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Lean Six Sigma case studies LSS case

studies
literature overview: critical literature
overview
success factors and difficulties

nior
Matheus Francescatto and Alvaro Neuenfeldt Ju 1
Federal University of Santa Maria, Santa Maria, Brazil
Fl
avio Issao Kubota Received 22 December 2021
Revised 18 May 2022
Federal University of Paran
a, Curitiba, Brazil Accepted 29 June 2022

Gil Guimar~aes
University of Cruz Alta, Cruz Alta, Brazil, and
Bruna de Oliveira
Federal University of Santa Maria, Santa Maria, Brazil

Abstract
Purpose – Recently, several areas are successfully applying the Lean Six Sigma methodology, specifically in
healthcare, public services, higher education institutions and manufacturing industries. This study aims to
present an extensive literature review involving Lean Six Sigma practical applications in the last five years,
described in a case studies format.
Design/methodology/approach – A systematic literature review was conducted, and 39 articles were
selected and analyzed.
Findings – An increase in Lean Six Sigma applications in healthcare and higher education institutions was
identified. Furthermore, Lean Six Sigma is effectively applied in several areas and is continuously used in
traditional industries. The main critical success factor identified was leadership and management involvement,
project management and organizational infrastructure, as well as training and education. Also, the main difficulties
found are related to the organization’s culture and developing communication with leaders and managers.
Research limitations/implications – The main difficulties found in this research are related to the lack of
data presented in some articles analyzed, where only information about how the Lean Six Sigma application
was conducted is shown, not mentioning difficulties or success factors identified.
Originality/value – Case studies are fundamental to help popularize Lean Six Sigma applications, showing a
real-life scenario of how the methodology is implemented, the main difficulties encountered and critical success
factors found. Thus, the value of this study is promoting and developing research involving Lean Six Sigma
case study applications to guide new researchers and practitioners on the subject.
Keywords Lean Six Sigma, Critical success factors, Systematic literature review, Case studies
Paper type Literature review

1. Introduction
Lean Six Sigma (LSS) methodology is an effective continuous improvement approach aiming
to support an organization to maintain a competitive position in the global market, achieving
business goals and organizational excellence (Papic et al., 2017). LSS is the union of two
known concepts: lean management and Six Sigma (SS). Lean focuses on speed and waste
reduction, and SS focuses on reducing variation, reducing defects and evaluating the
production process (Lande et al., 2016). The integration between lean and SS is essential; lean
itself cannot bring a process under statistical control, and SS alone cannot improve process
speed or reduce invested capital (George, 2002). An organization must capitalize on the
strengths of lean management and SS for an effective LSS implementation, thus providing International Journal of
improvements in the production process (Arnheiter and Maleyeff, 2005). Productivity and Performance
Management
Vol. 72 No. 1, 2023
pp. 1-23
This work was supported by the Brazilian National Council for Scientific and Technological © Emerald Publishing Limited
1741-0401
Development (CNPq), Award No. 88887.522103/2020-00. DOI 10.1108/IJPPM-12-2021-0681
IJPPM The automobile and manufacturing industries pioneered the LSS application in the 1990s.
72,1 However, with the increasing popularity and satisfactory results, different areas began using
LSS with success, such as healthcare, public services, higher education institutions and
aerospace segments. Literature reviews involving LSS applications have been developed,
presenting critical success factors (CSFs), applications in small and medium-sized companies,
the methodology evolution through the years, healthcare applications and critical failure factors
(CFFs). Lande et al. (2016) developed a review of CSFs for LSS applications in small and medium-
2 sized companies to aid researchers and practitioners achieve an effective LSS implementation.
Similarly, Stankalla et al. (2018) proposed a review of CSFs for the LSS implementation in small
and medium manufacturing companies. Papic et al. (2017) presented a review of critical factors
for LSS applications, using empirical data from 256 LSS projects. Abu Bakar et al. (2015)
developed a literature review to find current CSFs for LSS implementation.
Furthermore, Albliwi et al. (2014) proposed a literature review approaching the CFFs
involving LSS applications in different sectors. Ramori et al. (2019) and Amaratunga and
Dobranowski (2016) presented systematic reviews of healthcare LSS applications. Patel et al.
(2019) analyzed 127 articles, showing the difficulties of LSS implementation in the
manufacturing industry. In addition, Albliwi et al. (2015) explored common themes of LSS
application in the manufacturing sector to identify gaps that can complicate the methodology
implementation. Ruben et al. (2018) proposed a literature review focusing on the environmental
LSS aspects. Juliani and Oliveira (2020) provided a review of LSS applications, based on a
management perspective, to promote and facilitate LSS implementations. Pepper and Spedding
(2009) addressed the evolution of LSS in various industries. Finally, Prasanna and Vinodh (2013)
explored LSS articles to determine how to improve Lean methodology in LSS applications.
In recent years, new topics such as supply chain, higher education and LSS have been
studied within a performance management context (Sureka et al., 2020). Initially, LSS was
used in organizations as an effective tool kit with problem-solving tools focused on process
improvements. However, with the evolution in the understanding of the methodology, LSS is
considered an organizational strategy focused on leadership to improve quality culture in
organizations (Antony et al., 2018a). Furthermore, the LSS application in organizations is
increasing, especially combined with innovative approaches, where high-quality product
developments satisfying the latest trends are the ultimate goal for both approaches
(Alblooshi and Shamsuzzaman, 2020). Also, the importance of new articles approaching case
studies is highlighted, being used to promote LSS in new and consolidated areas, since an
already existing mentality of continuous improvement inside an organization can lead to
successful LSS implementations (Panayiotou et al., 2020).
From 2015 to 2020, a gap related to LSS systematic literature reviews specifically
addressing case studies was identified. Case studies show in practice how the implementation
of LSS methodology is developed, contributing to the academic and professional scenario by
showing the main difficulties encountered and CSFs found, serving as a reference for future
LSS applications. Thus, three research questions were formulated to support the main
objective and explore the research field:
RQ1. What are the areas LSS has been applied to recently?
RQ2. What are the CSFs found in different LSS applications?
RQ3. What are the main difficulties found in LSS applications?
The main objective of this research is to develop a systematic literature review based on the
last five years of LSS implementation in different areas, emphasizing case study approaches
and determining the CSFs and difficulties found during LSS implementations. Only articles
presenting CSFs or the main difficulties of LSS implementations were selected, aiming to
update the LSS literature, serving as a source of information and assistance for potential LSS
researchers and practitioners. Understanding the main factors impacting LSS LSS case
implementations is beneficial for organizations new to the methodology. Furthermore, by studies
analyzing case studies, information about production processes, engineering
methods, performance measurement tools and techniques used can be obtained, serving as
literature
guidelines for future LSS implementations. Also, LSS fits well within a performance overview
management context, improving the performance of an organization, department, process or
employees.
The remainder of this paper is structured as follows: Section 2 describes the conceptual 3
background. Section 3 explains the research protocol used to conduct the systematic
literature review. Section 4 discusses the case studies per area, while Section 5 presents the
CSFs found. Section 6 shows the main difficulties encountered in the articles analyzed, and
Section 7 draws the main conclusions.

