IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT, VOL. 70, NO.
10, OCTOBER 2023
Six Sigma Project Prioritization and Selection Using
AHP–CODAS Integration: A Case Study in
Healthcare Industry
Gülin Feryal Can , Fellow, IEEE, Pelin Toktaş , Fellow, IEEE, and Fatma Pakdil , Fellow, IEEE
Abstract—Given the complex nature of Six Sigma project
(SSP) prioritization and selection processes, multicriteria decision-
making (MCDM) methods may help organizations identify the
most effective projects. Considering potential limitations of subjec-
tive methods and advantages of MCDM methods, this article pro-
poses a model that integrates analytical hierarchy process (AHP)
and combinative distance-based assessment (CODAS) in SSP pri-
oritization and selection process. In the proposed approach, AHP
is employed to assign criteria weights, and CODAS is performed
to determine priorities of SSPs. CODAS was advanced in term of
its threshold function. Differences between Euclidean distances of
two alternatives were compared, based on the standard deviation of
Euclidean distances of all alternatives to overcome the subjectivity.
This is the first study that combines AHP and CODAS methods
for SSP selection, and CODAS is used with objective threshold
value computation, and developed for the healthcare industry. In
this article, ten SSPs were evaluated for four key criteria groups
as financial, operational, patient centric, and organizational main
criteria groups. In total, 18 subcriteria were considered under
these four main criteria groups. This article provides a support for
executives who make implementation plans for the potential SSPs.
Index Terms—Analytical hierarchy process (AHP), combinative
distance-based assessment (CODAS), multicriteria decision-
making (MCDM), project prioritization, Six Sigma project (SSP).
I. INTRODUCTION
IX SIGMA is an impactful continuous quality improve-
S ment strategy and received attention from a large group of
global organizations including Fortune 500 companies. Practice
and research demonstrate that project prioritization and selec-
tion in the define–measure–analyze–improve–control (DMAIC)
process bring challenges to Six Sigma practitioners [1]–[5].
More importantly, a great variety of research emphasized that
the likelihood of success or failure of Six Sigma practices is
associated with the project prioritization and selection methods
and strategies [6]–[9].
Manuscript received 28 February 2021; revised 12 June 2021; accepted 2 July
2021. Date of publication 19 August 2021; date of current version 21 July 2023.
Review of this manuscript was arranged by Department Editor D. Cetindamar.
(Corresponding author: Gülin Feryal Can.)
Gülin Feryal Can and Pelin Toktaş are with the Industrial Engineering De-
partment, Bağlıca Kampüsü, Başkent University, Ankara 06790, Turkey (e-mail:
gfcan@baskent.edu.tr; ptoktas@baskent.edu.tr).
Fatma Pakdil is with the Department of Management and Marketing,
Eastern Connecticut State University, Willimantic, CT 06226 USA (e-mail:
pakdilf@easternct.edu).
Color versions of one or more figures in this article are available at
https://doi.org/10.1109/TEM.2021.3100795.
Digital Object Identifier 10.1109/TEM.2021.3100795
0018-9391 © 2021 IEEE. Personal use is permitted, but republication/redistribution requires IEEE permission.
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3587
By its nature, a Six Sigma strategy is executed primarily
through time-limited projects and requires an effective project
management infrastructure in the organization [10], [11]. Im-
plementing systematic Six Sigma project (SSP) selection meth-
ods helps organizations allocate limited resources by aligning
selection with their strategic priorities and competitive advan-
tages [5], [12], [13]. In the same vein, poorly designed project
selection processes cause several irreversible consequences, in-
cluding wasted invaluable resources, decreased organizational
belief in Six Sigma, and reduced likelihood of long-term success
of Six Sigma strategy [14]–[18]. Although project selection is
identified as the most critical and complicated component of
Six Sigma [1], [19]–[22], purely subjective and gut feelings-
oriented approaches dominate project selection processes in
Six Sigma organizations [21], [23], [24]–[26]. However, the
complex and multifaceted nature of project prioritization and
selection process [9], [18], [27] and limited resources force
organizations to implement objective methods, such as multicri-
teria decision-making (MCDM) methods, as emphasized in the
literature, e.g., [14], [20], [26], [28]–[31]. Given the complex
nature of SSP prioritization and selection processes, MCDM
methods with multiple objectives may increase the probability
of selecting the most effective projects in business organizations
[28]. Considering the potential limitations of subjective methods
and advantages of MCDM methods, an integration of analytical
hierarchy process (AHP) and combinative distance-based as-
sessment (CODAS) is proposed to prioritize SSPs in this article.
In the proposed approach, AHP is employed to assign criteria
weights, and CODAS is performed to determine priorities of
SSPs. AHP is an extensively studied method, best used in
decision making for complex scenarios when decision makers
(DMs) work together and when human perceptions, judgments,
and consequences have long-term repercussions [32]. Addi-
tionally, AHP considers the consistency of DMs’ evaluations,
which produces more accurate results. In the CODAS method,
the preferability of one alternative over another is determined
by considering Euclidean and Taxicab distances. The method
is constructed upon the selection of the alternative that has
a longer distance from the negative ideal solution. The first
distance used is the Euclidean distance. If two alternatives
have equal Euclidean distance or if the Euclidean distance
difference of two alternatives is less than a predetermined
threshold value, the solution is reached by using the Taxicab
distance [33].
3588
In this article, CODAS was advanced in terms of its threshold
function. Differences between the Euclidean distances of two al-
ternatives were compared based on the standard deviation of the
Euclidean distances of all alternatives. In the traditional CODAS
method, this comparison is performed based on the threshold
value assigned by DMs between 0.01 and 0.05. The proposed
standard deviation strategy overcomes this subjectivity. This is
the first study that combines AHP and CODAS methods for SSP
selection, and CODAS is first used with objective threshold value
computation.
The rest of this article is organized as follows. Section II
focuses on the literature review of Six Sigma strategy, AHP,
CODAS, and project selection approaches employed in the
healthcare industry. Section III depicts the implementation of the
proposed method on a case performed in the healthcare industry.
Finally, Section IV concludes this article.
II. LITERATURE REVIEW
A. Six Sigma
Six Sigma is a corporate strategy [21], [34]–[39] in a great
variety of industries. As a strategy, Six Sigma focuses on im-
proving organizational performance based on a holistic approach
that includes various performance indicators, such as financials,
customers, and operations [28]. Six Sigma primarily focuses on
prioritizing the topics that are critical to stakeholders and on
solving problems by using data-driven cross-functional teams
[40]. SSPs also focus on improving efficiency and reducing
variation, waste, and defects [41], [42]. Six sigma concentrates
on the quality of the inputs, processes, and outputs of a sys-
tem using a well-structured problem-solving methodology. It
also aims to decrease the likelihood of nonconformities to 3.4
products per million by implementing methods developed in
total quality management and statistical process control. The
roots of Six Sigma methodology stem from a companywide
strategy developed at Motorola in the 1980s [39], [40], [43]. The
six-sigma-based problem-solving approach aims for identifying
the root causes of the problems and discovering appropriate
solutions by using the DMAIC process.
B. Analytic Hierarchy Process
AHP is a well-known MCDM approach, first introduced by
Wind and Saaty in 1980, that ranks alternatives and determines
the importance effects of criteria by pairwise comparisons [44].
AHP is a common MCDM method used to organize and analyze
complex decisions, using mathematics and psychology [45]. The
literature shows that most previous studies were constructed
using hybrid approaches with other MCDM methods. Hamurcu
et al. [46] selected the planned rail projects under different
budget scenarios using AHP and goal programming method in
an integrated manner. Çelikbilek [47] proposed a grey AHP
for engineering and managerial problems to make objective
decisions in the fields of science, engineering, and management.
Popovic et al. [48] reviewed AHP and conjoint analysis in
an empirical study. They stated that these methods could be
used in the same or similar problems even though the methods
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IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT, VOL. 70, NO. 10, OCTOBER 2023
were developed with different aims. Ho and Ma [49] reviewed
integrations and applications of AHP and found that the most
popular approach was fuzzy-AHP. Darko et al. [50] considered
applications of AHP in construction management (CM). As
a result, risk management and sustainable construction were
determined as the most popular application areas of AHP in
CM. Cahyapratama and Sarno [51] used weighting procedure of
AHP for some criteria and combined simple additive weighting
