Six Sigma in healthcare: a systematic review of the literature
08 May 2018-International Journal of Quality & Reliability Management (Emerald Publishing Limited)-Vol. 35, Iss: 5, pp 1075-1092
TL;DR: The authors believe this is possibly the most comprehensive systematic literature review on the topic and will set the foundation for various research avenues based on the key findings of this study.
Abstract: The purpose of this paper is to illustrate the systematic role played by Six Sigma methodology in improving the quality of healthcare. The literature review identifies the relevant opportunities for successful introduction and development of Six Sigma approach in healthcare sector.,A systematic methodology to identifying literature on Six Sigma in healthcare is presented. Web of Science, Medline, Emerald Insight, ASQ and ProQuest databases (1998-2016) were searched, and 68 papers of fair methodological quality were identified.,The findings of the systematic review reveal a growing interest in research on Six Sigma adoption in healthcare. The findings indicate that Six Sigma applications in healthcare have been focused on the entire hospital with no real focus on a particular department or function. The key findings on benefits, success factors, challenges and common tools of Six Sigma from the existing literature are also presented in the paper.,The papers included in the systematic review were peer-reviewed papers available in English. Due to these limitations, relevant papers may have been excluded. Moreover, the authors have excluded all conference and white papers for their inclusion in this study.,This paper can serve as a guide on how Six Sigma approach can be applied to improve the quality of healthcare. The authors also believe that this is possibly the most comprehensive systematic literature review on the topic and will set the foundation for various research avenues based on the key findings of this study.
Citations
More filters
[...]
TL;DR: The implementation of DTAP allowed the hospital to obtain a significant reduction of LOS with a consequently decrease of costs alleviating the hospital and the society from the socio-economic burden and the morbidity of this pathology.
Abstract: The rise of the mean age incremented the occurrence of femur fractures with respect to the past, leading thus to serious consequences, as regards morbidity and socio-economic impact. The direction of the A.O.R.N. Cardarelli of Naples has introduced a DTAP whose aim was the reduction of LOS. The paper aims to discuss this issue.,The aim of this paper is to analyze the introduction of DTAP, employing Lean Thinking and Six Sigma methodology based on the DMAIC cycle. To evaluate the effectiveness of DTAP, two groups of patients have been observed for 14 months (before and after the implementation of DTAP).,Statistical tests were performed on the groups and graphics were provided to visualize the decrease of LOS (29.9 per cent). The overall population was also divided in subgroups according to six variables potentially influencing LOS.,Authors considered six variables of influences; yet, others could be taken into account in the future.,The decrease of costs due to the management of elderly patients with femur fracture, the optimization of care processes in hospitals and a faster recovery for patients is the tangible contribute of DTAP.,The implementation of DTAP allowed the hospital to obtain a significant reduction of LOS with a consequently decrease of costs alleviating the hospital and the society from the socio-economic burden and the morbidity of this pathology.
29 citations
[...]
TL;DR: This is the first analysis through SS of DTAP showing its positive influences in terms of both socio-economic impact and patients’ outcome, and policy leaders could use this study as an example to evaluate the introduction of the same clinical pathway in other health facilities.
Abstract: The best treatment for femur fractures is the surgical one within 48 h from the admission to the hospital. These fractures have serious consequences, both in terms of morbidity and socio-economic impact. In the hospital A.O.R.N. Cardarelli of Naples in Italy, the mean pre-operative length of hospital stay (LOS) was nine days and just 4 per cent of patients was operated within the suggested time. Therefore, a diagnostic-therapeutic-assistance path (DTAP) was implemented to improve the process.,This paper analyzes two groups of patients (534 and 562, respectively) before and after the introduction of DTAP, through six sigma (SS) based on define, measure, analyze, improve and control cycle. Age, gender, American Society of Anaesthesiologists (ASA) score, cardiovascular diseases, diabetes and allergies were used as independent subgrouping variables. The t-tests and chi-square were performed to compare the groups, tools of SS were used.,The analyses were conducted considering overall patients and some subgroups. The overall reduction in LOS was about 54 per cent, patients without cardiovascular diseases and with a low ASA score had the highest reduction, more than 60 per cent. All the p-values proved a high statistically significant difference between the two groups.,The influence of the Italian health-care system is a minor limitation while, unfortunately, the lack of a follow-up did not allow quantifying the real gain in health of patients. A lean thinking analysis would suit this context.,There are practical advantages for both hospital and patients: the hospital will have an increase in admissions and more beds available, while patients will benefit of a faster intervention and a shorter wait.,This is the first analysis through SS of DTAP showing its positive influences in terms of both socio-economic impact and patients’ outcome. Policy leaders could use this study as an example to evaluate the introduction of the same clinical pathway in other health facilities.
