Purpose The purpose of this study was to investigate how Lean Six Sigma (LSS) may help mitigate the impact of COVID-19 within health care environments. The goals of this study were to understand the current knowledge of LSS and COVID-19 through a systematic review of the current literature, identify the gap in the current knowledge of LSS in COVID-19 mitigation within health care environments and define the principles of LSS, within organizational resilience that support a health care organization’s ability to mitigate the impact of COVID-19. Design/methodology/approach A narrative literature review was conducted to identify relevant research. A total of 21 subject matter experts (SMEs) meeting the inclusion criteria were approached through a guided interview process. Content analysis was conducted to describe how LSS principles contribute to supporting health care organizations operating in the era of COVID-19. Findings Study results report that personal safety is the primary subject, followed by supporting dimensions of process redesign, and telemedicine. LSS topics that directly relate to COVID-19 are in four thematic areas: tools, applications, benefits and challenges. Particular areas of application, techniques, challenges and benefits are identified and discussed that could be applied proactively and reactively, to organizational and supply chain resilience to recover from COVID-19. Research limitations/implications There were a number of limitations to the generalizability of this work. The sample size was small and purposeful, thus, external validity of the study results are not determined. The SMEs in this study have not implemented the practices noted in the results at the time of the study, and knowledge of results is limited to the study aims. Originality/value This study of LSS principles and COVID-19 has implications for practitioners and offers specific guidance for areas of health care adoption of LSS techniques and tools that benefit patient safety, challenges for the user to be mindful of and potential benefits in resilience of operations in the era of COVID-19.

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The production of row crops in the Midwestern (Indiana) region of the US has been facing environmental and economic sustainability issues. There has been an increase in trend for the application of fertilizers (nitrogen & phosphorus), farm machinery fuel costs and decreasing labor productivity leading to non-optimized usage of farm inputs. Literature describes how sustainable practices such as profitability (return on investments), operational cost reduction, hazardous waste reduction, delivery performance and overall productivity might be adopted in the context of precision agriculture technologies (variable rate irrigation, variable rate fertilization, cloud-based analytics, and telematics for farm machinery navigation). The literature review describes low adoption of Internet of Things (IoT)-based precision agriculture technologies, such as variable rate fertilizer (39%), variable rate pesticide (8%), variable rate irrigation (4%), cloud-based data analytics (21%) and telematics (10%) amongst Midwestern row crop producers. Barriers to the adoption of IoT-based precision agriculture technologies cited in the literature include cost effectiveness, power requirements, wireless communication range, data latency, data scalability, data storage, data processing and data interoperability. Therefore, this study focused on exploring and understanding decision-making variables related to barriers through three focus group interview sessions conducted with eighteen (n = 18) subject matter experts (SME) in IoT- based precision agriculture practices. Dependency relationships described between cost, data latency, data scalability, power consumption, communication range, type of wireless communication and precision agriculture application is one of the main findings. The results might inform precision agriculture practitioners, producers and other stakeholders about variables related to technical and operational barriers for the adoption of IoT-based precision agriculture practices.

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