Guest editorial

Citation

Lameijer, B.A. and Does, R. (2022), "Guest editorial", International Journal of Lean Six Sigma, Vol. 13 No. 1, pp. 1-7. https://doi.org/10.1108/IJLSS-02-2022-228

1. Operational excellence in The Netherlands: past developments, emergent topics and future research directions

1.1. Historical account of operational excellence research in The Netherlands

Lean Six Sigma (LSS) is a widely adopted methodology for operational excellence in Dutch organizations for several decades. Academic interest on the topic emerged relatively early, and a wide variety of research has appeared from The Netherlands over the past three decades.

The first accounts of research on LSS implementation from The Netherlands appeared in the midst of the 1990s, focusing especially on the impact of Lean production on the organization of work (Niepce and Molleman, 1996; Schuring, 1996), the implementation of statistical process control (Does and Roes, 1996) and the application of Six Sigma in Dutch subsidiaries of US multinationals (Van den Heuvel et al., 1997). In these early years, research predominantly focused on the manufacturing industry, and a widespread interest in LSS implementation for continuous improvement in The Netherlands was reported (Gieskes et al., 1997; Does et al., 2000). In 1998, the first research on LSS for sustainable production appeared (De Ron, 1998), and from 2004 onward, several reports on LSS applied in health-care settings were published (Van Den Heuvel et al., 2004; Joosten et al., 2009; Van Vliet et al., 2010; Niemeijer et al., 2011 and 2012; Gemmel et al., 2019). Contributions to understanding the value of LSS from a strategic perspective followed (De Mast, 2006). Following earlier work by Gieskes et al. (1997), research by Middel et al. (2007) reported that between 1997 and 2007, the initial interest in LSS had resulted in a widespread implementation of LSS in Dutch organizations. Middel et al. (2007) also showed that more mature LSS implementation problems emerged in need of scholarly attention. Contributions to properly define LSS as an improvement methodology appeared (Van Iwaarden et al., 2008), and research on the implementation of LSS in environments not characterized by high volumes and low variety was published (Slomp et al., 2009).

From 2011 onward, the research on LSS implementation from The Netherlands started to increase. Several universities took a leading role, such as the University of Amsterdam, the University of Groningen, the University of Tilburg and the University of Twente. The research output per researcher differed per university and especially the University of Amsterdam showed a high per researcher density of LSS research output. Topics that were studied comprised contributions to the development of the methodology (Does et al., 2002; De Mast, 2006; De Mast and Lokkerbol, 2012; Lameijer et al., 2016; Zwetsloot et al., 2018), applications in small- and medium-sized enterprises (Timans et al., 2012 and 2016; Powell et al., 2013; Knol et al., 2018) and the relation of LSS with other business management functions such as human resource management (De Koeijer et al., 2014), management control (Tillema and Van der Steen, 2015), leadership (Van Dun et al., 2016 and 2017; Van Assen, 2018a and 2018b), innovation management (Solaimani et al., 2019) and Industry 4.0 (Tortorella et al., 2019). Important emphases for LSS implementation success were reported (Knol et al., 2019; Van Assen, 2019 and 2020), and finally, several reports on research in other than the manufacturing and health-care industries appeared from The Netherlands (De Mast et al., 2013; De Jong and Van Blokland, 2016; Gutierrez-Gutierrez, 2016).

2. Overview of the articles in the special issue

There has been and is, as demonstrated by this special issue, a wide academic interest for topics related to LSS implementation in The Netherlands with eight out of 14 Dutch public universities that (have) actively publish(ed) on the topic (Web of Science, 2020; VSNU, 2020). With 17.5 million people and an annual economic output [gross domestic product (GDP)] of €750bn (World Bank, 2018), The Netherlands is ranked the 17th economy in the world. The economic output of The Netherlands is comparatively high, and the economic activity is concentrated in professional services (e.g. financial services) (23%), health care (15%), trade (15%), manufacturing (8%) and educational services (6%) (Statistics Netherlands, 2018). The adoption of LSS methodology in Dutch organizations is, although varying per service industry, relatively mature. Moreover, The Netherlands accommodates many highly innovative service-based companies. Therefore, this special issue on operational excellence in The Netherlands specifically contributes to a better understanding of LSS implementation in service-based organizations at both the project and organizational levels. Most of the research is centered around LSS implementation in health care, as that is where currently most of the operational excellence research in The Netherlands is being performed.

