Transforming Systematic Literature Synthesis into Meta-Data Analysis: The Impact of Lean Six Sigma in the Healthcare Sector

PurposeThis study aims to present Lean Six Sigma (LSS) deployment and sustainment strategies for the healthcare sector from a multi-level perspective. The objective is to present LSS implementation insights to enable policymakers, practitioners and academicians to test and develop an LSS framework for healthcare sectors.Design/methodology/approachThe strategies identified are the result of a multi-method research design involving literature review, action research (AR) and Delphi study. Further, the AR portion of the study involved more than 10 years of projects focused on the deployment of LSS in the healthcare sector.FindingsThe strategies include a holistic view from the multi-level perspective, considering the Top Management Level, Middle Management Level and Operational Level. The authors ascertained 27 strategies across the three levels of organizational structure for the effective deployment of LSS. Further, the authors present a customized LSS “pocket guide” from the healthcare perspective for quick reference.Research limitations/implicationsThe strategies delineated in this study are based on the Indian healthcare section only; thus, further research in additional geographic contexts is needed. Also, further research is necessary to provide additional empirical validation of the effects of the identified strategies on LSS program outcomes and to verify that the strategies operate at the proposed organizational levels. Future research should also focus on identifying the interrelationships between strategies within and across levels, developing a “road map” for LSS implementation in hospitals and designing the LSS curriculum for medical schools and other medical training programs.Practical implicationsObservations of this study can contribute to developing a holistic framework for successful LSS implementation in the healthcare sector for academicians, practitioners and policymakers. This, in turn, ensures an enhanced value proposition, improved quality of life and reduced healthcare operational costs. Thus, it ensures a win-win situation among all the stakeholders of the healthcare sector.Originality/valueThe strategies put forth will enable the LSS researchers, academicians and, more particularly, practitioners to delve deeper into specific enablers and safeguard the LSS deployment from backlash. The research has two significant benefits. Firstly, it enhances the understanding of LSS from the healthcare perspective. Secondly, it provides direction for future studies with specific components for hospitals’ LSS framework, which can be further tested, refined and improved.

Lean Six Sigma (LSS) has been applied in many healthcare organisations, but there has been limited research on the evolution of LSS application in healthcare. This paper aims to present the challenges, critical success factors (CSFs), readiness factors and most common tools and techniques used for LSS deployment in healthcare. A systematic literature review (SLR) was utilised to research the study objectives. Peer-reviewed literature over a 16-year period was studied to understand the deliverables of LSS. The SLR process identified relevant articles and screened a final selection for those under study. The systematic literature review helped the authors to identify the challenges and tools/techniques used for LSS in healthcare. Several CSFs and readiness factors for LSS deployment in healthcare are also presented. This work informs healthcare managers and professionals on the important factors for successful LSS deployment before embarking on the LSS journey. In addition, this work is a valuable resource for healthcare LSS practitioners and academic researchers to learn about, investigate and deploy LSS in the healthcare sector. This study is one of the most comprehensive SLRs covering the importance and specificity of understanding challenges, CSFs and organisational readiness for LSS in healthcare. This study provides knowledge of the successful deployment of LSS in healthcare.

PurposeThe present study aims to explore the barriers to Lean Six Sigma (LSS) implementation in the healthcare sector and develop the ranking of finalized barriers using the Decision-Making Trial and Evaluation Laboratory (DEMATEL) approach under a fuzzy environment.Design/methodology/approachThe LSS barriers are identified through the literature review and validated by the expert's opinion and statistical analysis. A total of 124 experts were identified through the purposive sampling method for conducting this study. A questionnaire survey method is used to collect the data related to identified LSS barriers in the healthcare sector. The screened barriers are ranked through the Fuzzy DEMATEL approach.FindingsIn this study, a total of 21 barriers were identified with the help of a systematic literature review and screened 13 significant barriers by the expert opinions of healthcare personnel. The result reveals that “Lack of top management commitment and support, lack of awareness about LSS”, “resistance to culture change and inadequate resources emerges as the most critical barriers”. The prioritization of barriers facilitates the managers to make effective policies and guidelines for LSS implementation in healthcare organizations.Practical implicationsTo avoid LSS implementation failure, the practitioners and researchers need to focus on LSS barriers as per suggested ranking more conventionally and make plans and adoption policies accordingly.Originality/valueThis study is unique in terms of investigation and empirical analysis of LSS implementation barriers in the healthcare sector in the Indian context. The outcomes of the present study will help the managers of healthcare organizations to make the strategies and policies for LSS implementation as per the recommended LSS barriers.

