Identifying and Prioritizing the Effective Criteria in Selecting Lean Six Sigma Improvement Projects in the Healthcare Sector


  • Ardeshir Bazrkar Islamic Azad University
  • Vahid Aramoon Islamic Azad University
  • Erfan Aramoon Islamic Azad University



Improvement projects, Lean Six Sigma, Healthcare Sector, Best Worst Method


The main objective of this study was to identify and prioritize effective criteria in selecting Lean Six Sigma improvement projects in the healthcare and treatment sector in Iran. The present study was an applied research in terms of objective and a descriptive and analytical one according to the research methodology and data collection approach. The research statistical population included experts and managers with experience in the field of implementing the lean six sigma methodology in the field of healthcare and treatment in Iran. We used interviews and questionnaire tools to collect the data. The effective criteria were identified through reviewing previous research, which were then prioritized based on the experts’ opinions using the BWM method. According to the results, out of the six main dimensions and 20 criteria identified, the customer development dimension with a weight of 0.387 and the customer satisfaction criterion with a weight of 0.066 were determined as the most effective dimension and the most effective criterion, respectively. Accordingly, the directors of medical centers and organizations affiliated with the healthcare sector are recommended to pay special attention to these defined criteria of the customer development dimension to effectively implement the lean six sigma methodology and managing an effective customer relationship.


Download data is not yet available.

Author Biographies

Ardeshir Bazrkar, Islamic Azad University

Department of Industrial Management, North Tehran Branch

Vahid Aramoon, Islamic Azad University

Department of Industrial Management

Erfan Aramoon, Islamic Azad University

Department of Industrial Engineering


Ahmed, S., Abd Manaf, N. H., & Islam, R. (2018). Effect of Lean Six Sigma on quality performance in Malaysian hospitals. International journal of health care quality assurance,13(8),973-987.

Antony, J., Rodgers, B., & Gijo, E. V. (2016). Can Lean Six Sigma make UK public sector organisations more efficient and effective?. International Journal of Productivity and Performance Management,65(7),995-1002.

Aramoon, V., Aramoon, E., & Bazrkar, A. (2020). Investigating the Effect of Implementing the Lean Six Sigma on Organizational Performance Based on the Mediating Role of Strategic Knowledge Management with Structural Equation Modeling Approach. Navus-Revista de Gestão e Tecnologia, 10, 01-16.

Assarlind, M., & Aaboen, L. (2014). Forces affecting one Lean Six Sigma adoption process. International Journal of Lean Six Sigma,5(3),324-340.

Bazrkar, A., & Iranzadeh, S. (2017). Prioritization of Lean Six Sigma improvement projects using data envelopment analysis cross efficiency model. Quality - Access to Success, 18(157), 72-76.

Bhat, S., Antony, J., Gijo, E. V., & Cudney, E. A. (2019). Lean Six Sigma for the healthcare sector: a multiple case study analysis from the Indian context. International Journal of Quality & Reliability Management.,37(1),90-111.

Bumjaid, S. E., & Malik, H. A. M. (2019). The Effect of Implementing of Six Sigma Approach in Improving the Quality of Higher Education Institutions in Bahrain. International Journal of Engineering and Management Research, 9,12-27.

de Miranda Lammoglia, J. A., Brandalise, N., & Hernandez, C. T. (2020). Analytical hierarchy processbocr applied for the best lean project selection for production lines. Independent Journal of Management & Production, 11(1), 054-064.

Erdil, N. O., Aktas, C. B., & Arani, O. M. (2018). Embedding sustainability in lean six sigma efforts. Journal of Cleaner Production, 198, 520-529.

Gupta, H., & Barua, M. K. (2016). Identifying enablers of technological innovation for Indian MSMEs using best-worst multi criteria decision making method. Technological Forecasting and Social Change, 107, 69-79.

Gupta, P., Anand, S., & Gupta, H. (2017). Developing a roadmap to overcome barriers to energy efficiency in buildings using best worst method. Sustainable Cities and Society, 31, 244-259.

