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India liberalized its economy in 1991, which resulted in intense global competition, quality-conscious and demanding customers. Additionally, significant technological advancements lead to enhancements in products and processes. These forced Indian organizations to adopt innovative business strategies in the past 30 years. Meanwhile, the Lean Six Sigma methodology has significantly grown with vast applicability during the past 30 years. Thus, the purpose of this study is to develop the learning on Lean Six Sigma methodology in the Indian context through investigation of literature.

A three-stage systematic literature review approach was adopted to investigate the literature during the present study. In total, 187 articles published in 62 journals/conference proceedings from 2005 to 2022 (18 years) were shortlisted. The first part of the article summarizes the significant milestones towards the quality journey in the Indian context, along with the evolution of the Lean Six Sigma methodology. The second part examines the shortlisted papers on Lean Six Sigma frameworks, their applicability in industrial sectors, performance metrics, outcomes realized, publication trends, authorship patterns and leading researchers from the Indian perspective.

Lean Six Sigma has emerged as a highly acclaimed and structured business improvement strategy worldwide. The Indian economy has seen remarkable growth in the past decade and is one of the fastest-growing economies in the 21st century. Lean Six Sigma implementation in India has significantly increased from 2014 onward. The study revealed that researchers have proposed several different frameworks for Lean Six Sigma implementation, the majority of which are conceptual. Furthermore, the balanced applicability of Lean Six Sigma in manufacturing and service sectors was observed with the highest implementation in the health-care sector. Additionally, the widely adopted tools, techniques along with performance metrics exploring case studies were reported along with a summary of eminent and leading researchers in the Indian context.

This study is confined to reviewed papers as per the research criteria with a significant focus on the Indian context and might have missed some papers due to the adopted papers selection strategy.

The present study is one of the initial attempts to investigate the literature published on Lean Six Sigma in the Indian context, including perspective on the Indian quality movement. Therefore, the present study will provide an understanding of Lean Six Sigma methodology in the Indian context to graduating students in engineering and management and entry-level executives. The analysis and findings on Lean Six Sigma frameworks, research approach, publications details, etc., will be helpful to potential research scholars and academia. Additionally, analysis of case studies on Lean Six Sigma implementation by Indian industries will assist the managers and professionals in decision making.

This paper aims to identify leadership behaviours in the manufacturing sector in Jordan that enable successful Lean Six Sigma implementation.

Qualitative data were collected through 27 interviews to identify the leadership behaviours that facilitate Lean Six Sigma and a focus group to categorise the aspects by grouping them into themes. A grounded theory approach was used in the field study. The processes of constant comparisons helped in identifying the relevant aspects of leadership behaviours and integrating specific aspects into themes; these processes were iteratives. Therefore, this research project relies on the grounded theory methodology to collect and analyse the data. The authors also used a focus group to categorise the aspects by grouping them into themes. In that, the aspects were grouped around core categories.

After analysing the data, 36 aspects have emerged. The data analysis processes helped in discovering the aspects of leadership that support the use of Lean Six Sigma in the manufacturing sector in Jordan. The aspects were developed through an iterative process of analysis until the saturation level was reached. Eight themes that influence the successful use of Lean Six Sigma emerged: Training and development; Continuous improvement and development; Communication; Empowering employees; Motivating employees; Managing qualities and operations; Employees engagement and involvement; and Supporting culture

There are some research limitations to this study, which opens avenues for future research. First, the data was collected through qualitative methods, which limits the generalizability of the results. Future studies are needed to generalize the results to the wider business community. Second, the data was collected only from manufacturing organizations and did not consider other sectors. Future researchers are urged to replicate the study in other sectors. Third, this study considered only Jordanian firms; therefore, the authors call upon further research to investigate other national settings that may have a different business culture.

This study encourages businesses to follow and adopt these behaviours in organisations, which can help in developing desirable behaviours among leaders to reach advanced levels in using Lean Six Sigma. Moreover, practitioners can develop training programmes for developing leaders. Thus, the Lean Six Sigma journey can become smoother by addressing the issues that face practitioners during the different phases of implementing Lean Six Sigma. In that respect, the practical implication of this research is to describe the practices that the leadership of organisations must develop to maintain high levels of Lean Six Sigma deployment.

