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The patient flow performance achievable by care pathways is constrained by competing flow and resource efficiency, which can negatively impact improvements. This paper probes the divergence between resource and flow efficiency and how care pathways can lead to improved patient flow. By framing the problem through the lens of paradox theory, a set of design principles is proposed to assist decision-makers in care pathway implementation. Implications are derived for research and practice.

The authors used conceptual research to develop design principles for care pathways based on a systematic review of relevant care pathway research. The initial search contained 515 unique articles, resulting in a final sample of 56 studies.

When applying care pathways, patient flow may be negatively affected in relation to the dimensions of bottlenecks, non-value-adding activities, and variability. However, the findings also indicate methods that can be applied to manage organizational paradoxes, which can contribute to more efficient patient flow along each of the three dimensions.

The study is limited to care pathways and therefore could have missed relevant studies in similar fields, such as care coordination.

Health care managers, politicians, and IT developers can apply the proposed design principles when developing, implementing, and improving care pathways and supporting technologies.

While existing research has studied care pathways from a medical perspective, this is the first paper to the author’s knowledge that addresses care pathways directly by considering paradox theory and in light of the operations management literature.

Guidelines stating maximum waiting times fail to take cancer patients’ expectations into account. Therefore, the purpose of this paper is to assess patients’ expectations and experiences with their waiting time at a fast-track clinic.

Patients were selected using a purposeful sampling strategy and were interviewed four times: before the visit; one day after; two weeks after the visit; and one week after starting treatment. Interviews were audiotaped and independently coded by two researchers.

All patients (n=9) preferred a short waiting time before the first visit; they feared that their disease would spread and believed that cancer warrants priority treatment. Six patients experienced the waiting time as short, one had no expectations and two felt they waited longer than expected; three patients changed this evaluation during the study. Six patients received treatment – four preferred to wait before treatment and two wanted to start treatment immediately. Reasons to wait included putting one’s affairs in order, or needing to adjust to the diagnosis.

Cancer patients prefer a short waiting time before the first visit but have different expectations and needs regarding waiting time before treatment. Ideally, their expectations are managed by their treating physician to match waiting time reality.

This is the first study to assess cancer patients’ waiting time experiences and how these experiences change over time. This study paves the way for establishing a framework to better assess patient satisfaction with oncology care waiting time. An important aspect, is managing patients’ expectations.

This paper aims to identify, analyze and categorize the major readiness factors for implementing Lean Six Sigma (LSS) in health-care organizations using total interpretive structural modelling technique. The readiness factors are identified would help the managers to recognize the areas that lack and provide importance to the successful implementation of LSS in those areas. The paper further intends to understand the hierarchical interrelationships among the readiness factors identified using dependence and driving power.

In total, 16 readiness factors are identified from the literature review and expert opinions are collected from hospitals. The scheduled interview is conducted based on a questionnaire survey in hospitals in the Indian context to identify the relevance of the relations among the readiness factors. The expert opinions are used in the initial reachability matrix and interpretative interaction matrix. Matrix impact cross multiplication applied to classification (MICMAC) analysis uses dependence and driving power to understand the hierarchical relationship among the readiness factors identified.

The result indicates that customer-oriented and goal management cultures are the key readiness factors for LSS. The execution technique and training are given according to the current demand of customers and goal change of organization. The manager needs to concentrate more on readiness factors to formulate the execution process of LSS for continuous improvement of the health-care organization. The readiness level helps the manager to identify the target area for LSS execution.

This research focuses mainly on readiness factors for the implementation of LSS in the health-care industry.

This study would be useful for researchers and practitioners to understand the readiness factors before starting the implementation process of LSS.

Many research studies are being done on the success and failure rate of implementation of factors. The present study identifies the readiness factors related to LSS, especially for the health-care industry.

The purpose of this paper is to examine and introduce comprehensive insights into the field of Lean Six Sigma (LSS) by reviewing the existing literature and identifying the research gap. The state of LSS research is assessed by critically examining the field, along with a number of dimensions, including time horizon, year, journal and publisher, university, country, author, geographic analysis, research design, research affairs, research methods, tools/techniques used, focus industries, major research area, benefits gained by LSS, critical success factors and barriers of LSS implementation.

This paper is based on a systematic literature review of 190 articles containing the word LSS in their title, which are published in a well-known database, such as Elsevier ScienceDirect, Taylor and Francis, Emerald Full Text, Springer Link, Wiley InterScience and Inderscience from January 2000 to September 2016.

