Pioneers of quality and their contribution to Six Sigma knowledge bank (adapted from Wortman, 2001)
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"701",leadTitle:null,fullTitle:"Human Papillomavirus and Related Diseases - From Bench to Bedside - Research Aspects",title:"Human Papillomavirus and Related Diseases",subtitle:"From Bench to Bedside - Research Aspects",reviewType:"peer-reviewed",abstract:"Cervical cancer is the second most prevalent cancer among women worldwide, and infection with Human Papilloma Virus (HPV) has been identified as the causal agent for this condition. The natural history of cervical cancer is characterized by slow disease progression, rendering the condition, in essence, preventable and even treatable when diagnosed in early stages. Pap smear and the recently introduced prophylactic vaccines are the most prominent prevention options, but despite the availability of these primary and secondary screening tools, the global burden of disease is unfortunately still very high. This book will focus on epidemiological and fundamental research aspects in the area of HPV, and it will update those working in this fast-progressing field with the latest information.",isbn:null,printIsbn:"978-953-307-855-7",pdfIsbn:"978-953-51-6725-9",doi:"10.5772/1210",price:139,priceEur:155,priceUsd:179,slug:"human-papillomavirus-and-related-diseases-from-bench-to-bedside-research-aspects",numberOfPages:420,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"dbaf0635e78a5900e85513add5bea345",bookSignature:"Davy Vanden Broeck",publishedDate:"January 25th 2012",coverURL:"https://cdn.intechopen.com/books/images_new/701.jpg",numberOfDownloads:40856,numberOfWosCitations:11,numberOfCrossrefCitations:6,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:17,numberOfDimensionsCitationsByBook:0,hasAltmetrics:0,numberOfTotalCitations:34,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 15th 2011",dateEndSecondStepPublish:"March 15th 2011",dateEndThirdStepPublish:"July 20th 2011",dateEndFourthStepPublish:"August 19th 2011",dateEndFifthStepPublish:"December 17th 2011",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"93213",title:"Dr.",name:"Davy",middleName:null,surname:"Vanden Broeck",slug:"davy-vanden-broeck",fullName:"Davy Vanden Broeck",profilePictureURL:"https://mts.intechopen.com/storage/users/93213/images/2523_n.jpg",biography:"Prof. Dr. Davy Vanden Broeck, MSc, PhD obtained this MSc degree Biochemistry from Antwerp University (Belgium) with judicium Cum Laude. Afterwards he pursued a PhD in Biomedical Sciences (Antwerp University). Later, he joined the International Centre for Reproductive Health (ICRH) and research efforts focused on sexually transmitted viruses. Finally, he obtained two consecutive post-doc grants at Ghent University (Ghent, Belgium), with specific focus on papilloma virus research.\nCurrently, Dr. Vanden Broeck holds the position of professor Molecular Virology and heads the ICRH HPV/cervical cancer research team. Within this team, multi-disciplinary research is performed on the prevention of cervical cancer (vaccine, screening), as well as clinical/translational aspects of cervical cancer research, but equally fundamental research forms part of the research agenda.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Ghent University",institutionURL:null,country:{name:"Belgium"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1046",title:"Infectious Diseases",slug:"infectious-diseases"}],chapters:[{id:"26625",title:"Epidemiology of Mucosal Human Papillomavirus (HPV) Infections Among Adult and Children",doi:"10.5772/29583",slug:"epidemiology-of-mucosal-human-papillomavirus-hpv-infections-among-adult-and-children",totalDownloads:2491,totalCrossrefCites:0,totalDimensionsCites:3,hasAltmetrics:0,abstract:null,signatures:"Helen Trottier",downloadPdfUrl:"/chapter/pdf-download/26625",previewPdfUrl:"/chapter/pdf-preview/26625",authors:[{id:"78452",title:"Dr.",name:"Helen",surname:"Trottier",slug:"helen-trottier",fullName:"Helen Trottier"}],corrections:null},{id:"26626",title:"Human Papillomavirus Type Distribution in Southern China and Taiwan",doi:"10.5772/28989",slug:"human-papillomavirus-type-distribution-in-southern-china-and-taiwan",totalDownloads:1973,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Chung-Yung Chen and Chin-Hung Wang",downloadPdfUrl:"/chapter/pdf-download/26626",previewPdfUrl:"/chapter/pdf-preview/26626",authors:[{id:"76113",title:"Prof.",name:"Chung-Yung",surname:"Chen",slug:"chung-yung-chen",fullName:"Chung-Yung Chen"},{id:"81751",title:"Mr.",name:"Chin-Hung",surname:"Wang",slug:"chin-hung-wang",fullName:"Chin-Hung Wang"}],corrections:null},{id:"26627",title:"Human Papillomavirus Worldwide Distribution in Women Without Cervical Cancer",doi:"10.5772/27116",slug:"human-papillomavirus-worldwide-distribution-in-women-without-cervical-cancer",totalDownloads:4598,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:null,signatures:"I. 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The integration of experimental methods with computational methods is invaluable both in the development of promising new bioactive compounds and in the molecular characterization of protein-ligand or protein-protein interactions. Molecular docking, in one of these molecular modeling methods, is a unique approach to revealing key interactions in important molecular recognition processes and to accurately predict receptor-ligand binding free energies. Today, the molecular docking method has not only enabled the discovery of new drugs and therapeutic agents but also opened different windows to the submicroscopic world of interacting partner molecules by providing a unique atomistic perspective in the explanation of important intermolecular phenomena.
\r\n\r\n\tThe topics covered in this book are mainly:
\r\n\t1. Emphasizing the unique power of the molecular docking method in new drug discovery;
\r\n\t2. Demonstration of how the molecular docking technique has led to the discovery of new molecules in cancer therapy, proteasome, and STAT3 inhibition, and the treatment of Alzheimer's disease;
\r\n\t3. Underlining the importance of molecular docking-based modeling methods in the various branches of biotechnology
\r\n\tWe hope that this book will be a common point where researchers working in the fields of life sciences and drug development will eventually meet.
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The aim of the businesses may differ, but the importance of customers is a matter of common interest. The ability of the organizations to adapt to new customer requirements in a globalized market is of vital importance for long-term success. Traditional quality initiatives such as statistical quality control, zero defects, and total quality management, have been key initiatives for many years. In last two decades, Six Sigma evolved as a new quality management initiative and now many organizations are working towards its implementation.
Six Sigma is a disciplined approach for improving manufacturing or service processes, based on defined metrics (Hahn et al., 1999). The strength of Six Sigma lies in its well defined framework involving methodology applying different tools and techniques (Goh, 2002). The Six Sigma journey started from Motorola in 1980s and spread its importance through adoptions by different high profile organizations such as General Electric (GE), Honeywell, Asea Brown Bovari (ABB), Lockheed-Martin, Polaroid, and Texas Instruments (Goh, 2002; Hahn et al., 1999). This initial success of Six Sigma has seen its implementation spreading in several other organizations mostly in mass-manufacturing sector (McAdam et al., 2005). These organizations adopted the systematic framework of Six Sigma through training and project management practices (Brady and Allen, 2006). The use of Six Sigma has been relatively high among many western organizations till now, see, for example, Inozu et al. (2006), Raisinghani et al. (2005), and Antony (2004b), but there exists a diversity of opinion among researchers regarding the actual benefits of Six Sigma. Literature explaining about the positive effects on financial performance can be found in e.g. Jones Jr. (2004), Goh (2002), Caulcutt (2001), and Rucker (2000). However, McAdam and Lafferty (2004), Senapati (2004), and Paul (1999), for instance, express a more pessimistic view regarding the benefit of Six Sigma investments.
Similar to Six Sigma, services in the last two decades have become an important part in economies of developed as well as for developing nations. The importance of services has also increased as it became a major employment provider (Cook et al., 1999). This increased importance of service sector has various researchers contributing to the service literature. The service research from its beginning can be divided into stages such as an initial realization of the difference between goods and service, the development of conceptual frameworks, the empirical testing of these frameworks and the application of the tools and frameworks to improve service management (Johnston, 1999). The various stages of service research have gained by the major contributions from marketing and after that to some extent from operations management field.
But in case of definitions, services still lack a unified definition and similar can be said about the classification scheme. So, there is a need to provide a universally accepted classification scheme which can be done through empirical derivation and considering different dimensions of service organizations. This will facilitate in exploration of service quality and service strategy (Cook et al., 1999). As service quality is now the major focus of service organizations, so a better understanding of unique characteristics of services will be helpful. This in turn will help spreading new quality initiatives such as Six Sigma, in services.
This spread, however, is limited in service industries. A key argument here is that many service processes are unseen, intangible, and even immeasurable. As such, they are not amendable to improvement using a Six Sigma approach. This thinking has turned out to be rather presumptuous at least for the health care, banking, and call center services which have been able to apply Six Sigma (Hensley and Dobie, 2005). Other services such as education and hospitality are also beginning to see Six Sigma applications.
The question of Six Sigma and its implementation and performance in service organizations has not before been under investigation. The literature includes many papers describing Six Sigma implementation in a variety of business types; however, very few of these papers report empirical research and include single case studies (Hendry and Nonthaleerak, 2005). Examples of non-manufacturing contexts discussed in the literature include healthcare and financial services, as well as in non-production internal functions within a manufacturing organization (Nonthaleerak and Hendry, 2008). The paper by Wyper and Harrison (2000), discuss Six Sigma implementation in non-manufacturing context and highlights the difficulties specific to that context. Does et al. (2002), present a comparison of eight Six Sigma projects in non-manufacturing processes with a theoretical manufacturing application in a case study company in the Netherlands. This paper addressed various problems, typical of non-manufacturing and also identified difficulties in tools application. They conclude that Six Sigma can be applicable in non-manufacturing contexts with minor adaptations. Given that, the research is based in a single case study setting, there are limits on the degree to which the conclusions can be generalized (Nonthaleerak and Hendry, 2008). McAdam and Lafferty (2004) conducted a survey in a single company on Six Sigma implementation issue from process and people perspective. They found low success of Six Sigma in non-manufacturing areas.
The literature on discussion about Six Sigma in service organizations also concentrate about issues in implementation due to inherent differences between manufacturing and service. The possible reason being the manufacturing roots of Six Sigma like other quality management initiatives. Antony (2004a), Benedetto (2003), and Sehwall and De Yong (2003), argue for example that there are certain differences in Six Sigma implementation in services from manufacturing which acts as a barrier in Six Sigma implementation in service organizations.
Failed implementation initiatives, especially as extensive as Six Sigma implementation, result in financial losses and potential resistance towards change among the actors involved. It is therefore of importance that the implementation strategies used are well adapted, see, e.g. Biolos (2002). Hence, the literature has conflicting evidence regarding the applicability of Six Sigma to non-manufacturing settings and therefore there is a need to investigate further this issue (Nonthaleerak and Hendry, 2008).
The studies so far focused on Six Sigma implementation in non-manufacturing context at project level. The studies are mostly single case studies and descriptive in nature. The survey based studies are either pilot survey or focused on a single organization. Thus, there are a number of key research gaps in the literature, which our research aims to address.
There is insufficient empirical evidence to verify and further explain the Six Sigma CSFs identified in service organizations.
The existing difficulties in Six Sigma implementation in service organizations are not well understood.
There is a scope to contribute to Six Sigma implementation in service organizations by enhancing the knowledge about tools and techniques usage.
Our research will focus on individual Six Sigma projects in service organizations to fill the identified research gaps.
In 1924, Walter A. Shewart from Bell Telephone Laboratories, proposed the concept of using statistical charts to control the variables of products manufactured at Western Electric. This was the beginning of statistical quality control (Small, 1956). Dr. Shewart kept on with his efforts and applied the fundamentals of statistical quality control to industry. This lead to the modern attention to the use of statistical tools for the manufacture of products and process, originated prior to and during World War II, when the United States of America geared up to a massive build-up of machinery and arms to successfully conclude the war (Brady, 2005). The Western Electric manufacturing company is noteworthy during this time because it was the breeding ground for many quality leaders, not only Shewart but Joseph Juran, Edwards Deming and Kaoru Ishikawa all worked there at some time (Dimock, 1977). Two prominent individuals were Deming and Juran. Deming promoted the use of the plan-do-check-act (PDCA) cycle of continuous improvement. Later Juran introduced the concepts of project by project quality improvement. Any discussion on quality today will most likely cite at least one from the group of Deming, Juran, Crosby, Feigenbaum, and Ishikawa, if not all. They certainly represent the preponderance of information about quality. Adding to this group, Bill Smith, Motorola Vice President and Senior Quality Assurance Manager, is widely regarded as the father of Six Sigma, Shina (2002). Because Six Sigma was built on previous quality methodologies, a list of the pioneers of the quality and their contribution is included in Table 1.
