CHAPTER II

THEORETICAL FRAMEWORK

This chapter presents relevant theories, a review of related literature, studies, and a

conceptual framework.

Relevant Theories

Theory of Public Value: Public value theory was developed by Moore (2019) to assist

public managers in addressing their often-conflicting obligations. The theory has been applied in

various fields, including public administration and management, ecology, and philosophy.

However, the theory has also been criticized for being too vague and empowering coercive

powers over civil society. Despite this, an extension of the public value triangle has been

proposed to make the role of civil society more explicit in situations of institutional voids. The

need to extend public value theory to a more complex world has also been raised by other

authors.

According to Moore, legitimacy, support, and the operational capacity to deliver are

necessary to create public value. Once public value is created, it establishes a virtuous cycle that

increases both legitimacy and support, as well as the operating capacity to create more public

value later on. This cycle is referred to as "Moore's strategic triangle". Moore emphasizes the

importance of functioning democratic structures in providing the framework for legitimate

coercive and calculative power by the public manager, who plays a crucial role in defining who

should be engaged in the process of defining and judging the public value created. It aligns well

with Lean Six Sigma, as both approaches focus on improving service quality, reducing costs, and

delivering better outcomes to citizens.

Theory of New Public Management: The New Public Management (NPM) Theory is a

widely studied and debated concept in public administration that has gained traction in recent

years (Gruening,2001) . The NPM approach is a rhetorical construction with diverse intellectual

roots, which means that it is open to reinterpretation and shifts in implementation across

countries. Scholars have extensively studied the application of NPM principles in various public

sectors, including healthcare systems.

 In their study of NPM implementation in EU healthcare systems, Sahlin-Andersson

(2001) and Smullen (2007) found that NPM led to a greater focus on market forces and

competition, improved information sharing and cooperation among health care networks, and

changed the way care is delivered. However, despite the potential benefits of NPM, significant

misfits between policy announcements and NPM implementation have been identified.

The implementation of NPM has varied across EU countries. For example, NPM has

taken root much more substantially in the United Kingdom (UK) than in France and Germany, as

noted by Greer et al. (2013). This may be due to the variety of capitalism and institutional

systems in these countries, which provides an explanation for divergences in NPM

implementation.

In recent years, researchers have focused on the impact of NPM on healthcare systems.

According to Hood and Peters (2004), NPM has led to a range of changes in the healthcare

sector, including decentralization of decision-making, the introduction of market mechanisms,

and an increased focus on performance measurement. However, critics argue that NPM has led

to the commodification of healthcare services and a reduction in the quality of care.

Moreover, the NPM approach has been widely debated and implemented in various

public sectors, including healthcare. While NPM has led to improvements in healthcare delivery

in some countries, misfits between policy announcements and NPM implementation have been

identified. The variety of capitalism and institutional systems in different countries provides an

explanation for divergences in NPM implementation. Researchers continue to explore the impact

of NPM on healthcare systems and its effectiveness in addressing the challenges faced by the

sector.

Both NPM and Lean Six Sigma are management approaches that aim to increase the

efficiency, effectiveness, and accountability of government operations. NPM emphasizes market-

based mechanisms and performance measurement, while Lean Six Sigma focuses on eliminating

waste and improving process efficiency. The combination of these approaches has the potential

to lead to significant improvements in government operations.

Theory of Evidence-Based Policymaking: Evidence-Based Policymaking is a central

concept that emphasizes the importance of using research evidence to inform policymaking.
Several studies have explored the use of evidence in policymaking and the challenges associated

with it.

One of the main challenges is the need for timely and relevant evidence. Nutley et al.

(2013) found that evidence-based policymaking can lead to improved policy outcomes, but there

are challenges in using evidence in policymaking, such as the need for timely and relevant

evidence.

Another challenge is the need to engage with stakeholders. Policymakers need to engage

with a range of stakeholders, including researchers, practitioners, and community members, to

ensure that policies are informed by a variety of perspectives and experiences. Lavis et al. (2009)

proposed a conceptual framework to guide the use of research evidence in policymaking. The

framework emphasizes the importance of engaging with stakeholders, synthesizing evidence, and

tailoring the evidence to the policy context.

Similarly, Oliver et al. (2014) conducted a systematic review of the use of evidence in

policymaking. The study found that policymakers use a range of sources of evidence, including

research evidence, expert opinion, and stakeholder views. The authors argue that the use of

evidence in policymaking is complex and context-dependent, and that policymakers need to be

able to navigate this complexity to use evidence effectively.

The Theory of Evidence-Based Policymaking emphasizes the importance of using

research evidence to inform policymaking. It aligns well with Lean Six Sigma, as both

approaches emphasize the importance of data-driven decision-making and continuous

improvement.

Theory of Systems Thinking: According to the seminal work of Ludwig von

Bertalanffy in his book "General System Theory" published in 1968, systems theory, as a general

theory of systems thinking, is a valuable tool for addressing many of the challenges facing the

21st century, a time of rapid development in modern information technologies. In a world where

constant change is the norm and sustainable development is key, purposeful systemic

management and high-quality systems thinking are essential for both individual and societal

success.
 Systems theory is based on several fundamental principles. Firstly, scholars such as

Niklas Luhmann and Ervin Laszlo believe that humans reflect the world around them in their

thoughts as systems. Secondly, a system is a totality of interconnected parts, and each system is

also a part of its surrounding environment composed of other systems. Thirdly, people study and

use systems properties to satisfy their various life needs.

To understand the world, scholars suggest that humans break it down into parts, compare

those parts, and then synthesize them back together. This process involves three fundamental

operations of systems thinking: analysis, comparison, and synthesis. Finally, the interconnection

of everything is considered the cause of diverse phenomena such as bodies, changes of bodies,

properties of bodies, and their changes, as argued by scholars such as Fritjof Capra.

