that lead the organization to move toward zero flys.Based on the analysis of lean previous studies, it is concluded that there are five key principles / overarching goals whi ch can be considered the bases for the lean philosophy. These principles are (1) waste elimination, (2) customer value identification, (3) continuous production flow, (4) employees involvement and (5) continuous improvement. Furthermore, the aforesaid lean principles confirm some issues in the proposed conceptual definition. The unambiguous believe that elimination of waste is the total goal is affirmed since lean is regularly defined as manufacturing without waste. Likewise, identifying value as perceived by customer is asserted in the proposed definition. Moreover, pursuit continuous improvement as a principle of lean philosophy reflects the long-term nature of lean implementation. Thus, the proposed definition attemptes the aim of continuous waste elimination and highlighted the need to continuously predefine customer value. Also, the importance of employees involvement emphasizes the social phase of the lean system as a socio-technical system. Finally, holding in mind these p rinciples / goals underscores the view of lean as a philosophy that affects the people way of thinking.Lean implementation frameworkPrevious studies concerning lean manufacturing revealed a number of manufacturing practices that are commonly associated with lean implementation. The initial step towards developing a framework for lean implementation is to capture different practices and combine them into inter-related groups in accordance to the multi-dimensional nature of lean manufacturing. The term practices in this context refers to the predominant methodologies that may imply many techniques and tools.Shah and Ward (2003) identified and through empirical observation validated combining lean practices into quatern item lean rams to wit essential Quality Management (TQM), Just In Time (JIT), Total Productive Maintenance (TPM) and Human Resources Management (HRM). Bonavia and Marin (2006) found enough agreement in literature to identify the first three bundles TQM, JIT and T PM, while Cua et al. (2001) are of the opinion that human and strategic-oriented practices are common practices that support all other three bundles.Although there is general agreement within operations management literature that JIT, TPM, TQM and HRM are conceptually, theoretically, and empirically well established (Shah and Ward, 2003), there is no unanimous classification of the lean manufacturing practices that make up each of the four bundles (Bonavia and Marin, 2006). Therefore, in an attempt to provide a framework for lean implementation comprises the actual practices that represent each of the four mentioned bundles, the basic theme of these bundles are identified. Then, different lean practices are combine into each of these bundles based on reviewing different research papers regarding lean implementation practices, in addition to articles that were focused mainly on one of these bundles.TQM bundleLack of quality is a major source of waste, since the defective parts and products that need to be reworked or scrapped do not add any value to the customer and should be eliminated in stray to attain high productivity (Karlsson and hlstrm, 1996). Sderquist and Motwani (1999) underscored that quality should be a top management issue and continuous improvement efforts together with the zero error objective should be company-wide and drawn-out over company limits in production bonds.Cua et al. (2001) defined total quality management (TQM) as a manufacturing program aimed at continuously improving and sustaining quality products and processes by capitalizing on the involvement of management, work ride, suppliers, and customers, in ordinate to meet or exceed customer expectations. Sderquist and Motwani (1999) emphasized that TQM approach is the philosophy that should underpin the quality project in a lean company.The practices combined to form the TQM bundle let in product quality visualize, visual management (Cua et al., 2001, McKone et al., 1999 and S derquist and Motwani, 1999), process management (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), product design and development (Cua et al., 2001 and Sderquist and Motwani, 1999), standardization (Sderquist and Motwani, 1999), suppliers quality management and customers involvement (Cua et al., 2001 and McKone et al., 1999).JIT bundleJust-in-time philosophy means to deliver the safe part in the necessary quantity and at the right time (Canel et al., 2000, Snchez and Prez, 2001 and Karlsson and hlstrm, 1996). Ahmed et al. (2004) defined JIT as a philosophy and system concept of doing, maintaining and producing what is value adding or what is just needed, be it raw materials, components, parts, WIP, employees, or finished products. Cua et al. (2001) asserted that the primary goal of JIT, as a manufacturing program, is continuously reducing and ultimately eliminating all forms of waste through JIT production and involvement of the work force.JIT basic techniques include set-up time and stria size reduction, pull production systems (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), equipment layout and cellular manufacturing (Shah and Ward, 2003 and Cua et al., 2001), production leveling and scheduling and JIT rake by suppliers (Cua et al., 2001 and McKone et al., 1999).TPM bundleIt has been accepted beyond any query that fear, as a support function in businesses, plays an important role in backing up many emerging business and operation strategies like lean manufacturing (Ahuja and Khamba, 2008b). Without having a productive aliment system, lean production, just-in-time (JIT) or total quality management (TQM) surroundings cannot be attained (Ahmed et al., 2004). TPM is a proven and successful procedure for introducing maintenance considerations into organizational activities (Eti et al., 2004). Ahuja and Khamba (2008b) stated that TPM is a methodology originating from Japan to support its lean manufacturing system, since depend able and effective equipment are essential pre-requisite for implementing lean manufacturing initiatives in the organizations.Cua et al. (2001) and Shah and Ward (2003) defined TPM as a manufacturing program designed primarily to maximize equipment effectiveness throughout its entire life through the participation and motivation of the entire work force for performing planned predictive and hold openive maintenance of the equipment and using maintenance optimization techniques.TPM, according to McKone et al. (1999), provides a comprehensive company-wide approach to maintenance management which is normally divided into short-term and long-term elements. In the short-term, TPM basic practices include industrial housekeeping, autonomous maintenance (Cua et al., 2001, Eti et al., 2004 and McKone et al., 1999), and planned preventive and predictive maintenance (Shah and Ward, 2003, Cua et al., 2001, Eti et al., 2004 and McKone et al., 1999). In the long-term, TPM efforts focus on new eq uipment and technology acquisition (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999).HRM bundleHuman resources have a critical role in carrying out the continuous improvement plans which are the basis for success in lean implementation (Panizzolo, 1998). Eti et al. (2004) claimed that the degree of employees eagerness to embrace change determines the rate of progress towards that goal. Moreover, McKone et al. (1999) declared that employees are the greatest sources of study for companies to improve their performance.Shah and Ward (2003) affirmed that the HRM bundle has significant theoretical and empirical support. The most commonly cited HRM practices are employees involvement (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), multi-skilled workforce, multi-functional work teams (Shah and Ward, 2003), education and training (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), performance-based compensation system (McKone et al., 1999) and inf ormation and feedback (Cua et al., 2001 and McKone et al., 1999).Lean operationalized modelTraditionally, managers have relied heavily on accounting rhythmic pattern to determine efficiency, such metrics reflect the final state achieved as the result of a long chain of decisions (Taj, 2008), while lean should be seen as a direction rather than a state to be reached after a certain time (Karlsson and hlstrm, 1996). Therefore, managing a lean pulverisation requires key information to assess the changes taking place in the effort to introduce lean (Snchez and Prez, 2001 and Karlsson and hlstrm, 1996).Consequently, in order to develop an operationalized model for lean manufacturing, the aforementioned bundles and practices will be discussed with focus on identifying the indicators that can be used in assessing changes towards lean implementation. It is important here to pedigree that the focus lies on the changes in these indicators, not on their actual values. So, the craved directi on of each indicator, if moving in a lean direction, will be also specified.Measurement of TQM basic practicesSince the ultimate goal of TQM practices is to achieve zero defects, Motwani (2001) mentioned that the percentage of defects (TQM1) and the percentage of products needing rework (TQM2) are among the common quality outcome indicators employed by several researchers.Product quality can be minceled through the involvement of production bill workers for identification and allowance account of defective parts and their authority to stop lines when defective parts are found in order to avoid any defective parts moving to the next production stage (Karlsson and hlstrm, 1996). Thus, Snchez and Prez (2001) used the percentage of defective parts adjusted by production line workers (TQM3) as an indicator of transferring the responsibility for products quality from the quality control division to the line workers. In addition, Karlsson and hlstrm (1996) alleged that the number of qu ality control psychenel (TQM4) and the size of repair area (TQM5) can be reduce as a consequence. Furthermore, Karlsson and hlstrm (1996) declared the use of autonomous defect control (poka yoke) as inexpensive means to help conducting inspection of all units with the ultimate goal of zero defects. Therefore, the percentage of inspection carried out