According to Shina (2002) before, January 15, 1987, Six Sigma was solely a statistical term. Since then, the Six Sigma crusade, which began at Motorola, has spread to other companies which are continually striving for excellence. At Motorola, Six Sigma is defined as “A quality improvement program with a goal of reducing the number of defects to as low as 3.4 parts per million opportunities or 0.0003%”. Six Sigma has a number of different meanings and interpretations (Henderson and Evans, 2000, pp 261). Its origin comes from statistics where sigma represents the amount of variation about a process average. From a business view of point, Six Sigma may be defined as “A business strategy used to improve business profitability, to improve the effectiveness and efficiency of all operations to meet or exceed customer’s needs and expectations” (Kwak and Anbari, 2006, pp 709). Various other definitions include:
Six Sigma is a formal methodology for measuring, analysing, improving, and then controlling or locking-in processes. This statistical approach reduces the occurrence of defects from a three sigma level or 66 800 defects per million to a Six Sigma level or less than four defects per million (Bolze, 1998).
Six Sigma is a comprehensive, statistics-based methodology that aims to achieve nothing less than perfection in every single company process and product (Paul, 1999).
Six Sigma is a disciplined method of rigorous data gathering and robust statistical analysis to pinpoint sources of error and ways of eliminating them (Harry and Schroeder, 1999).
Six Sigma as an information-driven methodology for reducing waste, increasing customer satisfaction, and improving processes, with a focus on financially measurable results (As defined by Minitab in Goh, 2002).
Quality Gurus | Contribution |
Philip B. Crosby | Senior manager involvement; four absolutes of quality management; quality costs measurements |
W. Edwards Deming | Plan-do-study-act; top management involvement; concentration on system improvement; constancy of purpose |
Armand V. Feigenbaum | Total quality control/management; top management involvement |
Kauro Ishikawa | Cause and effect diagram; company-wide quality control; |
Joseph M. Juran | Top management involvement; quality trilogy; quality cost measurement |
Walter A. Shewart | Assignable cause versus chance cause; control charts; plan-do-check-act; use of statistics for improvement |
Pioneers of quality and their contribution to Six Sigma knowledge bank (adapted from Wortman, 2001)
The statistical focus of various Six Sigma definitions reflects its basic philosophy. Six Sigma is an operating philosophy that can be shared beneficially by everyone, including customers, shareholders, employees, and suppliers. Fundamentally, it is also a customer-focused methodology that drives out waste, raises levels of quality, and improves the financial performance of organizations to breakthrough levels (Chua, 2001).
Six Sigma’s target for perfection is to achieve no more than 3.4 defects, errors, or mistakes per million opportunities whether this involves the design and production of a product or a customer-oriented service process. It is from this target that the name Six Sigma originated.
Compared to a process that has greater variation, a process with less variation will be able to fit more standard deviations or sigmas between the process centre and its specification limits. An increase in the number of sigmas between the specification limits means the acceptance of fewer defects. More sigmas imply a more consistent manufacturing or service delivery process (Chua, 2001).
The concept of Six Sigma was introduced at and popularized by Motorola in 1987. Six Sigma is a logical extension of Statistical Process Control (SPC). The concept behind SPC is simple enough but powerful, indeed. Variation is present in every production/operations process and such variation is due either to common causes or special causes. The breakthrough made by Shewart was the statistical definition and measurement of variation, where variation within three-sigma limits was deemed to be random and produced by common causes, and variation outside of the three-sigma limits was produced by special causes, indicating a process problem (Shewart, 1931). The ±3σ process limits mean a defect rate of 2.7/1000 or 2,700/1,000,000 opportunities, if one ignores lateral shifts in the process, and the capability of the process is thus defined as the range of natural variation, that is, ±3σ, or Cpk = 6σ. Six-Sigma doubles the range of normal variation to ±6σ, and allows for a 1.5σ lateral shift in the process average. The result is a dramatic tightening of acceptable defect rate target to 3.4/1,000,000 opportunities.
The basic elements of Six Sigma are not new. SPC, failure mode effect analysis, gage repeatability and reproducibility studies, and other tools and techniques, have been in use for some time. Six Sigma offers a framework that unites these basic quality tools and techniques with high-level management support.
There is much literature available on tools and techniques used in Six Sigma. Tools are mostly referred to as having a clearly defined role but narrow in focus, whereas techniques have wider application and require specific skills, creativity, and training (Antony, 2006). Similar to CSFs, CTQs, and KPIs; there is limited literature which discuss about STTs specific to service organizations. Discussion on STTs in the literature is mostly on its usage at different phases of DMAIC methodology. De Koning and De Mast (2006) used seven different literature sources and provided a summary of STTs used in DMAIC phases. Some other literature provide classification scheme for tools and techniques used. Henderson and Evans (2000) discussed about tool sets in three groups; team tools, process tools, and statistical tools. As for Six Sigma tools and techniques specific to service organizations, Antony (2006) provides a grid as a guideline for services.
A number of classification schemes for STTs exists, the majority of which are based on the DMAIC methodology. The classification schemes by the American Society for Quality (ASQ) and by Nancy Tague (1995) called the Tool Matrix provide an exhaustive list of tools and techniques which can be used during Six Sigma implementation. The ASQ classification scheme and the tool matrix have almost similar categories. The only difference being in the number of tools and techniques each category.
ASQ Classification
According to ASQ, tools and techniques that are utilized in different phases of DMAIC are classified according to their uses. There are 7 broad categories: Cause Analysis Tools, Data Collection and Analysis Tools, Evaluation and Decision Making Tools, Idea Creations Tools, Process Analysis Tools, Project Planning and Implementation Tools, Seven Basic Quality Tools, and Seven New Management and Planning Tools.
Categories | Description | Tools |
Cause analysis tools | Used to identify the cause of a problem. | Fishbone diagram, Pareto chart, Scatter diagram |
Data collection and analysis tools | Used to collect or analysis data. | Check sheet, Control chart, Design of experiment, Histogram, Scatter diagram, Stratification, Survey |
Evaluation and decision making tools | Used to select the best choices or to evaluate what is performance level of project so far. | Decision matrix, Multi-voting |
Idea creations tools | Used to create ideas or organize ideas. | Affinity diagram, Benchmarking, Brainstorming, Nominal group technique |
Process analysis tools | Used when an understanding of process flow is desired. | Flowchart, Failure mode effect analysis, Mistake-proofing |
Seven basic quality tools | These tools are the most fundamental tools of quality control. | Cause and effect diagram/ Fishbone diagram, Check sheets, Control charts, Histogram, Pareto chart, Scatter diagram, Stratification |
Seven new management and planning tools | Used to encourage innovation, communicate information and successful planning of key projects. | Affinity diagram, Relation diagram, Tree diagram, Matrix diagram, Arrow diagram, Process decision program chart |
Classification of tools and techniques according to ASQ(Source: American Society for Quality Website)
Tool Matrix
In Nancy R. Tague’s The Quality Toolbox (1995), she developed a Tool Matrix that classifies quality tools according to what the tools can offer. It is quite similar to the categorization suggested by ASQ, but differs, as it encompasses more tools.
Categories | Tools |
Ideas creation | Affinity diagram, Brainstorming. Brain writing Nominal group technique, Relation diagram |
Process analysis | Cost of quality analysis, Critical-to-quality analysis, Deployment flowchart, Flowchart Matrix diagram, Relations diagram, Requirements matrix, Requirements-and-measure matrix, Storyboard, Top-down flowchart, Work-flow diagram |
Cause analysis | Contingency diagram, Fishbone diagram, Force field diagram, Is-is not matrix, Matrix diagram Pareto chart, Scatter diagram, Stratification, Tree diagram, Why-why diagram |
Planning | Activity chart, Arrow diagram, Contingency diagram, Deployment flowchart, Flowchart Force field analysis, Matrix analysis, Mission statement, Operational definitions, Plan-do-check-act cycle, Relations diagram, Storyboard, Top-down flowchart, Tree diagram, Work-flow diagram |
Evaluation | ACORN test, Continuum of team goals, Decision matrix, Effective-achievable matrix, List reduction, Matrix diagram, Mission statement checklist, Multi-voting, Plan-results matrix, PMI |
Data collection and analysis | Box plot, Check sheet, Control chart, Histograms, Importance-performance analysis, Kologorov-Smirnov test, Normal probability plot, Operational definitions, Pareto chart, Performance index, Process capability, Requirements-and-measures tree, Run chart, Scatter diagram, Stratification, Survey |
Tool Matrix (Tague, 1995)
Innovation Tools
The literature on service design and development talks about various tools which are effective in describing and analysing service problems. The tools are shown in Table 4.
S. No. | Tool | Description |
1 | Structured analysis and design technique | Used to model service system |
2 | Function analysis | Maps customer requirements to required functions and means |
3 | Service blueprinting | Analyse and represents the steps in a service process |
4 | Quality function deployment (QFD) | Translate customers’ needs and expectations into specifications that are relevant to companies |
5 | Root cause analysis | Identify potential service failure points, service outcome or process problems in service recovery process |
6 | Theory of Inventive Problem Solving (TRIZ) | Algorithmic approach for solving technical and technological problems |
7 | Axiomatic design | Maintain the independence of the functional requirements and minimize the information content in a design |
Innovation tools
Much information is available about the DMAIC (define, measure, analyze, improve, control) methodology. DMAIC is used mostly for existing processes. This approach not only makes use of various tools and techniques, it also incorporates other concepts such as financial analysis and project schedule development. The DMAIC methodology is excellent when dealing with an existing process in which reaching a defined level of performance will result in the benefits expected. There are number of articles and books providing details about DMAIC methodology. Table 5 provides the details about each phase taken from one of the literature.
Phase | Description |
Define | Identify, evaluate and select projects; prepare the mission; and select and launch the team |
Measure | Measure the size of the problem, document the process, identify key customer requirements, determine key product characteristics and process parameters, document potential failure modes and effects; theorize on the cause or determinants of performance |
Analyse | Plan for data collection; analyse the data and establish and confirm the “vital few” determinants of performance |
Improve | Design and carry out experiments to determine the mathematical cause-effect relationships and optimize the process |
Control | Design controls; make improvements, implement and monitor |
DMAIC methodology (Chua, 2001)
The emergence of Six Sigma since 1980s has been phenomenal. Initially, the major focus of the organizations was to improve from their existing three sigma limits to Six Sigma limit of product or service quality. The importance of innovation in products and services has changed the focus of organizations now more towards proactive approach rather than being reactive. The design for Six Sigma (DFSS) approach is relatively new compared to Six Sigma and is discussed in different ways in various literatures. Most of the literatures though agree that DFSS is a proactive approach and focuses on design by doing things right the first time. DFSS can be said as “A disciplined and rigorous approach to design that ensures that new designs meet customer requirements at launch” (El-Haik and Roy, 2005, pp 33). According to GE corporate research and development, the importance of DFSS is in the prediction of design quality up front and driving quality measurement and predictability improvement during the early design phases (Treichler et al, 2002). DFSS can also be explained as a data-driven methodology based on analytical tools which provide users with the ability to prevent and predict defects in the design of a product or service (De Feo and Bar-El, 2002). The major focus of DFSS approach is to look for inventive ways to satisfy and exceed the customer requirements. This can be achieved through optimization of product or service design function and then verifying that the product or service meets the requirements specified by the customer (Antony and Coronado, 2002).
The literatures also concentrate on the differences between DMAIC and DFSS approach. Though DFSS involves designing processes to reach Six Sigma levels and is considered as an aggressive approach, but it still lacks a single methodology unlike Six Sigma (Hoerl, 2004). The different methodologies used in DFSS are:
IDOV (Identify, Design, Optimize, Validate)
ICOV (Identify, Characterize, Optimize, Validate)
DCOV (Define, Characterize, Optimize, Verify)
DMADO (Define, Measure, Analyze, Design, Optimize)
DMADV (Define, Measure, Analyze, Design, Verify)
DMADOV (Define, Measure, Analyze, Design, Optimize, Verify)
DCCDI (Define, Customer Concept, Design, Implement)
DMEDI (Define, Measure, Explore, Develop, Implement)
Some of the other differences are:
DFSS is a methodology that takes into account the issues highlighted by the end customers at the design stage while DMAIC solves operational issues (Ferryanto, 2005).
Benefits in DFSS are difficult to quantify and are obtained in long term in comparison to Six Sigma, where the benefits are expressed mainly in financial terms and obtained rather quickly (
The DMAIC methodology tends to provide incremental improvements in comparison to DFSS where there can be radical improvements (El-Haik and Roy, 2005).
The projects improved through DMAIC methodology are constrained by the assumptions made during the development and design stages, whereas DFSS builds quality into the design by implementing preventive thinking and tools in the product development process (Smith, 2001).
