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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.

The study aims to identify Green Lean Six Sigma (GLSS) barriers in the context of Higher Education Institutions (HEIs) and prioritize them for executing the GLSS approach.

A systematic literature review (SLR) was used to identify a total of 14 barriers, which were then verified for greater relevance by the professional judgments of industrial personnel. Moreover, many removal measures strategies are also recommended in this study. Furthermore, this work also utilizes Gray Relational Analysis (GRA) to prioritize the identified GLSS barriers.

The study reveals that training and education, continuous assessment of SDG, organizational culture, resources and skills to facilitate implementation, and assessment of satisfaction and welfare of the employee are the most significant barriers to implementing this approach.

The present study provides an impetus for practitioners and managers to embrace the GLSS strategy through a wide-ranging understanding and exploring these barriers. In this case, the outcomes of this research, and in particular the GRA technique presented by this work, can be used by managers and professionals to rank the GLSS barriers and take appropriate action to eliminate them.

The ranking of GLSS barriers gives top officials of HEIs a very clear view to effectively and efficiently implementing GLSS initiatives. The outcomes also show training and education, sustainable development goals and organizational culture as critical barriers. The findings of this study provide an impetus for managers, policymakers and consultants to embrace the GLSS strategy through a wide-ranging understanding and exploring these barriers.

The GLSS barriers in HEIs may significantly affect the society. HEIs can lessen their environmental effect by using GLSS practices, which can support sustainability initiatives and foster social responsibility. Taking steps to reduce environmental effect can benefit society as a whole. GLSS techniques in HEIs can also result in increased operational effectiveness and cost savings, which can free up resources to be employed in other areas, like boosting student services and improving educational programs. However, failing to implement GLSS procedures in HEIs could have societal repercussions as well. As a result, it is critical for HEIs to identify and remove GLSS barriers in order to advance sustainability, social responsibility and operational effectiveness.

GLSS is a comprehensive methodology that facilitates the optimum utilization of resources, reduces waste and provides the pathway for sustainable development so, the novelty of this study stands in the inclusion of its barriers and HEIs to prioritize them for effective implementation.

In the current era, the focus on circular economy (CE) has gained substantial momentum among the research communities across the manufacturing world. It has become the need of the hour to act fast due to the alarming issues of unsustainability such as climate change, global warming, waste generation, environmental pollution, resource scarceness and ecological degradations. This research aims to investigate and model the CE enablers in the product development process related to the moderating effect of net zero.

The significant CE enablers are identified through literature review and expert brainstorming. The Pythagorean fuzzy decision-making trial and evaluation laboratory (PF-DEMATEL) technique has been used to investigate and evaluate the significant CE enablers in product development process. PF-DEMATEL determines the inter-relationship and casual dependency among the selected CE enablers. Indian automobile small and medium enterprises (SMEs) have been considered as a case organization to demonstrate the effectiveness of the proposed method.

The findings reveal that “Top management support and clear vision towards CE adoption” is the most important enabler and “Artificial intelligence in product value chain” is recognized as the least vital enabler. This research aids the managers, decision-makers, policy planners and workforce to develop and formulating efficient blueprints for the effective adoption of CE in Indian SMEs.

This is the first kind of research that explores CE enablers in product development process for Indian SMEs.

This study aims to investigate the implementation of lean human resource management (HRM) practices in manufacturing small- and medium-sized enterprises (SMEs) and explore how various factors interact to influence their successful adoption. By exploring the interplay among these factors, the research seeks to identify key drivers affecting the adoption of lean HRM in manufacturing SMEs. Ultimately, the research intends to provide insights that can guide organisations, practitioners and policymakers in effectively implementing lean HRM practices to enhance operational efficiency, workforce engagement and competitiveness within the manufacturing SME sector.

The study combined total interpretive structural modelling (TISM) and Matrice d'Impacts Croisés Multiplication Appliquée à un Classement (MICMAC) analysis. TISM helped in understanding the hierarchical relationship among different factors influencing lean HRM implementation, whereas MICMAC analysis provided insights into the level of influence and dependence of each factor on others.