At a high level, systems theory provides a holistic framework for understanding the

organization as a system and its interrelationships with the external environment. This

understanding can help to identify opportunities for improvement and provide a basis for

integrating Lean Six Sigma initiatives into the broader organizational context.

Theory of Customer-Centricity: Customer-Centricity is a theory that emphasizes the

importance of putting customers at the center of organizational decision-making. According to

Galbraith (2005) and Shah et al. (2006), customer centricity is often conceptualized as the

opposite of product centricity. While product-centric organizations focus on manufacturing and

selling superior products efficiently, without much consideration for purchasers or users,

customer-centric organizations prioritize customer value creation. Specifically, the value

perception of the customer is placed at the heart of key business and organizational processes.

The organizational strategy, structure, systems, and processes are optimized to further superior

value creation in the eyes of the customer.

Customer value creation in a customer-centric way requires genuine "outside-in thinking"

where customer value perceptions shape the organization. Consequently, customer-centric

organizations start developing new products and services or improving existing ones from the

wants, needs, and priorities of (groups of) customers. The outside-in train of thought starts

consistently at the customer and flows back to the organization. This is in contrast to product-
centric "inside-out thinking" where organizations develop products or services, push them out to

the customer, and only then figure out whether the customer likes them.

Rather than pushing products or services to customers, customer-centric organizations

master the art of deeply understanding customers' needs first, and only then do they start

developing products, services, or solutions. Counter-intuitively, offerings of customer-centric

organizations do not necessarily include the best products in terms of superior properties.

Instead, what counts is having reliable products, services, and solutions tailored to the wants and

needs of the customer. For example, Southwest Airlines, a no-frills low-cost airline, consistently

wins awards reflecting high customer satisfaction because it focuses on the particular needs of

customers in the market.

Based on the above, customer centricity can be defined as a business approach that places

the value perception of the customer at the center of attention and takes it as the starting point for

all organizational activities. Strategy development starts consistently at the customer and flows

back to the organization, as opposed to inside-out thinking. The aim is to create an optimal and

distinctive fit between the value perception of the customer and the products/services offered. In

this way, superior value is created for the customer, and superior value is captured by the

organization.

The cited theories provide a framework for the application of Lean Six Sigma in

government organizations. By understanding these theories and applying Lean Six Sigma

principles and tools, government agencies can improve service quality, reduce costs,

and increase efficiency, ultimately leading to better outcomes for citizens.

Related Literature

Importance of Good Governance in Public Services

Good Governance countries with government bureaucracies are required to carry out

good public services. The private sector as a resource manager outside the state and government

bureaucracy must contribute to the business of managing the resources. Good governance can be

realized if supported by principles that can generate trust in the form of participation, law
enforcement, transparency, responsiveness, equity and justice, and accountability (Nawawi,

2012).

Good governance is the most prominent central issue in the management of public

administration today. The demand for good governance arises because of the deviation in the

implementation of the state of democratic values that encourages the awareness of the citizens to

create a new system or paradigm to oversee the path of government so as not to deviate from its

original purpose. The demand to realize the state administration capable of supporting the

smoothness and integrity of the execution of the duties and functions of state governance and

development can be realized by practicing good governance.

Importance of Electronic Services in Government Processes

Quality of e-service is one of the most significant factors that play a major role in the

success or failure of online organizations. Organizations invest heavily in providing online

services to customers in order to enhance their competitive advantages, improve relationships

with clients and increase satisfactions. The clear potential of utilizing ICT in government

services has led many governments to make great investments in ICT (Chohan and Hu, 2020).

E-government is the application of ICT used by governments to generate a comfortable,

transparent and less costly environment for interacting with citizens (Ullah et al, 2021).

Worldwide, governments are upgrading their procedures for remodeling their services to provide

online public services (Sharma et al, 2018). Offering e-governmental services by countries

provides many advantages to citizens. Less frustration, effort, money and time wasted in face-to-

face government services are at the top of the list that make e-government portals a more

convenient option (Samsor, 2020). Those facts encouraged governments worldwide to try and

provide efficient and effective service to a number of stakeholders (Sharma et al, 2018).

Recently, the importance of e-services and specifically e-government has increased even

more after the pandemic period of Covid-19 experienced worldwide (Dawi, N. et al, 2021).

When face-to-face interaction became very limited and nearly unavailable, e-government

solutions become more vital. Thus, e-government services turned to become a necessity rather

than a luxury.

Six Sigma
 According to its definition, Six Sigma is "a well-established technique that tries to detect

and remove defects, mistakes, or breakdowns in business processes or systems by focusing on

those process performance characteristics that provide significant value to customers. Six Sigma

is a statistical methodology that aims to decrease variation in any process, lower costs of goods

and, boost customer satisfaction, and generate financial savings (Albliwi et al., 2015). Six Sigma

is based on the scientific method of identifying problems' root causes and applying critical

thinking to solve them. Six Sigma may be characterized as a technique that applies statistical

tools and the scientific process (Brue 2015).

The best quality approaches for addressing business concerns including customer focus,

process innovation, and quality improvement, according to academics and practitioners, are

found in Six Sigma. Although, there are conflicting findings regarding its beneficial effects on

organizational performance, and about 60% of Six Sigma implementations fails (Alcaide and

Gutierrez 2017). The goal of the Six Sigma technique is to find and eradicate the root causes of

flaws, mistakes, or errors in business processes. Six Sigma focuses on essential processes that

produce undesirably high levels of customer-perceived defects. Six Sigma principles can be

applied to build strong goods, services, and processes, increase process average and design, and

decrease process variation to an acceptable level (Antony et al., 2019). In order to do a detailed

analysis, Six Sigma is based on actual data and facts. It is based on continuing development of

all organizational function and developmental components, proactive management, and

unrestricted collaboration at all levels of the firm. It should be emphasized that it is a strategy for

addressing issues with both business operations and production (Smętkowska and Mrugalska,

2018).

