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Patient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.

This study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.

The findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.

Previous studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.

When a railway emergency occurs, it often leads to unexpected consequences, especially for trains of higher speed and larger passenger flow. Therefore, the railway emergency plan, a pre-established plan to deal with emergencies, plays an important role in reducing injuries and losses. However, the existing railway emergency plans remain as plain-text documents, requiring lots of manual work to capture the important regulations. This paper aims to propose a visualized, formal and digital railway emergency plan modeling method based on hierarchical timed Petri net (HTPN), which is also of better interpretability.

First, the general railway emergency plan was analyzed. Second, the HTPN-based framework model for the general railway emergency plan was proposed. Then, the instantiated model of electric multiple units rescue emergency plan was built by ExSpect, a Petri net simulation tool.

The experiments show that the proposed model is more digital and of better readability, visualization and performability, and, meanwhile, can generally conform to the practice well, offering a promising reference for future analysis of the optimization of railway emergency plans.

This study offers a promising reference for future analysis of the optimization of railway emergency plans.

Emergency logistics is an important means to deal with disasters and public crises. Since the outbreak of the severe acute respiratory syndrome (SARS) virus in 2003, China has established and developed an emergency logistics management system. With the outbreak of coronavirus disease (COVID-19) in China, its emergency logistics system is facing unfolded challenges. The main purposes of this study are to explore the development of China’s emergency logistics system in this context and identify the critical success factors for such systems. A series of focus groups are organized to collect the opinions of 24 interviewees from three Chinese cities, namely Wuhan, Shanghai, and Xi’an. Through the analysis, a framework of the critical success factors for emergency logistics in China is recreated. The key elements are demand forecasting and planning, inventory management, distribution network, and systematic information management. Findings suggest critical points on the design and imple-mentation of the emergency logistics operations during a chaotic period.

Covid-19 is a worldwide pandemic disease that changed the government communication to citizens about the health emergency. This study aims to provide in-depth research about regional Italian government communication through social media (SM) and its effects on citizens' engagement.

The study uses a case analysis, focusing on the Italian context. In detail, the authors analyse the more involved Italian regions in Covid-19 pandemic (Lombardy, Veneto, Piedmont, Emilia Romagna and Tuscany) applying the Crisis and Emergency Risk Communication (CERC) model.

The results reveal that SM is a powerful tool for communication during a health emergency and for facilitating the engagement with stakeholders. However, results also highlight a different perception about the timing of the Covid-19 crisis.

Findings suggest a gap between the answer of the public government compared to the citizens' needs that are clear since the first earlier stage of the pandemic event. The engagement level is very high since the first phase of the pandemic event; however, to be adequately developed, it requires specific and timing information that are not always in line with the citizens’ communication needs.

This is the first research that aims to study the citizens' engagement in the Italian regions during the Covid-19 pandemic.

Healthcare environments are highly complex and full of variation and inefficiency. However, variation and inefficiency can be measured and improved, providing better quality care at a lower cost. This study aims to report the application of Lean Six Sigma (LSS) in a haematology laboratory in a university hospital in Egypt.

The authors used case study research. Applying the define, measure, analyse, improve and control phases of the DMAIC methodology together with lean tools, the problem was identified, the process mapped, the causes analysed and improvements implemented.

Results show that LSS can be successfully implemented in challenging public sector healthcare settings. Management commitment, generating and implementing ideas from frontline staff, using a variety of quality tools and previous LSS training were all key to success. This is evidence that the LSS methodology is adaptable to any process, people or place.

There are no publications on LSS implementation in health care in Egypt. This study demonstrates the successful use of LSS in a university hospital (public sector) in a developing country, sharing insight into the facilitators and barriers in a real context with others in the healthcare field.

This study aims to compare the humanitarian supply chains and logistics of two countries in earthquake preparedness by modifying and using a previously established preparedness evaluation framework.