The research revealed that “top management support” emerged as the most independent factor, indicating that strong support from top management is crucial for initiating and sustaining lean HRM practices in manufacturing SMEs. On the other hand, “employee involvement and empowerment” was identified as the most dependent factor, suggesting that fostering a culture of employee engagement and empowerment greatly relies on the successful implementation of lean HRM practices.

While the study provided valuable insights, it has certain limitations. The research was conducted within the specific context of manufacturing SMEs, which might limit the generalizability of the findings to other industries. Expert opinions introduce subjectivity in data collection. Additionally, the study may not cover all critical factors, allowing room for further exploration in future research.

The findings have practical implications for manufacturing SMEs aiming to implement lean HRM practices. Recognising the pivotal role of top management support, organisations should invest in cultivating a strong leadership commitment to lean HRM initiatives. Furthermore, enhancing employee involvement and empowerment can lead to better adoption of lean HRM practices, resulting in improved operational efficiency and overall competitiveness.

This research contributes to the field by offering a comprehensive exploration of the interplay among factors influencing lean HRM implementation. The use of TISM and MICMAC analysis provides a unique perspective on the relationship dynamics between these factors, allowing for a nuanced understanding of their roles in the adoption of lean HRM practices in manufacturing SMEs. The identification of “top management support” as the most independent and “employee involvement and empowerment” as the most dependent factors adds original insights to the existing literature.

Small and medium-sized enterprises (SMEs) are a major source of employment and revenue growth in developing nations like India, but they also face challenges from resource shortages, shifting consumer demand and heightened competition. This research aims to discover the aspects that enhance SMEs' competitiveness and performance.

By analyzing literature and consulting experts, 10 factors that boost a firm's competitiveness were identified. The total interpretive structural modeling (TISM) method was then used to determine their interaction and structural hierarchy. Neutrosophic-MICMAC analysis was employed to assess the driving-dependence power of each factor.

The study discovered that the factor, namely “entrepreneurial orientation,” was found to be a significant one. “Manufacturing strategy” was found to be extremely dependent on the remaining competitive advantage factors.

This SME-focused framework can be adopted by large businesses to enhance organizational performance by focusing on critical factors. The study depends on experts' judgment, which might be biased. Findings will assist SMEs in identifying significant factors influencing competitive advantage and relationships, increasing awareness of factors contributing to competitive edge.

The results of the research may encourage SME sector managers and practitioners to prioritize the factors that contribute to a firm's competitive advantage.

The majority of research on SME competitive advantage focuses on individual aspects. To add to the body of knowledge on the subject, this study applies the TISM technique to Indian SMEs to identify the contextual interactions among factors that increase long-term competitiveness.

The ability of a business to outperform its rivals is known as its competitive edge, and it presents special difficulties in the context of the “digital revolution,” or the fourth industrial revolution. To obtain a competitive edge in the startup operations 4.0 era, this study aims to examine the organizational, technological and competence-related challenges presented by Industry 4.0. It does this by concentrating on the tools, competencies, methods, approaches, tools and strategies that are crucial. Using the Total Interpretive Structural Modeling (TISM) technique, the goal is to find, analyze and classify enablers for startup operations 4.0.

A closed-ended questionnaire and planned interviews were used in the data collection process. In startup operations 4.0, the cross-impact matrix multiplication applied to classification method is used to rank and categorize competitive advantage factors, whereas the TISM technique is used to analyze how components interact.

The study highlights the critical significance of the “Internet of Things (IoT),” “information technologies,” “technological platforms,” “employee empowerment,” “augmented reality (AR)” and “operational technologies” in its identification of 12 enablers for startup operations 4.0.

The main focus of the study is on the variables that affect startup operations 4.0’s competitive advantage.

Academics and important stakeholders can better understand the factors influencing competitive advantage in startup operations 4.0 with the help of this research.

