Implementation of DMAIC Cycle to Study the Impact of COVID-19 on Emergency Department-LOS

Lean Six Sigma (LSS) is a methodological approach that originated in industry and has, over time, become increasingly popular in healthcare. Its tool-to, the DMAIC cycle, consisting of 5 main steps, offers methodological rigor that helps improve processes by comparing results quantitatively. In this study, the LSS and in particular the DMAIC cycle was used to investigate the impact of COVID-19 on patients' length of stay in the Emergency Department (ED-LOS) of the Evangelical Hospital "Betania” of Naples (Italy). The study revealed a general increase in ED-LOS due mainly to the new steps that the hospital added to the standard flow, such as those for performing screening swabs, and the reduction of treatment stations, with the exception of patients discharged home for whom there was a statistically significant reduction. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Enhancing sustainable supply chain performance by adopting sustainable lean six sigma-Industry 4.0 practices

PurposeThe Sustainable Lean Six Sigma (SLSS) adoption approach, advancements in Internet technologies and the use of Industry4.0 technologies has resulted in faster customer need fulfilment. The Industry4.0 technologies have resulted in a new paradigm where strategic and operational decisions are in favour of profitability and long-term viability. The purpose of this study is to identify Industry4.0-SLSS practices and sustainable supply chain performance metrics, as well as to develop a framework for decision-makers and managers to make supply chains more sustainable.Design/methodology/approachThe 33 Industry4.0-SLSS practices and 24 performance metrics associated with the sustainable supply chain are shortlisted based on extensive literature review and expert opinion. The Pythagorean Fuzzy Analytical Hierarchy Process (PF-AHP) approach is used to evaluate the weights of Industry4.0-SLSS practices after collecting expert panel opinions. The Weighted Aggregated Sum Product Assessment (WASPAS) methodology used these weights to rank performance metrics.FindingsAccording to the results of PF-AHP, "Product development competencies (PDC)" are first in the class of major criteria, followed by "Advanced technological competencies (ATC)" second, "Organisational management competencies (OMC)" third, "Personnel and sustainable competencies (PSC)" fourth and "Soft Computing competencies (SCC)" fifth. The performance metric "Frequency of NPD" was ranked first by the WASPAS method.Research limitations/implicationsThe proposed paradigm helps practitioners to comprehend Industry4.0 technology and SLSS practices well. The identified practices have the potential to boost the sustainability and supply chain's performance. Organizational effectiveness will benefit from practices that promote a sustainable supply chain and the use of developing technology. Managers can evaluate performance using performance metrics that have been prioritized.Originality/valueThe present study is one of the unique attempts to establish a framework for enhancing the performance of the sustainable supply chain. The idea of establishing Industry4.0-SLSS practices and performance measures is the authors' original contribution.

An integrated Industry 4.0-Sustainable Lean Six Sigma framework to improve supply chain performance: a decision support study from COVID-19 lessons

Purpose: The COVID-19 pandemic era has severely hampered the economy over the globe. However, the manufacturing organizations across all the countries have struggled heavily, as they were among the least who worked on online mode. The organizations are adopting various innovative quality methodologies to improve their performance. In this regard, they are adopting the Sustainable Lean Six Sigma (SLSS) concept and Industry 4.0 technologies to develop products at a faster rate. The use of Industry 4.0 technologies may reduce material movement and supply chain disruptions with the help of smart intelligent systems. There is a strong synergy between SLSS and Industry 4.0 technologies, resulting in an integrated approach for adoption. This study aims to develop a framework that practitioners can use to adopt Industry 4.0-SLSS practices effectively. Design/methodology/approach: This study portrays 31 Industry 4.0-SLSS practices and 22 performance metrics identified through a literature review to improve the manufacturing supply chain performance. To compute the weights of these practices, the Robust Best–Worst Method (RBWM) is used. The Pythagorean fuzzy combined compromise solution (PF-CoCoSo) method is used to rank performance metrics. Findings: According to the RBWM results, "Process Development Practices (PDP)” are first among the major criteria, followed by "Organizational Management Practices (OMP)” at second, "Technology Adoption Practices (TAP)” at third, "Strategy Management Practices (SMP)” at fourth and "Executive Management Practices (EMP)” at fifth, whereas the PF-CoCoSo method resulted in the performance metric "On time product delivery” ranking first. Research limitations/implications: The identified practices have the potential to significantly improve the performance of the manufacturing supply chain. Practices that encourage a sustainable manufacturing supply chain and the usage of emerging technology will benefit organizational effectiveness. Managers can assess performance using prioritized performance metrics. Originality/value: During the COVID-19 pandemic era, this is one of the unique attempts to provide a framework to improve the manufacturing supply chain performance. This study integrates and identifies Industry 4.0-SLSS practices and performance metrics for enhancing overall performance. © 2022, Emerald Group Publishing Limited.

