Search Results (35)

Background/Objectives: Clinical laboratories are fundamental to healthcare systems, contributing to over 70% of clinical decisions while accounting for only 2–3% of hospital budgets. Among them, microbiology laboratories provide critical information that directly influences patient outcomes and satisfaction. This study presents a structured review of the current state of Lean Six Sigma (LSS) implementation in microbiology and comparable laboratory environments. The objective is to identify relevant contributions within the state of the art to highlight potential benefits applicable to microbiology laboratories and to detect persistent gaps and unresolved needs. Methods: A systematic literature review was performed across six databases (Web of Science, ScienceDirect, Scopus, ProQuest, PubMed, and Google Scholar) to identify studies published between 2012 and September 2024. After screening, 33 studies were selected for full-text analysis. Results: The selected literature was analyzed to assess the extent to which LSS methodologies have been applied in microbiology laboratories. Particular attention was given to the definition and use of key performance indicators (KPIs). While industry-adapted metrics such as cost reduction and turnaround time are commonly employed, clinical indicators, such as patient impact, satisfaction, and diagnostic accuracy, are underutilized. Additionally, the analysis revealed a frequent omission of the control phase in LSS projects, limiting long-term process monitoring. The review also identifies the most suitable LSS tools and evaluates how laboratories manage interruptions in routine workflows. Conclusions: Future research should prioritize the integration of clinical KPIs into LSS frameworks, establish robust control phases for sustained monitoring, and systematically address the impact of process interruptions on optimization efforts. Full article

Lean Six Sigma (LSS) is recognized as a powerful process improvement methodology for enhancing operational efficiency and long-term sustainability. This study examined the barriers hindering LSS implementation in the chemical process industry within an emerging economy, Brazil. It developed a structured methodology for designing mitigation measures to overcome those barriers. First, 26 barriers from the literature were ranked by LSS experts through a Delphi survey to select the top 15. Then, a combined interpretive structural modeling (ISM) approach and impact matrix cross-reference multiplication applied to a classification (MICMAC) analysis approach was used, supported by a focus group, to determine the hierarchical relationships among the barriers and their driving power and dependence. Finally, a second focus group defined adequate mitigation measures. The top four main barriers are the lack of time, insufficient systemic understanding of lean principles, misalignment between LSS and corporate strategies, and inadequate top management commitment. Additionally, 10 mitigation measures are proposed. This study contributes to LSS implementation in the chemical process industry in Brazil, thus enhancing industry sustainability by improving operational efficiency, curbing waste, reducing transportation-related emissions through a decreasing reliance on imported chemical products, and contributing to economic growth and job creation within the industry. Full article

In pursuit of a comprehensive understanding of Lean Six Sigma (LSS) adoption within Saudi Arabian maintenance companies, this research aimed to evaluate the prevalence of its utilization and gauge the level of comprehension among practitioners. Furthermore, this study sought to pinpoint the Critical Success Factors (CSFs) crucial for the effective implementation of LSS. Employing an electronically disseminated survey, this investigation delved into the realm of LSS, with a specific focus on identifying and assessing these pivotal CSFs. This study encompassed data from 77 participants employed across diverse maintenance organizations in Saudi Arabia, gathered through a digital questionnaire and analyzed utilizing SPSS 22.0. This study used a variety of statistical techniques, such as descriptive statistics, frequency analysis, t-tests, and one-way ANOVA, to investigate the adoption of LSS and identify key success factors. According to the report, 77.9% of Saudi maintenance businesses have yet to implement LSS, with quality improvement serving as the primary reason for those who have. Comprehensive LSS training, effective people selection, increased awareness, and a strong, data-driven approach are all critical aspects in successful LSS deployment. Furthermore, this study emphasized the importance of training, staff selection, and knowledge of the benefits of LSS in influencing the effectiveness of implementation. Finally, this study provided significant insights into the barriers and enablers of LSS adoption, making both theoretical contributions to the academic area and practical recommendations for firms looking to use LSS for continuous improvement. Full article

Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women globally. CRC is considered a priority public health issue due to its incidence and the high associated costs. Surgery is the predominant therapeutic approach for CRC. Given the involvement of the intestinal tract in the surgical process, there is a significant increase in postoperative morbidity rates, and the average length of hospital stay (LOS) tends to lengthen. In this research, we employed the Lean Six Sigma (LSS) methodology, specifically utilizing the DMAIC cycle, to identify and subsequently examine the effects of fast-track surgery on hospitalization times for interventions related to CRC at the AORN “Antonio Cardarelli” Hospital in Naples (Italy). The process analysis, guided by the DMAIC cycle, facilitated a reduction in the median LOS from 14 days to 12 days. The most notable improvement was observed in the 66–75 age group without comorbidities. The LSS approach provides methodological rigor, as previously recognized, enabling substantial enhancements to the process. This involves standardizing outcomes, minimizing variability, and achieving an overall reduction in the LOS from 14 to 12 days. Full article

