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Untimely responses to emergency situations in urban areas contribute to a rising mortality rate and impact society's primary capital. The efficient dispatch and relocation of ambulances pose operational and momentary challenges, necessitating an optimal policy based on the system's real-time status. While previous studies have addressed these concerns, limited attention has been given to the optimal allocation of technicians to respond to emergency situation and minimize overall system costs.

In this paper, a bi-objective mathematical model is proposed to maximize system coverage and enable flexible movement across bases for location, dispatch and relocation of ambulances. Ambulances relocation involves two key decisions: (1) allocating ambulances to bases after completing services and (2) deciding to change the current ambulance location among existing bases to potentially improve response times to future emergencies. The model also considers the varying capabilities of technicians for proper allocation in emergency situations.

The Augmented Epsilon-Constrained (AEC) method is employed to solve the proposed model for small-sized problem. Due to the NP-Hardness of the model, the NSGA-II and MOPSO metaheuristic algorithms are utilized to obtain efficient solutions for large-sized problems. The findings demonstrate the superiority of the MOPSO algorithm.

This study can be useful for emergency medical centers and healthcare companies in providing more effective responses to emergency situations by sending technicians and ambulances.

In this study, a two-objective mathematical model is developed for ambulance location and dispatch and solved by using the AEC method as well as the NSGA-II and MOPSO metaheuristic algorithms. The mathematical model encompasses three primary types of decision-making: (1) Allocating ambulances to bases after completing their service, (2) deciding to relocate the current ambulance among existing bases to potentially enhance response times to future emergencies and (3) considering the diverse abilities of technicians for accurate allocation to emergency situations.

This case was written using primary data through various channels, including in-depth structured interviews with the CEO and other individuals at the Crisis Center of Tampa Bay (CCTB), as well as exchanging email messages and phone conversations with employees at CCTB. All interviews were recorded and transcribed. In addition, one of the authors took a tour of the main offices of CCTB and took notes on the physical facilities as well as the information provided by the tour guide. Public information from CCTB was used to enhance the information and provide background. All accounts presented in this case are real, and no information was altered or fabricated.

Clara Reynolds had been CEO of CCTB for over eight years. The agency had almost tripled its budget in the time she had been there. Her leadership style had positively impacted the culture of the organization. Employees valued her open and transparent leadership style. Employees saw her commitment to training employees, creating work–life balance and helping employees be exceptional at their jobs. There was an issue, however, with Transcare, the organization’s ambulatory service. The performance of the business was declining, and Clara wanted to update the board within 60 days at the next quarterly board meeting. She was not sure what she could do to increase engagement with Transcare’s staff, which would show the board that the staff was fully willing to do what was necessary.

This case is appropriate for teaching undergraduate or graduate-level courses in leadership, organizational behavior or principles of management. It is designed to be discussed during one class period. It will save time and improve the flow if the students read the case before class and are prepared when they arrive. Any information needed for the case discussion has been presented in the case; no further research by the students is necessary. Students should think about the role of leadership in a nonprofit. They should put themselves in the protagonist’s shoes throughout the reading of the case.

Public safety (communicators; e.g. 9-1-1, police, fire and ambulance call-takers and dispatchers), like many other public safety personnel (e.g. police, paramedics), (re)suffer operational stress injuries (OSIs) that are too often hidden and at a prevalence higher than the general population. Unfortunately, there are very little data for OSI rates in Canadian communicators. To the authors’ knowledge, this is the only pan-Canadian study focusing on organizational culture, and its potential influence on OSIs, within the communicator context.

The authors conducted a 179-item online survey of Canadian communicators comprising 17 validated screenings for occupational stress injuries and symptoms and four open-ended questions relating to their agency's organizational culture. The authors thematically analysed participants' open-ended responses and their screening scores.

A semi-grounded thematic approach revealed that managers and supervisors were significant contributors to negative perceptions (n = 165) of organizational culture, potentially resulting in or worsening existing OSIs. Specifically, leadership was viewed as ineffective, inconsistent, unsupportive, abusive and toxic, with limited understanding of communicator roles. Communicators described feeling devalued, particularly when leaders fail to recognize communicator OSIs, which can perpetuate stigma. Conversely, positive leaders (n = 24) were described as supportive, communicative and encouraging.

The findings suggest that while leadership behaviours are a key factor in employee well-being, it varies considerably across agencies, impacting treatment-seeking behaviours. The authors’ new understandings of leaders' roles in OSIs may help reduce the frequency and severity of communicator OSIs, helping ensure that emergency services are delivered to Canadians.

The purpose of this study is to explore the sustainability of innovations introduced during the coronavirus disease 2019 (Covid-19) pandemic in remote and rural primary care advanced clinical practice.

The methodology includes an exploratory qualitative study of eight key stakeholders from Scottish remote and rural primary care advanced practice (three policymakers and five advanced practitioners). Data were collected using semi-structured interviews during 2022 and analysed thematically.

Advanced practice in remote and rural primary care is characterised by a shortage of doctors, close-knit communities and a broad scope of practice. Covid-19 catalysed changes in the delivery of healthcare. Innovations which participants wanted to sustain include hybrid working, triage, online training and development, and increased inter-professional support networks.

Findings provide valuable insights into how best to support remote and rural advanced practice which may have implications for retaining healthcare professionals. They also identified useful innovations which could benefit from further investment.

Given current healthcare workforce pressures, identifying and sustaining innovations which will support and retain staff are imperative. Hybrid consultations and online access to training, development and support should be sustained to support the remote and rural advanced practice workforce. Further research should explore the sustainability of innovations introduced during the Covid-19 pandemic in other care contexts.