2. Conceptual background
The LSS methodology helps organizations achieve global excellence, by improving different
processes, resulting in a competitive organization from a global market perspective. Around
the 1990s, the LSS methodology is developed, combining principles of lean manufacturing
with tools and techniques used in SS applications, being two of the most popular business
strategies for continuous improvement (Lande et al., 2016).
With the combination of principles and tools from both methodologies, the strong points of
the Lean and SS are highlighted, and the weak points are overcome. Considering the lean
approach, the main focus is on removing process waste to improve the production process
efficiency, while the SS approach focuses on controlling the production process statistically,
removing variations, and increasing the production process effectiveness (Stankalla et al., 2018).
For an LSS implementation to be successful and sustainable, the organization needs to
develop a model which allows organizational growth and a flexible implementation
framework. To determine the right implementation model, several factors must be
considered, which are directly related to the organization’s initial state. Furthermore, the
organization’s initial state can be defined by the organization’s knowledge of continuous
improvement, culture, resource capability, industry and market dynamics, and current
strategic goals (Papic et al., 2017).
Different approaches can be used for a successful LSS implementation, classified
according to the organization’s approach used (strategic, cross-functional and local), the
nature of the application (breakthrough and incremental), the business focus (customer
intimacy, product leadership and operational leadership) and the response of the organization
(reactive and proactive), based on SS applications (Truscott and Truscott, 2003). Usually,
different approaches are found in the implementation phase of LSS. The four approaches
exist simultaneously, and, depending on the LSS implementation dynamics, each approach
can take a dominant role during a specific part of the implementation process. The knowledge
of the characteristics, advantages and disadvantages of each approach is critical to the LSS
implementation. Furthermore, the approach used is determined based on the organization’s
culture, continuous improvement maturity, market and industry-related dynamics,
customers’ needs and expectations, and many other factors (Papic et al., 2017). Considering
the flexibility of LSS, different areas can find a suitable approach to improve the production
processes with great success. As the number of articles applying LSS in different areas
increases, new areas can use the knowledge and experience documented in the literature as a
guideline to start LSS implementations.
In recent years, LSS is one of the most popular methodologies used by organizations to
promote and develop continuous improvement. LSS was established in 2003 as part of the
evolution process of the SS (Timans et al., 2014) and, from 2003 onwards, an increase in LSS
IJPPM popularity and deployment in the industrial world was verified (Shah et al., 2008), especially
72,1 in large organizations such as Motorola, Honeywell and General Electric (Timans et al., 2014;
Laureani and Antony, 2012), as well as some small and medium-sized manufacturing
organizations (Kumar et al., 2006).
With the increase in popularity, the focus of LSS implementations shifted from
manufacturing industries to a wide range of sectors, such as financial/banking service, call
centers, healthcare, IT, textile, chemical industry etc. The world is in the postmodern era,
4 where the quality of life is the guiding principle in society (Sreedharan and Raju, 2016). The
most supported services are healthcare, education, transport, construction, banking services,
accounting firms and public services, utilized by citizens and essential to society (Su
arez-
Barraza and Ramis-Pujol, 2012).
There are many reasons for organizations to implement LSS, mainly to improve the
business performance and operational efficiency, improve product quality (Vinodh et al.,
2012), reduce production costs and enhance customer satisfaction (Chen and Lyu, 2009). With
the benefits of LSS, new areas started adopting the methodology, being essential to determine
the main factors impacting a successful LSS implementation, by characterizing CSFs and the
main difficulties found, thus aiding new researchers and practitioners by presenting critical
points which need to be addressed to increase the chances of an efficient LSS implementation.
To understand how LSS can be successfully implemented, the CSFs must be identified.
CSFs are defined by Brotherton and Shaw (1996) as essential factors which must be achieved
by the company to identify areas where the greatest competitive leverages were produced.
CSFs are not major objectives but are the actions and processes controlled by the
management to achieve the organization’s goals (Lande et al., 2016), also be defined as “those
few things that must go well to ensure success” by Boynton and Zmud (1984) and essential
factors which are critical for the success of any program, company or organization (Coronado
and Antony, 2002; Rockart, 1979).
The LSS implementation will fail if the results from the CSFs are not achieved, bringing
negative consequences for the organization (Rockart, 1979). Also, the lack of any CSFs during
the development and implementation stages of LSS can be the defining factor between the
implementation failure or success (Antony and Banuelas, 2002). Thus, a special focus must be
given to each CSF, being vital for managers and decision-makers, guiding a successful LSS
implementation (Pereira et al., 2019).
Similar to the CSFs, difficulties during the LSS implementation are common, called CFFs,
which cause the failure of continuous improvement deployments in organizations and are
impacted by the areas where LSS was implemented (Sunder and Prashar, 2020). Furthermore,
CFFs can also be defined as “key aspects (areas) where things must go wrong” (Opoku
Appiah and Abor, 2009; Sreedharan et al., 2018).
Both CSFs and CFF have an impact on the LSS implementation and can be the deciding
factor between a successful or a failed approach. This research presents the CSFs and the
main difficulties found in different areas, providing information for new researchers and
practitioners to facilitate new LSS implementations, especially by approaching only case
studies, which are based on practical scenarios, representing the reality found within
organizations.

