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Our universities must adapt to increasingly uncertain environments, face fierce international competition, manage budget cuts, increased auditing, rapid technological changes and increasing expectations of various increasingly demanding social partners, and even personalise their academic programs. The 2000s brought interest in lean, six-sigma, and lean six sigma methods. This review of the literature summarises and analyses the documented experience of public and private universities around the world with these approaches.Scientific databases were queried to retrieve the relevant literature published from 2000 to 2016. The search was completed using the snowball effect. The results were sorted by geographical region, type of process and decisional level. The challenges addressed were also listed and sorted.These approaches are innovative in the university setting. While few results are documented, experiments at American, British, Mexican, Finnish, South African, Indian and Saudi institutions are all on record. Activities in support of teaching and university community services were the principal targets. A single research-related case was retrieved, which dealt with supporting activities.Lean, six sigma and lean six sigma methods are not deployed in any systematic way. The principal obstacles are system complexity and the difficulties of adapting the tools to institutional reality and of defining and applying the concepts of client and added value. The few documented measured results are isolated and do not support any generalisation. Impact studies are limited primarily to qualitative statements describing challenges and factors associated with success. No study of the impact of these approaches on the occupational health and safety of university staff was retrieved. Since the lean manufacturing literature mentions frequently both positive (task enrichment, autonomy) and negative (musculoskeletal injuries, stress, fatigue, professional burn-out and others) impacts, it cannot be ruled out that such impacts might be noted also in the university setting.