(SAW) for value processing of participants in the best singer
selection. The best performers were determined based on the
weight priority level analysis for the consistency of the cri-
teria [50], [51]. Wang et al. [52] suggested a framework for
supplier selection problem in a resilient construction supply
chain using the integration of AHP and grey relational analysis
(GRA). First, criteria weights were obtained by AHP and GRA,
then the suppliers were ranked, respectively. Each criterion was
weighted differently, and a sensitivity analysis was conducted
to determine the criteria of resilience that impact the selection
priorities of suppliers [52]. Toktaş and Can [53] proposed an
advanced Modified Kemeny Median Indicator Rank Accordance
(KEMIRA-M) approach based on stochastic evaluation process
considering consistent weighting procedure of AHP to improve
the criteria weighting procedure of KEMIRA-M.
The fuzzy AHP (F-AHP) methodology was used to rank
different project criteria based on relative importance and impact
on sustainable projects. Project costs, novelty, and uncertainty
were the most important criteria, respectively, in sustainable
project selection [54]. David and Saaty [55] found that AHP
was invaluable in Six Sigma, lean Six Sigma, and other business
process improvement prioritization decisions with both tangible
and intangible strategic considerations. Vargas and Ipma [56]
discussed the application of AHP in the prioritization and selec-
tion of projects in a portfolio. They discussed the importance of
criteria in project selection and inconsistency of the prioritiza-
tion of projects. Liang [57] developed a model using AHP based
on benchmarking method to evaluate the project termination or
continuation with a case study conducted on R&D in Taiwan
to illustrate the proposed approach [56], [57]. Yoo and Choi
[58] proposed an approach applying group F-AHP with easy
defuzzified number of Trapezoidal Fuzzy Number (TrFN) and
GRA for SSP selection. While group F-AHP provided both
weight of project selection criteria and the relative importance
of team member’s competencies, defuzzified scale of TrFN,
in case of incomplete information, was used to assess project
preferences. Ortíz et al. [59] recommended use of a hybridization
of the Decision Making Trial and Evaluation Laboratory and
AHP for determining the best allied hospital for an integrated
network of outpatient service.
C. Combinative Distance-Based Assessment (CODAS)
CODAS is a new-generation MCDM method that first devel-
oped by Keshavarz Ghorabaee et al. [33], who demonstrated its
validity. In CODAS, the Euclidean and Taxicab distances from
negative ideal solution are utilized for ranking alternatives; thus,
it can produce more precise results [33]. In Keshavarz Ghorabaee
et al.’s study, a sensitivity analysis compared the results of
CAN et al.: SIX SIGMA PROJECT PRIORITIZATION AND SELECTION USING AHP–CODAS INTEGRATION
CODAS with some existing MCDM methods and showed that
CODAS generated stable and efficient results. Ghorabaee et al.
[60] put forward a fuzzy extension of the CODAS method to
solve multicriteria group decision-making problems. To extend
the CODAS method, linguistic variables and TrFNs were used.
The application of the proposed fuzzy CODAS method was
conducted on market segment evaluation and selection problem
under uncertainty.
A modified CODAS method using Pamur was introduced by
Pamucar et al. [61]. Authors also suggested a new LNN pairwise
model to determine the weights of criteria. Validation and testing
of the LNN PW–CODAS model was demonstrated in a case
study of the selection of optimal Power-Generation Technology.
Badi et al. [62] proposed a suitable and useful tool using CODAS
for the DMs concerning the optimum location of desalination
facilities. In another study by Badi et al. [63], CODAS was
used as a supplier selection method for a steelmaking company.
Yeni and Özçelik [64] proposed an interval-valued Atanassov
intuitionistic fuzzy CODAS method for group decision-making
processes as a fuzzy extension of CODAS method. Bolturk
and Kahraman [65] suggested a method using CODAS un-
der intuitionistic fuzzy uncertainty by taking the hesitancy of
DMs into consideration based on both Euclidean and Taxicab
distances according to the negative-ideal point. Wave energy
facility location selection problem was considered to show the
effectiveness of the proposed method, and the obtained results
were compared with crisp CODAS method.
Bolturk [66] developed the Pythagorean fuzzy extension of
CODAS method for the solutions of MCDM problems under
vagueness and impreciseness. Supplier selection is one of the
most discussed problems using CODAS in the literature. Badi
et al. [67] demonstrated an application using the CODAS method
to select the best supplier among the six alternative suppliers.
He et al. [68] used a 2-tuple linguistic Pythagorean fuzzy
CODAS method to make financial management performance
evaluation as a multiple attribute group decision-making issue.
Karaşan et al. [69] developed a novel interval-valued neutro-
sophic CODAS method and compared crisp and ordinary fuzzy
CODAS methods for the selection problem among wind energy
plant locations. Deveci et al. [70] demonstrated the weaknesses
of using a Euclidean and Taxicab distance on interval-valued
intuitionistic fuzzy sets and provided alternative strategies to
model the vagueness and uncertainty in DM evaluations more
effectively. They suggested a new fuzzy aggregation method for
DM evaluations using fuzzy weights.
Yalçın and Pehlivan [71] focused on personnel selection
problem using fuzzy CODAS method based on fuzzy envelopes
for hesitant fuzzy linguistic term sets. The rankings obtained
with the presented method was shown efficient and stable for
personnel selection problems when compared with ranking
of fuzzy evaluation based on distance from average solution
(EDAS), fuzzy technique for order of preference by similarity
to ideal solution (TOPSIS), fuzzy weighted aggregated sum
product assessment (WASPAS), fuzzy additive ratio assessment,
and fuzzy complex proportional assessment. Karaşan et al. [72]
proposed a novel interval hesitant fuzzy CODAS method that
applied on a residential construction site selection problem.
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3589
Yıldız and Kahraman [73] advanced a Z-fuzzy CODAS method
based on restriction and reliability functions under uncertainty.
The Z-fuzzy pairwise comparison matrix was used to obtain the
criteria weights [73]. Supplier selection problem was chosen as
an application area, and the obtained results were compared with
ordinary fuzzy SAW method.
In a comparative study conducted by Tuş and Adalı [74],
preference selection index and CODAS were applied on the
personnel selection problem in a textile firm. The weights of per-
sonnel assessment criteria were obtained via criteria importance
through intercriteria correlation method and transferred to CO-
DAS method. When the obtained personnel assessments were
compared, the final rankings were the same for both methods.
Zhang et al. [75] applied the hybridization of CODAS method
with picture 2-tuple linguistic numbers to green supplier selec-
tion problem. To confirm the merits of the suggested method,
a comparison study was conducted. As a result, the second
supplier was found to be the best for all cases [75]. Mathew
and Sahu [76] dealt with material handling equipment selection
problem using CODAS, EDAS, WASPAS, and multiobjective
optimization on the basis of ratio analysis. It was reported that the
CODAS, EDAS, and WASPAS methods yielded consistent re-
sults [76]. Fuzzy Mamdani type inference system was proposed
to overcome uncertainty in human thoughts, as suggested by
Karaşan et al. [69], as an extended version of the CODAS method
[77]. The robustness of the decision-making methodology was
shown by the sensitivity analysis. Bolturk and Karaşan [78]
compared interval-valued neutrosophic CODAS method and
interval-neutrosophic TOPSIS to make the investment analysis
for hospitals. Ijadi Maghsoodi et al. [79] suggested a hybrid
decision-making approach supported by the stepwise weight
assessment ratio analysis method and CODAS containing target-
based attributes for the selection of optimal cement material
type based on a real-world conceptual dam construction project
[79]. To solve the maintenance decision problem in a process
industry, Panchal et al. [80] proposed a novel integrated MCDM
framework based on F-AHP and a new fuzzy CODAS approach.
A sensitivity analysis was performed to validate the proposed
framework. Seker and Aydin [81] integrated interval-valued
intuitionistic fuzzy AHP and CODAS to evaluate the public
transportation alternatives designed for a public university in
a large-sized metropolitan area. A comparative analysis was
employed to show the robustness of the proposed approach.
In our article, a hybrid method of AHP–CODAS is proposed
for SSP selection problem based on a case performed in health-
care industry. While the weights of the determined criteria are
obtained through AHP, the ranking of the projects is made using
the CODAS method. To the best of our knowledge, although
there are limited examples of AHP–CODAS hybridization in
the literature, this article is the first one that implements AHP–
CODAS in prioritizing and selecting SSPs in the healthcare
industry.
D. Six Sigma Project Selection in Healthcare Industry
Although the Six Sigma strategy was originally developed in
the manufacturing industry, service industries have successfully
3590 IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT, VOL. 70, NO. 10, OCTOBER 2023