3. Research protocol
A systematic literature review is used to investigate a scientific field, organizing the articles
published to verify the existing knowledge and facilitating the evolution of new theories and
research areas, and closing areas already developed. A research protocol was developed to
search for knowledge and analyze the results, consisting of three review stages: planning,
execution and analysis (Webster and Watson, 2002; Tranfield and Denyer, 2003;
Biolchini et al., 2007; Rigo et al., 2020; Baierle et al., 2021; Neuenfeldt et al., 2022). In the review LSS case
planning, the systematic literature review approach is defined. The review execution consists studies
of deciding on adequate sources to select and extract information from the articles found.
Lastly, the review assessment shows a descriptive analysis and the discussions and
literature
interpretations regarding the information found. Figure 1 presents the research protocol. overview
The review planning stage begins with the research objective, specifying the research
field approach, which relates to practical LSS applications. Hence, the main objective is to
develop a systematic literature review on LSS in different areas, through the analysis of case 5
studies.
Case studies is the most common research approach used in LSS articles (Yadav and
Desai, 2016), providing explanations of linkages among events and being suitable when
examining real-world scenarios (Voss et al., 2002) by analyzing contemporary phenomena in a
natural context. Researchers and practitioners are benefited from case studies, obtaining real
information regarding LSS approaches that can aid future implementations. Furthermore,
the information obtained can increase LSS usage across all areas, solidifying LSS in
traditional industries and increasing LSS presence in nontraditional areas.
Only English language articles from journals published from 2015 to 2020, and indexed in
the Scopus database, were selected to cover the research field. The period was chosen due to
the rise in LSS articles on the Scopus database, where, from 2015 to 2020, the term “Lean Six
Sigma” results in an average of 163 articles per year, while from 2003 to 2014 the term results
in an average of 59 articles per year. Furthermore, the LSS methodology suffered
modifications through the years, since LSS’s initial applications in manufacturing industries.
As LSS began to be applied in new areas, the methodology evolved. Thus, to understand how
Review planning

Objective ● Determine the main goal of the research.

Research question ● Formulate the research questions.

formulation

● Database selection;
● Language definition;
Sources
● Period of time definition;
selection
Review execution

● Keywords and strings of research

definition.

● Abstract and title review;

Studies selection
● Complete text review.

Data extraction ● Data extraction form.

Review analysis

● Case studies per area;

Descriptive ● Critical success factors;
analysis
● Main difficulties found. Figure 1.
Research protocol
IJPPM new LSS implementations are conducted in the current scenario, a shorter period must be
72,1 analyzed to determine actual CSFs and difficulties. The period of five years was used to
determine how LSS implementations are being developed recently, presenting actual data to
aid new researchers and practitioners.
The terms “Lean Six Sigma”, “DMAIC” and “LSS”, were the primary research string
keywords. “Lean Six Sigma” limits articles to the research theme. “DMAIC” was used due to
articles highlighting the DMAIC (define, measure, analyze, improve, control) strategy used
6 during LSS implementations. Furthermore, some articles describe the term “Lean Six Sigma”
abbreviated, justifying the “LSS” presence in the research string. The secondary keyword
“Case Study” limited the research field only to LSS applications in case studies. To eliminate
articles unrelated to LSS case studies, the abstracts and titles were reviewed and, after, a
complete review of the remaining articles was conducted.
A total of 255 articles were found. After the title and abstract review, only 64 articles were
selected as part of the research field covered by the research objective. Furthermore, after the
full-text analysis, only 39 articles were selected and analyzed to generate the results
presented. Figure 2 shows the results obtained with the research strings.
The main information from the 39 articles was organized in a data extraction form. The
data extraction form contains the bibliographic data, abstract, the citation number, source of
publication, advanced information related to the research objective, justification, CSFs and
main difficulties verified. In addition, strings focused only on CSFs or difficulties found in
LSS implementation returned a low number of articles when compared to the research string
used, as shown in Table 1, considering the same parameters from Figure 2.
A combination of words related to CSFs and difficulties found in LSS implementation was
used. However, since most articles approaching LSS do not specifically mention terms related
to CSFs or difficulties found in the title or abstract, the research strings returned a low
number of articles. A broader research string related to the CSFs returned 31 articles, while a
broader research string related to the difficulties found in LSS implementations returned 58
articles. Considering a combination of both strings, 74 articles were found. However, the
general string described in Figure 2 returned a higher number of articles (255), and, with the

Scientific Literature

String Scopus:
TITLE-ABS-KEY (“Lean Six Sigma” OR “DMAIC” OR
“LSS” AND “Case Study”)

255 articles

Abstract and title review:

191 articles excluded.

64 articles

Complete text review:

25 articles excluded.

