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The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.

The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.

An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.

The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.

This paper aims to define the efficiency achieved by urban transport companies in Spain concerning the resources they use, considering the type of management used for implementation, public-private, and size.

This study consisted of an analysis of the efficiency of 229 public-private urban transport operators during the period 2012–2021 using Data Envelopment Analysis, the Malmquist Index and inference estimators to determine productivity, efficiency change into Pure Technical Efficiency Change (PTECH), and scale efficiency change.

Based on the efficiency analysis, the authors concluded that of the 229 companies studied, more than 35 were inefficient in all analysed periods. Considering the sample used, direct management is considered significantly more efficient. It cannot be concluded that the size of these companies influences their efficiency, as the data show unequal development behaviours in the studied years.

This study provides arguments on whether there is a significant difference between the two types of management in the urban transport sector. It also includes firm size as a study variable, which has not been previously considered in other studies related to urban transport efficiency. Efficiency should be a crucial factor in determining funding allocation in this sector, as it encourages operators to optimize and improve their services.

Effective customer journey design (ECJD) is considered a key variable in customer experience management and an essential source of brand meaning and pro-brand behavior. Although previous research has confirmed its importance for driving brand attitudes and loyalty, the role of consumer-brand identification as a social identity-based influence in this relationship has not yet been discussed. Drawing on construal level and social identity theories, this paper aims to investigate whether effective journeys and the resulting overall journey experience are equally powerful in driving brand loyalty among customers with different levels of consumer-brand identification.

The present article develops and tests a research model using data from the European and US service sectors (N = 1,454) to investigate how and when ECJD affects service brand loyalty.

Across two cultural contexts, four service industries and 33 service brands, the results reveal that ECJD is a crucial driver of service brand loyalty for customers with low consumer-brand identification. Moreover, the findings show that different aspects of journey effectiveness positively impact the valence of customers’ experience related to those journeys – a process that is ultimately decisive for their brand loyalty.

This study is unique because it generates theoretical and practical knowledge by combining the literature streams of customer journey design, customer experience and branding. Furthermore, this work demonstrates that consumer-brand identification is a critical boundary condition to be considered in the relationship between ECJD and brand loyalty in services.

This study aims to examine the co-creation of customer experiences at different levels in service ecosystems, analyzing the case of a tourist destination.

A questionnaire was designed based on previously validated scales. The questionnaire was distributed through the social media platforms Facebook and Instagram. The survey yielded 1,476 valid responses for three types of destinations. Structural equation modeling and multigroup analysis were performed to test the hypotheses.

Aggregate service experience and memorable customer experience (MCE) in service ecosystems are determined by customer experiences at a dyadic level. Service experience at the ecosystem level is formed from ordinary experiences at the actor level, while MCE is formed from extraordinary experiences at the dyadic level. The type of ecosystem moderates the relationships between the variables but does not alter the importance of each of them.

The relationship between the co-creation of customer experiences at different levels of service ecosystems (dyadic vs aggregate) is addressed. A relationship is established between the ordinary and extraordinary character of experiences and their memorability at the ecosystem level.

This study aims to deepen the understanding of the challenges and implications entailed by deploying mobile clinics in conflict zones to reach populations affected by violence and cut off from health-care services.

This research combines an integrated literature review and an instrumental case study. The literature review comprises two targeted reviews to provide insights: one on conflict zones and one on mobile clinics. The case study describes the process and challenges faced throughout a mobile clinic deployment during and after the Iraq War. The data was gathered using mixed methods over a two-year period (2017–2018).

Armed conflicts directly impact the populations’ health and access to health care. Mobile clinic deployments are often used and recommended to provide health-care access to vulnerable populations cut off from health-care services. However, there is a dearth of peer-reviewed literature documenting decision support tools for mobile clinic deployments.

This study highlights the gaps in the literature and provides direction for future research to support the development of valuable insights and decision support tools for practitioners.

With the growing need for employees to be innovative, public-sector organizations are investing in employee training. This study aims to examine the effects of a combined Lean Six Sigma and innovation training, using action learning, on public-sector employees’ creative role identity and innovative work behavior.

The authors studied a public service agency in Singapore in which a five-day Lean Innovation Training was implemented, using a combination of Lean Six Sigma and Creative Problem-Solving tools, with a simulation on day one and subsequent team-based project coaching, spread over six months. The authors administered pre- and postintervention surveys among all the employees, and initiated group interviews and observations before, during and after the intervention.

Creative role identity and innovative work behavior had significantly improved six months after the intervention, enabled through senior management’s transformational leadership. The training induced managers to role-model innovative work behaviors while cocreating, with their employees, a renewal of their agency’s core processes. The three completed improvement projects contributed to an innovative work culture and reduced service turnaround time.

Starting with a role-playing simulation on the first day, during which leaders and followers swapped roles, the action-learning type training taught all the organizational members to use various Lean Six Sigma and Creative Problem-Solving tools. This nimble Lean Innovation Training, and subsequent team-based project coaching, exemplifies how advancing the staff’s creative role identity can have a positive impact.

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.

A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.

Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.

Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work.

This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level.

The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions.

The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.

This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities’ perspective and the organizational perspective to understand the manager’s role in handling the contingency of decisions and managing paradoxes in the decision-making process.

Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.

The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).

The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.

The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.

The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.