Lean Six Sigma

Lean Six Sigma is a methodology that uses statistical tools and techniques to identify and

eliminate process defects and inefficiencies. It combines the Lean approach of reducing waste

with Six Sigma's focus on reducing variation, resulting in the highly efficient and effective

improvement of a process. It focuses on creating value for the customer, improving quality, and

reducing costs while improving speed and delivery.

 The history of Lean Six Sigma can be traced back to the 1980s and 1990s when several

organizations were struggling with inefficient processes and poor-quality management.

By the early 2000s, Six Sigma and Lean had become popular approaches to process

improvement. Many organizations had found success in using one approach or the other, but

some were still struggling. It was during this time that companies began to combine Lean and

Six Sigma to form Lean Six Sigma.

In 2001, the Lean Six Sigma Institute was founded to offer training and certification on

the Lean Six Sigma methodology. Since then, many organizations have adopted the methodology

in their process improvement efforts.

Today, Lean Six Sigma has become a standard approach to process improvement in many

industries, including manufacturing, healthcare, finance, and services. It has helped organizations

to improve operational efficiency, reduce waste and errors, and improve customer satisfaction.

The application of Lean Six Sigma in government can bring about numerous benefits,

including improved constituent satisfaction, reduced costs, increased efficiency, improved

quality, and better decision-making ability. Ojo, Tunji, and Mccarthy (2015) revealed that the

use of Lean Six Sigma in the public sector resulted in increased customer satisfaction and

improved organizational performance. Moreover, Ojo et al., (2015) revealed that through Lean

Six Sigma, organizations within the public sector can eliminate or minimize the eight types of

waste that impact cost and time: overproduction, over-processing, wait time, defects, inventory,

motion, transportation, and underutilized talent.

By reducing process variation, Lean Six Sigma can increase the accuracy and reliability

of government service, ensuring that citizens receive consistent and high-quality services.

Additionally, the elimination of waste can reduce costs, freeing up resources that can be better

utilized for other important services and programs.

Lean Six Sigma also helps identify and address systemic issues in government services,

promoting a culture of continuous improvement, employee engagement, and increased customer

satisfaction. It enables government agencies to focus on meeting the needs of their constituents

effectively and efficiently.

Tools Used for Six Sigma Implementation

 Arifin et al (2021), used the DMAIC approach in implementing Six Sigma in the potato

chips production. In order to effectively implement this methodology, they assigned a lean

manufacturing tool for each phase. During the define phase, they implemented the SIPOC

diagram to completely describe the supply, input, process, output and customers. Followed by a

Pareto Diagram to measure the defects of each grade of product. Then they used a control chart

to identify the process capability, defects per million opportunities (DPMO), and the sigma

value. During the analyze phase, they used fishbone diagram to identify the factors that influence

the cause of rejects.

Praharsi et al., (2021) Implemented Lean Six sigma using the following methodology.

First, they identified the seven wastes of manufacturing. Meanwhile, waste in shipping and

logistics industries was referred as service waste. The next stage was to determine the critical to

quality metrics for waste processing. Afterwards, the defect per million opportunity (DPMO) and

sigma level value are computed in the measurement stage. Then the root cause is analyzed using

a fishbone diagram. Subsequently, the root cause is analyzed to determine the risk priority

number (RPN) using the failure mode effect analysis. Lastly, the high values of risk priority

number RPN are recommended to propose improvements.

Project Charter

The project charter is a crucial component of a Six Sigma project and the cornerstone of

its success. At the highest level of the company, management writes a one-page document that

serves as the project's executive summary. The charter can be modified as new information from

the DMAIC process becomes available because it is a dynamic, living document. In order to

ensure that the deliverables will assist in achieving the project's purpose, it is important to grasp

it before creating the charter for the documents (Gaudet and Collins, 2022).

Supplier-Input-Process-Output-Customer (SIPOC)

SIPOC is an organizational system model used for improving technologies and process

management. It is the preferred core process method (Meng et al., 2021) According to Brown

(2019), the SIPOC tool, which is used to examine suppliers, inputs, processes, outputs, and

customer, provides an easy-to-implement, swiftly created answer to problems. Before working

on a process improvement projects, the SIPOC is the best instrument for identifying all pertinent
project elements. It is generally used at the measure phase of the Six Sigma DMAIC (define,

measure, analyze, improve and control) approach to help define a complicated project that may

not have been effectively scoped. Although it offers more depth, it is comparable to process

mapping and "in/out of scope" tools. The SIPOC model's overall objective is to challenge

consensus view. Customers and suppliers have traditionally been seen as two independent

entities (Assis de Souza et al., 2022).

Process Mapping

Process mapping is a technique to pinpoint the major steps and decisions in a routine

system in visual form. It tracks the flow of information, materials, and documents involved in the

process and clarifies tasks, decisions, and actions that are needed at particular points in time.

Furthermore, process maps represent the roles of a variety of stakeholders who influence or act

in the process (Barbrow & Hartline, 2015). The major elements of a process map comprise the

inputs, outputs and the steps in the process. An excellent process map should visually present the

flow of the work and the interactions with the organization. It should make use of common

language or symbols that are easily

comprehended by everyone in the organization. The ideal process map should include proper

detail with respect to multiple paths, rework loops and decisions (Hessing, 2022).

Pareto Analysis

Vilfredo Pareto, an Italian economist, developed the Pareto diagram. Around 1896, 20%

of the population in Italy held 80% of the country's land, according to Pareto. This meant that

20% of the population possessed 80% of the wealth at the time. Data can be ranked using Pareto

analysis, a statistical method, according to how frequently certain events occur, from highest to

lowest. One of the core quality tools is the Pareto diagram. Each possible category of causes is

represented by a separate bar in the Pareto chart. Most frequent to least frequent is how the bars

are arranged in terms of frequency. As the "80/20 rule," it is also known as. The total frequency

is equal to 100% and it states that "80% of problems in a system arise from only 20% of the

possible sources." The "useful many" only make up the final 20% of occurrences, while the

"vital few" take up a significant portion (80%) of the total number of occurrences. Consequently,

most issues can be resolved by concentrating on the big issues first (Kumar et al., 2020).
Cause and Effect Diagram

Ishikawa Diagram also known as cause-and-effect diagrams, or fishbone diagram is one

of the seven basic quality control tools (Suárez-Barraza and Rodriguez 2019). Ma & al. (2020)

defines Ishikawa diagram as a tool that assists users to visualize and illustrate the complexity of

the problem and visualize how multiple factors can add to the effect. Today, the 5M acronym of

Machinery, Manpower, Material, measurement, and method was widely used (Suárez-Barraza

and Rodriguez 2019).

