Abstract:

Purpose:
The paper aims at investigating the adoption of Lean Six Sigma (LSS) in healthcare, grasping the state of the art and the level of the knowledge in this topic.

Methodology:
A systematic literature review was performed following a detailed review protocol created to select and study the papers interesting for the theme. A descriptive analysis of the selected database was conducted, investigating the year of publication, the country of origin, the journal, the research method. The content analysis was performed to synthesize the objectives, the field of application, the adopted tools and the results of the LSS projects described in the selected papers. Moreover, the authors caught the limitations of the projects and their potential future elements to be considered and improved, the obstacles, the team building, the timing and the methods of data collection of the projects reported in the papers.

Findings:
Searching the keywords “Lean six sigma” AND “health” on the academic databases of PubMed and Web of Science, excluding papers not published in English language and out of the research aim, 43 papers were selected. Most of them are published in journals indexed in Scopus and in PubMed. Half of them regard publication outlets indexed in Web of Science. Moreover, the papers come mostly from USA (65%) and from Europe (28%) and they were published mainly in “Quality Management in Health Care”. The papers are classified into: 5 systematic literature reviews, 1 grey literature review, 4 conceptual papers, 1 opinion paper, a paper with model conceptualization and 32 empirical papers. The projects of LSS reported in that literature were performed mostly in emergency medicine, but there are also projects regarding the improvement of support processes (35%). A multidisciplinary team is usually defined and trained at the beginning of the project. At least one LSS experts employed inside or outside the healthcare organization trains the trainers of the future through an initial training session and coaching the team during the project. Different tools were adopted, mainly using the cycle of Define-Measure-Analyse-Improve-Control (DMAIC), mapping the studied process and adopting techniques of root cause analysis, before defining solutions for process improvement. The types of performances pursued and obtained by implementing those tools and techniques, in the analysed projects, concern the healthcare efficiency and the improvement of clinical quality. Staff development (in terms of improved performance and staff empowerment), and enhanced communication between staff and patients or among healthcare staff come out as additional positive effects of LSS, not explicitly defined in the project objectives. Moreover, the results of the content analysis demonstrate that LSS projects are usually implemented within 6 months, but the assessments of patient and staff satisfaction are neglected in the literature and hence they deserve more attention in future projects.

Implication/ value:
Even if the application of LSS has to be customized to the specific healthcare context, the diffusion of LSS experiences is fundamental to trigger the realization of other projects in the same or in different healthcare settings. The research provides academics and practitioners with the key factors that define successful LSS projects, reducing wastes and variability of processes and improving quality in healthcare.

Keywords:

Lean management, healthcare, lean six-sigma, literature review.