Purpose The purpose of this paper is to evaluate the limitations and emerging trends of Six Sigma through an empirical study. Six Sigma is one of the most powerful business process improvement strategies used by numerous World Class corporations for over three decades. A handful of existing publications address some limitations and potential trends of Six Sigma, yet there are no empirical studies investigating the fundamental limitations and emerging trends of Six Sigma. Design/methodology/approach The authors developed an online survey instrument based on the existing literature addressing the above. In this study, 61 Six Sigma Master Black Belts and Black Belts from large manufacturing companies and 25 academics who are familiar with the Six Sigma topic participated and contributed to the research. Findings The study reports the top 5 limitations and emerging trends of Six Sigma from the viewpoints of both academics and experts from large manufacturing companies. These are: integration of Six Sigma with Big Data, use of Six Sigma in small medium and micro enterprises, over emphasis of Six Sigma on variability reduction, poor implementation of Six Sigma and its negative impact on employee satisfaction and non-exploitation of integration of Six Sigma with Industry 4.0. Practical implications In order to sustain Six Sigma initiatives, it is imperative that limitations and fundamental gaps are understood, and strategies developed to address them. The authors argue that leading academic scholars have a vital role to play in working with industry practitioners to overcome the limitations and emerging trends addressed above. Originality/value To the best of the authors’ knowledge, this is the first empirical study looking into the limitations, research gaps and emerging trends of Six Sigma.

Purpose Process improvement initiatives, such as Lean, Six Sigma and Lean Six Sigma, typically have common characteristics that are carried through projects. Whilst a project’s performance is an important determinant of the successful implementation of continuous improvement (CI) initiatives, its failure can undermine the impact of any CI initiative on business performance. As a result, an understanding of the reasons of process improvement project failures is crucial. The purpose of this paper is to present the results of a pilot survey highlighting the most common reasons for process improvement project failures. Design/methodology/approach This paper presents a pilot survey of 42 Brazilian manufacturing specialists who have been involved in process improvement projects. The participants of this survey were Six Sigma Master Black Belts, Black Belts, Green Belts and Six Sigma champions from manufacturing companies in Brazil. The survey questionnaire was piloted with five experts in the field in order to ensure that the questions were valid and technically sound. Findings The execution of Six Sigma projects in organizations results in a moderate rate of project failures. These failures can cost organizations several millions of dollars especially within the context of larger organizations. The main reasons for project failure, as cited by the specialists include: resistance to change, lack of commitment and support from top management and incompetent teams. Research limitations/implications The authors report the findings from a pilot survey having a limited sample size. Moreover, the data have been collected from one country and primarily from large manufacturing companies. Originality/value To the best of the authors’ knowledge, this is the first empirical study looking into the reasons for process improvement project failures. The authors argue that if the top reasons for such failures are understood, a framework can be developed in the future that can mitigate the chance of project failures during project execution. This could potentially lead to significant savings to the bottom-line of many organizations.

Purpose: Medication errors are a significant cause of injury in Norwegian hospitals.The purpose of this study is to explore how Lean Six Sigma has been utilised in the Norwegian public healthcare context to reduce medication errors.Design/Methodology/Approach: A mixed method approach was used to gather data from participants working in the four regions served by the Norway Health Authorities. A survey questionnaire was distributed to 38 healthcare practitioners and semi-structured interviews were conducted with 12 healthcare practitioners. Findings:The study finds that the implementation of Lean Six Sigma in the Norwegian public healthcare context is still in its infancy. This is amidst the several challenges faced by Norwegian hospitals, such as a lack of top management support, lack of LSS training and coaching and a lack of awareness around the benefits of LSS in healthcare.Research limitations/Implications: Due to the large geographical area, it was difficult to reach participants from all health regions in Norway. However, the study managed to assess the current status of LSS implementation through the participants' perspectives. This is a fruitful area for future research whereby an action research methodology could be employed.Originality/Value: To the best of the authors' knowledge, this is the first empirical study into the use of LSS methodology in reducing medication errors. In addition, this study is valuable for healthcare practitioners and professionals as a guideline to achieve the optimal benefit of Lean and Six Sigma implementation in order to reduce medication errors.

Background Technology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area. Objective The aim of this QES was to explore key stakeholders’ experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation. Methods QES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders’ experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research). Results A total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use. Conclusions This review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology.

PurposeThe purpose of this paper is to illustrate the use of Lean Six Sigma (LSS) and its associated tools to reduce dispensing errors in an inpatient pharmacy of a teaching hospital in Thailand.Design/methodology/approachThe action research methodology was used to illustrate the implementation of Lean Six Sigma through the collaboration between the researcher and participants. The project team followed the Lean Six Sigma Define, Measure, Analyze, Improve, Control (DMAIC) methodology and applied its tools in various phases of the methodology.FindingsThe number of dispensing errors decreased from 6 to 2 incidents per 20,000 inpatient days per month between April 2018 and August 2019 representing a 66.66% reduction. The project has improved the dispensing process performance resulting in dispensing error reduction and improved patient safety. The communication channels between the hospital pharmacy and the pharmacy technicians have also been improved.Research limitations/implicationsThis study was conducted in an inpatient pharmacy of a teaching hospital in Thailand. Therefore, the findings from this study cannot be generalized beyond the specific setting. However, the findings are applicable in the case of similar contexts and/or situations.Originality/valueThis is the first study that employs a continuous improvement methodology for the purpose of improving the dispensing process and the quality of care in a hospital. This study contributes to an understanding of how the application of action research can save patients' lives, improve patient safety and increase work satisfaction in the pharmacy service.