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This paper aims to characterize a sample of Lean Six Sigma (LSS) projects in healthcare settings and discuss some specificities of operational excellence (OPEX) initiatives in hospitals and healthcare organizations in the USA.

A content analysis involving a sample of 23 documents shared by US hospitals was performed in order to achieve the research objectives. Such analysis was based on a conceptual framework developed from the literature review. It was also applied to a quantitative approach, including descriptive statistics, hypothesis testing and correspondence analysis that supported the research.

Most LSSH projects were focused on business transformation and strategic improvements. Simple techniques and tools were predominant such as descriptive statistics, process mapping, 5S and spaghetti charts, usually implemented by Green Belts and Black Belts through the define, measure, analyze, improve and control (DMAIC) method. In addition to the expressive findings reported, these projects' results have been aligned with lead time and operational cost reduction, quality improvement and capacity increase.

The study adds knowledge to the OPEX literature by analyzing the Lean Six Sigma healthcare (LSSH) in hospitals and healthcare institutions in the USA. It also demonstrates that different approaches, such as the kaizen event and DMAIC project show different results according to some techniques and tools applied in the hospital environment.

The empirical evidence presented in this study provides scenery of the LSS practices in the healthcare settings, highlighting the implementation areas, outcomes, tools and techniques mostly used in the North American healthcare institutions.

This study aims to focus on the supply chain (SC) cost drivers of healthcare industries in the USA, as SC costs have increased 40% over the last decade. The second-most significant expense, the SC, accounts for 38% of total expenses in a typical hospital, while most other industries can operate within 10% of their operating cost. This makes healthcare centers supply-chain-sensitive organizations with limited facilities for high-quality healthcare services. As the cost drivers of healthcare SC are almost unknown to managers, their jobs become more complex.

Guided by pragmatism and positivism paradigms, a cross-sectional study has been designed using quantitative and deductive approaches. Both primary and secondary data were used. Primary data were collected from health centers across the country, and secondary data were from healthcare-related databases. This study examined the attributes that explain the most significant variation in each contributing factor. With multiple regression analysis for predicting cost and Student's t-tests for the significance of contributing factors, the authors of this study examined different theories, including the market-based view and five-forces, network and transaction cost analysis.

This study revealed that supply, materials and services represent the most significant expenses in primary care. Supply-chain cost breakdown results in four critical factors: facility, inventory, information and transportation.

This study examined the data from primary and secondary care institutions. Tertiary and quaternary care systems were not included. Although tertiary and quaternary care systems represent a small portion of the healthcare system, future research should address the supply chain costs of highly specialized organizations.

This study suggests methods that can help to improve supply chain operations in healthcare organizations worldwide.

This study presents an empirically proven methodology for testing the statistical significance of the primary factors contributing to healthcare supply chain costs. The results of this study may lead to positive policy changes to improve healthcare organizations' efficiency and increase access to high-quality healthcare.

This study aims to explore the intellectual connections of mission statement research to identify the influential domains of source knowledge and emergent areas of research for future studies.

The authors deployed bibliometric methods, namely, citation, co-citation and network analysis. The authors collected data from the Scopus and Web of Science databases and analyzed the connections of the most influential articles.

The authors identified four knowledge domains that informed the mission statements literature: guidance on mission statement development, the value of mission statements, mission statements and organizational issues, mission statement content and communication. And the authors spotted four opportunities for knowledge advancement based on theoretical frameworks, performance measures, content and context.

Practitioners should think beyond the immediate benefits of mission statements, such as performance and legitimacy improvement. Instead, they should focus on long-term benefits, information advantages and democratizing the development phase of mission statements.

Mission statements have attracted scholarly attention over the past 40 years. Despite the formation of a considerable body of knowledge, intellectual connections of mission statement research have been largely neglected. Previous studies had a narrow focus or insufficient coverage of the literature. To the best of the authors’ knowledge, this is the first full-scale bibliometric study on the intellectual connections of the mission statements literature.

This case study paper aims to explore the complexities and challenges of epidemic response and public health surveillance in Native American and Indigenous American communities in the United States and find viable solutions. This paper explores these topics through the emergence and impact of the hantavirus pulmonary syndrome (HPS) within the Navajo Nation in the United States using critical incident analysis and best practices.

