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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.

Quality improvement has developed and spread, and today, all Swedish Regions emphasize that their strategies are based on systematic improvement. This paper aims to describe and illuminate the development of Quality Improvement (QI) in Swedish healthcare and welfare organizations by using publications in a Swedish context.

The overview synthesis is inspired by a scoping literature review approach of relevant literature. All publications relevant to Swedish healthcare and welfare settings between 1992 until 2020 were included.

In all, 213 papers, 29 books and chapters and 34 dissertations related to QI and research in Swedish healthcare and welfare context were identified. From 2011 to 2020, the publication rate increased rapidly. Six different focus areas emerged: systematic and value-creating improvement work; collaboration between organizations and healthcare providers; use of improvement methods and (theoretical) models; leadership and learning; measurements, quality registers and follow-up; and involvement and patient safety. Further QI development in Swedish healthcare and welfare points to an increased importance of collaboration between organizations and coproduction with beneficiaries for the healthcare and welfare services.

This paper is one of the first to describe and illuminate the QI development in the healthcare and welfare sector in a country. The trajectory also points to a need for coproduction to handle future challenges.

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.

To better understand the nature and effective delivery of quality health-care globally, this paper aims to study the role of quality leadership on patient care quality (PCQ) delivered in hospitals, including the intervening role of technology integration and two country-level factors – national culture and infrastructure development – in North America (Canada, Mexico and the USA).

PCQ comprises four facets: interpersonal, technical, environmental and administrative quality. Using survey data and interdisciplinary theoretical support (e.g. quality management and the Global Leadership and Organizational Behavior Effectiveness Project [GLOBE] model of national culture), this paper tested for moderated mediation between hospital quality leadership and the four-facet PCQ model with technology integration as the mediator and national culture and infrastructure development as moderators.

Results show that technology integration partially mediates the relationship between hospital quality leadership and PCQ and that national culture and infrastructure development shape the role of hospital quality leadership on PCQ. Hence, these national factors must be considered holistically to understand the impact of hospital quality leadership on patient care.

To improve PCQ, hospital leaders should broaden their understanding of quality health-care to include technology integration and an awareness of cultural and institutional differences across nations.

This paper used primary data from hospital quality leaders and the four-facet PCQ conceptualization across three large North American nations, offering a more global understanding of service quality in health-care.

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.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

An integrated care system identified quality improvement (QI) capacity as a gap in advancing their integrated quality care priorities and improvement efforts. Here we describe the design and implementation of a QI capacity building program that aimed to (1) build QI capacity amongst diverse integrated care system members and (2) apply QI principles to advance integrated quality care priorities.

The integrated care system leaders, including community members, partnered with the University of Toronto Centre for Quality Improvement and Patient Safety to co-design and deliver the QI capacity building program focused on improving cancer screening rates. An existing acute care capacity building program was adapted. Content included QI tools, data to identify and monitor QI priorities, equity considerations, and empowering participants as change agents.

Participants were satisfied with the content and delivery of the program. Some described using QI tools and strategies in practice following the workshop. Challenges to using the tools included the current pressures facing primary care and the health system, resources, and data availability.

This QI capacity building program was challenging but feasible. Clarifying the target audience, being attentive to co-design, acknowledging post-pandemic system challenges and proactively addressing variable knowledge and barriers to QI work in practice will inform future iterations of this program.

While many examples of QI education programs exist, the majority target a single healthcare sector. We describe a novel QI capacity building model that bridges healthcare sectors and includes patient partners and community members as teachers and participants.

Patient safety is a top priority globally. A robust healthcare system requires strategic collaboration between research and development. The author analysed over 300 cases from seven hospitals using the failure modes, effects, and criticality analysis (FMECA) tool to understand the underlying causes of medical errors.

The author studied seven hospitals and 300 cases using FMECA to prioritise activities. The findings showed that high-priority events occurred less frequently but had the potential to cause the most harm. Team members evaluated independently to ensure unbiased evaluations. This approach is useful for setting priorities or assessing difficulties.

Poor communication and lack of coordination among staff in a healthcare organisation caused misunderstandings, ineffective decision-making, delays in patient care, and medical errors. Implementation of effective communication and coordination protocols can help avoid these problems.

The study recommends using FMECA to identify and prioritise failures and conducting in-depth analyses to understand their root causes. It also highlights the importance of interdisciplinary knowledge and soft skills for healthcare staff.

This study reveals the significance of FMECA in healthcare risk management and benchmarking. FMECA helps identify system failures, develop prevention strategies, and evaluate effectiveness against industry benchmarks. It offers healthcare professionals a valuable tool to enhance patient safety and improve healthcare quality.

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.