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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 present research focuses on improving the awareness related to soft total quality management (TQM) practices by looking from the viewpoint of strategic human resources (HR). In addition, it is intended to reflect on the resulting soft TQM-HR outcomes and determine the mediating effect between soft TQM-HR strategies and organizational effectiveness (OE).

An exploratory research methodology with an online survey technique was adopted for the study. Three hundred and three managerial-level personnel from nine large Indian manufacturing organizations participated in the research. A theoretical model is projected and verified using correlation and mediation analysis.

The results show that commitment, reduced turnover intentions and satisfaction levels of employees mediate the relationship between resources, development and retention strategies and OE. However, the retention strategy has the strongest association with the OE of the three strategies. Also, of the three HR outcomes, satisfaction was strongly associated with OE. The analysis proved that the proposed model is an acceptable fit.

Implementing HR-related TQM strategies will likely impact OE since it elicits positive HR outcomes such as commitment, reduced turnover intention and satisfaction. Recognizing human resources as a unique strategic asset will help HR managers devise adequate resourcing, development and retention strategies instrumental in executing TQM.

The present micro study is unique in scrutinizing the influence of soft TQM-HR practices on organizational effectiveness by analysing the mediating effects of commitment, reduced turnover intention and satisfaction in Indian large-scale manufacturing organizations. The study is unique since no literature deciphers the linkages between HR strategies and organizational effectiveness in the Indian manufacturing sector.

This study investigates the challenges and opportunities that organisations face in implementing Quality 4.0 as an approach to quality management and investigate the current state of Quality 4.0 implementation.

This study uses a qualitative research methodology to interview senior managers from globally based manufacturing and service industries.

The study explicates that most organisations implemented Quality 4.0 to improve their flexibility, efficiency, transparency and productivity while focusing on improving service quality, customer satisfaction and reducing cost. In terms of sustainability of Quality 4.0 the key factors found were a consistent effort from the top management, continuous training to employees, building leadership quality and creating a habit of using Quality 4.0.

The findings of this study offer useful guidance to organisations desirous of implementing Quality 4.0. In addition, the findings have identified key sustainability factors, helping organisations ensure a successful implementation and long-term returns from Quality 4.0.

The findings of this study contribute to the body of knowledge related to Quality 4.0 and help organisations in their digital transformation journey. In addition, it is one of the first studies to investigate the key factors for Quality 4.0 sustainability.