Since its establishment, the cause-and-effect diagram has gained vast popularity for

identifying root causes of a variety of problems (Shaw & Blundell, 2014). A study conducted by

Khan et al., (2019) used the cause-and-effect diagram and Pareto chart to identify problem area

that has an impact on the company’s efficiency and productivity.

The researcher of this study will use cause-and-effect diagram to analyze all possible

cause of process quality issue in the Demographic Report Generation process.

Failure Mode Effect Analysis

Failure mode effect analysis (FMEA) is a popular engineering technique for defining,

identifying, and removing known and/or prospective failures, issues, errors, and the like from

system, design, process, and/or service before they reach the consumer (Liu et al., 2015). In

addition to this, Failure mode effect analysis (FMEA), is a tool that may be used to investigate

and prioritize the effects and the frequency of occurrence of failure, is one of these proactive

management processes (Alamry et al., 2017).

According to Liu et al., (2015) FMEA is a crucial tool for improving the safety and

dependability of complex systems by locating and eliminating known or prospective problems. A

cross-functional expert team should be assembled to do FMEA prior to studying a specific

product or system. Finding all potential product or system failure modes is the first stage in the

FMEA process. The failure modes are then subjected to a critical analysis while accounting for

the risk elements of occurrence (O), severity (S), and detection (D). Traditionally, the risk

priority number (RPN), which is the mathematical product of the O, S, and D related to the

failure modes, is used to order the failure modes for corrective measures. Which is RPN = O × S
× D, where O is the likelihood that the system will fail, S is the severity of the failure, and D is

the likelihood that the system won't detect failure at all.

5 Why Analysis

The 5 Whys technique is a problem-solving method which relies on asking “why?” five

or more times in a continuous succession to identify and arrive at the root cause of a problem.

For each time you ask why a problem occurred, your answer then becomes the basis of your next

question, forcing you to dig deeper and deeper into the true cause of the problem. This

knowledgeable decision making technique is used to analyze the cause-and-effect relationships

concealed behind a specific problem. Rather than arriving with a solution that could only resolve

a certain symptom, the 5 Whys process focuses on countermeasures that aim to put a stop to the

problem from ever occurring again. (Masterclass staff, 2020). The researcher will combine 5

why analysis with cause-and-effect diagram in order to conduct an effective root cause analysis.

A study conducted by Benjamin et al., (2015) used 5 why technique to analyze the most

commonly occurring issues in order to identify and address the cause of speed loss in

manufacturing process.

Poka Yoke/Mistake Proofing

Poka-yoke, a quality management idea first put forth by Shigeo Shingo, is a method that

prevents human error from occurring in manufacturing (Malega, 2018). It addresses error-proof

or mistake-proof in accordance with the original wording, yokeru (avoid), and poka (mistakes)

(Kurhade, 2015). The error may involve any task of any kind, including misoperation, non-

compliance with protocol, improper tool use, missing parts, faults during assembly, improper

component use, or inaccurate measurement (Kurhade, 2015).

Poka-yoke assists operators in avoiding errors. Regardless of the technology being used,

the objective is to find and remove abnormal situations that result in the avoidance of product

defects. (Widjajanto et al., 2020).

In a book published by Shingo (2021), he discussed how Poka-yoke can be used to

control quality. This includes setting Management functions, Inspection systems, Poka-yoke

systems and discussing quality controls.

Statistical Process Control

 The goal of statistical process control (SPC) is to use statistical methods to monitor and

manage a process so that it runs as efficiently as possible and produces a conforming product. A

process acts consistently under SPC to generate the most compliant product with the least

amount of waste. Control charts, continuous improvement, and design experiments are essential

SPC tools (Madanhire & Mbohwa, 2016).

The most popular tool for statistically controlling operations is the control chart (RD).

They help with regulation and process quality improvement by making it easier to differentiate

between random and systematic causes of fluctuations in the value of a quality mark (Gejdoš

2015). Control charts are used to monitor processes and determine when adjustments or

corrections to the process are necessary in order to improve the process's mean value or to lower

its variability Criteria for comparing sample characteristics are frequently included in control

charts. (Gejdoš 2015). These criteria are control limits:

UCL= x+ A 2 x R

LCL=x− A2 x R

A central line serves as the center of the area covered by control limits (CL).
n
1 1
X = ( X 1+ X 2+ X k ) = ∑ Xi
k k i=1

Even though statistical process control (SPC) is frequently used in the manufacturing

sector, many people are skeptical of its application in the service sector due to the unique

characteristics of different kinds of service demands. However, stakeholder’s feedbacks in a

service can be monitored by using SPC (Altuntas et al.2020) so as to improve the quality of

services offered such as that in health care services (Muhammed 2004).

A study conducted by Madanhire & Mbohwa (2016), find out that the usage of the

Statistical Process Control tools was quite low due to economic challenges the economy is going

through, and some major stimulation is required to put the manufacturing on an awareness drive

to adopt Statistical Process Control initiatives for them to compete well in regional and global

markets.
 The researcher of this study implemented Statistical Process Control tools in this study.

Visual Controls

Visual Controls standardize decision-making based on facts. Visual controls drive

improvements and bring focus to the process.

