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The present environmental concern has enforced manufacturing firms to re-evaluate their business practices to reduce the adverse impact on the environment with optimum production. Therefore, the present study aims to deal with the implementation of the environmental lean six sigma (ELSS) framework in an Indian medical equipment manufacturing industry to obtain operational and environmental sustainability.

The proposed ELSS framework is based on the DMAIC (Define–Measure–Analyze–Improve–Control) methodology, sustainability and lean tools. The efficacy of the developed framework is tested through a case study in an Indian medical equipment manufacturing unit.

In the case company, four major issues were reported, i.e. improper material handling, non-productive movement of men and material, poor indoor air quality and rework. The ELSS project facilitates the case organization to enhance their capacity utilization from 59.25% to 74.3%, defects per million opportunities reduce from 309,523 to 48,951.44 and indoor air quality levels decrease from 156.87 to 86.85 µgm3.

The efficacy of the developed ELSS framework is evaluated through a case study conducted only in one Indian manufacturing environment.

The present study facilitates industrial managers and practitioners to achieve sustainability and process excellence through ELSS implementation. Organizations that intend to simultaneously improve operational and environmental performance can benefit from this paper as it can be used as a guide to conduct similar projects with both operational and environmental benefits.

This paper presents a successful implementation of the ELSS framework in the healthcare industry to achieve operational and environmental sustainability.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

Existing conceptual, empirical and case studies evidence suggests that manufacturing industries find the joint implementation of Kaizen philosophy initiatives. However, the existing practices rarely demonstrated in a single framework and implementation procedure in a structure nature. This paper, therefore, aims to develop, validate and practically test a framework and implementation procedure for the implementation of integrated Kaizen in manufacturing industries to attain long-term improvement of operational, innovation, business (financial and marketing) processes, performance and competitiveness.

The study primarily described the problem, extensively reviewed the current state-of-the-art literature and then identified a gap. Based on it, generic and comprehensive integrated framework and implementation procedure is developed. Besides, the study used managers, consultants and academics from various fields to validate a framework and implementation procedure for addressing business concerns. In this case, the primary data was collected through self-administered questionnaire, and 244 valid questionnaires were received and were analyzed. Furthermore, the research verified the practicability of the framework by empirically exploring the current scenario of selected manufacturing companies.

The research discovered innovative framework and six-phase implementation procedure to fill the existing conceptual gap. Furthermore, the survey-based and exploratory empirical analysis of the research demonstrated that the practice of the proposed framework based on structured procedure is valued and companies attain the middling improvements of productivity, delivery time, quality, 5S practice, waste and accident rate by 61.03, 44, 52.53, 95.19, 80.12, and 70.55% respectively. Additionally, the companies saved a total of 14933446 ETH Birr and 5,658 M² free spaces. Even though, the practices and improvements vary from company to company, and even companies unable to practice some of the unique techniques of the identified CI initiatives considered in the proposed framework.

All data collected in the survey came from professionals working for Ethiopian manufacturing companies, universities and government. It is important to highlight that n = 244 is high sample size, which is adequate for a preliminary survey but reinforcing still needs further survey in terms of generalization of the results since there are hundreds of manufacturing companies, consultants and academicians implementing and consulting Kaizen. Therefore, a further study on a wider Ethiopian manufacturing companies, consultants and academic scale would be informative.

This work is very important for Kaizen professionals in the manufacturing industry, academic and government but in particular for senior management and leadership teams. Aside from the main findings on framework development, there is some strong evidence that practice of Kaizen resulted in achieving quantitative (monetary and non-monetary) and qualitative results. Thus, senior management teams should use this research out to practice and analyze the effect of Kaizen on their own organizations. Within the academic community, this study is one of the first focusing on development, validating and practically testing and should aid further study, research and understanding of Kaizen in manufacturing industries.

