The effects of Lean Six Sigma critical success factors on organizational performance: a mixed-methods study on United Arab Emirates hospitals
Bawab, Fawzi A.
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Healthcare is an industry where mistakes are not tolerated. Various Improvement methodologies such as Total Quality Management (TQM), Lean and Six Sigma intend to improve the performance of processes and impact organisational performance. Lean Six Sigma (LSS) combines approaches for flow and quality with the intent to reduce waste, variation and defects in processes. There have been many attempts to implement LSS. However, there is a lack of academic research on the extent of implementation or whether it leads to improvement. Generic lists of Critical Success Factors (CSFs) have been created, but they have not yet been explored in more dynamic settings such as healthcare in developing countries. The purpose of this study was to examine LSS implementation in UAE hospitals being a multi-cultured, professional and high labour turnover environment. The study also examined whether Strategic, Tactical and Operational (STO) CSFs are positively correlated with LSS successful implementation measured by hospital performance. A mixed-method approach was adopted to explore the study aim and objectives also enhancing the study quality in terms of reliability and validity. A conceptual model was developed from a review of the literature and existing improvement frameworks identifying three distinct CSFs themes (Strategic, Tactical and Operational) and eight hospital performance indicators. The study analysed the findings from a survey, interviews and a brainstorming session using SPSS, thematic analysis, Partial Least Squares Structural Equation Modelling (PLS-SEM) and Interpretive Structural Modelling (ISM). The study revealed that CSFs in healthcare should be sequenced in clusters, therefore creating a new framework for deploying LSS. Workforce stability and job security emerged as two new CSFs. Moreover, the empirical results showed that LSS CSFs have a positive effect on the performance of the UAE hospitals confirming previous research in other sectors. While the results confirmed that the UAE healthcare sector shares many common LSS CSFs and barriers identified in previous research, the study revealed three new barriers, namely lack of sustainability of LSS, lack of a holistic approach to deploy LSS and lack of advertising LSS success stories. This study contributes to academics and practitioners by providing a deployment framework for LSS in healthcare, offering better insights on the current status of LSS in UAE healthcare to enhance LSS deployment towards better organisational performance.