Performance and service quality enhancement in a healthcare setting through lean six sigma strategy

A conceptual model for evaluating readiness for lean practices using a fuzzy logic approach: A case study in Bangladeshi healthcare institutes

In the realm of healthcare, an imperative necessity for all, institutions are increasingly recognizing the advantages of adopting lean strategies to enhance performance. Lean implementation in healthcare can lead to significant improvements in efficiency, patient care, and overall institutional performance. This paper aims to assess the readiness levels for implementing lean practices in healthcare institutes in Bangladesh, employing a fuzzy logic approach. The construction of a conceptual model is grounded in literature review and expert opinions, incorporating critical enablers, criteria, and attributes identified from extensive research. Factors measured include leadership commitment, workforce capability, operational processes, technological infrastructure, and organizational culture, each pivotal in determining readiness for lean implementation. The fuzzy logic approach is particularly useful in this context due to its ability to handle uncertainty and imprecision, which are common in complex environments like healthcare. This methodology not only provides a clear picture of current capabilities but also highlights specific areas that need enhancement, paving the way for more targeted and effective lean interventions. Data sourced from consultations with experts in three prominent hospitals in Bangladesh forms the basis of the analysis, enabling a detailed examination of readiness levels. The model's application of fuzzy logic facilitates a comprehensive assessment, revealing 12 critical attributes across the hospitals that require attention. Interestingly, the evaluation identifies varying levels of readiness, with two hospitals demonstrating moderate readiness and one showing a lower level. This conceptual approach has significant potential to assist top management in healthcare companies by providing a structured framework to prioritize crucial areas for improvement. By accurately assessing readiness levels and pinpointing weaker aspects before implementing lean strategies, this study aims to transform the healthcare industry. Ultimately, its implementation has the potential to enhance organizational performance and elevate standards in patient care, contributing to improved healthcare delivery in Bangladesh and beyond.

A balanced approach involving hard and soft factors for internalizing Lean Management and Six Sigma in hospitals

Purpose

This study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.

Design/methodology/approach

A cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.

Findings

A systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.

Research limitations/implications

This study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.

Practical implications

In their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.

Originality/value

This is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors

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.

Strategies for successful deployment and sustainment of Lean Six Sigma in healthcare sector in India: a multi-level perspective

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.