PurposeThe purpose of this paper is to examine and introduce comprehensive insights into the field of Lean Six Sigma (LSS) by reviewing the existing literature and identifying the research gap. The state of LSS research is assessed by critically examining the field, along with a number of dimensions, including time horizon, year, journal and publisher, university, country, author, geographic analysis, research design, research affairs, research methods, tools/techniques used, focus industries, major research area, benefits gained by LSS, critical success factors and barriers of LSS implementation.Design/methodology/approachThis paper is based on a systematic literature review of 190 articles containing the word LSS in their title, which are published in a well-known database, such as Elsevier ScienceDirect, Taylor and Francis, Emerald Full Text, Springer Link, Wiley InterScience and Inderscience from January 2000 to September 2016.FindingsThis analysis reveals 15 significant dimensions to identify the state of LSS research. Authors find a noticeable rise in the attention of LSS research in the available literature. Major findings show that, the empirical research holds greater credibility. Statistics prove that the case study method scores the highest among all the research methods used in the discipline. The largest number of studies have investigated research issues related to implementation and process of LSS. The LSS uses a wide range of tools/techniques/methodologies: the choice of tools is situation-specific. Manufacturing and health-care sectors have been the focus of LSS research, but LSS has also been adopted by other types of industries. The organizations following LSS have improved bottom-line results, improved company profitability and growth and enhanced customer satisfaction. In general the research is more interpretive in nature; there is still a lack of standard in the LSS implementation framework.Research limitations/implicationsThis study is limited to reviewing those articles which contain the word LSS appeared in the title.Originality/valueThis study will help understand the current state of research on LSS, various trends in the field, its applicability and future prospects of investigation in the field.

Despite extensive research on Lean Six Sigma (LSS), several aspects about this topic are unexplored. As a result, Lean Six Sigma community face challenges during implementation. This paper aims to address some unexplored aspects of Lean Six Sigma using 5W and 1H approach. This approach answers all cognitive aspects of Lean Six Sigma i.e. Why, What, Where, Who, Which, and How. By conducting an empirical study using questionnaire method, 105 responses are collected from diversified population of organizations and individuals to explore 16 research questions and test 10 hypotheses related with different aspects of Lean Six Sigma. Manufacturing and service firms from different business verticals such as Automotive, Electrical and Electronics, Healthcare, Information Technology (IT), and other sectors participated in study. The hypotheses are framed about influence of Lean Six Sigma on different key performance indicators (KPI) under multiple determinants. Most affected KPI include Quality Performance, Material Handling, and Non-Value adding processes. Most influencing determinants are Lean Six Sigma sustenance period, Where (in the value chain) LSS is implemented, and Investment incurred for Lean Six Sigma. Research implications for managers, academicians, and society are prescribed.

