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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 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.

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.

In a packaging olives manufacturing system, the drained weight of the product plays a decisive role in customer’s satisfaction as well as in financial saving for the organization. The purpose of this study is to minimize the variation of the drained weight of olives in the production system to avoid the negative consequences.

The research develops a practical implementation step-by-step of Six Sigma define, measure, analyze, improve and control (DMAIC) in reducing the variation of the drained weight of olives.

Data analysis was used at various phases of the project to identify the root causes of rejection and rework. As a result of the necessary interventions and actions to optimize the manufacturing process, the standard deviation of drained weight was significantly reduced by 51.02%, with a 99.97% decrease in the number of parts per million defectives. Thus, the yield of the production process was improved by 8.24%. The estimated annual savings from this project were US$ 228,000 resulting from reduced rejection and rework.

This research may be used in packaging olives production systems as a tool for managers and engineers planning to increase productivity and efficiency while also improving product quality. The study also provided the organization with helpful actions that will be used to guide future Six Sigma operations management on the system. Thus, practical guidelines and solutions are provided.

In this project, for the first time, the Six Sigma methodology has been applied to solve a real-world problem in the packaging olives manufacturing system and to show that the DMAIC approach may assist to improve the efficiency of their operations and hence contribute to their quest toward continuous improvement.

This paper explores Lean Six Sigma principles and the DMAIC (define, measure, analyze, improve, control) methodology to propose a new Lean Six Sigma 4.0 (LSS 4.0) framework for employee occupational exams and address the real-world issue of high-variability exams that may arise.

This study uses mixed methods, combining qualitative and quantitative data collection. A detailed case study assesses the impact of LSS interventions on the exam management process and tests the applicability of the proposed LSS 4.0 framework for employee occupational exams.

The results reveal that changing the health service supplier in the explored organization caused a substantial raise in occupational exams, leading to increased costs. By using syntactic interoperability, lean, six sigma and DMAIC approaches, improvements were identified, addressing process deviations and information requirements. Implementing corrective actions improved the exam process, reducing the number of exams and associated expenses.

It is important to acknowledge certain limitations, such as the specific context of the case study and the exclusion of certain exam categories.

The practical implications of this research are substantial, providing organizations with valuable managerial insights into improving efficiency, reducing costs and ensuring regulatory compliance while managing occupational exams.

This study fills a research gap by applying LSS 4.0 to occupational exam management, offering a practical framework for organizations. It contributes to the existing knowledge base by addressing a relatively novel context and providing a detailed roadmap for process optimization.

This paper aims to design a hybrid model of knowledge-based performance management system (KBPMS) for facilitating Lean Six-Sigma (L6s) application to increase contractor productivity without compromising human safety in Indonesian upstream oil field operations that manage ageing and life extension (ALE) facilities.

The research design applies a pragmatic paradigm by employing action research strategy with qualitative-quantitative methodology involving 385 of 1,533 workers. The KBPMS-L6s conceptual framework is developed and enriched with the Analytical Hierarchy Process (AHP) to prioritize fit-for-purpose Key Performance Indicators. The application of L6s with Human Performance Modes analysis is used to provide a statistical baseline approach for pre-assessment of the contractor’s organizational capabilities. A comprehensive literature review is given for the main pillars of the contextual framework.

The KBPMS-L6s concept has given an improved hierarchy for strategic and operational levels to achieve a performance benchmark to manage ALE facilities in Indonesian upstream oil field operations. To increase quality management practices in managing ALE facilities, the L6s application requires an assessment of the organizational capability of contractors and an analysis of Human Performance Modes (HPM) to identify levels of construction workers’ productivity based on human competency and safety awareness that have never been done in this field.

The action research will only focus on the contractors’ productivity and safety performances that are managed by infrastructure maintenance programs for managing integrity of ALE facilities in Indonesian upstream of oil field operations. Future research could go toward validating this approach in other sectors.

This paper discusses the implications of developing the hybrid KBPMS- L6s enriched with AHP methodology and the application of HPM analysis to achieve a 14% reduction in inefficient working time, a 28% reduction in supervision costs, a 15% reduction in schedule completion delays, and a 78% reduction in safety incident rates of Total Recordable Incident Rate (TRIR), Days Away Restricted or Job Transfer (DART) and Motor Vehicle Crash (MVC), as evidence of achieving fit-for-purpose KPIs with safer, better, faster, and at lower costs.

This paper does not discuss social implications

This paper successfully demonstrates a novel use of Knowledge-Based system with the integration AHP and HPM analysis to develop a hybrid KBPMS-L6s concept that successfully increases contractor productivity without compromising human safety performance while implementing ALE facility infrastructure maintenance program in upstream oil field operations.

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

This paper aims to explore a framework for implementing Lean Construction (LC) to provide corrective actions for quality defects, customer dissatisfaction and value creation during the construction of megaprojects.

This paper presents a case study involving the construction of the Mohamed VI Tower in Morocco. It is the tallest tower in Africa, with 55 floors and a total height of 250 m. This study of the quality of the work and the involvement of the LC was carried out using the Define–Measure–Analysis–Improve–Control approach from Lean six sigma. It describes the Critical to Quality and analyses the root causes of quality defects, customer dissatisfaction and variation in the quality process.

Firstly, the results of this study map the causal factors of lack of quality as established in the literature. Secondly, the LC tools have reduced non-value-added sources of quality waste and, consequently, improved critical quality indicators.

This document focuses on one part of the tower’s construction and is limited to a project case in a country where LC is rarely used.

This study reinforces the literature reviews, surveys and the small number of case studies that have validated the potential of LC and further clarifies future directions for the practical emergence of this quality improvement approach, especially for large-scale projects.

Managing project completion within the stipulated time is significant to all firms' sustainability. Especially for software start-up firms, it is of utmost importance. For any schedule variation, these firms must spend 25 to 40 percent of the development cost reworking quality defects. Significantly, the existing literature does not support defect rework opportunities under quality aspects among Indian IT start-ups. The present study aims to fill this niche by proposing a unique mathematical model of the defect rework aligned with the Six Sigma quality approach.

An optimization model was formulated, comprising the two objectives: rework “time” and rework “cost.” A case study was developed in relevance, and for the model solution, we used MATLAB and an elitist, Nondominated Sorting Genetic Algorithm (NSGA-II).

The output of the proposed approach reduced the “time” by 31 percent at a minimum “cost”. The derived “Pareto Optimal” front can be used to estimate the “cost” for a pre-determined rework “time” and vice versa, thus adding value to the existing literature.

This work has deployed a decision tree for defect prediction, but it is often criticized for overfitting. This is one of the limitations of this paper. Apart from this, comparing the predicted defect count with other prediction models hasn’t been attempted. NSGA-II has been applied to solve the optimization problem; however, the optimal results obtained have yet to be compared with other algorithms. Further study is envisaged.

The Pareto front provides an effective visual aid for managers to compare multiple strategies to decide the best possible rework “cost” and “time” for their projects. It is beneficial for cost-sensitive start-ups to estimate the rework “cost” and “time” to negotiate with their customers effectively.

This paper proposes a novel quality management framework under the Six Sigma approach, which integrates optimization of critical metrics. As part of this study, a unique mathematical model of the software defect rework process was developed (combined with the proposed framework) to obtain the optimal solution for the perennial problem of schedule slippage in the rework process of software development.

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.