A book published by Ortiz et al., (2018) discussed that applying visual control in

manufacturing had resulted with the following: Employees waste less time waiting, more timely,

correct decisions can be done on the production area, improvement of first pass yield and

reduction of rework, lower work in progress levels and lower inventory levels.

To aid in sustaining the improvements in the study, visual controls had been applied by

the researcher.

Lean Manufacturing Implementation in Service Industry

The case studies in the book entitled “Lean six sigma in service: Applications and Case

Studies” (Furterer 2016) illustrate the application of Lean Six Sigma tools to a wide variety of

processes and problems including, but not limited to financial process improvement, designing a

recruiting process, managing a college's assets, and improving educational processes. Examples

of tools include Pareto analysis, cause and effect analysis, failure mode and effects analysis,

statistical process control, SIPOC, process flow charts, project management tools, cost of quality

analysis, and Lean tools, such as 5S, 8 wastes, and the 5 whys.

However, despite these facts, companies are not offering quality services to customers

(Piercy and Rich, 2009). One reason that lean has not been applied to a great extent in the service

industry is that there is organizational traditional thinking that it is related to production, as it

was developed firstly for manufacturing purposes (George, 2003). Bertels and Appiotti (2010)

also highlighted that lean behavior was only considered beneficial for manufacturing industries;

however, nowadays, lean is considered a simple tool applicable to all sectors.

In organizations, 80% of the costs come from product design which includes services,

such as finance, human resources, and product development, while costs from manufacturing

labor comprise only 20%. This leads to higher costs caused by services and with increasing

competition, it will lead to loss of customers, which are more apparent in services than in
manufacturing (George, 2003). To keep customers satisfied, companies are trying to increase the

service quality by integrating the lean principle to reduce costs and increase profitability (Bowen

and Youngdahl, 1998; George, 2003).

Related Studies

Local

The study by Hoyer et. AL (2013) delves into the utilization of Lean Six Sigma

methodology as an intervention to enhance the completeness of required elements in the

discharge paperwork admission system in the Philippines. The said study focused on a specific

healthcare context, to examine the impact of Lean Six Sigma on complex health care workflow

issues. By implementing data analysis and Lean Six Sigma interventions, the study showcases a

remarkable 32.4% improvement in the completeness of required elements. These findings affirm

that Lean Six Sigma is a well-established process improvement methodology with significant

potential for enhancing complex health care workflow issues.

On the other hand, a study made by Veroya et al., (2021) implemented Lean six sigma to

improve overall equipment efficiency in a manufacturing firm in the Philippines. This study,

which showed how OEE may be raised by utilizing the Lean Six Sigma approach along with

other statistical tools and methodologies. The study used the DMAIC approach and the OEE

ideas was analyzed including its components such as Availability, Performance, and Quality.

The results of this study cleared the path for Lean Six Sigma to be applied in OEE improvement

projects, which led to significant improvements.

Another study conducted by Alata et al., (2020) used Lean six sigma in an advanced

manufacturing firm in the Philippines to improve capacity. The DMAIC methodology was able

to increase the weekly capacity of advanced manufacturing from 50,000 to 60,000. Targets that

were precise, measurable, and achievable were correctly created throughout the define phase. In

the define phase, the scope, timing, and overall expected annual cost savings were all

established. Using statistical process control on weekly production data, baseline data were

gathered.
 A related study to reduce defects in the manufacturing process was published by Curbano

et al., (2020). Lean Six Sigma is a powerful strategy that works with eliminating defects from

processes utilizing its well-known DMAIC methodology. The researchers used this in a module

line at Business Y, and the company formed a team with the researchers to carry out this

investigation. Using a Pareto chart, the researchers determined that Direct Copper Bond (DCB)

were the most common defect in the module line is a dent problem. On this, the researchers

concentrated their study. Researcher data on defects from December 2017 to May 2018 were

presented. They choose April 2018, the month with the highest occurrences of DCB Dent. The

researchers were able to determine that the primary issue is from the material: dirty plane plates

and housing using the Ishikawa Diagram and Why-Why analysis. The team came up with

corrective and preventive measures. The modification could only be completed in the final two

weeks of July due to time constraints. The team's improvement was successful, as evidenced by

the sigma level, which rose to 3.98 from 3.64 after the corrective measure was put in place. The

straightening section needs to take corrective action in order to maintain the improvement.

The studies conducted by Hoyer et al. (2013), Veroya et al. (2021), Alata et al. (2020),

and Curbano et al. (2020) share similarities with the present study in that all five studies utilized

Lean Six Sigma methodology to improve specific processes in different contexts. All studies

found that Lean Six Sigma can lead to significant improvements in the processes they targeted.

Hoyer et al. (2013) reported a 32.4% increase in the completeness of required elements, Veroya

et al. (2021) achieved significant improvements in overall equipment efficiency, Alata et al.

(2020) increased the weekly capacity of advanced manufacturing from 50,000 to 60,000, and

Curbano et al. (2020) reduced defects in the manufacturing process.

However, the studies differ in terms of the specific processes they targeted and the

industries they focused on. Hoyer et al. (2013) targeted a specific process in a healthcare setting,

Veroya et al. (2021) focused on improving overall equipment efficiency in a manufacturing firm,

Alata et al. (2020) used Lean Six Sigma to improve capacity in an advanced manufacturing firm,

and Curbano et al. (2020) reduced defects in a module line in business.

The studies also differ in terms of the tools and techniques used during the

implementation of Lean Six Sigma. Veroya et al. (2021) used the DMAIC approach and
analyzed OEE components such as Availability, Performance, and Quality, while Alata et al.

(2020) used precise and measurable targets throughout the Define phase and Curbano et al.

(2020) utilized Pareto charts, Ishikawa diagrams, and Why-Why analysis.

In summary, all studies demonstrate the potential of Lean Six Sigma in improving

processes and achieving significant improvements in performance metrics. While the present

study provides specific insights into the implementation of Lean Six Sigma in government

agencies in the Philippines, the other studies provide evidence of the applicability of Lean Six

Sigma in different contexts, such as healthcare, manufacturing, and advanced manufacturing.

