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The purpose of this paper is to provide details on a study to determine the wait time and service time for various emergency department (ED) patient care processes and to apply the science of plan‐do‐study‐act (PDSA) cycles to improve patient flow.

The paper used direct observation to collect patient flow data on 1,728 patients at multiple ED sites in Saskatchewan, Canada. It calculated wait times and services associated with important care processes and then tested, measured and implemented ideas to reduce wait time.

On an average, patients spend nearly five hours in the ED with about one‐half of the visit devoted to waiting for the next required service to take place. Waiting for an inpatient bed, specialist consultation or physician reassessment comprised relatively long wait times. Through the use of visual reminders and standard process worksheets, quality improvement teams were able to achieve large reductions in physician reassessment waiting time. These improvements required minimal materials cost and no additional staff.

The case study featured EDs within a particular Canadian province, so may not be generalizeable to other settings. We only sampled a fraction of ED patients at each facility.

Admitted patients waiting for a hospital bed represent a key contributor to ED congestion. PDSA cycles are a valuable approach to achieving quality improvement in health care.

The paper fulfils an identified need by breaking down an ED patient's waiting time into several high‐level processes. It also applies improvement science to ED patient flow.

Citizens are substantial stakeholders in every e-government system, thus their willingness to use and ability to access the system are critical. Unequal access and information and communication technology usage, which is known as digital divide, however has been identified as one of the major obstacles to the implementation of e-government system. As digital divide inhibits citizen’s acceptance to e-government, it should be overcome despite the lack of deep theoretical understanding on this issue. This research aimed to investigate the digital divide and its direct impact on e-government system success of local governments in Indonesia as well as indirect impact through the mediation role of trust. In order to get a comprehensive understanding of digital divide, this study introduced a new type of digital divide, the innovativeness divide.

The research problems were approached by applying two-stage sequential mixed method research approach comprising of both qualitative and quantitative studies. In the first phase, an initial research model was proposed based on a literature review. Semi-structured interview with 12 users of e-government systems was then conducted to explore and enhance this initial research model. Data collected in this phase were analyzed with a two-stage content analysis approach and the initial model was then amended based on the findings. As a result, a comprehensive research model with 16 hypotheses was proposed for examination in the second phase.

In the second phase, quantitative method was applied. A questionnaire was developed based on findings in the first phase. A pilot study was conducted to refine the questionnaire, which was then distributed in a national survey resulting in 237 useable responses. Data collected in this phase were analyzed using Partial Least Square based Structural Equation Modeling.

The results of quantitative analysis confirmed 13 hypotheses. All direct influences of the variables of digital divide on e-government system success were supported. The mediating effects of trust in e-government in the relationship between capability divide and e-government system success as well as in the relationship between innovativeness divide and e-government system success were supported, but was rejected in the relationship between access divide and e-government system success. Furthermore, the results supported the moderating effects of demographic variables of age, residential place, and education.

This research has both theoretical and practical contributions. The study contributes to the developments of literature on digital divide and e-government by providing a more comprehensive framework, and also to the implementation of e-government by local governments and the improvement of e-government Readiness Index of Indonesia.

To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States.

Data were derived from 13 semistructured focus groups, plus three semistructured interviews, and were analyzed inductively consistent with a grounded theory approach.

Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, nonphysician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers.

Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power.

This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

While there was heightened awareness on the technologies of the fourth industrial revolution (IR 4.0) prior to COVID-19, studies have shown that the adoption of these advanced technologies (e.g. Big Data, robotics, Internet of Things, etc.) continues to remain low across global industries. This qualitative study sought to explore the reasons for the low rate of adoption of these technologies and appropriate measures to enhance their adoption at hotels, through the lens of hotel executives.

Based on interpretivist's ideals, this study follows a case study design and adopts a qualitative method of enquiry. The heterogenous purposive sampling technique was employed to gather data for the study, using semi-structured interviews.

Grounded on the technology-organisation-environment (TOE) framework, the thematic analysis revealed technology, organisation and environment-related reasons for the low rate of IR 4.0 technologies adoption at hotels in Malaysia. Also, the study uncovered some interesting measures that will enhance the adoption of these advanced technologies at hotels.

This study unearths technology, organisation and environment-related reasons for low adoption, and measures to enhance the adoption of IR 4.0 technologies in hotels. This study also enlightens hotel owners and technology providers about practical issues that will ensure the successful adoption of such technologies to enhance hotel business. In line with SDG 9, this study also seeks to promote sustainable innovation in the hospitality industry. Practical and theoretical implications have also been discussed in this study.

Serious questions have been raised regarding the necessity to continue focusing our research on what constitutes individual, or what the authors refer to as singular leadership. Although the authors consider these questions to be important to advancing the field of leadership theory, research, and practice, they also suggest that attempts to minimize the relevance of singular leadership may hinder progress in other domains of leadership research. In this chapter, the authors explore how and why singular leaders and their leadership matter, and how they may influence follower, peer, and organizational outcomes. The authors use a paradoxical framework to present a theoretical model and propositions that allow us to clarify the influence of different forms of singular leadership within organizations. In our examination of singular leadership, the authors consider both positive and harmful modes of attributes, cognitions, and behaviors.

Motivated by the growing importance of the expected shortfall in banking and finance, this study aims to compare the performance of popular non-parametric estimators of the expected shortfall (i.e. different variants of historical, outlier-adjusted and kernel methods) to each other, selected parametric benchmarks and estimates based on the idea of forecast combination.

Within a multidimensional simulation setup (spanned by different distributional settings, sample sizes and confidence levels), the authors rank the estimators based on classic error measures, as well as an innovative performance profile technique, which the authors adapt from the mathematical programming literature.

The rich set of results supports academics and practitioners in the search for an answer to the question of which estimators are preferable under which circumstances. This is because no estimator or combination of estimators ranks first in all considered settings.

To the best of their knowledge, the authors are the first to provide a structured simulation-based comparison of non-parametric expected shortfall estimators, study the effects of estimator averaging and apply the mentioned profiling technique in risk management.