Evidence map›Paper›PMID 42178216›Full record

ReviewInternational journal for quality in health care : journal of the International Society for Quality in Health Care2026

Augmenting healthcare systems for pandemic preparedness: a Lean Six Sigma perspective.

Utkarsh Chadha, Artem Kushnirenko, Darren Charles Fernandes, Krisha Bhavesh Patel, Norah Jean Crothers, Harpreet Singh, Mete Isiksalan, Ibrahim Nasir, Stephen Armstrong, Kamran Behdinan

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in International journal for quality in health care : journal of the International Society for Quality in Health Care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Utkarsh ChadhaDepartment of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.ORCID 0000-0002-5044-3761
Artem KushnirenkoDepartment of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada.ORCID 0009-0004-2880-3750
Darren Charles FernandesDepartment of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.
Krisha Bhavesh PatelDepartment of Civil and Mineral Engineering, University of Toronto, Toronto, ON M5S 1A4, Canada.
Norah Jean CrothersHealth Studies Program, University College, University of Toronto, Toronto, ON M5S 3H7, Canada.
Harpreet SinghDepartment of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.
Mete IsiksalanThe Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.
Ibrahim NasirThe Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.
Stephen ArmstrongDepartment of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.
Kamran BehdinanAdvanced Research Laboratory for Multifunctional Lightweight Structures, Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPast global healthcare crises have exposed vulnerabilities in healthcare systems, including inefficiencies in hospital operations, delayed response times, and overburdened infrastructure. Traditional hospital systems built for routine care were sometimes not resilient or adaptable in the face of such crises, resulting in global failures. This narrative review examines how Lean Six Sigma (LSS) principles can be incorporated into conventional hospital operations to enhance pandemic preparedness by building the resilience of hospital infrastructure, streamlining processes during time-sensitive situations, and improving waste reduction, all while being adaptable and sustainable.

methodsThis narrative review synthesizes literature using Coronavirus Disease 2019 (COVID-19) as a benchmark to evaluate hospital response strategies, failures, and factors contributing to failure, including the critical assessment of ethical disruptions, operational weaknesses, and healthcare business models. LSS principle applications, i.e. DMAIC, Value Stream Mapping, SIPOC, FMEA, and Control Charts, were explored for facilitating efficient care, crisis response, and policy integration. Various case studies were used to support the comparative analysis and insights.

resultsThe literature indicates that adoption of LSS tools in the most vulnerable aspects of healthcare, including patient triage, supply chain optimization, and controlling and reducing mortality, has been associated with measurable improvements. Most importantly, integrating data-driven LSS resulted in enhanced surge responsiveness and ethical compliance within national healthcare frameworks and policies. However, despite its efficacy, there are institutional barriers like capital constraints, resistance to change, data inconsistencies, and a lack of legislative frameworks that impede widespread LSS adoption.

conclusionLSS offers an adaptable and scalable methodology to re-engineer conventional hospital operations and pandemic preparedness. The emphasis on 'kaizen' (continuous improvement), data-informed decision making, and focus on precision aligns with the needs of healthcare systems as revealed by recent crises. To unlock the potential for preparedness, healthcare systems and legislation must focus on institutionalizing LSS across public and private sectors through strategic investment, education, and cross-sector collaborations. This review provides a comprehensive framework for policymakers, governments, epidemiologists, doctors, and hospital business managers for building resilient, efficient, and pandemic-ready hospitals.

Indexed as

COVID-19Delivery of Health CarePandemicsTotal Quality ManagementEfficiency, OrganizationalHospital AdministrationHumansPandemic PreparednessPublic Health InfrastructureSARS-CoV-2Healthcare managementHealthcare resilienceHealthcare systemsHospital operationsLean Six SigmaPandemic PreparednessQuality improvement

Identifiers

PMID42178216
PMCPMC13253150

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.