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This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

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.

This article presents a novel case study that analyzes the applicability of DoE in the curling sport in order to improve their own performance and the performance of its athletes. Specifically, this study analyzes the most important factors to increase accuracy and precision in the draw game with curlers' opinions. It was decided to use the “Last Stone Draw (LSD)’ as an appropriate play situation.

Specifically, this study analyzes most important factors to increase accuracy and precision in the draw game with curlers opinions from the German Curling association. Three research techniques were used in this study: case study, interviews and a well-designed experiment. The analysis through the use of DoE includes a measurement system analysis, an initial variance test between two players, a screening and a characterization experiment.

The results obtained from DoE suggest that the factors routine, stress, release, balance, and the previous play situation have a substantial impact on the score of the player's draw game. However, no factor has a statistically significant impact on the average distance to the center of the target. Moreover, the DoE analysis also concludes that the accuracy and precision of the player's performance is not affected equally by all analyzed factors, but they turn into highly significant when examining their relationship to the other factors.

The findings of this study can be beneficial to other sports events in improving the performance. Moreover, DoE has proved to be an invaluable tool for many people in the German Curling Association in understanding the factors which influence the curlers performance and also factors which do not affect the curlers performance.

This research attempts to contribute to the existing sports management literature by identifying a way in which DoE can be an effective tool in non-manufacturing settings for identification of most important factors which influence the curling performance.

This research aims to systematically review studies on significant risks for Critical Infrastructure Projects (CIPs) from selected top-tier academic journals from 2011 to 2023.

In this research, a three-step systematic literature review methodology was employed to analyse 55 selected articles on Critical Infrastructure Risks (CIRs) from well-regarded and relevant academic journals published from 2011 to 2023.

The findings highlight a growing research focus on CIRs from 2011 to 2023. A total of 128 risks were identified and grouped into ten distinct categories: construction, cultural, environmental, financial, legal, management, market, political, safety and technical risks. In addition, literature reviews combined with questionnaire surveys were more frequently used to identify CIRs than any other method. Moreover, oil and gas projects were the subjects most often explored in the reviewed papers. Furthermore, it was observed that publications from Iran, the USA and China dominated CIRs research, making significant contributions, accounting for 49.65% of the analysed articles.

This research specifically focuses on five types of CIPs (i.e. roadways, bridges, water supply systems, dams and oil and gas projects). Other CIPs like cyber-physical systems or electric power systems, were not considered in this research.

Governments and contracting firms can benefit from the findings of this study by understanding the significant risks associated with the execution of CIPs, irrespective of the nation, industry or type of project. The results of this investigation can offer construction professionals valuable insights to formulate and implement risk response plans in the early stages of a project.

As a novel literature review related to CIRs, it lays the groundwork for future research and deepens the understanding of the multi-faceted effects of these risks, as well as sets practical response strategies.

As an emerging technology, Radio Frequency IDentification (RFID) and blockchain have the potential to disrupt many areas of business and social structure. However, it is loaded with significant technical, social, legal, financial and ethical complications that bring difficulty in its widespread use within the public distribution system (PDS). This research aims to analyze the barriers to integrated RFID and blockchain adoption in developing countries' PDS. Furthermore, this study also aims to validate the proposed framework against the Indian PDS.

The proposed framework consists of 10 potential barriers to integrated RFID and blockchain adoption. To identify the barriers, this study referred to the extant literature followed by consultations with domain experts. This study prepared the DEMATEL-based questionnaires, collected the data from four domain experts and analyzed them using an integrated Grey-DEMATEL approach.

The obtained results provide a precise list of barriers and the correlations among them. From the results, it is concluded that the unavailability of a skilled workforce at affordable cost, lack of knowledge about privacy level and unclear return on investment and benefits are the most critical blockchain adoption barriers in the context of Indian PDS.

This research proposes a framework consisting of 10 integrated RFID and blockchain adoption barriers in relation to Indian PDS. It also proposes a method for analyzing causal interrelationships between the barriers while allowing for data input from domain experts. Consequently, the framework is capable of coping with experts' biases and data scarcity.

The apparel and textile sector poses a significant environmental challenge due to its substantial contribution to pollution in the form of air, water and soil pollution. To combat these issues, the adoption of sustainable practices is essential. This study aims to identify and analyse the barriers that hinder the progress of sustainability in the apparel and textile industry. By consulting experts in the field, critical barriers were identified and given special attention.

To achieve the research objective, an integrated approach involving Interpretive Structural Modelling (ISM) and fuzzy MICMAC decision-making techniques was employed. The results were further validated through the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method.

The findings highlight that barrier related to clothing disposal, inadequate adaptation to modern technology, challenges affecting sector efficiency and issues related to fashion design are crucial in influencing the remaining six barriers. Based on the outcomes of the DEMATEL method, a comprehensive cause-and-effect diagram was constructed to gain a deeper understanding of these challenges.

This research provides valuable insights for policymakers and stakeholders in the apparel and textile industry. It offers a strategic framework to address and overcome sustainability barriers, promoting the development of a more environmentally responsible and resilient sector.

The purpose of this research is to conduct an in-depth investigation of the barriers apparel and textile sectors. It is feasible that both the management team and the medical experts who provide direct patient care could benefit from this research.