2.1 Systematic literature review of process improvement project failures

The first contribution to this special issue reviews the existing literature on process improvement (PI) (Lean, Six Sigma, LSS) project failures. Recent attempts to better understand PI project failure have emerged and provided preliminary insights into dominant failure factors. Going forward, the authors argue, apart from what, questions about why and how PI project failure occurs need to be answered.

Reviewing the literature on project failure resulted in three propositions for future research, each holding implications for practice. First, existing reconstructions and researches elaborately explored the effects of failure factors on project outcome, revealing a predominant focus on failure factors that originated from within the project management organizations. Second, exploration of failure factor interdependencies revealed a pattern of initially project managerial failure factors in predominantly earlier project phases, i.e. many failures appeared to be rooted in factors that are to be influenced by the project manager or the project team. Finally, research on project failure revealed the importance of learning and adaption to prevent (future) project failure: PI practitioners are advised to follow the identified before, during and after the project failure mitigation strategies.

Managers and LSS practitioners that are confronted with the task of managing projects may find direction in the typology of project failure factors and the consecutive strategies for project failure mitigation that the authors have developed. This first paper was originally accepted for publication in a regular issue of International Journal of Lean Six Sigma, and subsequently by editor-in-chief decree integrated into this special issue due to its relevance to the topic.

2.2 Case study of outpatient clinic process improvement with Lean Six Sigma

The second paper in this special issue is a case study in health care that specifically studies the implementation of LSS at the project level. In this article, the authors describe the successful implementation of an LSS project aimed at increasing the efficiency of the orthopedic outpatient clinic of the Red Cross Hospital in Beverwijk, The Netherlands. The goal of this LSS project was to increase efficiency by improving the main process at the orthopedic outpatient clinic, the consultation and treatment of patients with musculoskeletal problems, thereby freeing up capacity for new patients.

With this project, the authors have demonstrated that it is not only possible to perform health care in a more efficient way but also to reduce the amount of unnecessary care delivered by physicians. The authors argue that it would be beneficial for both care organizations and patients to look at processes from this perspective as well: does the care really add medical value for the patient? To do so is typically not easy for those actors heavily involved. Unique to this case study was the leading role of an external orthopedic surgeon as project lead who was able to have such an outside-in view, thereby generating valuable lessons for LSS practitioners and physicians looking for PI in healthcare.

2.3 Process study of organization wide Lean implementation in health care

The third contribution to this special issue is a process study of organization-wide Lean implementation in two Dutch university hospitals that engaged in different implementation approaches during the same four-year period: top-down vs bottom-up. Lean implementations in hospitals are known to be lengthy or lack the desired results. To better understand the potential causes for that, the authors have addressed how two different Lean implementation approaches, top-down and bottom-up, contributed to effective organization-wide adoption of Lean in Dutch hospitals.

The authors found that during the six implementation stages, the roles played by top, middle and frontline managers stood out. While the top managers of one hospital initiated the organization-wide implementation, and then delegated it to others, the top managers of the other similar hospital merely tolerated the bottom-up Lean activities. Eventually, only the hospital with the top-down approach achieved high organization-wide performance gains, but only in its fourth year after the top managers embraced Lean in their own daily work practices and had started to co-create Lean themselves. Then, the earlier developed Lean infrastructure at the middle and frontline ranks led to the desired hospital-wide Lean implementation results. The implications from this process study include basic tenets of the social learning and goal-setting theory. The authors found Lean implementation is “best-oiled” through role-modeling by top managers who use a phased-based process and engage in close cross-hierarchical or co-creative collaboration with middle as well as frontline managerial members. Thereby, the authors have provided important insight for managers and LSS leaders tasked with organization-wide Lean implementation in health care.