implemented it to improve quality and decrease the cost of ser-

vice delivery processes, e.g., [23], [82], [83]. GE implemented
Six Sigma methodology to improve the business processes [39].
The Bank of America and Commonwealth Health Corporation
were the first service companies implementing Six Sigma, fol-
lowing pioneering manufacturing companies in North America
[39], [84].
Among service industries, the healthcare industry has taken
a primary position in implementing Six Sigma to deliver higher
quality, better service, and lower cost in a highly regulated
marketplace. The bottlenecks and regulations in the healthcare
industry pushed healthcare executives and DMs toward Six
Sigma, along with other management philosophies and quality
improvement strategies. Since 2000, the healthcare industry
has focused on integrating Six Sigma strategy into corporate
strategy (e.g., [85], [86]) to minimize medical errors and im-
prove healthcare delivery quality [87]. Although Six Sigma was
successfully implemented in healthcare management systems,
project prioritization and selection is in an immature phase of the
DMAIC process in Six Sigma efforts. Research concentrating on
SSP prioritization and selection is scarce in healthcare industry
settings [28], [88]. Also, the complex and multidimensional
nature of healthcare, including their variety of stakeholders,
makes the SSP selection process more problematic.
Additionally, research shows that organizations rely primarily
on subjective methods, including “gut feelings” and experiences
of team members to prioritize and select SSPs [7], [21], [23]–
[25]. SSP prioritization and selection process contains a multi-
dimensional nature; therefore, MCDM approaches are needed
Fig. 1. Flow chart of the proposed SSP selection process.
to make better decisions in this process in healthcare industry.
Using MCDM methods makes that process more robust and
well-structured to minimize the impacts of subjective methods Research shows that criteria selection is a pivotal step in
implemented by the DMs. project selection process in Six Sigma efforts [28], [89]. Lit-
erature indicates that a variety of critical variables have been
identified for such criteria [28]. For instance, the criteria should
link the scope of the potential SSPs with strategic organizational
III. IMPLEMENTATION OF THE PROPOSED APPROACH goals and objectives (e.g., [18], [19]). The criteria should also
In this section, the implementation of the proposed method prioritize projects that are most likely to produce the greatest
constructed using AHP–CODAS for SSP selection is presented benefit to the organization [9], [21], [27], [28]. Additionally,
with a case from the healthcare industry, as depicted in Fig. 1. 1) the urgency of project scopes [23], [28],
This section presents the applicability of the proposed approach 2) the probability of success of the potential projects [28],
for DMs who need to prioritize and select SSPs in the healthcare [90], [91],
industry, as well as the other industries. 3) project completion time [7], [23], [91], [92], [93],
Step 1. Build SSP selection decision-making team. 4) project execution cost [28], [88],
Five DMs denoted as (DMl , l = 1, . . . , L, L = 5) formed a 5) resource utilization [7], [28], [94],
decision-making team in this article. The ability and knowledge 6) process cycle time [23], [28], [90],
of DMs is paramount for prioritizing and selecting the SSPs. 7) cost reduction [28], [90],
The researchers of this article who are experts in Six Sigma 8) revenue enhancement [19], [28], [95],
and MCDM disciplines form the decision-making team. In 9) inventory reduction [28], [94],
real-world cases, black belts, master black belts, and executive 10) sigma level [28], [37],
committee members may take roles as DMs for the SSP selec- 11) impact on organizational goals [7], [18], [28],
tion. 12) data availability [7], and
Step 2. Identify and list potential SSPs. 13) timeliness of services [23], [28], [96] have been imple-
This article includes 10 potential SSPs indicated as mented in the previous studies.
SSPk , where k = 12, . . . m, . . . , K, K = 10, that will be eval- In addition to these variables, various healthcare-related vari-
uated for prioritization within certain number of criteria. ables should also be taken into consideration in this step. For
Step 3. Identify criteria for selecting SSPs. example, patient complaints [23], [28], patient safety [28], [94],

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CAN et al.: SIX SIGMA PROJECT PRIORITIZATION AND SELECTION USING AHP–CODAS INTEGRATION
TABLE I
DECISION CRITERIA FOR SSP SELECTION
patient satisfaction [7], [28], [37], [90], impact on care givers and
staff [28], [95], and compliance with regulatory requirements
[28], [94] are the variables that can be effective in this step.
Using many variables may make the decision-making process
complex, and it is recommended to limit the number of variables
in this step [1].
Considering the studies in the literature, decision criteria were
defined for selecting the best SSP among all potential projects.
The criteria under consideration were divided into four main
groups in terms of their similarities, as shown in Table I. Each
main group is denoted as Cj , j = 1, ..n, . . . , J and J = 4. Each
subcriterion in the first group (C1 ) is indicated as C1b ; j = 1; b =
1, . . . t, . . . , B and B = 5. Each subcriterion in the second group
(C2 ) is denoted as C2z ; j = 2; z = 1, . . . v, . . . , Z and Z = 6.
Each subcriterion in the third group (C3 ) is presented as C3u ; j =
3; u = 1, . . . y, . . . , U and U = 4. Each subcriterion in the fourth
group (C4 ) is defined as C4d ; j = 4; d = 1, . . . e, . . . , D and
D = 3.
Step 4. Identify decision-making method.
In this article, AHP was preferred to assign criteria impor-
tance weights. AHP is comprised of three components: 1) the
ultimate goal or problem, 2) all of the possible solutions, i.e.,
alternatives, and 3) the constraints that will be used to judge the
alternatives [43]. In this article, the ultimate goal is selecting
the best SSP, alternatives are potential SSPs, and constraints are
predetermined 18 criteria in four groups. AHP provides a ratio-
nal framework for a needed decision by quantifying its criteria
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3591
TABLE II
AHP SCALE
and alternative options and for relating those elements to the
overall goal [43]. DMs compare the criteria importance through
pairwise comparisons. As a result, the relative weights among
each of the criteria are established, and the numerical probability
of each alternative is calculated. This probability determines the
likelihood that the alternative can achieve the expected goal.
The higher the probability, the higher the chances the alternative
will satisfy the goal of the portfolio. This quantifying capability
distinguishes AHP from other decision-making methods. The
steps of the integrated AHP and CODAS methods used at this
stage are detailed as follows.
Step 4.1. Form pairwise comparison matrix for decision cri-
teria in AHP.
To determine the relative importance between the two criteria,
a 1–9 scale [97] is used to form the criteria pairwise comparison
matrix. This well-known AHP scale is shown in Table II.
In the proposed approach, pairwise comparison matrices are
formed for subcriteria in each main criteria group and structured
for main criteria groups separately for each DM. In this context,
25 pairwise comparison matrices were structured in this article.
The pairwise comparison matrix is a square matrix, and diagonal
elements of this matrix are equal to 1.
Pairwise comparison matrix for criteria in each main crite-
ria group for each DM is denoted as [X]lj , j = 1, . . . , J; l =
1, . . . , L. For five criteria in C1 , the pairwise comparison matrix
for each DM is presented as [X]l1 , the pairwise comparison
matrix for six criteria in C2 for each DM is indicated as [X]l2 ,
the pairwise comparison matrix for four criteria in C3 for each
DM is presented as [X]l3 , and the pairwise comparison matrix
for three criteria in C4 for each DM is defined as [X]l4 . The fifth
pairwise comparison matrix was structured for four main criteria
groups for each DM as [X]l . Additionally, xl1bt is the element
of [X]l1 which presents the pairwise comparison value between
bth and tth criteria in the first (j = 1) main criterion group for
lth DM. xl1bt defines the relative importance of bth criterion
when compared tth criterion in the first main criterion group for
the lth DM. If bth criterion dominates over tth criterion for the
lth DM, xl1bt is used in [X]l1 . If not, xl1 takes place in [X]l1
1b
t
as a reciprocal of xl1bt . In other words, xl1t = 1
. This also
xl1
b
bt
applies to xl2zv , xl3uy , xl4de , and xljn . xl2zv is the element of [X]l2
which presents the pairwise comparison value between zth and
vth criteria in the second (j = 2) main criterion group for lth
3592
TABLE III
PAIRWISE COMPARISON MATRIX FOR THE CRITERIA IN FINANCIAL MAIN
CRITERION GROUP FOR THE FIRST DM; [X]11
TABLE IV
PAIRWISE COMPARISON MATRIX FOR FOUR MAIN CRITERIA GROUP FOR THE
FIRST DM; [X]1
DM. xl3uy is the element of [X]l3 which presents the pairwise
comparison value between uth and yth criteria in the third
(j = 3) main criterion group for lth DM. xl4de is the element
of [X]l3 which presents the pairwise comparison value between
dth and eth criteria in the fourth (j = 4) main criteria group for
lth DM. Finally, the element of [X]l presented as xljn means the
pairwise comparison value between jth and nth main criteria
for the lth DM.
To exemplify, the pairwise comparison matrix for the criteria
in financial main criterion group for the first DM; [X]11 and
the pairwise comparison matrix for four main criteria group for
the first DM; [X]1 are shown in Tables III and IV. As seen
from Table III, if x11bt = 3, then x11t = 13 = 0.33. For example,
b matrix for decision criteria in AHP.
as seen in Table III, the project execution cost (C11 ) is three
times ( x111 = 3.00) more important than the urgency of the
2
topic (C12 ) and C12 is 1/3(x112 = x11 = 0.333) times more
1 11
2
important than C11 for the first DM.
Step 4.2. Form aggregated pairwise evaluation matrix for
decision criteria in AHP.
Pairwise comparison matrices of each DM obtained in Step
4.1 are aggregated through a geometric mean operator. In this
way, aggregation can be provided between DMs. Aggregated
pairwise comparison matrix for criteria in the financial main
criteria group is denoted as [X]1 , aggregated pairwise compar-
ison matrix for criteria in the operational main criteria group is
indicated as [X]2 , aggregated pairwise comparison matrix for
criteria in the patient-centric main criteria group is presented
as [X]3 , aggregated pairwise comparison matrix for criteria in
the organizational main criteria group is indicated as [X]4 , and
aggregated pairwise comparison matrix for four main criteria
group is indicated as [X]. The element of [X]1 is shown as x1bt
which means the aggregated pairwise comparison value between
bth and tth criteria in the first main criterion group. This applies
to x2zv , x3uy , x4de , and xjn which are the elements of [X]2 ,
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IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT, VOL. 70, NO. 10, OCTOBER 2023
TABLE V
AGGREGATED PAIRWISE COMPARISON MATRIX FOR THE CRITERIA IN
FINANCIAL MAIN CRITERION GROUP; [X]1
TABLE VI
AGGREGATED PAIRWISE COMPARISON MATRIX FOR FOUR MAIN CRITERIA
GROUPS; [X]
[X]3 , [X]4 , and [X], respectively. For example, x112 , computed
as 0.72, is the aggregated value between the first and second
criterion in the first main criterion group.
The aggregated pairwise comparison matrixes for the criteria
in financial main criterion group; [X]1 and for four main criteria
groups; [X] are presented in Tables V and VI as examples,
respectively.
Step 4.3. Form normalized aggregated pairwise evaluation
To normalize aggregated pairwise evaluation matrixes, each
value of aggregated pairwise comparison matrixes is divided by
the total column value as given in Tables V and VI, as examples.
The normalized value of x1bt , x2zv , x3uy , x4de , and xjn
are denoted as, x∗1bt , x∗2zv , x∗3uy , x∗4de , and x∗jn , respectively,
and normalized aggregated pairwise comparison matrixes are
indicated as [X]∗1 , [X]∗2 , [X]∗3 , [X]∗4 , and [X]∗ , respectively.
The normalization process of the aggregated pairwise com-
parison matrix for the criteria in financial main criterion group;
[X]1 is shown in (1) as an example. This process is performed
for the other sub and main criteria in the same manner:
x 1b
x∗1bt = B Bt ; b = 1, . . . , B; t = 1, . . . , B; j = 1.
b=1 t=1 x1bt
(1)
For example, x∗11 , computed as 0.14, is the normalized value
2
between the first and second subcriteria in the first main criterion
group.
The normalized aggregated pairwise comparison matrix for
the criteria in financial main criterion group; [X]∗1 and for four
main criteria groups; [X]∗ are presented in Tables VII and VIII,
respectively, as examples.
CAN et al.: SIX SIGMA PROJECT PRIORITIZATION AND SELECTION USING AHP–CODAS INTEGRATION
TABLE VII
NORMALIZED AGGREGATED PAIRWISE COMPARISON MATRIX FOR THE
CRITERIA IN FINANCIAL MAIN CRITERION GROUP; [X]∗1
TABLE VIII
NORMALIZED AGGREGATED PAIRWISE COMPARISON MATRIX FOR FOUR MAIN
CRITERIA GROUPS; [X]∗
Step 4.4. Make computations to obtain eigen vector.
The contribution of each criterion to the SSP selection is
determined by computations using eigen vector, as presented
in (2) for the first criterion in the financial criteria group, as an
example. The eigen vector presents the relative weights between
each criterion. It is obtained by computing the row averages of all
sub and main criteria in [X]∗1 , [X]∗2 , [X]∗3 , [X]∗4 , and [X]∗ . It can
be observed that sum of all values of the eigen vector is always
equal to 1. Eigen vector for criteria in C1 , C2 , C3 , and C4 and
for four main criteria groups are denoted as EV 1 , EV 2 , EV 3 ,
EV 4 , and EV , respectively. The elements of EV 1 , EV 2 , EV 3 ,
EV 4 , and EV are w1b , w2z , w3u , w4d , and wj , respectively.
w1b , w2z , w3u , and w4d are the local weights of subcriteria, and
wj is the global weight of main criteria (Table IX):
x∗11 
B is financial criteria group ( w1 = 0.38). Additionally, the most
w 1b = B t ∗ ; w1b = 1.00. (2)
t=1 x1bt b=1
Step 4.5. Compute consistency index.
The objective of this step is to capture enough information
to determine whether the DMs have made consistent choices
[98]. For example, if the DMs affirm that project execution cost
is more important than the urgency of the topic, and that the
urgency of the topic is more important than cost reduction, it
would be inconsistent to affirm that the cost reduction criterion
is more important than project execution cost. To overcome this,
an inconsistency index is computed based on the maximum eigen
value denoted as λmax . The computation of λmax for financial
criteria group is given in (3) as an example:

