Supply Chain 4.0: Lean Six Sigma, Industry 4.0 Technologies and Circular Supply Chain Applied to an Italian Hospital Case Study

The aim of the paper is to present a circular supply chain 4.0 in the healthcare sector of an Italian hospital through the implementation of Lean and Six Sigma techniques to reduce waiting times and improve processes in the surgical unit. Lean Six Sigma methodology is preliminary to a good implementation of Industry 4.0. Before digitalizing and robotizing, it is necessary to improve efficiency both in terms of Lean waste and in terms of variance and efficiency for Six Sigma to be able to “feed” Industry 4.0 with a product that is already optimized and ready for digitalization. The methodology adopted is based on a literature review and a case study. The results show a dramatic increase in the average number of surgery interventions and that the joint adoption of Industry 4.0 technologies, circular economy strategies, and Lean Six Sigma methodologies enables a circular supply chain.