Gupta, S., Modgil, S., & Gunasekaran, A. (2020). Big data in lean six sigma: a review and further research directions. International Journal of Production Research, 58(3), 947-969.

Guo, S., & Zhao, H. (2017). Fuzzy best-worst multi-criteria decision-making method and its applications. Knowledge-Based Systems, 121, 23-31.

Henrique, D. B., & Godinho Filho, M. (2020). A systematic literature review of empirical research in Lean and Six Sigma in healthcare. Total Quality Management & Business Excellence, 31(3-4), 429-449.

Improta, G., Cesarelli, M., Montuori, P., Santillo, L. C., & Triassi, M. (2018). Reducing the risk of healthcareâ€associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy). Journal of evaluation in clinical practice, 24(2), 338-346.

Kadarova, J., & Demecko, M. (2016). New approaches in lean management. Procedia Economics and Finance, 39(1), 11-16.

Laureani, A., & Antony, J. (2017). Leadership characteristics for lean six sigma. Total Quality Management & Business Excellence, 28(3-4), 405-426.

Li, J., Wang, J. Q., & Hu, J. H. (2019). Multi-criteria decision-making method based on dominance degree and BWM with probabilistic hesitant fuzzy information. International Journal of Machine Learning and Cybernetics, 10(7), 1671-1685.

Lizarelli, F. L., & Alliprandini, D. H. (2020). Comparative analysis of Lean and Six Sigma improvement projects: performance, changes, investment, time and complexity. Total Quality Management & Business Excellence, 31(3-4), 407-428.

Maghsoodi, A. I., Mosavat, M., Hafezalkotob, A., & Hafezalkotob, A. (2019). Hybrid hierarchical fuzzy group decision-making based on information axioms and BWM: Prototype design selection. Computers & Industrial Engineering, 127, 788-804.

Malek, J., & Desai, T. N. (2019). Prioritization of sustainable manufacturing barriers using Best Worst Method. Journal of Cleaner Production, 226, 589-600.

Marodin, G. A., Frank, A. G., Tortorella, G. L., & Saurin, T. A. (2016). Contextual factors and lean production implementation in the Brazilian automotive supply chain. Supply Chain Management: An International Journal,21(4),417-432.

Mason, S. E., Nicolay, C. R., & Darzi, A. (2015). The use of Lean and Six Sigma methodologies in surgery: A systematic review. The Surgeon, 13(2), 91-100.

McCann, L., Hassard, J. S., Granter, E., & Hyde, P. J. (2015). Casting the lean spell: The promotion, dilution and erosion of lean management in the NHS. Human Relations, 68(10), 1557-1577.

Mi, X., Tang, M., Liao, H., Shen, W., & Lev, B. (2019). The state-of-the-art survey on integrations and applications of the best worst method in decision making: Why, what, what for and what's next?. Omega, 87, 205-225.

Morell-Santandreu, O., Santandreu-Mascarell, C., & Garcia-Sabater, J. J. (2021). A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center. International Journal of Environmental Research and Public Health, 18(6), 2876.

Morell-Santandreu,O., Santandreu-Mascarell, C., & García-Sabater, J. (2020). Sustainability and Kaizen: Business Model Trends in Healthcare. Sustainability, 12(24), 10622.

Mrugalska, B., & Wyrwicka, M. K. (2017). Towards lean production in industry 4.0. Procedia Engineering, 182, 466-473.

Naumovich, A. (2020). The Japanese concept of lean production: possibility of implementation in the Belarusian economy,

Okpala, C. C., Obiuto, N. C., & Elijah, O. C. (2020). Lean Production System Implementation in an Original Equipment Manufacturing Company: Benefits, Challenges, and Critical Success Factors. International Journal of Engineering Research & Technology,9(7),1665-1672.

