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Many healthcare institutions, such as hospitals, have recently implemented quality improvement initiatives such as Lean Six Sigma (LSS). However, only a few have sustained the initiatives and remained successful. One of the main reasons for the failure of LSS implementation is that managers tend to view LSS as individual projects. Managers lack a Change Management (CM) focus during the implementation. The primary purpose of this study is to document the implementation of LSS through a CM approach to improve sustainability.

Define-Measure-Analyse-Improve-Control (DMAIC) and the Awareness-Desire-Knowledge-Ability-Reinforcement (ADKAR), a popular CM approach, are combined to propose a new framework. The usefulness of the proposed framework is demonstrated using a case study in a multispeciality hospital located in southern India.

The study found that several factors are responsible for the high Length of Stay (LOS) for patients in the Emergency Department (ED). By implementing this proposed model to implement LSS and taking corrective actions, the average LOS was reduced from 267 to 158 min (a 40% reduction approximately).

The complete step-by-step approach is explained, and the LOS was considerably reduced during the pilot project. The findings will provide valuable insights for healthcare practitioners to understand the steps involved in the combined DMAIC-ADKAR model. The findings would also give healthcare practitioners the confidence to identify suitable tools and implement LSS in organisations where the practitioners work.

According to the authors' knowledge, this is the first study that synergises two models (DMAIC and ADKAR) into a single framework to implement in a hospital.

This paper aims to understand how the global supply chain in the medical device industry embraces resilience by adopting agility approach following COVID-19.

This study adopts an interpretative approach to examine the qualitative data drawn from interviews and observation under dynamic capability theory. The data collection concerned multiple stakeholders involved in purchasing and supply management in the medical device market: manufacturing suppliers, channel partners, hospital management and end-users. The coding analysis uses an application that helps the researchers categorise the nodes and extend the existing literature.

The findings show that global supply chain leaders leverage the dynamic capability by centralising the business process decision to respond to the shifting demand from the local governments to the national health ministry, shaping the partnership style from the area- to the funnel-based agreement, even though it exposes a risk of product acceptability from the end-users, encouraging the distributor to convert just-in-time approach into holding safety stock to avoid penalty from missing the procurement target even and restructuring the local partners’ debts to manage long-term performance.

This study extends the emerging literature in international business by underpinning dynamic capability theory.

In this paper, the authors examine auditor upward feedback, which provides a unique opportunity for staff auditors to exercise their voice within an audit firm. Upward feedback can improve employee perceptions of fairness and justice while mitigating feelings of burnout and turnover intentions, thus enhancing audit quality. However, it is unclear which circumstances improve the likelihood that auditors will use their voice and give feedback to superiors. The purpose of this study is to investigate contextual factors that impact the likelihood that auditors will provide upward feedback.

Using a 2 × 2 + 2 experiment with staff auditors, the authors test the likelihood of giving feedback when presented with different feedback systems (electronic anonymous, face-to-face or no opportunity) and experiences with managers (favorable or unfavorable).

The authors find that, while feedback type alone does not change the likelihood of auditors providing upward feedback, auditors are more likely to provide feedback after a favorable manager experience than an unfavorable one. The likelihood of providing feedback after an unfavorable experience is higher, however, when the feedback type is electronic and anonymous as opposed to face-to-face. Additional analyses illustrate strong relationships between manager experience, feedback type and procedural justice, which significantly influence the turnover intentions of staff auditors.

To the best of the authors’ knowledge, the authors are the first to examine the value of subordinates’ upward feedback on firm outcomes, including burnout and turnover intention.

This paper’s objective is to provide a systematic literature review of the contextual factors affecting downward communication from supervisors to subordinates in the audit environment. In addition, this review identifies emerging research themes and directions for future research.

I accomplish this review’s objectives by leveraging communication literature to establish a framework to identify and synthesize contextual factors affecting downward communication in the audit environment. The review identifies 50 published articles in the last 20 years from leading accounting and auditing journals.

This study consolidates research findings on downward communication under two primary contextual factors: (1) message and (2) channel. Findings indicate that empirical research examining communication in audit is fragmented and limited. Studies examining the message focus heavily on its content and treatment in the areas of feedback, nonverbal cues, and fraud brainstorming, and a handful of additional studies examine the effectiveness of the channel in these areas. Additional research is needed to understand a broader set of supervisor–subordinate communication practices, including those that are computer-mediated, and their effect on subordinate auditors’ judgments and behaviors in the contemporary audit environment.

