Purpose: This research aims to propose a framework to integrate Green Lean Six Sigma (GLSS) and Industry 4.0 to improve organizational sustainability.Design/methodology/approach: The integration of GLSS and Industry 4.0 is proposed based on theoretical facets of the individual approaches. A generic, conceptual framework of an integrated GLSS-Industry 4.0 approach is then proposed using the application of different tools and techniques of GLSS and Industry 4.0 at different stages of the realization of a project.Findings: Both approaches have common facets related to enablers and barriers, and the integrated application of tools and techniques of each approach supplements the common focus of both related to sustainability enhancement. The proposed, conceptual framework provides systematic guidelines from the project selection stage to the sustainment of the solution, with the enumerated application of different techniques and tools at each step of the framework.Originality/value: This research is the first of its kind to propose the integration of GLSS and Industry 4.0 under the umbrella of a unified approach, including a conceptual framework of this integrated GLSS-Industry 4.0 approach.

Purpose: By applying a systematic literature review, this paper aims to identify the major healthcare problem domains (i.e.target areas) for lean supply chain management (LSCM) and to provide a list of the most common techniques for implementing LSCM in healthcare. Moreover, this study intends to investigate various contingency factors that may have influenced the selection of LSCM target areas or the application of LSCM techniques by healthcare organizations.Design/methodology/approach: A systematic literature review was carried out following the method presented by Tranfield et al. (2003). Thereby, 280 peer-reviewed journal articles, published between 1995 and 2018, were selected, profiled and reviewed. In total, 75 papers were also selected for a qualitative analysis, known as meta-study, on the basis of high relevancy to the research objectives.Findings: This work extracts, from previous research, a set of target areas for improving supply chain in healthcare by applying lean approaches. The work also unifies the language of lean thinking and supply chain in healthcare by defining metaphors in circumstances under which healthcare organizations pursue similar objectives from their supply chain management and lean programs (Schmitt, 2005). This paper also outlines a list of applications of lean for supply chain improvement in healthcare. Finally, a set of contingency factors in the field of lean supply chain in healthcare is found via the published literature.Practical implications: This paper provides insights for decision-makers in the healthcare industry regarding the benefits of implementing LSCM, and it identifies contingency factors affecting the implementation of LSCM principles for healthcare. Implementing LSCM can help healthcare organizations improve the following domains: internal interaction between employees, supply chain cost management, medication distribution systems, patient safety and instrument utilization.Social implications: The research shows potential synthesis of LSCM with the healthcare industry’s objectives, and, thus, the outcome of this research is likely to have positive influence on the quality and cost of healthcare services. The objectives of the healthcare industry are cost reduction and providing better service quality, and LSCM implementation could be an effective solution to help healthcare to achieve these objectives.Originality/value: The prime value of this paper lies in conducting a systematic literature review using a meta-study to identify the major factors of implementing LSCM in healthcare. Only a few other studies have been published in the literature about LSCM in healthcare.

Purpose: Evidence suggests that hospitals are having problems achieving continuous improvement project (CIP) goals or sustaining their results. Therefore, the purpose of this paper is to identify those critical success factors (CSFs) most strongly related to CIP success in hospitals (Lean-Kaizen project, Lean Six Sigma project, Six Sigma projects, and Quality Improvement projects). Design/methodology/approach: A retrospective survey was applied to any CIP leaders/facilitators from hospitals that conducted at least one CIP during the last two years. Findings: Three main findings were obtained from the 116 valid responses. First, the level of importance of 47 out of 53 CSFs to achieve CIPs success in hospitals was assessed as very important or higher (4 or higher on a six-point scale). Second, there are important differences between the CSFs to achieve CIP success in hospitals in this research and previous investigations. Third, the type of CIP affects the level of importance of 16 out of 53 CSFs to achieve CIP success in hospitals. Originality/value: Practitioners involved with CIPs activities in hospitals could use the knowledge extracted from this investigation to improve the impact of their CIPs. Future research should continue in two lines: test if the 53 CSFs for CIPs measure a unique factor and identify the main relationships or paths between CSFs for CIPs and CIP outcomes.

Purpose: This 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/approach: The 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.Findings: The 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/implications: The 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 implications: Observations 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/value: The 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.

As program managers seek to improve the quality, speed and financial benefits of the programs they manage, many are turning to process improvement methodologies, such as Lean Six Sigma (LSS). However, although existing literature includes multiple studies that apply the methodology to non-manufacturing environments, there is no specific framework for applying LSS within program management (PM). Therefore, the purpose of this paper is to examine the relationships between LSS tools, project scope, program phase and functional area and project outputs, in PM organizations. The study uses archival data from 511 LSS projects completed from 2006 to 2015 by a large government agency in the USA composed of 13 PM organizations. The study focuses on four types of input factors: LSS tools, project scope, program phase and functional area; and two output variables: LSS project average financial benefits and percentage of improvement. Multiple regressions are applied to determine what relationships exist between the input and output variables, as well as the nature of such relationships. The results of this study show LSS is beneficial to PM and also indicate which tools and organizational contexts have positive and negative associations with project outcomes, serving as guide for future applications. In addition, this study can provide clarity and confidence to program managers who are currently skeptical of LSS, by showing that it can provide cost, schedule and performance improvements beneficial to their programs. Limitations of this research include the use of a single government agency in the USA, the non-experimental design of the study and limitations associated with the nature and data collection process of the archival data. Future studies should include additional PM organizations, input variables and research designs. There is no specific framework formalizing the concept of LSS application within PM. The literature includes several studies that apply the methodology to non-manufacturing environments, but not to PM specifically. Furthermore, the existing literature on PM does not explicitly cite any continuous improvement methodology as a critical success factor or provide any detailed guidelines for the application of LSS in PM. This paper contributes by studying the relationships between LSS tools, project scope, program phase and functional area, and project outputs, in a PM environment.

Purpose: Organizations spend considerable time and money educating individuals on Six Sigma; however, existing literature does not examine Six Sigma adoption at the individual level or the factors that impact individual Six Sigma adoption. The purpose of this paper is to increase the understanding of individual adoption of Six Sigma tools and methodology.Design/methodology/approach: This paper used a single-site field study in a manufacturing organization to empirically test and refine a theory of the factors impacting Six Sigma adoption at the individual level.Findings: Reaction to training, project management and project infrastructure were found to be significant input factors for individual Six Sigma adoption with anR²of 0.482, which indicates that about 48 per cent of the variation in Six Sigma adoption is explained by the input factors. All of the identified input factors were found to have a positive relationship with individual Six Sigma adoption, as well as positive correlations with each other.Research limitations/implications: This paper was not a controlled experiment or a longitudinal study, so it is not possible from the results of this research to prove causal relationships, although the literature supports a causal relationship between the input factors and outcome.Practical implications: The findings of this paper will be useful to practicing organizations which seek to improve individual Six Sigma adoptions, as well as inform future Six Sigma adoption research.Originality/value: Six Sigma adoption at the organizational level has been well documented in the existing literature. The successful adoption of Six Sigma in an organization is dependent, at least in part, to adoption Six Sigma at the individual level. A review of the existing literature indicates that there has been no research into individual adoption of Six Sigma tools and methodology.