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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.

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.

Improving the quality of madrasah in the digital era is a must. This can be committed by strengthening aspects of madrasah governance through implementing management strategies that refer more to the integration of technology and Islamic education. This research focuses on madrasah management strategies through the Madrasah Reform program.

This research uses a case study research design that focuses attention on strategic aspects of developing madrasah through the Madrasah Reform program. The informants in this study were 18 people consisting of three madrasah heads from Madrasah Ibtidaiyah (MI), Madrasah Tsanawiyah (MTs) and Madrasah Aliyah (MA), five teachers and 10 students. Data collection in this study used in-depth and semi-structured interviews with madrasah heads and teachers regarding the implementation of the Madrasah Reform program and also regarding madrasah management strategies at three levels of education.

This study shows that the strategy of managing madrasahs through the Madrasah Reform program in three madrasahs in Indonesia has had a positive impact on improving the quality of madrasahs, although there are still aspects that require development.

This research implies that the quality of madrasah in the digital era is determined by management strategies based on the use of educational technology.

This program has implications for the development of the quality of human resources in educational institutions, especially in relation to digital literacy among students and teaching staff. The use of digital technology, which is one of the main projections of the Madrasah Reform program, is continuously able to change the face of education in a more modern direction, both in terms of governance and the learning process, so that the output of this program, especially what occurs at Madrasah Madani, is significant development in the aspects of digital literacy and technology. Which is the main criterion in facing a digital-based educational context.

For a policy aspect, the success of the Madrasah Reform program at Madrasah Madani can be used as a blueprint or model for implementing this program in Islamic educational institutions, specifically Madrasas in South Sulawesi and in general at Madrasas throughout Indonesia.

This proves that Madrasah Reform program is a program that can be implemented in madrasahs to improve the quality of madrasah management in the digital era while continuing to carry out simultaneous improvements and evaluations of the program.

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.

The purpose of this study is to evaluate an in-service training (INSET) programme for improving the quality of English language teaching in Zanzibar’s secondary schools. Specifically, there were two objectives: i) to explore the teachers’ views on the zanzibar improvement students prospect (ZISP) training programme in improving the English language teaching techniques in secondary schools in Zanzibar and ii) to find out the organisational support provided to teachers when they are using the skills and knowledge acquired from the ZISP teaching programme.

The study used a qualitative research approach, particularly the case-study design. It used interviews to collect qualitative data that was analysed thematically. Twelve English language teachers from seven secondary schools who had benefited from the ZISP teaching programme and five headmasters from five schools participated in the study as respondents.

The study found that the ZISP training programme equipped teachers with pedagogical skills useful for preparing lessons and materials, using technology in teaching and providing timely feedback to students. In terms of support, teachers receive materials and motivation from various organisations.

This study focused on ordinary teachers and headmasters. Nevertheless, other studies could use classroom observation, focus group discussion, document review or survey questionnaire to evaluate the impact of the programme and look at how the skills obtained are used in the teaching and learning of the English language. In addition, this study involved 12 participants who were teachers and headmasters, respectively. Other studies could include students, their families, employers and non-teaching staff. This would provide a holistic view of how the stakeholders perceive the INSET programme.

The study contributes to the body of knowledge regarding the benefits and organisational support teachers receive after participating in the INSET training programme in Zanzibar. Thus, teachers need regular exposure to INSET so that they improve the quality of their teaching.

In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes.

Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature.

ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised.

This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as “agents”, “stewards” or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems.

The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance.

This paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes.

In their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review (N = 68), qualitative interviews (N = 16) and a Delphi study (N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders.

The authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept.

The authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool.

New product development (NPD) is necessary for business sustenance and customer satisfaction. Six Sigma and Design for Lean Six Sigma (DLSS) efficiently employ the repetitive stages for NPD, leading to quality performance and profitability. This study aims to map the quality performance through NPD attributes through the Lean methodology.

The data on NPD were collected from 267 respondents from manufacturing companies to map the relationship between Six Sigma and DLSS for NPD. Confirmatory factor analysis was employed to confirm model fit, while structural equation modeling was employed to analyze the empirical data for framework testing. The study included nine variables and fourteen hypotheses identified from the literature.

The statistical results of this study show that NPD attributes such as innovation, marketing, organization, customer, product and technology positively influence the Lean Six Sigma structured improvement process (LSSSIP) and DLSS. Moreover, integrating these attributes in Lean planning enhance quality performance. This empirical investigation's findings indicate that ten of the 14 hypotheses were supported, giving the study a strong foundation.

The data collection was limited to northern India; therefore, the results may not be generalizable to other areas of the world.

NPD involves handling technical issues and factors such as cost, operational bottlenecks, economic changes, competitors' strategy and company policy. This study helps understand the various NPD parameters and their relationship to Lean, which enables an effective NPD implementation strategy.

The current philosophy of NPD calls for a concurrent engineering approach; therefore, the entire organization must be part of this process. This study uses the holistic framework by optimizing NPD with Lean Six Sigma (LSS) principles. The study is unique in that, to date, research does not integrate NPD attributes with the objectives of LSS to develop an efficient NPD implementation strategy.

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.