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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.

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

In light of the recent changes in the internal audit (IA) landscape, the role of auditors has undergone a significant transformation. This paper aims to investigate the effects of applying Lean Six Sigma (LSS) techniques on the effectiveness and efficiency of IA.

The study used a quantitative approach, surveying Iranian internal auditors with a sample size of 384 participants. Data analysis involved confirmatory factor analysis and structural equation modeling.

The analyses demonstrate a significant association between LSS application and IA effectiveness and efficiency. In addition, an exploratory analysis indicates that the application of LSS techniques by less experienced internal auditors had a reverse effect on IA function quality as a component of IA competency. However, IA motivation factors, including education and position, did not mediate the impact of LSS on IA effectiveness and efficiency.

This study was conducted with Iranian internal auditors, which may limit the generalizability of the findings to other countries. However, the primary academic implication of this research lies in its novel perspective on emphasizing the concept of continuous improvement in IA through the use of LSS techniques. By focusing on the need for internal auditors to add value to the business in new ways, this research contributes to the literature on IA quality.

This study has significant implications for the effective management of IA departments. By promoting the application of LSS techniques in IA, lean auditing is enhanced, and IA can create value by improving the quality of its functions. Moreover, IA regulators can benefit from this study as it emphasizes providing guidance and training on LSS techniques to enhance IA skills.

This research is pioneering in applying LSS methodology to enhance the effectiveness and efficiency of internal auditing. It also considers the integration of lean thinking into current audit practices, making it unique and valuable in internal auditing research.

This article aims to focus on implementing Lean Six Sigma (LSS) in steel manufacturing to enhance productivity and quality in the galvanizing process line. In recent trends, manufacturing organizations have expressed strong interest in the LSS since they attempt to enhance its overall operations without imposing significant financial burdens.

This article used lean tools and Six Sigma's DMAIC (Define, Measure, Analyze, Improve and Control) with Yin's case study approach. This study tried to implement the LSS for the steel galvanizing process in order to reduce the number of defects using various LSS tools, including 5S, Value stream map (VSM), Pareto chart, cause and effect diagram, Design of experiments (DoE).

Results revealed a significant reduction in nonvalue-added time in the process, which led to improved productivity and Process cycle efficiency (PCE) attributed to applying lean-Kaizen techniques. By deploying the LSS, the overall PCE improved from 22% to 62%, and lead time was reduced from 1,347 min to 501 min. DoE results showed that the optimum process parameter levels decreased defects per unit steel sheet.

This research demonstrated how successful LSS implementation eliminates waste, improves process performance and accomplishes operational distinction in steel manufacturing.

Since low-cost/high-effect improvement initiatives have not been adequately presented, further research studies on adopting LSS in manufacturing sectors are needed. The cost-effective method of process improvement can be considered as an innovation.

The purpose of this paper is to contribute to the limited body of empirical knowledge on the impact of Lean Six Sigma (LSS) program implementations on organizational performance in financial services by investigating how antecedents of Lean Six Sigma program success (motivations, selected LSS methods and challenges) affect organizational performance enhancement via LSS program performance.

A sample of 198 LSS professionals from 7 countries are surveyed. Structural equation modeling (SEM) is performed to test the questioned relations.

This study’s findings comprise: (1) LSS program performance partially mediates the relationship between motivations for LSS implementation and organizational performance, (2) selected LSS method applications has a fully (mediated) indirect impact on organizational performance, (3) LSS implementation challenges also have an indirect (mediated) impact on organizational performance and (4) LSS program performance has a positive impact on organizational performance.

The findings of this research predominantly provide nuances and details about LSS implementation antecedents and effects, useful for managers in advising their business leaders about the prerequisites and potential operational and financial benefits of LSS implementation. Furthermore, the paper provides evidence and details about the relationship between important antecedents for LSS implementation identified in existing literature and their impact on organizational performance in services. Thereby, this research is the first in providing empirical, cross-sectional, evidence for the antecedents and effects of LSS program implementations in financial services.

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

The purpose of this paper is to investigate how successful lean six sigma (LSS) manifests in the Australasian (Australian and New Zealand) context relative to the context in the USA in terms of LSS project definition, structure and practices.

In-depth investigation through case studies – 12 Australian/New Zealand cases and 4 US cases – on the implementation mechanisms of successful LSS initiatives.

A significant difference was found between Australasian and US definitions of an LSS project. However, firms in both regions followed similar project selection, initiating and execution practices. LSS reporting structures were found to be well-established in US organizations, but none of the Australasian organizations were found to be equipped with such a structure, although the effectiveness of LSS implementation success remained unaffected.

Sufficient uniformity of LSS was found across two regions implying its usefulness/generalizability, but the findings are based only on 12 cases.

The paper provides the groundwork to develop a unique LSS model for Australasian organizations to improve processes in an effective and efficient manner.