This project is a case study paper based on a topical review of the literature. A topical review of the literature is a comprehensive exploration of the current body of knowledge within a particular research field. It is an important tool used by scholars and practitioners to further the development of existing knowledge as well as to identify potential directions for future research (Fourie, 2020). Such a paper can provide a useful insight into the various aspects of the process that the researcher may have overlooked, as well as highlighting potential areas of improvement (Gall et al., 2020). It can also provide a useful source of ideas and inspiration for the researcher as it can provide an overview of the various approaches used by other researchers in the field (Göpferich, 2009). Case study papers using a topical review of the literature have been used to help frame and inform research topics, problems and best practices for some time. They are typically used to explore a topic in greater depth and to provide an overview of the literature to improve the world of practice to provide a foundation for future comprehensive empirical research. Case study papers can provide research value by helping to identify gaps in the literature and by providing a general direction for further research. They can also be used to provide a starting point for research questions and hypotheses and to help identify potential areas of inquiry.

This study explores best practices in public health surveillance and epidemic response that can help strengthen public health infrastructure by informing the development of effective surveillance systems and emergency response plans, as well as improving data collection and analysis capabilities within Native American and Indigenous American communities in the United States that also have the option to include new technologies like artificial intelligence (AI) with similar outbreaks in the future.

The literature review did not include any primary data collection, so the existing available research may have limited the findings. The scope of the study was limited to published literature, which may not have reported all relevant findings. For example, unpublished studies, field studies and industry reports may have provided additional insights not included in the literature review. This research has significant value based on the limited amount of studies on how infectious diseases can severely impact Native American communities in the United States, leading to unnecessary and preventable suffering and death. As a result, research on viable best practices is needed on the best practices in public health surveillance and epidemic response in Native American and Indigenous American communities through historical events and critical incident analysis.

Research on public health surveillance and epidemic response in Native American communities can provide insights into the challenges faced by these communities and help identify potential solutions to improve their capacity to detect, respond to and prevent infectious diseases using innovative approaches and new technologies like AI.

More research on public health surveillance and epidemic response can inform policies and interventions to improve access to healthcare for Native American populations, such as increasing availability of healthcare services, providing culturally appropriate health education and improving communication between providers and patients. By providing better public health surveillance and response capacity, research can help reduce the burden of infectious diseases in Native American communities and ultimately lead to improved public health outcomes.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

Dominant quality standards are present in all industries. Implicit in their use is the assumption that once adopted, there is little or no reason to replace them. However, there is evidence that, under certain circumstances, such standards do get replaced. The reasons for this action are not well-understood, either as they pertain to the displacement decision or to the selection and adoption of the alternative standard. The purpose of this study is to identify and explore these two issues (displacement and replacement) by drawing on data from the American healthcare system. This study is viewed through the theoretical lens of legitimacy theory. In addition, the process is viewed from a temporal perspective. The resulting findings are used to better understand how this displacement process takes place and to identify directions for interesting and meaningful future research.

This is an explanatory study that draws on data gathered from quality managers in 89 hospitals that had adopted a new healthcare quality standard (of these, some fifty percent had displaced the dominant quality standard – the Joint Commission – with a different standard – DNV Healthcare.

The combined literature review and case study data provide insights into the displacement process. This is a process that evolves over time. Initially, the process is driven by the need to meet customer demands. However, over time, as the organizations try to integrate the guidelines contained within the standards into the organization, gaps in the quality standard emerge. It is these gaps that motivate the need to displace standards. The legitimacy perspective is highly effective at explaining this displacement process. In addition, the study uncovers some critical issues, namely the important role played by the individual auditors in the certification process and the importance of fit between the standard and the context in which it is deployed.

The data for the propositions in this case study were derived from interviews and survey data from 89 healthcare organizations. It would be interesting to examine similar relationships with other quality standards and industries.

Our findings provide new insights related to motivations to decouple from a dominant quality standard. Results provide a cautionary tale for standards that hold a dominant market share such that perceived legitimacy of such standards is not as stable as originally thought.

This study illuminates the fragile nature of the stability of dominant standards and emphasizes the linkages between legitimacy concerns and divestiture of such standards.

Leadership literature has identified that the servant leadership style can reduce employee negative work outcomes, even in challenging work environments like the health-care sector as nurses play an important role in the performance of a hospital. That is why, the efficiency and effectiveness of the nurses are believed to be directly linked to improved health benefits to the public. So, this study aims to investigate the inter-relationship between servant leadership, organizational justice and workplace deviance of nurses in public sector hospitals.

A self-administrated questionnaire using a drop-and-collect method was used for collecting the data from nurses working in the public sector hospitals of Pakistan using a convenient sampling technique. In total, 370 questionnaires were distributed among the nursing staff, of which 201 completed and usable questionnaires were returned and used for data analysis. Further, the partial least squares structural equation modeling approach is used in this study using SmartPLS version 3 software to test the hypothesized model and determine the direct and indirect effects.

