Six sigma project prioritization and selection: a multi-criteria decision making approach in healthcare industry Fatma Pakdil Department of Management and Marketing, Eastern Connecticut State University, Willimantic, Connecticut, USA, and Pelin Toktas  and Gülin Feryal Can Department of Industrial Engineering, Bas kent University, Ankara, Turkey Abstract Purpose – The purpose of this study is to develop a methodology in which alternate Six Sigma projects are prioritized and selected using appropriate multi-criteria decision-making (MCDM) methods in healthcare organizations. This study addresses a particular gap in implementing a systematic methodology for Six Sigma project prioritization and selection in the healthcare industry. Design/methodology/approach – This study develops a methodology in which alternate Six Sigma projects are prioritized and selected using a modified Kemeny median indicator rank accordance (KEMIRA- M), an MCDM method based on a case study in healthcare organizations. The case study was hypothetically developed in the healthcare industry and presented to demonstrate the proposed framework’s applicability and validity for future decision-makers who will take place in Six Sigma project selection processes. Findings – The study reveals that the Six Sigma project prioritized by KEMIRA-M assign the highest ranks to patient satisfaction, revenue enhancement and sigma level benefit criteria, while resource utilization and process cycle time receive the lowest rank. Practical implications – The methodology developed in this paper proposes an MCDM-based approach for practitioners to prioritize and select Six Sigma projects in the healthcare industry. The findings regarding patient satisfaction and revenue enhancement mesh with the current trends that dominate and regulate the industry. KEMIRA-M provides flexibility for Six Sigma project selection and uses multiple criteria in two- criteria groups, simultaneously. In this study, a more objective KEMIRA-M method was suggested by implementing two different ranking-based weighting approaches. Originality/value – This is the first study that implements KEMIRA-M in Six Sigma project prioritization and selection process in the healthcare industry. To overcome previous KEMIRA-M shortcomings, two ranking based weighting approaches were proposed to form a weighting procedure of KEMIRA-M. As the first implementation of the KEMIRA-M weighting procedure, the criteria weighting procedure of the KEMIRA-M method was developed using two different weighting methods based on ranking. The study provides decision-makers with a methodology that considers both benefit and cost type criteria for alternates and gives importance to experts’ rankings related to criteria and the performance values of alternates for criteria. Keywords Six sigma, Health care, Multi-criteria decision-making, KEMIRA-M, Six sigma project prioritization and selection Paper type Research paper 1. Introduction Over the past six decades, continuous quality improvement strategy has become a dominant element of strategic management efforts in a great variety of industries, including Fortune Six sigma project Received 27 April 2020 Revised 25 May 2020 17 August 2020 Accepted 19 September 2020 International Journal of Lean Six Sigma © Emerald Publishing Limited 2040-4166 DOI 10.1108/IJLSS-04-2020-0054 The current issue and full text archive of this journal is available on Emerald Insight at: https://www.emerald.com/insight/2040-4166.htm