B 
B 
B
λmax = w 1b × x1bt ; t = 1, . . . , B. (3)
b=1 b=1 t=1
λmax values for criteria in C1 , C2 , C3 , and C4 , and for
main criteria groups are computed as 5.37, 6.54, 4.22, 3.08,
and 4.08, respectively. After obtaining λmax values, consistency
index (CI) is calculated for each pairwise comparison matrix.
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3593
CI computation for financial group criteria is shown in (4) as an
example [99]:
λmax − B
CI = . (4)
B−1
CI values for criteria in C1 , C2 , C3 and, C4 for main criteria
groups are computed as 0.09, 0.11, 0.07, 0.04, and 0.03, respec-
tively. To verify whether CI is adequate, Saaty [99] suggests the
consistency rate (CR), which is determined by the ratio between
the CI and the random consistency index (RI). The matrix will
be considered consistent if the resulting ratio is less than 10%
as in (5) [99]:
CI
CR = < 0.10. (5)
RI
RI values change according to criteria numbers as shown in
Table X [99].
Using (5), consistency evaluation was performed for all pair-
wise comparison matrices in the study. As a result, CR values
for financial group, operational group, patient-centric group,
organizational group, and the main criteria were calculated as
0.08, 0.09, 0.08, 0.07, and 0.03, respectively. Since, all CR
values are less than 10%, pairwise comparison matrices were
considered to be consistent.
Step 4.6. Compute global criteria weights.
Global subcriteria weights given in Table XI are computed
through main criteria groups’ weights (wJ ). Global criteria
weights for financial group, operational group, patient-centric
group, and organizational group criteria are denoted as w1∗b , w1∗z ,
w1∗u , and w1∗d , respectively. Computation of w1∗b is given in (6)
as an example for the financial criteria group. The sum of all
subcriteria global weights should be equal to 1:
w1∗b = w1b × w1 . (6)
As seen in Table XI, the most important main criterion group
important criterion in this group is revenue enhancement (C13 )
criterion ( w13 = 0.11).
Step 4.7. Form initial decision matrix to prioritize SSPs via
implementing CODAS.
The CODAS method starts with structuring initial decision
matrix [I] given in Table XII. [I] shows the performance values
of SSPs for all subcriteria. The element of [I] is denoted as
tkjb , where k = 1, . . . , K; j = 1, . . . , J; b = 1, . . . , B for fi-
nancial criteria (j = 1), tkjz for operational criteria (j = 2),
tkju for patient-centric criteria (j = 3), tkjd for organizational
criteria (j = 4). tkjb denotes the performance value of kth
SSP for bth criterion in financial criteria group (j = 1). This
explanation applies to the other criteria.
Step 4.8. Form normalized initial decision matrix for CODAS.
Then, [I] is normalized considering the cost and benefit type
criteria, and the normalized initial decision matrix [N ] is formed,
as presented in Table XIII. In financial criteria group, excluding
C11 , the other criteria are benefit type. In operational criteria
group, C21 , C22 , and C23 are cost type, the others are benefit
type criteria. In patient-centric criteria group, excluding C34 , the
other criteria are benefit type. In organizational criteria group,
3594 IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT, VOL. 70, NO. 10, OCTOBER 2023

TABLE IX
LOCAL WEIGHTS OF SUBCRITERIA AND GLOBAL WEIGHTS OF MAIN CRITERIA

TABLE X
RI VALUES

TABLE XI
GLOBAL SUBCRITERIA WEIGHTS

TABLE XII
INITIAL DECISION MATRIX

TABLE XIII
NORMALIZED INITIAL DECISION MATRIX

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CAN et al.: SIX SIGMA PROJECT PRIORITIZATION AND SELECTION USING AHP–CODAS INTEGRATION 3595

TABLE XIV
WEIGHTED NORMALIZED INITIAL DECISION MATRIX

TABLE XV
NISPS FOR ALL SUBCXRITERIA

all of the criteria in this group are benefit type. Normaliza- nsjb = min rkjb . (10)
tion process for financial criteria group is shown in (7) as an
example: Here, nsjb is the NISP for bth criterion in financial criteria
 tkjb group (j = 1). NISP for operational criteria group is denoted
tkjb , for benefit type criteria in financial group
as nsjz , for patient-centric group nsju , for organizational group
tkjb = max
∗
min tkjb nsjd . NISP for all subcriteria are demonstrated in Table XV .
tkjb , for cost type criteria in financial group
For example, ns11 = 0.00 means that the distance of the first
(7)
subcriterion in the first main criterion group from NISP is 0.00.
where t∗kjb is the normalized performance value of kth SSP
Step 4.11. Compute Euclidean distance and Taxicab distance
(k = 1, . . . , K) for bth criterion in financial criteria group (j =
for all SSPs in CODAS.
1), max tkjb is the maximum value of bth criterion in financial
According to NISPs, Euclidean distance (Ek ) and Taxicab
criteria group (j = 1) for all SSPs, min tkjb is the minimum
distance (Tk ) seen in Table XVI are computed for all SSPs using
value of bth criterion in financial criteria group (j = 1) for all
(11) and (12):
SSPs.