PurposeThe purpose of this study is to propose a Lean Six Sigma (LSS) roadmap to guide healthcare practitioners in the implementation of LSS along with a customized LSS tool kit for reducing medication errors.Design/methodology/approachThe authors initially critically reviewed several frameworks/roadmaps of Lean, Six Sigma and LSS which have been proposed in healthcare sector from the existing literature. This review has led to an understanding of key characteristics, limitations and reasons behind the development of such frameworks/roadmaps. A conceptual roadmap was developed and then validated by a number of LSS experts and a healthcare practitioner. Based on the previous studies and taking LSS experts’ opinions into account, a revised roadmap for reducing medication is presented.FindingsThe roadmap for LSS in reducing medication errors is developed. This roadmap includes three phases: Phase 1 cultural readiness for LSS employment in reducing medication errors; Phase 2 preparation, initialization and implementation; and Phase 3 sustainability.Research limitations/implicationsThe roadmap has been tested with only a handful of practitioners of LSS. Moreover, only two case studies have been carried out in a Thai hospital setting which followed the roadmap. In order to improve the validity of research, more case studies need to be executed and more people should be used for testing the roadmap with varied cultures.Originality/valueThis is the first attempt in the development of a LSS roadmap that healthcare practitioners can follow to reduce medication errors using LSS methodology and sustaining LSS in their organizations.

This paper analyses the aspects for successful implementation of Lean Six Sigma (LSS) in manufacturing, service and healthcare sectors in India. The information available in the literature is not very comprehensive for LSS implementation. It is an attempt to find effective critical success factors in Indian industries. A survey questionnaire was used for the data collection on critical success factors for effective Lean Six Sigma implementation in the organisation. A total of 186 responses received from 450 industries including three sectors. Automobile manufacturing industries have maximum numbers of application in LSS implementation. Hypothesis testing was used for validation of the common critical success factors. Mean and standard deviation was used for the priority of common critical success factors. Top management initiatives towards LSS, structured review approach of LSS to manage quality improvement activities, mentoring by Master Black Belt (MBB) in an improvement project, organisational roles and responsibilities linkage with LSS were found to be top four common CSFs in Indian industries. The output of this study can be used as a guide for successful implementation of LSS in Indian industries with increased success ratio.

Lean six sigma in the healthcare sector: A systematic literature review

PurposeThe purpose of this paper is to present the implementation of Lean Six Sigma (LSS) to reduce medication errors, by using four case examples. The paper will also suggest appropriate Lean and Sigma tools to improve the medication process.Design/methodology/approachThe authors critically analyze four case examples that used LSS projects, to demonstrate the approach, benefits, success factors and lessons learnt.FindingsLSS is a powerful process improvement methodology that could be applied by health-care sectors to reduce medication errors, increase patient safety and reduce operational costs. Common Lean and Six Sigma tools play a significant role in improving and sustaining the medication process.Practical implicationsIt is necessary for the project team to select the most appropriate LSS tools to address medication process problems. Adoption of a LSS roadmap could help health-care organizations in the successful implementation of LSS.Originality/valueThe paper is valuable for health-care professionals seeking to reduce errors in the medication process or other processes that need to be improved.

Purpose – The purpose of this paper is to investigate the migratory nature of Lean Six Sigma (LSS) implementation and adoption in manufacturing-based SMEs in the UK. The companies were surveyed at two points over a five-year period. These periods were before and after the 2008 recession point. This being done in order to identify the level of LSS adoption as a result of the tougher economic climate that has prevailed since 2008. Design/methodology/approach – Analysis is carried out on a sample of 96 manufacturing SMEs from a range of manufacturing sectors in the UK. Data were gathered from company CEOs via a triangulated method of questionnaire, direct observation and interviews. Findings – The paper provides research information into the characterisation, compatibility and innovativeness of SMEs towards LSS implementation and goes on to provide an implementation classification system and characterises the dynamical nature of LSS development in manufacturing SMEs. Research limitations/implications – The findings analyse the dynamic nature of LSS implementation in SMEs. Further work will include extending the LSS categorisation system to provide a wider category set that further defines the dynamical nature of LSS implementation. Also, more focused studies in to specific manufacturing sectors will yield greater understanding of the effects of LSS on those sectors. Practical implications – The paper provides practical research information into the characterisation, compatibility and innovativeness of SMEs towards LSS implementation. It will be of use to practitioners seeking to implement or develop LSS further in their organisations. Originality/value – This study compares at depth the LSS implementation issues within SMEs. It not only analyses the survey data but characterises their attitudes towards implementing LSS and as such this work makes a contribution to this under researched area.

