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Recent years have seen an increased demand for healthcare services, presenting a need to improve service quality through the deployment of sustainable Lean Six Sigma (LSS). This study aims to identify critical success factors (CSFs) of sustainable LSS and prioritize them based on their intensity of importance for the effective implementation of sustainable LSS in the healthcare environment.

The present study identified 33 leading CSFs through a comprehensive literature review and expert experience and classified them into six major categories based on organizational functions. The primacy of these CSFs is established using the best-worst-method (BWM) approach. The significant advantage of this approach is that the decision-maker identifies both the best and worst criteria among alternatives prior to pairwise comparisons, leading to fewer pairwise comparisons and saving time, energy and resources. It also provides more reliable and consistent rankings.

The findings of the present study highlight the economic and managerial (E&M) CSFs as the most significant CSFs among the major category criteria of sustainable LSS-CSFs, followed by organizational (O), knowledge and learning (K&L), technological (T), social and environmental (S&E), and external factors (EF). Similarly, management involvement and leadership to implement sustainable LSS (E&M1), structured LSS deployment training and education (K&L2), and availability of required resources and their efficient utilization (O2) are ranked as the topmost CSFs among sub-category criteria of sustainable LSS-CSFs.

The prioritization of sustainable LSS-CSFs determined in this study can provide healthcare managers, researchers and decision-makers with a better understanding of the influence on effective deployment of sustainable LSS, resulting in improved service quality in hospitals.

This paper is an original contribution to the analysis of CSFs in an Indian healthcare institute, utilizing the BMW method for ranking the sustainable LSS-CSFs. The advantage of utilizing and distinguishing the performance of this approach compared to other MCDA approaches in terms of (1) least pairwise comparison and violation, (2) consistency (3) slightest deviation and (4) conformity.

The purpose of this study is to develop a structured hierarchical interrelationship-based model to evaluate the critical failure factors (CFFs) that affect the sustainable Lean Six Sigma (SLSS) framework implementation in a healthcare organization. Further, solution approaches have been provided that guide to eliminate them.

The CFFs has been identified through empirical study and clustered into six major categories for their better understanding. The interrelation among CFFs has been developed through total interpretive structural modeling (TISM) and classifies the nature using MICMAC technique. Further, prioritized the CFFs based on its driving and dependents power. The methodology enabled the decision-makers, practitioners to systematically analyze the CFFs and develop a structural model for implementing SLSS in the healthcare environment.

A total of 14 leading CFFs have been identified, and 7-level structured interrelationship-based model has been formed. The experts have provided the solution approach after careful analysis of the developed model. Based on the analysis, it was observed that the significant CFFs affect the deployment of the SLSS framework in healthcare organizations.

The structured model and methodological approach have been tested in a healthcare organization. In the future, the approach can be applied in the different service sectors.

The present study has been conducted in a real-time industrial problem. The practitioners, decision-makers and academicians expressed the usefulness of methodology for understanding the CFFs interrelation and their effect on SLSS implementation. This study also guides decision-makers to systematically tackle related problems.

The development of a structured CFFs based model for SLSS framework implementation using the integrated TISM-MICMAC with a detailed solution approach is a unique effort in a healthcare environment.

Operational excellence (OPEX) initiatives such as Lean, Six Sigma, Lean Six Sigma and Agile have some common characteristics that can be understood through their adoption in organizations. The objective of this research is to present the results of an online survey highlighting the most critical reasons for failure of OPEX initiatives.

This study presents the results of a survey from 106 experts from different countries who have been involved in OPEX implementation. The experts were Six Sigma Master Black Belts, Black Belts and Champions from different manufacturing and service organizations. The developed questionnaire was initially tested with the help of seven experts to ensure their technical validity and soundness.

The study found 15% of companies surveyed have not adopted any form of OPEX methodology. The top three reasons for non-adoption of OPEX were also found. In terms of the use of various OPEX methodologies, more than 75% of companies were employing Six Sigma and less than 50% were engaged in Lean initiatives. Another surprising result was that less than 5% of the companies were utilizing Kaizen and other continuous improvement methodologies for improving the efficiency and effectiveness of organizational processes. The study further finds top five failure factors for sustaining OPEX initiatives in manufacturing, service, large and small organizations.

The study reports the outcomes based on an online survey with limited sample size. Moreover, the number of samples from small and medium-sized enterprises (SMEs) was less than 25, and therefore it was difficult to make any robust conclusions in the comparison of failure factors between large enterprises and SMEs.

