Six Sigma in Health Literature, What Matters?

Six Sigma has been widely used in the health field for process or quality improvement, constituting a quite profusely investigated topic. This paper aims at exploring why some studies have more academic and societal impact, attracting more attention from academics and health professionals. Academic and societal impact was addressed using traditional academic metrics and alternative metrics, often known as altmetrics. We conducted a systematic search following the PRISMA statement through three well-known databases, and identified 212 papers published during 1998-2019. We conducted zero-inflated negative binomial regressions to explore the influence of bibliometric and content determinants on traditional academic and alternative metrics. We observe that the factors influencing alternative metrics are more varied and difficult to apprehend than those explaining traditional impact metrics. We also conclude that, independently of how the impact is measured, the paper's content, rather than bibliometric characteristics, better explains its impact. In the specific case of research on Six Sigma applied to health, the papers with more impact address process improvement focusing on time and waste reduction. This study sheds light on the aspects that better explain publications' impact in the field of Six Sigma application in health, either from an academic or a societal point of view.