While Lean Six Sigma (LSS) has been applied extensively in healthcare organisations, there has been limited research on the trends of LSS application in healthcare in recent years. This paper aims to present the key motivations and benefits of LSS in healthcare with a view to highlighting the types of problems that LSS in healthcare can aid in solving. The authors used a systematic literature review (SLR) approach to achieving the article’s purpose. Peer-reviewed journal articles published between 2011 and 2021 are considered to achieve the study objectives. The systematic review helped the authors to identify the evolution, benefits, and motivations for LSS in healthcare. This work includes directions for managers and healthcare professionals in healthcare organisations to embark on a focused LSS journey aligned with the strategic objectives. This study is perhaps one of the most comprehensive SLRs covering a vital agenda of LSS in healthcare. This study provides all the deliverables of LSS for its successful deployment in healthcare.

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.

Purpose: Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.Design/methodology/approach: A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.Findings: Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.Research limitations/implications: The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.Practical implications: The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.Originality/value: LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

The fourth industrial revolution, also referred to as Industry 4.0, has resulted in many changes within the manufacturing industry. The purpose of the study is to demonstrate how an Industry 4.0 project was scoped and deployed utilising Lean tools to reduce non-value add wastes and aid regulatory compliance. A case study research approach was utilised to demonstrate how the Lean Industry 4.0 project was implemented in a Medtech company to enhance Lean processes while increasing digitalisation. This research demonstrates that Industry 4.0 can enhance Lean, improve flow, reduce nonvalue add waste, and facilitate product lifecycle regulatory compliance to reduce defects, enhance quality, improve cycle time, and minimise reworks and over-processing. Lean and Industry 4.0 combined offer many benefits to the MedTech Industry. This research will support organisations in demonstrating how digital technologies can synergistically affect Lean processes, positively impact product lifecycle regulatory compliance, and support the industry in building a business case for future implementation of Industry 4.0 technologies.

This paper investigates the differences in timelines involved in Lean Six Sigma (LSS) project deployment in a regulated industry versus in an unregulated one. Two case studies utilising Lean Six Sigma methods—in order to compare the transfer of manual manufacturing lines within a medical device and electronics manufacturing site—are discussed and utilised. This research aims to show the effects of regulatory procedures on LSS project implementation and timelines. This study particularly highlights how a regulatory environment can be a barrier, or bottleneck, to project management, continuous improvement, and engineering changes in the MedTech or medical device manufacturing industry. The results of this study represent an important first step towards a full understanding of the influence of regulations on operations in medical devices and, by extension, on pharmaceutical manufacturing industries on a global scale. The research limitations are that the data collected were from two specific case study comparisons alone.

Purpose: The current paper aims to discuss the implementation of Green Lean Six Sigma (GLSS) in the food industry to improve sustainable practices. The focus is more specifically on dairy processors to ascertain the current state of the literature and aid future research direction.Design/methodology/approach: Utilising a systematic literature review (SLR), the paper addresses various terms and different written forms in the literature. The study characterises the current deployment of GLSS in the food industry and explains the reported benefits of this approach.Findings: GLSS, a concept that has yet to be fully explored in the food industry, as in other sectors, holds significant potential to enhance the food industry’s sustainability practices. The dairy sector, a subsector of the food industry known for its high greenhouse gas emissions, is a prime candidate for the application of GLSS. In instances where it has been applied, GLSS has demonstrated its effectiveness in improving sustainability, reducing waste, lowering greenhouse gas emissions and minimising water usage. However, the specific tools used and the model for GLSS implementation are areas that require further study, as they have the potential to revolutionise food industry operations and reduce their environmental impacts.Practical implications: Benchmarking of this research by the food industry sector and by academics can aid understanding of the practical application of GLSS tools and aid implementation of these practices to evolve the dairy processing sector in the next decade as sustainability champions in the sector.Originality/value: This study extensively analyses GLSS in the food industry, with a particular focus on dairy processors.