28 citations
[...]
TL;DR: In this article , the authors present the benefits and motivations of integrating Lean Six Sigma (LSS) and Industry 4.0 as well as the critical success factors and challenges within this emerging area of research.
Abstract: PurposeThis purpose of this study is to provide an overview of the current state of research on Lean Six Sigma (LSS) and Industry 4.0 and the key aspects of the relationships between them. The research analyses LSS's evolution and discusses the future role of LSS 4.0 in an increasingly digitalized world. We present the benefits and motivations of integrating LSS and Industry 4.0 as well as the critical success factors and challenges within this emerging area of research.Design/methodology/approachA systematic literature review methodology was established to identify, select and evaluate published research.FindingsThere is a synergistic nature between LSS and Industry 4.0. Companies having a strong LSS culture can ease the transition to Industry 4.0 while Industry 4.0 technologies can provide superior performance for companies who are using LSS methodology.Research limitations/implicationsOne limitation of this research was that as this area is a nascent area, the researchers were limited in their literature review and research. A more comprehensive longitudinal study would yield more data. There is an opportunity for further study and analysis.Practical implicationsThis study reviews the evolution of LSS and its integration with Industry 4.0. Organisations can use this study to understand the benefits and motivating factors for integrating LSS and Industry 4.0, the Critical Success Factors and challenges to such integration.Originality/valueThis is the first systematic literature review on LSS 4.0 and can provide insight for practitioners, organisations and future research directions.
23 citations
[...]
TL;DR: The proposed model is based on the identification of enablers, criteria and attributes to assess the readiness level of a healthcare organization and it helps to improve the readinesslevel for successful implementation of LSS.
Abstract: Lean Six Sigma (LSS) is a widely accepted business improvement methodology in healthcare, which aims to improve operations and quality and reduce cost, medical errors and waiting time by combing the principles of lean thinking with Six Sigma methodologies. To implement LSS successfully in healthcare organizations it is necessary to know the readiness level before starting the change process. Thus, the purpose of this paper is to assess the readiness level for the implementation of LSS in healthcare using a fuzzy logic approach.,The current study uses a fuzzy logic approach to develop an assessment model for readiness to implement LSS. The conceptual model for readiness is developed with 5 enablers, 16 criteria and 48 attributes identified from the literature review. The current study does the study in a medium-size hospital from India.,The fuzzy readiness for implementation of LSS index (FRLSSI) and fuzzy performance importance index (FPII) are calculated to identify the readiness level for the implementation of LSS in the case hospital. The FRLSSI is computed as average ready with (3.30, 5.06 and 6.83) and the FPII computed helps to identify 15 weaker attributes from 48 attributes.,The current study uses only one hospital for study. In the future, the model can be tested in many hospitals.,The current study would be used by the managers of a healthcare organization to identify the readiness level of their organization to implement LSS. The proposed model is based on the identification of enablers, criteria and attributes to assess the readiness level of a healthcare organization and it helps to improve the readiness level to implement LSS effectively.,The present study contributes to the knowledge of readiness for the implementation of LSS in a healthcare organization. The conceptual model is developed for assessing the readiness level of a healthcare organization and it helps to improve the readiness level for successful implementation of LSS. Weaker attributes are identified and necessary corrective actions should be taken by the management to improve the readiness. The continuation of the assessment readiness model over a period of time would help to improve the readiness level of healthcare for the implementation of LSS.