The tools and techniques involved in the DFSS methodology are also somewhat different from those of the DMAIC methodology. DFSS includes innovation tools such as the theory of inventive problem solving, axiomatic design, and quality function deployment, which DMAIC does not. Detailed information about the methodologies can be found in (Kwak and Anbari, 2006; Hendry and Nonthaleerak, 2005; El-Haik and Roy, 2005; Goel, et al., 2005; Raisinghani et al., 2005; Basu, 2004; Antony and Coronado, 2002; Stamatis, 2002 (a and b); Harry and Schroeder, 1999).
Though there are differences among Six Sigma and DFSS approaches but still these two complement each other. Different DFSS stages are shown in Figure 1. Problem definition is the first stage, where customer requirements are incorporated. This stage is followed by the characterization stage. The model of the problem in the process or engineering domain is developed at this stage, which is basically the translation of the voice of customer and the customer usage conditions into an engineering system (Ferryanto, 2005). As seen from Figure 1, improvements from the DMAIC are added to the model at the characterization stage. After model development, optimal and robust solutions are found out. At the last stage the solutions are verified for their usefulness to solve the real problem.
DFSS versus Six Sigma (
CSFs are the essential ingredients required for success of Six Sigma projects in an organization (Coronado and Antony, 2002). There have been many studies on CSFs. One of the earliest is by Harry (2000), who discussed about six success factors involving management’s leadership, belt system, etc. Later on Antony and Banuelas (2002) mentioned twelve success factors which include management involvement and commitment, linking Six Sigma to business strategy, etc. There are several other studies and all of them have at least one common CSF, i.e. top management commitment. The discussion on CSFs by Antony (2006) is the only one specific to service organizations. Some of the common CSFs are discussed below.
Top management commitment and involvement
Almost all the literature reviewed agrees that this factor is a must for successful Six Sigma implementation. And this has to be ‘top-down’ rather than initiated by a particular department or from the ground (Goh, 2002). Top management involvement helps to influence and restructure the business organization and the cultural change in attitudes of individual employees toward quality in a short implementation period (Henderson and Evans, 2000).
Education and training
Another important feature of Six Sigma is the elaborate training and certification processes that result in Black Belts, Green Belts, etc (Goh, 2002). Education and training help people understand the fundamentals of Six Sigma along with the application of tools and techniques to different phases of DMAIC. Training is part of the communication process to make sure that manager and employees apply and implement the Six Sigma techniques effectively (Kwak and Anbari, 2006).
Cultural change
Six Sigma is considered a breakthrough management strategy, and it involves the adjustment of a firm’s values and culture. In some cases, substantial change to an organization’s structure and infrastructure need to take place (Coronado and Antony, 2002). People facing cultural change and challenges due to the implementation of Six Sigma need to understand this requirement. Also needed are a clear communication plan and channels to motivate individuals to overcome resistance and to educate senior managers, employees, and customers on the benefits of Six Sigma (Kwak and Anbari, 2006).
Customer focus
Customer focus is one of the major requirements in implementing Six Sigma. This is emphasized in terms of critical to quality characteristics. Six Sigma is highly much more sensitive to requirements for customer satisfaction (Goh, 2002).
Clear performance metrics
This is an important factor from a service point of view. Often the difficulty is with identifying what to measure (Sehwall and De Yong, 2003). Before starting any Six Sigma initiative it is better to have a clear idea and agreement on the performance metrics to be used.
Attaching the success to financial benefits
Representing the success of Six Sigma projects in terms of financial benefits and measurement performance has made their selection and completion an important aspect for the organizations (Henderson and Evans, 2000). Financial benefits as a measure of achievement makes it easily understandable for the employees and helps them to relate to Six Sigma project outcome (Goh, 2002).
Organizational understanding of work processes
The amount of effort that a service organization puts into measuring its work processes is important. Some organizations expend much time and effort in developing ways to measure the processes that ultimately impact customer satisfaction. Other organizations attempt this half-heartedly and measure only part of what is important to the customer. Like in hospitals the focus may be only on a particular laboratory or facility where the interaction with customer tends to be relatively greater. Because Six Sigma programs rely on measurements from processes, organizations with robust measurement systems in place are more likely to be ready for a Six Sigma implementation (Hensley and Dobie, 2005).
The factors discussed above are equally applicable to services and manufacturing. Our literature review found that top management commitment, education and training, cultural change, and financial benefits are the most important CSFs. Figure 2 summarizes the importance of the CSFs as seen by each of the articles that were reviewed.
Percentage of articles mentioning each of 19 CSFs
In case of CTQs, we focused on its definitions mentioned in the literature. CTQ is defined in different ways in the literature but mostly they agree that it is a quality characteristic of product or service which is required to be improved from customer point of view. In other words, CTQ is generated from critical customer requirements derived from voice of customer (refer Figure 3).
Understanding critical-to-quality (adapted from
CTQs are the key measurable indicators of a product or process whose performance standards or specification limits must be met in order to satisfy the customer. CTQs align improvement or design efforts with customer requirements. In a layman term, CTQs are what customers expect of a product or service. They are the spoken needs of the customer (isixsigma/dictionary). Six Sigma focuses on process improvement, and improving the service process is a major determinant of customer satisfaction.
The discussion on CTQs in the Six Sigma service literature is limited. Although services are widely different, the analysis from various literatures (Kwak and Anbari, 2006; Jones Jr., 2004; Sehwall and De Yong, 2003; Rucker, 2000) shows that some common CTQs exist across service. They are discussed below.
Time (service time, waiting time, cycle time)
In the case of services where the customer is involved in the process itself, time is an important consideration. The following three types of time should be considered:
Service time: The time required to serve a particular customer
Waiting time: The time customer waits in the system to get the work done
Cycle time: The total time including service and waiting time.
Like time, cost is sometimes a critical factor from the customer’s point of view. The two are in fact intertwined. Customers may at times be willing to pay more for a service that can be completed in a shorter time. The trade-off between cost and time is, thus, important for services.
Employee behaviour
For services where there is high degree of customer contact, employee behavior may be an important consideration. An employee’s attitude towards a customer’s problem may well decide whether the customer wishes to continue being serviced by the organization.
Information (accurate information, timely information)
The growing importance of call center services shows the emergence of information needs. Getting the right information at the right time to one’s customers is, thus, an important aspect from a customer point of view.
KPI is not well defined in the literature and there exist different interpretations of this term. Mostly the literature discuss about it as performance metrics, i.e., it is a measure of performance in terms of cost, quality, yield, and capacity (Basu and Wright, 2003; Hahn et al., 1999). A few of the suggested definitions of KPI is provided below (refer Table 6).
Author(s) | KPI Definitions |
Hahn et al. (1999) | Performance metrics are established that directly measure the improvement in cost, quality, yield, and capacity. |
Basu and Wright (2003) | KPIs are measurements of a performance such as asset utilization, customer satisfaction, cycle time from order to delivery, inventory turnover, operations costs, productivity, and financial results. |
Antony (2006) | KPIs can be termed as performance metrics of Six Sigma. |
ASQ Glossary | KPI is a statistical measure of how well an organization is doing in a particular area. A KPI could measure a company’s financial performance or how it is holding up against customer requirements. |
Key performance indicator definitions
KPIs show actual data of a particular outcome. The outcomes of Six Sigma projects are usually required to be expressed in financial terms. This leads to a direct measure of achievement which is easy to understand (Goh, 2002). The majority of the KPI literature on Six Sigma in services talks about financial benefits. Other KPIs include expressions in terms of customer satisfaction and efficiency. Similar to CTQs, some KPIs are common across services. Some of the common KPIs are discussed below.
Efficiency
Efficiency in a service industry means the timely delivery of services at a reasonable cost.
Cost reduction
Cost can be reduced by eliminating waste, such as reducing errors or mistakes in a process or reducing the time taken to complete a task. A concrete example is to reduce a patient’s stay at a hospital (Heuvel et al., 2005), which can provide opportunity for more admissions.
Time-to-deliver
Like in manufacturing, the time to deliver a service determines organizational performance. Examples may be the timely delivery of information or document as per customer requirement.
Quality of the service
Quality of the service is a measure of the extent to which the service delivered, meets the customer’s expectations. This depends on two aspects; one is the technical aspect and another is functional aspect. The technical aspect is the actual outcome of the service encounter. Functional aspect is the interaction between the service provider and customer i.e. the service process (Ghobadian et al., 1994).
Customer satisfaction
This factor is difficult to measure as it varies from service to service. For example, for a call center service, customer satisfaction is measured by the receipt of timely information. For a hospital, the comfort and assurance that patient feels may be the all important criterion (Sehwall and De Yong, 2003). Overall customer satisfaction can also be indicated by the retention rate of one’s customer.
Employee satisfaction
This is another intangible measure of organizational performance. Employee retention rate can be an excellent indicator of employee satisfaction. Financial benefits due to Six Sigma can provide employees with a means to visualize their contribution. This may increase employee morale and satisfaction (Henderson and Evans, 2000).
Reduced variation
Statistical process control and Six Sigma refer to the reduction of variation through improved standards and consistency. In the case of services, variation reduction may be in terms of, for example, the cycle time of processing statements, or the decision cycle of a process (such as credit process in a bank) or the inaccuracy of a billing process and incorrect laboratory test results (such as in a hospital) (Sehwall and De Yong, 2003; Rucker, 2000).
Financial benefits
The impact of Six Sigma on the bottom line is huge (Henderson and Evans, 2000). In comparison to success and failure as a measure, financial bottom lines are a better indicator of the impact of improvements as well as a vivid calibration of progress (Goh, 2002).
Although different terms may be used, scrap and rework exist in services just as they do in manufacturing. Inconsistent and out-of-specification processes cost money to rework. Such examples in services may include the need to re-contact a customer to verify an order, providing an incorrect service, providing a substandard service, or even over-servicing or providing more than what is required. Some widely publicized success stories due to implementation in services include GE Medical Systems, Mount Carmel Health System, Virtua Health, GE Capital Corp, Bank of America, and Citibank. Limited application can also be found in call centers, human resources such as DuPont de Nemours (Bott et al., 2000; Wyper and Harrison, 2000) and in product support services such as by Caterpillar (Schmidt and Aschkenase, 2004).
The literature analysis also revealed that applications are limited mostly to service organizations in North America and Europe. Benefits-wise, these are mostly expressed in financial terms and not much is published about the benefits in process improvement terms. The literatures (Brady and Allen, 2006; Inozu et al., 2006; Mortimer, 2006; Antony et al., 2005a; Dudman, 2005; Goel et al., 2005; Hensley and Dobie, 2005; Basu, 2004; McAdam and Evans, 2004; Schimdt and Aschkenase, 2004; Hill and Kearney, 2003; Sehwall and De Yong, 2003; Rucker, 2000; Hahn et al., 1999; Harry and Schroeder, 1999; Paul, 1999) on Six Sigma application in manufacturing or services discuss mainly about CSFs, CTQs, KPIs and STTs. The following section provides an overview of these factors. Table 7 presents the similarities and differences of these between manufacturing and services on the basis of observations from the literatures.
Dimensions | Manufacturing | Service | |
Top management commitment, education and training, cultural change, linking Six Sigma to customers, linking Six Sigma to business strategy, effective communication | Top management commitment, cultural change, clear performance metrics, customer focus, education and training, attaching the success to financial benefits, organizational understanding of work processes | ||
Similarities | Cycle time, cost of quality, machine or human error | ||
Differences | Product performance characteristics such as, strength; weight, defects, poor packaging, breakage, defects, inventory reduction, product travel distance, poor packaging, quantity of rework, time spent in rework | Service time, waiting time, employee behaviour, responding to customer complaints, providing accurate and timely information to customers | |
Cost savings, customer satisfaction, reducing variation, employee satisfaction, increasing productivity, product quality improvement | Efficiency, cost reduction, time to deliver, quality of the service, customer satisfaction, employee satisfaction | ||
Similarities | Histogram, Pareto analysis, cause and effect analysis, brainstorming, flowchart, project charter, process mapping, root cause analysis, control charts | ||
Differences | FMEA, DOE, SPC, gauge repeatability and reproducibility, measurement system analysis, regression analysis, QFD |
CSFs, CTQs, KPIs, and STTs (manufacturing versus service)
The above table provides some important insights regarding Six Sigma implementation aspects in manufacturing and services. There are similar CSFs in manufacturing and services but their order of preference differs between two. This difference in order of preference can also be observed within the literature involving Six Sigma implementation in services. The paper by Antony (2004b) shows that linking Six Sigma to business strategy is the most important of success factors whereas some other literatures discuss that top management commitment is the most important one, followed by education and training (Johnson and Swisher, 2003; Henderson and Evans, 2000).
CTQs show similarities in terms of cycle time and cost. The concentration in manufacturing is more on product specifications/characteristics, inventory reduction, and reducing variation whereas services focus more on service time, waiting time, responding to customer, employee behaviour, etc. The reason for this difference can be because of more customer contact in services.
