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The purpose of this study is to establish empirical relationships between patient flow problems, healthcare service quality and patient satisfaction with emergency department (ED) service factors from the patient perspective.

In the overall study, of which the current investigation is a part, a mixed-method research approach was to achieve the research objectives. The results reported in this paper are based on a comprehensive questionnaire survey where a well-designed and reliable questionnaire was used to survey ED patients. This study conducted partial least squares structural equation modelling (PLS-SEM) by using Smart PLS software.

Results show that the respondents mostly agreed with the proposed concept of quality in ED and patients were less satisfied with ED services in general and with the internal and external environments in ED in particular. It was found that relationships between nine identified scales of patient flow problems, healthcare service quality, and patient satisfaction are significant. The findings reveal that the relationship between patient flow problems and patient satisfaction is positively mediated through healthcare service quality, which shows the predictive capability of the model, indicating high predictive relevance.

This research involves a relatively small sample from a single case study. The positive relationship between patient flow problems and patient satisfaction indicate practical significance of the model for guiding to improve overall patient satisfaction.

This research, through the involvement of both hospital staff and the patient, brings out a holistic approach in terms of operational excellence in a critical unit such as the ED. The empirically established relationships form the benchmarking and guide for developing guidelines for designing policies for service improvements of ED practices.

Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.

New product development (NPD) is necessary for business sustenance and customer satisfaction. Six Sigma and Design for Lean Six Sigma (DLSS) efficiently employ the repetitive stages for NPD, leading to quality performance and profitability. This study aims to map the quality performance through NPD attributes through the Lean methodology.

The data on NPD were collected from 267 respondents from manufacturing companies to map the relationship between Six Sigma and DLSS for NPD. Confirmatory factor analysis was employed to confirm model fit, while structural equation modeling was employed to analyze the empirical data for framework testing. The study included nine variables and fourteen hypotheses identified from the literature.

The statistical results of this study show that NPD attributes such as innovation, marketing, organization, customer, product and technology positively influence the Lean Six Sigma structured improvement process (LSSSIP) and DLSS. Moreover, integrating these attributes in Lean planning enhance quality performance. This empirical investigation's findings indicate that ten of the 14 hypotheses were supported, giving the study a strong foundation.

The data collection was limited to northern India; therefore, the results may not be generalizable to other areas of the world.

NPD involves handling technical issues and factors such as cost, operational bottlenecks, economic changes, competitors' strategy and company policy. This study helps understand the various NPD parameters and their relationship to Lean, which enables an effective NPD implementation strategy.

The current philosophy of NPD calls for a concurrent engineering approach; therefore, the entire organization must be part of this process. This study uses the holistic framework by optimizing NPD with Lean Six Sigma (LSS) principles. The study is unique in that, to date, research does not integrate NPD attributes with the objectives of LSS to develop an efficient NPD implementation strategy.

Despite extensive research on Lean Six Sigma (LSS), it predominantly remains focussed on organisational aspects. Individual perceptions were often sidelined. Comparative studies about different perspectives of LSS from the point of view of top management, consultants and employees are unavailable. This paper captures the opinions of these stakeholders about different dimensions of LSS and presents the comparison.

Using empirical research, opinion is captured of three LSS stakeholder categories: top management/business owners, facilitators/consultants and practising managers/employees. Their opinions about 15 different perspectives of LSS, including its future in the Industry 4.0/Quality 4.0 era, are evaluated in this study under 95 variables (decision aspects). Comparison among the opinions of these stakeholders is performed using chi-square hypothesis testing and ANOVA (analysis of variance) methods.

In a total of 95 comparisons, a statistically significant difference among different stakeholders' views is observed in 62 cases. In 33 cases, the opinions of the three stakeholder groups can be considered in agreement with one another.

The findings will help different LSS stakeholder groups better understand the expectations of other groups. During LSS implementation, it will help in aligning priorities and achieving success. Theoretically, it will help in narrowing the research gap about the rarity of comparing views of multiple stakeholder groups.

