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This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

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 concept of sustainable product design (SPD) is gaining significant attention in recent research. However, due to inherent uncertainties associated with new product development and incorporation of multiple qualitative and quantitative criteria; SPD is a complex and challenging task. The purpose of this paper is to introduce a novel approach by integrating quality function deployment (QFD), multi-criteria decision making (MCDM) technique and Six Sigma evaluation for facilitating SPD in the context of Industry 4.0.

The customer requirements are evaluated through the neutrosophic-decision-making trial and evaluation laboratory-analytic network process (DEMATEL-ANP)-based approach followed by utilizing QFD matrix to estimate the weights of the engineering characteristics (EC). The Six Sigma method is then employed to evaluate the alternatives’ design based on the ECs’ values.

The effectiveness of the suggested approach is illustrated through an example. The result indicates that utilization of the neutrosophic MCDM technique with integration of Six Sigma methodology provides a simple, effective and computationally inexpensive method for SPD.

The proposed approach is helpful in upstream evaluation of the product design with limited experimental/numerical data, maintaining a strong competitive position in the market and enhancing customer satisfaction.

This work provides a novel approach to objectively quantify performance of SPD under the paradigm of Industry 4.0 using the integration of QFD-based hybrid MCDM with Six Sigma method.

This research paper aims to analyze the scientific and grey literature on Quality 4.0 and zero-defect manufacturing (ZDM) frameworks to develop an integrated quality 4.0 framework (IQ4.0F) for quality improvement (QI) based on Six Sigma and machine learning (ML) techniques towards ZDM. The IQ4.0F aims to contribute to the advancement of defect prediction approaches in diverse manufacturing processes. Furthermore, the work enables a comprehensive analysis of process variables influencing product quality with emphasis on the use of supervised and unsupervised ML techniques in Six Sigma’s DMAIC (Define, Measure, Analyze, Improve and Control) cycle stage of “Analyze.”

The research methodology employed a systematic literature review (SLR) based on PRISMA guidelines to develop the integrated framework, followed by a real industrial case study set in the automotive industry to fulfill the objectives of verifying and validating the proposed IQ4.0F with primary data.

This research work demonstrates the value of a “stepwise framework” to facilitate a shift from conventional quality management systems (QMSs) to QMSs 4.0. It uses the IDEF0 modeling methodology and Six Sigma’s DMAIC cycle to structure the steps to be followed to adopt the Quality 4.0 paradigm for QI. It also proves the worth of integrating Six Sigma and ML techniques into the “Analyze” stage of the DMAIC cycle for improving defect prediction in manufacturing processes and supporting problem-solving activities for quality managers.

This research paper introduces a first-of-its-kind Quality 4.0 framework – the IQ4.0F. Each step of the IQ4.0F was verified and validated in an original industrial case study set in the automotive industry. It is the first Quality 4.0 framework, according to the SLR conducted, to utilize the principal component analysis technique as a substitute for “Screening Design” in the Design of Experiments phase and K-means clustering technique for multivariable analysis, identifying process parameters that significantly impact product quality. The proposed IQ4.0F not only empowers decision-makers with the knowledge to launch a Quality 4.0 initiative but also provides quality managers with a systematic problem-solving methodology for quality improvement.

This paper aims to unearth the essential components of Six Sigma for successful deployment and sustainment of service quality in four different organizations in the United Arab Emirates (UAE). More specifically, the paper is intended to determine the motivation to apply Six Sigma, Voice of Customer, Key Performance Indicators (KPIs), Critical-to-Quality (CTQ), readiness factors, Critical Success Factors, sustainment measures, tools and techniques used, challenges/barriers and performance impact on the company.

An exploratory research methodology with multiple case study analyses was adopted to determine the answers to the research objectives. Four case studies from different service processes of four companies were analyzed. The case studies were collated from these companies via a case study protocol with pre-defined criteria.