Results showed a negative relationship between servant leadership and workplace deviance, positive relationship between servant leadership and organizational justice, negative relationship between organizational justice and workplace deviance and that organizational justice mediates in the relationship between servant leadership and workplace deviance.

This study provides valuable recommendations and practical implications to address the nurses’ deviant workplace behaviors in the public sector hospitals of Pakistan.

This study is novel as it shows the significance of servant leadership behavior which has the ability to positively influence organizational justice perception leading to less likelihood of the emergence of nurses’ deviant workplace behavior, specifically in the context of public sector hospitals of Pakistan.

The purpose of this study was to better understand the state of the healthcare facility management (FM) workforce and trends and how it compares to the nonhealthcare industries.

A survey was developed, based on relevant literature, regarding respondents’ gender, race, age, educational attainment and job tenure. The survey was sent electronically via Qualtrics^® system in February 2021 to members of the International Facility Management Association membership; 3,557 individuals completed the survey by April 2021, for a 29% response rate. Only data from 1,407 US respondents working in facility operations were included in this study. Of the 1,407 respondents included in this study, 89 worked in the healthcare industry. The majority of respondents not working in healthcare industry (1,318) were employed in government, education or banking and investment.

The demographics of facility managers in the healthcare industry are similar to the demographics of facility managers in other industries: the majority of the FM workforce is male, middle-aged, white, college educated and employed in-house. While healthcare and nonhealthcare facility managers have similar responsibilities across job levels, compensation for entry-level FM roles in the healthcare industry is significantly lower than for entry-level FM roles in other industries. This low pay in healthcare FM, compared to other industries, may exacerbate ongoing challenges related to talent recruitment and retention and justify pay banding increases to improve attraction of top talent into healthcare FM. Both healthcare and nonhealthcare industries hire new college graduates for entry-level FM jobs, but the healthcare industry is more likely to hire individuals who majored in liberal arts compared to other industries more likely to hire individuals who majored in subjects related to the built environment such as FM and engineering. To compensate for low entry-level pay, healthcare organizations may be focusing recruitment efforts on liberal arts students who have little to no training in the built environment because they have lower pay expectations. Older healthcare facility professionals also have shorter job tenures with their current employers than do older facility professionals in other industries; this trend appears to be recent and not be related to pay or the COVID-19 pandemic. A surge of senior-level FM retirements may be creating advancement opportunities for older entry- and mid-level FM personnel in healthcare; if this situation is a factor, research should be conducted to understand its implications for recruiting and developing healthcare FM talent.

Only data from US respondents who were working in healthcare facility operations at the time of the study were included in the data analysis.

Healthcare organizations can use the study’s findings to help address FM workforce challenges unique to their industry staff recruitment, retention and succession planning.

The purpose of this research was to empirically examine the career transitions of mid-career African American women leaving traditional careers for entrepreneurship. The authors illustrate how transition theory and effectuation principles ameliorate an African American woman's transition to entrepreneurship.

The authors conducted semi-structured interviews with nine African American woman entrepreneurs. The data collected were evaluated through the lens of transition theory and effectuation theory.

The study results show that despite being the chief officer, many African American women still face inequalities when negotiating business deals, interacting with partners and when seeking capital for their business. Effectuation theory partially supports an African American woman's career transition to entrepreneurship, but the theory does not fully address the unique experiences of this demographic.

The results of this study reveal that effectuation principles do not fully explain the entrepreneurial career transition experiences of African American women. Theory development and extensions of existing theories should consider the potential discriminatory practices that limit financial resources and strategic partnerships for African American women entrepreneurs. The authors also advocate for consideration of identities, particularly related to gender and race, as factors that contribute to entrepreneurial experiences.

The study findings support the notion that each woman's situation will be different and unique, requiring aspiring African American woman entrepreneurs to assess their individual situation. Consistent access to minority-specific programs can help aspiring African American women entrepreneurs visualize her new identity and provide the support needed to enhance her career transition. There is no one-size-fits-all solution, so each woman will need to craft her own individualized plan.

Findings from this study solidify the role of African American women entrepreneurs as business leaders with influence and direct impact on the US economy. Their success enables African American women to contribute to more inclusive societies through their service to diverse members of society. In addition, their attainment of success serves as a testimony to aspiring African American women that entrepreneurial success is achievable, encouraging more diversity in entrepreneurship.

Few entrepreneurial studies exist on both women and racial minorities, resulting in a paucity of strategies to support African American women throughout their entrepreneurial journey. The results of this study revealed barriers which require specific strategies to address discriminatory lending practices and acceptance when forging new business relationships.