Development of Lean & Six Sigma Integration Model through Axiomatic Design Theory

After Pandemic covid19 Era, Uncertain Rapid changes in product demand, product design and introduction of new products and increasing global Competition require manufacturing systems to be highly flexible, adaptable and responsive. These characteristics of a manufacturing system must be addressed at the design stage. This paper presents a method for design of manufacturing systems by combining Lean Manufacturing and Six Sigma Methodology by the means of Axiomatic Design approach. To achieve the desired goals of a manufacturing enterprise, manufacturing systems must be designed to satisfy a specific set of functional requirements (FRs) and constraints (C).Axiomatic design theory can help you achieve this type of design. This developed Integration model, albeit hypothetical, may be an ideal and practical model for many manufacturing firms competing in consumer-oriented industries with worldwide during this Pandemic Era. © 2021 ACM.

Implementation of Lean Six Sigma in Improving Competitive Advantage through Patient Satisfaction and Nurse Resources to Face the Covid-19 Pandemic at USU Medan Hospital

BACKGROUND: Human resources (HR) are very important in a field, as well as hospitals which are service providers. Once the importance of HR to a development process, so it can be concluded that HR are the core of the development of an agency. The right strategy is needed to find what should be the priority of improvement so that the quality of service can be provided optimally. AIM: One way that can be used is the application of lean six sigma. The application of the Lean six sigma concept can be done in the service and manufacturing industries. One of the service industries that is interesting to apply the Lean six sigma concept is health services through hospitals. METHODS: This concept uses five stages, namely, define (problem identification), measure (measurement of quality performance), analyze (analyze the causes of defects), improvement (make improvement efforts to improve quality), and control or control. The method used in this research is action research with univariate and bivariate analysis. RESULTS: The results of the application of the lean six sigma concept indicate that there are problems in nursing services where nurse services should be a competitive value or competitive advantage from Universitas Sumatera Utara (USU) Hospital in accordance with the hospital’s motto. After the analysis, it was found that there was an influence between rewards on the performance of nurses. CONCLUSION: There needs to be more attention from the hospital on the rewards given to nurses. Because of the nurse is satisfied with the reward given, the performance will be better. and there is no effect of training on the performance of nurses at USU Hospital. This improvement will certainly increase the competitive value or competitive advantage of USU Hospital.

Digital transformations and supply chain management: a Lean Six Sigma perspective

Purpose>With the advent of technological connectivity and access to massive data, the possibilities of augmenting Lean Six Sigma’s Define-Measure-Analyze-Improve-Control (LSS’s DMAIC) problem-solving approach with advanced technologies are enormous. This paper aims to examine digital transformations (DT) of supply chains from a process improvement angle using the LSS DMAIC approach.Design/methodology/approach>This paper uses a case study approach. Three exemplary case studies were examined to shed light on how LSS can aid in DT to achieve enterprise-wide improvements and enhance value across the supply chains.Findings>The paper provides a conceptual framework based on a structured DMAIC problem-solving approach to drive improvements in supply chains. The conceptual framework also provides a systematic approach for big data to be integrated in LSS initiatives to achieve greater supply chain performance.Originality/value>This paper extends research in LSS supply chains by providing a guidance through a conceptual framework that integrate DT and LSS supply chains to support successful digital transformation and LSS supply chains.

