• Six Sigma
• Lean management
• Healthcare quality improvement

Lean Six Sigma (LSS) is a quality improvement (QI) methodology that has gained popularity in recent decades in health care management as a means to reduce waste and unwarranted variability.1 A combination of Lean Management System and Six Sigma, the principles and tools of LSS have been adapted from the manufacturing sector to the more service-oriented healthcare settings.2 3 At the same time, diversity, equality and inclusion (DEI) are increasingly acknowledged as core tenets of high-quality healthcare delivery and that concerted institutional changes are necessary to support DEI efforts.2 3

For the most part, the increased emphasis of DEI has been running parallel to LSS and QI. Indeed, the philosophies, principles and tools are largely separate, with DEI often described as a ‘lens’ through which to focus efforts towards an aspirational target and LSS as a method for QI.4 5 DEI explicitly recognises the heterogeneity of a population and the need to design systems that may offer differential service to achieve equity. LSS strives to achieve consistency in both process and outcome. While many observers have noted opportunities for synergy,6 an existential tension between LSS and DEI remains: how do we reduce unnecessary variation in health outcomes while tailoring care to patient’s individual circumstances?

In this viewpoint, we discuss six practical suggestions to QI specialists to harmonise LSS methods with DEI principles from conception to dissemination (table 1). Because LSS significantly overlaps with other QI methods, tools and principles, many suggestions may apply globally within other paradigms.

1. Promote inclusivity among QI teams.

Central to DEI is meaningful representation of vulnerable populations within teams that contribute to their …