The comparison among views of three critical LSS stakeholder groups – top management/business owners, facilitators/consultants and managers/employees, is currently unavailable, and therefore, this research provides a fresh perspective to an otherwise extensively researched theme. It is immensely helpful in preventing LSS failures arising from misaligned stakeholder views and expectations.

This study aims to identify key supply chain challenges and opportunities of the case of Hong Kong toy manufacturing company during the COVID-19 outbreak and develop a comprehensive structural relationship to rank them.

In this study, a toy model company in Hong Kong is considered to discuss about what challenges and opportunities have the biggest impacts on non-necessary goods companies and how to deal with different impacts on entire supply chain flow disruption during COVID-19. A semi-structured interview with five decision-makers from the company was made to give key challenges and opportunities scores. The Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) technique is used to establish the model and rank them afterward to overcome the challenges.

From the data analysis and results, “salary of employee” and “inconvenient transportation” have emerged as top and bottom key challenges respectively. The sequence of organized challenges in the list needs to mitigate one by one in this order to improve the supply chain performance. The “client's orders’ frequency, customer management” and “supplier/partner relationship management” are identified as the top and bottom respectively to develop the opportunities.

These key challenges and opportunities are identified as contributing attributes and provide the way to measure to improve production, profits and sustainable growth of the toy manufacturing company during a pandemic. Moreover, it helps to improve the distribution level and good planning with appropriate decision making to manage the supply chain performance considering humanitarian aspects during a pandemic outbreak.

The novelty of this study is to identify the key supply chain challenges and opportunities measured by the TOPSIS method to rank them and consider the case of a Hong Kong toy manufacturing company as a case-based approach to measuring its performance during the COVID-19 outbreak.

The study aims to identify Green Lean Six Sigma (GLSS) barriers in the context of Higher Education Institutions (HEIs) and prioritize them for executing the GLSS approach.

A systematic literature review (SLR) was used to identify a total of 14 barriers, which were then verified for greater relevance by the professional judgments of industrial personnel. Moreover, many removal measures strategies are also recommended in this study. Furthermore, this work also utilizes Gray Relational Analysis (GRA) to prioritize the identified GLSS barriers.

The study reveals that training and education, continuous assessment of SDG, organizational culture, resources and skills to facilitate implementation, and assessment of satisfaction and welfare of the employee are the most significant barriers to implementing this approach.

The present study provides an impetus for practitioners and managers to embrace the GLSS strategy through a wide-ranging understanding and exploring these barriers. In this case, the outcomes of this research, and in particular the GRA technique presented by this work, can be used by managers and professionals to rank the GLSS barriers and take appropriate action to eliminate them.

The ranking of GLSS barriers gives top officials of HEIs a very clear view to effectively and efficiently implementing GLSS initiatives. The outcomes also show training and education, sustainable development goals and organizational culture as critical barriers. The findings of this study provide an impetus for managers, policymakers and consultants to embrace the GLSS strategy through a wide-ranging understanding and exploring these barriers.

The GLSS barriers in HEIs may significantly affect the society. HEIs can lessen their environmental effect by using GLSS practices, which can support sustainability initiatives and foster social responsibility. Taking steps to reduce environmental effect can benefit society as a whole. GLSS techniques in HEIs can also result in increased operational effectiveness and cost savings, which can free up resources to be employed in other areas, like boosting student services and improving educational programs. However, failing to implement GLSS procedures in HEIs could have societal repercussions as well. As a result, it is critical for HEIs to identify and remove GLSS barriers in order to advance sustainability, social responsibility and operational effectiveness.

GLSS is a comprehensive methodology that facilitates the optimum utilization of resources, reduces waste and provides the pathway for sustainable development so, the novelty of this study stands in the inclusion of its barriers and HEIs to prioritize them for effective implementation.

The purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process.

A survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED.

The results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times.

The research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process.

This research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.