IMPLEMENTING LEAN SIX SIGMA IN MICRO, SMALL AND MEDIUM ENTERPRISES FOR COMPETITIVENESS AND RESILIENCE: AN ANALYSIS OF THE AFRICA MSME'S DURING AND AFTER COVID-19

This research aims at evaluating possible ways of implementing the lean six sigma tools and principles to micro, small and medium enterprises (MSMEs) to develop Competitiveness and resilience during and after the pandemic. The emergence of COVID-19's economic repercussion on MSMEs is part of a global a crisis that has positioned SMEs under enormous strain to survive, requiring them to effectively adapt to changes in crisis situations. SMEs make a substantial contribution to various economies globally, as evidenced by the fact that they account for a large portion of the countries' GDP while also providing a source of income for millions of individuals. SMEs are the most susceptible during the pandemic because of their limited access to capital, technology among other causes. This study will provide MSMEs' recommendations and remain competitive through resilience by developing inherent operational excellence for continuous improvement in their business process. Copyright © 2021 by Naudé Scribante. Permission granted to IAMOT to publish and use.

ADDRESSING FOOD PRODUCTION WASTE IN AFRICA: INTEGRATION OF LEAN SIX SIGMA AND INDUSTRY 4.0 TECHNOLOGIES

This research aims to investigate a possible integration between Lean Six Sigma tools and principles and Industry 4.0 technologies to address pre-harvest and post-harvest food waste with a focus on Sub-Saharan Africa. With the projected increase in world population by United Nations to increase by 33% in 2050 and 99% increase in Sub-Saharan African in the same year. These foreseen changes will present global food security concerns in the future, with the greatest demand growth from the Sub-Saharan African region. The United Nations and the Food and Agriculture Organization predict that about 1.3 billion tons of food are globally wasted or lost per year, which also further adds to a global food security concern, bringing about a rise in food prices due to growing consumer demand. To address this impending challenge on food security globally, we aim to introduce analytics by applying advanced information systems synergies with the lean six sigma DMAIC methodology to systematically proffer solutions to production waste by understanding the critical factors responsible and curbing them with the latest innovations. This integration will bring about a more resilient food system, especially during and after the Covid-19. Copyright © 2021 by Naudé Scribante. Permission granted to IAMOT to publish and use.

A Lean Six Sigma Training Providers Transition to a 100% Online Delivery Model

This research is a case study on SQT a leading Irish Lean Six Sigma training provider and their transition to online training and the digitalisation of their Lean Six Sigma training programs and other associated programs during the COVID-19 pandemic. The changes and challenges in transitioning from the existing classroom-based training model are discussed. A quantitative survey and qualitative interviews were carried out with the customers (trainee’s and sponsoring employer organisations/clients) of the Lean Six Sigma trainer provider for 9–12 months. The results of the survey on the customers learning experiences with online Lean training is analysed. The results will demonstrate that the move to online Lean training was positive for both the customers and the training provider in terms of quality of delivery, cost minimisation, elimination of non-value-add travel and classroom time, improved online teamwork, program structure and engagement and enhanced benefits of the application of the learning in the workplace. © 2021, IFIP International Federation for Information Processing.

The Digitalisation and Virtual Delivery of Lean Six Sigma Teaching in an Irish University During COVID-19

This research discusses how lecturers in an Irish university transferred their classroom-based blended learning Lean Six Sigma modules to online delivery. The transfer from a practical classroom environment to an online classroom needed to be seamless in the students Lean active learning experiences. The output of the paper is to discuss the designing of appropriate delivery methods and practical examples, games, scenarios, exercises in a flipped online classroom. Problem-based learning is ideal for teaching lean manufacturing, driven by a problem-solving culture that values learning as a critical output. The design of a “practical problem based” online Kaizen utilising the virtual classroom as an obeya room enabled students to learn Lean Six Sigma tools and practically deploy the tools. Qualitative and quantitative measures were deployed to assess the success of the transition. © 2021, IFIP International Federation for Information Processing.