by autonomous defect control (TQM6) is a common measure (Snchez and Prez, 2001 and Karlsson and hlstrm, 1996).Visible graphs and panels are used to gather performance data, to plot different measurements and to identify specific problems and causes of delay in order to take efforts for resolvent (Lee-Mortimer, 2006 and Bonavia and Marin, 2006). For this, Bonavia and Marin (2006) measured the percentage of work areas where visible graphs panels are used (TQM7) as an indicator for visual management.In addition to controlling products quality, process management is essential to obtain fault surplus parts and products from the very anc estor (Karlsson and hlstrm, 1996). Cua et al. (2001) emphasized the use of Statistical Process Control (SPC) techniques in observe processes to ensure that each process will supply defect free units to subsequent process. Shah and Ward (2007) and Bonavia and Marin (2006) measured the percentage of equipment / processes under SPC (TQM8) as an indicator to represent the expansion of using SPC.Panizzolo (1998) emphasized the attention that has been devoted to the relationships between product development and manufacturing activities. Sderquist and Motwani (1999) claimed that design for manufacturing through integrating product and process engineering is one of the core features of quality management within the lean production framework. Thus, the percentage of parts designed by cross-functional teams (TQM9) can be used as a measure for this practice. In addition, Snchez and Prez (2001) mentioned the use of common parts (TQM10) to manufacture different products as a technique used to r educe inventory and lead multiplication as well. Moreover, participation of suppliers in the design stage (TQM11) palliates manufacturing of components they have designed.normalization is an essential principle of lean manufacturing that involves establishing the sequence of tasks to be done by each worker and how those tasks are done (Olivella et al, 2008), measuring and comparing the bout time against the required takt time (Motwani, 2003) and specifying procedures, tools and materials (Bonavia and Marin, 2006). The percentage of procedures which are written preserve (TQM12) is the measure used by Snchez and Prez (2001) and Bonavia and Marin (2006) to quantify the limit to which the company standardize its operations.Several researches emphasized the significant role that suppliers can play when involved in quality improvement programs (Panizzolo, 1998, Shah and Ward, 2007, Papadopoulou and -zbayrak, 2005 and Motwani, 2003). In order to enhance suppliers involvement, Snchez an d Prez (2001) stressed the importance of information replace with suppliers through conducting visits by engineers and technicians from both sides and interchanging documents. This will help to reduce inefficiencies and eliminate activities that are not value added (Snchez and Prez, 2001). This practice is measured by two indicators the frequency of visits between companys and suppliers technicians (TQM13) and the number of suggestions do to suppliers (TQM14) (Snchez and Prez, 2001).With the focus on customers and their needs, Motwani (2001) declared that customer service programs should include quick responsiveness to complaints and maintaining a corporate goal to reduce the quantity of complaints (TQM15). Furthermore, Panizzolo (1998) affirmed that customer-driven enterprises dedicate much attention to organize customer participation in design, manufacturing and delivery activities. Thus, Bhasin and Burcher (2006) considered the percentage of projects in which the customer was involved (TQM16) as a foretoken of the systematically and continuously focus on the customer. In conclusion, table 3.1 summarizes the indicators developed to assess changes towards implementing the previously discussed TQM practices.Measurement of JIT basic practicesSeveral authors (Snchez and Prez, 2001, Karlsson and hlstrm, 1996, Lee-Mortimer, 2006 and Salaheldin, 2005) have proposed the value of WIP (JIT1) and the lead time to customer order (JIT2) as common indicators of JIT implementation. Moreover, Motwani (2003) and Bhasin (2008) affirmed that total product cycle time (total time that material spends in the production system) (JIT3) is the best measure for tracking lean progress. reduction set-up times simultaneously with reducing lot sizes is a technique used to reduce inventories and also it contributes to the reduction of lead times (Snchez and Prez, 2001) and increase flexibility (Karlsson and hlstrm, 1996). The progress in this practice can be straightaway measured by two indicators set-up times (JIT4) and production and delivery lot sizes (JIT5).Firms use pull production systems to facilitate JIT production with the aim to incur the kind of units needed, at the time needed, and in the quantities needed (Shah and Ward, 2007). Bonavia and Marin (2006), Cua et al. (2001), McKone et al. (1999) and Shah and Ward (2007) highlighted the use of kanban squares, containers or signals as a means to pull material from an upriver station and manage product flow. Karlsson and hlstrm (1996) argued that as the work with implementing pull system proceeded, the number