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The sustainability of the Lean Six Sigma (LSS) program represents the most challenging aspect for most of the organizations dealing with this methodology. In this scenario, the purpose of this paper is the description of the AMSE (which stands for Assessment, Monitoring, Sustainability, Expansion) Model, that represents a leading-edge approach to implement an effective LSS deployment on a permanent basis, by means of a structured roadmap.

The AMSE roadmap is made of four operating phases – Assessment, Monitoring, Sustainability, Expansion – it is a Model to govern the LSS deployment and to maximize both operative and economical results on a long-term basis.

One of the main problems of LSS programs is their sustainability (sustainability of projects and the overall program) over time; the AMSE Model allows the deployment of an LSS Governance Structure with a clear definition of tasks; this model can be effectively applied both to small and medium enterprises (SMEs) and global companies, regardless of the sector.

Both SMEs and global corporations could benefit from applying the AMSE in terms of operational efficiency, culture improvement and people engagement.

The AMSE Model represents an innovative approach for sustaining a continuous improvement culture in the organizations over time, by defining four steps (Assessment, Monitoring, Sustainability, Expansion), divided into detailed tasks, each of which is characterized by its own specific tools.

This paper aims to identify key factors that impact operating room (OR) utilization and evaluate different scenarios on OR performance.

Five months of data were collected. stepwise regression and best subset models were used to select factors and generate regression model for OR utilization. We further used simulation to test the influence of case duration mean, case duration variation, scheduled utilization and first-case delay on OR utilization, OR cost inefficiency and patient wait time on the day of surgery.

The scheduled utilization, case cancellation and add-on cases were the most important factors identified in all models. The larger the case duration variation, the lower the OR cost efficiency and utilization, the longer the patient wait time. First-case delay and turnover times are not critical in OR utilization or cost efficiency.

OR management should focus on creating an effective way to manage case cancellation and add-on policy to tackle the change on the day of surgery. In addition, several weeks before the surgery, the management needs to consider how to schedule cases to fit the allocated OR time.

In complementary of current OR management, this research assists OR management by identifying the factors that would result in the most significant improvement on OR utilization.

This paper gives the background to the ISO 18404:2015 standard and explains its rationale. It aims to correct misconceptions and erroneous statements about the standard appearing in the paper by Antony et al. (2021) and to demonstrate the usefulness of the standard in a wide range of application sectors.

A review of recently reported misconceptions and erroneous statements is presented and clarifications are provided. A qualitative interview approach was utilised to obtain the views of leading academics and practitioners familiar with Six Sigma and Lean in a range of sectors and from different parts of the world. This includes the results of a survey for capturing expectations and requirements for the next ISO18404 version.

Clarifications were needed to correct some misconceptions and erroneous statements in recently published work. However, on review, the reports of the interviews in Antony et al. (2021) indicate that most Lean Six Sigma professionals have positive experiences with ISO 18404:2015 and see the advantages of a common standard in helping continuous improvement deployment. Possible causes of some reported negative results are already scheduled to be addressed in the forthcoming review of ISO 18404:2015.

A very real constraint when conducting research into ISO 18404:2015 is to obtain a balanced view of the standard from those who have a vested interest in its continuation and evolution, or not. Whilst the authors cannot claim to be any more objective than Antony et al.’s (2021) authors and commentators, they are, in contrast to that group, highly knowledgeable about the reality of the standard, rather than speculating in ignorance.

A very real constraint when conducting research into ISO 18404:2015 is to obtain a balanced view of the standard which is balanced with respect from those who have a vested interest in its continuation and evolution, or not. Whilst the current authors cannot claim to be any more objective than previous authors, Antony et al.’s (2021) authors and commentators, they are, in contrast to that group, highly knowledgeable about the reality of the standard, rather than speculating in ignorance.

The paper gives a clear description of the ISO standard development process and provides a resource for people to obtain insight into the value or non-value add of a standard in Six Sigma and Lean, and the appropriate details of such a standard. These results can form the basis of a case for the implementation of the standard for those organisations currently trying to decide whether or not to implement it.

This paper aims to present and summarise the arguments for and against the ISO 18404 standard and the perceived advantages and disadvantages of implementing it.

A qualitative interview approach was utilised by interviewing a panel of leading academics and practitioners familiar with Lean Six Sigma.

The results indicate that Lean Six Sigma professionals have conflicting opinions on ISO 18404. An overwhelming majority of the panel questioned the “quality” of the standard and whether it is “fit for purpose”, while others see the advantages of a common standard in helping continuous improvement deployment.

As the standard has not been widely adopted, there were limited examples on ISO 18404 discussion in the literature. Much of the current literature focuses on the theoretical application of the standard, with sparse practical examples providing case study deployment. Also, the interviews were short and at a high level. There is an opportunity for further study and analysis. It was difficult to find qualified interviewees who were familiar with the standard. A very real constraint when conducting research into ISO 18404 is to obtain a balanced view of the standard from those who have a vested interest in its continuation and evolution, or not.

The paper provides a resource for people to obtain insight into the value or non-value add of a standard in Lean Six Sigma and the appropriate details of such a standard. These results can form the basis of a case for the implementation of the standard for those organisations currently trying to decide whether to implement it or not.