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Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.

This article intends to comprehend the Lean Six Sigma (LSS) approach adopted in the aerospace industry in India for process improvement. This research has the objective of determining LSS deliverables such as Voice of Customer (VOC), Key Performance Indicators (KPIs), Critical-to-Quality (CTQ), project approach, deployment strategies and tools and techniques used to execute the project.

The study adopted an exploratory research methodology and a multiple case study analysis to draw robust inferences. The research is carried out in the Indian aerospace industry and analyses five case studies. The case studies were collated from the company via a case study protocol with pre-defined criteria. Also, a semi-structured interview is conducted with the stakeholders of each case study to determine the deployment strategies followed during the respective projects.

It is reconfirmed that LSS is crucial in the aerospace industry, particularly in engine and gear shops, to reduce rework and rejections. Also, it was found that cost and time savings are essential KPIs. Some LSS projects require multiple CTQs for process improvement in aero industries. The DMAIC approach is used for project execution, with the Design of Experiment (DOE) being an essential tool. Top management engagement, effective HRM practices, customer focus, cross-functional collaboration and clear roles are essential for successful LSS projects. Eventually, a road map was developed based on the analysis of multiple case studies.

The study is focused on the aerospace industry in India, which may limit the generalizability of the findings to other industries or regions. The small sample size and reliance on qualitative data through semi-structured interviews may introduce subjectivity. Additionally, the long-term effects of LSS implementation, particularly in the context of evolving technologies, were not fully explored.

This study provides actionable insights for aerospace companies and related organisations to enhance quality and operational performance. The developed roadmap offers a practical guide for LSS deployment, helping organisations improve efficiency and competitiveness, especially in an era of economic slowdown and high competition.

The study reveals similarities and differences in LSS deliverables in Indian aerospace industries, creating a roadmap and tool matrix for project execution and serving as a template for manufacturing industries.