Foreign

A research by Ghaleb et al. (2014) titled “Implementation of Lean Six Sigma (LSS)

Techniques in Small and Medium Enterprises (SMEs) to Enhance Productivity”, implemented

Lean Six Sigma. According to this study, Lean Six Sigma can be applied in all business areas.

Then the implementation of Lean Six Sigma supports to establish best practices within the

company. Next is that a significant improvement was observed in the key metrics after the

implementation of lean six sigma. Followed by that the implementation of Lean Six Sigma has

resulted in savings from reduction in defects and waste time. Then there was a significant

increase of Over all equipment efficiency by 20%. Lastly, the researchers concluded that an

increase in sigma level of the company by 2.3% to 3.91%.

The study by Ghaleb et al. (2014) and the present study both aim to improve productivity

and efficiency through the implementation of Lean Six Sigma. Both studies report that Lean Six

Sigma can be applied in all business areas and leads to the establishment of best practices within

the company. Moreover, both studies observe significant improvements in key performance

metrics and savings from the reduction of defects and wasted time.

However, there are also some differences between the studies. The study by Ghaleb et al.

(2014) focused on the implementation of Lean Six Sigma in small and medium-sized enterprises

in USA, while the present study examines its application in LGUs particularly in the Philippines.

Likewise, the study by Ghaleb et al. (2014) reports a significant increase in overall equipment

efficiency which was not reported on the present study but found significant improvements in

key performance metrics and employee engagement and satisfaction. Additionally, the present
study emphasizes the importance of stakeholder engagement and communication in the

implementation process in government agencies.

Another study by Santhakumar et al. (2017) examines the implementation of Lean Six

Sigma in the public sector and its impact on process improvement and organizational

performance. The findings of the study reveal several significant outcomes. Firstly, the

application of Lean Six Sigma proves highly effective in streamlining processes within local

government units by identifying and eliminating non-value-added activities and inefficiencies.

This, in turn, leads to enhanced operational efficiency, reduced delays, and optimal resource

utilization. Secondly, the study highlights the positive influence of Lean Six Sigma in

overcoming bureaucratic obstacles in the public sector. By critically evaluating and simplifying

bureaucratic processes, Lean Six Sigma facilitates faster decision-making and improves service

delivery to citizens. Lastly, the study demonstrates that Lean Six Sigma implementation in the

government results in substantial cost savings. Through waste elimination, resource

optimization, and heightened productivity, government organizations achieve reduced

operational costs while maintaining or even improving service quality.

In addition to the study by Santhakumar et al. (2017), another notable research conducted

by Shukla and Jain (2014) focused on the application of Lean Six Sigma specifically in the

context of the Indian railways. The study examined the impact of Lean Six Sigma

implementation on various aspects of railway operations. The findings of the study revealed

several noteworthy outcomes. Firstly, the use of Lean Six Sigma methodologies in the Indian

railways led to significant improvements in safety measures. By identifying and addressing

potential hazards and risks, Lean Six Sigma contributed to creating a safer environment for

passengers and staff. Secondly, Lean Six Sigma was found to enhance the efficiency of railway

operations. By streamlining processes, eliminating waste, and optimizing resource allocation,

Lean Six Sigma enabled smoother and more reliable train operations. Lastly, the study

highlighted the positive impact of Lean Six Sigma on customer satisfaction. Through improved

service delivery, reduced delays, and enhanced communication, Lean Six Sigma contributed to a

higher level of customer satisfaction among railway passengers.

 The studies by Santhakumar et al. (2017) and Shukla and Jain (2014) are similar to the

present study on the application of Lean Six Sigma in the Philippines in that they aim to improve

process efficiency, reduce bureaucracy, and enhance service delivery. They all highlight the

importance of data analysis and measurement to identify the root causes of problems and to track

the effectiveness of process improvements. Additionally, all three studies emphasize the value of

Lean Six Sigma tools and techniques in identifying and implementing process improvements,

resulting in significant cost savings, improved safety, and increased customer satisfaction.

However, there are also differences in the specific context and focus of each study. The present

study is specific to the Philippine government sector, while the previous studies focus on the

public sector in India and Indian railways. The present study highlights the need to consider

political factors and bureaucratic processes in implementing Lean Six Sigma in a government

context, which may not have been as relevant in the previous studies. Additionally, the present

study emphasizes the importance of sustainability and continuous improvement in implementing

Lean Six Sigma, which may not have been as emphasized in the previous studies. Despite these

differences, the studies collectively demonstrate the potential of Lean Six Sigma in enhancing

public service delivery and process efficiency, highlighting its relevance across different

contexts.

Lean Six Sigma Methodology in Local Government

A study conducted by Rodgers et. al (2018) explored an established gap in the literature

over the leadership role of government in delivering high quality efficient public services and

presents an initial assessment of whether government approaches support and encourage

improvement or audit improvement and how this fits with good practice in leadership.

Another study conducted by Furterer and Elshennawy (2005) entitle “Implementation of

TQM and Lean Six Sigma Tools in Local Government: a Framework and a Case Study”

presented some efforts of implementing TQM tools in local government and a case study of

applying Lean and Six Sigma tools and principles to improving the quality and timeliness of

providing local government services.

A related study aimed to examine a contextualized local government case study of the

application of Lean Six Sigma (LSS) in conjunction with the Australian Business Excellence
Framework (ABEF) to highlight the importance of a good strategic fit between LSS and

organizational objectives before implementation that was conducted by Price et. al (2019) found

out that LSS provides focus on organizational learning practices embedded within the

implementation of continuous improvement when used in conjunction with the ABEF.

The studies conducted by Rodgers et al. (2018), Furterer and Elshennawy (2005), and

Price et al. (2019) share similarities with the present study in that all five studies explore the

application of process improvement methodologies in the context of government agencies.

