Lean six sigma for health care: multiple case studies in Latin America

Purpose Health-care organisations face many challenges in delivering safe, high-quality services while experiencing significant pressure to increase productivity and reduce costs. In this context, hospitals have implemented lean six sigma (LSS) programmes to improve their performance. This study aims to explore the application of LSS in three different non-profit Ecuadorian hospitals to comprehend the effectiveness of the methodology under this context. Design/methodology/approach A multiple-case analysis was performed in four phases: selecting the cases, defining a data collection protocol, performing a within-case analysis of each case and performing a cross-case analysis. Findings This research found that the LSS application positively impacts hospital performance indicators by reducing service time. The most frequently used tools include the supplier input process output customer diagram, value stream mapping, cause-and-effect diagram, five-why analysis, Gemba walk and paired two-sample test. Lastly, the results show that the most common challenges faced were lack of top management engagement, technical training and data availability. Research limitations/implications The study is limited by the constraint of a single Latin American country from which the cases were analysed. Collaboration with external partners, like universities, and government policies promoting training in continuous improvement methodologies are crucial for success. Academic implications stress the importance of integrating soft skills in LSS implementation and engineering education. Originality/value This study shows a multiple-case analysis of LSS in a Latin American country highlighting the most commonly used tools, their impact on performance and the challenges of implementing LSS in health-care organisations in non-profit Ecuadorian hospitals.