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India liberalized its economy in 1991, which resulted in intense global competition, quality-conscious and demanding customers. Additionally, significant technological advancements lead to enhancements in products and processes. These forced Indian organizations to adopt innovative business strategies in the past 30 years. Meanwhile, the Lean Six Sigma methodology has significantly grown with vast applicability during the past 30 years. Thus, the purpose of this study is to develop the learning on Lean Six Sigma methodology in the Indian context through investigation of literature.

A three-stage systematic literature review approach was adopted to investigate the literature during the present study. In total, 187 articles published in 62 journals/conference proceedings from 2005 to 2022 (18 years) were shortlisted. The first part of the article summarizes the significant milestones towards the quality journey in the Indian context, along with the evolution of the Lean Six Sigma methodology. The second part examines the shortlisted papers on Lean Six Sigma frameworks, their applicability in industrial sectors, performance metrics, outcomes realized, publication trends, authorship patterns and leading researchers from the Indian perspective.

Lean Six Sigma has emerged as a highly acclaimed and structured business improvement strategy worldwide. The Indian economy has seen remarkable growth in the past decade and is one of the fastest-growing economies in the 21st century. Lean Six Sigma implementation in India has significantly increased from 2014 onward. The study revealed that researchers have proposed several different frameworks for Lean Six Sigma implementation, the majority of which are conceptual. Furthermore, the balanced applicability of Lean Six Sigma in manufacturing and service sectors was observed with the highest implementation in the health-care sector. Additionally, the widely adopted tools, techniques along with performance metrics exploring case studies were reported along with a summary of eminent and leading researchers in the Indian context.

This study is confined to reviewed papers as per the research criteria with a significant focus on the Indian context and might have missed some papers due to the adopted papers selection strategy.

The present study is one of the initial attempts to investigate the literature published on Lean Six Sigma in the Indian context, including perspective on the Indian quality movement. Therefore, the present study will provide an understanding of Lean Six Sigma methodology in the Indian context to graduating students in engineering and management and entry-level executives. The analysis and findings on Lean Six Sigma frameworks, research approach, publications details, etc., will be helpful to potential research scholars and academia. Additionally, analysis of case studies on Lean Six Sigma implementation by Indian industries will assist the managers and professionals in decision making.

This paper aims to identify leadership behaviours in the manufacturing sector in Jordan that enable successful Lean Six Sigma implementation.

Qualitative data were collected through 27 interviews to identify the leadership behaviours that facilitate Lean Six Sigma and a focus group to categorise the aspects by grouping them into themes. A grounded theory approach was used in the field study. The processes of constant comparisons helped in identifying the relevant aspects of leadership behaviours and integrating specific aspects into themes; these processes were iteratives. Therefore, this research project relies on the grounded theory methodology to collect and analyse the data. The authors also used a focus group to categorise the aspects by grouping them into themes. In that, the aspects were grouped around core categories.

After analysing the data, 36 aspects have emerged. The data analysis processes helped in discovering the aspects of leadership that support the use of Lean Six Sigma in the manufacturing sector in Jordan. The aspects were developed through an iterative process of analysis until the saturation level was reached. Eight themes that influence the successful use of Lean Six Sigma emerged: Training and development; Continuous improvement and development; Communication; Empowering employees; Motivating employees; Managing qualities and operations; Employees engagement and involvement; and Supporting culture

There are some research limitations to this study, which opens avenues for future research. First, the data was collected through qualitative methods, which limits the generalizability of the results. Future studies are needed to generalize the results to the wider business community. Second, the data was collected only from manufacturing organizations and did not consider other sectors. Future researchers are urged to replicate the study in other sectors. Third, this study considered only Jordanian firms; therefore, the authors call upon further research to investigate other national settings that may have a different business culture.

This study encourages businesses to follow and adopt these behaviours in organisations, which can help in developing desirable behaviours among leaders to reach advanced levels in using Lean Six Sigma. Moreover, practitioners can develop training programmes for developing leaders. Thus, the Lean Six Sigma journey can become smoother by addressing the issues that face practitioners during the different phases of implementing Lean Six Sigma. In that respect, the practical implication of this research is to describe the practices that the leadership of organisations must develop to maintain high levels of Lean Six Sigma deployment.

