Search Results (40)

Lean Six Sigma (LSS) improvement work increasingly depends on information-intensive activities such as document handling, data interpretation, reporting, and communication, yet current discussions of Artificial Intelligence in LSS remain largely technology-centric. This paper proposes a task-first, process-centric framework to support the governed application of Large Language Model (LLM)-enabled tools in such environments. The study makes three contributions: (i) a set of cross-functional organizational process types relevant to LSS practice, (ii) a functional classification of recurring tasks and LLM-enabled tool categories, and (iii) a dual-encoded task–tool matching matrix that separates alignment strength from interaction mode, distinguishing capability fit from governance logic. The framework is empirically anchored through two real-world industrial applications: customs document processing and shop-floor data digitalization and reporting. The results show that (i) stronger outcomes emerge when LLM-enabled support is matched to bounded, repetitive, and structured work, or when analytical support is built on stable and traceable data layers; (ii) operational value depends not only on technical capability, but on workflow embeddedness, data readiness, and human validation checkpoints. The framework also clarifies where support, augmentation, and partial automation are appropriate for different task classes and under explicit accountability constraints in information-intensive administrative work connected to improvement practice and governance. Full article

In recent years, the food processing industry in the Gulf Cooperation Council (GCC) has faced increasing pressures to improve operational efficiency while improving its environmental performance. This research examines whether Lean Six Sigma (LSS) methodologies can be used as tools to incorporate sustainability into current operational processes at a date processing facility in Saudi Arabia. In addition to illustrating the ways in which production was improved, this research developed and preliminarily validated a Sustainability Integration Index (SII) framework to measure the contributions of improvement projects to sustainable practices in terms of their impact on the environment, society, and economy. Furthermore, this research examined the role of organizational culture as a moderator of the effectiveness of integrated LSS–sustainability approaches using a Cultural Readiness Assessment Model (CRAM). This research addressed production bottlenecks and aligned production with selected United Nation Sustainable Development Goals (SDGs) using the Define–Measure–Analyze–Improve–Control (DMAIC) methodology. Production bottlenecked in packaging operations resulted in schedule overruns and excessive overtime; therefore, the intervention focused on improving the production process in these areas. There were three distinct improvement streams: demand-based resource leveling, advanced production planning to allow for pull-based flow, and targeted maintenance to raise Overall Equipment Effectiveness (OEE) from 48.2% to 74.6%. Results indicated a 23% increase in daily processing capacity, a 38 min decrease in the average length of time of production closures, and estimated annual cost savings of 940,000 SAR (approximately USD 250,000). The SII framework showed a 21.2% improvement in sustainability scores, with a total composite score improvement from 0.66 to 0.80. Social sustainability had the greatest relative increase (+24.2%). Exploratory correlation analysis found that improvements in cultural maturity and cross-functional collaboration are possible predictors of successful sustainability integration; however, the limitations of the single case study limit the ability to draw causal inferences. The results provide both empirical evidence and possible measurement tools to an under-explored area: the use of LSS in Middle Eastern food processing industries with specific sustainability goals. Validation of the frameworks across different industries will be necessary to establish generalizability. Full article

Occupational exposure to sharps waste represents a critical challenge for public health systems, directly affecting healthcare workers’ safety, institutional costs, and environmental sustainability. This study aimed to analyze sharps waste management practices and to structure improvement actions for biosafety governance in Brazilian Emergency Care Units (ECUs) through the application of the Lean Six Sigma (LSS) and DMAIC method (Define, Measure, Analyze, Improve, and Control). A single multiple-case study was conducted across three public units in different regions of Brazil, combining direct observation, regulatory checklists based on ANVISA Resolution No. 222/2018 (RDC), and cause–and–effect (5M) analysis. The diagnostic phase identified recurrent nonconformities in labeling, documentation, and internal transport routes, primarily due to managerial and behavioral gaps. Based on these findings, the DMAIC framework supported the development of a low-cost, evidence-based action plan that outlined proposed interventions, including visual checklists, standardized internal routes, and key performance indicators (KPIs), intended to strengthen biosafety traceability and occupational safety. The se proposed actions are expected to support continuous learning, staff engagement, and a culture of shared responsibility for safe practices. Overall, the study provides a structured basis for future implementation and empirical validation of continuous improvement initiatives, aimed at enhancing public health governance and occupational safety in resource-constrained healthcare environments. Full article

This study implemented a Lean Six Sigma (LSS) methodology to enhance the productivity of the mechanical and industrial engineering technology workshops of an international higher education institution. The efficiency and effectiveness of the engineering workshops were often compromised by poor housekeeping and operational practices, which resulted in incomplete tasks, long operational and activity times, disorganized tools, cluttered workspaces, and a lack of systematic processes for managing materials. These issues led to waste in the form of lost time, unnecessary movement, and safety risks. This eventually affected the overall productivity of the workshops. Following the combination of the Define, Measure, Analyze, Improve, and Control (DMAIC) methodology of Six Sigma with Lean manufacturing, the investigation was conducted in two parts. The first part of this research mainly consisted of measuring the existing state of the three workshops to map the process and frame issues and origins of variations. During the second part of this study, the focus shifted towards Lean thinking while applying the chosen Lean Six Sigma (LSS) tools. Implementation revealed several benefits in the workshops during each phase of DMAIC. A Plan–Do–Check–Act (PDCA) continuous improvement board was installed in the main workshop to promote continuous improvement and sustainability. The process capability increased for the main workshop and welding laboratory, which shows an increase in service and performance standards after LSS implementation. For the main workshop, the process capability ‘Cp’ increased from 0.33 to 1.24 and the process capability index (Cpk) increased from 0.26 to 0.99. The process capability index (Cpk) for the main workshop increased; however, it did not reach the value of 1.33 due to the computer workstation installation not being completed during the study. The welding laboratory showed an increased ‘Cp’ from 0.67 to 2.13, and the process capability index (Cpk) increased from 0.18 to 1.34. The layout of the workshop office was improved to support efficient workflow by providing easy access to frequently used resources while keeping movement paths clear, thereby minimizing interruptions and promoting productivity. As a result, machines and tools were used more productively and operation times decreased. The mechanical workshops can continue increasing their process capability by following the outcomes and findings of the current study, leading to sustainable quality, efficiency, and operational reliability improvements. Full article

Person-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures. Full article

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