Abstract-The success of the implementation of LeanMethodologies and Six Sigma tools has been very well documented, particularly for manufacturing plants. Furthermore, the use of both methodologies, simultaneously, is recommended in scenarios where simplicity and a focus on waste reduction are required. With the objective of taking most of the benefit of the Lean and Six Sigma methodologies, we are interested in designing a framework for the implementation of a Lean Six Sigma (LSS) methodology in an Ecuadorian Children Hospital, where the final goal is to be recognized as a world-class healthcare institution. Abstract-The success of the implementation of Lean Methodologies and Six Sigma tools has been very well documented, particularly for manufacturing plants. Furthermore, the use of both methodologies, simultaneously, is recommended in scenarios where simplicity and a focus on waste reduction are required. With the objective of taking most of the benefit of the Lean and Six Sigma methodologies, we are interested in designing a framework for the implementation of a Lean Six Sigma (LSS) methodology in an Ecuadorian Children Hospital, where the final goal is to be recognized as a world-class healthcare institution. Keywords-Lean

Choosing and designing production planning and control systems are critical tasks because they provide the means to translate the corporate strategy into direct shop floor actions. However, it is not always easy to find the correct systems for an application. This difficulty occurs if the company does not present the necessary criteria for the system, in which case the expected benefits may not be achieved. This study proposes a framework to support the selection or design of a production planning and control system (PPCS) based on the current characteristics of a company. Using relevant parameters, companies are categorized and posteriorly evaluated, identifying the negative and positive relations between the company characteristics and the principles of the evaluated PPCSs. To test the proposed framework, we apply it to determine a suitable system for Ecuadorian small and medium-sized enterprises. Simplified drum buffer rope (S-DBR) approach is found to be a suitable PPCS, and the framework suggested some necessary enhancements to resolve potential weaknesses that could arise during the application of S-DBR.Keywords-production planning and control systems, framework, PPCS selection, small and medium manufacturing enterprises, simplified drum buffer rope

A balanced nursing workload is crucial for patient and staff safety. Although there are several nursing planning models, there is no generic methodology to identify critical workload factors and their relative impact on different healthcare environments. We propose Six Sigma (SS) as a generic methodology and its DMAIC (Define, Measure, Analyze, Improve, Control) framework to identify statistically proven factors that affect nursing workload (NW) in any healthcare environment. Additionally, using a regression model, we estimated their relative importance. For our case study, we found that the number of patients per ward, the number of times medication was administered per shift, the number of nurses and the type of shifts were significant factors in predicting nursing workload. Using their relative importance as input for the nursing planning process, we improved the nursing assignment process performance from 0.09 to 1.05, with an increase in the sigma level from −0.34 to 2.97. Also, we reached the 55% target for the percentage of NW, from a baseline of 50.3%. We also reached the percentage target of NW set by the management of 55%, from the baseline of 50.3%. This study shows that SS can be used effectively to estimate the importance of the main factors that affect nursing workload, providing a methodology to improve the nurse–patient assignment process.