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Workflow optimisation is crucial for establishing a viable acute stroke (AS) intervention programme in a large tertiary care centre. This study aims to utilise Lean Six Sigma (LSS) principles to enhance the hospital's workflow.

The Action Research methodology was used to implement the project and develop the case study. The study took place in a large tertiary care academic hospital in India. The Define-Measure-Analyse-Improve-Control approach optimised the workflow within 6 months. Lean tools such as value stream mapping (VSM), waste audits and Gemba were utilised to identify issues involving various stakeholders in the workflow. Sigma-level calculations were used to compare baseline, improvement and sustainment status. Additionally, statistical techniques were effectively employed to draw meaningful inferences.

LSS tools and techniques can be effectively utilised in large tertiary care hospitals to optimise workflow through a structured approach. Sigma ratings of the processes showed substantial improvement, resulting in a five-fold increase in clinical outcomes. Specifically, there was a 43% improvement in outcome for patients who underwent acute stroke revascularisation. However, certain sigma ratings deteriorated during the control and extended control (sustainment) phases. This indicates that ensuring the sustainability of quality control interventions in healthcare is challenging and requires continuous auditing.

The article presents a single case study deployed in a hospital in India. Thus, the generalisation of outcomes has a significant limitation. Also, the study encounters the challenge of not having a parallel control group, which is a common limitation in quality improvement studies in healthcare. Many studies in healthcare quality improvement, including this one, are limited by minimal data on long-term follow-up and the sustainability of achieved results.

This study pioneers the integration of LSS methodologies in a large Indian tertiary care hospital, specifically targeting AS intervention. It represents the first LSS case study applied in the stroke department of any hospital in India. Whilst most case studies discuss only the positive aspects, this article fills a critical gap by unearthing the challenges of applying LSS in a complex healthcare setting, offering insights into sustainable quality improvement and operational efficiency. This case study contributes to the theoretical understanding of LSS in healthcare. It showcases its real-world impact on patient outcomes and process optimisation.

The COVID-19 outbreak has severely impacted the health tourism industry. This study aims to examine the research undertaken on health tourism during COVID-19.

A bibliometric analysis was performed using 211 documents written by 645 authors between 2020 and 2024. The databases used for this analysis are SCOPUS, Web of Science and PubMed. The study was conducted using the Biblioshiny application for R software. Various analyses, including citation analysis, keyword analysis, thematic mapping and evolution and collaboration analysis, were conducted to get a comprehensive picture of the impact of COVID-19 on health tourism.

The findings suggest that medical tourism was the major area of focus for researchers during COVID-19, whereas wellness tourism was studied in the later stages of the pandemic and is considered important for coping with the negative effects of COVID-19. The thematic review indicates that pre-pandemic research focused on strategies that accelerate the growth of the health tourism sector, whereas during and post-pandemic, the focus was on studying the impact of COVID-19 on the survival and recovery of the sector. Overall, health tourism was considered instrumental in the post-pandemic revival of the tourism industry.

The bibliometric analysis is limited to only four years, as the focus was on studying health tourism during COVID-19. Hence, the study offers more precise insights into the research focus on health tourism during a pandemic. The current study offers limited insights into the post-pandemic scenario as the research is still emerging.

There is a significant opportunity for future research on post-COVID-19 recovery strategies, wherein this research will be helpful for researchers, particularly from emerging countries and countries with high dependence on health, medical and wellness tourism. The thematic analysis provides a valuable comparison of pre-, during and post-pandemic research.

The research indicates an opportunity to study the policies and strategies adopted by various countries regarding the health tourism sector in the post-COVID-19 era. The research also highlights the interwoven, intricate, interdisciplinary nature of health tourism in relation to public and mental health and the need for collaborative efforts.

The study provides critical insights and new directions for future research by highlighting the crucial role of health tourism in mitigating the impact of COVID-19.