The analysis shows that service operation improvement projects are primarily dependent on the voice of the internal customer, with return on investment in savings as the KPI of the process. Most organizations prefer cycle time and errors as the CTQs in the Six Sigma projects. Even novice users can effectively apply the Six Sigma methodology with external experts’ assistance, mentoring and interventions. Across the case studies, it is observed that the projects were successfully deployed due to the support of top management leadership, effective communication and cross-functional teams. Employee resistance to change is the common barrier observed during the case study analysis. Eventually, in all the four case studies, Six Sigma is executed with standard tools and techniques within the define, measure, analyze, improve, control (DMAIC) approach.

The present study’s findings cannot be generalized due to the limited number of case study analyses in different ecosystems in the UAE. The authors would like to analyse and report more case studies in service quality improvement through the Six Sigma methodology to comprehend and develop a generic roadmap for the deployment of Six Sigma in the UAE service industry.

The study’s findings provide insights into commonalities and differences between the essential factors of Six Sigma deployment and sustainability in UAE companies.

The study results might help the policymakers and key decision makers in UAE and other countries understand the effectiveness of Six Sigma in service quality improvement with its essential factors for deployment.

The purpose of this study was conducted at an enterprise that produces fasteners and is one of the leading companies in the sector in terms of market share. Possible defects in the coating of bolts and nuts either lead to products being scrapped or all of the coating process being repeated from beginning to end. In both cases, the enterprise faces a waste of time and excessive costs. Through this project, the six sigma theory and its means were effectively used to improve the efficiency and quality management of the company. The selection of the six sigma project has also contributed to the creation of various documents to be used for project screening and evaluation of financial results.

Six sigma is an optimization strategy that is used to improve the profitability of businesses, avoid waste, scrap and losses, reduce costs and improve the effectiveness of all activities to meet or exceed customers’ needs and expectations. Six sigma’s process improvement model, known as Definition-Measurement-Analysis-Improvement-Control, contributes to the economic and technical achievements of businesses. The normal distribution of a process should be within ±3 sigma of the mean. This represents a scale of 99.7% certainty. However, improving the process through the utilization of the six sigma rule, which accepts normal variabilities of processes twice as strict, will result in an error rate of 3.4 per million instead of 2,700 per million for each product or service.

Using six sigma practices to reduce the costs associated with low quality and to increase economic added value became a cultural practice. With this, the continuation of six sigma practices throughout the Company was intended. The annual cost reduction achieved with the utilization of six sigma practices can be up to $21,780. When time savings are also considered, a loss reduction of about $30,000 each year can be achieved. The coating thickness efficiency increased from 85% to 95% after the improvements made through the six sigma project. There is a significant increase in the efficiency of coating thickness. In addition, the coating thickness efficiency is also close to the target value of 95%–97%.

The results of the study were optimized with the help of deep learning. The performance of the model created in deep learning was quite close to the actual performance. This result implicates the validity of the improvement work. The results may act as a guide for the use of deep learning in new projects.

The purpose of this article is to study the link between mean shift and inflation coefficient when the underlying null hypothesis is rejected in the analysis of variance (ANOVA) application after the preliminary test on the model specification.

A new approach is proposed to study the link between mean shift and inflation coefficient when the underlying null hypothesis is rejected in the ANOVA application. First, we determine this relationship from the general perspective of Six Sigma methodology under the normality assumption. Then, the approach is extended to a balanced two-stage nested design with a random effects model in which a preliminary test is used to fix the main test statistic.

The features of mean-shifted and inflated (but centred) processes with the same specification limits from the perspective of Six Sigma are studied. The shift and inflation coefficients are derived for the two-stage balanced ANOVA model. We obtained good predictions for the process shift, given the inflation coefficient, which has been demonstrated using numerical results and applied to case studies. It is understood that the proposed method may be used as a tool to obtain an efficient variance estimator under mean shift.

In this work, as a new research approach, we studied the link between mean shift and inflation coefficients when the underlying null hypothesis is rejected in the ANOVA. Derivations for these coefficients are presented. The results when the null hypothesis is accepted are also studied. This needs the help of preliminary tests to decide on the model assumptions, and hence the researchers are expected to be familiar with the application of preliminary tests.

After studying the proposed approach with extensive numerical results, we have provided two practical examples that demonstrate the significance of the approach for real-time practitioners. The practitioners are expected to take additional care before deciding on the model assumptions by applying preliminary tests.

