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The reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues.

Lean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems.

The corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified.

The follow up and the satisfaction of patients were not analyzed and could be a future development of this study.

Patients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management.

The introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs’ with a money saving of more than 50,000 euro per year.

Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

The authors aimed to contribute to the interface of comparative international entrepreneurship and international marketing by exploring the micro-foundations and micro-processes of network bricolage aimed at international market entry among the entrepreneurs of small biotechnology firms. The research questions of the study are (1) How do the international entrepreneurs of small firms act and use their domestic and/or international networks for new market entry? (2) How are the micro-foundations and micro-processes of networking similar or different between individuals from different countries?

A qualitative research design was used to investigate six cases from different countries of origin, looking at the micro-foundations and micro-processes underlying international market entry undertaken by entrepreneurs from Canada, Finland and New Zealand.

The micro-foundations for network bricolage by international entrepreneurs were taken to involve features of the country of origin, including market size and location, and the usefulness of the official language of the nation. The micro-processes were taken to involve the international entrepreneur’s network bricolage actions (i.e. collaborating and generating, obtaining and applying, reaching and maintaining, and seeking and reviewing), while encompassing also the location of their networks (domestic and/or international) and the operational domains these belonged to (R&D, funding, sales channel and customer). The study categorised three types of international entrepreneurs undertaking new market entry, illustrating cross-national differences: (1) sales-channel-oriented seekers, (2) funding-oriented riders and (3) customer-oriented hunters.

The study contributes to research on comparative international entrepreneurship and international marketing. This findings show that national-level micro-foundations influence the actions of network bricolage, the importance of various operational domains and the location of the network ties used. This main contribution is a conceptual model based on our cross-national investigation of international entrepreneurs’ networking actions. The authors reveal the micro-foundations and micro-processes relevant to international entrepreneurs’ network bricolage for new market entry, and present examples of international entrepreneur types emerging from our cross-national setting.

Three different pedagogical approaches grounded in three different definitional foundations of entrepreneurship have been compared in relation to their effects on students. They are: (1) “Idea and Artefact-Creation Pedagogy” (IACP), grounded in opportunity identification and creation, (2) “Value-Creation Pedagogy” (VaCP), grounded in value creation and (3) “Venture-Creation Pedagogy” (VeCP), grounded in organisation creation.

Data were collected at 35 different sites where education was deemed to be entrepreneurial and experiential. A quantitative, smartphone app-based data collection method was used alongside a qualitative interview approach. 10,953 short-survey responses were received from 1,048 participants. Responses were used to inform respondent selection and discussion topics, in 291 student and teacher interviews. Comparative analysis was then conducted.

The three approaches resulted in very different outcomes, both in magnitude and in kind. VaCP had strong effects on entrepreneurial competencies, on student motivation and on knowledge and skills acquisition. VeCP had weaker effects on knowledge and skills acquisition. IACP had weak effects on all outcomes probed for. Differences were attributed to variation in prevalence of certain emotional learning events and to variation in purpose as perceived by students.

VaCP could serve as an escape from the potential dilemma faced by many teachers in entrepreneurial education, of being caught between two limiting courses of action; a marginal VeCP approach and a fuzzy IACP one. This could prompt policymakers to reconsider established policies. However, further research in other contexts is needed, to corroborate the extent of differences between these three approaches.

Most impact studies in experiential entrepreneurial education focus only on organisation-creation-based education. This study contributes by investigating entrepreneurial education that is also grounded in two other definitional foundations. Allowance has been made for novel comparative conclusions.

Focusing on critical discourse analysis, this paper aims to propose a framework for analysing the way activist anti-tourism groups construct their social action of protest. The authors argue that activist groups use different narrative strategies to construct and legitimise their discourse of protest to convey social meanings for social action practices. This study represents an attempt to explain how anti-tourism activist groups have the agency to build different paradigms of protest rooted in particular views of tourism.

As a result of the lack of research in this area, this study used a comparative case study methodology drawn on four case studies in the field of anti-tourism protest. Case study is deemed adequate to explore a complex social phenomenon, how activist groups differ from each other, in a specific socio-economic context. A critical discourse analysis method is used to study primary (interviews) and secondary sources (reports, websites and online campaigns documents) of information, which express the activist group motivations and objectives to protest against tourism.

This study’s findings provide evidence in how discourse differs among the protest groups. Three narrative paradigms of protest are identified, which guide their agency: scepticism, based on a global and ecological approach; non-interventionist transformation, rooted in local community issues; and direct transformation, based on a sectoral problem-solving approach. These differences are interpreted as the consequences of the emergence and the development of different paths of protest according to specific social contexts and power relations in which anti-tourism groups are embedded.

This paper provides a contemporary approach to anti-tourism activism within the context of social movements. This case study may be of interest to practitioners and international destination managers interested in gaining a better understanding of anti-tourism protest strategies, new anti-tourism narratives following COVID-19 and the opportunities and challenges for opening a dialogue with those involved in activism and social urban movements as part of sustainable tourism governance. Our results can also help activists to rethink how they integrate differences and particular strategic positions to avoid hindering collective action. This knowledge is especially useful for managers and authorities seeking to develop more accurate collaborative governance practices with local activists, and especially those interested in fostering participative action without marginalising the diverse range of local community perspectives.