To achieve changing customer demands, organizations are striving hard to embrace cutting-edge technologies facilitating a high level of customization. Industry 4.0 (I4.0) implementation aids in handling big data that could help generate customized products. Lean six sigma (LSS) depends on data analysis to execute complex problems. Hence, the present study aims to empirically examine the key operational characteristics of LSS and I4.0 integration such as principles, workforce skills, critical success factors, challenges, LSS tools, I4.0 technologies and performance measures.

To stay competitive in the market and quickly respond to market demands, industries need to go ahead with digital transformation. I4.0 enables building intelligent factories by creating smart manufacturing systems comprising machines, operators and information and communication technologies through the complete value chain. This study utilizes an online survey on Operational Excellence professionals (Lean/Six Sigma), Managers/Consultants, Managing Directors/Executive Directors, Specialists/Analysts/Engineers, CEO/COO/CIO, SVP/VP/AVP, Industry 4.0 professionals and others working in the field of I4.0 and LSS. In total, 83 respondents participated in the study.

Based on the responses received, reliability, exploratory factor analysis and non-response bias analysis were carried out to understand the biasness of the responses. Further, the top five operational characteristics were reported for LSS and I4.0 integration.

One of the limitations of the study is the sample size. Since I4.0 is a new concept and its integration with LSS is not yet explored; it was difficult to achieve a large sample size.

Organizations can utilize the study findings to realize the top principles, workforce skills, critical success factors, challenges, LSS tools, I4.0 tools and performance measures with respect to LSS and I4.0 integration. Moreover, these operational characteristics will help to assess the organization's readiness before and after the implementation of this integration.

The authors' original contribution is the empirical investigation of operational characteristics responsible for I4.0 and LSS integration.

The purpose of this study is to implement lean six sigma (LSS) methodology to improve the admission process in a higher education institute (HEI).

In this study, case study research methodology is adopted and implemented through an LSS define-measure-analyze-improve-control (DMAIC) framework.

The preliminary investigation showed that the completion of the whole admission process of a new student takes an average of 88 min, which is equivalent to a sigma level of about 0.71 based on the targeted admission cycle time of 60 min. The implementation of the proposed LSS approach increased the sigma level from 0.71 to 2.57, which indicates a reduction in the mean admission cycle time by around 55%. This substantial improvement is expected not only to provide an efficient admission process but also to enhance the satisfaction of students and employees and increase the reputation of the HEI to a significant level.

In this study, the sample size used in the analysis is considered small. In addition, the effectiveness of the proposed approach is investigated using a discrete event simulation with a single-case study, which may limit generalization of the results. However, this study can provide useful guidance for further research for the generalization of the results to wider scopes in terms of different sectors of HEIs and geographical locations.

This study uses several statistical process control tools and techniques through a LSS DMAIC framework to identify and element the root causes of the long admission cycle time at a HEI. The approach followed, and the lessons learned, as documented in the study, can be of a great benefit in improving different sectors of HEIs.

This study is one of the few attempts to implement LSS in HEIs to improve the administrative process so that better-quality services can be provided to customers, such as students and guardians. The project is implemented by a group of undergraduate students as a part of their senior design project, which paves the way for involving students in future LSS projects in HEIs. This study is expected to help to improve understanding of how LSS methodology can be implemented in solving quality-related problems in HEIs and to offer valuable insights for both academics and practitioners.

The integration of Lean Six Sigma (LSS) and Industry 4.0 (I4.0) is in the nascent stage and promises to achieve new optimums in operational excellence. This study aims to empirically examine the enablers, barriers, benefits and application of I4.0 technologies in LSS and I4.0 integration.

A pilot survey was chosen as an appropriate methodology, as LSS and I4.0 integration is still budding. The survey targeted senior quality management professionals, quality managers, team leaders, LSS Black Belts and operations managers to collect the relevant research data. The questionnaire was sent to 200 respondents and received 53 valid responses.

This study reveals that “top management support” is an essential enabler for LSS and I4.0 integration. The most significant barrier was “poor understanding of data analysis” and “lack of top management support”. The findings further illustrated that LSS and I4.0 integration resulted in greater efficiency, lower operational costs, improved productivity, improved customer satisfaction and improved quality. Regarding I4.0 technology integration at different phases of LSS, the authors noticed that big data analytics and artificial intelligence (AI) are the most prominent technologies used in all phases of LSS implementation.

One of the limitations of this study is the sample size. LSS and I4.0 are emerging concepts; hence, obtaining a larger sample size is difficult. In addition, the study used non-parametric tests to analyse the data. Therefore, future studies should be conducted with large sample sizes across different continents and countries to understand differences in the key findings.

The outcomes of this study can be useful for organisational managers to understand the enablers and barriers before integrating LSS and I4.0 for adoption in their organisations. Secondly, it helps to convince top management and human resource personnel by providing a list of benefits of LSS and I4.0 integration. Finally, it can help decision-makers understand which I4.0 technologies can be used in different stages of LSS methodology.

LSS and I4.0 integration was studied at a conceptual level. This is the first empirical study targeted toward understanding the LSS and I4.0 integration. In addition, this study investigates the application of widely used I4.0 technologies in different phases of LSS.