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Analysis and Evaluation of Reviews on Lean and Six Sigma in Health Care

Peimbert-García, Rodrigo E. PhD

doi: 10.1097/QMH.0000000000000226
Literature Review

Background and Objectives: Health care is a complex industry in which professionals are facing the challenge of balancing lower costs with better health and quality of care. To remain competitive, health care organizations have promoted the use of Lean and Six Sigma in various settings. More than 300 refereed English-language articles about Lean and/or Six Sigma in health care are found in the literature, and many reviews have been published on this subject.

Methods: This article characterizes the literature by evaluating and classifying 22 reviews, based on year of publication, country, taxonomy, health care setting, outcome, tools, and enabling factors, in order to identify gaps in the literature and set new directions for research.

Results: Findings indicate that 90% of reviews are characterized by restrictive inclusion criteria that result in the inclusion of only 3% to 66% of the literature at the corresponding time. Furthermore, there is no full comprehensive literature review available on Lean and Six Sigma in health care. Other gaps in the literature include more studies with better research design, broader applications in various health care settings and various countries, sustainability assessment and long-term effects, and evidence of failed Lean and Six Sigma implementations.

Conclusion: This study provides an updated starting point for future research to researchers and practitioners in the field.

School of Engineering and Sciences, Tecnologico de Monterrey, Monterrey, Nuevo Leon, Mexico.

Correspondence: Rodrigo E. Peimbert-García, PhD, School of Engineering and Sciences, Tecnologico de Monterrey, Monterrey 64849, Nuevo León, México (

The author declares that he has no conflict of interests.

© 2019Wolters Kluwer Health | Lippincott Williams & Wilkins