Search results

Health care organisations implement lean six sigma (LSS) methodology to achieve improved performance in terms of cost, quality and productivity. However, the way it gets implemented differs between organisations. Hence, this paper deal with a review of case studies describing the implementation of LSS in health care organisations to understand the nuances of implementation and identify future research directions.

The journal articles indexed in the Web of Science and Scopus database were filtered out. In total, 154 articles were evaluated using specific structural dimensions to categorise the literature into various groups, and content analysis was performed to synthesise the same.

This review revealed that the number of articles publishing the application of LSS in health care has been increasing in the last five years. Academic hospitals play a pivotal role to bridge the gap between LSS theory and practice. Despite this fact, certain themes remain unexplored. Not many studies are available that document the application of LSS in non-clinical areas such as pharmacy, internal logistics, maintenance and medical records. Only 20% of articles mentioned the post-intervention data up to three years, thus questioning the sustainability aspect of the achieved improvements.

Various research gaps were identified, which can be used by the researchers to build the body of knowledge in the domain of LSS in health care.

This review provides a diversified view regarding the utility of LSS in the health care scenario. The findings will provide valuable insights for the health care practitioners regarding tools, techniques, drivers and performance measures.

To the best of the authors’ knowledge, this is the first study to review only the case studies that describe the implementation of LSS in the health care sector.

Many healthcare institutions, such as hospitals, have recently implemented quality improvement initiatives such as Lean Six Sigma (LSS). However, only a few have sustained the initiatives and remained successful. One of the main reasons for the failure of LSS implementation is that managers tend to view LSS as individual projects. Managers lack a Change Management (CM) focus during the implementation. The primary purpose of this study is to document the implementation of LSS through a CM approach to improve sustainability.

Define-Measure-Analyse-Improve-Control (DMAIC) and the Awareness-Desire-Knowledge-Ability-Reinforcement (ADKAR), a popular CM approach, are combined to propose a new framework. The usefulness of the proposed framework is demonstrated using a case study in a multispeciality hospital located in southern India.

The study found that several factors are responsible for the high Length of Stay (LOS) for patients in the Emergency Department (ED). By implementing this proposed model to implement LSS and taking corrective actions, the average LOS was reduced from 267 to 158 min (a 40% reduction approximately).

The complete step-by-step approach is explained, and the LOS was considerably reduced during the pilot project. The findings will provide valuable insights for healthcare practitioners to understand the steps involved in the combined DMAIC-ADKAR model. The findings would also give healthcare practitioners the confidence to identify suitable tools and implement LSS in organisations where the practitioners work.

According to the authors' knowledge, this is the first study that synergises two models (DMAIC and ADKAR) into a single framework to implement in a hospital.

The purpose of this study is to develop a theoretical model for consumer behavioral intention by integrating the technology acceptance model (TAM) and the theory of perceived risk, which is tested on the intended use of credit cards in Vietnam.

The data were collected from 485 bank customers through a nationwide online survey. An exploratory and confirmatory factor analyzes were performed to validate the factor structure of the measurement items while structural equation modeling was used to validate the proposed model and testing the hypotheses.

The results of structural equation modeling reveal that perceived risk, perceived usefulness, social influence and perceived ease of use were significant determinants of consumer intention to use a credit card. Of them, only perceived risk discouraged the intended use of a credit card, which was synthesized from psychological, financial, performance, privacy, time, social and security risk.

This study measured the first-order risk dimensions based on the payment function of the credit card only; these measurements missed potential losses relevant to credit function of credit cards.

This study can be beneficial to banks enacting policies to attract more consumers and to help decide how to allocate resources to retain and expand their customer base.

The study adds value to the literature on consumer behavior by confirming the impact of second-order perceived risk on the intended use of credit cards, which most previous studies have not demonstrated. The research also provides an empirical evidence to the academic research platform on e-banking services in Vietnam, especially related to the credit card industry.

The purpose of this paper is to provide an insight into the determinants of the customers’ attitude and behavioural intention to use Internet banking services, paying special attention to the role of perceived risk, trust, enjoyment, website design and social influence.

A research model grounded on the technology acceptance model (TAM) reflecting the effects of trust, perceived risk, perceived enjoyment, perceived website design and social influence on TAM constructs is proposed. The structural equation modelling technique is used to analyse a sample of 697 individual Internet banking users in India through an online survey.

