Abstract
When taking a broader view, ‘leanness’ can be conceptualized in terms of a quest for structural flexibility involving restructuring, downsizing and outsourcing. Looking for efficiency, quality and profitability gains, healthcare organizations adopt outsourcing solutions in the attempt of “doing more with less” seeking for benefits such as cost reduction, risk mitigation, adapting to quick changes without compromising internal resources (value mapping and value chain reconstruction) but also taking big risks as loss of control and flexibility. In order to understand how healthcare organizations find the best value equation combining internal and external resources, 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. The main conclusion, among others, is that in ambitious start-ups, when the speed of entrance is a conditioning factor, trade-offs between cost and quality gains (leanness) and between cost and time gains (agility) can be combined through outsourcing strategies in a so called “leagile” paradigm. This study contributes for a wider understanding of the “leagile” concept associated to an outsourcing strategy as a way of coping with market and services volatility, uncertainty and complexity, hyper competition and market share/sped of entrance goals. © Springer-Verlag Berlin Heidelberg 2012.

Abstract
Este artigo tem como objetivo investigar a decisão de externalização, integrada na gestão da cadeia de suprimentos no setor da saúde, nomeadamente os motivos e condicionantes da decisão, os critérios de escolha das atividades a entregar a terceiros, os tipos de acordos possíveis e o impacto que a decisão tem na organização e na pratica. Através do estudo de caso de uma unidade de saúde prestadora de cuidados continuados de forma inovadora, com grandes níveis de customização e em início de atividade, investigou-se todo o processo de terceirização em contexto do início do ciclo de vida de uma organização (não no contexto comum de mudança organizacional) e construiu-se uma matriz de avaliação de risco para atividades terceirizadas de modo a permitir a definição do processo de monitorização da performance a implementar. Este estudo visa compreender como se avaliam e balizam os riscos da adopção de uma estratégia de terceirização e sugere um modelo de monitorização, com recurso a ferramentas de gestão de risco. Concluiu-se que uma abordagem de Gestão de Risco pode ser uma solução para monitorização de terceirização em atividade que se iniciam. Retiram-se, ainda, conclusões acerca da insatisfação com os resultados da estratégia de externalização adotada.

Abstract

Abstract
This article seeks to investigate outsourcing decisions in supply chain management of healthcare organizations, namely the motives and constraints behind the decision, the selection criteria for activities to be outsourced to third parties, the type of possible agreements, and the impact of this decision on the organization per se. A case study of the start-up phase of a Longterm Care unit with an innovative approach and high levels of customization was conducted to understand the outsourcing process in a start-up context (not in the standard context of organizational change) and a risk evaluation matrix was created for outsourcing activities in order to define and implement a performance monitoring process. This study seeks to understand how to evaluate and assess the risks of an outsourcing strategy and proposes a monitoring model using risk management tools. It was shown that the risk management approach can be a solution for monitoring outsourcing in the organizational start-up phase. Conclusions concerning dissatisfaction with the results of outsourcing strategies adopted are also presented.

Abstract

Abstract
Looking for efficiency, quality and profitability gains, healthcare organizations are adopting outsourcing solutions in the attempt of "doing more with less". 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. 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 "leagile" paradigm. This study contributes for a wider understanding of the "leagile" 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. © 2012 Guimarães and de Carvalho; licensee InTech.