Step 4.9. Structure weighted normalized initial decision ma-   2 
B Z
2
trix for CODAS.  rkjb − nsjb + rkjz − nsjz +
b=1
In this step, [N ] is transformed through weighted normal- Ek =  U z=1
D  (11)
  2  2
ized matrix [R] as in Table XIV based on global weights of rkju − nsju + rkjd − nsjd
subcriteria. This computation is shown for financial criteria u=1 d=1
group in (8) as an example. Element of [R] is denoted as rkjb for 
B 
n
criteria in financial group, rkjz for criteria in operational group, Tk = rkjb − nsjb + rkjz − nsjz
rkju for criteria in patient-centric group, and rkjd for criteria in b=1 z=1
organizational group:

U 
D
+ rkju − nsju + rkjd − nsjd . (12)
rkjb = w1∗b × t∗kjb . (8)
u=1 d=1

Step 4.10. Compute negative ideal solution point (NISP) for
all subcriteria in CODAS.
In CODAS, it is important to compute NISP to compare each
SSP for this point. NISP for each subcriterion is computed
separately. This computation is given in (9) and (10) for the
financial criteria group, as an example:
As seen from Table XVI, the eighth SSP has the highest
Euclidean distance ( E8 = 0.26), and the second SSP has the
highest Taxicab distance ( T8 = 0.57).
Step 4.12. Form relative evaluation matrix in CODAS.
Relative evaluation matrix denoted as [Ra] is formed as in
(13) and (14) using Ek and Tk :

ns = [nsjb ]1xb (9) [Ra] = [hkm ]m×k (13)

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3596 IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT, VOL. 70, NO. 10, OCTOBER 2023

TABLE XVI
EUCLIDEAN DISTANCE AND TAXICAB DISTANCE OF SSPS

TABLE XVII
DIFFERENCES BETWEEN EUCLIDEAN DISTANCES OF PROJECTS

TABLE XVIII
RELATIVE EVALUATION MATRIX

hkm = (Ek − Em ) + (ψ (Ek − Em ) × (Tk − Tm )) . (14) TABLE XIX

SELECTION SCORES AND RANKINGS OF SSPS
Here, ψ given in (15) is used for defining equality of
two SSPs’ Euclidean distances as a threshold function with
m{12, . . . , K} :
0, |x| < τ
ψ= (15)
1, |x| ≥ τ.
In (15), τ is a threshold parameter determined by the DM.
In the literature, this parameter is recommended to take a value
between 0.01 and 0.05. If the difference between the Euclidean
distances of the two projects is less than τ , these two projects
are compared with their Taxicab distances. In this article, the
variability between Euclidean distances was used to define
the equality of Euclidean distances, which is a new approach
compared to the traditional CODAS process. For this purpose,
τ value is defined as the variance (σ 2 ) of Euclidean distances of distances of the projects which these values belong to. Using
all projects as in (16): Table XVII, hkm values were computed as shown in Table XVIII.
n 2 For example, h11 computed as −0.045 means that the relative
(Ek − Ē)
σ 2 = i=1 . (16) evaluation value between the first SSP and the second SSP is
K −1
−0.045, and this value is smaller than 0.0272. Therefore, these
In this step, σ 2 was calculated as 0.0272. When the dif- two projects should be compared based on the two Taxicab
ference between two SSPs’ Euclidean distances was smaller distances between them.
than 0.0272, these two projects were compared based on their Step 4.13. Compute selection score of each SSP and prioritize
Taxicab distances to obtain hkm values. The differences between them.
Euclidean distances of projects are shown in Table XVII. Since Selection score for each SSP indicated with Hk was computed
the values in the highlighted cells in Table XVII were less than as in (17). Afterwards, Hk values were listed in the descend-
0.0272, the selection scores were calculated using the Taxicab ing order. The SSP with the highest Hk was identified as the

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CAN et al.: SIX SIGMA PROJECT PRIORITIZATION AND SELECTION USING AHP–CODAS INTEGRATION 3597

most important project that should be performed in the first method proposed in this article is the first implementation in
place. Hk values of ten SSPs are shown in Table XIX. As seen SSP selection in the healthcare industry. AHP is a quantitative
in Table XIX, SSP8 (Project 8) is the most important project ( method used to rank decision alternatives using multiple criteria.
H8 = 0.459), which should be performed as the first one: AHP, by choosing the best alternative that meets all the criteria
of the DM, finds answers to the questions: “Which one will we

K
Hk = hkm . (17) choose?” or “Which is the best?”
m=1
In the CODAS method, the preferability of alternatives is
determined by the Euclidean and Taxicab distances. This pro-
IV. RESULTS AND DISCUSSION vides a more accurate evaluation because two different distance
measurements are considered to rank alternatives. Additionally,
This article proposed a hybrid model integrating AHP and
the distances of the decision alternatives to the negative ideal
CODAS methods for SSP selection processes and presented a
solution are determined using Euclidean and Taxicab distances.
proposed model using information from the healthcare industry.
The alternative that is farthest from the negative ideal solution is
In the implementation section, ten SSPs were evaluated using 18
considered to be the most attractive. If two decision alternatives
subcriteria under four main criteria groups categorized into two
incomparable in terms of their Euclidean distance (equal or very
main criteria: benefit criteria and cost criteria. The decision crite-
close values), a second measure of their Taxicab distance is
ria used in this article were comprised of financial, operational,
considered.
patient-centric, and organizational criterions, considering that
In this article, CODAS was advanced in term of its threshold
these factors significantly dominate the healthcare marketplace
function, unlike the CODAS studies in the literature. In tra-
dynamics, strategic priorities, and stakeholders’ considerations.
ditional CODAS, differences between the Euclidean distances
One of the main outcomes of the hybrid method of AHP-
of two alternatives are compared according to the threshold
CODAS implemented in this case revealed that the most im-
function value. Additionally, this threshold function value is
portant criterion group used in SSP selection process was
subjectively assigned by the DM between 0.01 and 0.05. The
the financial criteria group. The outcomes also pointed out
threshold function value computation proposed in this article
that the most important criterion in financial criteria was the
overcomes subjectivity. The proposed computation is based on
revenue enhancement (C13 ) criterion. These findings signifi-
the standard deviation of Euclidean distances of all alternatives.
cantly align with the recent dynamics and challenges emerg-
If the differences between the Euclidean distances of two al-
ing globally in the healthcare industry. Allocating financial
ternatives is less than the standard deviation of the Euclidean
and nonfinancial resources effectively and efficiently on time,
distances of all alternatives, these two alternatives are compared
minimizing the constantly rising costs of health services, re-
using their Taxicab distances.
ceiving reimbursements from insurance companies and other
The purpose of this article is to develop a methodology in
third-party payers, and increasing revenues are relatively more
which alternate SSPs are prioritized and selected using AHP-
strategic priorities and competitive advantages for healthcare
advanced CODAS integration in healthcare organizations. This
organizations.
article addresses a particular gap in implementing a systematic
The second most important main criterion group was defined
methodology for SSP prioritization and selection based on a case
as the patient-centric criteria group. As shown in the literature
study in healthcare organizations. The case study was hypotheti-
(e.g., [100], [101]) and addressed by the accreditation bodies
cally formed to present applicability and validity of the proposed
such as Joint Commission and the U.S. National Committee
approach for DMs responsible for SSP selection processes. In
for Quality Assurance, healthcare providers and organizations
this article, a more objective CODAS method was proposed by
have been expected to be patient-centric, rather than being
implementing a new threshold function based on the standard
physician- or disease-centric in delivery services. Simply put,
deviation. This is the first study that implements AHP-advanced
given that SSPs are expected to improve overall performance,
CODAS integration in SSP prioritization and selection process
these findings and criteria will help Six Sigma practitioners
in the healthcare industry. The standard deviation-based com-
conduct successful SSPs in healthcare industry. As the final
parison was proposed to overcome subjectivity in computing
outcome of the integrated AHP–CODAS method, SSP8 is
threshold value in CODAS.
identified as the most important project among the ten SSPs
Additionally, it is known that criteria weights influence the al-
analyzed in this article. The Executive Committee of the Six
ternative rankings in MCDM methods. These effects are known
Sigma organization may utilize the results of this article to pri-
as importance weights. In this article, AHP was integrated
oritize ten alternative SSPs and allocate resources to those SSPs
into the proposed methodology, and DMs played a key role in
accordingly.
determining the criteria weights. In AHP, pairwise comparisons
of DMs related to the superiority of criteria were considered to
V. CONCLUSION obtain the effect of each criterion on decision.
Given that organizations have limited resources to allocate This article proposes a hybrid MCDM method including AHP
to varying needs and that all potential projects cannot be and CODAS to help Six Sigma practitioners prioritize and select
conducted simultaneously, project prioritization and selection relatively more important SSPs and allocate limited resources
is a paramount and complex decision-making problem for in an objective way in a dynamic decision-making environment
Six Sigma practitioners. The AHP and CODAS hybridization in healthcare industry. This article also significantly helps DMs

