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Companies are concerned about the well-being of workers in their supply chains, but conventional audits fail to uncover critical problems. Yet, if the happy worker – productive worker thesis is correct, it would benefit factories in fast-developing countries, particularly China which is key to many global supply chains, to ensure the well-being of their workers. The authors set out to better understand the relationship between well-being and performance in four Chinese factories.

Over 12-months the authors collected digital diaries from 466 workers in four factories, and monthly data about the performance of their factories. The authors used this data to gain insights into the well-being of workers in these factories; to design experimental interventions to improve this; and to consider any effects these had on factory performance.

The experiments showed that training interventions to improve workers' well-being through their work relationships and individual skills improved not just a factory's general worker well-being, but also some aspects of its performance and worker retention. Thus, it brought benefits not only for the workers but also for the factory owners and their client companies.

While there is a significant body of research investigating the happy worker – productive worker thesis, this was not conducted in Chinese factories. The authors’ work demonstrates that in this and similar environments, workers' eudaimonic well-being is more important than might be assumed, and that in this context there is a relationship between well-being and performance which can be practically addressed.

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.