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Theory of Constraints (TOC), though a well-established process improvement methodology in manufacturing, is still a novel philosophy for healthcare and an exhaustive review of literature is needed to summarize the key findings of various researchers. Such a review can provide a direction to the researchers and academicians interested in exploring the application of TOC in the healthcare sector. This paper aims to review the existing literature of TOC tools and techniques applied to the healthcare environment, and to investigate motivating factors, benefits and key gaps for identifying directions for future research in the domain of healthcare.

In this paper, different electronic repositories were searched using multiple keywords. The current study identified 36 articles published between January 1999 to mid-2021 to conceptualize and summarize the research questions used in the study. Descriptive analysis along with pictorial representations have been used for better visualization of work.

This paper presents a thorough literature review of TOC in healthcare and identifies the evolution, current trends, tools used, nature of services chosen for application and research gaps and recommends future direction for research. A variety of motivating factors and benefits of TOC in healthcare are identified. Another key finding of this study is that almost all implementations listed in literature reported positive outcomes and substantial improvements in the performance of the healthcare unit chosen for study.

This paper provides valuable insight to researchers, practitioners and policymakers on the potential of TOC to improve quality of services, flow of patients, revenues, process efficiency and cost reduction in different health care settings. A number of findings and suggestions compiled in the paper from literature study can be used for diagnosing, learning and making substantial changes in healthcare. The methodologies used by different researchers were analysed and combined to propose a generic step by step procedure to apply TOC. This methodology will guide the practising managers about the appropriate tools of TOC for their specific need.

Good health is always the first desire of all men and women around the globe. The global aim of healthcare is to quickly cure more patients and ensure healthier population both today and in future. This article will work as a foundation for future applications of TOC in healthcare and guide upcoming applications in the booming healthcare sector. The paper will help the healthcare managers in serving a greater number of patients with limited available resources.

This paper provides original collaborative work compiled by the authors. Since no comprehensive systematic review of TOC in healthcare has been reported earlier, this study would be a valuable asset for researchers in this field. A model has been presented that links various benefits with one another and clarifies the need to focus on process improvement which naturally results in these benefits. Similarly, a model has been presented to guide the users in implementation of TOC in healthcare.

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.

This paper aims to appraise the effectiveness of gender quotas in breaking the glass ceiling for women on boards (WoBs) in companies that are legally obliged to comply with quotas (listed companies and state-owned companies, LP) and in those that are not (unlisted companies and nonstate-owned companies, NLNP). Furthermore, it investigates the glass cliff phenomenon, according to which women are more likely to be appointed to apical positions in underperforming companies.

A balanced panel data of the top 116 Italian companies by total assets, which are present in both 2010 and 2017, is used for estimating ANOVA tests across sectors and fixed-effects panel regression models.

WoBs significantly increased in both the LP and the NLNP companies, and this increase was greater in the financial sector. Furthermore, the relationship between the percentage of WoBs and firm performance is not linear but depends on the financial corporate health. Specifically, the situation in which a woman ascends to a leadership position in challenging circumstances where the risk of failure is high (glass cliff phenomenon) is only present in companies with the lowest performance in the sample, in other words, when negative values of Roe and negative or zero values of Roa occur together.

These findings have relevant policy implications that encourage the adoption of gender quotas even in specific top positions, such as CEO or president, as this could lead to a “double spillover effect” both vertically, that is, in other job positions, and horizontally, toward other companies not targeted by quotas. Practical interventions to support women in glass cliff positions, on the other hand, relate to the extent of supervisor mentoring and support to prevent women from leaving director roles and strengthen their chances for career advancement.

The authors explore the ability of gender quotas to break through the glass ceiling in companies that are not legally obliged to do so, and to the best of the authors’ knowledge, for the first time, the glass cliff phenomenon in the Italian context.

The need to enhance student support is evident in higher education (HE) curricula. In addition to the complications created by the COVID-19 pandemic, the current strategies used in academia are criticised for their lack of appropriate student support in HE. The study focused on the themes under Section 4 of the National Student Survey (NSS): availability to contact tutors, receiving good advice and guidance and availability of good advice. The study aimed to provide recommendations for enhancing academic support by developing drivers that need implementation during course delivery.

