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Lean, Six Sigma, and Simulation: Evidence from Healthcare Interventions

Author

Listed:
  • Diego Tlapa

    (Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 23080, Mexico)

  • Ignacio Franco-Alucano

    (Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 23080, Mexico)

  • Jorge Limon-Romero

    (Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 23080, Mexico)

  • Yolanda Baez-Lopez

    (Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 23080, Mexico)

  • Guilherme Tortorella

    (Department of Mechanical Engineering, University of Melbourne, Melbourne, VIC 3010, Australia
    IAE Business School, Universidad Austral, Buenos Aires B1630FHB, Argentina
    Department of Systems and Production Engineering, Universidade Federal de Santa Catarina, Florianopolis 88040, Brazil)

Abstract

In the Industry 4.0 era, healthcare services have experienced more dual interventions that integrate lean and six sigma with simulation modeling. This systematic review, which focuses on evidence-based practice and complies with the PRISMA guidelines, aims to evaluate the effects of these dual interventions on healthcare services and provide insights into which paradigms and tools produce the best results. Our review identified 4018 studies, of which 39 studies met the inclusion criteria and were selected. The predominantly positive results reported in 73 outcomes were mostly related to patient flow: length of stay, waiting time, and turnaround time. In contrast, there is little reported evidence of the impact on patient health and satisfaction, staff wellbeing, resource use, and savings. Discrete event simulation stands out in 74% of the interventions as the main simulation paradigm. Meanwhile, 66% of the interventions utilized lean, followed by lean-six sigma with 28%. Our findings confirm that dual interventions focus mainly on utilization and access to healthcare services, particularly on either patient flow problems or problems concerning the allocation of resources; however, most interventions lack evidence of implementation. Therefore, this study promotes further research and encourages practical applications including the use of Industry 4.0 technologies.

Suggested Citation

  • Diego Tlapa & Ignacio Franco-Alucano & Jorge Limon-Romero & Yolanda Baez-Lopez & Guilherme Tortorella, 2022. "Lean, Six Sigma, and Simulation: Evidence from Healthcare Interventions," Sustainability, MDPI, vol. 14(24), pages 1-25, December.
  • Handle: RePEc:gam:jsusta:v:14:y:2022:i:24:p:16849-:d:1004595
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    References listed on IDEAS

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    1. Syed Salleh & Praveen Thokala & Alan Brennan & Ruby Hughes & Andrew Booth, 2017. "Simulation Modelling in Healthcare: An Umbrella Review of Systematic Literature Reviews," PharmacoEconomics, Springer, vol. 35(9), pages 937-949, September.
    2. Carlos Zepeda-Lugo & Diego Tlapa & Yolanda Baez-Lopez & Jorge Limon-Romero & Sinue Ontiveros & Armando Perez-Sanchez & Guilherme Tortorella, 2020. "Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review," IJERPH, MDPI, vol. 17(15), pages 1-24, August.
    3. Ailish Daly & Nicola Wolfe & Seán Paul Teeling & Marie Ward & Martin McNamara, 2021. "Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach," IJERPH, MDPI, vol. 18(22), pages 1-15, November.
    4. Baril, Chantal & Gascon, Viviane & Miller, Jonathan & Côté, Nadine, 2016. "Use of a discrete-event simulation in a Kaizen event: A case study in healthcare," European Journal of Operational Research, Elsevier, vol. 249(1), pages 327-339.
    5. Mazen Hassanain & Mohammed Zamakhshary & Ghada Farhat & Ahmed Al-Badr, 2017. "Use of Lean methodology to improve operating room efficiency in hospitals across the Kingdom of Saudi Arabia," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(2), pages 133-146, April.
    6. Giovanni Improta & Guido Guizzi & Carlo Ricciardi & Vincenzo Giordano & Alfonso Maria Ponsiglione & Giuseppe Converso & Maria Triassi, 2020. "Agile Six Sigma in Healthcare: Case Study at Santobono Pediatric Hospital," IJERPH, MDPI, vol. 17(3), pages 1-17, February.
    7. Hicks, Chris & McGovern, Tom & Prior, Gary & Smith, Iain, 2015. "Applying lean principles to the design of healthcare facilities," International Journal of Production Economics, Elsevier, vol. 170(PB), pages 677-686.
    8. Cagatay Tasdemir & Rado Gazo, 2018. "A Systematic Literature Review for Better Understanding of Lean Driven Sustainability," Sustainability, MDPI, vol. 10(7), pages 1-54, July.
    9. Davies, R & Davies, HTO, 1994. "Modelling patient flows and resource provision in health systems," Omega, Elsevier, vol. 22(2), pages 123-131, March.
    10. Eva K. Lee & Hany Y. Atallah & Michael D. Wright & Eleanor T. Post & Calvin Thomas & Daniel T. Wu & Leon L. Haley, 2015. "Transforming Hospital Emergency Department Workflow and Patient Care," Interfaces, INFORMS, vol. 45(1), pages 58-82, February.
    11. Miguel Ortiz-Barrios & Juan-José Alfaro-Saiz, 2020. "An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-28, June.
    12. D’Andreamatteo, Antonio & Ianni, Luca & Lega, Federico & Sargiacomo, Massimo, 2015. "Lean in healthcare: A comprehensive review," Health Policy, Elsevier, vol. 119(9), pages 1197-1209.
    13. Mohammad Asif Salam & Sami A. Khan, 2016. "Value creation through lean management: a case study of healthcare service operations," International Journal of Services and Operations Management, Inderscience Enterprises Ltd, vol. 25(3), pages 275-293.
    14. Lisa O’Mahony & Kerrie McCarthy & Josephine O’Donoghue & Seán Paul Teeling & Marie Ward & Martin McNamara, 2021. "Using Lean Six Sigma to Redesign the Supply Chain to the Operating Room Department of a Private Hospital to Reduce Associated Costs and Release Nursing Time to Care," IJERPH, MDPI, vol. 18(21), pages 1-14, October.
    15. Diego Tlapa & Guilherme Tortorella & Flavio Fogliatto & Maneesh Kumar & Alejandro Mac Cawley & Roberto Vassolo & Luis Enberg & Yolanda Baez-Lopez, 2022. "Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review," IJERPH, MDPI, vol. 19(15), pages 1-23, July.
    16. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    17. Agnetis, Alessandro & Bianciardi, Caterina & Iasparra, Nicola, 2019. "Integrating lean thinking and mathematical optimization: A case study in appointment scheduling of hematological treatments," Operations Research Perspectives, Elsevier, vol. 6(C).
    18. Shivam Gupta & Sachin Modgil & Angappa Gunasekaran, 2020. "Big data in lean six sigma: a review and further research directions," International Journal of Production Research, Taylor & Francis Journals, vol. 58(3), pages 947-969, February.
    19. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
    20. Jahangirian, Mohsen & Eldabi, Tillal & Naseer, Aisha & Stergioulas, Lampros K. & Young, Terry, 2010. "Simulation in manufacturing and business: A review," European Journal of Operational Research, Elsevier, vol. 203(1), pages 1-13, May.
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