This article aims to focus on implementing Lean Six Sigma (LSS) in steel manufacturing to enhance productivity and quality in the galvanizing process line. In recent trends, manufacturing organizations have expressed strong interest in the LSS since they attempt to enhance its overall operations without imposing significant financial burdens.

This article used lean tools and Six Sigma's DMAIC (Define, Measure, Analyze, Improve and Control) with Yin's case study approach. This study tried to implement the LSS for the steel galvanizing process in order to reduce the number of defects using various LSS tools, including 5S, Value stream map (VSM), Pareto chart, cause and effect diagram, Design of experiments (DoE).

Results revealed a significant reduction in nonvalue-added time in the process, which led to improved productivity and Process cycle efficiency (PCE) attributed to applying lean-Kaizen techniques. By deploying the LSS, the overall PCE improved from 22% to 62%, and lead time was reduced from 1,347 min to 501 min. DoE results showed that the optimum process parameter levels decreased defects per unit steel sheet.

This research demonstrated how successful LSS implementation eliminates waste, improves process performance and accomplishes operational distinction in steel manufacturing.

Since low-cost/high-effect improvement initiatives have not been adequately presented, further research studies on adopting LSS in manufacturing sectors are needed. The cost-effective method of process improvement can be considered as an innovation.

To develop a fuzzy causal model of enterprise flexibility dimensions in a case study of Indian pharmaceutical industry.

The eight dimensions of enterprise flexibility were identified based on literature review. Fermatean fuzzy decision-making trail and evaluation laboratory (FF-DEMATEL) technique is applied to develop the cause-and-effect interrelationship model among various enterprise flexibility dimensions.

The information technology flexibility, supply chain flexibility, technical flexibility and marketing flexibility are found to be causing/influencing other flexibilities and contributing to overall enterprise flexibilities. Therefore, more attention needs to be paid to develop and sustain them for competitive advantage.

Fermatean fuzzy sets offer more flexibility and more accurate handling complex uncertain group decision making. FF-DEMATEL is a more accurate method to develop inter-dependencies and causal model than ISM, TISM. Ratings from the limited number of decision experts (DEs) from few pharmaceutical firms were done. Future study should take bigger sample of firms and more number of DEs to generalize the findings.

The model will help managers in pharmaceutical industry to prioritize the dimensions of enterprise flexibility to achieve agility, responsiveness, resilience and competitive advantage.

To the best knowledge of the authors, causal modeling enterprise flexibility dimensions using FF-DEMATEL has been studied for the first time in a developing economy context.

Effective total quality management (TQM) practices rely on the accurate classification of critical success factors (CSFs). The impact matrix cross-reference multiplication technique for classification (MICMAC) or/and fuzzy MICMAC (FMICMAC) can be used to identify key factors in the complex set. However, TQM includes both “hard” and “soft” factors, limiting application of the traditional MICMAC/FMICMAC method.

Previous literature on TQM was reviewed, CSFs were identified, and factors were sorted into soft and hard categories. The combined fuzzy integration and dual-aspect MICMAC (fuzzy dual-aspect MICMAC approach) was then applied to identify, cluster and prioritize the CSFs of TQM.

A total of 20 factors (10 soft and 10 hard) were identified and isolated to assess the manufacturing- and service-related TQM practices of the Pearl River Delta Region of China. Seven driver factors and one linkage factor emerged as the key CSFs that managers should prioritize.

A major limitation of this study is the dependency of the results on the definitions of linguistic labels. If the linguistic definitions of TQM CSFs do not closely correspond to the expert opinion data, then the analysis results may be inaccurate. Additionally, although expert opinions are utilized in the proposed method for comprehensive assessments, these opinions may influence the final results due to their inherent subjectivity.

A novel fuzzy dual-aspect MICMAC approach was developed to identify and classify CSFs for optimal TQM practices. This approach allows clustering of CSFs so that decision-makers can prioritize factors according to their dependence and driving powers. Practitioners should concentrate on the CSFs with higher driving powers for successful TQM.

The purpose of this paper is to identify and analyze the interdependence of project complexity factors (PCFs) in metro rail projects using the Decision-Making Trial and Evaluation Laboratory (DEMATEL). The study provides qualitative and quantitative analysis of project complexities factors and their relationships. The results of the study facilitate effective project planning, proactive risk management and informed decision-making by stakeholders.

This study employs a case-based method for identifying PCFs and a DEMATEL method for analyzing the interdependence of complexity factors in metro rail projects. Initially, PCFs were identified through an extensive literature review. To validate and refine these factors, semi-structured interviews were conducted with thirty experienced professionals, each having 5–20 years of experience in roles such as project management, engineering, and planning. Further, elevated and underground metro rail projects were purposefully selected as cases, for identifying the similarities and differences in PCFs. A questionnaire survey was conducted with various technical experts in metro rail projects. These experts rated the impact of PCFs on a five-point Likert scale, for the evaluation of the interdependence of PCFs. The DEMATEL technique was used to analyze the interdependencies of the PCFs.

Metro rail projects are influenced by project complexity, which significantly impacts their performance. The analysis reveals that “design problems with existing structures,” “change in design or construction” and “land acquisition” are the key factors contributing to project complexity.

The study of project complexity in metro rail projects is limited because most of the studies have studies on examining complexity in mega projects. The existing literature lacks adequate attention in identifying project complexity and its effects on metro rail project performance. This research aims to bridge this gap by examining project complexity and interdependencies in metro rail projects.