To survive in highly competitive markets, industries focus on enhancing product quality and customer satisfaction. One specific iteration of this approach sees industries striving to optimize processes to improve product quality while generating minimum waste. This has encouraged companies to begin adopting management practices such as lean six sigma (LSS) and kaizen alongside their implementation of digital technologies of automating processing. This study aims to identify and analyze the barriers to integrating LSS practices with Industry 4.0 technologies for small and medium enterprises. Upon shortlisting fifteen barriers from an exhaustive literature review, the Grey-Decision-Making Trial and Evaluation Laboratory (DEMATEL) methodology is used to analyze those shortlisted barriers and establish causal relations between barriers and outcomes. The findings identify the lack of available infrastructure, lack of training on LSS, and lack of consultants in the field as the most dominant barriers in the cause group. Furthermore, the influence map of barriers produced demonstrates the relationship between cause-and-effect barriers. This study’s findings will ensure that small and medium enterprises formulate business strategies that mitigate the barriers to integrating LSS with Industry 4.0. This study offers insights into overcoming the identified challenges by proposing strategies to enhance product quality and the accuracy of enterprise decision-making, thereby facilitating a successful integration and fostering sustainable growth in SMEs. Full article

Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both emergency and elective surgery. The incidence of the disease related to an increasingly elderly population coupled with the efficacy and safety of LC treatment resulted in an increase in the frequency of interventions without an increase in surgical mortality. For these reasons, managers implement strategies by which to standardize the process of patients undergoing LC. Specifically, the goal is to ensure, in accordance with the guidelines of the Italian Ministry of Health, a reduction in post-operative length of stay (LOS). In this study, a Lean Six Sigma (LSS) methodological approach was implemented to identify and subsequently investigate, through statistical analysis, the effect that corrective actions have had on the post-operative hospitalization for LC interventions performed in a University Hospital. The analysis of the process, which involved a sample of 478 patients, with an approach guided by the Define, Measure, Analyze, Improve, and Control (DMAIC) cycle, made it possible to reduce the post-operative LOS from an average of 6.67 to 4.44 days. The most significant reduction was obtained for the 60–69 age group, for whom the probability of using LC is higher than for younger people. The LSS offers a methodological rigor that has allowed us, as already known, to make significant improvements to the process, standardizing the result by limiting the variability and obtaining a total reduction of post-operative LOS of 67%. Full article

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. Full article

Background: Antimicrobial resistance (AMR) is one of the key challenges in healthcare, and effective antimicrobial stewardship programs (ASPs) can play a vital role to control it. The aim of the current study was to assess the impact of the Lean Six Sigma (LSS) methodology on a hospital-wide ASP. Methods: This retrospective descriptive study was conducted at Mediclinic Welcare Hospital (MWEL), Dubai, the United Arab Emirates (UAE). The critical-to-quality (CTQs) data were collected pre/post interventions, including leadership support, guideline implementation, and audits. The study focused on inpatients who received antimicrobials from January 2021 to July 2022, analyzing ASP metrics (utilization, processes, and outcome measures). Results: The ASP improvements led to an 81.7% decrease in hospital’s parenteral antimicrobial expenses from January 2021 to July 2022, and a 54.2% reduction in antimicrobial usage while maintaining clinical outcomes. The average defined daily dose per 100 bed-days drop of 12.5% further demonstrated this positive trend. The intervention was not accompanied by higher nosocomial infection rates, longer stays, or mortality. Additionally, intervention led to better compliance with surgical prophylaxis bundles, antimicrobial protocols, hand hygiene and other ASP CTQ metrics. Conclusions and recommendations: This study emphasized the significance of implementing the LSS methodology in addressing process variations, enhancing ASP outcomes, and reducing antimicrobial use. These findings can inform health policymakers to improve future ASP outcomes. Additionally, sustainability through continuous monitoring and ongoing education initiatives should be considered to ensure the long-term success of these improvements. Full article

Since 2020, the Catania-Messina-Enna Cancer Registry (CR) has operated a transformational and incremental program while also applying a Lean Six Sigma methodology (LSS) to optimize the processes and reduce waste. Each project aimed to raise the performance of the CR while also providing the opportunity for human resources to express their talent. In this context, a machine learning project was developed to reduce the time spent on raw free-text histopathological reports that contain relevant information for cancer evaluation. The ability to extract meaningful information from histopathology reports is really important because reports provide crucial insights into the morphology and topography of cancer, enabling operators to validate oncology cases with the utmost diagnostic precision. However, the CR faced a significant challenge due to the extensive volume of written natural language reports, where only a small fraction contains pertinent information for cancer evaluation. In this paper, we describe how we applied the LSS method, the observed difficulties, and the benefits achieved by adopting a machine learning algorithm as a strategic solution in the Improve phase. Full article

