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Pressure to change is politically driven owing to escalating healthcare costs and an emphasis on efficiency gains, value for money and improved performance proof in terms of productivity and recently to some extent by demands from less satisfied patients and stakeholders. In a background of newly immerging expensive techniques and drugs, there is an increasing consumer expectation, i.e. quality services. At the same time, health system managers and practitioners are finding it difficult to cope with demand and quality expectations. Clinicians are frustrated because they are not recognised for their contribution. Managers are frustrated because meaningful dialogue with clinicians is lacking, which has intensified the need for change to a more efficient system that satisfies all arguments about cost effectiveness and sustainable quality services. Various strategies, originally developed by management quality “gurus” for engineering industries, have been applied to health industries with variable success, which largely depends on the type of health care system to which they are applied.

Business process re‐engineering is examined as a quality management tool using past and recent publications.

The paper finds that applying business process re‐engineering in the right circumstances and selected settings for quality improvement is critical for its success. It is certainly “not for everybody”.

The paper provides a critical appraisal of business process re‐engineering experiences in UK healthcare. Lessons learned regarding selecting organisations and agreeing realistic expectations are addressed. Business process re‐engineering has been evaluated and reviewed since 1987 in US managed health care, with no clear lessons learned possibly because unit selection and simultaneous comparison between two units virtually performing at opposite ends has never been done before. Two UK pilot studies, however, add useful insights.

In the recent climate of consumerism and consumer focused care, health and social care needs to be more responsive than ever before. Consumer needs and preferences can be elicited with accepted validity and reliability only by strict methodological control, customerisation of the questionnaire and skilled interpretation. To construct, conduct, interpret and implement improved service provision, requires a trained work force and infrastructure. This article aims to appraise various aspects of consumer surveys and to assess their value as effective service improvement tools.

The customer is the sole reason organisations exist. Consumer surveys are used worldwide as service and quality of care improvement tools by all types of service providers including health service providers. The article critically appraises the value of consumer surveys as service improvement tools in health services tool and its future applications.

No one type of survey is the best or ideal. The key is the selection of the correct survey methodology, unique and customised for the particular type/aspect of care being evaluated. The method used should reflect the importance of the information required.

Methodological rigor is essential for the effectiveness of consumer surveys as service improvement tools. Unfortunately so far there is no universal consensus on superiority of one particular methodology over another or any benefit of one specific methodology in a given situation. More training and some dedicated resource allocation is required to develop consumer surveys. More research is needed to develop specific survey methodology and evaluation techniques for improved validity and reliability of the surveys as service improvement tools. Measurement of consumer preferences/priorities, evaluation of services and key performance scores, is not easy.

Consumer surveys seem impressive tools as they provide the customer a voice for change or modification. However, from a scientific point‐of‐view their credibility in service improvement in terms of reproducibility, reliability and validity, has remained debatable.

This artcile is a critical appraisal of the value of consumer surveys as a service improvement tool in health services – a lesson which needs to be learnt.

Children with rheumatic disease, who are infected with influenza, have an increased rate of complications. These complications can be reduced by improving the flu vaccination rate. This paper's aim is to document the authors' purpose of increasing the influenza vaccination rate through information technology (IT) intervention in this high risk population of patients.

The authors retrospectively reviewed the electronic health records (EHR) of three yearly cohorts (2007, 2008, and 2009) of rheumatology clinic patients from a large pediatric hospital for evidence of influenza vaccination. They introduced an automatic best practice reminder intervention in patients' EHR from September 2009 to April 2010. Using Clarity Report Write for EPIC, each chart was examined for evidence of influenza vaccination to test for vaccination rate difference among the cohorts. The authors employed logistic regression equations to control for possible confounders using SAS 9.1.3.

There was a significant difference in the probability of being vaccinated before and after intervention (p value <0.0001).The vaccination rate increased from 5.9 percent in 2007, 7.8 percent in 2008 and to 25.5 percent in 2009. During all three years, individual attending's contribution and ethnicity of patients had significant effects on vaccination rate. Confounders such as age, sex, insurance status and distance travelled from clinic had no effect on the vaccination rate.

EHR‐embedded information in past studies has been only modestly effective in improving care for many chronic conditions. The automatic best practice reminder for flu‐vaccine appears to be effective for changing physician's behaviors and improving the vaccination rate in rheumatology clinics.

The purpose of this work is to gain insights about Lean Six Sigma (LSS) in the Indian context by reviewing the related literature for one decade based on various perspectives, such as author profile, year of publication, type of firm, type of methodology used, type of industry for which the research work is carried out and the key findings from the research.

This study reviews the research related to LSS from the articles published in the reputed journals. The literature used for reviewing is derived from the sources, including Science direct, Google scholar, IEEE, Taylor and Francis Group, Emerald Insight, Springer, Inderscience and Elsevier during the period between 2010 and 2021. Totally, the authors have included 141 LSS-related research articles that are published in the Indian context. The keywords used are Lean Six Sigma, Lean Six Sigma in the Indian context, Lean Sigma and LSS to identify and consolidate the research papers published during this timeframe.

The research papers collected from various reputed journals, including Scopus and non- Scopus enlisted, are classified and grouped under various categories to identify the class of author who publishes more in this field, research trend over the years, the type of firm which implements LSS, the research methodology which is commonly used in LSS and related research and also the key takeaway from these articles are highlighted. Further, the authors have also identified the major contributions of researchers in various sectors during this period in India.

This classification framework and the systematic review help in identifying the research gap and in giving directions for future researchers. It will be useful for researchers and practitioners working on the area of LSS, rural and urban entrepreneurs, start-up managers, professionals working in micro, small and medium enterprises (MSMEs) and executives of the Make in India Project to make India as Aatmanirbhar Bharat Abhiyan. Further, the clear direction of progress over the current decade in manufacturing industries, service sectors and processing industries can help the professionals working in these sectors.