KPIs for both manufacturing and services show much similarity and are not much discussed in literatures. The application of tools and techniques has similarities in usage of flowcharts, process map, histograms, Pareto analysis, etc. The use of statistical tools and techniques such as SPC and regression analysis is more prominent in manufacturing may be because of ease of data collection and continuity of the process. The tools and techniques such as gauge repeatability and reproducibility is commonly used in manufacturing but not so in services, the reason is non-repeatable nature of service processes (Does et al., 2002).
First, although the industry has an increased interest in Six Sigma implementation and many companies have gained the profits and advantages from this disciplined approach, the literature is limited and the research impacts of Six Sigma implementation and factors contributing to its success remain unclear. Many articles on the impact analysis of operations performance do not mention the detailed improvements in the operating areas, but focus on the overall bottom line impact. Therefore, it is necessary to do a deeper and more detailed study in this area.
Second, only a few articles were found that dealt with factors in the area of success factor analysis to Six Sigma implementation. Existing studies are not well integrated and current concepts in the field of Six Sigma are largely based on case studies, anecdotal evidences and are prescriptive in nature. Consequently there is little consensus on which factors are critical to the success of the approach (Nonthaleerak and Hendry, 2008; Brady, 2005). Most of the articles concentrated on few success factors and reported that top management commitment is the main factor to Six Sigma success (Goh, 2002; Henderson and Evans, 2000). However, many other factors affecting Six Sigma’s success are important and need to be better documented.
To fill this gap, Antony and Baneulas (2002) identified 10 typical CSFs from their review of literature. Several others also provided sets of CSFs which have similarities or differences among them. It could be argued that this list of CSFs is comprehensive and that many of the issues are in common with those found for any implementation process, and are thus not specific to Six Sigma. However, all of the papers that identify these issues are descriptive in nature and there is a need to verify them through rigorous empirical research.
Finally, some authors have called for theoretic research (Nonthaleerak and Hendry, 2008; Schroeder et al., 2008; Oke, 2007; Brady and Allen, 2006), as too much research is focused only on description of practice rather than on theory development that is of use to practitioners as well as academics.
Management research is mainly based on deductive theory testing and positivistic research methodologies (Alvesson and Willmott, 1996). These methodologies incorporate a more scientific approach with the formulation of theories and the use of large data samples to observe their validity. However, these approaches mostly fail to give deep insights and rich data in Six Sigma practice within service organizations. Schroeder et al. (2007) state the need for more theory grounded and contingency based research rather than be restrictive to deductive approaches. Antony et al. (2007) and Nonthaleerak and Hendry (2008) emphasize this point by saying there is a
In this section we describe the three phase approach for this study. First phase involved literature review and exploratory case studies. A small-scale questionnaire survey and 15 case studies were done in the second phase. The third phase included a large-scale questionnaire survey and further case studies. Questionnaire structure and design for each phase is also discussed. Then details about the measures are provided. Finally, we explain how we test the sample bias, which population is targeted, and how to proceed for the data collection.
This phase focused on providing the necessary breadth to produce an understanding of the implementation of Six Sigma in service organizations and from which reliable patterns and theories can be formed. Next phase of this research focused on the issues uncovered by the first.
The phase is termed as macro study (Leonard and McAdam, 2001), and it provides an overview not only of Six Sigma implementation in services, but also a database of critical success factors (CSFs), critical-to-quality (CTQ) characteristics, key performance indicators (KPIs), and set of tools and techniques (STTs).
The study included two services one is library and the other one is a call center. During this phase, interviews were conducted with a black belt, who was considered by the organization as most knowledgeable and responsible for Six Sigma implementation. The study concentrated on the implementation aspect of Six Sigma which involves CSFs, CTQs, KPIs, STTs, and also the difficulties faced. The BB provided an essential insight and understanding of Six Sigma implementation in service organizations. The other methods of data collection in this phase involved documentation and archival records.
Once the macro study is completed and insights are developed, preparation for next phase was done to focus on additional relevant questions that had arisen in phase one. This next phase involved a small-scale questionnaire survey and simultaneous case studies. The study included multiple respondents which overcame the problem of using single respondent in phase one. It also provided a degree of validation.
At this phase a questionnaire survey of Singapore service organizations was conducted to understand the status of Six Sigma implementation. The survey was exploratory in nature as the objective was to gain insights about Six Sigma in service organizations. This kind of survey helps to uncover or provide preliminary evidence of association among concepts. Further, it can help to explore the valid boundary of a theory (Forza, 2002).
Three-phase approach (adapted from
There are five parts in the questionnaire. The first part of the questionnaire is intended to get some general information of the respondent company, which includes the type of service organization, the size of the company, the type of company (local, multinational, or joint venture), whether they have quality department, there is a proper quality system in place, any business process improvement initiatives they are doing, and finally whether they have implemented Six Sigma. It is also designed as a filter to segregate the data based on service organizations which have or have not implemented Six Sigma.
The second part of the questionnaire attempts to identify the CSFs which are important while implementing Six Sigma in organization. The third part consists of two questions. First question is directed at identifying CTQs that are to be improved through Six Sigma implementation. Second question explores the tools and techniques used in Six Sigma DMAIC methodology and also in DFSS. The fourth part is focused on finding about KPIs while in the fifth part the objective is to identify the difficulties faced by service organizations in Six Sigma implementation. The fifth part is for those service organizations which have not implemented Six Sigma. There is one question in this part to explore about the reasons behind not implementing Six Sigma. The last part is designed to obtain background information on respondents including their name, job title, company, mailing address, phone/fax number, and e-mail. In order to share our findings with the respondents who are interested, we also left a space for them to tick whether they want to have the summary of our survey results.
Besides the six parts above, a cover letter with university letterhead explaining the aims and benefits of the research was designed.
The response format of the questionnaire is a major design consideration since this will alter the type and wording of the questions as well as focus on the type of analysis that the researcher wants to perform (Antony et al., 2007; Fowler, 2002; Kidder, 1986). For our research close-ended question format was considered since the data would be in a quantifiable form ensuring that statistical analysis can be used. Moreover, it is fast and easy to complete, enables automated data entry, and facilitates data analysis and summary of data (Antony et al., 2007; Fowler, 2002). The rating scale (Likert scale) and ranking used within this format is to obtain the answers from the respondents. The questionnaire focused on CSFs, CTQs, STTs, and KPIs as observed from the literature. CSFs, STTs, and KPIs are measured by a 5-point Likert-type scale (CSFs and KPIs: 1 = not important, 5 = very important; STTs: 1 = never, 5 = frequently). The Likert scale used provide a more precise measure than yes/no or true/false items and it is fast and easy to complete (Neuman, 2006). The rating scale used for few questions allows the respondents to indicate the relative importance of choices that facilitates the researchers in identifying the critical issues or factors (Antony et al., 2007).
Further, in the question content we intended to assure the respondents will be willing to answer honestly. To achieve this, personal information was not required across all the questions. The respondent profile which needed personal information was optional.
The case studies in this phase focused on the critical issues that emerged from phase one. The case study was chosen as the research method primarily due to the nature of the research questions. Yin (1994) recommends this method as the most appropriate when contextual conditions are believed to be highly pertinent to the phenomenon of study. The case study method is also recommended when research questions embodies an explanatory component, such as in this study (how CSFs impact Six Sigma implementation in services?) (Yin, 1994).
We opted for an intricate sample design (Harrigan, 1983). This is a design where the sample is selected to coincide with sites that possess observable traits that are key factors in the propositions to be examined (Sousa and Voss, 2001).
The process for selecting individual service organizations was based on publicly available information and the respondents of small-scale questionnaire survey. From publicly available information, an initial list of 20 service organizations was compiled that were likely to comply with our research objective. 8 organizations which declined to participate in small-scale survey were removed from the initial list of 20, as they clearly mentioned about not revealing any data. We then started by contacting remaining 12 firms for participation in case study. At the end there were 3 firms which agreed to participate in the study. These 3 organizations were included for case study in next phase.
For second phase case studies we searched in public domain about the information available related to 17 organizations which were not interested for direct participation in the case study. We found Six Sigma implementation information related to 15 service organizations through different sources available. Finally second phase comprised 15 organizations which have completed around 29 projects between them for a period of 5 years, i.e. from 2003 to 2007.
A case study protocol was developed comprising a list of the research variables to address, and the respective questions, potential sources of information, and field procedures. Although data collection focused on the formal research variables, we also addressed other issues enabling us to understand the observed pattern of use of Six Sigma implementation, such as the history of use of its implementation and the difficulties experienced by the service organizations in using Six Sigma. Several data collection methods were used in both the phases including semi-structured interviews, direct observation, and secondary data.
Evidence for case studies can be obtained from various sources such as documents, archival records, interviews, direct or participant observation, and physical artefacts. In this phase of the study the data collection is based on documentary evidences, which helps in providing specific details to corroborate information and also inferences can be made from documents (Yin, 1994). The documents considered for this study is in the form of articles, interviews, and speeches published in journals, magazines, newspapers, and websites.
The first two phases of case studies were devised to provide a breadth of data and understanding of the Six Sigma implementation in service organizations. Along with the small-scale survey the second phase further enhanced the database on different aspects of Six Sigma implementation. The third phase will provide more rich and deep data, which involve a large scale questionnaire survey and case studies with in-depth interviews.
Phases one and two are specific and as detailed and rich in data as the third phase, but they are limited in time, access, and practitioner involvement. Thus, specific areas of inquiry could be examined, but a true behind the scenes, and multi-faceted picture and understanding could not be provided. To provide such an understanding, in-depth case studies and large-scale survey were needed that would allow a significant access to different managerial levels and inputs from the use of different research techniques. This constituted the third phase where case studies ran parallel with the second phase.
Except for single case versus multiple-case design possibilities, one can also distinguish a case design separating and choosing between a single unit of analysis and multiple unit of analysis, see Yin (1994). In the literature, unit of analysis refers to a great variety of objects of study, for example, a person, a program, an organisation, a classroom or a clinic (Mertens, 1998), or a community, state or nation (Patton, 1987). Other authors have considered the unit of analysis as interviews or diaries in their entity, and the amount of space allocated to a topic or an interaction under study (Downe-Wamboldt, 1992).
For case studies, the overarching unit of analysis was the Six Sigma projects but there are sub-units that were investigated in order to reveal the main unit as realistically as possible. These sub-units are the experiences from different expertise (belt levels), the difficulties faced, the tools and techniques used, which also counts for the opinions among the actors involved in the implementation work. The reason behind choosing different expertise is because of different roles of black belt (BB) and green belt (GB) in Six Sigma project. BBs are the project leaders who are responsible towards project management while GBs are involved in data collection and analysis process. Following the experiences from different expertise will help in understanding the concerns from different levels, about Six Sigma projects.
Therefore, during the case studies different expertise in Six Sigma are chosen, which indicates that the chosen research design is an embedded multiple-case design. The replication does not necessarily mean that each case study needs to be either holistic or embedded (Hansson, 2003). The individual cases, within a multiple case study design may be either. When an embedded design is used, each individual case may include the collection and analysis of high quantitative data including the use of surveys within each case (Yin, 1994). During this study, each individual case in the multiple-case design represented an embedded design. This unity between the individual cases was chosen in order to discover possible differences between the respondent groups, different levels of expertise and experience in Six Sigma implementation, as they may not share the same experience from an implementation process.
The small-scale questionnaire survey helped in understanding the status of Six Sigma in service organizations. It also highlighted certain issues which are required to be studied further in order to develop the theory. The next step is to conduct a large scale questionnaire survey and further case studies.
The case study organizations were selected based on the idea of theoretical sampling. In case of theory building, theoretical sampling is preferable in comparison to generalizability concept in statistical studies. So, the cases are chosen for theoretical rather than statistical reasons (Schroeder et al., 2007; Eisenhardt, 1989).
The case studies in this phase involved three different service organizations and provided an opportunity for detailed understanding of Six Sigma implementation. After the second phase overall 8 organizations were contacted, 3 of which agreed to participate in the study. Similar to second phase, a range of data collection methods which include participant observation (e.g., organization tours), formal interviews, and review of company documents and archives, were used in this phase. This allowed a multi-perspective view on Six Sigma implementation in service organization.
We conducted structured interviews with all the informants. In case of the four Staff Nurses for the healthcare service organization the questions were mainly towards their experience about the current projects, because of their limited knowledge of Six Sigma. The structured questionnaire involved questions on the Six Sigma initiative, project selection, Six Sigma implementation process, and the learning experience. As a part of Six Sigma initiative, we asked the informants about the reason they prefer Six Sigma over other initiatives, how the preparations were done to implement Six Sigma, and what was their approach to training personnel for Six Sigma. In project selection the informants were asked about the criteria of selection for the projects, factors involved in success of a project, and reasons behind unsuccessful projects. For the process of Six Sigma implementation, the questions are about their considerations on CTQs, tool and techniques used at different phases of DMAIC, selection criteria of STTs, and KPIs. We also asked the informants about their learning experience on the basis of Six Sigma’s relevance to their organization, problems faced during the implementation process, and how they overcame those problems.