Scholarly studies in this field are scarce, especially in developing countries, so identifying the leadership behaviours can help researchers create a theory of leadership behaviours for Lean Six Sigma. Furthermore, practitioners of Lean Six Sigma can take into account these behaviours as crucial to the effective use of Lean Six Sigma. They can encourage leaders to follow and adopt these behaviours in organisations which can help in developing desirable behaviours among leaders to reach advanced levels in using Lean Six Sigma. Thus, the Lean Six Sigma journey can become smoother by addressing the issues that practitioners face during the different phases of implementing Lean Six Sigma.

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.

The purpose of this paper is to present a case study the application of lean six sigma combined with mining transportation overall vehicle effectiveness (MTOVE) to improve mining transportation performance. MTOVE is a newly developed model to measure the overall effectiveness of mining transportation.

The method used is case study combines the MTOVE and LSS methodologies. Data were collected from the hauling operation during a three-month period. Various lean six-sigma tools, such as the Pareto chart, ANOVA, two sample t-tests, one sample t-test, cause-and-effect analysis and time study, have been used.

The case study resulted in improvement of vehicle overall effectiveness; a 35% increase in MTOVE value, a 17% improvement in productivity and a 9% increment in truck utilization. Statistical tests confirmed the significance of reducing the mean and variation in the hauling process cycle time, which led to productivity improvement.

This study provides practitioners with additional quantitative evidence of the potential benefits of LSS methods in the coal mining industry.

This paper practically and unquestionably has contributed to the LSS body of knowledge focused on the mining sector, which is recently still far behind the manufacturing sector. The study has demonstrated that some challenges in the mining environment can be solved through the effective implementation of LSS tools. Hence, this paper could be used as a reference for both researchers and practitioners.

The study contributes in the field of LSS spread in mining industries using a case study. This study shows practical evidence of improving overall vehicle effectiveness using LSS. Practitioners can refer to this study to understand the benefits of LSS in mining sector. Since the mining industry should also adopt the LSS principle into the mining business process due to its ability to improve business performance (Valente et al., 2020; Tupamahu et al., 2019; Zanon et al., 2021).

There has been little scientific study of the LSS implementation in the mining industry. This research provides detailed evidence of LSS implementation in the mining sector. The main contribution is the implementation framework, which shows the combination of newly developed indicators (MTOVE and LSS) to enhance hauling operation effectiveness. This paper demonstrates how LSS tools and methods can be applied in the mining transportation industry.

Lean Six Sigma 4.0 has brought about a paradigm shift in customization, automation, value creation and digitalization to achieve excellence in human factors, operations and sustainable development. Despite its potential, LSS 4.0 is still in its nascent stage, with researchers striving to identify the key and relevant components of LSS in relation to Industry 4.0. The present study aims to address this knowledge gap through a literature review and subsequently provide a conceptual framework for LSS within the context of digital transformation.

In this study, the authors have conducted a thorough review of reputable articles published between 2011 and 2022, focusing on the integration of Lean Six Sigma (LSS) and Industry 4.0 (I4.0). By using appropriate keywords, the authors identified around 85 relevant articles. The main objective of this integrative literature review was to analyze and extract valuable knowledge from the existing literature on LSS and I4.0. Based on the authors’ findings, a conceptual framework was developed.

The review revealed the motivators, building blocks, tools and challenges of LSS 4.0. The conceptual framework delves into the key aspects of LSS 4.0, focusing on the dimensions of people, process and technology, as well as their subdimensions. These subdimensions serve as the building blocks for developing LSS 4.0 capabilities. The proposed framework visually represents the conceptualization and the relationships among its components.

Only a few conceptual approaches to LSS are developed that include the concepts, new roles and elements of I4.0. As a result, this research investigates the gap in current LSS models preceding I4.0 and develops a conceptual framework to provide a novel and comprehensive summary of the new concepts and components driving nascent and current LSS practices in the digital era.