This analysis reveals 15 significant dimensions to identify the state of LSS research. Authors find a noticeable rise in the attention of LSS research in the available literature. Major findings show that, the empirical research holds greater credibility. Statistics prove that the case study method scores the highest among all the research methods used in the discipline. The largest number of studies have investigated research issues related to implementation and process of LSS. The LSS uses a wide range of tools/techniques/methodologies: the choice of tools is situation-specific. Manufacturing and health-care sectors have been the focus of LSS research, but LSS has also been adopted by other types of industries. The organizations following LSS have improved bottom-line results, improved company profitability and growth and enhanced customer satisfaction. In general the research is more interpretive in nature; there is still a lack of standard in the LSS implementation framework.

This study is limited to reviewing those articles which contain the word LSS appeared in the title.

This study will help understand the current state of research on LSS, various trends in the field, its applicability and future prospects of investigation in the field.

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 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.

Health care organisations implement lean six sigma (LSS) methodology to achieve improved performance in terms of cost, quality and productivity. However, the way it gets implemented differs between organisations. Hence, this paper deal with a review of case studies describing the implementation of LSS in health care organisations to understand the nuances of implementation and identify future research directions.

The journal articles indexed in the Web of Science and Scopus database were filtered out. In total, 154 articles were evaluated using specific structural dimensions to categorise the literature into various groups, and content analysis was performed to synthesise the same.

This review revealed that the number of articles publishing the application of LSS in health care has been increasing in the last five years. Academic hospitals play a pivotal role to bridge the gap between LSS theory and practice. Despite this fact, certain themes remain unexplored. Not many studies are available that document the application of LSS in non-clinical areas such as pharmacy, internal logistics, maintenance and medical records. Only 20% of articles mentioned the post-intervention data up to three years, thus questioning the sustainability aspect of the achieved improvements.

Various research gaps were identified, which can be used by the researchers to build the body of knowledge in the domain of LSS in health care.

This review provides a diversified view regarding the utility of LSS in the health care scenario. The findings will provide valuable insights for the health care practitioners regarding tools, techniques, drivers and performance measures.

To the best of the authors’ knowledge, this is the first study to review only the case studies that describe the implementation of LSS in the health care sector.

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.

The purpose of this paper is to present relationship between operation and management practices analyzing the results achieved by both public organizations prone to deploy Lean Six Sigma (LSS) and public organizations that have already implemented the method. The goal is to support the start of method deployment by public managers and the creation of more efficient and effective processes in public organizations.

An analysis of synergies between findings in the multiple case study carried out in Brazilian public organizations from health and education sectors and successful implementations found in the LSS literature is made.

The fact that this research comprised organizations from different segments allowed good practices and difficulties to be identified in a unique way, adding more value to the research carried out and increasing the potential of support to the public manager. In addition, it was possible to map the most mentioned benefits of LSS deployment in both health and education sectors and link them to systematized LSS practices.

The presenting research should initiate a scientific discussion on public sector areas more prone to LSS and guide researchers in the development of case studies aimed at the application of this method in public organizations in general.

This paper can assist public managers to become aware of the potential of the organization they manage in the adoption of LSS principles and practices enabling a better quality of services provided to citizens.

The finding that public health organizations are more likely to implement LSS principles and practices when compared to public organizations from other segments can guide more in-depth studies that justify why some organizations would be better able to implement the LSS method and others would face more difficulties in a hypothetical deployment.

This paper aims to develop an initial understanding of the Lean Six Sigma methodology since its inception and examine the few Lean Six Sigma dimensions as a research domain through a critical review of the literature.

The paper is structured in two-part. The first part of the paper attempts to dwell on the evolution of the Lean Philosophy and Six Sigma methodology individually and the emergence of Lean Six Sigma methodology, covered under the Lean Six Sigma: a historical outline section. The second part of the study examines the dimensions associated with Lean Six Sigma such as frameworks, critical success factors, critical failure factors, type of industry, performance metric, year, publisher and journal, based on a total of 223 articles published in 72 reputed journals from the year 2000 to 2019 as a literature review.

The adoption of Lean Six Sigma, as a continuous improvement methodology, has grown enormously in the manufacturing and few service sectors such as health care and higher education during the past decade. The study revealed that researchers came out with conceptual frameworks for the implementation of Lean Six Sigma, whereas the validation through case studies seems to be lacking. The integration of Lean Six Sigma and other approaches with a focus on sustainability and the environment has emerged as a research field. A few of the most common critical success and failure factors were identified from the articles studied during the study.

This paper may not have included some of the studies due to the inaccessibility and selection criteria followed for the study.

This paper will provide an initial introduction on Lean, Six Sigma and Lean Six Sigma and research insights Lean Six Sigma to beginners such as students, researchers and entry-level professionals.