A lean six sigma framework for continuous and incremental improvement in the oil and gas sector

This article aims to explore synergies between Lean Production (LP) and Six Sigma principles in order to propose a Lean Six Sigma (LSS) framework for continuous and incremental improvement in the oil and gas sector. The Three-Dimensional LSS Framework seeks to provide various combinations about the integration between LP principles, DMAIC cycle and PDCA cycle to support operations management needs. Design/methodology/approach - The research method is composed of two main steps: (i) diagnostic of current problems and proposition of a conceptual framework that qualitatively integrates synergistic aspects of LP and Six Sigma; and (ii) analysis of the application of the construct through semi-structured interviews with leaders from oil and gas companies to assess and validate the proposed framework. Findings - As a result, a conceptual framework of LSS is developed contemplating the integration of LP and Six Sigma and providing a systemic and holistic approach to problemsolving through continuous and incremental improvement in the oil and gas sector. Originality/value - This research is different from previous studies because it integrates LP principles, DMAIC and PDCA cycles into a unique framework that fulfils a specific need of oil and gas sector. It presents a customized LSS framework that guides wastes and costs reduction, while enhances quality and reduces process variability to elevate efficiency in operations management of this sector. The paper type is an original research that present new and original scientific findings.N/

Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry.

AIMS: To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice. METHODS AND RESULTS: The ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin-angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues. CONCLUSION: This pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written