To the best of the authors’ knowledge, this is the first empirical study that has attempted to explore the reasons for failure of OPEX initiatives. The authors argue that a greater understanding of the reasons for failure of OPEX initiatives can provide an input to develop a framework that can mitigate the failures and costs associated with such failures.

The objective of this paper is to investigate, assess and develop a hierarchical model to evaluate the interrelationship of critical success factors (CSFs) that influence the deployment of Sustainable LSS framework in hospitals. Further, developed model has been validated to investigate its applicability in hospitals towards sustainable LSS implementation.

“Interpretive Structural Modeling” (ISM) has been utilized to develop a convenient hierarchy and contextual relationship of key CSFs throughout the implementation pathway in Indian healthcare industry through systematic literature review and expert opinion, which is ensured by a taxonomy of CSFs using MICMAC (“Matrice d' Impacts Croisés-Multiplication Appliquée á un Classement”) and questionnaire-based survey to empirically validate the model through utilizing “Structural Equation Modelling” (SEM).

In this study, 17 keys CSFs to sustainable LSS implementation in healthcare industry have been investigated, and modeled. “Social and environmental responsibility,” “Financial return and project success stories,” “Top management involvement and leadership to implement Sustainable LSS,” “Availability of required resources, and their efficient utilization” are found to be the most essential CSFs for successful sustainable LSS implementation in healthcare industry. Further, classification of CSFs has been done for better interpretation of their nature using MICMAC approach. Moreover, the applicability of the proposed model has been empirically assessed utilizing SEM.

The scrutiny of data reveals that the initial inputs from experts throughout the ISM pathway could trigger biased inputs into the study and generalization of the results into others, it might be viable that this propounded model might trigger distinct outcomes for contrasting types of healthcare organizations.

This model on sustainable LSS would support the decision-makers, practitioners and researchers to predict key CSFs through deployment and support the existing academic research on sustainable LSS. Accordingly, the focus on the CSFs of the sustainable LSS can be prioritized to diminish waste, and enhance patient satisfaction and safety.

This paper is an original contribution of analysis of CSFs in Indian healthcare industry utilizing an integrated ISM-MICMAC and SEM approach.

This study aims to identify, analyze and rank the critical success factors (CSFs) of Lean Six Sigma (LSS) implementation in Indian manufacturing sector based micro, small and medium enterprises (MSMEs). This study provides critical insight for managers and researchers aspiring for successful implementation of LSS in Indian manufacturing MSMEs.

The CSFs were extracted from literature followed by a questionnaire-based survey from 120 industry professionals with extensive knowledge and experience about LSS working in Indian manufacturing MSMEs. Further, the CSFs were grouped based on their fundamental relevance and ranked using best worst method (BWM) approach using inputs from LSS experts.

This study provides insights on success factors that have helped Indian manufacturing MSMEs to implement LSS. The findings signify that “Strategy based CSFs” were ranked as the top most important factors, followed by two other category factors namely “Bottom-Line CSFs” and “Supplier based and other category-based CSFs”.

The proposed research is specifically relevant to the context of MSMEs in the Indian manufacturing sector. In the future, the same approach can be extended to a global context, encompassing service sector-based MSMEs in healthcare and finance.

This study provides valuable inputs for managers, decision-makers, industrial practitioners and researchers about Indian manufacturing MSMEs. The identified CSFs and their prioritization offer a roadmap for successful adoption of LSS. Managers can allocate resources, and make strategic decisions based on the prioritized CSFs. Decision-makers can align their initiatives with the identified CSFs. Industrial practitioners gain insights to enhance their LSS initiatives, and researchers can focus their efforts on areas critical to LSS implementation in Indian MSMEs. Furthermore, the structured approach employed in this study can be adopted by various MSME sectors globally, thereby broadening the comprehension of LSS implementation.

This study contributes to the existing body of knowledge by addressing the gaps in literature on CSFs related to LSS adoption within Indian manufacturing MSMEs. While LSS has been widely studied, there is limited focus on its adoption in the context of Indian MSMEs. The combination of extensive literature review, questionnaire-based survey and the application of the BWM approach for prioritizing CSFs adds originality to the research.

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.

The purpose of this study is to present the systematic literature review (SLR) on Lean Six Sigma (LSS) by exploring the state of the art on growth of literature on LSS within the manufacturing sector, critical factors to implement LSS, the role of LSS in the manufacturing sector from an implementation and sustainability viewpoint and Industry 4.0 viewpoints while highlighting the research gaps.

