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This article provides a theory-driven framework simultaneously linking Lean Management and Six Sigma (LM&SS), enabling HRM and strategic climate to outcomes in health care. This framework contributes toward our understanding of direct and indirect (moderating and mediating) effects related to LM&SS in the context of health care. We argue that enabling HRM is crucial in creating mutual gains. The general underlying idea is that LM&SS, combined with enabling HRM, foster employee well-being (happiness, health and trusting relationships) and improve organizational performance. The challenge is to go beyond the simple application of LM&SS and to develop a climate of continuous improvement. We suggest that in order to sustain continuous improvement, it is important that health-care organizations aim for a strategic climate, which focuses the shared perceptions of employees on quality, efficiency and innovation.
