Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors

Abstract

Lean Six Sigma (LSS) has been applied in many healthcare organisations, but there has been limited research on the evolution of LSS application in healthcare. This paper aims to present the challenges, critical success factors (CSFs), readiness factors and most common tools and techniques used for LSS deployment in healthcare. A systematic literature review (SLR) was utilised to research the study objectives. Peer-reviewed literature over a 16-year period was studied to understand the deliverables of LSS. The SLR process identified relevant articles and screened a final selection for those under study. The systematic literature review helped the authors to identify the challenges and tools/techniques used for LSS in healthcare. Several CSFs and readiness factors for LSS deployment in healthcare are also presented. This work informs healthcare managers and professionals on the important factors for successful LSS deployment before embarking on the LSS journey. In addition, this work is a valuable resource for healthcare LSS practitioners and academic researchers to learn about, investigate and deploy LSS in the healthcare sector. This study is one of the most comprehensive SLRs covering the importance and specificity of understanding challenges, CSFs and organisational readiness for LSS in healthcare. This study provides knowledge of the successful deployment of LSS in healthcare.

Lean Six Sigma and quality performance in Italian public and private hospitals: a gender perspective

“…The loss of available resources and increasing demand for qualified services provides a search for solutions aimed at increasing productivity through the reduction of various forms of waste (McDermott et al, 2022). In addition, continuous service improvement is the cornerstone of patient-centred prerogatives of healthcare systems (Ciasullo et al, 2020).…”

“…Public and private healthcare systems face extremely delicate environmental contingencies. The loss of available resources and increasing demand for qualified services provides a search for solutions aimed at increasing productivity through the reduction of various forms of waste (McDermott et al. , 2022).…”

A cross-organizational Lean deployment in an Italian regional healthcare system

“…Authors investigating this issue argue that failures are due to the inability of organizations to deal with critical failure factors and to define effective paradigm introduction and diffusion strategies based on internal and external contextual factors (Coles et al, 2017). While contextual factors refer either to the structural, managerial and cultural characteristics of organizations or exogenous environmental factors in the state before the Lean introduction, critical failure factors refer to organizational barriers during the Lean dissemination phase (Coles et al, 2017;McDermott et al, 2022a). The failure factors related to the internal Lean context and those factors most critical to consider are not managing benchmarking activities (van Rossum et al, 2016), thinking in "silos" in administrative and clinical areas (de Souza and Pidd, 2011), the lack of confidence in applying Lean methodology (McDermott et al, 2022a), the absence or Lean deployment in the healthcare system ineffectiveness of communication systems (Al-Balushi et al, 2014;de Souza and Pidd, 2011), the inability to manage cross-functional teams (Bhat et al, 2019;McDermott et al, 2022a), and, most importantly, the lack of a project management approach and skillset (Henrique et al, 2021).…”

“…Lean management has been recognized as one of the most effective operational excellence methodologies to improve operational performance and the reduction of waste (Graban, 2016). Interest in Lean in healthcare has grown among researchers and practitioners in recent years (Al-Balushi et al, 2014;McDermott et al, 2022a). Many examples of Lean hospital applications have been published (Ahmed et al, 2018;Rosa et al, 2023a).…”

The existence of Human resource development (HRD) on the development of employee creativity

“…Workshops, coaching, mentorship, and projects involving cross-departmental teams are all examples of human resource development programs and activities that can contribute to a more welcoming workplace culture that recognizes and supports employees' ability to think creatively. Human resource development (HRD) also facilitates alignment of employee goals with organizational objectives, which boosts motivation and engagement and, in turn, drives innovation and creativity (McDermott et al, 2022).…”