Purpose The purpose of this study is to reflect upon the ramifications of two decades of Lean Six Sigma implementations in Dutch healthcare institutions in the light of the current COVID-19 pandemic. Design/methodology/approach The authors provide an evaluation of the impact that Lean Six Sigma implementations have had on the ability of Dutch healthcare institutions to respond adequately to healthcare needs during the COVID-19 crisis. Findings Process improvement in healthcare has had a tendency to cut capacity and flexibility which are needed to deal with excessive demand shocks, such as during a pandemic. The main reason for this failure seems to be an overly strong focus on cost reduction instigated by Lean Six Sigma during stable times. Research limitations/implications Besides the research method being an inferential procedure, the research focuses on the Netherlands and so the generalizability might be limited. However, using Lean Six Sigma to improve healthcare processes has found broad acceptance, so the implications may well carry over to other countries. Practical implications The authors call for a more comprehensive approach of process improvement within healthcare that takes flexibility and buffering in anticipation of excess variability and disruption into greater account. Therefore, this study provides a new perspective on how and to which aim Lean Six Sigma should be applied in healthcare. Originality/value An assessment is given of the impact of Lean Six Sigma implementations on the ability to respond to the COVID-19 crisis. This is done by identifying the focus points of improvement projects and considering the impact on the resilience of healthcare operations.