Figure 2.
Articles’ selection 39 articles selected
Research string Articles
LSS case
studies
TITLE-ABS-KEY (“Lean Six Sigma” OR “LSS” OR “DMAIC” AND “Critical Success Factors”) AND 8 literature
(“Case Study”)
TITLE-ABS-KEY (“Lean Six Sigma” OR “LSS” OR “DMAIC”) AND (“Critical Success Factor” OR 12 overview
“Success Factor”) AND (“Case Study”)
TITLE-ABS-KEY (“Lean Six Sigma” OR “LSS” OR “DMAIC”) AND (“Critical Success Factor” OR 31
“Success Factor” OR “Success”) AND (“Case Study”) 7
TITLE-ABS-KEY (“Lean Six Sigma” OR “LSS” OR “DMAIC”) AND (“Limitations”) AND (“Case 46
Study”)
TITLE-ABS-KEY (“Lean Six Sigma” OR “LSS” OR “DMAIC”) AND (“Limitations” OR “Barriers” 55
OR “Barrier”) AND (“Case Study”)
TITLE-ABS-KEY (“Lean Six Sigma” OR “LSS” OR “DMAIC”) AND (“Limitations” OR “Barriers” 57
OR “Barrier” OR “Difficulty” OR difficulties) AND (“Case Study”)
TITLE-ABS-KEY (“Lean Six Sigma” OR “LSS” OR “DMAIC”) AND (“Limitations” OR “Barriers” 58
OR “Barrier” OR “Difficulty” OR difficulties OR “Failure Factor” OR “Failure Factors”) AND (“Case Table 1.
Study”) Results from strings
TITLE-ABS-KEY (“Lean Six Sigma” OR “LSS” OR “DMAIC”) AND (“Limitations” OR “Barriers” 74 focused on CSFs and
OR “Barrier” OR “Difficulty” OR difficulties OR “Failure Factor” OR “Failure Factors” OR “Success” difficulties in LSS
OR “Critical Success Factor” OR “Success Factor”) AND (“Case Study”) implementation

two revision stages proposed, a significant number of articles aligned with the research
objective were found.

4. Case studies per area

The first Lean and Six Sigma applications occurred in the automobile and the manufacturing
industry, respectively. Over the years, Lean and Six Sigma were applied to new areas,
originating the LSS methodology. The development of LSS has increased overall production
quality through faster operation times and lower operational costs for the organizations.
Figure 3 shows the distribution of LSS case studies per area in the last five years.
Higher education institutions (HEIs) and healthcare are the areas with the most LSS
applications, with nine and six articles, respectively, showing the popularity of LSS
applications in areas involving services, in addition to applications focused on more
traditional industries, such as automotive and manufacturing. The manufacturing industry
was explored in five articles, having the second-largest number of case studies. However, the
applications are distributed in several branches within the manufacturing industry, such as
cylinder, gas stove and mold manufacturing. In the manufacturing industry, there is no
defined pattern of LSS application, increasing the number of articles. Finally, areas such as
handcraft manufacturing, construction services, the wood industry and policing services
have a lower number of articles, not showing many LSS implementations in the last
five years.
In HEIs, the main LSS goal is to reduce the execution time of certain services and improve
performance in different sectors of the institution through projects which, in some cases, are
applied with students’ participation. Some applications approach the library sector (Sunder,
2016) moving offices cost reduction (Wheeler-Webb and Furterer, 2019) and improving the
teaching program development (Thomas et al., 2017), and the educational experience between
the student and teacher (Oliver et al., 2019) and services in general (Li et al., 2019; Haerizadeh
and Sunder, 2019). Furthermore, Antony et al. (2018b) and O’reilly et al. (2019) show the main
challenges and CSFs observed in LSS applications within HEIs. Finally, Sunder and
Mahalingam (2019) investigate the applicability and implementation of LSS in HEIs based on
the analysis of five case studies.
IJPPM 10 9
72,1 8
6
6
Articles