A European flood emergency management system (FEMS) is a seven-dimensional framework to assess a country’s preparedness for flood emergencies. The FEMS framework was modified to apply to earthquakes. Leveraging a multiple explanatory case study approach with data analysis, the authors reconstructed the events of the earthquakes in Pakistan (2005) and Japan (2011) with an applied grading (1–5). Findings were evaluated within the adopted FEMS framework. From a practitioner’s perspective, the framework is applicable and can accelerate support in the field.

Pakistan lacked emergency plans before the 2005 earthquake. In contrast, Japan possessed emergency plans before the disaster, helping minimise casualties. Overall, Japan demonstrated considerably better emergency management effectiveness. However, both countries significantly lacked the distribution of responsibilities among actors.

Practical factors in the humanitarian supply chain are well understood. However, synthesising individual factors into a comprehensive framework is difficult, which the study solves by applying and adopting the FEMS framework to earthquakes. The developed framework allows practitioners a structured baseline for prioritising measures in the field. Furthermore, this study exemplifies the usefulness of cross-hazard research within emergency management and preparedness in a real-world scenario.

The CoViD-19 pandemic has brought about a panoply of institutional challenges both domestically and in the international arena. Classical constitutional theory thereby underwent a reinvention by the executive for the sake of speedy policy action and to the detriment of institutional control while favouring authoritarian forms of governance. This paper concerns itself with institutional responses to such developments, placing emphasis on the role of the judiciary and people*s in contesting emergency decrees and other executive orders, especially where fundamental rights are infringed upon. The paper aims to explore the difficulties arising with exerting absolute executive powers during the health crisis, the respective role assumed by constitutional courts and the impact of the new governance paradigm on forms of public contestation, also as a means of quasi institutional control.

Indeed, the right to health may be translated into political discourse and become foundational to security and public interest paradigms. This may result in a shrinking public space given the constraints to the freedom of movement. In the name of public safety, the (collective) right to assembly, expression and protest have been submitted to major limitations in that regard.

Ultimately, this re-opens debates on the meaning of absolute rights and contextualities of derogations, as well as the reconcilability of civil and political rights and economic, social and cultural rights. It also exposes social inequalities, social justice dimensions and vulnerabilities, often exacerbated by the health crisis; migrant rights demonstrably face particularly severe and intersectional forms of violations.

Particular values lie with the interdisciplinary approach embraced in this paper; the authors draw on a variety of social sciences disciplines to shed light on this very current issue. Both theoretical and empirical methods are used and combined here, making sense of the underlying logic of virus governance and its impacts on fundamental rights.

Unforeseen events can disrupt the operational process and negatively impact emergency resources optimization and its supply chain. A limited number of studies have addressed risk management issues in the context of emergency supply chains, and this existing research lacks inbuilt and practical techniques that can significantly affect the reliability of risk management outcomes. Therefore, this paper aims to identify and practically analyze the specific risk factors that can most likely disrupt the normal functioning of the emergency supply chain in disaster relief operations.

This paper has used a three-step process to investigate and evaluate risk factors associated with the emergency supply chain. First, the study conducts a comprehensive literature review to identify the risk factors. Second, the research develops a questionnaire survey to validate and classify the identified risk factors. At the end of this step, the study develops a hierarchical structure. Finally, the research investigates the weighted priority of the validated risk factors using the fuzzy-analytical hierarchy process (FAHP) methodology. Experts were required to provide subjective judgments.

This paper identified and validated 28 specific risk factors prevalent in emergency supply chains. Based on their contextual meanings, the research classified these risk factors into two main categories: internal and external risk factors; four subcategories: demand, supply, infrastructural and environmental risk factors; and 11 risk types: forecast, inventory, procurement, supplier, quality, transportation, warehousing, systems, disruption, social and political risk factors. The most significant risk factors include war and terrorism, the absence of legislative rules that can influence and support disaster relief operations, the impact of cascading disasters, limited quality of relief supplies and sanctions and constraints that can hinder stakeholder collaboration. Therefore, emergency supply chain managers should adopt appropriate strategies to mitigate these risk factors.