Rodgers et al. (2018) explore the role of government in delivering high-quality public

services and the leadership approaches that support or hinder improvement. Furterer and

Elshennawy (2005) present efforts to implement TQM and Lean Six Sigma tools in local

government to improve the quality and timeliness of services. Price et al. (2019) examine the

application of Lean Six Sigma in conjunction with the Australian Business Excellence

Framework to highlight the importance of a good strategic fit between process improvement

methodologies and organizational objectives before implementation.

All studies emphasize the importance of process improvement methodologies in

enhancing the efficiency and effectiveness of government agencies. Rodgers et al. (2018) suggest

that government leadership approaches can either support or hinder process improvement efforts,

while Furterer and Elshennawy (2005) and Price et al. (2019) demonstrate the potential of Lean

Six Sigma and TQM in improving the quality and timeliness of services provided by government

agencies.

Conversely, the studies differ in terms of their specific focus. Rodgers et al. (2018) and

Price et al. (2019) explore the broader context of government agencies, while Furterer and

Elshennawy (2005) focus specifically on local government. Additionally, the present study

focuses on the application of Lean Six Sigma in government agencies in the Philippines, while

the other studies do not specify a particular country or region.

Overall, the studies demonstrated the potential of process improvement methodologies in

enhancing the efficiency and effectiveness of government agencies. While the present study

provides specific insights into the implementation of Lean Six Sigma in government agencies in
the Philippines, the other studies provide evidence of the applicability of TQM and Lean Six

Sigma in different government contexts.

Six Sigma DMAIC Phase

As mentioned in this study, Six Sigma uses an organized approach to solving problems

using the DMAIC cycle. For each phase of the DMAIC; Define-Measure-Analyze-Improve-

Control or Identify-Define-Design-Optimize-Validate (IDDOV) problem-solving process, Six

Sigma or Design for Six Sigma projects are used. Each phase offers the real answer the

researcher came up with, which can be utilized as a reference for tackling the project's

subsequent phase (Furterer 2016).

The previous and present study both have a similar focus on Six Sigma methodology and

its application for problem-solving and process improvement. They both use the DMAIC cycle

or a similar problem-solving framework and aim to improve quality and efficiency in processes

and products. In addition, both studies emphasize the importance of data analysis and

measurement in the problem-solving process. However, there are some differences between the

studies. The previous study may have focused on a different industry or application area for Six

Sigma methodology, while the present study specifically focuses on government processes. The

present study highlights unique challenges and considerations for implementing Six Sigma in

government processes, such as bureaucratic processes or political factors. It may also provide

specific examples of Six Sigma implementation in government agencies, whereas the previous

study may have focused on more general principles and practices. The previous study may have

used different data sources or research methods than the present study. Generally, while both

studies share common themes, the present study specifically addresses the unique challenges and

opportunities of implementing Six Sigma in government processes.

According to a study conducted by Purwanto et al., (2020), they state each cycle as

follows: Define phase is the goal setting of Six sigma quality improvement activities. This phase

is to define action plans that must be carried out to successfully implement the target

improvement of the key business processes. Measure phase have two main objectives, they are

obtaining data to validate and qualify problems and opportunities. This is usually a critical

information for improving and completing the target improvement. Analyze phase is the third
phase in a Six Sigma quality improvement program. In the Analyze phase, it is used to analyze

the root causes of processes and problems, in order to identify the root of the problem. Improve

phase is an implementation phase of improvement activities which is the results of the analysis

in the previous stage. Control phase is the last phase of the six sigma quality improvement

activities. At this phase, control of the process is carried out continuously to increase capabilities,

also to ensure that improvements made to the process will be maintained.

Both the previous and present Six Sigma implementation studies aimed to improve

processes by defining the problem and identifying specific issues. The studies prioritized data

analysis and measurement to identify root causes of problems. The previous study's Define phase

set goals and action plans, while the present study focused on local government unit identifying

service quality issues. The previous study's Measure phase obtained data, while the present study

collected data on key performance indicators. The Analyze phase in the previous study examined

root causes, while the present study analyzed data for identified issues. Both studies emphasized

implementing process improvements, with the previous study's Improve phase implementing

activities and the present study using Lean Six Sigma tools. Finally, both studies stressed the

importance of controlling improvements to maintain effectiveness. The studies differed in their

approach and strategies, with the previous study more general and the present study specific to

implementing Six Sigma in government contexts.

In a study conducted by Gupta et al., (2018) they deployed the Six sigma methodology in

a tire-manufacturing company using the DMAIC phases. In the first phase of the study, their

goals were defined to improve the current process. The most important goals were acquired by

using the voice of customer (VOC) method. These goals would be beneficial for the

improvement of the company. In addition, the goals will guide to lower down the defect level

and increase the output of a specific process. The process cannot be improved without measuring

the performance metrics. Hence, the main goal of the measure phase was to create an efficient

measurement system to gauge the efficiency of the operation. Cpk, the process capability index,

was chosen to gauge process performance. The process capability index was calculated using

observations of bead splice variation using MINITAB version 16.0. During the analyze phase,

the process was examined to find any gaps between the goal's definition and the process's current
level of quality performance. Throughout the improvement phase, innovatively different ways to

accomplish tasks more efficiently and affordably were sought after. The new strategy was

established using several methodologies (such as project management, other planning and

management tools, etc.), and statistical methods were suggested for ongoing improvement. For

the organization to continue to be successful, it is necessary to maintain the improvement made

through the previous processes. To maintain these process improvements going, the control

phase was used. It was recommended to use the new or improved method to maintain quality

control within the business.

The utilization of the DMAIC methodology in Six Sigma quality improvement activities

is a shared characteristic between the previous study by Gupta et al. (2018) and the present study.