5
4 4
4 3
8 2 2
2 1 1 1 1

Figure 3.
Distribution of LSS
case studies per area in
the last five years
Areas

For healthcare, LSS has been gaining notoriety recently, being applied to improve the flow
and satisfaction of patients (Furterer, 2018; Persis et al., 2020; Sunder et al., 2020; Chaurasia
et al., 2017) implementing more efficient medication administration processes (Nayar et al.,
2016) and better preparation and maintenance of medical records (Bhat et al., 2016).
Due to the range of applications involving the manufacturing industry, all case studies
related to the development of products not involved in any other defined area were classified
as belonging to the manufacturing industry. Thus, LSS is applied to improve the production
processes of various types of products, including water pumps (Klochkov et al., 2019), lamp
production (Trehan et al., 2019), molds production (Chiarini, 2015), screws manufacturing
(Cabrita et al., 2015) and gas stoves manufacturing (Supriyanto and Maftuhah, 2017). In the
automotive industry, LSS applications are focused on increasing the production efficiency,
either by decreasing the product rejection rate (Nallusamy et al., 2018) or by improving the
production line processes (Gijo et al., 2018; Ruben et al., 2017). Furthermore, Al-Hosani and
Tariq (2020) use the LSS to reduce the hiring time of employees within an automotive
company. For the aerospace industry, LSS applications are used to achieve greater
production efficiency (Thomas et al., 2016), identify factors related to the supply chain (Hill
et al., 2018) and reduce audit time (Mentheri and Tariq, 2020).
Regarding logistics, the main focus is on enhancing the quality and efficiency of material
distribution (Lu and Liu, 2018), analyzing the possibility of implementing LSS in the area
(Gutierrez-Gutierrez et al., 2016) and identifying the need for quality improvement within the
organization (Burch et al., 2016). In addition, Gomes Leite et al. (2018) applied the LSS in a
logistical approach to reduce the trucks’ loading time inside a cylinder distribution company.
For the information technology (IT) industry, the LSS application is related to improving
the quality and reducing the development cost (Xu et al., 2016), as well as lowering the
complaints’ response time (Gijo et al., 2019). Similarly, the focus of LSS in banking services is
improving processes (Sunder et al., 2019) and determining the sigma level of the organization
(Ndaita et al., 2015). In the wood industry, the focus of LSS implementations is to find the main
development problems and opportunities (Guerrero et al., 2017). Regarding policing services,
the main LSS application objective is to maintain the quality of services at low costs through a
sector restructuring (Antony et al., 2018c). The focus of LSS applications in the construction LSS case
sector is to investigate critical factors affecting the service quality and waste generated in studies
construction (Jowwad et al., 2017). Finally, in handcrafted manufacturing, the LSS is used to
improve operational efficiency (Tran et al., 2020).
literature
LSS implementation in healthcare and HEIs has been increasing, being both areas overview
fundamental to society’s functioning. Thus, the application of different methods to generate
continuous improvement was expected. In addition, continuous improvement methodologies
were well accepted within healthcare and HEIs, especially the LSS, being adapted and 9
modified through the years. The LSS implementations from 2015 to 2020 in healthcare are
both related to patient satisfaction and improving flow and quality of time the patient must
spend in hospitals, being important not only for the patient recovery but also for the hospital
logistic, enhancing the patient flow and effectively using the hospital space and resources.
Articles related to the LSS approach in healthcare show the methodology can be successfully
utilized, improving different processes.
Furthermore, recent literature reviews, such as those of Singh and Ravi (2022), presented
possible future research areas within healthcare. The vast majority of LSS applications in
healthcare are limited to management operations; however, there is an increase in LSS
implementations to reduce medication errors in developed countries (Trakulsunti et al., 2018).
Also, articles approaching waste and defect reduction in surgical and operational theatre
activities are needed, together with articles providing information and guidance to aid the
creation and maintenance of a continuous improvement culture in healthcare (Rathi et al.,
2022). Finally, a gap was found in healthcare, related to articles approaching how to choose
and classify LSS projects, articles focused on identifying major barriers in LSS
implementation and possible solutions, as well as articles related to the effective use of the
LSS toolkit (Singh and Rathi, 2019; Trakulsunti et al., 2018). As new articles related to LSS
implementations emerge and the gaps found began to be fulfilled, the performance and
productivity of healthcare increases.
A wide range of LSS applications was found for HEIs, which is expected since an HEI is
related to different sectors and processes. An LSS approach to reduce the time used by
students to find books in an HEI library was presented in Sunder (2016). Initially, the average
time needed to find a book was 15 min. After the LSS implementation, the time was reduced to
five min, returning the equivalent of 83 man-hours saved per day. Furthermore, with the rise
in library performance, students were able to utilize the time saved in other activities,
increasing overall productivity.
The cost of moving inside an HEI was analyzed by Wheeler-Web and Furterer (2019). As
the moving company used could not reach all university demands, a new moving company
was hired as a backup. However, the monetary loss was generated due to the university not
knowing what the moving companies could and could not do. With the LSS implementation,
the time between invoice receipt and payment was lowered by 38%, improving the university
finance department’s cash flow. Furthermore, the authors highlighted the importance of the
study in demonstrating how LSS tools can be applied inside an HEI, reducing costs and
improving financial and administrative processes, especially in a quality and productivity
context.
Oliver et al. (2018) approached the problem faced by teachers in an HEI related to the
unusually long hours used to grading homework. Also, due to the time used to grade
homework, the daily routine of teachers was affected, incapacitated the providing of
comprehensive feedback for the students. Thus, the LSS was applied to decrease the grading
time, resulting in an improvement in teachers’ work-life experience, and an increase in
teachers’ motivation to help students achieve academic success. The grading cycle time was
reduced by 50%, where the time saved could be used to improve the teachers’ relationship
with students and productivity.
IJPPM In Haerizadeh and Sunder (2019), the relationship between students and advisers was
72,1 approached. The waiting time to meet advisers and the time needed for advisers to return
phone calls or respond to emails were high. By applying the LSS, a reduction of 15% on wait
time was made, and the students’ satisfaction rate increased by 82%. Furthermore, the
authors confirmed the applicability of the LSS in HEIs, through a case study, enabling quality
excellence thinking as a solution.
The problem related to grant application was discussed by Li et al. (2019), where the office
10 capacity was exceeded with 350 monthly proposals. Also, in peak months, the late
submissions’ rate increased. However, a loss of time and effort from the personnel involved
and loss of funding, personnel and reputation was generated with late submissions. With the
LSS, the rate of late submission decreased from 0.56% to 0.32%. Furthermore, the authors
showed the LSS can be used in a highly complex, knowledge-based service process and also
noted that the LSS can be extended to many operations, by using and modifying proven
techniques and concepts.
O’Reilly et al. (2019) approached the LSS application in HEIs considering a general context,
focused on optimum efficiency, effectiveness, agility and responsiveness to internal and
external needs, transforming the HEI into a more responsive ambience, with simpler
processes and reduced bureaucracy. With the LSS, DMAIC was used, which aided the
simplification of administrative processes, reducing cycle time, cost, error and rework, as well
as improving customer and employee satisfaction.
A lack of library utilization and a decrease in students reading frequency was identified in
Sunder and Mahalingam (2019). In addition, the authors also approached the customers’ low
satisfaction related to the computer center’s effective functioning. By using a cross-functional
team of postgraduate students, the LSS implementation was successful. Also, the authors
highlighted the LSS is related to a paradigm shift in HEIs, changing the functioning of the
various academic and administrative processes.
Considering the nature of HEI processes, a wide range of LSS applications was described.
The articles implementing LSS in HEI approached case studies with different problems.
However, the LSS implementation’s main goal was to increase the productivity and
performance of a determined sector, creating an environment to enable employees to produce
the highest-quality work most efficiently and effectively. Also, the LSS range of applications
in HEIs shows the LSS methodology can be applied effectively, returning satisfactory results.
Furthermore, the use of the LSS to enhance the relationship between the teacher and student
is highlighted, being important for the creation and passing of knowledge in the educational
system.
Figure 4 shows the number of articles from the literature approaching LSS evolution in
healthcare and HEI, since 2004, when the first articles based on the two strings used were
found. The first string was related to healthcare, being “Lean Six Sigma”, “Healthcare”, and
“Health Care” the terms used, returning 405 articles. The second string was a combination
between “Lean Six Sigma”, “HEI”, “Higher Education Institutes”, “Education” or “School”,
returning 203 articles. Both strings used do not limit the articles to only case studies,
obtaining a more general approach for LSS implementations in healthcare and HEI.
From 2004 onwards, articles started approaching LSS implementations in healthcare and
HEI. For healthcare, there was an increase in articles from 2012 to 2020, with an average of 29
articles per year, while for HEIs, the increase in articles was from 2015 to 2020, with an
average of 21 articles per year. Considering the number of articles obtained, there is a trend
for a continuous increase in articles involving LSS implementations in both areas. Areas with
a low number of articles and not traditional to the LSS such as banking services, policing, IT
and construction, can suffer an increase in articles due to the positive results obtained with
LSS implementations in healthcare and HEI, also being areas related to services. For areas
such as handcraft manufacturing and the wood industry, the increase in articles approaching
 50 LSS case
45 studies
literature
40
overview
35