Pakdil, F., Toktaş, P. and Can, G.F. (2020), Six sigma project prioritization and selection: a multi-criteria decision making approach in healthcare industry,International Journal of Lean Six Sigma, Vol. ahead-ofprint No. ahead-of-print.

Pamučar, D., Petrović, I., & Ćirović, G. (2018). "Modification of the Best-Worst and MABAC methods: A novel approach based on interval- valued fuzzy-rough numbers. Expert Systems with Applications, 91, 89-106.

Rahul, G., Samanta, A. K., & Varaprasad, G. (2020, July). A Lean Six Sigma approach to reduce overcrowding of patients and improving the discharge process in a super-specialty hospital. In 2020 International Conference on System, Computation, Automation and Networking (ICSCAN) (pp. 1-6). IEEE.

Rezaei, J. (2015). Best-worst multi-criteria decision-making method. Omega, 53, 49-57.

Rezaei, J., van Roekel, W. S., & Tavasszy, L. (2018). Measuring the relative importance of the logistics performance index indicators using Best Worst Method. Transport Policy, 68, 158-169.

Sá, J. C., Vaz, S., Carvalho, O., Lima, V., Morgado, L., Fonseca, L., ... & Santos, G. (2020). A model of integration ISO 9001 with Lean six sigma and main benefits achieved. Total Quality Management & Business Excellence, 1-25.

Shenshinov, Y., & Abdulsattar Al-Ali. (2020). THE TOOLS OF INCREASING EFFICIENCY OF HUMAN RESOURCE IN THE LEAN PRODUCTION ENVIRONMENT: CONCEPTUAL STUDY. International Journal of Core Engineering & Managenet,6(7),1-18.

Singh,M.,Rathi,R.,Antony,J.,Garza-Reyes,J.A.(2021).L Lean Six Sigma Project Selection in a Manufacturing Environment Using Hybrid Methodology Based on Intuitionistic Fuzzy MADM Approach, IEEE Transactions on Engineering Management, doi: 10.1109/TEM.2021.3049877.

Sunder, M. V. (2013). Synergies of lean six sigma. IUP Journal of Operations Management, 12(1), 21.

Sunder., M, V., & Kunnath, N. R. (2020). Six Sigma to reduce claims processing errors in a healthcare payer firm. Production Planning & Control, 31(6), 496-511.

Swarnakar, V., & Vinodh, S. (2014). Lean Six Sigma Project Selection using Analytical Network Process. Proceedings of SOM, Conference: XVIII Annual International Conference of the Society of Operations Management,2014.

Trakulsunti, Y., & Antony, J. (2018). Can Lean Six Sigma be used to reduce medication errors in the healthcare sector?. Leadership in Health Services, 31(4),426-433.

Trakulsunti, Y., Antony, J., Ghadge, A., & Gupta, S. (2020). Reducing medication errors using LSS Methodology: A systematic literature review and key findings. Total Quality Management & Business Excellence, 31(5-6), 550-568.

Vinodh, S., & Swarnakar, V. (2015). Lean Six Sigma project selection using hybrid approach based on fuzzy DEMATEL-ANP-TOPSIS. International Journal of Lean Six Sigma,6(4),313-338.

Wang, F. K., & Chen, K. S. (2010). Applying Lean Six Sigma and TRIZ methodology in banking services. Total Quality Management, 21(3), 301-315.

Yadav, G., & Desai, T. N. (2017a). A fuzzy AHP approach to prioritize the barriers of integrated Lean Six Sigma. International Journal of Quality & Reliability Management,34(8),1167-1185.

Yadav, G., & Desai, T. N. (2017b). Analyzing lean six sigma enablers: a hybrid ISM-fuzzy MICMAC approach. The TQM Journal,29(3).488-511.




How to Cite

Bazrkar, A., Aramoon, V., & Aramoon, E. (2021). Identifying and Prioritizing the Effective Criteria in Selecting Lean Six Sigma Improvement Projects in the Healthcare Sector. WPOM-Working Papers on Operations Management, 12(2), 41–55.



Research Articles