So far, it is rare to find preceding studies proposed, validated and practically test an integrated Kaizen framework with the context of manufacturing industries. Thus, authors understand that this is the very first research focused on the development of the framework for manufacturing industries continuously to be competitive and could help managers, institutions, practitioners and academicians in Kaizen practice.

Generic quality management system standard ISO 9001 and the automotive quality management system standard IATF 16949 both require organisations to demonstrate continual improvement in their customer satisfaction and the number of non-conformities identified during quality system audits. However, the long-term trends of these two parameters under ISO 9001 and IATF 16949 standards are not researched so far. It is expected that under continual improvement, organisations will achieve a step-function/stair-case shaped pattern. This study evaluates if this expectation is true when long-term performance of certified organisations is assessed.

A longitudinal exploration of three organisations certified to ISO 9001 standard and three certified to IATF 16949 standard is done. The observations are further substantiated using secondary data for the same ten years period about customer satisfaction of the major automobile manufacturers.

It is observed that none of the two indicators, i.e. the customer satisfaction and number of non-conformities, in any of the six organisations show step-wise/stair-case type improvement. All indicators followed random up and down patterns like ocean waves. It is paradoxical that certified organisations are claiming continual improvement and are remaining certified but there is actually no long-term improvement.

Longitudinal studies for the generic quality management standard ISO 9001 and the quality system standard for automotive sector IATF 16949 are rare. The revelation about ocean wave patterns observed in the long-term trends for customer satisfaction and the number of non-conformities in ISO 9001 and IATF 16949 certified organisations is a startling finding. It is outlandishly different from the conventional perception of a staircase-styled continual improvement pattern expected a priori in certified organisations.

Numerous attempts at installing six sigma (SS) have faced challenges and fallen short of the desired success. Thus, it becomes vital to identify the critical factors and characteristics that play a pivotal role in achieving successful adoption. In this study the research has aimed to highlight that a considerable number of corporate SS initiatives, around 60%, fail primarily due to the improper incorporation of essential elements and flawed assumptions.

To validate the influence of critical success factors (CSFs) on SS accomplishment, the study employed a research design combining exploratory and mixed-methods approaches. A Likert-scale questionnaire was utilized, and a simple random sampling method was employed to gather data. Out of the 2,325 potential participants approached, 573 responses were received, primarily from Germany, the United Kingdom and Sweden. The analysis focused on 260 completed questionnaires and statistical methods including structural equation modeling (SEM), exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) were utilized for data analysis.

The study acknowledged four essential components of CSFs that are imperative for sustaining the success of SS: (1) Competence of belt System employees; (2) Project management skills; (3) Organizational economic capability and (4) Leadership commitment and engagement. These factors were identified as significant contributors to the maintenance of SS’s success.

The practical implications of this research imply that institutions, practitioners, and researchers can utilize the four identified factors to foster the sustainable deployment of SS initiatives. By incorporating these factors, organizations can enhance the effectiveness and longevity of their SS practices.

The investigation's originality lies in its contribution to assessing CSFs in SS deployment within the European automobile industry, utilizing a mixed-methods research design supplemented by descriptive statistics.

The purpose of this article is to study the link between mean shift and inflation coefficient when the underlying null hypothesis is rejected in the analysis of variance (ANOVA) application after the preliminary test on the model specification.

A new approach is proposed to study the link between mean shift and inflation coefficient when the underlying null hypothesis is rejected in the ANOVA application. First, we determine this relationship from the general perspective of Six Sigma methodology under the normality assumption. Then, the approach is extended to a balanced two-stage nested design with a random effects model in which a preliminary test is used to fix the main test statistic.

The features of mean-shifted and inflated (but centred) processes with the same specification limits from the perspective of Six Sigma are studied. The shift and inflation coefficients are derived for the two-stage balanced ANOVA model. We obtained good predictions for the process shift, given the inflation coefficient, which has been demonstrated using numerical results and applied to case studies. It is understood that the proposed method may be used as a tool to obtain an efficient variance estimator under mean shift.