This study offers practical guidance for implementing LSS in the context of I4.0, emphasizing digital transformation. The findings highlight motivators, building blocks, tools, challenges and spread of LSS 4.0 practices, and present a conceptual framework of LSS 4.0. These insights can help organizations enhance their LSS capabilities and achieve excellence in human factors, operations and sustainable development.

This study aims to make a significant contribution to the model-building efforts of researchers focusing on LSS 4.0. By offering practical guidance, the points discussed in this study help enhance the implementation efforts of practitioners and organizations in the context of I4.0, with a specific focus on digital transformation. The guidance provided takes into account the perspectives of people, processes and technology, providing valuable insights for successful integration.

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.

Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.

Green Lean Six Sigma (GLSS) is a comprehensive approach that aims to reduce waste, emissions and non-value added activities, thus mark an effective impact on sustainability of firms. Despite the numerous benefits of GLSS implementation, it is evident that Micro Small and Medium Enterprises (MSMEs) are still struggling to understand, integrate and implement this strategy. This research work provides a comprehensive analysis of GLSS within MSMEs and proposes a conceptual integration framework of GLSS for improving economic and environmental dimensions of sustainability MSMEs.

A systematic literature review (SLR) methodology was planned to assess and analyse the research articles from 2007 to 2022. Different key elements of GLSS such as barriers, enablers and tool sets have been thoroughly reviewed and analysed for MSME organisations to understand their behaviour and effectively adopt the GLSS approach in their operations.

This study provides the analysis of different perspectives of GLSS and this will contribute to improve different metrics related to emissions and quality in MSMEs. It provides MSMEs industrial managers with a comprehensive knowledge base of GLSS elements, enabling effective deployment.

The present study provides a significant knowledge base and know-how of GLSS to researchers that will assist in deploying this sustainable approach in different industrial domains. The study also assists industrial managers by providing a systematic framework of GLSS for MSMEs. Further, the study also supports society by proving pathway to improve the environmental dynamics through the execution GLSS.

The study is of the first kind that review different facets of GLSS related to MSME. The study not only enhances theoretical know how of GLSS but also guides practitioners how to implement comprehensive GLSS program for improved environmental sustainability.

Workflow optimisation is crucial for establishing a viable acute stroke (AS) intervention programme in a large tertiary care centre. This study aims to utilise Lean Six Sigma (LSS) principles to enhance the hospital's workflow.

The Action Research methodology was used to implement the project and develop the case study. The study took place in a large tertiary care academic hospital in India. The Define-Measure-Analyse-Improve-Control approach optimised the workflow within 6 months. Lean tools such as value stream mapping (VSM), waste audits and Gemba were utilised to identify issues involving various stakeholders in the workflow. Sigma-level calculations were used to compare baseline, improvement and sustainment status. Additionally, statistical techniques were effectively employed to draw meaningful inferences.

LSS tools and techniques can be effectively utilised in large tertiary care hospitals to optimise workflow through a structured approach. Sigma ratings of the processes showed substantial improvement, resulting in a five-fold increase in clinical outcomes. Specifically, there was a 43% improvement in outcome for patients who underwent acute stroke revascularisation. However, certain sigma ratings deteriorated during the control and extended control (sustainment) phases. This indicates that ensuring the sustainability of quality control interventions in healthcare is challenging and requires continuous auditing.

The article presents a single case study deployed in a hospital in India. Thus, the generalisation of outcomes has a significant limitation. Also, the study encounters the challenge of not having a parallel control group, which is a common limitation in quality improvement studies in healthcare. Many studies in healthcare quality improvement, including this one, are limited by minimal data on long-term follow-up and the sustainability of achieved results.

This study pioneers the integration of LSS methodologies in a large Indian tertiary care hospital, specifically targeting AS intervention. It represents the first LSS case study applied in the stroke department of any hospital in India. Whilst most case studies discuss only the positive aspects, this article fills a critical gap by unearthing the challenges of applying LSS in a complex healthcare setting, offering insights into sustainable quality improvement and operational efficiency. This case study contributes to the theoretical understanding of LSS in healthcare. It showcases its real-world impact on patient outcomes and process optimisation.

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.