Scholarly studies in this field are scarce, especially in developing countries, so identifying the leadership behaviours can help researchers create a theory of leadership behaviours for Lean Six Sigma. Furthermore, practitioners of Lean Six Sigma can take into account these behaviours as crucial to the effective use of Lean Six Sigma. They can encourage leaders to follow and adopt these behaviours in organisations which can help in developing desirable behaviours among leaders to reach advanced levels in using Lean Six Sigma. Thus, the Lean Six Sigma journey can become smoother by addressing the issues that practitioners face during the different phases of implementing Lean Six Sigma.

This study aims to fully assess the readiness for Lean Six Sigma (LSS) and Quality Performance Improvement (QPI) in an Italian Public Healthcare ecosystem.

Drawing from previously established survey development and adaptation protocols, a replication study was carried out; Lean, Six Sigma and QPI were extracted and validated through confirmatory factor analysis in an Italian Public Healthcare setting, with a sample of health professionals from the Campania region.

This study reports the adaptation of an existing scale for measuring LSS and QPI in an Italian public healthcare organisation. This analysis extracts six conceptual domains and constitutes an original adaptation of an existing scale to assess the readiness to adopt Lean, Six Sigma and Quality Performance in Italian Public Health Organizations. The constructs show strong levels of internal consistency, as demonstrated by each item factor loading and each subscale reliability.

Managers, policymakers and academics can employ the proposed tool to assess the public healthcare ecosystem’s capability to implement LSS initiatives and strategies to improve quality performance.

This is one of the first studies to assess cross-regional organisational readiness for LSS and QPI in an Italian Public Healthcare environment at this scope and level.

The purpose of this paper is to present a case study the application of lean six sigma combined with mining transportation overall vehicle effectiveness (MTOVE) to improve mining transportation performance. MTOVE is a newly developed model to measure the overall effectiveness of mining transportation.

The method used is case study combines the MTOVE and LSS methodologies. Data were collected from the hauling operation during a three-month period. Various lean six-sigma tools, such as the Pareto chart, ANOVA, two sample t-tests, one sample t-test, cause-and-effect analysis and time study, have been used.

The case study resulted in improvement of vehicle overall effectiveness; a 35% increase in MTOVE value, a 17% improvement in productivity and a 9% increment in truck utilization. Statistical tests confirmed the significance of reducing the mean and variation in the hauling process cycle time, which led to productivity improvement.

This study provides practitioners with additional quantitative evidence of the potential benefits of LSS methods in the coal mining industry.

This paper practically and unquestionably has contributed to the LSS body of knowledge focused on the mining sector, which is recently still far behind the manufacturing sector. The study has demonstrated that some challenges in the mining environment can be solved through the effective implementation of LSS tools. Hence, this paper could be used as a reference for both researchers and practitioners.

The study contributes in the field of LSS spread in mining industries using a case study. This study shows practical evidence of improving overall vehicle effectiveness using LSS. Practitioners can refer to this study to understand the benefits of LSS in mining sector. Since the mining industry should also adopt the LSS principle into the mining business process due to its ability to improve business performance (Valente et al., 2020; Tupamahu et al., 2019; Zanon et al., 2021).

There has been little scientific study of the LSS implementation in the mining industry. This research provides detailed evidence of LSS implementation in the mining sector. The main contribution is the implementation framework, which shows the combination of newly developed indicators (MTOVE and LSS) to enhance hauling operation effectiveness. This paper demonstrates how LSS tools and methods can be applied in the mining transportation industry.

This paper aims to highlight how the six sigma methods helped the medical equipment manufacturing company in finding and analysing the root causes that lead to the reduction in production rate, rejection rates, quality and other major causes that lead to the reduction in productivity of the blood bags manufacturing unit.

Given the critical nature of blood bag manufacturing Six Sigma was chosen as the primary methodology for this research since Six Sigma’s data-driven approach provides a structured framework to identify, analyse and rectify inefficiencies in the production processes. This study proposes the Six Sigma DMAIC (D-Define, M-Measure, A-Analyse, I-Improve, C-Control) encompassing rigorous problem definition, precise measurement, thorough analysis, improvement and vigilant control mechanisms for effectively attaining predetermined objectives.

