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PurposeThe purpose of this study is to develop a structured hierarchical interrelationship-based model to evaluate the critical failure factors (CFFs) that affect the sustainable Lean Six Sigma (SLSS) framework implementation in a healthcare organization. Further, solution approaches have been provided that guide to eliminate them.Design/methodology/approachThe CFFs has been identified through empirical study and clustered into six major categories for their better understanding. The interrelation among CFFs has been developed through total interpretive structural modeling (TISM) and classifies the nature using MICMAC technique. Further, prioritized the CFFs based on its driving and dependents power. The methodology enabled the decision-makers, practitioners to systematically analyze the CFFs and develop a structural model for implementing SLSS in the healthcare environment.FindingsA total of 14 leading CFFs have been identified, and 7-level structured interrelationship-based model has been formed. The experts have provided the solution approach after careful analysis of the developed model. Based on the analysis, it was observed that the significant CFFs affect the deployment of the SLSS framework in healthcare organizations.Research limitations/implicationsThe structured model and methodological approach have been tested in a healthcare organization. In the future, the approach can be applied in the different service sectors.Practical implicationsThe present study has been conducted in a real-time industrial problem. The practitioners, decision-makers and academicians expressed the usefulness of methodology for understanding the CFFs interrelation and their effect on SLSS implementation. This study also guides decision-makers to systematically tackle related problems.Originality/valueThe development of a structured CFFs based model for SLSS framework implementation using the integrated TISM-MICMAC with a detailed solution approach is a unique effort in a healthcare environment.