The results of data analysis confirm some of the hypotheses drawn from the literature. Consistent with some of the other studies, perceived usefulness, perceived ease of use, trust and perceived enjoyment are found to be immediate direct determinants of customers’ attitude towards using Internet banking. Attitude, perceived risk, perceived enjoyment and trust determine the customers’ behavioural intentions to use Internet banking. Although the direct effect of perceived website design is significant only on perceived ease of use, its indirect effects are significant on perceived usefulness, attitude and behavioural intentions. Furthermore, perceived enjoyment exerts both direct and indirect effects on perceived usefulness but exerts only direct effect on perceived ease of use.

Generalizability of the research is a practical limitation in consumer research studies and the present study is not an exception to that. The current study focused only on some technological, behavioural and attitudinal factors, and many customer-specific factors and other psychographic and behavioural factors such as cost, perceived value, service quality and satisfaction, which can provide more significant insight into the adoption process, are not a part of the scope of the study.

This research specifies the implications in three perspectives, viz., theoretical, methodological and managerial. Furthermore, this study provides the practical recommendations to enhance customer trust and guidelines to reduce perceived risk. The most significant implication for the banking sector is that apart from offering useful and user-friendly services, they need to build a trusting relationship with customers.

This study extends existing body of Internet banking literature by incorporating trust and risk perceptions. The effects of website design and perceived enjoyment on Internet banking acceptance have been examined and were found to be significant in the Indian context. In addition, it enables us to contribute to the current literature on the emerging Indian Internet banking services (IBS) market, which is largely under-researched.

The purpose of this paper is to explore consumers’ understanding of autonomous driving by comparing perceptions of occasional drivers (ODs) and frequent drivers (FDs).

Data were gathered through semi-structured interviews with 41 drivers. Their responses were categorized into thematic categories or topics on the basis of content analysis, and the topics were structured based on the core-periphery model. Finally, the authors visualized the structure on a perceptual map by adopting a maximum tree approach.

Respondents’ understanding of autonomous driving were categorized into 10 topics. There were significant differences in topics and their relationships between ODs and FDs. Findings also show that FD can better detect hazardousness from autonomous driving environments than ODs.

Differently from prior studies’ focus on its technological aspect and some derived benefits, the study examines it from the viewpoint of consumers, who are critical participants in the dissemination of autonomous driving.

The findings suggest that rather than focusing on developing the highest level of autonomous cars, developing in an evolutionary way by adding automated functions to existing cars can be the better strategy to dominate the autonomous vehicle market.

This study is a pioneering work in that it can be an initial empirical work on autonomous driving from the customer standpoint.

The global automobile industry is striving towards a sustainable future. Emerging countries including India are gearing up for the revolution. Considering the key role of customer acceptance in the success of any technological shift, the study endeavors to ascertain the catalysts accelerating the adoption of Electric Two-Wheelers (E2W) in India by leveraging an extended Unified Theory of Acceptance and Use of Technology-2 model. The same would assist Electric Vehicle (EV) stakeholders in directing their efforts toward pivotal aspects having the potential to significantly bolster E2W penetration.

Data was collected using convenience sampling technique from 1,254 electric two-wheeler owners across four Indian states and analyzed using Structural Equation Modelling.

Performance Expectancy, Price Value and Hedonic Motivation have a significant influence on purchase intention leading to actual buying behavior. Effort Expectancy, Social Influence, habit value and facilitating conditions were insignificant. Pro-Environmental Approach and Government Support significantly impact adoption intention and behavior respectively in addition to model predictors thus supporting the study’s novelty. Purchase intention proved to influence Actual Buying Behavior. Synergized efforts of EV stakeholders towards performance innovation, cost-effectiveness, improved infrastructure and information diffusion on sustainability and user-friendliness could aid in achieving transition to green mobility.

The study predominantly intends to address the intention–behavior gap related to electric two-wheelers in India. Also, two additional constructs, government support and pro-environmental approach, were incorporated resulting in a novel research framework that aims to test their nuanced ability to impact the model predictors.

The purpose of this paper is to investigate the acceptance of mobile advertising by consumers in public service institutions in Lagos Nigeria from the perspective of non-permission-based nature of advertising practice in Nigeria.

Guided by the theory of reasoned action, data were collected from 389 respondents in a sample survey using a structured questionnaire, and the variables were measured on ordinal scale.

The respondents reported that the mobile advertising is informative; they also strongly agreed that the media is ubiquitous but irritating. Attitude of consumers towards mobile advertising, behavioural control and subjective norm have correlations with acceptance. Irritation and informativeness significantly and positively predicted acceptance of mobile advertising, while credibility and ubiquity predicted acceptance of the technology negatively. Age has a negative relationship with acceptance; both gender (male =1) and tertiary education have a significant relationship with acceptance of mobile advertising just as marital status.