An SLR of 2,876 published articles extracted from Scopus, WoS, Emerald Insight, IEEE Xplore, Taylor & Francis, Springer and Inderscience databases was carried out following the protocol of systematic review. In total, 154 articles published in different journals over the past 10 years were selected for quantitative and qualitative analysis which revealed a number of research gaps.

The findings of the SLR revealed the growth of literature on LSS within the manufacturing sector. The review also highlighted the most cited critical success factors, critical failure factors, performance indicators and associated tools and techniques applied during LSS implementation. The review also focused on studies related to LSS and sustainability viewpoint and LSS and Industry 4.0 viewpoints.

The findings of this SLR can help senior managers, practitioners and researchers to understand the current developments and future requirements to adopt LSS in manufacturing sectors from sustainability and Industry 4.0 viewpoints.

Academic publications in the context of the role of LSS in various research streams are sparse, and to the best of the authors’ knowledge, this paper is one of the first SLRs which explore current developments and future requirements to implement LSS from sustainability and Industry 4.0 perspective.

This study investigates the challenges and opportunities that organisations face in implementing Quality 4.0 as an approach to quality management and investigate the current state of Quality 4.0 implementation.

This study uses a qualitative research methodology to interview senior managers from globally based manufacturing and service industries.

The study explicates that most organisations implemented Quality 4.0 to improve their flexibility, efficiency, transparency and productivity while focusing on improving service quality, customer satisfaction and reducing cost. In terms of sustainability of Quality 4.0 the key factors found were a consistent effort from the top management, continuous training to employees, building leadership quality and creating a habit of using Quality 4.0.

The findings of this study offer useful guidance to organisations desirous of implementing Quality 4.0. In addition, the findings have identified key sustainability factors, helping organisations ensure a successful implementation and long-term returns from Quality 4.0.

The findings of this study contribute to the body of knowledge related to Quality 4.0 and help organisations in their digital transformation journey. In addition, it is one of the first studies to investigate the key factors for Quality 4.0 sustainability.

The purpose of this study is to examine the critical failure factors (CFFs) linked to various types of process improvement (PI) projects such as Kaizen, Lean, Six Sigma, Lean Six Sigma and Agile. Proposing a mitigation framework accordingly is also an aim of this study.

This research undertakes a systematic literature review of 49 papers that were relevant to the scope of the study and that were published in four prominent databases, including Google Scholar, Scopus, Web of Science and EBSCO.

Further analysis identifies 39 factors that contribute to the failure of PI projects. Among these factors, significant emphasis is placed on issues such as “resistance to cultural change,” “insufficient support from top management,” “inadequate training and education,” “poor communication” and “lack of resources,” as primary causes of PI project failures. To address and overcome the PI project failures, the authors propose a framework for failure mitigation based on change management models. The authors present future research directions that aim to enhance both the theoretical understanding and practical aspects of PI project failures.

Through this study, researchers and project managers can benefit from well-structured guidelines and invaluable insights that will help them identify and address potential failures, leading to successful implementation and sustainable improvements within organizations.

To the best of the author’s knowledge, this paper is the first study of its kind to examine the CFFs of five PI methodologies and introduces a novel approach derived from change management theory as a solution to minimize the risk associated with PI failure.

The purpose of this study is to identify, evaluate and develop a structured model to measure the interrelation between critical failure factors (CFFs) that affects the implementation of the sustainable Lean Six Sigma (SLSS) framework in a manufacturing organization. Further solution approaches have been provided that inhibit those CFFs and help in successful implementation of the framework.

To find the interrelation among the selected CFFs and develop a systematic structured model, a total interpretive structural modeling (TISM) approach has been used. A 13-level model for selected CFFs has been formed after the application of the TISM approach. Further classification of CFFs has been performed for a better understanding of their nature through MICMAC analysis.

A total of 26 SLSS CFFs have been identified through a detailed study of case organization, various literature reviews and experience of panel experts toward developing a systematic model of CFFs. The solution approach has been provided by panel experts based on their industrial experiences after observing the role of CFFs in the developed model. Based on the analysis, it was found that most dependent and dominant CFFs affect the implementation of the SLSS framework in the case organization.

This study helps SLSS practitioners, project managers, decision-makers and academicians of manufacturing industries to a better understanding of the failure factors and their interrelations while implementing the SLSS framework in manufacturing organizations. This study also guides the systematic solution approach which helps in tackling such problems that occurred in manufacturing organizations.

In this study, the TISM-based structural model of CFFs for implementing the SLSS framework in manufacturing organizations has been proposed which is a very new effort in the area of a manufacturing environment.