In recent years, the application of Lean models in manufacturing processes has received significant attention due to the successful implementation of relatively simple measures to eliminate or reduce waste. Similarly, Six Sigma has attracted the interest of the industry for reducing production costs through statistical methods and data analysis tools. The combination of both techniques constitutes a powerful management model known as Lean Six Sigma (LSS), whose application has been unevenly spread across the different services and industrial sectors. Despite the multiple studies conducted on the use of LSS methodologies in manufacturing processes, few studies have focused on its direct application in chemical manufacturing are less numerous. Consequently, many chemical companies still face major challenges in implementing the LSS model. This study explores the state of the art, current trends, and perspectives of Lean and Six Sigma integration in the chemical manufacturing sector. For this purpose, a bibliometric analysis was conducted covering topics from the implementation of the LSS on a global scale, i.e., non-manufacturing and manufacturing environments, to its application in the manufacturing of chemical products. The literature search was carried out in the Scopus and Web of Science databases using a different sequence of terms. The findings of this study revealed the most important contributions in terms of publications, authors, countries, and institutions over the past two decades. Additionally, avenues for future research are discussed. Full article

The research aims to prioritize the solutions to overcome the challenges of Lean Six Sigma 4.0 (LSS 4.0). It is an integrated approach with lean, six sigma, and Industry 4.0 attributes. This integrated approach helps to achieve organizational excellence and sustainable development goals. Fuzzy stepwise weight assessment ratio analysis (fuzzy-SWARA) was used to estimate the weights of LSS 4.0 challenges. Furthermore, fuzzy-weighted aggregated sum product assessment (fuzzy-WASPAS) was used to prioritize the LSS 4.0 solutions. In this study, 23 challenges and 23 solutions of LSS 4.0 implementation were identified with the help of an extensive literature review and discussion with the area experts having vast experience. Management participation in LSS 4.0 implementation and planning for long-term vision were found to be the topmost solutions to overcome LSS 4.0 challenges. To the best of our knowledge, to date, the prioritization of solutions to overcome the challenges of LSS 4.0 have not yet been investigated in the developing economic context. Full article

Modern manufacturing operations always aim toward sustainable production through sustainable operations. Lean Six Sigma manufacturing is one of the leading models to increase operational efficiency and productivity and reduce product manufacturing costs. The lean Six Sigma problem-solving methodology DMAIC has been one of the several techniques organizations use to improve their productivity and the quality of their product and services. This paper aims to apply Lean Six Sigma and DMAIC to enhance production capacity and reduce per-unit cost. Furthermore, this research work has been carried out to analyze the impact of stakeholders on Lean Six Sigma projects. The research follows the DMAIC methodology to investigate and analyze the root cause of the problems and give possible solutions for eliminating or reducing the issues. Particularly, fishbone and 5-Whys techniques were used to determine whether the two key processes, AC Outdoor unit testing with the help of reusable power cords and the un-efficient use of expanding machine, had an impact on low productivity and high per-unit cost. The analysis indicated the importance of stakeholders in lean Six Sigma projects. It has been found that key stakeholders can affect the result of lean Six Sigma projects, e.g., in the power cord modification project, a total of USD 7738 has been lost, while in expanding machine modification project total of USD 1339 has been lost due to ignorance of key stakeholders in both projects. This paper provides practical guidance to lean Six Sigma project team leaders to develop and define the key stakeholders at the beginning of the project and clearly identify the stakeholders’ responsibilities. Furthermore, the project leader must analyze and identify internal and external stakeholders b/c stakeholders may be internal or external. This paper provides theoretical guidance to lean Six Sigma project team leaders since ignoring stakeholders could give a misleading picture in terms of project cost, savings, and duration of the project. The project leader must consider key stakeholders’ costs and future strategies before starting the project. Although some project managers and experts have conducted analyses of stakeholders’ impact on projects, lean Six Sigma literature lacks solid examples of stakeholders’ impact on LSS project results. This study tries to address this research gap by analyzing the impact of key stakeholders on LSS projects. Full article

In recent years, Industry 4.0 (I4.0) has been a recurrent theme in the literature on Lean Six Sigma (LSS), given the synergies that can arise from their combination. However, their joint implementation presents several challenges. In this article, a systematic literature review (SLR) of research on I4.0 and LSS integration was performed. This review involved five database platforms and included seventy-four articles providing state-of-the-art knowledge on the topic, focusing on the barriers to and enablers of integration. As a result, 20 integration barriers were identified, highlighting the high implementation cost, long learning curve, and technology incompatibility as the main barriers. Seventeen enablers were found to facilitate and guarantee implementation success, highlighting investment in IT infrastructure and employee training, stakeholder involvement, and top management support. In addition, the article discusses actions to facilitate I4.0 and LSS integration in practice, determined by connecting the identified enablers to their corresponding barriers. Finally, the SLR identifies several avenues for future research. Full article

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. Full article