Large businesses have been profoundly impacted by Industry 4.0 principles; however, startup operations 4.0’s competitive advantage has not received as much attention. This paper offers a fresh take on the concept of competitive advantage in startup operations 4.0 research.

When coping with uncertainties, three characteristics distinguish firms: agility, adaptability and alignment (triple-A). Based on significant field research, the triple-A highlights the significance of coordinating agility, adaptability and alignment. Start-ups are facing a lot of challenges in this turbulent environment. However, this sector is undergoing a major transformation. Agility, adaptability and alignment concepts have had a major influence on the supply chain, but their implementation in start-ups has been less visible. This paper aims to identify, analyze and categorize the enablers for agility, adaptability and alignment in start-ups using the total interpretive structural modeling (TISM) approach.

In addition to the scheduled interview, a closed-ended questionnaire was used to collect data. To identify how the factors interact, the TISM technique is used, and the Matriced’Impacts Croises-Multipication Applique’ and Classment method is used to rank and categorize the agility, adaptability and alignment enablers.

This study identified ten agility, adaptability and alignment factors for start-ups. It has been found that the key importance should be given to management involvement, conflict management, collaboration and information integration.

This study primarily focused on the agility, adaptability and alignment factors in start-ups.

This study will help academics and key stakeholders understand the aspects that lead to agility, adaptability and alignment in start-ups.

Agility, adaptability and alignment concepts have had a major influence on the supply chain, but their implementation in start-ups has been less visible. Therefore, this is a novel attempt in this industry’s agility, adaptability and alignment.

The textile industry contributes 2 and 3% to the global and Indian Gross Domestic Product (GDP), respectively. India supplies a quarter of global cotton yarn. Yet, most yarn manufacturing companies use outdated methods and lack organisational skills and strategies. Improvement in processes in India could significantly help the industry worldwide.

The variables that influence the performance of the system were identified. Their interrelationships and impact were identified from the employees in the chosen case study, a yarn manufacturing industry. A System Dynamics (SD) approach was employed to study the benefits of implementing 5S lean strategies. The impact of each variable on various performance measures such as throughput, Work In Progress, processing time, waiting time, idle time, over-processing and scraps was analysed.

Improvement in outcomes reflected an enhanced adoption of leanness in the industry. The decision-makers can utilise this study to optimise the necessary parameters in the system and attain the desired productivity levels. Better resource management and reduced processing time helped increase the despatch rate by 9.735% and decrease the WIP by 23.01%. Time management helped to reduce the inventory, idle time and waiting time. Over-processing, defects and scraps were minimised, indicating a shift towards lean.

This study pioneers the use of SD simulation models for optimising yarn manufacturing using lean strategies. Improvement in performance measures by integrating these strategies opens avenues for future research using multiple approaches to address a problem.

Implementing 5S lean principles and simulations enhances productivity, reduces waste and optimises resource management for the yarn manufacturing industry. Decision-makers can employ simulation to witness the outcomes of their changes without investing cost and time and without associated implementation risks.

The use of a simulation model to witness the benefits of incorporating lean strategies in yarn production has not been explored. This approach could help the managers and policymakers understand their existing system's shortcomings and critical areas that require improvement.

This research investigates the barriers for Complementary and Alternative Medicine (CAM) adoption among the patients in India. Despite the established role of CAM in the Indian healthcare system for several years, the WHO (WHO) reports limited adoption of these therapies among Indian patients. This study investigates the key barriers toward wider CAM use within the Indian context.

This study used a combined interpretive structural modeling (ISM)-MICMAC approach to identify barriers to CAM usage. In the first phase, a comprehensive literature review was conducted to understand the barriers. Subsequently, experts in the Indian healthcare system were identified and interviewed to capture the contextual intricacies of these barriers within the Indian context.