In total there were 10 interviews; 6 formal and 4 informal. All formal interviews were taped, transcribed, and coded. The list of interviewees is provided in Table 8.
Organization | Interviewee | Designation |
Hospital | I1 | Director, Human Resource |
I2 | Head of Department | |
Construction and Related Engineering Service | I3 | Assistant Director |
I4 | Senior Development Officer | |
Consultancy | I5 | Consultant |
I6 | Building Manager |
List of interviewees
Having already established a database from the literature review, initial questionnaire survey, and exploratory case studies on different aspects of Six Sigma implementation in service organizations, phase three interviews were more focused and directed.
In the case study of healthcare service organization, I was also involved in as a team member for two Six Sigma projects. This provided an opportunity to develop a partnership which lasted for six months. Combining retrospective and longitudinal study; as done in case of healthcare service organization for the study enhances construct, external, and internal validity (Barton, 1990). Moreover, this type of partnership in grounded theory research helps in observing phenomenon development and to develop framework from the collected data (Leonard and Mc Adam, 2001). Approaching the interviewees was not a problem, as I was visiting the organization on regular basis. This helped in getting completed answers on all questions and returning at a later date to seek clarification to questions that arose. For the other two organizations though there is no participant involvement, but the interviewees were approachable when required. Overall, interviewees represent different level in terms of experience and expertise with Six Sigma; this helps to avoid a bias or unqualified opinion which can be a problem in single respondent study (Nonthaleerak and Hendry, 2008; Voss et al., 2002).
My involvement in one of the case studies helped in observing changing attitudes towards Six Sigma and the development of the project. These observations included the challenges and issues involved in Six Sigma projects in service organizations. It allowed a more detailed history of Six Sigma implementation in the organization to be plotted, with wide access to documentation providing a clear picture of the reasoning for Six Sigma adoption, CSFs, CTQs, selection of tools and techniques, and the difficulties faced. Therefore, the case study research included an element of ethnography as what was being attempted was to learn the implementation of Six Sigma, and not only to accept or listen to the views articulated but also to actively use those views in discussion.
The documentary evidences for information about these case studies is gathered through various sources which include websites such as Singapore Government website (PS21–Public Service for 21st Century), articles, interviews and speeches from newspapers, magazines, and journals. Other sources of data are the reports and presentations of the completed projects.
This third phase of research was being carried out at the same time as the studies in phase two. The issues emerging from the previous phases were brought over and examined in the three case studies. Though, the specific questions raised during previous phases could not be specifically answered by these three case studies but wider issues that were replicated throughout were examined. Thus, these three case studies allowed greater detail and more intricate issues to be dealt with.
This phase also involves a large-scale questionnaire survey by focusing on companies which operate in different geographical locations, following the integrative approach suggested by Gilmore and Carson (1996). Combining such compatible and complimentary methods provide depth, breadth, and subtlety of information to the study (Carson and Coviello, 1996). This survey is done concurrently with the case studies and the responses from it further strengthen the development of conceptual framework for Six Sigma implementation in service organizations.
There are six parts in the questionnaire. The first part of the questionnaire is intended to get some general information of the respondent company, which includes the type of service organization, the size of the company, the type of company (local, multinational, or joint venture), whether they have quality department, there is a proper quality system in place, any business process improvement initiatives they are doing, and finally whether they have implemented Six Sigma. It is also designed as a filter to segregate the data based on service organizations which have or have not implemented Six Sigma. The second part of the questionnaire attempts to identify the CSFs which are important while implementing Six Sigma in organization. The third part consists of four questions. First two questions are related to CTQs. One is asking about definition of CTQ and the other is to identifying CTQs that are to be improved through Six Sigma implementation. Third question explores the tools and techniques used in Six Sigma DMAIC methodology and last one is about their selection criteria. The fourth part focused on finding about KPIs and its definition while in the fifth part the objective is to identify the difficulties faced by service organizations in Six Sigma implementation. The last part is for those service organizations which have not implemented Six Sigma. There is one question in this part to explore about the reasons behind not implementing Six Sigma.
Besides the six parts above, the web-based respondents were sent an introductory letter and follow-up letter by e-mail. In each e-mail, the targeted person was directed to a specific web page address posted on the university internet server, where the survey was presented. After completing the survey and pressing a
Following Gilmore and Carson’s (1996) integrative approach, we focused on survey of service organizations in different geographical locations. Web-based surveys are one of the most preferred methods when data collection is to be done from organizations spread world-wide. They have several advantages over other collection methods, such as low cost, broader distribution, potentially higher response rates, faster survey turnaround time times and high selectivity (Coderre and Mathieu, 2004; Boyer et al., 2002; Klassen and Jacobs, 2001).
The design of the survey web page was similar to hard-copy survey. Like a paper survey, the respondents can scroll through questions in a particular section and also browse through the questions in other sections without any restrictions. They could also answer questions in any order and could complete the survey in several sessions. In terms of appearance user friendly features was designed (e.g. radio buttons, check boxes, scrollable dialog boxes, etc. where appropriate, given the nature of the question) to speed completion of survey (Kalssen and Jacobs, 2001; Dillman, 1999).
Similar to small-scale questionnaire survey, here also in the question content we intended to assure the respondents will be willing to answer honestly. To achieve this, there was no requirement for personal information in any of the questions. The respondent profile which needed personal information was optional.
The framework involves three sections. First is CSFs, followed by Six Sigma implementation, and bottom-line result. The Six Sigma implementation section consists of CTQs or measurable process parameters, DMAIC methodology, and STTs.
Conceptual framework for Six Sigma implementation in service organizations
The framework evolved on the basis of data collected through surveys, case studies, and continuous referrals with the literature. The initial framework developed was a kind of assessment model, i.e. in auditing role instead of an evaluative model to understand the dynamics of Six Sigma implementation in service organizations (Leonard and McAdam, 2001). There are works by Senapati (2004) and more recently by Parast et al. (2007) towards developing an assessment model for Six Sigma implementation. Though, both are descriptive in nature and lacks rigorous empirical research to support their applicability. We rather feel that a fuller understanding of dynamics of Six Sigma in service organizations, using suitable frameworks, will assist organizations to evaluate and predict the current and potential business benefits from Six Sigma implementation. Also, methods of reenergizing and directing Six Sigma efforts will be more specific and accurate. Furthermore there is a paucity of research literature in this area. Thus, our research study adds to the body of knowledge. The modified framework is presented in Figure 5.
The idea of identifying CSFs as a basis for determining information needs of managers was popularized by Rockart (1979). In the context of Six Sigma implementation, CSFs represent the essential ingredients without which the initiative stands little chance of success (Antony et al., 2007). Based on this discussion and our findings from literature and data collected through surveys and case studies, CSFs are included in our framework. There are various CSFs identified but we feel only a few are essential as observed from the views of respondents from surveys and case studies.
First and foremost of CSF is top management commitment and involvement. Once top management buys in the decision to implement Six Sigma, they also have to involve themselves to ensure success of the program. This is highlighted by the respondents during interview sessions. They feel occasional involvement of top management during team meetings will motivate the team members and this will also help in solving certain problems which the team members cannot solve at their levels.
Next is support of team members. Since Six Sigma implementation requires project teams so, proper coordination and support between team members is an important aspect. Further in case of service organizations, the projects are done part-time so involvement of each member in team meetings becomes very important to keep everyone well versed about the project. This will also ensure timely completion of the project.
Linking Six Sigma to business strategy is another CSF which is mentioned both in surveys and case studies. This is important as there has to be alignment between the Six Sigma projects and company objectives as mentioned by one of the interviewee of consultancy service organization. This also ensures top management commitment towards Six Sigma program.
The surveys also highlighted two CSFs which are customer focus and education and training. Education and training on Six Sigma will be useful as it will help employees of service organization overcome fear on the use of rigorous statistical and quality tools and techniques (Nonthaleerak and Hendry, 2008).
We also propose definition for CTQ to have a clear distinction with KPI. CTQ can be defined as product or service process characteristic derived from critical customer requirements whereas KPI as mentioned is more specifically performance metric. The following example (adapted from Frings and Grant, 2005) will help in understanding about CTQ clearly.
So in order to reduce the ambiguity between terms we use only CTQ which include both CTQ definition and CTQ measure. Since CTQ is actually process characteristics so for a clear understanding, in the framework we mention it as measurable process characteristics.
The CTQs or measurable process characteristics which are important from service organization’s perspective are time, cost, and quality. The study shows that most of the Six Sigma projects associated with service organizations are concerned with reduction in time. From our analysis of service strategy context we found that cycle time is an important CTQ for mass service organizations whereas waiting time is critical for professional service organizations. Reduction in cost is concerned with cost of transaction and quality is related to improved accuracy in information provided to customer or improved reliability of service systems, etc. The most important aspect related to measurable process characteristics is our finding that it is context dependant. As our research showed that importance of process parameters vary across service types. So to overcome the barrier of identification of process parameters it will be useful to position service organizations as professional service, service shop or mass service.
It is observed that there is ambiguity about KPI. It is often synonymously used with CTQ. The practitioners feel it more as key process input/output variable rather than key performance indicator. Key performance indicator is more like performance metric as mentioned in some literature and is strategic in nature. Table 9 provides the definitions identified from our study. Majority of these definitions are related to organization strategy.
It can be observed from the above table that KPI is significant when interpreted in terms of overall organization strategy rather than specific to Six Sigma strategy. Another interpretation of it being similarity with CTQ makes us to think of a uniform and clearly understandable term instead of two different terms. We feel in this scenario the term measurable process characteristic mentioned in our framework definition can overcome this problem.
KPI\'s is the chosen indicators to control a process and used to have data when a decision is required. KPIs are agreed in an organization as the measurement points without discussion. |
The metrics that help guide the organization in the right directions. Tells you if you are succeeding in your goals. |
We believe that excellence in service will be the nucleus for all actions and decisions. So the KPIs are a measure for our excellence in service and customer support. KPIs are based on SMART targets. |
KPI is designed based on the results required and in line with the Company strategy. |
We use KPIs to measure how we are doing on our strategic and financial goals. |
KPIs are set up to indicate organization/department goals, set up dashboards and score cards w/ baseline metrics and monitor the performance based on key indicators. |
Quantifiable indicators to measure the fit for purpose and efficiency of the organisation. |
Same as CTQs. |
Key performance inputs. |
KPI - key measure that are critical to evaluate the performance of a product/process. |
Definitions of KPI from large-scale survey
In case of Six Sigma, financial benefits or bottom-line result is the most common performance metric (Goh, 2002). So, in the conceptual framework instead of key performance indicator, bottom-line result is included as the main outcome.
In general Six Sigma projects utilize a number of tools and techniques in different phases of DMAIC methodology. The service organizations utilize specifically lesser number of tools and techniques compared to manufacturing (Antony et al., 2007). Our study observed that generally organizations mention a number of tools and techniques applicable in Six Sigma implementation but closer analysis showed that actually the number is quite small. We also found that organizations which have limited success and progress with Six Sigma so far use more number of tools and techniques in comparison to those service organizations which have moderate progress and success. Based on our findings we provide a set of tools and techniques which can act as a guide and provide better advice to those attempting to implement Six Sigma in service organizations. Table 10 provides STTs applicable to specific DMAIC phases for Six Sigma implementation in service organizations.
We also observed that literatures were mainly talking about difficulties or obstacles in Six Sigma implementation in service organizations. The reasons cited such as the inherent differences between services and manufacturing, or differences in application of tools and techniques (Antony et al., 2007; Hensley and Dobie, 2005; Antony, 2004b; Benedetto, 2003).
Define | Project charter, Brainstorming, Flowchart, Process map, Project management |
Measure | Cause and effect diagram, Pareto analysis, Brainstorming, Check sheet, Histogram, Normal probability plot, Flowchart, Matrix diagram, Work flow diagram, Project Management, Process capability analysis |
Analyse | Cause and effect diagram, Pareto analysis, Brainstorming, Histogram, Normal probability plot, Flowchart, Matrix diagram, Work flow diagram, Project management, Analysis of variance, Root cause analysis, Process capability analysis, Descriptive statistics |
Improve | Brainstorming, Flowchart, Check sheet, Decision matrix, Project management |
Control | Control chart, Project management |
STTs for service organizations
There are also views that Six Sigma will not work for every service processes, and adjustments may be required for it to suit even for those processes for which it does apply (Biolos, 2002). Like much of the literature in this area these obstacles discussed are descriptive and does not involve empirical studies for support. Building-up on this gap and based on our data collection we identified difficulties faced by service organizations during Six Sigma implementation and included them in our framework. These obstacles goes beyond the inherent differences between service and manufacturing, are practical problems faced by the organizations which may or may not be specific to a certain service organization.