of manufacturing stages producing against customer orders should extend. Accordingly, they considered the percentage of stages in the material flow that uses pull (JIT6) as a determinant of the change towards this practice.Cua et al. (2001) and McKone et al. (1999) emphasized the importance of equipment layout to facilitate low inventories (JIT1) and fast throughput (i.e. shorten lead time (JIT3)) . mathematical group machines together in a cell-based layout (Cellular manufacturing) is one technique that is developed to facilitate line balancing with the ultimate goal of creating single piece flow (Lee-Mortimer, 2006 and Motwani, 2003). Implementing cellular manufacturing technique helps to eliminate the frequency (JIT7) and physical distances (JIT8) of parts transfer of training (Karlsson and hlstrm, 1996) and to reduce the investments (JIT9) in handling systems (Snchez and Prez, 2001).Panizzolo (1998) considered production leveling as a practice, in addition to small lots and pull control that is adopted to synchronize production and market demand. Thus, this practice contributes in achieving reductions in the value of WIP (JIT1) and the lead times to customer order (JIT2). Moreover, the synchronization between production output and market demand helps company to minimize finished goods inventory (JIT10).Suppliers are required to deliver the right quantity, at the right t ime, and at the right quality (Shah and Ward, 2007) in order to facilitate JIT production. numerous researches agreed on the importance of reducing the number of key suppliers (JIT11) for the main components and engaging with them in long term contracts (JIT12) (Snchez and Prez, 2001, McKone et al., 1999, Shah and Ward, 2007, Doolen and Hacker, 2005, Bhasin and Burcher, 2006 and Papadopoulou and -zbayrak, 2005). Furthermore, the case study of (Comm and Mathaisel, 2005) highlighted how maintaining good relationships with suppliers helped to keep minimum raw material inventories (JIT13).In general, McKone et al. (1999) highlighted the importance of on-time delivery (JIT14) to customers as an indicator of the JIT concept implementation. Likewise, Bhasin (2008) mentioned measuring on-time delivery as one of the customer / market indicators of lean implementation. In the same vein, Motwani (2001) recommended monitor the amount of lateness in orders delivery as a tool in measuring the sp read of delivery time. Furthermore, since the change towards JIT production and delivery is made gradually (Snchez and Prez, 2001), the proportion of products transferred just-in-time between production stages (JIT15) and that delivered just-in-time by suppliers (JIT16) should be measured. Table 3.2 summarizes the indicators developed to assess changes towards implementing the previously discussed JIT practices.Measurement of TPM basic practicesIt is agreed upon in literature that overall equipment effectiveness OEE (Adaptive Immune rejoinder Case thinkAdaptive Immune Response Case StudyAdaptive ResponseAbstractAdaptive immunity is an important part of the immune system. It is the third line of defense in the human luggage compartment, which includes super specialized systemic cells and processes that eliminate or prevent pathogenic growth. erst external barriers have been compromised and inflammation (innate immunity) has been get offd, the adaptative reaction is called int o action (Huether McCance, 2012). It develops bumper-to-bumper than the innate inflammatory rejoinder and is specificunlike inflammation, which is non-specificand has immunological stock that recognizes each pathogen by a signature antibody (Huether McCance, 2012). In addition, the activated B cells and T cells can develop to memory cells that respond rapidly and expeditiously to a subsequent encounter with a pathogen. Adaptive immunity repartee primary obligation is destroying infectious agents that are resistant to inflammation and provides long-term protection against future icon to the same agents (Huether McCance, 2012).Adaptive ResponseThe adjustive response consists of an antibody response and cell-medicated response, which are carried out by different lymphocytes cells, B cells and T cells respectively. B cells (B indicates bone marrow) are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph, where they have efficiency g et to almost any foreign antigen found in the environment (Huether McCance, 2012). Binding of antibody inactivates virus and microbial toxins by blocking their ability to bind to receptors on host cells. Antibodies, also known as immunoglobulin, are large Y shaped proteins, which are typically composed of two large heavy pair chains and two small light chains (Huether McCance, 2012). There are five types of immunoglobulin IgA, IgD, IgE, IgG, and IgM, which are characterized by differences in structure and function, each has evolved to handle particular antigens (Huether McCance, 2012). The antibody responses are also called humoral immunity. Another adaptational response is known as cell-medicated immunity responses that activate T cells to combat against a foreign antigen presented on the surface of a host cell. Also, T cells produce signal molecules that trigger macrophages, natural