The paper demonstrates how the Six Sigma principles were executed in a blood bag manufacturing unit. After a detailed and thorough data analysis, it was found that a total of 40 critical-to-quality factors under the five drivers such as Machine, Components, Inspection and Testing, People and Workspace were influential factors affecting the manufacturing of blood bags. From the study, it is identified that the drivers such as inspection and testing, components and machines contribute significantly to increasing productivity.

The paper offers valuable strategic insights into implementing Six Sigma methodologies within the specific context of a blood bag manufacturing unit. The Six Sigma tools and techniques used by the project team to solve issues within the blood bag manufacturing unit can be used for similar healthcare organizations to successfully deploy Six Sigma. The insights from this research might not be directly applicable to other manufacturing facilities or industries but can be used as a guiding reference for researchers and managers.

The current state of scholarly literature indicates a significant absence in the examination of Six Sigma methodologies designed specifically to improve production output in healthcare equipment manufacturing. This paper highlights the application of Six Sigma principles to enhance efficiency in the specific context of blood bag manufacturing.

Healthcare organizations have been facing challenges due to high costs and low efficiency in health services. The growth of costs and losses caused by avoidable mistakes lead to the search for solutions, and Health Lean Management appears as a potential solution to help in solving service quality problems, as well as reducing risks. This study aims to analyse the state of the art in the literature centred on the Lean approach in the context of risk management in healthcare organizations, and to identify new research opportunities, highlighting possible lines of future research.

Following a systematic literature review approach, 51 papers were considered relevant for this research, and reviewed to explore the development of literature in this area.

Based on the results, five main research streams were identified: (1) risk management oriented towards patient safety; (2) risk management oriented towards employee safety; (3) importance of attitudes and behaviours in risk reduction projects; (4) Lean tools used in healthcare risk management and (5) Integration of approaches. Moreover, several shortcomings were identified in literature.

Identified shortcomings represent significant opportunities for further research development.

Workflow optimisation is crucial for establishing a viable acute stroke (AS) intervention programme in a large tertiary care centre. This study aims to utilise Lean Six Sigma (LSS) principles to enhance the hospital's workflow.

The Action Research methodology was used to implement the project and develop the case study. The study took place in a large tertiary care academic hospital in India. The Define-Measure-Analyse-Improve-Control approach optimised the workflow within 6 months. Lean tools such as value stream mapping (VSM), waste audits and Gemba were utilised to identify issues involving various stakeholders in the workflow. Sigma-level calculations were used to compare baseline, improvement and sustainment status. Additionally, statistical techniques were effectively employed to draw meaningful inferences.

LSS tools and techniques can be effectively utilised in large tertiary care hospitals to optimise workflow through a structured approach. Sigma ratings of the processes showed substantial improvement, resulting in a five-fold increase in clinical outcomes. Specifically, there was a 43% improvement in outcome for patients who underwent acute stroke revascularisation. However, certain sigma ratings deteriorated during the control and extended control (sustainment) phases. This indicates that ensuring the sustainability of quality control interventions in healthcare is challenging and requires continuous auditing.

The article presents a single case study deployed in a hospital in India. Thus, the generalisation of outcomes has a significant limitation. Also, the study encounters the challenge of not having a parallel control group, which is a common limitation in quality improvement studies in healthcare. Many studies in healthcare quality improvement, including this one, are limited by minimal data on long-term follow-up and the sustainability of achieved results.

This study pioneers the integration of LSS methodologies in a large Indian tertiary care hospital, specifically targeting AS intervention. It represents the first LSS case study applied in the stroke department of any hospital in India. Whilst most case studies discuss only the positive aspects, this article fills a critical gap by unearthing the challenges of applying LSS in a complex healthcare setting, offering insights into sustainable quality improvement and operational efficiency. This case study contributes to the theoretical understanding of LSS in healthcare. It showcases its real-world impact on patient outcomes and process optimisation.

Health-care organisations face many challenges in delivering safe, high-quality services while experiencing significant pressure to increase productivity and reduce costs. In this context, hospitals have implemented lean six sigma (LSS) programmes to improve their performance. This study aims to explore the application of LSS in three different non-profit Ecuadorian hospitals to comprehend the effectiveness of the methodology under this context.