Managing a lean six sigma project in a remote environment

As a result of the COVID-19 pandemic, organizations are forced to operate in a remote environment with several restrictions on travel, group meetings, and in-person interactions. This is especially difficult for lean six sigma projects where observing the process and interacting with the workers is essential to understanding and improving the process. The Army's Lean Six Sigma methodology includes five phases: Define, Measure, Analyze, Improve, Control;each of these phases includes interaction between the project and process team. This paper focuses on the application of Lean Six Sigma methodology at Tobyhanna Army Depot to help reduce overruns and repair cycle time within the sheet metal cost center. At the initiation of the project, the process incurred over 4000 hours of overruns, a situation in which it takes longer to repair an asset than the standard hours allocated for the repair. Additionally, the average repair cycle time, amount of time required to repair an individual asset, exceeded customer expectations by almost 4 days. The paper discusses how the lean six sigma team executed tradition tools for each phase, like process mapping, data analysis, communication plans, and brainstorming in a remote environment. © 2021 IISE Annual Conference and Expo 2021. All rights reserved.

The impact of Lean Six Sigma practices on supply chain resilience during COVID 19 disruption: a conceptual framework

The purpose of this research is to explore the potential impact of Lean Six Sigma practices on supply chain resilience proposing a conceptual framework. A content analysis method was used to identify themes from the interview data conducted with (n = 21) participants who are involved within the healthcare sector. The first-order coding of interview data performed by the researchers with inter-reliability (k = 0.74) identified IT management, big data analytics, risk management, efficient process management, process reconfiguration and disruption readiness as the emerging themes. The second-order coding of interview data with inter-reliability (k = 0.84) analysed the relationship between the first-order themes exploring the impact of Lean Six Sigma practices on building supply chain resilience. As a result, a framework was developed for achieving resilience in the supply chain through the application of six sigma practices.

Implementation of Lean Six Sigma to Lessen Waiting Times in Public Emergency Care Networks: A Case Study

Emergency Care Networks (ECNs) are integrated healthcare systems comprised of emergency departments (EDs). ECNs are called to be the primary response of healthcare authorities to deal with the expected uptick in the future demands for emergency care during the current Covid-19 pandemic. Lean Six Sigma (LSS) has been proposed to address this challenge since it allows managers to detect factors contributing to the extended waiting times (WT) throughout the patient journey. The suggested framework follows the DMAIC cycle that was initiated with the project charter definition;in the meantime, a SIPOC diagram was drawn to analyze the emergency care process and pinpoint critical process variables. Following this, a nested Gage R&R study was undertaken to study the measurement system performance;subsequently, a normal-based capability analysis was carried out to determine how well the ECN process satisfies the specifications. The next step was to identify the potential causes separating the ECN nodes from the desired target. Afterwards, improvement strategies were devised to lessen the average WT. After suitable data collection, a before-and-after analysis was performed to verify the effectiveness of the implemented strategies. Ultimately, a control plan containing an I-MR control chart was designed to maintain the improvements achieved with the LSS implementation. The results revealed that the average WT of the showcased node passed from 190.02 min to 103.1 min whereas the long-term sigma level increased from −0.06 to 0.11. The proposed framework was validated through a case study including the involvement of a medium-sized hospital from the public sector. © 2021, Springer Nature Switzerland AG.

Íç Denetim Süreçlerini Íyileştirme ve Risk Yönetimi Araçları: Yalın Altı Sigma ve FMEA

