Implementation of Green Lean Six Sigma in Dutch Healthcare: A Qualitative Study of Healthcare Professionals’ Experiences

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

The authors analyze how applying green lean six sigma (GLSS) to a hospital affects healthcare workers, utilizing a quantitative approach. Six sigma, a methodology aimed at enhancing system performance and efficiency, along with lean production tools, can significantly boost the sustainability of innovations and overall effectiveness when adopted by the workforce. However, the article has some shortcomings that need addressing before it can be published:

1. The abstract needs revision. It should highlight the significance and necessity of green lean six sigma in healthcare systems within the Introduction section of the abstract.
2. The final sentence of the abstract should be removed and incorporated into the main text instead.
3. The Introduction’s penultimate paragraph provides insufficient detail about the study’s purpose. This section should be expanded to clearly outline the study's objectives, its distinction from existing literature, and the methodology used.
4. Add an organizational paragraph at the end of the Introduction to guide readers through the structure of the paper.
5. The literature review is currently absent. Start by citing studies that focus on methods like simulation and optimization for enhancing healthcare systems, such as:
• “Integrating Discrete-Event Simulation and Artificial Intelligence for Shortening Bed Waiting Times in Hospitalization Departments During Respiratory Disease Seasons,” Computers & Industrial Engineering, 194, 110405. https://doi.org/10.1016/j.cie.2024.110405
• “A Comprehensive and Integrated Hospital Decision Support System for Efficient and Effective Healthcare Services Delivery Using Discrete Event Simulation,” Healthcare Analytics, 4, 100028. http://dx.doi.org/10.1016/j.health.2023.100248

Then, include studies that explore system optimization using six sigma and lean manufacturing techniques in healthcare settings. Finally, highlight articles similar to your study and emphasize its unique contributions, such as:

·        Lean Six Sigma Approach for Reducing Length of Hospital Stay for Patients with Femur Fracture in a University Hospital. Int. J. Environ. Res. Public Health 2021, 18, 2843. https://doi.org/10.3390/ijerph18062843

·        Reducing pharmacy medication errors using Lean Six Sigma: A Thai hospital case study. Total Quality Management & Business Excellence, 33(5–6), 664–682. https://doi.org/10.1080/14783363.2021.1885292

·       Improving patient care at a multi-speciality hospital using lean six sigma. Production Planning & Control, 33(12), 1135–1154. https://doi.org/10.1080/09537287.2020.1852623

6. Include a main section detailing the GLSS project implemented at the hospital. This information will help readers better understand the study's context and relevance.
7. Identify and discuss the study’s limitations in the Conclusion section.
8. In the Conclusion, elaborate on the study’s potential contributions to future research.

Comments on the Quality of English Language

Minor editing of English language required.

Author Response

Dear reviewer,

Thank you for your review efforts and valuable feedback with recommendations for improving our paper. In the attached file we've listed your review comments as well as the review comments from the other reviewers together with our response.

Kind Regards, on behalf of the research team,

Marieke Sijm-Eeken

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Firstly, the lack of coherence between the introduction, theory, model, and discussion sections is apparent. It is essential to establish clear linkages between these components to ensure the logical flow and structure of your research.

Furthermore, the reliance on tautological reasoning instead of empirical evidence detracts from the rigor and credibility of the study. I encourage you to bolster the empirical foundation of your work through robust data analysis and validation.

The content doesn't have good reviews. It appears that the authors have engaged in cherry-picking. Many latest articles on GLSS and Lean Six Sigma still not covered in literature.

The method is appropriate. However, the justification is missing.

The results are satisfactory but need to be discussed.

How can the research be used in practice (economic and commercial impact), in teaching, to influence public policy, in research (contributing to the body of knowledge)?  What is the impact upon society (influencing public attitudes, affecting quality of life)? 

Comments on the Quality of English Language

The paper need to pay attention towards the clarity of expression and readability, such as sentence structure, jargon use, acronyms, etc

Author Response

Dear reviewer,

Thank you for your review efforts and valuable feedback with recommendations for improving our paper. In the attached file we've listed your review comments as well as the review comments from the other reviewers together with our response.

Kind Regards, on behalf of the research team,

Marieke Sijm-Eeken

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Accepted