Moreover, the guest editorial team of this special issue is particularly pleased with this excellent example of process study research in operations management. Typically, this type of research is more commonly accepted in general management research and provides a rich and detailed understanding not so much on what or why things happened, but focuses on how organizational processes evolved throughout time, leading to certain outcomes. Thereby valuable longitudinal insights are generated, which is considered to be a great contribution to the vast body of cross-sectional operations management research on the topic of Lean, Six Sigma and LSS implementation to date.

2.4 Survey research on the effects of Lean Six Sigma implementation on employee well-being

The fourth contribution from The Netherlands for this special issue is a large-sample survey research looking into the effects of Lean and Six Sigma implementation on employee well-being. The authors show that the debate about the relationship between LSS and employee well-being is still open and requires further analyses. LSS is known not to be a neutral and value-free activity, and to date, there is no agreement on the effect – positive or negative – of LSS on employee well-being.

The authors make several contributions. First, based on a review of the literature, LSS attributes are translated from a manufacturing perspective into a health-care perspective. Second, the authors show that the conceptualization of employee well-being in LSS research has been limited to date, with workers satisfaction as the most common component. In advancement of prior research, the authors adopted three components of employee well-being: happiness, trust and health. Third, the authors focused on the conceptualization as well as the moderating effect of human resource management in the relation between LSS and employee well-being. Although there is increasing evidence that organizations that combine LSS with human resource management (HRM) outperform organizations that do not apply this combination, studies that focus on LSS, HRM and employee well-being are scarce to date.

Important findings that the authors report include no or weak effects of LSS on employee well-being. In addition, the authors report unexpected side effects of HRM on employee well-being. Thereby this study presents a cautiously optimistic view about LSS in health care, provided that it is applied in a targeted manner (to improve processes), and that HRM is strategically aligned with the goals of the LSS initiative to improve employees’ well-being.

2.5 Abductive commentary on Lean Six Sigma in health care in light of COVID-19 events

The fifth and final paper in this special issue on operational excellence in The Netherlands is a commentary paper that reflects upon the ramifications of two decades of LSS implementations in Dutch health-care institutions, in light of the current COVID-19 pandemic. Specifically, the authors provide an evaluation of the impact that LSS implementations have had on the ability of Dutch health-care institutions to respond adequately to health-care needs during the COVID-19 crisis. The authors, by means of abductive reasoning, conclude that PI in Dutch health care has had a tendency to cut capacity and flexibility, which are needed to deal with excessive demand shocks, such as during a pandemic. The main reason for this failure seems to be an overly strong focus on cost reduction instigated by LSS implementations during stable times. The authors call for a more comprehensive approach of PI within health care that takes flexibility and buffering in anticipation of excess variability and disruption into greater account. Therefore, this study provides a new perspective on how and to which aim LSS should be applied in healthcare.

3. Conclusions and future research considerations

The research presented in this special issue has provided new insights and a better understanding of how and under which conditions LSS affects organizational performance. This entails among others a better understanding of the enabling versus the inhibiting factors that enable long-term success of LSS implementations.

Future research directions resulting from this special issue are various and mainly point out the importance of further research on LSS in services. The collection of research show that indeed LSS projects in service environments can yield great results. Nevertheless, it also shown that there is still much to discover about why and how LSS projects fail, how LSS implementations in services are best be managed, how to appropriately manage negative externalities from LSS implementation in services and, more importantly, how LSS philosophy, principles and methods need adjustment given specific industry and company contexts. Further future research directions indirectly resulting from this special issue include questions of how developments in the area of data-driven PI influence LSS implementations in service organizations, such as increasing developments in and adoption of artificial intelligence, process automation and iterative ways of working.