One is between CSFs and Six Sigma implementation. This barrier includes lack of support from team members, resistance to change, long-term sustaining of Six Sigma, attaching incentives to successful Six Sigma projects, staff turnover, and lack of support from employees not involved in Six Sigma project. The second barrier is between measurable process characteristics and the methodology. This includes difficulty in identifying process parameters, difficulty in collecting data, and time consuming effort in collecting data. The third barrier is between STTs and the methodology. This barrier includes difficulty in identifying proper STTs, some tools and techniques are too complex to use and requires more time to learn.
The framework developed on the basis of grounded theory methodology, is an attempt to understand the aspects of Six Sigma implementation and performance in service organizations. The study contributes to Six Sigma knowledge through development of theory and building a prescriptive model to advice both managers and scholars attempting to implement or study Six Sigma in service organizations. The framework provides a set of CSFs, measurable process characteristics, and tools and techniques which will act as a guide and also overcome the difficulties or barriers in Six Sigma implementation in service organizations. The strength of our study is coming out of the service versus manufacturing differences paradigm and highlight the practical difficulties faced by service organizations in Six Sigma implementation.
Using qualitative analysis technique, we are able to find empirical support for critical success factors, measurable process parameters, tools and techniques, bottom line result and difficulties in Six Sigma implementation in service organizations. There exist different configurations of Six Sigma implementation for discriminating between high and low performance depending on the significance attributes to performance dimensions. This is in line with the systems approach to fit that upholds the criticality of the internal consistency of each design and match between the structural patterns of practices to the contingencies facing the organization. We are able to show which are the CSFs required for Six Sigma implementation at project level and how these CSFs can help in overcoming barriers observed at different phases of Six Sigma projects in service organizations. The research also highlights a set of tools and techniques used in Six Sigma projects and also explain the selection criteria for these STTs. One of the important developments is related to the interpretation of the term KPI related to Six Sigma at project level. KPI is better understood as key process input or output variables at Six Sigma project level and key performance indicator at strategic level in an organization. Last but not the least, understanding of the practical problems faced by service organizations during Six Sigma projects is a major contribution of our research since we feel this was one of the important missing links in existing literature.
We hope that this study encourages investigation of Six Sigma implementation in service organizations and promote rigorous development and explicit articulation of theories. It is necessary to increase theory development related to Six Sigma implementation that is grounded on relevant established theories and empirical evidence from related disciplines. So that empirical investigations of related phenomenon can be integrated into the building and modification of useful and interesting theories.
This study demonstrates the value of methodological triangulation in the development of framework and theory of Six Sigma implementation in service organizations using literature review, surveys, and case-based research. The use of different methods of investigation provides complimentary assessment of the same issues and brings out salient details that cannot be obtained by a single method of analysis.
The case-based research draws attention to the existence of contingencies and the need to further investigate the ambiguous role of contextual factors in affecting Six Sigma implementation in service organizations. Studies by Nonthaleerak and Hendry (2008); Schroeder et al. (2008); Antony (2004) prescribes that Six Sigma can be implemented in service organizations, our study suggests that the implementation and impact of Six Sigma can be affected by contextual factors such as service types.
In summary, this research contributes to theory-grounded empirical research. This is a worthwhile endeavour because contributions to valid and reliable measurements and explicit theory development help lay a foundation for future Six Sigma implementation studies. By identifying and testing theories we encourage the development of a stream of cumulative research.
This study offers conceptual clarity and specificity on Six Sigma implementation in service organizations, managers can use a guideline for choosing the fundamental practices that they can implement. We provide conceptual and empirical evidence on CSFs, measurable process characteristics, STTs, and difficulties faced by service organizations, encouraging managers to plan and implement Six Sigma with a systematic view of service environment. Furthermore, there is empirical evidence of the importance of committed and involved leadership in the implementation of Six Sigma in service organizations. We also find that a general emphasis on company-wide Six Sigma projects is significant in differentiating high and low performance.
The study has shown that there is a relationship between successful Six Sigma implementation and financial performance. The study also reveals that there are common features of the implementation of process of Six Sigma in service organization context. However there are still several areas that require further investigation related to these findings.
Six Sigma and organizational success, progress can be further studied based on the specific service types. The studies can involve the organizations included in the investigation, in order to study whether the advantageous financial performance of Six Sigma projects also holds in a longer perspective. Advantageous financial performance might be considered a major encouragement for commitment and motivation among employees and management. Since their commitment and involvement is vital areas for sustaining Six Sigma, see Goh (2002), maintained advantageous financial performance is vital for the future progress of Six Sigma. Furthermore one could include other organizations from individual service types, which have won quality awards or reached a certain level in the assessment, in order to enlarge the empirical foundation and further outline how different levels of Six Sigma implementation affect financial performance.
Additionally, an investigation aiming at exploring major Six Sigma achievements, e.g. increased customer satisfaction, reduction in cycle time or waiting time, among organizations that successfully implemented Six Sigma and studying their link to financial figures, could further explore the relationship between Six Sigma and success and progress. Also, a study of the major areas of costs when implementing Six Sigma compared with possible gain, and put in a relation to financial benefits after implementation, will possibly add supplementary information important for facilitating the understanding of the relationship between Six Sigma and its success and progress.
Furthermore, investigations based on individual service types and the effect on success and progress would further complement the findings presented within the framework of this thesis.
When considering the process of Six Sigma implementation in service organizations, several interesting opportunities could be mentioned for expanding the findings of the study. One appealing approach would be to do a longitudinal study in one or several service organizations that intend to start Six Sigma implementation in order to follow the implementation process in a more detailed manner and without being forced to totally rely on historical and personal information. A major problem with such a study might be that the outcome of the implementation efforts is not necessarily successful, i.e. the researcher will not know at the beginning that the study will investigate a successful Six Sigma implementation. If the studied organization(s) do not succeed in implementing, the findings may outline problems and reasons although not as reliable implications for successful implementation as the findings could have resulted otherwise.
Several core values of Six Sigma focus to a large extent on intangible factors related to e.g. support of team members, education and training, and top management issues. At the same time many of the concrete components, e.g. process parameters, tools and techniques, are more focused on tangible factors, of which some tools and techniques are statistical in nature and are not readily acceptable in service organizations. By making studies, with an increased focus on how service organizations which have implemented Six Sigma, address and develop intangible factors, and linking the findings to a further developed version of the implementation framework presented in chapter 7, an implementation framework even more adapted to service organizations could be created.
On the other hand, although the service organizations studied have implemented Six Sigma using CTQs, and STTs, with a focus on intangible factors, it is also very important to help service organizations to introduce and use different statistical tools and techniques to support and facilitate the handling and control of variation in process parameters in different ways. An interesting area is therefore, how to support service organizations’ use of statistical tools and techniques. An approach might be to focus on a specific branch or sector in the service organization context. This will help to build a more specific background of the service organizations’ characteristics within the chosen frame. By making such a study the specific characteristics of the included service organizations could be more accurately put in relation to their implementation process. Consequently, an increased consideration of contextual issues might be obtained.
Finally, the data collected for this study used the key informant approach (Bonner et al., 2002; Kumar et al., 1993). Therefore, all conclusions should be interpreted with this possible bias in mind. In addition although the reviewers in the pre-test did not find the survey questionnaires difficult to do, it was found that some of the questions are difficult to understand by some of the respondents. It was likely that the respondents who answered the surveys were more interested in Six Sigma than the non-respondents. Future studies with multiple respondents are recommended in which respondents come from different seniority and functional areas.
Six Sigma as a quality management practice is gaining importance in service organizations. Literature review shows that Six Sigma is mainly implemented in healthcare and banking service organizations. There is limited literature exploring Six Sigma implementation in service organizations and lacks rigorous empirical approach. Our study findings suggest Six Sigma implementation in different service organizations such as information technology, transportation, utilities, etc. Further most of these organizations are in moderate success and moderate progress category regarding Six Sigma implementation. On the basis of service types, it is found that most of the organizations are mass services.
Exploration of Six Sigma aspects in service organizations showed the importance of top management commitment and involvement along with some other CSFs. It is also observed that CSFs, CTQs, and STTs are to a certain extent depends on service types. There is some variation in CSFs, CTQs, and STTs across service types. The use of tools and techniques showed that successful organizations use limited number of tools in comparison to less successful organizations. One of the most significant finding is about KPI. The terms interpretation is best understood from strategic viewpoint. From the perspective of Six Sigma KPI is similar to CTQ and can be interpreted as process parameter. Another finding is about the difficulties faced in Six Sigma implementation by service organizations, which shows rather than the difficulty of data collection; part-time involvement, extension of project timeline, and staff turnover during projects or after training are the major difficulties. Unknown to us as a reason for not implementing Six Sigma prompts us to further understand the unique nature of service organizations and provide a customized approach to Six Sigma implementation in service organizations.
Agriculture is a soil-based industry that is heavily burdened to feed the increasing global population. And soil has been described as “the fragile living skin of the Earth”, but yet both its aliveness and fragility have often been ignored in the expansion of agriculture across the face of the globe [1]. Since it is a pivotal component in a global nexus of soil, water, air, and energy, how we treat the soil can impact massively on agriculture and climate change. Soils constitute one of the largest reservoirs of biodiversity on Earth and soil organisms are the source of key ecological functions and services that support agriculture, including soil conservation, water cycling, pest and disease regulation, carbon sequestration, and nitrogen fixation [2].
Currently, sustainable agriculture which is expressed as “industrialized agriculture” [3] relies on monoculture cropping, increasing use of mechanization, the application of synthetic fertilizers, pesticides, and herbicides, along with liberal government subsidies. Although this approach can be considered successful, in that it has managed to feed a massively rising human population [4], a range of environmental and social burdens have also been incurred, including erosion, soil nutrient depletion and contamination; loss of water resources and biodiversity, loss of forests and desertification; human labor abuses; and naturally the decline of the traditional farming practices.
In Ethiopia, one of the most singly destructive factors in farming is land resource degradation [5]. Almost all the land resource balances in Ethiopia show a soil nutrient deficit, water and soils are eroded, forests are depleted, wildlife and biodiversities are disturbed; representing a loss of yield and quality for consumption and causes climate change. Once the land becomes degraded, fertility and health of the soil are lost; farmers suffer extreme losses in very low yields on their farms. Such losses are projected in an environment sensitive to climate change, cost of living, and starvation. Hence, urgent steps are needed to avoid this and regenerate the depleted resources.
Therefore, there is no need of sustaining the already degraded land resources, rather regenerating them and formulating sustainable agriculture. The agricultural revolution in Ethiopia is wishing for effective solutions which are fundamental to land management and agricultural practices. Regenerative Agriculture which defined as “
Regenerative agriculture at its core has the intention to improve the health of soil or to restore highly degraded soil, which symbiotically enhances the quality of water, vegetation, and land productivity [8, 9]. Essentially, regenerative agriculture depends upon soil biodiversity and there may be no soil biodiversity without practices of regenerative agriculture; they have evolved together. By using methods of regenerative agriculture, it is possible not only to increase the amount of soil organic carbon in existing soils but to build new soils through attenuate the rate of soil erosion, restoration of the soil food web, improvement of soil fertility, and the activities of plants, animals, insects, fungi, bacteria, and humans too, all play a part in the formation of soil [1]. Hence, for the future scenarios challenging the agricultural sector such as soil degradation, increasing food demand, climate change, water scarcity, global soil biodiversity education and consideration of soil biology as a long term solution is needed to realize the full benefits of regenerative agriculture and respond to the needs of farmers and consumers relating to agriculture and land management.
Similarly, soil biodiversity plays a role in the formation of soil and enhances the ecosystem functions, services [10], and intern production and productivity of regenerative agriculture. Thus, this would lead to the consideration of soil biodiversity (activities of plant roots, animals, insects, fungi, bacteria…) as nature-based solutions in the restoration of the soil food web, improvement of soil health and fertility, agricultural productivity, while locking-up carbon from the atmosphere.
Increased education and awareness are key strategies in ensuring that soil biodiversity is no longer out of sight, out of mind. As agricultural soils are under threat, there is a need to promote interactions between scientists, policymakers, and the general public to transfer and implement scientific findings of the benefits of soil biodiversity and ways to restore and conserve it [11]. These organizations and Elizabeth
And finally, increasing knowledge and literacy, and passion, particularly around soil biodiversity is essential to draw on the diverse community of stakeholders required to discover and implement biological solutions for the daunting challenges people face in climate change, agriculture, ecosystem restoration, environmental pollution, and human health. Once more, this review is the place to get awareness and understanding of the contribution of soil biodiversity to regenerative agriculture.