A multiple-case analysis was performed in four phases: selecting the cases, defining a data collection protocol, performing a within-case analysis of each case and performing a cross-case analysis.

This research found that the LSS application positively impacts hospital performance indicators by reducing service time. The most frequently used tools include the supplier input process output customer diagram, value stream mapping, cause-and-effect diagram, five-why analysis, Gemba walk and paired two-sample test. Lastly, the results show that the most common challenges faced were lack of top management engagement, technical training and data availability.

The study is limited by the constraint of a single Latin American country from which the cases were analysed. Collaboration with external partners, like universities, and government policies promoting training in continuous improvement methodologies are crucial for success. Academic implications stress the importance of integrating soft skills in LSS implementation and engineering education.

This study shows a multiple-case analysis of LSS in a Latin American country highlighting the most commonly used tools, their impact on performance and the challenges of implementing LSS in health-care organisations in non-profit Ecuadorian hospitals.

This study aims to address challenges related to long lead time within a hazelnut company, primarily attributed to product quality issues. The purpose is to propose an integrated lean-based methodology incorporating a continuous improvement cycle, drawing on Lean Six Sigma (LSS) and Industry 4.0 applications.

The research adopts a systematic approach, commencing with a current state analysis using VSM and fishbone analysis to identify underlying problems causing long lead time. A Pareto analysis categorizes these problems, distinguishing between supplier-related issues and deficiencies in lean applications. Lean tools are initially implemented, followed by a future state VSM. Supplier-related issues are then addressed, employing root cause analyses and Industry 4.0-based countermeasures, including a proposed supplier selection model.

The study reveals that, despite initial lean implementations, lead times remain high. Addressing supplier-related issues, particularly through the proposed supplier selection model, significantly reduces the number of suppliers and contributes to lead time reduction. Industry 4.0-based countermeasures ensure traceability and strengthen supplier relationships.

This research introduces a comprehensive LSS methodology, practically demonstrating the application of various tools and providing managerial insights for practitioners and policymakers. The study contributes theoretically by addressing challenges comprehensively, practically by showcasing tool applications and managerially by offering guidance for system performance enhancement.

India’s manufacturing sector employs about 12% of the labour force and contributes to about 17% of the nation’s GDP. The Indian government intends to implement several initiatives under the “Make in India” and Atma Nirbhar Bharat banners to increase the manufacturing sector’s share of the nation’s GDP to 25% by 2025. Applying lean manufacturing, green manufacturing and Six Sigma is crucial to ensure that India’s manufacturing sectors grow sustainably in international markets. This study aims to identify sustainability indicators and ascertain their respective weights to evaluate the sustainability performance of the Indian manufacturing industry.

This research identifies 25 sustainability indicators and classifies them into the triple bottom line of sustainability based on an evaluative literature review and expert opinion. The Best Worst Method was utilised to determine the weights of the sustainability indicators. The sustainability index was developed to evaluate economic, social and environmental sustainability.

The sustainability performance of a foundry in a significant Western Indian State city was assessed by applying the developed sustainability index. After the adoption of integrated lean, green and Six Sigma (LG&SS) strategies and related practices in the foundry, there has been a notable improvement of 68.03% in the economic index, 61.62% in the social index and 13.24% in the environmental index.

The proposed sustainability index is applied and evaluated specifically for assessing the sustainability performance of Indian manufacturing SMEs. It can be used to substantiate firm’s sustainability performance and also to assess the improvement in firm’s performance in economic, environmental and social dimensions after implementing various operational excellence practices. However, it cannot serve as a benchmark tool across similar companies or organisations.

The developed sustainable index can be used to analyse the company or organisation’s sustainability performance and see how various strategies have improved things. Practitioners can use this index to assess social, economic and environmental performance and focus on areas that need improvement.

The proposed sustainability index serves as a vital tool for monitoring a firm’s progress in triple bottom line (TBL) dimensions of sustainability, tracking a diverse range of indicators and encouraging sustainable organisational practices.

This study attempts to assess the economic, social and environmental performance of Indian Manufacturing SMEs by proposing a sustainability index.