30 11
Articles

25

20

15

10

0
Figure 4.
LSS applications in
Years HEI and healthcare
through the years
Healthcare HEI

LSS implementations is unlikely, since both areas are becoming obsolete due to the industry
modernization.
Considering the articles obtained from the Scopus database using only the term “Lean Six
Sigma”, from 2015 to 2020, an average of 163 articles per year were found, being an increase
compared with the articles from 2003 to 2014, where the search returned an average of 59
articles per year. For future years, LSS will continue to increase, being one of the best and
most used continuous improvement methodologies. Furthermore, the body of knowledge has
been developed, mainly in recent years, expanding LSS approaches to new areas, increasing
the efficiency of LSS implementations in service areas (healthcare and HEI), consolidating
LSS applications in industrial areas (automobile and automotive), as well as being more
applied in areas such as construction, IT, banking and policing services.

5. Critical success factors

Based on the 39 articles obtained through the systematic literature review, a classification
related to the main factors which influenced the success of LSS implementations in the
different areas analyzed was developed. The CSFs for each case study studied were
organized into six main topics, based on the classification proposed by Abu Bakar et al.
(2015). Table 2 shows the main CSFs found.
Leadership and management involvement are related to the participation of leadership
and management during LSS applications. Cultural change is one of the prominent factors in
the topic, involving a change in the general mindset of the organization to seek continuous
improvement. In addition, strong leadership and management commitment and involvement
are also noteworthy, being related to the support of leaders and the leaders’ ability to
influence other employees for LSS’s better development.
LSS competence involves the organization’s LSS knowledge and is related to the
experience and prior knowledge of the methodology by the organization and its employees.
IJPPM Topic CSFs
72,1
Leadership and management involvement Management commitment and involvement
Cultural change
Strong leadership
CEOs very accessible and available during
implementation
12 Strategic and visionary leadership
Sponsors agreed from the beginning
Stakeholders involved
Leadership at unit levels
LSS competence Knowledgeable teams
Advanced knowledge of the benefits of LSS
integration
Proper people selection
Qualified people for LSS application
Dedicated cross-functional teams
Training and education Continuous LSS training
Employee development
Effective LSS training program
Suitable professionals for teaching
Project selection and prioritization Project selection
Correct people designation for certain projects
Project prioritization
Project management, organizational infrastructure and Effective communication between teams
communication General communication
Quick implementation of improvement ideas
Well-planned continuous improvement of
organizational structure
Table 2. Data accessibility Appropriate data evidence
CSFs found Extensive data storage

For an LSS implementation to be successful, the assigned teams must have basic knowledge
of the methodology. The importance of a cross-functional team is essential, especially in areas
with little experience in continuous improvement of methodologies and unfamiliarity with
statistical process control tools, such as HEI and healthcare. Furthermore, the involvement of
professionals with a higher qualification in the LSS (black and master black belt) is essential
and often necessary for a successful LSS implementation.
Training and education are related to the need for training and familiarization by the
organization’s employees in the LSS methodology, facilitating its application. Employees
must be aware of LSS benefits to increase a successful implementation. In addition, the
importance of hiring suitable professionals to promote effective LSS education in the
organization is highlighted. Project selection and prioritization is found in scenarios where
the LSS application involves several sectors within the organization, being common in HEIs
and healthcare. Several improvement projects are developed for different sectors, justifying
the need for a proper project selection and prioritization to focus on suitable projects with
more benefits for the company.
Project management and organizational infrastructure are related to the rapid
implementation of improvement ideas, meaning the control phase of the DMAIC
process can be quickly started. Furthermore, due to the complexity of certain LSS
applications, the company’s continuous improvement organizational structure must be
well planned. In addition, the general communication present in the organization is one
of the most mentioned success factors among the articles. Data accessibility has a
crucial role in a successful LSS implementation. With appropriate data and information LSS case
available, LSS methods are more easily applied. Obtaining appropriate data is essential studies
for the success of the LSS. Without appropriate processes’ data, it is impossible to
apply some LSS tools. Figure 5 shows the six CSFs topics and the areas applied.
literature
Articles from handcraft manufacturing and construction did not present the success overview
factors found.
The importance of leadership and management involvement is visible, being approached
in 21 of the 39 selected articles. For a successful LSS application, the main priority is the 13
presence and support of the organization’s leadership and management. The topics of project
management and organizational infrastructure and Training and Education are the second
and third most cited, with 12 and 10 citations, respectively, becoming important factors to
ensure the good development of the LSS implementation.
Project selection and prioritization and data accessibility are only cited in four articles,
with a lower impact on the success of LSS applications. The main reason is project selection
and prioritization is strongly related to the LSS application in HEI and, considering LSS
applications, a high number of projects to justify the need for project selection and

