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Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.

Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).

The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.

Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.

This paper aims to identify the interaction of different intervention strategies implemented in Malaysia towards flattening the curve of COVID-19 cases. Since the outbreak of COVID-19, many approaches were adopted and implemented by the Malaysian government. Some strategies gained quick wins but with negative unintended consequences after execution, whereas other strategies were slow to take effect. Learning from the previous strategies is pivotal to avoid repeating mistakes.

This paper presents the cause, effect of and connection among the implemented COVID-19 intervention strategies using systems thinking through the development of a causal loop diagram. It enables the visualisation of how each implemented strategy interacted with each other and collectively decreased or increased the spread of COVID-19.

The results of this study suggested that it is not only essential to control the spread of COVID-19, but also to prevent the transmission of the virus. The Malaysian experience has demonstrated that both control and preventive strategies need to be in a state of equilibrium. Focusing only on one spectrum will throw off the balance, leaving COVID-19 infection to escalate rapidly.

The developed feedback loops provided policy makers with the understanding of the merits, pitfalls and dynamics of prior implemented intervention strategies before devising other effective intervention strategies to defuse the spread of COVID-19 and prepare the nation for recovery.

Recently, interest and necessity for cloud-based hospital information systems (HISs) have emerged as an appropriate alternative for revitalizing medical information exchange between hospitals, analyzing “big data” medical information and developing the use of new medical technologies. The purpose of this paper is to investigate factors that affect the switching of information systems in existing on-premise environments into cloud-based HISs.

A research model was developed using the push–pull–mooring model based on migration theory. The research model was analyzed using confirmatory factor analysis and path analysis using partial least squares structural equation modeling.

The results of this study showed that low compatibility, perceived value, low cost and inertia influenced the intention to switch to cloud-based HISs; low flexibility and low compatibility influenced dissatisfaction; and low cost, ease of maintenance and ease of managing indicators influenced perceived value.

This study is expected to be used as the basis for developing a research model in subsequent studies to analyze the transition to new innovative technologies. Also, in practice, it is expected to contribute to the activation of cloud computing environments in hospitals.

During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs.

We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC.

We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals’ commitment; (2) information technology and the controller’s technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance.

The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.

This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of “upstreamist”, health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department.

Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of “upstreamist” system leadership to advance the integration of health care.

Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with “upstreamist” system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED.

At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services.

This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps.

To the best of the authors’ knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop “Esther” patient-centred approaches in the design of integrated health and care services.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

Lean healthcare (LHC) applies lean philosophy in the healthcare sector to promote a culture of continuous improvement through the elimination of non-value-added activities. Studies on the subject can be classified as conceptual (theoretical) or analytical (applied). Therefore, this research compares bibliometric indicators between conceptual and analytical articles on LHC.

For data collection, the PRISMA Protocol was employed, and 488 articles published from 2009 to 2021, indexed in the Scopus and WoS databases, were retrieved.

This study reveals how conceptual and analytical LHC studies are organized in terms of the most relevant journals, articles, institutions, countries, the total number of citations, collaboration networks (co-authorship, international collaboration network and institutional collaboration network) and main co-words.

Only four papers conducting bibliometric analysis on LHC studies were identified in the Scopus and Web of Science databases. In addition, none of these papers compared conceptual and analytical bibliometric indicators to reveal the evolution, organization and trends of each category. Therefore, this work is not only the first to make this comparison but also the first to analyze the collaboration between authors, institutions and countries in relation to studies on LHC. The analyses performed in this work allow one new possible understanding, by researchers and health professionals, of the literature behavior in this field of study.

Previous research provides adequate evidence on performance management (PM) for hospitals and healthcare providers; however, less is known about their individual and PM appraisal process. Additionally, there is limited research exploring PM in the Middle Eastern context. This study investigates PM practices in the Middle Eastern healthcare industry.

This study adopts the qualitative research methodology through semi-structured interviews of healthcare professionals in Kingdom of Saudi Arabia and the United Arab Emirates. Thematic analysis was adopted for analyzing this qualitative data.

The main findings have uncovered different facets of appraisal challenges for both the appraiser (i.e. manager) and the appraisee (i.e. employee). These challenges include communication deficits, lack of goal setting standards and regular meeting updates in order to ensure employee satisfaction and motivation in the workplace.

This study has significant implications for policymakers in Middle Eastern hospitals in terms of implementing PM for their staff. Moreover, future studies can conduct in-depth analysis and provide comparison between public and private sectors in the Gulf countries.

This study is one of the first to portray challenges involved in conducting PM in the Middle East healthcare sector specifically in the UAE and Kingdom of Saudi Arabia (KSA), both from the perspectives of the appraiser and appraisee.

This study aims to examine the relationship between neutrophil to lymphocyte ratio (NLR), handgrip strength (HGS) and nutritional status in non-critically ill patients and outpatients.

A cross-sectional study was conducted on 80 geriatric patients. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form, Geriatric Nutritional Risk Index, some anthropometric and biochemical parameters. NLR was calculated from the complete blood count results. Data were analyzed using SPSS 24.0.

While 38.3% of patients were malnourished or at risk of malnutrition, 61.7% had normal nutritional status. Mini Nutritional Assessment Short Form was not correlated with NLR, whereas it showed a weak positive correlation with HGS. According to the logistic regression analysis, age, HGS, hemoglobin and platelet to lymphocyte ratio were significant independent factors for predicting malnutrition or risk of malnutrition. The receiver operator characteristic curve analysis showed that the optimum HGS cut-off point for patients with malnourished or at risk of malnutrition was 13.2. In conclusion, HGS was associated with the nutritional status. NLR was not associated with nutritional status but associated with nutritional risk.

It is well known that malnutrition is a serious health problem among older adults, and it is important to assess the nutritional status of older adults because of the adverse health effects. In addition, to the best of the authors’ knowledge, this is the first study to determine the relationship between NLR, HGS and nutritional status in non-critically ill patients and outpatients.