Much of the audit literature examining communication to date is topic-versus construct-based, making it difficult to see how the research findings relate to one another. This review is the first to synthesize the literature to provide academics recommendations for a way forward, and inform practitioners of communication practices whereby supervisors can be trained to improve audit quality.

The purpose of this paper is to investigate the comment letters (CLs) in the standard-setting process of audits of less complex entities (LCEs). The objective is to gain insight into the overall picture of the CLs and to report on areas where comment providers agree or disagree with IAASB's Part 10.

A content analysis of 60 comment letter (CLs) was conducted to investigate the suggested additional Part 10 on audits of groups' financial statements in the proposed ISA for LCEs. Hence, this study examines three specific topics: (1) the views related to the use of the International Standard on Auditing (ISA) for LCEs for group audits in which component auditors are involved, (2) the proposed group-specific qualitative characteristics to describe the scope of group audits and, finally, (3) insights into the content of the proposed Part 10 and related conforming amendments. The Gioia method is used to provide a holistic approach to concept development of the arguments about the new Part 10.

The CLs stated that, while the proposed Part 10 has some weak points, it still provides a solid and practical structure within which to undertake an LCE group audit and a promising basis for further development. For instance, when discussing the improvements, the CLs stated that Part 10 should allow for more auditor judgment when determining when the involvement of component auditors renders a group audit complex. In addition, the CLs asserted that professional judgment should be engaged when considering the qualitative characteristics and the complexity of the group.

This study contributes to the very scarce research about the ISA for LCEs and the role of lobbying in shaping the audit standard-setting process.

This study aims to examine the direct influence of workplace bullying (WB) on internal auditors’ independence using the nexus between the agency theory and social exchange theory. From the internal auditors’ perspective, the investigation covered both government and private colleges and universities in one of the Middle East countries.

A survey was administered and delivered to internal auditors at each of the 85 educational institutions. A total of 267 valid questionnaires were analysed. The study’s measurement and structural models were tested and evaluated by using SmartPLS v.4 and partial least squares-structural equation modelling.

The study results indicated that bullying is common among senior managers, and that it has a significant, negative, high-level and direct effect on the independence of internal auditors in the higher education sector.

Regulators and other stakeholders should make a deliberate effort to promote positive behaviours and abandon negative ones regarding the independence of internal auditors and the performance of audit teams, which play a crucial role in enhancing the efficiency of audit units. For example, enhancing coordination and communication internally and externally. In addition to providing the internal auditors with equitable advancement and learning opportunities, senior management should also support their professional development.

To the best of the author’s knowledge, this study is the first to examine the relationship between WB and the internal auditor’s independence in the context of government and private organisations in Southwest Asian countries.

This study aims to investigate the extent to which audit committee (AC) members who are formally independent are truly independent in practice, and what challenges they face that undermine their independence.

The study utilizes semi-structured interviews with 18 members of the AC in Jordan.

The responses indicate that AC is mostly labelled as independent but fails to play an effective monitoring role due to different institutional factors. These factors include family ownership, government ownership, culture, compensation package and the lack of qualified directors.

This research addresses this gap by presenting qualitative evidence from a civil law jurisdiction, featured by a developing financial market, a prevalence of family businesses, limited investor protection and a low risk of litigation. Additionally, this study aims to rectify the current imbalance between qualitative and quantitative studies on AC and bridge the gap between research conducted in developed countries and their developing counterparts.

This study offers valuable insights for regulatory authorities to engage in a more profound contemplation of extant governance regulations. Also, this study offers useful feedback for nomination committees of public companies, and it also has an implication for shareholders as they rely on independent directors to protect their investment. Furthermore, implications of the findings derived from this research possess the potential for generalization to other developing nations characterized by akin institutional contexts, notably encompassing the countries situated in the Middle East and North Africa (MENA) region.

This research introduces novel qualitative empirical evidence from a distinctive jurisdiction governed by civil law, thereby enriching the existing scholarly discourse. It also contributes to the AC literature by suggesting that it is not only the existence of conventionally independent ACs that affect the integrity of financial statements, but also the absence of social ties and other contextual obstacles.

