Lean Six Sigma enablers and their effect on perceived operational efficiency in Ethiopian public hospitals

Purpose Lean Six Sigma (LSS) has emerged as a globally recognized methodology for enhancing health-care efficiency, minimizing waste and fostering patient-centered outcomes. Despite its extensive application in high-income countries, its empirical investigation in low-resource settings remains scarce. This study aims to evaluate the impact of five critical LSS enablers technology utilization, staff engagement, patient-centric focus, LSS adoption and process improvement on operational efficiency in public hospitals in Ethiopia. Design/methodology/approach A cross-sectional quantitative design was used, using structured survey responses from 356 health-care professionals across public hospitals in Ethiopia. Structural equation modeling (SEM) was conducted using SmartPLS 4 to examine the hypothesized relationships among the constructs. The measurement model was rigorously assessed for internal consistency, convergent validity and discriminant validity based on established psychometric benchmarks. Findings All five enablers demonstrated statistically significant positive associations with operational efficiency (p < 0.05). Technology utilization (β = 0.313) and staff engagement (β = 0.267) emerged as the most influential predictors, followed by LSS adoption (β = 0.215), patient-centric focus (β = 0.165) and process improvement (β = 0.095). The model showed strong psychometric properties, with average variance extracted (AVE) values exceeding 0.50 and heterotrait–monotrait (HTMT) ratios below 0.90. Originality/value This study contributes to the limited body of empirical research on LSS implementation in low-income health-care systems. It highlights the critical role of digital infrastructure and human capital engagement in driving efficiency gains. The results provide practical insights for policymakers and hospital administrators aiming to institutionalize LSS practices in resource-constrained environments.