The study identified ten key barriers to CAM adoption through ISM. A hierarchical model was developed to understand the relationships and interactions among these barriers, revealing their linkages. A MICMAC chart was created to determine the driving and dependent power of the barriers, categorizing them as dependent barriers, linkage barriers or independent barriers. The House of CAM framework was then derived from the ISM-MICMAC analysis, providing a structured, sequential approach for CAM adoption.

The awareness of the potential benefits and usage of CAM is significantly low among Indian patients. There is a pressing need to investigate and systematically conceptualize the barriers to CAM adoption. This research provides valuable insights for policymakers, insurers, practitioners of alternative and complementary medicine, multi-specialty hospitals offering CAM services and regulatory bodies. Understanding these barriers will enable these stakeholders to develop and implement strategies that effectively address these issues.

This research makes substantial contributions to the understanding of barriers to the adoption of CAM. Through a comprehensive investigation, the study introduces the House of CAM framework developed using ISM-MICMAC analysis, providing a strategic approach for targeted intervention against identified barriers.

The research provides new strategies for enhancing resilience in pharmaceutical manufacturing by addressing the dynamic nature of digital technology within the challenging framework of a VUCA (volatility, uncertainty, complexity and ambiguity) world, focusing on the concept of digital twins (DTs). This paper aims to emphasize the pivotal role of resilience in navigating disruptions and propose future research directions to contribute to the industry’s effective adaptation to uncertainties and dynamic challenges.

This research uses a qualitative approach, drawing insights from an extensive literature review on pharmaceutical manufacturing resilience and the integration of digital technologies. Methodologically, it synthesizes information from scholarly articles, empirical studies and industry reports to construct a comprehensive understanding. This design facilitates a thorough examination of the subject, providing valuable insights for practitioners, researchers and policymakers in the pharmaceutical industry.

This paper illustrates the practical application of DTs in vaccine production, emphasizing their critical role in ensuring quality, safety and adaptability. It adopts the “seizing, sensing and transforming” framework, showcasing the strategic integration of Industry 4.0 technologies to address dynamic challenges. Key insights include the significance of human elements alongside technological advancements, the need for real-time monitoring using Internet of Things (IoT) and artificial intelligence (AI) and the transformative potential of sustainability practices, diversified supply chains and collaborative ecosystems.

This paper highlights the integration of human and digital elements, emphasizing IoT, AI and DTs for resilience. It underscores sustainable practices, supply chain diversification and collaboration as key strategies for addressing pharmaceutical industry challenges.

This paper offers practical insights for pharmaceutical manufacturing, emphasizing the need for robust cybersecurity measures, strategic investments in digital technologies and proactive regulatory compliance. Managers are encouraged to allocate budgets for digital integration, prioritize change management for technology adoption and invest in a skilled workforce. The adoption and management of DTs are highlighted to enhance resilience. Overall, the paper guides pharmaceutical organizations in navigating the complexities of the VUCA environment, ensuring the quality and safety of products through a multifaceted approach that combines advanced technologies with sustainability practices, supply chain diversification and collaborative ecosystems.

The research addresses VUCA challenges, including volatility, uncertainty, complexity and ambiguity in pharmaceutical manufacturing. It emphasizes societal benefits such as uninterrupted drug supply, environmental responsibility through sustainable practices and enhanced collaboration among stakeholders. By leveraging digital technologies and resilience strategies, the study highlights the pharmaceutical sector’s pivotal role in managing health crises and ensuring patient safety.

This paper offers substantial originality and value by presenting a comprehensive framework for bolstering resilience in pharmaceutical manufacturing within the VUCA environment. The integration of advanced digital technologies, notably DTs, is explored in-depth, providing novel insights into their practical application. The “seizing, sensing and transforming” concept contributes a nuanced approach, considering both technological and human dimensions. This paper addresses the gaps in current literature by combining diverse elements such as Industry 4.0, risk assessment, sustainability practices and collaborative ecosystems. Its practical implications for managers and detailed exploration of research directions add tangible value, guiding future endeavors in enhancing pharmaceutical industry resilience.