16 citations
[...]
TL;DR: In this paper, a conceptual framework for performance measurement (PM) for the integration of supply chain management (SCM) and quality management (QM) is presented, which can help to improve the overall performance of the supply chain.
Abstract: Purpose
The purpose of this paper is to present a conceptual framework for performance measurement (PM) for the integration of supply chain management (SCM) and quality management (QM).
Design/methodology/approach
A systematic literature review on SCM and QM was conducted to develop key performance measures related to six areas of integration between QM and SCM: leadership; continuous improvement and innovation; sustainability performance; stakeholders; information system; and management and strategic planning.
Findings
Supported by the literature concerning to supply chain quality management (SCQM) integration, a set of nine propositions about performance measures, that contribute to the integration of SCQM, were developed.
Originality/value
This study contributes to QM practices within a supply chain environment from an integrated perspective. Additionally, the propositions have significant implications from both managerial and theoretical perspectives. This study also extends the concept of supply chain quality integration by focusing on key aspects of PM that may help to improve the overall performance of the supply chain.
16 citations
References
More filters
[...]
TL;DR: In this article, the authors examine three aspects of the stakeholder theory and critique and integrate important contributions to the literature related to each, concluding that the three aspects are mutually supportive and that the normative base of the theory-which includes the modern theory of property rights-is fundamental.
Abstract: ?The stakeholder theory has been advanced and justified in the management literature on the basis of its descriptive accuracy, instrumental power, and normative validity. These three aspects of the theory, although interrelated, are quite distinct; they involve different types of evidence and argument and have different implications. In this article, we examine these three aspects of the theory and critique and integrate important contributions to the literature related to each. We conclude that the three aspects of stakeholder theory are mutually supportive and that the normative base of the theory-which includes the modern theory of property rights-is fundamental. If the unity of the corporate body is real, then there is reality and not simply legal fiction in the proposition that the managers of the unit are fiduciaries for it and not merely for its individual members, that they are . . . trustees for an institution [with multiple constituents] rather than attorneys for the stockholders.
9,532 citations
Posted Content•
[...]
TL;DR: The extent to which the process of systematic review can be applied to the management field in order to produce a reliable knowledge stock and enhanced practice by developing context-sensitive research is evaluated.
Abstract: Undertaking a review of the literature is an important part of any research project. The researcher both maps and assesses the relevant intellectual territory in order to specify a research question which will further develop the knowledge base. However, traditional 'narrative' reviews frequently lack thoroughness, and in many cases are not undertaken as genuine pieces of investigatory science. Consequently they can lack a means for making sense of what the collection of studies is saying. These reviews can be biased by the researcher and often lack rigour. Furthermore, the use of reviews of the available evidence to provide insights and guidance for intervention into operational needs of practitioners and policymakers has largely been of secondary importance. For practitioners, making sense of a mass of often-contradictory evidence has become progressively harder. The quality of evidence underpinning decision-making and action has been questioned, for inadequate or incomplete evidence seriously impedes policy formulation and implementation. In exploring ways in which evidence-informed management reviews might be achieved, the authors evaluate the process of systematic review used in the medical sciences. Over the last fifteen years, medical science has attempted to improve the review process by synthesizing research in a systematic, transparent, and reproducible manner with the twin aims of enhancing the knowledge base and informing policymaking and practice. This paper evaluates the extent to which the process of systematic review can be applied to the management field in order to produce a reliable knowledge stock and enhanced practice by developing context-sensitive research. The paper highlights the challenges in developing an appropriate methodology.
5,444 citations
[...]
TL;DR: In this article, the authors evaluate the process of systematic review used in the medical sciences to produce a reliable knowledge stock and enhanced practice by developing context-sensitive research and highlight the challenges in developing an appropriate methodology.
