Lean Six Sigma for the healthcare sector: a multiple case study analysis from the Indian context

Shreeranga Bhat, Jiju Antony*, E. V. Gijo, Elizabeth A. Cudney

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Citations (Scopus)


Purpose: The purpose of this paper is to explore the voice of the customer, key performance indicators, critical to quality characteristics, critical success factors, and commonly used tools and techniques for deploying the Lean Six Sigma (LSS) strategy in Indian private hospitals, with special attention to the medical records. Design/methodology/approach: The study utilizes the action research methodology to obtain a greater understanding of the use of LSS in the Indian healthcare sector. Multiple case studies were designed and successfully deployed to understand and ascertain challenges in LSS implementation. Five case studies were carried out in the Medical Records Departments (MRD) of four private hospitals in India. Findings: Patients perceive that waiting in queue harms their health, which can be rectified by addressing the cycle time of the system. The research also found that effective leadership, availability of data, involvement of cross-functional team and effective communication are critical to the success of LSS projects. In addition, control charts, cause and effect diagram, 5S, gemba, two-sample t-test, standardization, waste analysis and value stream mapping are some of the common tools used to improve healthcare systems. Research limitations/implications: The research was restricted to studying the impact of LSS on the workflow and resource consumption of the MRD in Indian allopathic hospitals only. The validity of the results can be improved by including more hospitals and more case studies from the healthcare sector in different countries. Originality/value: The findings will enable researchers, academicians and practitioners to incorporate the results of the study in LSS implementation within the healthcare system to increase the likelihood of successful deployment. This will provide greater stimulus across other departments in the hospital sector for wider and broader application of LSS for creating and sustaining process improvements.

Original languageEnglish
Pages (from-to)90-111
Number of pages22
JournalInternational Journal of Quality and Reliability Management
Issue number1
Early online date30 Sept 2019
Publication statusPublished - 2020


  • Healthcare
  • India
  • Lean
  • Lean Six Sigma
  • Medical records
  • Six Sigma

ASJC Scopus subject areas

  • General Business,Management and Accounting
  • Strategy and Management


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