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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.

According to Yubin et al. (2023), films serve as a medium for conveying visual representations of various elements such as landscapes, buildings, landmarks and monuments, which provide a contextual backdrop for the narrative. According to Vila et al. (2021), the number of global tourists visiting film locations exceeds 80 million. In addition, according to Yubin et al. (2023), the promotion of tourism is facilitated through the utilisation of films, which serve to create novel representations, counteract negative perceptions and enhance the portrayal of underdeveloped destinations. A significant number of individuals engage in the practise of visiting movie sets with the intention of re-experiencing the emotional impact of the film. The devaluation of film marketing has been observed. This method represents a highly indirect approach to enticing tourists. This chapter examines the comprehension of travellers' motivations and the perception of film-exposed locations in Bollywood films (Salnick, 2023). Film tourism provides a tailored and personalised experience for individuals. The difficulty in measuring this concept arises from factors such as the emotional responsiveness, personality traits, background and interpretive abilities of the viewers in relation to media images. According to Castro et al. (2023), the inclusion of a destination on a screen can serve as a means to enhance the diversity of a site's tourist offerings or mitigate the effects of seasonality by providing opportunities for experiential activities, showcasing notable landmarks or serving as a filming location. Film destinations have the potential to gain popularity and benefit from advertising and the perception of spectators.