Abstract: Undertaking a review of the literature is an important part of any research project. The researcher both maps and assesses the relevant intellectual territory in order to specify a research question which will further develop the knowledge hase. However, traditional 'narrative' reviews frequently lack thoroughness, and in many cases are not undertaken as genuine pieces of investigatory science. Consequently they can lack a means for making sense of what the collection of studies is saying. These reviews can he hiased by the researcher and often lack rigour. Furthermore, the use of reviews of the available evidence to provide insights and guidance for intervention into operational needs of practitioners and policymakers has largely been of secondary importance. For practitioners, making sense of a mass of often-contrad ictory evidence has hecome progressively harder. The quality of evidence underpinning decision-making and action has heen questioned, for inadequate or incomplete evidence seriously impedes policy formulation and implementation. In exploring ways in which evidence-informed management reviews might be achieved, the authors evaluate the process of systematic review used in the medical sciences. Over the last fifteen years, medical science has attempted to improve the review process hy synthesizing research in a systematic, transparent, and reproducihie manner with the twin aims of enhancing the knowledge hase and informing policymaking and practice. This paper evaluates the extent to which the process of systematic review can be applied to the management field in order to produce a reliable knowledge stock and enhanced practice by developing context-sensitive research. The paper highlights the challenges in developing an appropriate methodology.
4,989 citations
[...]
TL;DR: To better realise the potential benefits of lean thinking, healthcare organisations need to directly involve senior management, work across functional divides, pursue value creation for patients and other customers, and nurture a long-term view of continual improvement.
Abstract: Objective To understand how lean thinking has been put into practice in healthcare and how it has worked. Design A realist literature review. Data sources The authors systematically searched for articles in PubMed, Web of Science and Business Source Premier (January 1998 to February 2008) and then added articles through a snowball approach. Review methods The authors included empirical studies of lean thinking applications in healthcare and excluded those articles that did not influence patient care, or reported hybrid approaches. The authors conducted a thematic analysis based on data collected using an original abstraction form. Based on this, they articulated interactions between context, lean interventions, mechanisms and outcomes. Results The authors reviewed 33 articles and found a wide range of lean applications. The articles describe initial implementation stages and emphasise technical aspects. All articles report positive results. The authors found common contextual aspects which interact with different components of the lean interventions and trigger four different change mechanisms: understand processes to generate shared understanding; organise and design for effectiveness and efficiency; improve error detection to increase awareness and process reliability; and collaborate to systematically solve problems to enhance continual improvement. Conclusions Lean thinking has been applied successfully in a wide variety of healthcare settings. While lean theory emphasises a holistic view, most cases report narrower technical applications with limited organisational reach. To better realise the potential benefits, healthcare organisations need to directly involve senior management, work across functional divides, pursue value creation for patients and other customers, and nurture a long-term view of continual improvement.
500 citations
[...]
TL;DR: In this paper, the integration of lean principles with Six Sigma methodology as a coherent approach to continuous improvement is examined, and a conceptual model for their successful integration is provided. But, although research has been undertaken on the implementation of lean within various industries, the many tools and techniques that form the “tool box”, and its integration with six Sigma (mainly through case studies and action research), there has been little written on the journey towards integration of the two approaches.
Abstract: Purpose – Although research has been undertaken on the implementation of lean within various industries, the many tools and techniques that form the “tool box”, and its integration with Six Sigma (mainly through case studies and action research), there has been little written on the journey towards the integration of the two approaches. This paper aims to examine the integration of lean principles with Six Sigma methodology as a coherent approach to continuous improvement, and provides a conceptual model for their successful integration.Design/methodology/approach – Desk research and a literature review of each separate approach is provided, followed by a view of the literature of the integrated approach.Findings – No standard framework for lean Six Sigma or its implementation exists. A systematic approach needs to be adopted, which optimises systems as a whole, focusing the right strategies in the correct places.Originality/value – This paper contributes to knowledge by providing an insight into the evol...
468 citations