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3598 IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT, VOL. 70, NO. 10, OCTOBER 2023
and Six Sigma practitioners reduce the chance of relying on gut
feelings and subjective factors in this process that is highly likely
to affect the survival chance of Six Sigma strategies in healthcare
industry in the long run.
For future research, other hybrid methods that include multi-
ple MCDM methods could be implemented in the SSP selection
processes. Additionally, other criteria may be employed in the
hybrid AHP–CODAS process. Actual data can be incorporated
into the proposed model by the healthcare DMs, as well as from
other industries. In the same vein, any organizations or systems
that work on the SSP selection process may implement the
proposed method in their own decision-making environments.
REFERENCES
[1] P. Pande, R. Neuman, and R. Cavanagh, The Six Sigma Way: How GE,
Motorola and Other Top Companies are Honing Their Performance. New
York, NY, USA: McGraw-Hill, 2000.
[2] R. D. Snee, “Lean Six Sigma–Getting better all the time,” Int. J. Lean Six
Sigma, vol. 1, no. 1, pp. 9–29, 2010.
[3] K. Jeyaraman and L. K. Teo, “A conceptual framework for critical success
factors of lean Six Sigma,” Int. J. Lean Six Sigma, vol. 3, pp. 191–215,
2010.
[4] B. Duarte, D. Montgomery, J. Fowler, and J. Konopka, “Deploying LSS
in a global enterprise–project identification,” Int. J. Lean Six Sigma, vol. 3,
no. 3, pp. 187–205, 2012.
[5] D. Adebanjo, T. Laosirihongthong, and P. Samaranayake, “Prioritizing
lean supply chain management initiatives in healthcare service opera-
tions: A fuzzy AHP approach,” Prod. Planning Control, vol. 27, no. 12,
pp. 953–966, 2016.
[6] Y. H. Kwak and F. T. Anbari, “Benefits, obstacles, and future of Six Sigma
approach,” Technovation, vol. 26, no. 5–6, pp. 708–715, 2006.
[7] M. Kumar, J. Antony, and B. R. Cho, “Project selection and its impact
on the successful deployment of Six Sigma,” Bus. Process Manage. J.,
vol. 15, no. 5, pp. 669–686, 2009.
[8] F. A. A. Bakar, K. Subari, and M. A. M. Daril, “Critical success factors
of lean Six Sigma deployment: A current review,” Int. J. Lean Six Sigma,
vol. 6, no. 4, pp. 339–348, 2015.
[9] B. Kornfeld and S. Kara, “Selection of lean and Six Sigma projects in
industry,” Int. J. Lean Six Sigma, vol. 31, no. 10, pp. 1071–1088, 2013.
[10] D. S. L. Marzagão and M. M. Carvalho, “Critical success factors for Six
Sigma projects,” Int. J. Project Manage., vol. 34, no. 8, pp. 1505–1518,
2016.
[11] Y. H. Kwak and F. T. Anbari, “Analyzing project management research:
Perspectives from top management journals,” Int. J. Project Manage.,
vol. 27, no. 5, pp. 435–446, 2009.
[12] R. Snee Jr. Rodebaugh, “The project selection process,” Qual. Prog.,
vol. 35, no. 9, pp. 78–80, 2002.
[13] E. V. Gijo and T. S. Rao, “Six Sigma implementation–hurdles and
more hurdles,” Total Qual. Manage. Bus. Excellence, vol. 16, no. 6,
pp. 721–725, 2005.
[14] R. Bañuelas, C. Tennant, I. Tuersley, and S. Tang, “Selection of Six Sigma
projects in the U.K.,” TQM Mag., vol. 18, no. 5, pp. 514–527, 2006.
[15] A. Saghaei and H. Didehkhani, “Developing an integrated model for
the evaluation and selection of Six Sigma projects based on ANFIS and
fuzzy goal programming,” Expert Syst. Appl., vol. 38, no. 1, pp. 721–728,
2011.
[16] M. Shanmugaraja, M. Nataraj, and N. Gunasekaran, “Six sigma project
selection via quality function deployment,” Int. J. Prod. Qual. Manage.,
vol. 10, no. 1, pp. 85–111, 2012.
[17] R. Rathi, D. Khanduja, and S. Sharma, “A fuzzy MADM approach for
project selection: A Six Sigma case study,” Decis. Sci. Lett., vol. 5, no. 2,
pp. 255–268, 2016.
[18] R. Padhy, “Six Sigma project selections: A critical review,” Int. J. Lean
Six Sigma, vol. 8, no. 2, pp. 244–258, 2017.
[19] C. T. Su and C. J. Chou, “A systematic methodology for the creation
of Six Sigma projects: A case study of semiconductor foundry,” Expert
Syst. Appl., vol. 34, no. 4, pp. 2693–2703, 2008.
[20] G. Büyüközkan and D. Öztürkcan, “An integrated analytic approach
for Six Sigma project selection,” Expert Syst. Appl., vol. 37, no. 8,
pp. 5835–5847, 2010.
Authorized licensed use limited to: UNIVERSIDADE DE SAO PAULO. Downloaded on March 25,2024 at 14:05:27 UTC from IEEE Xplore. Restrictions apply.
[21] R. Rathi, D. Khanduja, and S. Sharma, “Six Sigma project selection using
fuzzy TOPSIS decision making approach,” Manage. Sci. Lett., vol. 5,
no. 5, pp. 447–456, 2015.
[22] V. Kalashnikov, F. Benita, F. López-Ramos, and A. Hernández-Luna,
“Bi-objective project portfolio selection in lean Six Sigma,” Int. J. Prod.
Econ., vol. 186, pp. 81–88, 2017.
[23] J. Antony, “Six Sigma in the U.K. service organisations: Results from a
pilot survey,” Manage. Auditing J., vol. 19, no. 8, pp. 1006–1013, 2004.
[24] A. F. Flifel, N. Zakić, and A. Tornjanski, “Identification and selection
of Six Sigma projects,” J. Process Manage. New Technol., vol. 5, no. 2,
pp. 10–17, 2017.
[25] M. S. Raisinghani, H. Ette, R. Pierce, G. Cannon, and P. Daripaly,
“Six sigma: Concepts, tools, and applications,” Ind. Manage. Data Syst.,
vol. 105, no. 4, pp. 491–505, 2005.
[26] R. K. Padhy and S. Sahu, “A real option based Six Sigma project
evaluation and selection model,” Int. J. Project Manage., vol. 29, no. 8,
pp. 1091–1102, 2011.
[27] G. Hu, L. Wang, S. Fetch, and B. Bidanda, “A multi-objective model for
project portfolio selection to implement lean and Six Sigma concepts,”
Int. J. Prod. Res., vol. 46, no. 23, pp. 6611–6625, 2008.
[28] F. Pakdil, P. Toktaş, and G. F. Can, “Six sigma project prioritization
and selection: A multi-criteria decision making approach in healthcare
industry,” Int. J. Lean Six Sigma, vol. 12, pp. 553–578, 2021.
[29] C. Kahraman and G. Büyüközkan, “A combined fuzzy AHP and fuzzy
goal programming approach for effective six-sigma project selection,”
J. Multiple-Valued Log. Soft Comput., vol. 14, no. 6, pp. 599–615,
2008.
[30] B. Ahadian and A. G. M. Abadi, “Six Sigma pilot project selections using
an MCDM approach,” Int. J. Manage. Sci. Eng. Manage., vol. 6, no. 1,
pp. 34–43, 2012.
[31] B. Bilgen and M. Şen, “Project selection through fuzzy analytic hierarchy
process and a case study on Six Sigma implementation in an automotive
industry,” Prod. Planning Control, vol. 23, no. 1, pp. 2–25, 2012.
[32] N. Bhushan and K. Rai, Strategic Decision Making: Applying the Analytic
Hierarchy Process. New York, NY, USA: Springer, 2004.
[33] M. Keshavarz Ghorabaee, E. K. Zavadskas, Z. Turskis, and J. Antuchevi-
ciene, “A new combinative distance-based assessment (CODAS) method
for multi-criteria decision-making,” Econ. Comput. Econ. Cybern. Stud.
Res., vol. 50, no. 3, pp. 25–44, 2016.
[34] S. M. Kazemi, M. Karmasian, S. M. Homayouni, and M. R. Vasili, “Six
Sigma project selections by using a fuzzy multi criteria decision making
approach: A case study in poly acryl corp,” in Proc. CIE42 CIE SAIIE,
2012, pp. 306–301.
[35] A. Van den Bos, B. Kemper, and V. de Waal, “A study on how to improve
the throughput time of lean six sigma projects in a construction company,”
Int. J. Lean Six Sigma, vol. 5, no. 2, pp. 212–226, 2014.
[36] S. Vinodh and V. Swarnakar, “Lean Six Sigma project selection using
hybrid approach based on fuzzy DEMATEL–ANP–TOPSIS,” Int. J. Lean
Six Sigma, vol. 6, no. 4, pp. 313–338, 2015.
[37] A. Yousefi and A. Hadi-Vencheh, “Selecting six sigma projects: MCDM
or DEA?,” J. Model. Manage., vol. 11, no. 1, pp. 309–325, 2016.
[38] V. R. Sreedharan and R. Raju, “A systematic literature review of lean
six sigma in different industries,” Int. J. Lean Six Sigma, vol. 7, no. 4,
pp. 430–466, 2016.
[39] J. Antony, R. Snee, and R. Hoerl, “Lean Six Sigma: Yesterday, today and
tomorrow,” Int. J. Qual. Rel. Manage., vol. 34, no. 7, pp. 1073–1093,
2017.
[40] T. Pyzdek and P. A. Keller, The Six Sigma Handbook, 5th ed. New York,