Íşletmelerin yapısında var olan karmaşıklık, 2019 yılı itibariyle dünyayı etkisi altına alan COVID-19 salgını ile daha da karmaşık hale gelmiştir. Íşletmelerin iş yapış şekillerini değiştirmesi ve salgından korunmak adına alınan önlemler kapsamında, faaliyetlerin uzaktan yürütülmesi birçok riski de beraberinde getirmiştir. Her geçen gün artan risklerle birlikte, iç denetimin etkin şekilde yürütülmesinin önemi artmış ve yeni yaklaşımların kullanılması zorunlu hale gelmiştir. Bu çalışmada, iç denetimde süreçlerin iyileştirilmesi ve risklerin belirlenmesi aşamalarında kullanılmak üzere, risk yönetim aracı olarak Yalın Altı Sigma kapsamında sunulan Tanımla-Ölçme-Analiz Etme-Íyileştirme-Kontrol (Define-Measure- Analyze-Improvement-Control/DMAIC ) modeli ve bu model içerisine gömülü olan Hata Türü ve Etkileri Analizi (Failure Mode and Effects Analysis-FMEA) aracı olmak üzere iki yaklaşım önerilmiştir. Çalışmada, iç denetimin Yalın Altı Sigma-DMAIC modeli ve Hata Türü ve Etkileri Analizi ile olan ilişkisi incelenmiştir. Süreçlerin iyileştirilmesinde kullanılan birçok yaklaşım olmakla birlikte, çalışma kapsamında önerilen bu iki yaklaşım, özellikle iş süreçlerinin verimliliğine, etkililiğine ve tutumluluğuna odaklanan iç denetimin, riskleri değerlendirmesi, süreçteki zayıflıkları belirlemesi ve iyileştirilmesi için tavsiyelerde bulunmaktadır.Alternate : In addition to the complexity inherent in businesses, the COVID-19 pandemic that affected the world as of 2019 has made this even more complex. Changing the way businesses do business and conducting activities remotely within the scope of the measures taken to protect against the epidemic has brought many risks. With the increasing risks day by day, the importance of conducting internal audit has increased and it has become necessary to use new approaches. In this study, two approaches are proposed as a risk management tool, the Lean Six Sigma-DMAIC model and the Failure Mode and Effects Analysis (FMEA) tool embedded in the DMAIC model, to be used in the stages of improving processes and identifying risks in internal auditing. In the study, the relationship between internal audit and FMEA and Six Sigma was examined. Although there are many approaches used in the improvement of processes, these two approaches suggested within the scope of the study, especially focusing on the efficiency, effectiveness and frugality of business processes, make recommendations for internal audit to assess risks, identify weaknesses in the process and improve them.

Releasing Operating Room Nursing Time to Care through the Reduction of Surgical Case Preparation Time: A Lean Six Sigma Pilot Study.

Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally.

Implementation of lean Six-Sigma project in enhancing health care service quality during COVID-19 pandemic.

The recent outbreak of coronavirus (COVID-19) pandemic has exposed the weakness of the existing healthcare facilities in developing countries, and Pakistan has no exception. The increasing amount of patients has made this condition more vulnerable to failure. It became difficult for health care management to handle the surge of patients. This case study is based on the XYZ hospital system of Pakistan. The hospital initiates passive immunization as a savior in the absence of a vaccine. The process initiates numerous challenges as the same facility was using for passive immunization and routine operations of the hospital. DMAIC lean sig-sigma problem-solving methodology has been adopted to Define, Measure, Analyze, Implement and Control the improvement process for smooth special and routine activities. The staff and patients were interviewed, their issues were listed, and a comprehensive solution was suggested to deal with operational uncertainties. The results identified various factors through VOC and SIPOC processes, prioritized using fishbone diagram, analyzed through Kano model, and finally proposed process improvement by incorporating Kaizen process improvement methodology. Other industries could use this set of tools to evaluate and optimize routine problems, which ultimately enhances the quality and reduces cost.

Lean Six Sigma Redesign of a Process for Healthcare Mandatory Education in Basic Life Support-A Pilot Study.

Healthcare staff are required to undertake mandatory training programs to ensure they maintain key clinical competencies. This study was conducted in a private hospital in Ireland, where the processes for accessing mandatory training were found to be highly complex and non-user friendly, resulting in missed training opportunities, specific training license expiration, and underutilized training slots which resulted in lost time for both the trainers and trainees. A pilot study was undertaken to review the process for accessing mandatory training with a focus on the mandatory training program of Basic Life Support (BLS). This was chosen due to its importance in patient resuscitation and its requirement in the hospital achieving Joint Commission International (JCI) accreditation. A pre- and post-team-based intervention design was used with Lean Six Sigma (LSS) methodology employed to redesign the process of booking, scheduling, and delivery of BLS training leading to staff individual BLS certification for a period of two years. The redesign of the BLS training program resulted in a new blended delivery method, and the initiation of a pilot project led to a 50% increase in the volume of BLS classes and a time saving of 154 h 30 min for staff and 48 h 14 min for BLS instructors. The success of the BLS process access pilot has functioned as a platform for the redesign of other mandatory education programs and will be of interest to hospitals with mandatory training requirements that are already facing healthcare challenges and demands on staff time.

