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The purpose of this work is to gain insights about Lean Six Sigma (LSS) in the Indian context by reviewing the related literature for one decade based on various perspectives, such as author profile, year of publication, type of firm, type of methodology used, type of industry for which the research work is carried out and the key findings from the research.

This study reviews the research related to LSS from the articles published in the reputed journals. The literature used for reviewing is derived from the sources, including Science direct, Google scholar, IEEE, Taylor and Francis Group, Emerald Insight, Springer, Inderscience and Elsevier during the period between 2010 and 2021. Totally, the authors have included 141 LSS-related research articles that are published in the Indian context. The keywords used are Lean Six Sigma, Lean Six Sigma in the Indian context, Lean Sigma and LSS to identify and consolidate the research papers published during this timeframe.

The research papers collected from various reputed journals, including Scopus and non- Scopus enlisted, are classified and grouped under various categories to identify the class of author who publishes more in this field, research trend over the years, the type of firm which implements LSS, the research methodology which is commonly used in LSS and related research and also the key takeaway from these articles are highlighted. Further, the authors have also identified the major contributions of researchers in various sectors during this period in India.

This classification framework and the systematic review help in identifying the research gap and in giving directions for future researchers. It will be useful for researchers and practitioners working on the area of LSS, rural and urban entrepreneurs, start-up managers, professionals working in micro, small and medium enterprises (MSMEs) and executives of the Make in India Project to make India as Aatmanirbhar Bharat Abhiyan. Further, the clear direction of progress over the current decade in manufacturing industries, service sectors and processing industries can help the professionals working in these sectors.

This paper explores Lean Six Sigma principles and the DMAIC (define, measure, analyze, improve, control) methodology to propose a new Lean Six Sigma 4.0 (LSS 4.0) framework for employee occupational exams and address the real-world issue of high-variability exams that may arise.

This study uses mixed methods, combining qualitative and quantitative data collection. A detailed case study assesses the impact of LSS interventions on the exam management process and tests the applicability of the proposed LSS 4.0 framework for employee occupational exams.

The results reveal that changing the health service supplier in the explored organization caused a substantial raise in occupational exams, leading to increased costs. By using syntactic interoperability, lean, six sigma and DMAIC approaches, improvements were identified, addressing process deviations and information requirements. Implementing corrective actions improved the exam process, reducing the number of exams and associated expenses.

It is important to acknowledge certain limitations, such as the specific context of the case study and the exclusion of certain exam categories.

The practical implications of this research are substantial, providing organizations with valuable managerial insights into improving efficiency, reducing costs and ensuring regulatory compliance while managing occupational exams.

This study fills a research gap by applying LSS 4.0 to occupational exam management, offering a practical framework for organizations. It contributes to the existing knowledge base by addressing a relatively novel context and providing a detailed roadmap for process optimization.