The review was done by a literature search and document sourcing using an online search in major websites that provide access to scientific research, like Research Gate, Science Direct, and Google Scholar to referring different research findings; reports, and working guidelines, as well as knowledge shared from different soil biodiversity conferences and webinar discussion points. Besides, citations in key papers were followed to identify additional relevant Articles and synthesize relevant peer-reviewed articles and related literature. Hence, it may represent a general diversity of regions and nations and provides a wealth of principles, examples, actions, and solutions to bring soil biodiversity into the light of regenerative agriculture.
Current conventional farming methods are resulting in the loss of fertile soil and biodiversity. According to Maria-Helena Semedo of the FAO, as cited by Chris [13], the world could run out of topsoil in about 60 years if we continue at current rates of soil destruction, as now about a third of the world’s soil has already been degraded. This affects the earth’s ability of food production, water filtering, carbon absorption, and farmers will no longer have enough arable topsoil to feed the growing world population. There might be a duty to transit towards regenerative agricultural practices.
Regenerative Agriculture is a system of farming principles and practices that increases biodiversity, enriches soils, improves watersheds, and enhances ecosystem services. The regenerative farming approach focuses on restoring soils that have been degraded by the industrial agricultural system. Its methods promote healthier ecosystems by rebuilding soil organic matter through holistic farming and grazing techniques. It enables the regeneration of land resources through the restoration of vegetation in a farm landscape using a high diversity of both annual and perennial crops [14, 15]. Moreover, it considers potential environmental and social impacts by eliminating the use of synthetic inputs and replacing them with site-specific management practices that maintain and increase long-term soil health, employment opportunities, and mitigation and adaptation to climate change.
Among the regenerative agriculture principles, No-till reduces soil erosion and encourages soil water infiltration [19]. Cover crops do the same, and can also reduce water pollution and contribute to reducing soil organic matter losses [20]. Diverse crop rotations can lower pesticide use [21] and reduce environmental pollution [22]. Focuses strongly on the environmental dimension of sustainability, which includes themes such as
In the experimental research of La Canne and Lundgren [24], regenerative corn fields generate nearly twice the profit of conventionally managed cornfields. Similarly, their finding discloses the insecticide-treated cornfields had higher pest abundance than untreated, regenerative cornfields. Reports from Burgess
For the goal of agricultural development in 3rd world countries, the future agricultural production systems should be designed to take better advantage of production resources found on the farm [28, 29]. While most of the regenerative and organic markets are in developed countries, developing countries like Ethiopia are becoming important suppliers, as regenerative agriculture practices are particularly suited for the conditions of their farmers, especially smallholders living in rainfed areas. However, yet Government agencies in developing countries cannot often make the corporate sector responsible for agricultural development and for preventing harm to the environment. According to reports made by EPAT [30], pesticides that are illegal in Europe are commonly applied throughout sub-Saharan Africa, owing to the industry’s open-door pesticide policy. Farmers in resource-constrained and low potential areas of Ethiopia traditionally use few external inputs [31, 32] but many of the environmental, social, and economic benefits of land management, which translate into ecological intensification, are hampered by a lack of appropriate regenerative agriculture knowledge and skills.
Therefore, by understanding and implementing regenerative agriculture; considering soil biodiversity; the farming community will benefit from enhanced nitrogen fixation, greater total organic matter production, nature-based pest management, genetic tolerance to stress conditions, and higher levels of biological activity all contribute to resource use efficiency and quality of products.
The sustainable development goal (SDG) which were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity provides a renewed motivation for focusing on using soil biodiversity for food and nutrition, and for linking it to the sustainability of future agricultural systems [22]. Soil biodiversity is critical for human health, plant growth and support, water and climate regulation, and erosion and disease control so as considered to be a common ground for achieving sustainability goals [12]. Hence, management and conservation of life in the soil are integral to governmental actions to provide healthy food, reduce greenhouse gases, lessen desertification and soil erosion, and prevent disease thereby regenerating agriculture.
According to the FAO and ITPS’s Status of the World’s Soil Resources report (2015) [33], soil organic carbon and soil biodiversity are crucial to increase food availability and the soil’s ability to buffer against climate change effects. On the International Day for Soil biologic diversity (May 22, 2020), Semedo, who’s the Deputy Director-General for primary natural resources of FAO highlighted
However, unfortunately, most of the case has not been explored so far, the knowledge that has about the soil biodiversity and soil mechanism biodiversity is really near nothing compared to the whole complexity that we have in all parts of the board and the sort of ecosystem. The United Nations in 2015 declared the year to the interest as the International Year of Soils and has asked FAO and the Global Soil Partnership to carry out the first global soil biodiversity assessment which is now in progress.
In agriculture, we have high productivity on the open networks soil. So, soils with biodiversity open networks have more productivity than soil with closed networks. So in nature, plants that are growing in these open networking sites (high diversity soil systems) are capable of taking out nutrients in an efficient way. Of course, the point is that we should not only increase soil biodiversity but also that we have to talk to crop breeders and agronomists to get the right crop species and crop varieties to grow on these biodiverse soils.
On the webinar held among 1136 participants on May 22, 2020, by representing more than 140 countries, around 72% of the people said that soil biodiversity is applied especially in crop production in their country. Then some have in ecosystem restoration, pollution and bioremediation, food processing, and very few in terms of the medical sector [34].
Going forward, harnessing natural resources (microbes, fauna, flora) together with SOM, is considered as the most effective approach for a sustainable increase in farm productivity, mitigating climate change, and restoring degraded environments [11]. Further evidence of the relationships between soil biodiversity and functioning concerning soil organic carbon (SOC) dynamics and primary productivity at farm scales can help in bridging the knowledge gaps in the biotic regulation of SOC turnover and plant productivity. This will represent a major advancement, not only in ecology but also in agriculture in the context of global climate change and food security [35].
Soil microorganisms are critical for the maintenance of functions in both natural and managed soils because they are involved in several key processes, such as decomposition of SOM, soil structure formation, the cycling of carbon, nitrogen, phosphorus, and sulfur, and toxin removal. Moreover, microorganisms are fundamental in promoting plant growth and in suppressing soil-borne plant diseases [36]. There is mounting evidence that healthy soils may promote the suppression of plant diseases, pests, and pathogens mediated by soil biodiversity through predation, competition, and parasitism [37]. There is confirmation that belowground plant mutualists can ameliorate the impacts of pollution on plant growth [38], and earthworms have been suggested as useful facilitators of ecosystem services in abandoned mining areas [39] all those again might contribute to regenerate agriculture and improve productivity.
In general, everything that we eat, drink, breathe, clothes that we wear, and materials that we use pass through soil and soil biodiversity over and over again. Healthy soil with soil biodiversity at the center of sustainability programs is capable of providing most ecosystem services and therefore achieving compliance with SDGs and human well-being through regenerative agriculture [12]. Half of all sustainable development goals zero hunger, good health and wellbeing, clean water and sanitation, affordable clean energy, responsible consumption and production, climate action, and life on land (SDG-2, 3, 6, 7, 12, 13 and 15, respectively) depend on soil and regenerative agriculture [12].
There are currently several lines being explored for agriculture making better use of enhanced soil biodiversity: going back to wild crop relatives and how do they make use of microbiomes and can those traits be restored in current crops? And studying wild plant species along successional gradients to unravel how plants may be productive in high-diversity soils. Considering soil biodiversity also requires considering traits, interactions, and network structure (so, not only numbers). Soil biodiversity as a nature-based solution to enhance sustainability is possible, but it takes two to tango as it requires crops that can handle these soils [34].
Studies show that Arbuscular Mycorrhizal Fungi (AMF) can alleviate both biotic and abiotic stresses since they can contribute to restoring degraded lands and ecosystems via artificial inoculation, while they improve access of nutrients to plants. They also can regulate abiotic and biotic stresses to plants such as drought, salinity stress, heavy metal phyto-accumulation, and protection against pathogens [40, 41]. AMF are promising soil microorganisms that improve soil health through their influences on plant photosynthesis [42], nutrient transfer [43], root exudation [44], osmotic potentials [45], soil bacteria interactions [46], and soil structural improvement and as a trade-off nutrient uptake, disease control and phytoremediation [47, 48].
Microorganisms provide us many ecosystems service that results in soil health and consequently can be related to soil productivity and regenerating agriculture. For instance, nitrogen-fixing bacteria associate with legume roots fixes large amounts of nitrogen that are of pivotal importance for plant productivity. And the soil biodiversity is an important indicator of soil health in agriculture management [49].
Above all, agriculture needs a healthy full human resource to feed the increasing human population globally. Therefore, consideration of the roles of soil biodiversity on the medical sector or human health is necessary to use the full potentials of soil biodiversity for regenerating the ecosystem and agriculture. Soil microorganisms have an immense potential for the pharmaceutical industry because historically the discovery of numerous new drugs and vaccines; from well-known antibiotics like penicillin to bleomycin using for treating cancer and amphotericin for fungal infections and therapeutic measures for treating and controlling diseases comes from soil organisms [50]. As the systems of soil like that of the human system, the management aspect of the soil should be in line with biology rather than focussing on industrial chemistry.
Soils support highly abundant and diverse communities of organisms that show a broad array of life histories and functional traits, and they range in body size from a few micrometers for some bacteria to several meters in length in the case of some earthworms. The soil microbial community is largely dominated by bacteria and fungi that account for most of the belowground biomass, roughly equal to 0.6 to 1.1% of soil organic C [51], and represent a biodiversity pool with estimated species richness of tens of thousands per gram soil [52]. Despite the importance of soil microorganisms, little is known about their distribution in the soil or how microbial community structure responds to changes in land management (Tables 1 and 2).
Taxon | Diversity per amount soil or area (taxonomic units indicated below) | Abundance (approximate) |
---|---|---|
Bacteria and Archaea | 100–9,000⋅cm−3 | 4–20⋅109⋅cm−3 |
Fungi operational taxonomic units | 200–235 m.g−1 | 100 m.g−1 |
AMF (species) | 10–20 m−2 | 81–111 m.cm−3 |
Protists sequence | 150–1,200 (0.25 g)−1 | 104–107⋅m−2 |
Nematodes (genera) | 10–100 m−2 | 2–90⋅105 m−2 |
Enchytraeids | 1–15 ha−1 | 12,000–311,000 m−2 |
Collembola | 20⋅m−2 | 1–5 104 m−2 |
Mites (Oribatida) | 100–150 m−2 | 1–10 104⋅ m−2 |
Isopoda | 10–100 m−2 | 10 ⋅ m−2 |
Diplopoda | 10–2,500 m−2 | 110 ⋅ m2 |
Earthworms (Oligochaeta) | 10–15 ha−1 | 300 ⋅ m−2 |
Estimated diversity and abundance of soil taxa according to published work of Bardgett and van der Putten [53].
Known and estimated number of species of soil organisms and vascular plants organized according to size.
Asterisks indicate numbers of species that live in the soil.
Source: Orgiazzi
While field research on bio-fertilizers in Ethiopia dating back to the early 1980s by the Institute of Agricultural Research; bio-fertilizers did not become available for farmers until 2010. Later, the National Soil Testing Center (NSTC), Menagesha Biotech Industry (MBI) PLC, and the Ethiopian Institute of Agricultural Research (EIAR) have developed capacities to produce Rhizobia-based biofertilizers (Table 3). Currently, postgraduate students and different researchers in Ethiopia have played significant roles in research activities of Rhizobial inoculants collection, characterization, selection, evaluation and revealed the potential of the local isolates to serve as biofertilizers at a commercial level to increase the yield of different leguminous crops [56].
Crop | Types of inoculant (rhizobia) | Crop | Types of inoculant (rhizobia) |
---|---|---|---|
Faba bean and Field pea | Rhizobia leguminosarum vicea | Common bean | |
Chickpea | Mesorhizobium cicer | Cowpea | |
Soybean | Groundnut | Rhizobium spp | |
Lentil | Alfalfa |
Rhizobia species in commercially available inoculants (biofertilizers) for legume crops in Ethiopia as of March 2014.
Source: EIAR [55].
Jida and Assefa have collected 30 isolates of efficient nitrogen-fixing lentil-nodulating rhizobia from farmers’ field soils in central and northern parts of Ethiopia and selected for symbiotically efficient ones, which possess plant growth-promoting characteristics. Under glasshouse conditions, they found characteristics such as IAA production in 36.7% and inorganic phosphate solubilization capacity in 16.7% [57].