In this work, as a new research approach, we studied the link between mean shift and inflation coefficients when the underlying null hypothesis is rejected in the ANOVA. Derivations for these coefficients are presented. The results when the null hypothesis is accepted are also studied. This needs the help of preliminary tests to decide on the model assumptions, and hence the researchers are expected to be familiar with the application of preliminary tests.

After studying the proposed approach with extensive numerical results, we have provided two practical examples that demonstrate the significance of the approach for real-time practitioners. The practitioners are expected to take additional care before deciding on the model assumptions by applying preliminary tests.

The proposed approach is original in the sense that there have been no similar approaches existing in the literature that combine Six Sigma and preliminary tests in ANOVA applications.

With the growing need for employees to be innovative, public-sector organizations are investing in employee training. This study aims to examine the effects of a combined Lean Six Sigma and innovation training, using action learning, on public-sector employees’ creative role identity and innovative work behavior.

The authors studied a public service agency in Singapore in which a five-day Lean Innovation Training was implemented, using a combination of Lean Six Sigma and Creative Problem-Solving tools, with a simulation on day one and subsequent team-based project coaching, spread over six months. The authors administered pre- and postintervention surveys among all the employees, and initiated group interviews and observations before, during and after the intervention.

Creative role identity and innovative work behavior had significantly improved six months after the intervention, enabled through senior management’s transformational leadership. The training induced managers to role-model innovative work behaviors while cocreating, with their employees, a renewal of their agency’s core processes. The three completed improvement projects contributed to an innovative work culture and reduced service turnaround time.

Starting with a role-playing simulation on the first day, during which leaders and followers swapped roles, the action-learning type training taught all the organizational members to use various Lean Six Sigma and Creative Problem-Solving tools. This nimble Lean Innovation Training, and subsequent team-based project coaching, exemplifies how advancing the staff’s creative role identity can have a positive impact.

Managing project completion within the stipulated time is significant to all firms' sustainability. Especially for software start-up firms, it is of utmost importance. For any schedule variation, these firms must spend 25 to 40 percent of the development cost reworking quality defects. Significantly, the existing literature does not support defect rework opportunities under quality aspects among Indian IT start-ups. The present study aims to fill this niche by proposing a unique mathematical model of the defect rework aligned with the Six Sigma quality approach.

An optimization model was formulated, comprising the two objectives: rework “time” and rework “cost.” A case study was developed in relevance, and for the model solution, we used MATLAB and an elitist, Nondominated Sorting Genetic Algorithm (NSGA-II).

The output of the proposed approach reduced the “time” by 31 percent at a minimum “cost”. The derived “Pareto Optimal” front can be used to estimate the “cost” for a pre-determined rework “time” and vice versa, thus adding value to the existing literature.

This work has deployed a decision tree for defect prediction, but it is often criticized for overfitting. This is one of the limitations of this paper. Apart from this, comparing the predicted defect count with other prediction models hasn’t been attempted. NSGA-II has been applied to solve the optimization problem; however, the optimal results obtained have yet to be compared with other algorithms. Further study is envisaged.

The Pareto front provides an effective visual aid for managers to compare multiple strategies to decide the best possible rework “cost” and “time” for their projects. It is beneficial for cost-sensitive start-ups to estimate the rework “cost” and “time” to negotiate with their customers effectively.

This paper proposes a novel quality management framework under the Six Sigma approach, which integrates optimization of critical metrics. As part of this study, a unique mathematical model of the software defect rework process was developed (combined with the proposed framework) to obtain the optimal solution for the perennial problem of schedule slippage in the rework process of software development.

The purposes of this paper are (1) to identify and rank the various enablers for an integrated sustainable-green-lean-six sigma-agile manufacturing system (ISGLSAMS), and (2) to study their correlations and their impact on organizational performance.