NY, USA: McGraw-Hill, 2018.
[41] F. Pakdil, Six Sigma for Students: A Problem Solving Methodology. New
York, NY, USA: Palgrave & Macmillan, 2020.
[42] M. M. Parast, “The effect of Six Sigma projects on innovation and firm
performance,” Int. J. Project Manage., vol. 29, no. 1, pp. 45–55, 2011.
[43] J. Antony, P. Palsuk, S. Gupta, D. Mishra, and P. Barach, “Six sigma
in healthcare: A systematic review of the literature,” Int. J. Qual. Rel.
Manage., vol. 35, no. 5, pp. 1075–1092, 2018.
[44] Y. Wind and T. L. Saaty, “Marketing applications of the analytic hierarchy
process,” Manage. Sci., vol. 26, no. 7, pp. 641–658, 1980.
[45] L. T. Saaty, “Axiomatic foundations of the analytic hierarchy process,”
Manage. Sci., vol. 32, no. 7, pp. 841–855, 1986.
[46] M. Hamurcu, H. M. Alağaş, and T. Eren, “Selection of rail system projects
with analytic hierarchy process and goal programming,” Sigma J. Eng.
Natural Sci., vol. 8, no. 2, pp. 291–302, 2017.
[47] Y. Çelikbilek, “A grey analytic hierarchy process approach to project
manager selection,” J. Org. Change Manage., vol. 31, no. 3, pp. 749–765,
2018.
CAN et al.: SIX SIGMA PROJECT PRIORITIZATION AND SELECTION USING AHP–CODAS INTEGRATION
[48] M. Popovic, M. Kuzmanović, and G. Savić, “A comparative empirical
study of analytic hierarchy process and conjoint analysis: Literature
review,” Decis. Making, Appl. Manage. Eng., vol. 1, no. 2, pp. 153–163,
2018.
[49] W. Ho and X. Ma, “The state-of-the-art integrations and applications
of the analytic hierarchy process,” Eur. J. Oper. Res., vol. 267, no. 2,
pp. 399–414, 2018.
[50] A. Darko, A. P. C. Chan, E. E. Ameyaw, E. K. Owusu, E. Pärn, and D. J.
Edwards, “Review of application of analytic hierarchy process (AHP) in
construction,” Int. J. Construction Manage., vol. 19, no. 5, pp. 436–452,
2019.
[51] A. Cahyapratama and R. Sarno, “Application of analytic hierarchy pro-
cess (AHP) and simple additive weighting (SAW) methods in singer
selection process,” in Proc. Int. Conf. Inf. Commun. Technol., Mar. 2018,
pp. 234–239.
[52] T. K. Wang, Q. Zhang, H. Y. Chong, and X. Wang, “Integrated supplier
selection framework in a resilient construction supply chain: An approach
via analytic hierarchy process (AHP) and grey relational analysis (GRA),”
Sustainability, vol. 9, no. 2, 2017, Art. no. 289.
[53] P. Toktaş and G. F. Can, “Stochastic KEMIRA-M approach with con-
sistent weightings,” Int. J. Inf. Technol. Decis. Making, vol. 18, no. 03,
pp. 793–831, 2019.
[54] R. Alyamani and S. Long, “The application of fuzzy analytic hierarchy
process in sustainable project selection,” Sustainability, vol. 12, no. 20,
2020, Art. no. 8314.
[55] J. David and D. Saaty, “Use analytic hierarchy process for project
selection,” ASQ Six Sigma Forum Mag., vol. 6, no. 4, pp. 22–29, 2007.
[56] R. V. Vargas and P. M. P. Ipma, “Using the analytic hierarchy process
(AHP) to select and prioritize projects in a portfolio,” PMI Global Congr.,
vol. 32, no. 3, pp. 1–22, 2010.
[57] W. Y. Liang, “The analytic hierarchy process in project evaluation,”
Benchmarking: Int. J., vol. 10, no. 5, pp. 445–456, 2003.
[58] J. S. Yoo and S. W. Choi, “Project selection of six sigma using group fuzzy
AHP and GRA,” J. Korea Convergence Soc., vol. 10, no. 11, pp. 149–159,
2019.
[59] M. A. Ortíz, J. P. Cómbita, A. L. A. D. L. Hoz, F. D. Felice, and A.
Petrillo, “An integrated approach of AHP-DEMATEL methods applied
for the selection of allied hospitals in outpatient service,” Int. J. Med.
Eng. Inform., vol. 8, no. 2, pp. 87–107, 2016.
[60] M. K. Ghorabaee, M. Amiri, E. K. Zavadskas, R. Hooshmand, and J.
Antuchevičienė, “Fuzzy extension of the CODAS method for multi-
criteria market segment evaluation,” J. Bus. Econ. Manage., vol. 18, no. 1,
pp. 1–19, 2017.
[61] D. Pamučar, I. Badi, K. Sanja, and R. Obradović, “A novel approach for
the selection of power-generation technology using a linguistic neutro-
sophic CODAS method: A case study in libya,” Energies, vol. 11, no. 9,
2018, Art. no. 2489.
[62] I. Badi, M. Ballem, and A. Shetwan, “Site selection of desalination
plant in libya by using combinative distance-based assessment (CODAS)
method,” Int. J. Qual. Res., vol. 12, no. 3, pp. 609–624, 2018.
[63] I. Badi, A. M. Abdulshahed, and A. Shetwan, “A case study of supplier
selection for a steelmaking company in Libya by using the combina-
tive distance-based assessment (CODAS) model,” Decis. Making, Appl.
Manage. Eng., vol. 1, no. 1, pp. 1–12, 2018.
[64] F. B. Yeni and G. Özçelik, “Interval-valued atanassov intuitionistic fuzzy
CODAS method for multi criteria group decision making problems,”
Group Decis. Negotiation, vol. 28, no. 2, pp. 433–452, 2019.
[65] E. Bolturk and C. Kahraman, “Interval-valued intuitionistic fuzzy CO-
DAS method and its application to wave energy facility location selection
problem,” J. Intell. Fuzzy Syst., vol. 35, no. 4, pp. 4865–4877, 2018.
[66] E. Bolturk, “Pythagorean fuzzy CODAS and its application to supplier
selection in a manufacturing firm,” J. Enterprise Inf. Manage., vol. 31,
pp. 550–564, 2018.
[67] I. Badi, A. G. Shetwan, and A. M. Abdulshahed, “Supplier selection
using COmbinative Distance-based assessment (CODAS) method for
multi-criteria decision-making,” in Proc. 1st Int. Conf. Manage., Eng.
Environ., Sep. 2017, pp. 395–407.
[68] T. He, S. Zhang, G. Wei, R. Wang, J. Wu, and C. Wei, “CODAS
method for 2-Tuple linguistic pythagorean fuzzy multiple attribute group
decision making and its application to financial management performance
assessment,” Technol. Econ. Develop. Econ., vol. 26, no. 4, pp. 920–932,
2020.
[69] A. Karaşan, E. Boltürk, and C. Kahraman, “A novel neutrosophic CO-
DAS method: Selection among wind energy plant locations,” J. Intell.
Fuzzy Syst., vol. 36, no. 2, pp. 1491–1504, 2019.
Authorized licensed use limited to: UNIVERSIDADE DE SAO PAULO. Downloaded on March 25,2024 at 14:05:27 UTC from IEEE Xplore. Restrictions apply.
3599
[70] K. Deveci, R. Cin, and A. Kağızman, “A modified interval valued
intuitionistic fuzzy CODAS method and its application to multi-criteria
selection among renewable energy alternatives in turkey,” Appl. Soft.
Comput., vol. 96, pp. 1–18, 2020.
[71] N. Yalçın and N. Yapıcı Pehlivan, “Application of the fuzzy CODAS
method based on fuzzy envelopes for hesitant fuzzy linguistic term sets:
A case study on a personnel selection problem,” Symmetry, vol. 11, no. 4,
2019, Art. no. 493.
[72] A. Karasan, E. K. Zavadskas, C. Kahraman, and M. Keshavarz-
Ghorabaee, “Residential construction site selection through interval-
valued hesitant fuzzy CODAS method,” Informatica, vol. 30, no. 4,
pp. 689–710, 2019.
[73] N. Yıldız and C. Kahraman, “CODAS method using Z-fuzzy numbers,”
J. Intell. Fuzzy Syst., vol. 38, no. 2, pp. 1–14, 2020.
[74] A. Tuş and E. A. Adalı, “Personnel assessment with CODAS and PSI
methods,” Alphanumer. J., vol. 6, no. 2, pp. 243–256, 2018.
[75] S. Zhang et al., “Improved CODAS method under picture 2-Tuple lin-
guistic environment and its application for a green supplier selection,”
Informatica, vol. 32, pp. 195–216, 2021.
[76] M. Mathew and S. Sahu, “Comparison of new multi-criteria decision
making methods for material handling equipment selection,” Manage.
Sci. Lett., vol. 8, no. 3, pp. 139–150, 2018.
[77] A. Karasan, E. Bolturk, and C. Kahraman, “An integrated methodology
using neutrosophic CODAS & fuzzy inference system: Assessment of
livability index of urban districts,” J. Intell. Fuzzy Syst., vol. 36, no. 6,
pp. 5443–5455, 2019.
[78] E. Bolturk and A. Karasan, “Prioritization of investment alternatives for
a hospital by using neutrosophic CODAS method,” J. Multiple-Valued
Log. Soft Comput., vol. 33, no. 4/5, pp. 381–396, 2019.
[79] A. Ijadi Maghsoodi, A. Ijadi Maghsoodi, P. Poursoltan, J. Antuchevi-
ciene, and Z. Turskis, “Dam construction material selection by imple-