In recent decades, managerial desire to use internal audit services to promote well-controlled organizational processes has significantly increased in the public sector. Yet, there is rare information on how internal audits may effectively be implemented in the public sector. The present research aims to design a comprehensive internal audit effectiveness model for the public sector.

This research is an applied mixed-methods (qualitative–quantitative) and descriptive survey study. The research population in both qualitative and quantitative sections included all internal and external audit managers and staff of Iraqi public organizations. The study sample of the qualitative section included 28 audit managers and staff selected using purposive sampling, and the study sample of the quantitative section included 399 individuals selected using convenience sampling. The data collection instruments in the qualitative and quantitative sections included semi-structured interviews and questionnaires, respectively. Data analysis was carried out using thematic analysis in Atlas.ti software in the qualitative section. Quantitative analysis and model validation were also performed using path analysis and structural equation modeling in Smart-PLS software in the quantitative section.

The results of the qualitative section led to the identification of 38 effectiveness factors among seven main categories, which were finally presented in the form of a comprehensive model. The main categories included the communication between internal and external auditors, granting independence and authority to internal auditors, providing specialized human resources, providing technological resources, developing management support, strengthening organizational culture and developing audit plans. In the qualitative section, the model was validated and confirmed. Quantitative results further showed that the compilation of audit plans and the development of management support were the most important factors.

The present study contributes to the literature by providing a comprehensive framework on internal audit with an emphasis on resource-based theory and reducing the research gap in the field of agents influencing internal audit efficacy in the public sector of developing countries. Further, the study provides insights into an under-studied developing country, Iraq.

This study reviews and discusses the accounting literature that analyzes the role of auditors and enforcers in the context of fraud.

This literature review includes both qualitative and quantitative studies, based on the idea that the findings from different research paradigms can shed light on the complex interactions between different financial reporting controls. The authors use a mixed-methods research synthesis and select 64 accounting journal articles to analyze the main proxies for fraud, the stages of the fraud process under investigation and the roles played by auditors and enforcers.

The study highlights heterogeneity with respect to the terms and concepts used to capture the fraud phenomenon, a fragmentation in terms of the measures used in quantitative studies and a low level of detail in the fraud analysis. The review also shows a limited number of case studies and a lack of focus on the interaction and interplay between enforcers and auditors.

This study outlines directions for future accounting research on fraud.

The analysis underscores the need for the academic community, policymakers and practitioners to work together to prevent the destructive economic and social consequences of fraud in an increasingly complex and interconnected environment.

This study differs from previous literature reviews that focus on a single monitoring mechanism or deal with fraud in a broadly manner by discussing how the accounting literature addresses the roles and the complex interplay between enforcers and auditors in the context of accounting fraud.

In recent years, Corporate Citizenship has continued to grow in importance and significance. It has been the subject of considerable debate and commentary among researchers, corporate leaders and public institutions like NGOs and even capital market companies. The development of this concept in internal audit functions can improve the level of responsibility of companies. The purpose of this study is to design an internal audit model of a corporate citizen in Iranian capital market companies.

This research is methodologically in the category of developmental and combined research. In this study, two meta-synthesis and Delphi analyzes in the qualitative part and systematic representation analysis were used to determine the systematic relationships of the Internal Audit Corporate Citizen Components to strengthen environmental sustainability. Because of the mix of the data collection method in both qualitative and quantitative parts, the research participants in the qualitative part were 13 university experts in the field of accounting and 19 internal auditors of Iranian capital market companies who had specialized experience participated in the quantitative part.

The results in the qualitative section indicate the existence of 14 confirmed studies and the determination of 8 main components of the internal audit of the corporate citizen, during two stages of Delphi analysis, the level of reliability of the components was confirmed with the concept of internal audit of the corporate citizen. Based on the results of system representation model in quantitative part, it was determined that Environmental training to human resources is the primary stimulus for the system’s internal audit system representation to monitor the financial performance of the company to achieve environmental sustainability.

To the best of the authors’ knowledge, this is the first study to exemplify environmental sustainability by focusing on the concept of corporate citizen internal auditing. An area that, although of research importance in terms of developing theoretical literature and practical basis in reducing the financial reporting gap with an independent auditor, However, less research has been done on this issue and conducting this research and expanding it to the level of internal auditing profession can enhance the institutional and educational capacities on it at the international level and help to integrate the development of theoretical literature.