A documental analysis and a qualitative survey were adopted for this study. A documental analysis of 334 mid-module reviews (MMRs) from levels three to six students in the built environment (BE) discipline. Critical themes identified from the MMRs were fed forward in developing a questionnaire for academics. A sample of 23 academics, including a Head of school, a Principal lecturer, Subject leads and Lecturers, participated in the questionnaire survey. Content analysis is adopted through questionnaire data to develop drivers to enhance academic support in BE. These drivers are then modelled by interpretive structural modelling (ISM) to identify their correlation to NSS Section 4 themes. A level partition analysis establishes how influential they are in enhancing academic support.

The study identified nine drivers, where two drivers were categorised as fundamental, two as significant, four as important, and one insignificant in enhancing academic support in HE. Module leaders’/tutors’ improving awareness and detailing how academic support is provided were identified as fundamental. Differentiating roles in giving advice and the importance of one-to-one meetings were identified as significant. A level partitioning diagram was developed from the nine drivers to illustrate how these drivers need to be implemented to promote the best practices in academic support in HE.

The identified drivers and their categories can be used to set prioritised guidelines for academics and other educational institutions to improve students’ overall satisfaction.

Novelty from the study will be the developed drivers and the level partitioning diagram to assist academics and academic institutions in successfully integrating academic support into HE curricula.

This study analyzes the advantages and disadvantages of the electoral mechanism of local education superintendents in South Korea, draws conclusions and makes suggestions for future reforms.

The research method of this study included document analysis and interviews. Document analysis was used to collect and analyze the relevant official documents of education superintendents across countries. Semi-structured interviews were conducted with four professors and two superintendents.

The results of the interviews indicate the following: 1) Korean stakeholders are getting more familiar with the direct election of superintendents, as the interviews indicate a more mature direct election system due to previous experience and public officials taking direct election into account; 2) The direct election of superintendents has advantages and disadvantages. The advantages include increasing the participation of the general public in education, and the disadvantages include conflict between the central government and local superintendents belonging to different political parties. However, the current system is likely to be retained; 3) The superintendent systems in various countries differ due to their respective traditions and social contexts. However, the authors can always learn lessons and implications from foreign countries if the authors compare their education systems with their foreign counterparts.

As far research limitations, although this was a small study, it shows the importance of collecting multiple stakeholders' views on the direct election of education superintendents as a basis for future reform of education management.

The Korean system for electing superintendents provides a good model for other countries reflecting on the educational autonomy and accountabilities of their own systems.

The direct election of superintendents provides an example of professionalism, independence and political neutrality in education that other countries can learn from. The separation of general and educational administration in Korea through direct elections protects educational activities from political influence.

In terms of originality/value, this study adds a new perspective to the debate about whether the general public should directly elect education superintendents, as well as to the literature on local education management.

Effectively engaging patients is critical for the sustainable development of online health communities (OHCs). Although physicians’ general knowledge-sharing, which is free to the public, represents essential resources of OHCs that have been shown to promote patient engagement, little is known about whether such knowledge-sharing can backfire when superfluous knowledge-sharing is perceived as overwhelming and anxiety-provoking. Thus, this study aims to gain a comprehensive understanding of the role of general knowledge-sharing in OHCs by exploring the spillover effects of the depth and breadth of general knowledge-sharing on patient engagement.

The research model is established based on a knowledge-based view and the literature on knowledge-sharing in OHCs. Then the authors test the research model and associated hypotheses with objective data from a leading OHC.

Although counterintuitive, the findings revealed an inverted U-shape relationship between general knowledge-sharing (depth and breadth of knowledge-sharing) and patient engagement that is positively associated with physicians’ number of patients. Specifically, the positive effects of depth and breadth of general knowledge-sharing increase and then decrease as the quantity of general knowledge-sharing grows. In addition, physicians’ offline and online professional status negatively moderated these curvilinear relationships.

This study further enriches the literature on knowledge-sharing and the operations of OHCs from a novel perspective while also offering significant specific implications for OHCs practitioners.

The European Union's Emissions Trading System (EU ETS), which is already one of the EU's most impactful instruments for reducing greenhouse gases (GHGs), will soon include the maritime transport industry. Although ports are this industry's most environmental-friendly component, there are still some barriers to including ports in the system. Therefore, the purpose of the study is to identify these barriers and to reveal the barriers' interrelationships.

The study was conducted by identifying barriers from a literature review before analyzing the barriers with the Fuzzy DEMATEL method. Finally, based on the Complex Adaptive System Approach, various solutions are proposed to overcome these barriers.