Lean Principles to Improve Quality in High-Throughput COVID-19 Testing Using SwabSeq: A Barcoded Sequencing-Based Testing Platform.

OBJECTIVE: To describe and quantify the effect of quality control (QC) metrics to increase testing efficiency in a high-complexity, Clinical Laboratory Improvement Amendments-certified laboratory that uses amplicon-based, next generation sequencing for the clinical detection of SARS-CoV-2. To enable rapid scalability to several thousands of specimens per day without fully automated platforms, we developed internal QC methods to ensure high-accuracy testing. METHODS: We implemented procedures to increase efficiency by applying the Lean Six Sigma model into our sequencing-based COVID-19 detection. RESULTS: The application of the Lean Six Sigma model increased laboratory efficiency by reducing errors, allowing for a higher testing volume to be met with minimal staffing. Furthermore, these improvements resulted in an improved turnaround time. CONCLUSION: Lean Six Sigma model execution has increased laboratory efficiency by decreasing critical testing errors and has prepared the laboratory for future scaling up to 50,000 tests per day.

Standardization of Procedures to Contain Cost and Reduce Variability of Care After the Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our private and professional routine. In particular, the lockdowns have severely affected the entire healthcare system and hospital activities, forcing it to rethink the protocols in force. We suggest that this scenario, in spite of the new challenges involving so far complex healthcare providers, may lead to the unique opportunity to rethink pathways and management of patients. Indeed, having to resume institutional activity after a long interruption that has completely canceled the previously existing schemes, healthcare providers have the unique opportunity to overcome obsolete and "we have always done in this way" model on the wave of the general desire to resume a normal life. Furthermore, the pandemic has highlighted some flaws in our health system, highlighting those critical issues that most need to be addressed. This article is a review of pre-pandemic literature addressing the use of Lean Six Sigma (LSS) and standardization processes in thoracic surgery to improve efficiency. Our goal is to identify the main issues that could be successfully improved along the entire pathway of a patient from the first referral to diagnosis, hospitalization, and surgical operation up to convalescence. Furthermore, we aim to identify the standardization processes that have been implemented to achieve significant improvements in patient outcomes while reducing costs. The methods and goals that could be used in the near future to modernize our healthcare systems are drawn up from a careful reading and interpretation in light of the pandemic of the most significant review articles in the literature.

Business Sustainability in Post COVID-19 Era by Integrated LSS-AM Model in Manufacturing: A Structural Equation Modeling.

The Manufacturing sector has suffered to a great extent due to global pandemic COVID-19. This pandemic is forcing the manufacturing industries to look forward to a long term and sustainable business plan, which ensures sustainability in three different aspects i.e. Social, Economic, and Environment. This demands a never before need of higher value to the customer in lesser resources. Implementation of innovative approaches of integrated manufacturing practices i.e. Lean Six Sigma (LSS) and Agile Manufacturing (AM) are need of the hour for long-term business sustainability which can be done by ensuring waste elimination and by adjusting the dynamic changes in the demands and requirements simultaneously without compromising in quality. However, the strategic linkage between LSS and AM practices with the three pillars of sustainability has yet not been described in the literature. In this study an integrated model which consists of six constructs i.e. Managerial practices (C1), Organizational culture practices (C2), Technological practices (C3), Economical Aspects (C4), Social Aspects (C5) and Environmental Aspects (C6) was developed. The purpose of the paper is to scrutinize the relationships between the integrated LSS and AM practices and three aspects of sustainability through Structural Equation Modeling (SEM) technique.. The results of this study depict that there is a correlation exists between integrated LSS -AM practices and sustainability pillars that leads to the improvement of firms' business competitiveness. This is one of the premier attempts to develop integrated LSS-AM practices structural model with the sustainability aspects.