killers (NK), antigen specific cytotoxic T-lymphocytes, and release of various cytokines in res ponses to an antigen (Huether McCance, 2012). The purpose of this paper is to justify pathophysiology of diseases presented in the scenarios, including associated alterations, and adaptive responses to the alteration as well as construct a mind map for the selected disorder. Furthermore, consider the epidemiology, pathophysiology, risks factors, clinical presentation, and diagnosis of the disorder and any adaptive responses to alteration.Scenario 1The first scenario the affected roles receive mentioned that Jennifer is usually healthy and has no significant medical narration. However, physical psychometric test revealed clinical manifestations, which include fever tympanic membranes slightly redden on the periphery, throat erythematous with 4+ tonsils and diffuse exudate anterior cervical nodes palpable and tender to touch. The child indicated throat hurts and painful to swallow. Vital signs reveal increased temperature, pulse and respiratory rate that suggested tonsillitis d isorder.PathophysiologyTonsillitis is an inflammatory condition of the tonsils cod to bacteria, allergies or respiratory problems (Tonsillitis, 2014). When inflamed, tonsils become swollen and red with a hoary or yellowish coating on its surface. Tonsillitis usually begins with a choppy sore throat and painful swallowing. Tonsillitis causes tonsils and throat tissues to swell obstructing air from extremely in and out of the respiratory system (Huether McCance, 2012). The tonsils contagious disease is common in children under age six and teenagers but rare in adults. The adaptive response activates the different B cells and T cells lymphocytes to eliminate the alteration, so body can return back to hemostasis.Scenario 2Pathophysiology pricker contact dermatitis is a common nonimmunologically mediated inflammation arising from the release of unhealthy cytokines from skin cells (principally keratinocytes), usually in responses to chemical stimuli such as cleansers, muck deterg ent, and various chemical agents (Hogan Elson, 2013). The main pathophysiological changes are skin barrier disruption, cutaneous cellular changes and cytokine release. pricker contact dermatitis is a major occupational disease skin disorders comprise up to 40% of occupational illness (Hogan Elson, 2013). Patient work storey is crucial in making diagnoses, and appearance of the skin. It may be enured with topical agents such as cortico steroid hormone skin creams, emollients or moisturizers to prevent further irritation (Hogan Elson, 2013).Scenario 2The patient presented with redness and irritation of his hands. The history revealed no allergies or significant medical history except for continual ear transmission systems as a child. He denied any unknown exposure to irritants. Also, patient admits to working in maintenance and often working with abrader solvent and chemical. Normally he wears gloves, but this particular time the patient did not wear gloves. He exposed his h ands to some modify solutions. The patients detailed history and clinical manifestations led the savant to a diagnosis of irritant contact dermatitis.PathophysiologyStress is any side that results in a reaction of the human body called the stress response (Huether McCance, 2012). The stress response is a set of adaptations that are mobilized throughout the body to correct state of allostatic imbalance. This involves a fairly stereotyped set unquiet an endocrine changes. A critical one is the secretion of catecholamines-epinephrine and norepinephrine from the brass instrument endings of the sympathetic nervous system projecting throughout the body (Huether McCance, 2012). Catecholamine induces vasoconstriction and increases in heart rate and blood pressure. It also increases the amount of nutrient and type O that is available to the muscles reaction during a stress response (Huether McCance, 2012). Another is secretion by the adrenal glands of a class of steroid hormones calle d glucocorticoids (GCs) ((Huether McCance, 2012). While there is an array of additional changes in levels of various hormones during stress (generally an increase in circulating levels of gluc pastn, prolactin, and beta-endorphin, decreases in insulin and reproductive hormones), secretion of GCs and the activation of the sympathetic nervous system constitute workhorses of the stress response (Huether McCance, 2012). around common symptoms can include increase heart rate, chest pain, suffering appetite, depression, and insomnia. Usually, coping strategies are beneficial in helping individuals manage stress physical and psychological (Huether McCance, 2012). Adaptive responses help prepare the body for commove or flight by activating adaptive immunity response to correct imbalance.Scenario 3The patient in this case study late retired from her note as an administrative assistance at a local hospital. She does have a history of hypertensive, but controlled for years with medic ation. Patient report having problem quiescenceing, occasionally rapid heart rate, and decrease appetite. She also mentioned her 87-year old mother moved in a few