Review of Contemporary Business Research

Six-Sigma And Lean Thinking in Healthcare: A Comprehensive Literature Review And Critical Assessment
Eisenhower C. Etienne, Ph.D; Mineke E. Etienne, MD, FACFP

Abstract
Purpose: This paper undertakes a comprehensive review of the literature on six-sigma and lean thinking in healthcare as the basis for critically evaluating current success in their deployment in the healthcare industry. Design/methodology/approach: A reasonably exhaustive search of the literature was undertaken. This search targeted both research on six-sigma and lean thinking and specific research on six-sigma and lean thinking in healthcare. Findings: Five conclusions emerge from the review. First, the measurable impact of six-sigma and lean thinking on the quality, cost, responsiveness and efficiency of healthcare organizations as evidenced by the results reported for improvement projects is modest, at best. Second, six-sigma and lean thinking improvement projects have targeted a very limited range of areas. There is no evidence of attempt to evaluate the extent to which these improvement were long lasting or permanent. Third, the improvement projects uncovered by our literature review generally leave untouched the core technologies, practices and methods of medical practice and delivery of healthcare. This means that none of the cases reported targeted or achieved the deep and permanent culture change that is the sine qua non of six-sigma and lean thinking implementation. Fourth, we uncovered no case of a healthcare organization that can be said to be prototypical six-sigma or lean thinking one of the calibre of Toyota Production System (TPS) or GE Capital. Finally, our research found no systematic attempt to build a theory of healthcare service delivery processes/operations. Such a theory is a pre-requisite to the systematic adaptation of six-sigma and lean thinking in these organizations. Originality/value: First, this research has documented the state-of-the-art on the deployment of six-sigma and lean thinking in healthcare. Such documentation is the first step in any systematic effort to identify areas where progress has been made as well as avenues for further research. The review demonstrates that very little systematic deployment of six-sigma and lean thinking in healthcare has been achieved and that the field of research is fundamentally wide open. Second, the review provides rather conclusive evidence that pronouncements to the contrary, the broad applicability of six-sigma and lean thinking, as these paradigms were originally conceived of and as they are currently used to guide research in healthcare, is far from established. Third, the very weak results of research undertaken thus far speak rather forcefully to the need to make radical change in the six-sigma and lean thinking paradigms to make them applicable to healthcare organizations. Fourth, the identification of a need for a theory of healthcare organizations may prove to be significant for the deployment of six-sigma and lean thinking in healthcare.

Full Text: PDF     DOI: 10.15640/rcbr.v9n1-2a2