Three tiers methodology is used to analyze the enablers for the successful adoption of ISGLSAMS. First, a total of 32 ISGLSAMS enablers are identified through a comprehensive literature review. Then, data are collected with a structured questionnaire from 108 Indian manufacturing industries. Then, an analytic approach is used to analyze (1) the relevance and significance of enablers and (2) their correlations (1) with each other, and (2) with the organizational performance outcomes, to strengthen the understanding of ISGLSAMS.

The findings suggest that top management commitment, sustainable reconfigurable manufacturing system, organization resources for 6 Rs, customers' and stakeholders' involvement, corporate social responsibility (CSR), customers and stakeholders-focused strategic alliances, dynamic manufacturing strategies, use of information and communication technology, concurrent engineering, standardized tasks for continuous improvement, virtual network of supply chain partners, real-time monitoring and control, training and education, employees' involvement and empowerment enablers are the higher level enablers for the adoption of ISGLSAMS. Findings also suggest that there is a scope for research in the incorporation of lot size reduction, Keiretsu-Kraljic supply chain relationship strategy, external collaborations with the stakeholders other than supply chain members, matrix flatter organization structure, employees' career development, justified employees' wages, government support for research fund and subsidies and vendor-managed inventory practices for ISGLSAMS. Top management commitment, sustainable reconfigurable manufacturing system, organization resources for 6 Rs, corporate social responsibility (CSR), dynamic manufacturing strategies, use of information and communication technology, concurrent engineering, virtual network of supply chain partners, real-time monitoring and control, training and education, employees' involvement and empowerment have a significant effect on (1) sustainable product design, (2) sustainable production system, (3) improvement in the sale, (4) improvement in market responsiveness, (5) improvement in the competitive position and (6) improvement in the global market image.

Through this study of ISGLSAMS enablers and their interdependence, and their impact on ISGLSAMS performance outcomes government, organizations, stakeholders, policymakers and supply chain partners may plan the policy, roadmap and strategies for the successful adoption of (1) ISGLSAMS in the organizational value chain, and (2) Industrial ecology and industrial symbiosis in India. The study also contributes to the industrial managers, and value chain partners a better understanding of ISGLSAMS.

This study is the first attempt to understand (1) the ISGLSAMS enablers and their correlations, and (2) the effect of ISGLSAMS enablers on ISGLSAMS performance outcomes to get the competitive and sustainability advantage. The study contributes to the practitioners, policymakers, organizations, government, researchers and academicians a better understanding of ISGLSAMS enablers and its performance outcomes.

Saudi Arabia's 2030 vision targets an increase of 34% in non-oil revenue participation in the GDP, thus the need for automation and digital transformation. The Company ER is a market leader producing high-quality dairy products in the Kingdom and is a pioneer in the production industry. The company has recently increased the capacity of its milk factory to meet its vision. An investment was made to automate the pallet handling procedures at the milk factory to provide increased production for daily consumption. The new automation transition in Company ER's milk factory provides a unique opportunity to utilize lean management tools to improve the current automated processes before commercialization.

OEE (overall equipment effectiveness) will monitor losses for different operational losses in the new automated system and indicate system improvements, with 85% as the target. Based on DMADV (design, measure, analyze, design and validate) methodology, this study analyzes the entire automated pallet handling system. It uses lean tools to identify areas for improvement, identify waste elements and propose solutions to achieve Company ER's OEE targets.

In this paper, the outcomes will be presented as documented solutions that address the losses encountered in the production system, showing a 12.8% increase in the system's OEE.

Owing the time and resource constraint, this study only involved automated pallet handling procedures in a milk production facility. Hence, the generalization of the result is slightly limited. More studies in several different processes and sectors are required.

This study provided a valuable tool for researchers for gaining deeper understanding regarding the lean manufacturing and its implementation. For practitioners, it is useful to evaluate the degree of lean manufacturing tools in their material handling systems.

This study is the first attempt to develop lean manufacturing constructs for evaluating the automated pallet handling procedures in a milk production facility.