Figure 5.
CSFs and areas applied
IJPPM prioritization is not common. For most traditional industries, data accessibility is easily
72,1 available and accessible, not being considered a CSFs. However, healthcare and HEI do not
have typical data used by LSS applications, becoming a CSF when data is available and well
documented. Furthermore, organized and available data can become a success factor in more
traditional industries.
Considering each area individually, for aerospace, CSFs are evenly distributed between
topics. Leadership and management involvement is highlighted in the automotive area,
14 followed by training and education. Similarly, in healthcare, leadership and management
involvement is the most mentioned success factor, in addition to LSS competence and data
accessibility. LSS Competence is related to the use of professionals with LSS knowledge to aid
LSS applications in healthcare. data accessibility is related to the different data used in
healthcare which, when available and well documented, becomes a CSF. Furthermore, in HEI,
apart from leadership and management involvement, project management and
organizational infrastructure appears in four articles, specifically addressing
communication as a CSF. The lower number of articles from Banking, IT, Logistics,
Manufacturing, Policing, and Wood Industry areas, results in a few CSFs found. However,
leadership and management involvement is considered in all areas, followed by project
management and organizational infrastructure, appearing in five of the six areas mentioned.
CSFs, such as leadership and management involvement, project management and
organizational infrastructure, as well as training and education, were mentioned in a high
number of LSS articles. The articles show the CSFs mentioned are essential to ensure a
successful LSS implementation, thus, those factors will continue to be approached in future
articles. However, less mentioned CSFs, such as project selection and prioritization, data
accessibility, and LSS competence, can be further explored to better determine the LSS
implementation impact and how necessary is for an organization to invest resources and time
developing the respective CSFs. Also, data accessibility and project selection and
prioritization could be approached by considering the point of view from different areas,
determining how the presence of those CSFs impact LSS implementations, since the CSFs are
only mentioned in healthcare, HEI, automobile and automotive areas.

6. Main difficulties in LSS implementations

During the LSS implementation, 21 articles from the 39 selected by the systematic literature
review presented the main difficulties found. Table 3 shows the main difficulties found in
each area where LSS was implemented. Articles involving the LSS approach in the
handcrafted manufacturing and construction industry did not expose the difficulties found,
not being presented in Table 3.
The main difficulties found by Thomas et al. (2016) in the aerospace industry are related to
the team’s resistance to changing the culture and a misunderstanding about the proposed
results of LSS and its benefit for the organization, occasioning a lack of effort in LSS
methodology application. In Hill et al. (2018) the difficulty found in the aerospace industry
was the lack of members with knowledge in LSS, resulting in a division of these members
among improvement teams, generating a need for greater communication between teams.
In the automotive industry, Ruben et al. (2017) show the main problem was the lack of
basic knowledge about LSS and its terminology in the organization, determining that, after
implementation, new LSS applications will be easier to develop due to the training performed.
HEIs presented the highest number of difficulties. Sunder and Mahalingam (2019) proposed
the involvement of students in the LSS application, resulting in a lack of responsibility and
sense of duty in some teams. Li et al. (2019) had difficulties in obtaining information since
most of the data were intangible factors, being difficult to quantify and track. In addition,
communication with the management of the HEI sometimes proved difficult, due to problems
Area Main difficulties found
LSS case
studies
Aerospace Employees refusing necessary changes literature
Lack of effort from the employees
Lack of understanding the desired results overview
Lack of employees with knowledge in the LSS
Automotive Lack of basic knowledge about the LSS and its terminology
Higher education Lack of responsibility and motivation of some teams 15
institutions Lack of availability or accessibility of data
Engineering and manufacturing terminologies are not well received in the
organization
Employees not used to use statistical tools and data-based decisions
The nature of the area makes it difficult to have an overview of the system that
will undergo changes
Lack of leadership at the highest levels of the institution
Lack of reward or the incentive system
Communication with sponsors difficult
Logistics Inappropriate organizational structure for LSS application
Inappropriate training and resources
Lack of communication
The wood industry Convince management of the continuous improvement program importance
Informality in the production process
Lack of data and evidence on the manufacturing process
Convincing leaders of the need for change
Manufacturing Lack of communication
Lack of incentive from the company
Healthcare Lack of available data
Lack of familiarity with engineering tools
Banking services Lack of change by management
Policing services Difficulty in obtaining essential data for LSS execution
Need for greater planning
Information technology Difficulty in selecting suitable LSS tools
Difficulty in selecting team members Table 3.
Lack of help from employees Main difficulties found
Limitations for getting data automatically per area