PurposeThe purpose of present study is to expose the detailed review for benefits and challenges about implementation of Lean Six Sigma (LSS) in business organization and spread of LSS literature in term of various sectors wise, research methodology wise and journal wise.Design/methodology/approachThis paper covers the literature on LSS from 2000 to 2018. The authors have selected a large number of research papers using the keywords as Lean Six Sigma implementation in automotive, micro small medium enterprises, health care, education, financial sectors and many more. A total of 216 research papers have been reviewed on LSS distribution of sector wise, research methodology adopted, active countries, year of publication and critical barriers in implementation of LSS.FindingsThe present literature classifies the spread of LSS in four important sectors of manufacturing, health care, human resource, financial and education. It presents the critical barriers and benefits of LSS implementation in various sectors mentioned above and an important research gap, where practitioner/researcher can focus more during their research on LSS.Practical implicationsIt is important for industry, researchers and LSS practitioners to be aware about challenges and success factor during LSS implementation in various sectors such as manufacturing, education, financial, human resource and health care. Hence, this paper could provide significant and valuable insights to industry and practitioners for successful implementation of LSS projects.Social implicationsLSS results in reduced waste, defects and improve process, which in turn provide high-quality products at minimum cost, and this leads to customer delight, which ultimately raises the societal living standard. The results encourage LSS practices without fear because there is a huge discussion of near about all success and failure parameters about LSS.Originality/valueTo the authors’ best knowledge, no studies have still covered the literature review of LSS implementation in three different sectors: manufacturing, service and process. The present study was mainly focused on presenting a systematic review of literature in said sectors and found the gap between current status and future direction for the implementation of LSS in different areas.

PurposeThe article evaluates the obstacles, lessons learned and managerial implications of deploying Lean Six Sigma (LSS) in a dental college hospital in India.Design/methodology/approachThe work adopts the action research (AR) methodology to establish a case study, which is carried out using the LSS define–measure–analyze–improve–control (DAMIC) approach in a dental college. It uses LSS tools to enhance the productivity and performance of the Conservative Dentistry Department of a dental college and to unravel the obstacles and success factors in applying it to the education and healthcare sector together.FindingsThe root cause for high turn-around time (TAT) is ascertained using LSS tools and techniques. The effective deployment of the solutions to the root causes of variation assists the dental college to reduce the TAT of the Conservative Dentistry process from an average of 63.9 min–36.5 min (i.e. 42.9% improvement), and the process Standard Deviation (SD) was reduced from 2.63 to 2 min. This, in turn, raises the sigma level from 0.48 to 3.23, a noteworthy successful story for this dental college.Research limitations/implicationsWhile the results and recommendations of this research are focused on a single case study, it is to be noted that the case study is carried out with new users of LSS tools and techniques, especially with the assistance of interns. This indicates the applicability of LSS in dental colleges; thus, the adopted modality can be further refined to fit India's education and hospital sector together.Originality/valueThis article explains the implementation of LSS from an aspiring user viewpoint to assist dental colleges and policymakers in improving competitiveness. In addition, the medical education sector can introduce an LSS course in the existing programme to leverage the potential of this methodology to bring synergy and collaborative research between data-based thinking and the medical field based on the findings of this study. The most important contribution of this article is the illustration of the design of experiments (DOE) in the dental college process.