Paramedics became nationally registered in 2018 in Australia. Prior to this, there was no central regulation of the profession with reliance on organisational regulation through employers. As paramedics expanded their scope, role and range of employers, especially outside statutory agencies, there was increasing need to engage in professional regulation. Regulation is more than a legal and bureaucratic framework. The purpose of the paper states that the way paramedics interact with their new regulatory environment impacts and is influenced by the professionalisation of the discipline. Regulation also redefines their positionality within the profession.

Two mixed-method surveys were undertaken. A pre-registration survey occurred in the month prior to regulation commencing (N = 419) followed by the second survey 31 months later (N = 407). This paper reports the analysis of qualitative data from the post-registration survey and provides comparison to the pre-registration survey which has been previously reported. Analysis was undertaken using interpretive phenomenological analysis (IPA).

Themes from the pre-registration survey continued however became more nuanced. Participants broadly supported registration and saw it as empowering to the profession. Some supported registration but were disappointed by its outcome, others rejected registration and saw it as divisive and oppressive.

Paramedics are beginning to come to terms with increasing professionalisation, of which regulation is one component. Changes can be seen in professional identity and engagement with professional practice; however, this is nascent and is deserving of additional research to track the profession as it continues to evolve.

This study examines potential ways to break the inequality reproduction circle faced by ethnic minority health workers and sustained by key performance indicators (KPIs)-centred management in the National Health Service (NHS) in England. It does so through the lens of signalling theory.

Three years panel data for 2018–2020 covering 207 hospitals was compiled from the annual NHS staff survey and matched with relevant administrative records. Structural equation modelling was used to test the proposed hypotheses at the organisational level.

The moderated mediating model reveals that persistent racial discrimination by managers and coworkers can disadvantage the career progression of ethnic minority health workers, which in turn reinforces and reproduces economic and health inequalities among them. More importantly, we show how the collective agreement that the senior management team acts (SMTA) on staff feedback can break this vicious circle.

While our research focuses on the not-for-profit health care sector, it opens important opportunities to extend the proposed model to understand organisational inequality and how to address it.

Perceived SMTA can send strong signals to reduce deep-rooted discrimination (race, gender, age, etc.) through resource allocations and instrumental functions. This is also a way to address the current staff burnout and shortage issues in the healthcare sector.

This article reveals why the purpose of organisations that provide public service to reduce social inequality was comprised during their business-like operations and more importantly, how to reflect their foundational purpose through management practice.

This study offers a way forward to resolve one of the unintended consequences of KPI-centred management in the not-for-profit sector through unpacking the process of inequality reproduction and, more importantly, how it is possible to break this vicious circle.

The migration of physicians is a global interest, causing imbalances between developed and developing countries. Romania is one of Europe's major providers of physicians, not because there is a surplus, but because physicians are drawn to places with better living and working conditions. Medicine in Romania is increasingly highly advanced, and Romanian physicians are well appreciated all over the world. Despite being one of the countries with the most medical graduates in the world, Romania is suffering a doctor exodus. After joining the EU, the problem of physician migration became widespread, resulting in a deficient and inefficient healthcare system. Therefore, the purpose of this study is to estimate the losses registered by Romania because of physicians' decision to migrate.

These losses were calculated in two ways: utilizing the statistical life value and the amount of money invested in training a medical graduate.

According to the findings, the losses in 2018 were 104.16 million euros, approximately 0.12% of GDP.

The originality of this paper consists in data, being provided by the College of Physicians from Romania and the method used, this study being the only one that estimates the cost of Romanian physicians' migration. The paper adds to existing knowledge an empirical results regarding quantifying the value reflecting the departure of physicians, using value of statistical life and the amount of money invested in preparing a medical graduate.

The need to develop effective approaches for responding to healthcare incidents for the purpose of learning and improving patient safety has been recognised in current national policy. However, research into this topic is limited. This study aims to explore the perspectives of professionals in mental health trusts in England about what works well and what could be done better when implementing serious incident management systems.

This was a qualitative study using semi-structured interviews. In total, 15 participants were recruited, comprising patient safety managers, serious incident investigators and executive directors, from five mental health trusts in England. The interview data were analysed using a qualitative-descriptive approach to develop meaningful themes. Quotes were selected and presented based on their representation of the data.

Participants were dissatisfied with current systems to manage serious incidents, including the root cause analysis approach, which they felt were not adequate for assisting learning and improvement. They described concerns about the capability of serious incident investigators, which was felt to impact on the quality of investigations. Processes to support people adversely affected by serious incidents were felt to be an important part of incident management systems to maximise the learning impact of investigations.

Findings of this study provide translatable implications for mental health trusts and policymakers, informed by insights into how current approaches for learning from healthcare incidents can be transformed. Further research will build a more comprehensive understanding of mechanisms for responding to healthcare incidents.

This systematic review paper aims to investigate seasonal ambient change’s impact on the incidence of falls among older adults.

The population, exposure, outcome (PEO) structured framework was used to frame the research question prior to using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Three databases were searched, and a total of 12 studies were found for inclusion, and quality appraisal was carried out. Data extraction was performed, and narrative analysis was carried out.

Of the 12 studies, 2 found no link between seasonality and fall incidence. One study found fall rates increased during warmer months, and 9 of the 12 studies found that winter months and their associated seasonal changes led to an increase in the incidence in falls. The overall result was that cooler temperatures typically seen during winter months carried an increased risk of falling for older adults.

Additional research is needed, most likely examining the climate one lives in. However, the findings are relevant and can be used to inform health-care providers and older adults of the increased risk of falling during the winter.