Specifically, both studies adopt a comparable approach in defining objectives and identifying the

underlying causes of issues. Furthermore, they both underscore the necessity of collecting data

and measuring outcomes to effectively monitor and evaluate the efficacy of process

enhancements. Additionally, they both emphasize the importance of ensuring sustainability and

continuous improvement to maintain the process improvements over time. Nevertheless, the

studies differ in terms of their specific focus and context. While the previous study is tailored to

a tire manufacturing company, the present study centers on government agencies in the

Philippines. The latter study places importance on identifying precise service quality issues in the

public sector, such as extended waiting times, elevated error rates, or inadequate customer

satisfaction. Additionally, the present study highlights the use of Lean Six Sigma tools and

techniques to identify and execute process improvements, whereas the previous study prioritizes

statistical approaches for ongoing enhancement. Despite these variances, both studies provide

evidence of the efficacy of Six Sigma in enhancing quality and efficiency across various

contexts.

Pareto Analysis

A study conducted by Erdil (2019) stated that Pareto analysis (PA) and QFD (Quality

Function Deployment) have both been extensively utilized. These approaches are also used for

recognizing the most major-dangerous failures, eliminating or reducing the most significant
failure modes. These powerful analytical techniques can be utilized to decide the recommended

course of action based on the calculated and determined values.

Furthermore, Erdil (2019) highlighted that Pareto analysis (PA) and Quality Function

Deployment (QFD) have proven to be effective approaches in identifying the most significant

and dangerous failures, and subsequently, eliminating or reducing the impact of these failures.

Through the utilization of these powerful analytical techniques, organizations can determine the

recommended course of action based on carefully calculated and determined values. Pareto

analysis helps organizations identify the most significant sources of issues, while QFD facilitates

the alignment of customer needs with the organization's capabilities and processes. By

implementing these techniques, organizations can improve their quality management processes,

enhance customer satisfaction, and increase efficiency and profitability. Therefore, the use of

these approaches can be highly beneficial for organizations looking to improve their operational

processes and achieve their overall business objectives.

The previous study by Erdil (2019) and the present study share a commonality in their

application of analytical techniques to enhance quality management processes, particularly by

utilizing Pareto analysis. Both studies emphasize the importance of data collection and

measurement to evaluate the effectiveness of process improvements. Nonetheless, there are

distinctions between the studies concerning the specific techniques employed and the context of

the research. While Erdil's study employed Quality Function Deployment to align customer

needs with organizational capabilities, the present study utilized a fishbone diagram to identify

the causes of product defects in a manufacturing setting. Furthermore, while Erdil's study

focused on general quality improvement, the present study was designed to improve product

quality. Despite these differences, both studies demonstrate the efficacy of analytical techniques

in enhancing quality management processes, leading to improved efficiency, profitability, and

customer satisfaction.

Conceptual Framework
 Figure 1 Shows the conceptual framework that illustrates how this study will implement

Lean Six Sigma Technique in the Demographic Report Generation Process at Municipal

Population Office of Bustos, Bulacan.

Input Process Output

Data of current Lean Six Sigma Methodology: Improved standard

process failures  5 lean principles process procedure
 8 waste check sheet
Current Process  Matrix diagram Redesigned report-
Maps  Lean office assessment generation process
 5S transactional
Project Charter assessment Process control
 Sigma level assessment monitoring plan
 Voice of the customer
translational matrix
 DMAIC Approach

Figure 1. Research Paradigm

The study will begin by gathering three inputs of data as follows: (1) the data of current

process failures which will be used as the baseline of this study. The baseline is critical in any

Lean Six Sigma Study, this will be used to determine whether a significant improvement will

take place, (2) the input will serve as the current process maps, which will show the existing

procedure to analyze the source of the problem and (3) the project charter which is a document

that describes the project in its entirety.

The process of this study is the implementation of lean six sigma methodology to achieve

the target improvement of the study. The DMAIC framework will be implemented while using

the appropriate lean six sigma tools as solution.

The output of this study will be the improved standard process procedure at Demographic

Report Generation Process. Secondly is the redesigned report-generation process, which will

increase process efficiency. Lastly is the process control monitoring plan which will be used in

order to sustain the improvement that this study will bring to the selected process.

Hypothesis of the study

 H o : There is no significant difference in the measure of process quality before and after

the improvement.

H a : There is a significant difference in the measure of process quality before and after the

improvement.

Definition of Terms

The following terms are defined operationally to aid readers in understanding the study:

DMAIC phase. Also known as: Define, measure, analyze, improve and control, is a data-

driven quality strategy used to improve processes.

Lean Manufacturing. Lean Manufacturing aims to enhance productivity, quality, reduce

costs, and ensure on-time delivery by optimizing human effort, manufacturing space, tool

investment, engineering hours, inventory management, and product variety.

Lean Waste. Lean waste is different from non-value-adding activities. Virender and

Narwal (2017), Created a lean waste relationship matrix with different Lean Manufacturing

Strategy he identified them as Overproduction, Waiting, Inventory, Transportation, Over-

Processing, Motion, Flaw/Fault, Workforce, Worker Fatigue, Work in Process, Process Fail. In

this study, Lean waste would refer to all non-value-adding activity.

LGU. Pertains to Local Government Unit which is the governing body at the local level,

responsible for the administration and implementation of government policies and services

within a specific geographic area, such as a city, municipality, or barangay (village). LGUs play

a crucial role in local governance, providing essential public services, promoting local

development, and representing the interests of their constituents.

Lower control limit. This is calculated from the data that is plotted in the control chart.

It is usually plotted 3 sigma below from the average line. The lower control limit is used to mark

the point below a sample value is considered a special cause of variation.

Process entitlement. The performance level that it is possible to attain. This shows the

best possible scenario and performance a process can achieve. This is the ideal performance level

to aim.
 Sigma. A description of how far a sample point of data is away from its mean, expressed

in standard deviations.

Upper control limit. This is calculated from the data that is plotted in the control chart. It
is usually plotted 3 sigma above from the average line. The upper control limit is used to mark
the point beyond a sample value is considered a special cause of variation.