Fekadu and Tesfaye [58] reported that
The research outputs of Muluneh and Zinabu [60] revealed that the application of dried cyanobacteria on lettuce crop increased the number of leaves, leaf area, leaf length, fresh weight of the leaf, leaf dry weight, and the root dry weight of the lettuce by 159.5, 112.4, 80.8, 48, 137.5 and 110%, respectively, over their control. Tesfaye
Although different studies have been undertaking on microbial inoculation trials of several pulse crops in Ethiopia, the knowledge and data regarding Ethiopian soil biodiversity are very limited. Of course, the country has a responsible institute (Ethiopian Biodiversity Institute) to ensure the country’s biodiversity and the associated community knowledge for proper conservation and sustainable utilization [63]. However, the most focus is given to above-ground diversity, but the attention given for belowground diversity is less which leads to the presence of limited knowledge and data in soil biodiversity throughout the country.
In 2015 the “Ethiopia’s National Biodiversity Strategy and Action Plan 2015-2020” were developed through the involvement of different stakeholders and higher officials. However, the attention and discussions given for soil biodiversity in the document as well as in the key not messages of higher officials look limited. Different state ministers who participated in the event was forwarded their message regarding Ethiopia’s geographical, climatic, cultural, linguistic diversity and then about the above-ground diversity (plant, birds, mammals, fish…) but not on the diversity under their feet [64]. This reflects that society in general and policymakers, in particular, have neglected soil biodiversity; no attention was given to the large biodiversity pool stored belowground.
Generally, although some research findings were done and doing on the use of soil microbes as a biofertilizer in Ethiopia mainly by the academic group, there are no confidential estimates on the number of species, taxonomic groups, ecological functions and services, and interactions among soil organisms so far in Ethiopia. Moreover, there is no exact data on the level of threats to soil microbial genetic resources of the country. However, all factors affecting the ecosystem, plant, and animal biodiversity are believed to affect directly or indirectly the soil biodiversity base of the country [65]. Therefore, collecting, identifying, conserving, and knowing the status of soil biodiversity genetic resources of the country will be a forthcoming major task.
The landmark FAO state about soil biodiversity for food and agriculture [66], the first-ever launch last year highlighted that associate biodiversity species living in around production seasons, particularly microorganisms and invertebrates, has never been documented. In many cases, there is a limited understanding of ecosystem function and service and consequently, the contribution of specific soil biodiversity components to the production systems is poorly understood [67]. This discloses that due to the presence of knowledge gap and complex interaction of soil life, soil biodiversity is increasingly under threat which results in changes in the composition of soil communities and loss of species, as well as the benefits they provide to all life. Therefore, governments and society all need to better understand the complexity of the interaction regarding all elements of future agriculture and the soils to think about resilience and food systems.
As a whole, soil degradation by erosion, land-use change, climate change, soil pollution, salinization, and sealing all threaten soil biodiversity by compromising or destroying the habitat of the soil biota. Management practices that reduce the deposition or persistence of organic matter in soils, or bypass biologically mediated nutrient cycling, also tend to reduce the size and complexity of soil communities. For instance, land-use intensification results in fewer functional groups of soil biota with fewer and taxonomically more closely related species [68]. Intensive agriculture and sealing of fertile lands due to urbanization can cause declines in abundance and species of soil biodiversity, making soil food webs less diverse [10, 69]. Wagg
Deforestation can alter the structure of soil communities and decrease species richness (including natural predators and pollinators) and leading to homogenization. Consequently, the area will have a reduction of ecosystem resilience due to organism imbalance, which can favor pests and disease outbreaks. [73, 74, 75]. In the findings of Migliorini
The introduction of all kinds of invasive alien species has harmed the above-ground biodiversity and the native soil biodiversity. The effects of invasive species in soil biodiversity vary depending on the species trophic position. Many invasive soil species are related to agricultural pests while certain species are introduced as biocontrol agents. Another example is the introduction of non-native earthworms (which are ecosystem engineers), but their invasions can cause cascading effects that impact plant communities, forest, carbon sequestration, and wildlife [78, 79].
Soil biodiversity is part of the biological resources of the agroecosystems and must be considered in national and international management decisions. As indicated in the publication of Lijbert
Global Soil Partnership (GSP) was established in December 2012 to enhance collaboration and synergy of efforts for sustainable soil management, and to protect biodiversity through sustainable soil management. The GSP supports soil biodiversity enhancement through monitoring soil biodiversity; maintaining or enhancing soil organic matter levels; the regulation of authorization and use of pesticides in agricultural systems; the use of nitrogen-fixing leguminous species; restoring plant biodiversity and crop rotation. All those activities lead to sustainable soil management and higher and more stable productivity [83]. Over the past few years, there has been an increased interest in organic farming practices, which could have benefits for soil biodiversity, particularly owing to the reduced use of pesticides [84].
There is a need to celebrate discoveries about life under our feet, as well as to integrate knowledge about soil biodiversity into international policies. Understanding how limitations to agricultural production at various levels (social, cultural, economic, political, agronomic, biological, environmental, edaphic, genetic) can be overcome is essential, to predict possible management options for the conservation of soil biodiversity and regenerative agriculture. To restore soil biodiversity, there is a need to think about ecosystem management, first, and store by diversity and its multi-functionality that what they are doing and how they are interacting with other species.
Soil biodiversity is highly linked with the ecosystem functions and services in the atmosphere, hydrosphere, lithosphere, and biosphere; all those do have their contribution and influence on land resources and agriculture. The soil organisms are contributing to climate mitigation and adaptation, water infiltration, and purification, soil health improvements and productivity, and playing countless roles through modification of conditions for the proper plant, animal, and human health all those are intern involved in regenerative agriculture. So, regenerative agricultural practices and soil biodiversity are evolved together and they are important components for future agricultural directions both in developed and developing countries.
However, there are knowledge and skill gaps in the area of soil biodiversity particularly on invertebrates and soil microorganisms to taxonomically classify and determine the complex interaction among themselves and the environmental factors. Therefore, more attention should be given to the discoveries of soil biodiversity and moving beyond academic circles particularly in the developing countries, to use them as a natured based solution for regenerative agriculture in the 21st century and to meet the 2030 sustainable development goals.
The author of this review thanks and highly appreciates the scientific contributions of the different authors, organizations, institutions, and webinar organizers cited in the text.
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osteogenic cells from adjacent bony edges or bone marrow into the defect in an unimpeded fashion. 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Management of patient with an odontogenic infection is a multifaceted approach involving (1) an examination and assessment of the patient, (2) identifying the source of the infection, (3) anatomic considerations, (4) surgical intervention, (5) administration of the appropriate antimicrobial therapy, and (6) referral to an appropriate provider if indicated. This chapter provides the clinician with a better understanding of diagnosis and pharmacological management as well as surgical treatment of patients with odontogenic infections.",book:{id:"5112",slug:"a-textbook-of-advanced-oral-and-maxillofacial-surgery-volume-3",title:"A Textbook of Advanced Oral and Maxillofacial Surgery",fullTitle:"A Textbook of Advanced Oral and Maxillofacial Surgery Volume 3"},signatures:"Robert Pellecchia, Curtis Holmes, Golaleh Barzani and Francesco R.\nSebastiani",authors:[{id:"177670",title:"Dr.",name:"Robert",middleName:null,surname:"Pellecchia",slug:"robert-pellecchia",fullName:"Robert Pellecchia"},{id:"185973",title:"Dr.",name:"Golaleh",middleName:null,surname:"Barzani",slug:"golaleh-barzani",fullName:"Golaleh Barzani"}]}],onlineFirstChaptersFilter:{topicId:"1149",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:32,numberOfPublishedChapters:318,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:113,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:106,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:19,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:5,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:15,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. She is a reviewer for several local and international journals such as Unilag Journal of Science, Libyan Journal of Medicine, Journal of Medicine and Medical Sciences, and Annual Research and Review in Science. \nShe has authored 45 scientific research publications in local and international journals, 8 scientific reviews, 4 books, and 3 book chapters, which includes the books “Malaria Parasites” and “Malaria” which are IntechOpen access publications.",institutionString:"Lagos State University",institution:{name:"Lagos State University",country:{name:"Nigeria"}}},{id:"273100",title:"Dr.",name:"Vijay",middleName:null,surname:"Gayam",slug:"vijay-gayam",fullName:"Vijay Gayam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/273100/images/system/273100.jpeg",biography:"Dr. Vijay Bhaskar Reddy Gayam is currently practicing as an internist at Interfaith Medical Center in Brooklyn, New York, USA. He is also a Clinical Assistant Professor at the SUNY Downstate University Hospital and Adjunct Professor of Medicine at the American University of Antigua. He is a holder of an M.B.B.S. degree bestowed to him by Osmania Medical College and received his M.D. at Interfaith Medical Center. His career goals thus far have heavily focused on direct patient care, medical education, and clinical research. He currently serves in two leadership capacities; Assistant Program Director of Medicine at Interfaith Medical Center and as a Councilor for the American\r\nFederation for Medical Research. As a true academician and researcher, he has more than 50 papers indexed in international peer-reviewed journals. He has also presented numerous papers in multiple national and international scientific conferences. His areas of research interest include general internal medicine, gastroenterology and hepatology. He serves as an editor, editorial board member and reviewer for multiple international journals. His research on Hepatitis C has been very successful and has led to multiple research awards, including the 'Equity in Prevention and Treatment Award” from the New York Department of Health Viral Hepatitis Symposium (2018) and the 'Presidential Poster Award” awarded to him by the American College of Gastroenterology (2018). He was also awarded 'Outstanding Clinician in General Medicine” by Venus International Foundation for his extensive research expertise and services, perform over and above the standard expected in the advancement of healthcare, patient safety and quality of care.",institutionString:"Interfaith Medical Center",institution:{name:"Interfaith Medical Center",country:{name:"United States of America"}}},{id:"93517",title:"Dr.",name:"Clement",middleName:"Adebajo",surname:"Meseko",slug:"clement-meseko",fullName:"Clement Meseko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/93517/images/system/93517.jpg",biography:"Dr. Clement Meseko obtained DVM and PhD degree in Veterinary Medicine and Virology respectively. He has worked for over 20 years in both private and public sectors including the academia, contributing to knowledge and control of infectious disease. Through the application of epidemiological skill, classical and molecular virological skills, he investigates viruses of economic and public health importance for the mitigation of the negative impact on people, animal and the environment in the context of Onehealth. \r\nDr. Meseko’s field experience on animal and zoonotic diseases and pathogen dynamics at the human-animal interface over the years shaped his carrier in research and scientific inquiries. He has been part of the investigation of Highly Pathogenic Avian Influenza incursions in sub Saharan Africa and monitors swine Influenza (Pandemic influenza Virus) agro-ecology and potential for interspecies transmission. He has authored and reviewed a number of journal articles and book chapters.",institutionString:"National Veterinary Research Institute",institution:{name:"National Veterinary Research Institute",country:{name:"Nigeria"}}},{id:"158026",title:"Prof.",name:"Shailendra K.",middleName:null,surname:"Saxena",slug:"shailendra-k.-saxena",fullName:"Shailendra K. Saxena",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRET3QAO/Profile_Picture_2022-05-10T10:10:26.jpeg",biography:"Professor Dr. Shailendra K. Saxena is a vice dean and professor at King George's Medical University, Lucknow, India. His research interests involve understanding the molecular mechanisms of host defense during human viral infections and developing new predictive, preventive, and therapeutic strategies for them using Japanese encephalitis virus (JEV), HIV, and emerging viruses as a model via stem cell and cell culture technologies. His research work has been published in various high-impact factor journals (Science, PNAS, Nature Medicine) with a high number of citations. He has received many awards and honors in India and abroad including various Young Scientist Awards, BBSRC India Partnering Award, and Dr. JC Bose National Award of Department of Biotechnology, Min. of Science and Technology, Govt. of India. Dr. Saxena is a fellow of various international societies/academies including the Royal College of Pathologists, United Kingdom; Royal Society of Medicine, London; Royal Society of Biology, United Kingdom; Royal Society of Chemistry, London; and Academy of Translational Medicine Professionals, Austria. He was named a Global Leader in Science by The Scientist. He is also an international opinion leader/expert in vaccination for Japanese encephalitis by IPIC (UK).",institutionString:"King George's Medical University",institution:{name:"King George's Medical University",country:{name:"India"}}},{id:"94928",title:"Dr.",name:"Takuo",middleName:null,surname:"Mizukami",slug:"takuo-mizukami",fullName:"Takuo Mizukami",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94928/images/6402_n.jpg",biography:null,institutionString:null,institution:{name:"National Institute of Infectious Diseases",country:{name:"Japan"}}},{id:"233433",title:"Dr.",name:"Yulia",middleName:null,surname:"Desheva",slug:"yulia-desheva",fullName:"Yulia Desheva",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/233433/images/system/233433.png",biography:"Dr. Yulia Desheva is a leading researcher at the Institute of Experimental Medicine, St. Petersburg, Russia. 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