Continuous improvement (CI) is an initiative to improve the performance of processes in alignment with the customer needs and organizational strategy. Lean Six Sigma (LSS) is one of the most successful CI techniques in redesigning and improving significant processes to improve quality and eliminate waste. The healthcare sector has benefited from applying LSS due to its complicated work practices that face many challenges including increased expenditures and difficulties related to individual or community access to appropriate care. In particular, Emergency Departments (ED) have an important unit within healthcare organizations due to their essential role in providing urgent medical care services to patients. The aim of this doctoral research study is to develop a theoretical model using grounded theory to investigate the factors for successful LSS implementation in ED including how ED work environment affects the reduction of patient length of stay, which is one of the biggest issues that ED face. Therefore, the main objectives of this research are to: (1) investigate trends in the research area using systematic literature review, (2) develop an Initial Conceptual Framework including identifying the relationships between the variables of LSS implementation, (3) use an expert study where a group of experts will provide additional evidence regarding LSS implementation, and (4) test the model using survey questionnaire that examines the behavior of the variables. This research will be documented as a manuscript-style dissertation including four peer-reviewed academic journal articles each summarizing the results from a phase of this research. The results of this research will provide a conceptual model to guide the implementation of LSS in ED bringing the potential benefits of this approach to a critical department in healthcare organizations. Further, this research will inform future research by investigating the work environment effects on application of LSS.


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Graduation Date





Keathley, Heather


Doctor of Philosophy (Ph.D.)


College of Engineering and Computer Science


Industrial Engineering and Management Systems

Degree Program

Industrial Engineering




CFE0008200; DP0023554





Release Date

August 2020

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)

Restricted to the UCF community until August 2020; it will then be open access.