years ago after falling down a flight of stairs and low-spirited her hip. Martha is taking care of her mother who requires enormous amount assistance with activities of nonchalant living. She is worried about her own health at her age and sleep habits therefore clinical manifestations suggested stress disorder.Mind Map for Tonsillitis DisorderEpidemiology pricker contact dermatitis is common in occupations that involve repeated hand airstream or repeated exposure of the skin to water, food materials, and other irritants. questioning occupations include maintenance, health care workers food preparation, and hairstylists (Hogan Elson, 2013). The prevalence of occupational hand dermatitis was found to be 55.6% in 2 intensive care units and was 69.7% in the most highly exposed workers. Irritant contact dermatitis is sign ificantly more common in women than men. The high frequency of hand eczema in women in comparison with men is caused by environmental factors, not genetic factors.PathophysiologyIrritant Contact Dermatitis (ICD) is a common nonimmunologically mediated inflammation arising from the release of proinflammatory cytokines from skin cells (principally keratinocytes), usually in responses to chemical stimuli such as cleansers, soap detergent, and various chemical agents (Hogan Elson, 2013). The main pathophysiological changes are skin barrier disruption, epidermal cellular changes and cytokine release hones nave T- lymphocytes to the skin. Patients with altered barrier function are more prone to ICD.Risk factorsPeople who work in occupational hazard environment and handles irritant such as cleaners, nurses, construction workers, mechanics, and hoidenish workers are at risk for developing irritant contact dermatitis (Mayo Clinic, 2012). Another risk factor is younger workers often less ex perienced than their sr. colleagues or may have a more careless military strength about safety measures causing them to develop the disorder (Mayo Clinic, 2012).Clinical presentationClinically, irritant contact dermatitis presents with scaly erythematous plaques, cracking of the skin, inflammation, dryness, and fissuring. It commonly involves weathervane spaces that extend to the dorsal and ventral surface of the hand and fingers (Mayo Clinic, 2012). Vesicles do not typically form. Pruritus can be diffused however, stinging, burning and pain are frequently reported symptoms.DiagnosisIrritant contact dermatitis does not need a specific test because ICD can be diagnosed through clinical examination and a careful history. A clinical examination must include a careful look at the distribution of the dermatitis (palmar, dorsal, face, abdomen, network spaces, and fingernails) as well as the extension of dermatitis to wrists or forearms (Mayo Clinic, 2012). The history should include a questionnaire that addresses the individual name and address of the employer the workers jobs title and a description of functions. The worker should provide a list of all chemicals handled and supply information about them, such as found on the Material Safety Data Sheets (MSDS) in order to provide an appropriate diagnosis (Mayo Clinic, 2012).Adaptive responses to alterationHarding or alteration has been defined as the adaptation of the skin from altered local aspect of multiple cytokines and inflammatory mediators with repeated irritation from skin irritants. Accommodated skin has a relatively thicker layer of stratum granulosum versus normal skin. Accommodated skin may award a slight sheen and glossy appearance with a mild scale. On manipulation, there may also be a slight loss of elasticity (Huether McCance, 2012).ConclusionWhen successful, an adaptive immune response terminates transmission and provides long-lasting protective immunity against the pathogen that provoked r esponse. Adaptive immunity is an evolving process within a persons lifetime, in which each infection changes the make-up of that individuals lymphocyte population. Adaptive immunity is an evolving process within a persons lifetime, in which each infection changes the make-up of that individuals lymphocyte population (Huether McCance, 2012). These changes are uncomplete inherited nor passed on but, during the course of a lifetime, they determine a persons fitness and their susceptibility to disease. Failures to develop a successful adaptive response can arise from inherited deficiencies in the immune system or from the pathogens ability to escape, avoid, or subvert the immune response. Such failures can lead to debilitating chronic infections or death (Huether McCance, 2012).ReferencesGolden, S. Shaw, T. (2013). knock over dermatitis Review of clinical features and treatment options. Retrieved from www.cutis.com/fileadmin/content/SCMS_vol32_No3_Golden.pdfHogan, D., Elston, D. M . (2013). Irritant contact dermatitis. Medscape. Retrieved from emedicine.medscape.com/article/1049353-overviewHuether, S. E., McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO Mosby.Mayo Clinic. (2012). Tonsillitis. Retrieved from www.mayoclinic.org/diseases/tonsillitis//con-20023538Tonsillitis. (2014). In Encyclopedia Britannica. Retrieved from http//wwe.britannica.com/Ebchecked/topic/599370/tonsillitis