This study will contribute to the general knowledge of risk management in emergency supply chains. The identified risk factors and structural hierarchy taxonomic diagram will provide a comprehensive risk database for emergency supply chains.

The research findings will provide comprehensive and systemic support for respective practitioners and policymakers to obtain a firm understanding of the different risk categories and specific risk factors that can impede the effective functioning of the emergency supply chain during immediate disaster relief operations. Therefore, this will inform the need for the improvement of practices in critical aspects of the emergency supply chain through the selection of logistics and supply chain strategies that can ensure the robustness and resilience of the system.

This research uses empirical data to identify, categorize and validate risk factors in emergency supply chains. This study contributes to the theory of supply chain risk management. The study also adopts the fuzzy-AHP technique to evaluate and prioritize these risk factors to inform practitioners and policymakers of the most significant risk factors. Furthermore, this study serves as the first phase of managing risk in emergency supply chains since it motivates future studies to empirically identify, evaluate and select effective strategies that can eliminate or minimize the effects of these risk factors.

The purpose of this paper is to discuss the themes emerging from the first studies exploring accounting, accountability and management practices during the COVID-19 pandemic and coming from a diversity of experiences, across countries, organizations and individuals. In so doing, the paper gives an overview of the most recent findings about the role of accounting and accountability in times of crisis that are hosted in this special issue of Accounting, Auditing and Accountability Journal (AAAJ).

The paper draws together and identifies emerging themes related to the current COVID-19 pandemic and its impacts on accounting, accountability and management practices and considers how the studies in this issue extend one’s knowledge of accounting and contribute to accounting research.

Three emerging themes are drawn and their contribution to accounting scholarship is discussed. The first theme deals with the role of accounting and numbers in supporting governmental responses to COVID-19. The second theme considers accounting practices used to make exceptional decisions at the organizational level in times of crisis. The third theme addresses a relevant frontier of research into accounting and inequalities.

In considering the diverse contributions of this special issue, the paper points out how uncertainty and change can impact the design, use and understanding of accounting, management and accountability practices and can be accepted by scholars and practitioners as part of such practices.

This paper provides a timely and comprehensive picture of the first reflections and research findings on the impacts of the COVID-19 pandemic on one’s interpretation of accounting, accountability and management practices.

In the face of diverse national and international threats, the purpose of this paper is to explore the transformational leadership challenges in emergency services systems in Canada. These adaptive complex systems respond to critical mass emergencies, disasters and catastrophes.

This qualitative research study uses grounded theory to examine the phenomenology of emergency services leadership from systems perspective. Using the theoretical Wu-Shi-Ren (WSR)-Li systems paradigm, this key informant study of 103 emergency leaders from 81 organizations focusses on the systemic challenges that transformational leaders face in emergency services systems. The response rate was 83.5 percent using a semi-structured and open-ended questionnaire.

This key informant study underscores the competencies for transformational leadership and identifies 12 key leadership challenges in the context of the future evolution of emergency services systems. From the use of a grounded theory methodology, the new theory of transcendental transformational emergency leadership is posited.

Qualitative studies such as this key informant study underscores the relevance of the WSR-Li systems paradigm and grounded theory approach in discerning leadership challenges that are specific if not unique to emergency services systems.

This study underscores the theoretical and pragmatic implications of the transformational leadership challenges for leadership paradigms, innovation and inter-sectorial collaborative networks and possible future emergency services research.

This study stresses the importance of addressing leadership challenges of emergency services systems as instrumental in ultimately saving lives, minimizing injuries and assuring complete health and social recovery from the scourges of emergency events nationally and internationally.

Qualitative studies of the perspectives of strategic emergency leadership of systemic emergency services systems has not hitherto been done in Canada nor internationally. This key informant study underscores the relevance of the WSR-Li systems paradigm and grounded theory approach in discerning transformational leadership challenges that are specific if not unique to emergency services systems. Moreover, from the use of a grounded theory approach, a new theory of transcendental transformational emergency leadership emerged.