in the management office. For O’reilly et al. (2019), the lack of expertise in the LSS becomes a
difficult factor, together with the need to follow a data-based approach in HEIs. Antony et al.
(2018b) found difficulty using LSS terminologies inside the HEI environment, and employees
were not used to applying statistical tools and basing decisions on data. Furthermore, the
overview of the system that will be improved within the HEI proved difficult, as well as the
culture already present, making employees feel uncomfortable to propose improvements and
specify problems, due to the lack of a reward and incentive system.
Considering LSS application in logistics services, in Gutierrez-Gutierrez et al. (2016) an
inappropriate organizational structure is highlighted as a difficulty, together with inadequate
training and resources for the LSS implementation phase, which reduced the chance of
success. Guerrero et al. (2017) show how the wood industry struggles to convince
management of the importance of a continuous improvement program and to convince
leaders of the need for change. The authors also pointed out the informality in the production
process and the lack of data, together with a lack of familiarity with the LSS by the
organization. Also, Gomes Leite et al. (2018) found difficulty in changing the culture of the
company and customers related to communication, since the changes in the process after
the implementation of the LSS directly affected the communication between the logistics
department and the organization’s drivers.
IJPPM In healthcare, both Bhat et al. (2016) and Sunder et al. (2020), report the lack of available
72,1 data found is one of the main difficulty factors, together with the lack of exposure to
engineering tools by employees in the area. For banking services, Ndaita et al. (2015) show the
lack of change from the management becomes the main factor of difficulty found, specifically
in service provision where the readiness for change is critical for the LSS application.
Furthermore, in policing services, Antony et al. (2018c) found the lack of essential data limited
the execution of the LSS, and better planning regarding the inclusion of a data collection plan
16 in the early stages of the processes would benefit the LSS application.
Finally, the selection of LSS tools suitable for the data present in the IT area was the
main difficulty found by Xu et al. (2016). The assistance of employees working at lower
levels in the factory and the selection of team members proved difficult. In addition, the
limitation of data collection in the company contributed to hindering LSS implementation.
Furthermore, in the manufacturing industry, the lack of incentive from the company to help
and to show their biggest problems was determined as the main difficulty found (Trehan
et al., 2019).
The main difficulties found can be organized into five groups: lack of leadership and
management involvement, lack of data, lack of LSS knowledge, nontraditional areas to LSS,
and lack of communication. Lack of leadership and management involvement relates to how
the organization aids LSS implementations, being involved by promoting and explaining the
LSS importance, following the implementation process and encouraging and rewarding
employees. Lack of data refers to the lack of information related to the organization’s
processes. Lack of LSS knowledge represents areas where the organization has insufficient
LSS training, complicating the formation of teams and the LSS implementation.
Nontraditional areas to the LSS are linked to industries in which LSS implementations are
not common, where LSS tools and terminologies can cause confusion and the process data
tracking is often difficult. Finally, lack of communication relates to the lack of communication
between management and employees, as well as the lack of communication between
LSS teams.
For new practitioners, the five difficult topics must be analyzed to increase the chances of
successful LSS implementation, understanding how the different groups are applicable in the
organization and finding the right approaches to overcome the difficulties found.
Furthermore, it is important to study each difficulty group separately, to investigate and
determine new methods and techniques to mitigate the impact of a particular group,
increasing the chance of a successful LSS implementation in the future. Finally, the lack of
leadership and management involvement will continue to be approached in future articles,
due to its high impact in determining the success of an LSS implementation.

7. Conclusion
This article defines the academic scenario in the last five years regarding case studies
involving LSS application, highlighting the CSFs found, the main difficulties identified and
the areas in which the methodology has been recently applied. Furthermore, the article
showed the main factors involved in successful LSS application in different areas, helping
practitioners and researchers, as well as updating the literature.
From the systematic literature review on LSS applications with an emphasis on case
studies, there is a growing trend related to the adoption of the LSS in the healthcare sector,
considering its contribution to aspects such as patient satisfaction, process efficiency and
administration of medicines. HEIs are also benefiting from LSS implementations by
improving the execution time of various services and operations, indicating possibilities of
applications in the area. In addition, it is shown traditional industries are still applying the
LSS methodology to improve production efficiency and generate benefits for the company.
 Considering LSS implementations found in case studies, the body of knowledge has LSS case
improved in recent years, especially from 2015 to 2020, due to a significant increase in the studies
number of articles. Furthermore, with the increase in articles, the number of areas related to
the LSS also increased and the LSS implementations in healthcare and HEI improved. New
literature
areas such as construction, IT, banking and policing services, showed potential to increase overview
the number of LSS implementations in the subsequent years, following the pattern found in
healthcare and HEIs.
Based on the CSFs found, leadership and management involvement are the main priorities 17
when starting a LSS implementation, being the most mentioned CSF across all areas.
Furthermore, to ensure the LSS development and implementation within the company, the
topic of project management and organizational infrastructure and the topic of training and
education must also be considered, being the second and third most mentioned topics.
The main difficulties found in LSS implementations are changing the organization’s
culture and developing good communication with the leaders and the management, being
directly connected with the CSFs found. Most difficulties are specifically related to the area
where the LSS is being applied, as is the case with lack of data, (HEIs, the wood industry,
healthcare and policing services), lack of familiarity with engineering tools (HEIs and,
healthcare) and difficulty in selecting suitable LSS tools (IT). However, difficulties such as
employees not used to use statistical tools and data-based decisions, lack of employees with
knowledge in LSS, inappropriate training and resources, as well as lack of communication,
are common in all areas where LSS was applied, highlighting the importance of overcoming
such difficulties to obtain a successful LSS implementation.
Furthermore, a gap could be explored in future articles related to the less mentioned
CSFs and the difficulties, to evaluate each one individually, determining the benefits, if
any, for an organization to spend resources and time on each factor. From the
popularization of LSS in a performance management context in the last years, this
research can benefit new practitioners and researchers by using recent case studies to
show where and how the LSS is being applied recently. The CSFs and main difficulties
found can be used as guidelines for new LSS implementations, providing information to
help practitioners obtain a successful implementation. Also, by analyzing case studies,
information about production processes, engineering methods, performance measurement
tools and techniques used, can be obtained, being useful for performance management
researchers and practitioners.
The main difficulties found in this research are related to the lack of data presented in
some articles analyzed, where only information about how the LSS application was
conducted is shown, not mentioning difficulties or success factors identified, generating a
lack of information in some areas.

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Corresponding author
Matheus Francescatto can be contacted at: matheus.francescatto@acad.ufsm.br

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