menting the integrated SWARA—CODAS approach with target-based
attributes,” Arch. Civil Mech. Eng., vol. 19, pp. 1194–1210, 2019.
[80] D. Panchal, P. Chatterjee, R. K. Shukla, T. Choudhury, and J. Tamo-
saitiene, “Integrated fuzzy AHP-CODAS framework for maintenance
decision in urea fertilizer industry,” Econ. Comput. Econ. Cybern. Stud.
Res., vol. 51, no. 3, pp. 179–196, 2017.
[81] S. Seker and N. Aydin, “Sustainable public transportation system evalua-
tion: A novel two-stage hybrid method based on IVIF-AHP and CODAS,”
Int. J. Fuzzy Syst., vol. 22, no. 1, pp. 257–272, 2020.
[82] J. Antony, F. J. Antony, M. Kumar, and B. R. Cho, “Six sigma in service
organisations,” Int. J Qual. Rel. Manage., vol. 24, no. 3, pp. 294–311,
2007.
[83] A. Chakraborty and T. K. Chuan, “An empirical analysis on six sigma
implementation in service organisations,” Int. J. Lean Six Sigma, vol. 4,
pp. 141–170, 2013.
[84] R.. D. Snee and R. W. Hoerl, Six Sigma Beyond the Factory Floor:
Deployment Strategies for Financial Services, Health Care and the Rest
of the Real Economy. New York, NY, USA: FT Pearson Prentice Hall,
2005.
[85] M. T. Taner, B. Sezen, and J. Antony, “An overview of six sigma
applications in healthcare industry,” Int. J. Health Care Qual., vol. 20,
no. 4, pp. 329–340, 2007.
[86] D. W. Moorman, “On the quest for six sigma,” Amer. J. Surgery, vol. 189,
no. 3, pp. 253–258, 2005.
[87] Y. J. Hsieh, L. Y. Huang, and C. T. Wang, “A framework for the selection
of six sigma projects in services: Case studies of banking and health care
services in Taiwan,” Service Bus., vol. 6, no. 2, pp. 243–264, 2012.
[88] M. A. Ortíz, H. A. Felizzola, and S. N. Isaza, “A contrast between
DEMATEL-ANP and ANP methods for six sigma project selection: A
case study in healthcare industry,” BMC Med. Inform. Decis. Making,
vol. 15, 2015, Art. no. S3.
[89] P. Nonthaleerak and L. Hendry, “Exploring the six sigma phenomenon
using multiple case study evidence,” Int. J. Oper. Prod. Manage., vol. 28,
no. 3, pp. 279–2303, 2018.
[90] P. A. Marques, P. M. Saraiva, J. G. Requeijo, and F. F. Guerreiro, Six
Sigma Life Cycle in Technology and Manufacturing Process Selection.
London, U.K.: Springer, 2014, pp. 33–57.
[91] M. C. Holmes, L. O. Jenicke, and J. L. Hempel, “A framework for
six sigma project selection in higher educational institutions, using a
weighted scorecard approach,” Qual. Assurance Educ., vol. 23, no. 1,
pp. 30–46, 2015.
[92] J. J. Flaig, “Improving project selection using expected net present value
analysis,” Qual. Eng., vol. 17, no. 4, pp. 535–538, 2005.
3600 IEEE TRANSACTIONS ON ENGINEERING MANAGEMENT, VOL. 70, NO. 10, OCTOBER 2023
[93] J. Chen and R. G. Askin, “Project selection, scheduling and resource
allocation with time dependent returns,” Eur. J. Oper. Res., vol. 193,
no. 1, pp. 23–34, 2009.
[94] S. Lifvergren, I. Gremyr, A. Hellström, A. Chakhunashvili, and B.
Bergman, “Lessons from Sweden’s first large-scale implementation of six
sigma in healthcare,” Oper. Manage. Res., vol. 3, no. 3–4, pp. 117–128,
2010.
[95] D. Adebanjo, T. Laosirihongthong, and P. Samaranayake, “Prioritizing
lean supply chain management initiatives in healthcare service opera-
tions: A fuzzy AHP approach,” Prod. Planning Control, vol. 27, no. 12,
pp. 953–966, 2016.
[96] S. Bisgaard and J. Freiesleben, “Six sigma and the bottom line,” Qual.
Prog., vol. 37, no. 9, pp. 57–62, 2004.
[97] T. L. Saaty, “Decision making with the analytical hierarchy process,” Int.
J. Service Sci., vol. 1, no. 1, pp. 83–98, 2008.
[98] K. Teknomo, “Analytic hierarchy process (AHP) tutorial,” 2006. [On-
line]. Available: http://people.revoledu.com/kardi/tutorial/ahp/
[99] T. L. Saaty, Theory and Applications of the Analytic Network Process:
Decision Making With Benefits, Opportunities, Costs, and Risks. Pitts-
burgh, PA, USA: RWS Publications, 2005, p. 21.
[100] N. Mead and P. Bower, “Patient-centredness: A conceptual framework
and review of the empirical literature,” Social Sci. Med., vol. 51, no. 7,
pp. 1087–1110, 2000.
[101] M. T. Jarrar, M. S. Minai, M. Al-Bsheish, A. Meri, and M. Jaber,
“Hospital nurse shift length, patient-centered care, and the perceived
quality and patient safety,” Int. J. Health Planning Manage., vol. 34,
no. 1, pp. e387–e396, 2019.
Gülin Feryal Can (Fellow, IEEE) was born in Di-
yarbakır, Turkey, in 1982. She received the B.S. de-
gree in industrial engineering and the M.S. degree
in production management and planning from the
University of Kocaeli, İzmit, Turkey, in 2004 and
2006, respectively, and the Ph.D. degree in indus-
trial engineering from Kocaeli University, Kocaeli,
Turkey, in 2013.
Between 2006 and 2013, she worked as an Indus-
trial Engineer in different public institutions and in
different companies in the private sector. In 2013,
she started to work as an Assistant Professor with Faculty of Engineering,
Department of Industrial Engineering, Başkent University, Ankara, Turkey. She
has authored three book chapters and more than 90 articles. Her research interests
include multicriteria decision making, fuzzy logic and its different versions,
ergonomics, work study, and lean manufacturing.
Dr. Can is an Associate Editor of the Ergonomics International Journal.
Authorized licensed use limited to: UNIVERSIDADE DE SAO PAULO. Downloaded on March 25,2024 at 14:05:27 UTC from IEEE Xplore. Restrictions apply.
Pelin Toktaş received the B.S. degree in statis-
tics from Middle East Technical Univesity, Ankara,
Turkey, in 1997, the M.S. degree in industrial engi-
neering from Bilkent University, Ankara, Turkey, in
2000, and the Ph.D. degree in statistics from Ankara
University, Ankara, Turkey, in 2011.
Between 1999 and 2002, she worked as an Instruc-
tor with the Department of Industrial Engineering,
Faculty of Engineering, Çankaya University, Ankara,
Turkey. She is currently working with Engineering
Faculty, Industrial Engineering Department, Başkent
University, Ankara, Turkey, as an Assistant Professor. She has various articles
and many studies presented at various national and international conferences.
Her research interests include the statistical analysis and its applications in in-
dustrial engineering and social sciences, multicriteria decision making methods,
and statistical quality control applications.
Fatma Pakdil (Fellow, IEEE) received the B.S. de-
gree in econometrics, the MBA and the Ph.D. de-
grees in management and organization from Uludag
University, Bursa, Turkey, in 1993, 1996, and 2002,
respectively.
She is currently a Professor of management at the
Eastern Connecticut State University, Willimantic,
CT, USA. From 2003 to 2015, she was a Professor
of industrial engineering with Baskent University,
Ankara, Turkey. She worked as a Visiting Profes-
sor with Auburn University, Auburn, AL, USA for
Academy of Aerospace Quality Project between August 2014 and August 2015.
She has authored/coauthored peer-reviewed articles in journals such as Admin-
istration and Society, International Journal of Intercultural Relations, Interna-
tional Journal of Production Research, International Journal of Cross-Cultural
Management, and Transportation Research Part C and presented in numerous
national and international conferences. Her research interests include quality
engineering, statistical process control, lean production and management, Six
Sigma, and quality improvement in healthcare.
Prof. Pakdil was the recipient of the Undergraduate Research and Creative
Activity Mentor Award in 2021 and the CSU-AAUP Research Award in 2018 at
ECSU. She was also awarded by the Turkish National Scientific and Technolog-
ical Council in 2011 and 2012. She wrote a book titled Performance Leadership
with Dr. Leonard by Business Expert Press and a textbook titled Six Sigma for
Students: A Problem Solving Methodology published by Palgrave-Macmillan
and Springer in December 2020.