This study aims to present a conceptual framework that brings together reward and recognition, and customer focus (organizational factors), which can help organizations achieve a competitive advantage (CA) through applying Lean Six Sigma (LSS) in healthcare. A critical review of the models of reward and recognition, and customer focus, LSS, and CA measures was performed to create the conceptual framework. A synthesis of the existing literature provides the basis for the development of the conceptual framework of the LSS measures. The independent variables are reward and recognition, and customer focus. The mediator variable in this framework is LSS, and CA is employed as the dependent variable. The framework offers a systematic method of evaluating the determinants of LSS in healthcare. Accordingly, the newly developed conceptual framework identifies and describes the direct associations between organizational factors and CA in the healthcare (HC) sector and the indirect associations through LSS. This study is important for professionals working in HC seeking to achieve CA in hospitals. Additionally, this study is valuable to researchers and academics working in the LSS field as it explores the importance of LSS implementation in hospitals. In addition, limited studies have been conducted to explore the status of LSS implementation in HC and this study is expected to provide theoretical contributions to the LSS approach in healthcare.

Lean Six Sigma (LSS) is widely accepted as an effective management concept in minimising wastes and variation of the processes. However, few studies can be found to integrate LSS for improving administrative processes in manufacturing and services industries. Out of the practicing LSS tools, identification of the most suitable LSS tools for each stage of LSS is vital to streamline the administrative process. Although, studies were conducted on lean implementation in different sectors in ad-hoc manner, dearth of studies were focused to compare the existing literature in detail. Therefore, the study aimed to conduct a systematic literature review (SLR) on LSS tools used in administrative processes in different sectors for every LSS stage. This SLR was conducted to addressing the above-mentioned research gap by adopting to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guideline for healthcare, education, public administration and other sectors. The initial repository comprised with 1817 and the final repository was comprised with 23 articles. The SLR has contributed to the theory by exploring suitable LSS tools and techniques for each DMAIC (Define, Measure, Analysis, Improvement, and Control) stages of LSS. Out of the identified tools, SIPOC and project charter can be recommended for the define stage whereas, process map is suggested for the measure stage. Further, Cause and effect analysis, Value Stream Mapping (VSM) and control charts are recommended for analysis, improvement and control stages. Further, some specific LSS tools were screened as a specifically applied to a particular sector. Ultimately, the results will propose to industry by applying appropriate LSS tools for administrative processes in different sectors which are not transformed into LSS incorporated internal environment.

The purpose of this study is to develop a nested theoretical model (LSS-DC) by critically examining two distinct theoretical concepts, including Lean Six Sigma (LSS) and Dynamic Capabilities (DC), for achieving organizational sustainable performance optimizations (PO). The robust integration of this dynamic concept is achieved using a systematic literature review, synthesis, and empirical evidence derived from 2005 to 2022. The vital benefits of LSS-DC are identified. This study utilizes a systematic literature review method adapted. It reveals the cross-sectional literature search strategy deploying selective keywords DCs, LSS, DCs and LSS, DCs and LSS and PO. In this niche domain employing descriptive and thematic analysis, key insights are extracted from the literature, encompassing a total of 21 peer-reviewed journals. The selection criteria revolve around three aspects: ‘Purpose’, ‘Authorship’, and ‘Credibility and Accuracy’. The authors gathered the secondary data from credible databases such as Scopus, Web of Science, PubMed, ERIC, and IEEE using the keyword search. The study reveals the robust integration of theoretical concepts of LSS and DCs and their impact on organisational performance. The findings suggest that integrating the micro-foundations of DCs (sensing, seizing, and transforming) with LSS allows organisations to not only identify improvement opportunities but also efficiently and effectively act upon them, ultimately leading to sustainable performance optimisation across various aspects of the business. The specific type of DC integration with LSS depends on the organisation’s goals and priorities. The findings of this study are subjective to some extent due to the applied research methodology. Further empirical research is needed to gain a deeper understanding of the phenomenon. This study considers LSS as DC providing an empirical (LSS-DCs) model for sustainable performance optimisation. This is achieved by robustly integrating two distinct theoretical concepts derived from an extensive literature review and the analysis of the data-driven implementation. Finally, the study offers a deeper understanding in terms of how contextual organisational characteristics enhance the outcome of LSS-DC.