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How can we champion diversity, equity and inclusion within Lean Six Sigma? Practical suggestions for quality improvement
  1. Bharat Kumar1,2,
  2. Hilary Mosher1,2,
  3. Amany Farag2,3,
  4. Melissa Swee1,2
  1. 1Department of Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
  2. 2VA Quality Scholars Program, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
  3. 3College of Nursing, The University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Bharat Kumar, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa, IA 52242, USA; bharat-kumar{at}

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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.

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Table 1

Lean Six Sigma practitioners and other quality improvement experts can better incorporate the principles of diversity, equity and inclusion into their work through these six practical suggestions

1. Promote inclusivity among QI teams.

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

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  • Contributors All authors contributed to the conception, drafting and editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.