{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T09:56:57Z","timestamp":1781171817634,"version":"3.54.1"},"reference-count":68,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":54,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Past global healthcare crises have exposed vulnerabilities in healthcare systems, including inefficiencies in hospital operations, delayed response times, and overburdened infrastructure. Traditional hospital systems built for routine care were sometimes not resilient or adaptable in the face of such crises, resulting in global failures. This narrative review examines how Lean Six Sigma (LSS) principles can be incorporated into conventional hospital operations to enhance pandemic preparedness by building the resilience of hospital infrastructure, streamlining processes during time-sensitive situations, and improving waste reduction, all while being adaptable and sustainable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review synthesizes literature using Coronavirus Disease 2019 (COVID-19)\u00a0as a benchmark to evaluate hospital response strategies, failures, and factors contributing to failure, including the critical assessment of ethical disruptions, operational weaknesses, and healthcare business models. LSS principle applications, i.e. DMAIC, Value Stream Mapping, SIPOC, FMEA, and Control Charts, were explored for facilitating efficient care, crisis response, and policy integration. Various case studies were used to support the comparative analysis and insights.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The literature indicates that adoption of LSS tools in the most vulnerable aspects of healthcare, including patient triage, supply chain optimization, and controlling and reducing mortality, has been associated with measurable improvements. Most importantly, integrating data-driven LSS resulted in enhanced surge responsiveness and ethical compliance within national healthcare frameworks and policies. However, despite its efficacy, there are institutional barriers like capital constraints, resistance to change, data inconsistencies, and a lack of legislative frameworks that impede widespread LSS adoption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LSS offers an adaptable and scalable methodology to re-engineer conventional hospital operations and pandemic preparedness. The emphasis on \u2018kaizen\u2019 (continuous improvement), data-informed decision making, and focus on precision aligns with the needs of healthcare systems as revealed by recent crises. To unlock the potential for preparedness, healthcare systems and legislation must focus on institutionalizing LSS across public and private sectors through strategic investment, education, and cross-sector collaborations. This review provides a comprehensive framework for policymakers, governments, epidemiologists, doctors, and hospital business managers for building resilient, efficient, and pandemic-ready hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag071","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T11:41:51Z","timestamp":1779277311000},"source":"Crossref","is-referenced-by-count":0,"title":["Augmenting healthcare systems for pandemic preparedness: a Lean Six Sigma perspective"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5044-3761","authenticated-orcid":false,"given":"Utkarsh","family":"Chadha","sequence":"first","affiliation":[{"name":"Department of Mechanical and Industrial Engineering, University of Toronto , Toronto, ON M5S 3G8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2880-3750","authenticated-orcid":false,"given":"Artem","family":"Kushnirenko","sequence":"additional","affiliation":[{"name":"Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto , Toronto, ON M5G 2C4,","place":["Canada"]},{"name":"Arthur and Sonia Labatt Brain Tumour Research Centre (BTRC), Peter Gilgan Centre for Research and Learning, SickKids\u2014The Hospital for Sick Children , Toronto, ON M5G 0A4,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren Charles","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Industrial Engineering, University of Toronto , Toronto, ON M5S 3G8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisha Bhavesh","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Civil and Mineral Engineering, University of Toronto , Toronto, ON M5S 1A4,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norah Jean","family":"Crothers","sequence":"additional","affiliation":[{"name":"Health Studies Program, University College, University of Toronto , Toronto, ON M5S 3H7,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Industrial Engineering, University of Toronto , Toronto, ON M5S 3G8,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mete","family":"Isiksalan","sequence":"additional","affiliation":[{"name":"The Edward S. 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