Purpose The purpose of this paper is to evaluate the limitations and emerging trends of Six Sigma through an empirical study. Six Sigma is one of the most powerful business process improvement strategies used by numerous World Class corporations for over three decades. A handful of existing publications address some limitations and potential trends of Six Sigma, yet there are no empirical studies investigating the fundamental limitations and emerging trends of Six Sigma. Design/methodology/approach The authors developed an online survey instrument based on the existing literature addressing the above. In this study, 61 Six Sigma Master Black Belts and Black Belts from large manufacturing companies and 25 academics who are familiar with the Six Sigma topic participated and contributed to the research. Findings The study reports the top 5 limitations and emerging trends of Six Sigma from the viewpoints of both academics and experts from large manufacturing companies. These are: integration of Six Sigma with Big Data, use of Six Sigma in small medium and micro enterprises, over emphasis of Six Sigma on variability reduction, poor implementation of Six Sigma and its negative impact on employee satisfaction and non-exploitation of integration of Six Sigma with Industry 4.0. Practical implications In order to sustain Six Sigma initiatives, it is imperative that limitations and fundamental gaps are understood, and strategies developed to address them. The authors argue that leading academic scholars have a vital role to play in working with industry practitioners to overcome the limitations and emerging trends addressed above. Originality/value To the best of the authors’ knowledge, this is the first empirical study looking into the limitations, research gaps and emerging trends of Six Sigma.

Purpose Process improvement initiatives, such as Lean, Six Sigma and Lean Six Sigma, typically have common characteristics that are carried through projects. Whilst a project’s performance is an important determinant of the successful implementation of continuous improvement (CI) initiatives, its failure can undermine the impact of any CI initiative on business performance. As a result, an understanding of the reasons of process improvement project failures is crucial. The purpose of this paper is to present the results of a pilot survey highlighting the most common reasons for process improvement project failures. Design/methodology/approach This paper presents a pilot survey of 42 Brazilian manufacturing specialists who have been involved in process improvement projects. The participants of this survey were Six Sigma Master Black Belts, Black Belts, Green Belts and Six Sigma champions from manufacturing companies in Brazil. The survey questionnaire was piloted with five experts in the field in order to ensure that the questions were valid and technically sound. Findings The execution of Six Sigma projects in organizations results in a moderate rate of project failures. These failures can cost organizations several millions of dollars especially within the context of larger organizations. The main reasons for project failure, as cited by the specialists include: resistance to change, lack of commitment and support from top management and incompetent teams. Research limitations/implications The authors report the findings from a pilot survey having a limited sample size. Moreover, the data have been collected from one country and primarily from large manufacturing companies. Originality/value To the best of the authors’ knowledge, this is the first empirical study looking into the reasons for process improvement project failures. The authors argue that if the top reasons for such failures are understood, a framework can be developed in the future that can mitigate the chance of project failures during project execution. This could potentially lead to significant savings to the bottom-line of many organizations.

Purpose: Medication errors are a significant cause of injury in Norwegian hospitals.The purpose of this study is to explore how Lean Six Sigma has been utilised in the Norwegian public healthcare context to reduce medication errors.Design/Methodology/Approach: A mixed method approach was used to gather data from participants working in the four regions served by the Norway Health Authorities. A survey questionnaire was distributed to 38 healthcare practitioners and semi-structured interviews were conducted with 12 healthcare practitioners. Findings:The study finds that the implementation of Lean Six Sigma in the Norwegian public healthcare context is still in its infancy. This is amidst the several challenges faced by Norwegian hospitals, such as a lack of top management support, lack of LSS training and coaching and a lack of awareness around the benefits of LSS in healthcare.Research limitations/Implications: Due to the large geographical area, it was difficult to reach participants from all health regions in Norway. However, the study managed to assess the current status of LSS implementation through the participants' perspectives. This is a fruitful area for future research whereby an action research methodology could be employed.Originality/Value: To the best of the authors' knowledge, this is the first empirical study into the use of LSS methodology in reducing medication errors. In addition, this study is valuable for healthcare practitioners and professionals as a guideline to achieve the optimal benefit of Lean and Six Sigma implementation in order to reduce medication errors.

PurposeThe purpose of this paper is to illustrate the use of Lean Six Sigma (LSS) and its associated tools to reduce dispensing errors in an inpatient pharmacy of a teaching hospital in Thailand.Design/methodology/approachThe action research methodology was used to illustrate the implementation of Lean Six Sigma through the collaboration between the researcher and participants. The project team followed the Lean Six Sigma Define, Measure, Analyze, Improve, Control (DMAIC) methodology and applied its tools in various phases of the methodology.FindingsThe number of dispensing errors decreased from 6 to 2 incidents per 20,000 inpatient days per month between April 2018 and August 2019 representing a 66.66% reduction. The project has improved the dispensing process performance resulting in dispensing error reduction and improved patient safety. The communication channels between the hospital pharmacy and the pharmacy technicians have also been improved.Research limitations/implicationsThis study was conducted in an inpatient pharmacy of a teaching hospital in Thailand. Therefore, the findings from this study cannot be generalized beyond the specific setting. However, the findings are applicable in the case of similar contexts and/or situations.Originality/valueThis is the first study that employs a continuous improvement methodology for the purpose of improving the dispensing process and the quality of care in a hospital. This study contributes to an understanding of how the application of action research can save patients' lives, improve patient safety and increase work satisfaction in the pharmacy service.

PurposeThe purpose of the Irish dual-energy X-ray absorptiometry (DXA) Health Informatics Prediction (HIP) for Osteoporosis Project is to create a large retrospective cohort of adults in Ireland to examine the validity of DXA diagnostic classification, risk assessment tools and management strategies for osteoporosis and osteoporotic fractures for our population.ParticipantsThe cohort includes 36 590 men and women aged 4–104 years who had a DXA scan between January 2000 and November 2018 at one of 3 centres in the West of Ireland.Findings to date36 590 patients had at least 1 DXA scan, 6868 (18.77%) had 2 scans and 3823 (10.45%) had 3 or more scans. There are 364 unique medical disorders, 186 unique medications and 46 DXA variables identified and available for analysis. The cohort includes 10 349 (28.3%) individuals who underwent a screening DXA scan without a clear fracture risk factor (other than age), and 9947 (27.2%) with prevalent fractures at 1 of 44 skeletal sites.Future plansThe Irish DXA HIP Project plans to assess current diagnostic classification and risk prediction algorithms for osteoporosis and fractures, identify the risk predictors for osteoporosis and develop novel, accurate and personalised risk prediction tools, by using the large multicentre longitudinal follow-up cohort. Furthermore, the dataset may be used to assess, and possibly support, multimorbidity management due to the large number of variables collected in this project.