Although the use of management control systems (MCS) in crisis management has received extensive attention, limited knowledge exists regarding the benefits of the broad scope, timeliness, integration and aggregation dimensions. This study aims at examining the performance implications of the context-structure combinations of pandemic management strategy (PMS), MCS use and pandemic-induced uncertainty of public health institutions (PHIs) in Ghana.

Data were collected using online survey questionnaire where 246 public health managers qualified for the study. Data were analyzed using covariance-based structural equations modeling (version 23).

PMS was found to have a significant and positive impact on three (broad scope, timeliness and aggregation) of the four dimensions. The integrated dimension was statistically insignificant. In addition, the three dimensions had a significant impact on top managers’ satisfaction with MCS use, which in turn impact on cost containment and quality of care. Finally, COVID-19 uncertainty moderated the relationship between MCS use and operational performance.

The three dimensions of broad scope, timeliness and aggregation are critical for PHIs when it comes to crisis management. Moreover, the presence of pandemics strengthens the relationship between top manager use of MCS and performance in health care. More sophisticated MCS information is required when managing pandemic-related crisis by PHIs.

This study presents a theoretical framework that integrates PMS, MCS use and performance of public health care from a contingency perspective. It extends the benefits of contingency theory to include the three dimensions of MCS with respect to crisis management.

This review paper aims to explore and investigate the Quality 4.0 current knowledge, emerging areas, and trends available in the literature and provide insights for future research directions. The bibliometric analysis determines the most prominent journals, authors, countries, articles, and themes. The Citation and PageRank analysis identifies the most influential and prestigious articles. The author's keyword analysis identifies the research theme, patterns, and trends within a particular area of research.

This study utilised the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) declaration as a review protocol, and the data is retrieved accordingly. Therefore, 104 articles from Scopus and 28 from Web of Science were combined in R-Environment, and 25 duplicates were removed using RStudio. Finally, 107 papers were selected for further analysis. After the abstract level screening, the study reviewed 99 articles bibliographically published in peer-reviewed journals from prominent academic databases Scopus and WoS between 2011 to April 2023. We used the VOSviewer software tool for analysing bibliometric networks that allow the construction, visualisation, and exploration of maps based on any form of network data.

The review identified emerging themes: artificial intelligence, digitalization, sustainability, root cause analysis, topic modelling, and digital voice-of-customers. To establish the intellectual structure of the field and identify gaps, co-citation and content analysis were used. The content of 49 papers in the identified clusters was then carefully analysed. The four primary themes are the relationship of Quality 4.0 with Industry 4.0, the conceptualization of Quality 4.0, recommendations for the new Quality 4.0 model, and the impact of Quality 4.0. The findings provide an excellent foundation for future research in this field for policymakers, managers, practitioners, and academia.

This is the first systematic literature review-cum-bibliometric analysis on quality 4.0 that covers the field comprehensively. Based on the present review, the paper proposes six possible future research directions to investigate.

This research aims to analyze the literature on Quality 4.0 and pinpoint the essential factors contributing to its success. Additionally, the research aims to develop a framework that can be used to create a capable workforce necessary for the successful implementation of Quality 4.0.

By following a systematic approach, the authors could ensure that their literature review was comprehensive and unbiased. Using a set of pre-determined inclusion and exclusion criteria, the authors screened 90 research articles to obtain the most relevant and reliable information for their study.

The authors' review identified essential findings, including the evolution of literature in the field of Quality 4.0 and the systematization of previous literature reviews focusing on training and development. The authors also identified several training barriers to implementing Quality 4.0 and proposed a model for building a competent workforce using Kolb's experiential learning model.

The authors' research offers insights into the training barriers that must be considered when building a competent workforce. Using the framework proposed in the authors' research, consultants and managers can better integrate Quality 4.0 into their organizations.

The adoption of Quality 4.0 has significant social implications and is essential for advancing sustainability. It can improve efficiency, reduce waste, minimize environmental impacts and better meet the needs and expectations of stakeholders.

The authors' study stands out as one of the earliest reviews of the literature on Quality 4.0 to incorporate the theory-context-method (TCM) framework, allowing to provide unique insights into future research directions that had not been previously explored.