The study focused only on public service mobile consumers in Lagos, Nigeria.

Mobile adverts are ubiquitous in Nigeria, but consumers do not trust or use the adverts, although they consider them informative. The telecomm regulatory body needs to control deployment of mobile technologies for produce and service ads, so that ads will be subject to individual choices and discretion, and thereby reducing the ubiquity and increase the trust consumers have on the strategy.

There is hype that mobile advert has penetrated Nigerian market, but the strategy is not credulous to the people.

There is no study focusing on the acceptance of this ad strategy in the public service sector in Nigeria.

India liberalized its economy in 1991, which resulted in intense global competition, quality-conscious and demanding customers. Additionally, significant technological advancements lead to enhancements in products and processes. These forced Indian organizations to adopt innovative business strategies in the past 30 years. Meanwhile, the Lean Six Sigma methodology has significantly grown with vast applicability during the past 30 years. Thus, the purpose of this study is to develop the learning on Lean Six Sigma methodology in the Indian context through investigation of literature.

A three-stage systematic literature review approach was adopted to investigate the literature during the present study. In total, 187 articles published in 62 journals/conference proceedings from 2005 to 2022 (18 years) were shortlisted. The first part of the article summarizes the significant milestones towards the quality journey in the Indian context, along with the evolution of the Lean Six Sigma methodology. The second part examines the shortlisted papers on Lean Six Sigma frameworks, their applicability in industrial sectors, performance metrics, outcomes realized, publication trends, authorship patterns and leading researchers from the Indian perspective.

Lean Six Sigma has emerged as a highly acclaimed and structured business improvement strategy worldwide. The Indian economy has seen remarkable growth in the past decade and is one of the fastest-growing economies in the 21st century. Lean Six Sigma implementation in India has significantly increased from 2014 onward. The study revealed that researchers have proposed several different frameworks for Lean Six Sigma implementation, the majority of which are conceptual. Furthermore, the balanced applicability of Lean Six Sigma in manufacturing and service sectors was observed with the highest implementation in the health-care sector. Additionally, the widely adopted tools, techniques along with performance metrics exploring case studies were reported along with a summary of eminent and leading researchers in the Indian context.

This study is confined to reviewed papers as per the research criteria with a significant focus on the Indian context and might have missed some papers due to the adopted papers selection strategy.

The present study is one of the initial attempts to investigate the literature published on Lean Six Sigma in the Indian context, including perspective on the Indian quality movement. Therefore, the present study will provide an understanding of Lean Six Sigma methodology in the Indian context to graduating students in engineering and management and entry-level executives. The analysis and findings on Lean Six Sigma frameworks, research approach, publications details, etc., will be helpful to potential research scholars and academia. Additionally, analysis of case studies on Lean Six Sigma implementation by Indian industries will assist the managers and professionals in decision making.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

Nowadays, application of biopolymers on geotechnical engineering works is booming to avoid the harsh effects on environment by using conventional methods for soil treatment. In this present study, xanthan gum (XG) is used as a biopolymer to improve dispersive properties of the soils because these soils are easily prone to erosion, which may lead to the damage of many hydraulic structures.

In the present study, attempts are made to reduce the dispersive potential and increase the Strength and erosion resistance by treating the soils with various percentages of XG (0.5%, 1%, 1.5% and 2%). To assess the dispersive potential and erosion resistance of soils, tests such as double hydrometer test, pinhole erosion test, crumb test and cylinder dispersion test were conducted. Further tests were expanded for its geotechnical characteristics such as Atterberg’s limits, standard proctor test, unconfined compressive strength test, one-dimensional consolidation for various curing days. Scanning electron microscopy analysis was also carried out to know the microscopic view towards its particle orientation and bindings. Chemical tests such as sodium absorption ratio, total dissolved solids (TDS) and percentage sodium (PS), electronic conductivity and pH tests were also conducted.

The results revealed that there is a reduction in the dispersive potential of XG treated soils for all the combinations. Addition of XG decreased the PS in the soil as a result dispersivity of soil decreased. Strength and erosion resistance of soil increased with the addition of XG and 1% XG was observed to be the optimum percentage for stabilizing these types of soils.

These results will be very much helpful for engineers when they come across with dispersive soils for better handling and management.

The originality of this study was an attempt towards sustainable development by treating dispersive soils with XG and effects on various geotechnical and dispersive characterizes.