The identified barriers were grouped into cause-and-effect groups. Two barriers, namely long payback period and high investment costs, were evaluated as triggers of the model while the others were more sensitive to the model.

This study only includes the perceptions of green certificated ports in Türkiye. The results revealed an expectation that elimination of financial concerns will alleviate other barriers to including ports in the system. The study's findings can guide port managers on the integration of the managers' processes into the system.

This study provides novel findings regarding the relationships between barriers hindering ports from involvement in the EU ETS.

Despite the substantial body of international research exploring the effects of forced migration on mental health and the obstacles faced by refugee cohorts in accessing mental health services, there is a lack of in-depth studies specifically focusing on Bosnian refugees in Australia – one of the largest ethnic groups of displaced peoples. This qualitative investigation seeks to convey the experiences of mental health services by five Bosnian refugees in Melbourne, highlighting perceived pathways and barriers to service utilisation. This study aims to address two primary research questions: firstly, what characterises the experiences of Bosnian refugees in Australia when accessing mental health services? Secondly, what are the main barriers encountered by this population when seeking mental health services?

This study used qualitative inquiry and in-depth interviews to investigate the experiences of Bosnian refugees with mental health services in Australia. Data was collected through face-to-face interviews with five Melbourne-based Bosnian refugees who had previously accessed mental health services. Participants were recruited from community groups or associations using purposive sampling. Thematic analysis was used.

Key themes were revealed, such as the crucial role of social and community services, preferences for individual vs group therapy, potential re-traumatisation from therapeutic engagement, distrust of government-run mental health services and concerns regarding psychopharmaceutical prescription practices. Addressing barriers to mental health service access necessitates a multifaceted approach, including flexible social and community service support, an increased number of co-ethnic professionals and a recognition of cultural variations for effective service provision. Implementing these strategies can enhance help-seeking behaviours, provide culturally appropriate mental health services and improve the experiences of Bosnian refugees in Australia.

To the best of the authors’ knowledge, this study is the first to qualitatively explore how Bosnian refugees in Melbourne perceived the adequacy and availability of mental health services upon arrival to Australia. They are a large and potentially vulnerable community, due to experiences of war trauma and dislocation from country of origin. A lack of understanding regarding how this cohort engage with mental health services can lead to persistent inequities and ineffective service provision. This study identifies unique experiences and perspectives of Bosnian refugee participants, including distrust of government-run mental health services, and concerns regarding psychopharmaceutical prescription practices. This research is expected to contribute positively to the discourse on mental health service provision for Bosnian refugees and wider refugee communities in Australia.

This study aims to examine the impact of board characteristics on firm performance while also exploring the influential mechanisms that help Chinese listed companies establish effective boards of directors and strengthen their corporate governance mechanisms.

This paper uses machine learning methods to investigate the predictive ability of the board of directors' characteristics on firm performance based on the data from Chinese A-share listed companies on the Shanghai and Shenzhen stock exchanges in China during 2008–2021. This study further analyzes board characteristics with relatively strong predictive ability and their predictive models on firm performance.

The results show that nonlinear machine learning methods are more effective than traditional linear models in analyzing the impact of board characteristics on Chinese firm performance. Among the series characteristics of the board of directors, the contribution ratio in prediction from directors compensation, director shareholding ratio, the average age of directors and directors' educational level are significant, and these characteristics have a roughly nonlinear correlation to the prediction of firm performance; the improvement of the predictive ability of board characteristics on firm performance in state-owned enterprises in China performs better than that in private enterprises.

The findings of this study provide valuable suggestions for enriching the theory of board governance, strengthening board construction and optimizing the effectiveness of board governance. Furthermore, these impacts can serve as a valuable reference for board construction and selection, aiding in the rational selection of boards to establish an efficient and high-performing board of directors.

The study findings unequivocally demonstrate the superiority of nonlinear machine learning approaches over traditional linear models in examining the relationship between board characteristics and firm performance in China. Within the suite of board characteristics, director compensation, shareholding ratio, average age and educational level are particularly noteworthy, consistently demonstrating strong, nonlinear associations with firm performance. Within the suite of board characteristics, director compensation, shareholding ratio, average age and educational level are particularly noteworthy, consistently demonstrating strong, nonlinear associations with firm performance. The study reveals that the predictive performance of board attributes is generally more robust for state-owned enterprises in China in comparison to their counterparts in the private sector.