The proposed approach is original in the sense that there have been no similar approaches existing in the literature that combine Six Sigma and preliminary tests in ANOVA applications.

The purpose of this paper is to test and develop a method for generation and selection of six sigma projects. This is done by testing the use of the generation and selection method for six sigma projects (GSM_SSP) in a Brazilian manufacturing industry with the participation of managers, aiming to gather the user’s perspective and improvement opportunities for the approach itself.

The work adopts the action research (AR) approach once the researchers were busily involved in the training, implementation and use of the GSM_SSP. The intervention was performed in on a series of 15 workshops, with a group of managers, during six months.

The application of the eight steps of the GSM_SSP approach assisted the company’s management team to generate nine project candidates and also to select three six sigma projects. This study also finds and discusses barriers and lessons learned used to improve the GSM_SSP.

This study presents an example of how six sigma project generation and selection has been applied to a manufacturing industry by adapting AR to the process using the eight steps of GSM_SSP, demonstrating how the management team was involved. This study should be replicated in different companies because AR is limited in its generalization.

To the best of the authors’ knowledge, this study represents the first use of AR methodology in six sigma project selection. This study contributes a method that can generate and select six sigma projects. In doing so, the research offers a simple approach that can be used by managers. In addition, the steps of the approach before selection were explored.

The purpose of this study is to identify the critical readiness factors (CRFs) that mainly affect the implementation of Lean Six Sigma (LSS) in an organization and their interactions, and to develop a model that allows the management to assess the Lean Implementation Readiness Level.

The methodology is separated into two main parts: the literature review and the assessment model development. In the literature review, the main CRFs and their interactions for LSS implementation in Scopus Data Base were identified. The second part of the methodology is the model development. It was built on a stepwise framework that considers the relations among the CRFs and their importance. Moreover, it was used fuzzy-based linguistic variables given by the experts working in the company to consider the actual performance rating of each CRF. The model has been validated in the healthcare sector in nine hospitals.

From the model application, it is possible to note that the most frequent level among the nine hospitals interviewed is “Average Ready”. Also, the most extreme level of readiness occurred ones while the most extreme level of not readiness never occurred. Results show that in 78% of the cases, there would have been a high probability of implementation failure. Also, it was possible to identify for each hospital if the CRFs are good, if they are weak and need to change or if another factor needs to be improved before it and what this factor is.

This work proposes a new methodology that eliminates the negative aspects and limitations of the total interpretive structural modeling methodology and the fuzzy logic approach currently applied to evaluate the LSS readiness of a company. The present methodology lies in the fact that it provides a solution not only by defining the weak CRFs but also by giving an indication of priority as it identifies the weak antecedent factors that inhibit the preparedness of the depending factors.

The present environmental concern has enforced manufacturing firms to re-evaluate their business practices to reduce the adverse impact on the environment with optimum production. Therefore, the present study aims to deal with the implementation of the environmental lean six sigma (ELSS) framework in an Indian medical equipment manufacturing industry to obtain operational and environmental sustainability.

The proposed ELSS framework is based on the DMAIC (Define–Measure–Analyze–Improve–Control) methodology, sustainability and lean tools. The efficacy of the developed framework is tested through a case study in an Indian medical equipment manufacturing unit.

In the case company, four major issues were reported, i.e. improper material handling, non-productive movement of men and material, poor indoor air quality and rework. The ELSS project facilitates the case organization to enhance their capacity utilization from 59.25% to 74.3%, defects per million opportunities reduce from 309,523 to 48,951.44 and indoor air quality levels decrease from 156.87 to 86.85 µgm3.

The efficacy of the developed ELSS framework is evaluated through a case study conducted only in one Indian manufacturing environment.

The present study facilitates industrial managers and practitioners to achieve sustainability and process excellence through ELSS implementation. Organizations that intend to simultaneously improve operational and environmental performance can benefit from this paper as it can be used as a guide to conduct similar projects with both operational and environmental benefits.

This paper presents a successful implementation of the ELSS framework in the healthcare industry to achieve operational and environmental sustainability.