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The various quality improvement (QI) frameworks and maturity models described in the health services literature consider some aspects of QI while excluding others. This paper aims to present a concerted attempt to create a quality improvement maturity model (QIMM) derived from holistic principles underlying the successful implementation of system-wide QI programmes.

A hybrid methodology involving a systematic review (Phase 1) of over 270 empirical research articles and books developed the basis for the proposed QIMM. It was followed by expert interviews to refine the core constructs and ground the proposed QIMM in contemporary QI practice (Phase 2). The experts included academics in two academic conferences and 59 QI managers from the New Zealand health-care system. In-depth interviews were conducted with QI managers to ascertain their views on the QIMM and its applicability in their respective health organisations (HOs).

The QIMM consists of four dimensions of organisational maturity, namely, strategic, process, supply chain and philosophical maturity. These dimensions progress through six stages, namely, identification, ad-hoc, formal, process-driven, optimised enterprise and finally a way of life. The application of the QIMM by the QI managers revealed that the scope of QI and the breadth of the principles adopted by the QI managers and their HOs in New Zealand is limited.

The importance of QI in health systems cannot be overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality.

This paper contributes new knowledge by presenting a maturity model with an integrated set of quality principles for HOs and their extended supply networks.

Despite differing strategies towards environmental sustainability in developed and developing nations, the manufacturing sector in these regional domains faces substantial environmental issues. The purpose of this study is to examine the green-lean-six sigma (GLSS) enablers and outcomes for enhancing environmental sustainability of manufacturing firms in both, a developed and developing country context by using an environment-centric natural resource-based view (NRBV).

First, a framework of GLSS enablers and outcomes aligned with the NRBV strategic capabilities is proposed through a systematic literature review. Second, this framework is used to empirically investigate the GLSS enablers and outcomes of manufacturing firms through in-depth interviews with lean six sigma and environmental consultants from New Zealand (NZ) and Pakistan (PK) (developed and developing nations).

Analysis from both regional domains highlights the use of GLSS enablers and outcomes under different NRBV capabilities of pollution prevention, product stewardship and sustainable development. A comparison reveals that NZ firms practice GLSS to comply with environmental regulatory requirements, avoid penalties and maintain their clean-green image. Conversely, Pakistani firms execute GLSS to reduce energy use, satisfy international customers and create a green image.

This paper provides new insights on GLSS for environmental sustainability which can assist industrial experts and academia for future strategies and research.

This is one of the early comparative studies that has used the NRBV to investigate GLSS enablers and outcomes in manufacturing firms for enhancing environmental performance comparing developed and developing nations