Diabetes is regarded as a global epidemic with 382 million people globally suffering from diabetes. It also has major implications on patients’ quality of life. There are also high cost of treatment associated with diabetes for both patient and healthcare provider. Telemonitoring represents an excellent technology opportunity to redefine health care delivery. Using technology for home-based care promises the ability to deliver more cost effective care whilst also enhancing quality of care and patient satisfaction. The paper aims to discuss these issues.

The current research aims to contribute to the methodological design of action research projects in their use to implementation health technologies such as telemonitoring. In particular, it seeks create a model which can be used to demonstrate the efficacy of the use of the action research method as a viable alternative to the traditional randomised control trials methodology currently employed in healthcare.

The paper contributes towards the methodological design to investigate the area of practice making use of the telemonitoring programme within a Victorian Health Services Network using action research.

It intends to address the research problem of the low utilisation of telemonitoring within Monash Health as a whole, and more specifically within the diabetes unit. In this context the research intends to utilise the benefits of telemonitoring to improve clinical outcomes of patients by increasing insulin stabilisation. It is also intended the research organisation benefits by increased efficiency by decreasing clinical workforce time spent on managing patient insulin data.

In this research, the authors demonstrate the advantage of reinforcement learning (RL) based intrusion detection systems (IDS) to solve very complex problems (e.g. selecting input features, considering scarce resources and constrains) that cannot be solved by classical machine learning. The authors include a comparative study to build intrusion detection based on statistical machine learning and representational learning, using knowledge discovery in databases (KDD) Cup99 and Installation Support Center of Expertise (ISCX) 2012.

The methodology applies a data analytics approach, consisting of data exploration and machine learning model training and evaluation. To build a network-based intrusion detection system, the authors apply dueling double deep Q-networks architecture enabled with costly features, k-nearest neighbors (K-NN), support-vector machines (SVM) and convolution neural networks (CNN).

Machine learning-based intrusion detection are trained on historical datasets which lead to model drift and lack of generalization whereas RL is trained with data collected through interactions. RL is bound to learn from its interactions with a stochastic environment in the absence of a training dataset whereas supervised learning simply learns from collected data and require less computational resources.

All machine learning models have achieved high accuracy values and performance. One potential reason is that both datasets are simulated, and not realistic. It was not clear whether a validation was ever performed to show that data were collected from real network traffics.

The study provides guidelines to implement IDS with classical supervised learning, deep learning and RL.

The research applied the dueling double deep Q-networks architecture enabled with costly features to build network-based intrusion detection from network traffics. This research presents a comparative study of reinforcement-based instruction detection with counterparts built with statistical and representational machine learning.

This study aims to systematise the methodology used in comparative urban planning law and propose primary contexts for comparison in planning law.

This study undertook a review of comparative law methodology discourse and sought to establish connections between the discourse and the field of planning law.

This study argues for establishment of a realistic goal for comparative planning law by focusing on the planning law's modifiability. The goal of comparison in planning law should not be to find universally desirable principles or better solutions. Rather, the goal should be to identify a motive for devising a solution. This is because it is not only difficult to establish legal values that are universally applicable to planning law but also inappropriate to determine superiority of planning laws that have been developed over time by each jurisdiction’s sovereignty and policies on land use. When determining comparable systems for analysis among legal systems that are functionally equivalent, it is important to consider the context of land use relations alongside the comparative analysis to be done. To set realistic goals, the context should not be extended indefinitely but be systematised. Based on the foundational relationship underlying planning law, including the tension between planning authorities and property owners, this study presents five specific contexts for comparative analysis: “Strength of Property Rights,” “Level of Judicial Intervention,” “Plan- or Development-led System,” “Allocation of Planning Power” and “Level of Participation.” Examination of these contexts will allow better understanding of the similarities and differences among different systems and practical application of the results of comparative studies.

This study presents a novel approach to systematising the methodology and framework of comparative planning law.

The paper provides a detailed historical account of Douglass C. North's early intellectual contributions and analytical developments in pursuing a Grand Theory for why some countries are rich and others poor.

The author approaches the discussion using a theoretical and historical reconstruction based on published and unpublished materials.

The systematic, continuous and profound attempt to answer the Smithian social coordination problem shaped North's journey from being a young serious Marxist to becoming one of the founders of New Institutional Economics. In the process, he was converted in the early 1950s into a rigid neoclassical economist, being one of the leaders in promoting New Economic History. The success of the cliometric revolution exposed the frailties of the movement itself, namely, the limitations of neoclassical economic theory to explain economic growth and social change. Incorporating transaction costs, the institutional framework in which property rights and contracts are measured, defined and enforced assumes a prominent role in explaining economic performance.

In the early 1970s, North adopted a naive theory of institutions and property rights still grounded in neoclassical assumptions. Institutional and organizational analysis is modeled as a social maximizing efficient equilibrium outcome. However, the increasing tension between the neoclassical theoretical apparatus and its failure to account for contrasting political and institutional structures, diverging economic paths and social change propelled the modification of its assumptions and progressive conceptual innovation. In the later 1970s and early 1980s, North abandoned the efficiency view and gradually became more critical of the objective rationality postulate. In this intellectual movement, North's avant-garde research program contributed significantly to the creation of New Institutional Economics.

The purpose of this paper is to introduce translational mobilization theory (TMT) and explore its application for healthcare quality improvement purposes.

TMT is a generic sociological theory that explains how projects of collective action are progressed in complex organizational contexts. This paper introduces TMT, outlines its ontological assumptions and core components, and explores its potential value for quality improvement using rescue trajectories as an illustrative case.

TMT has value for understanding coordination and collaboration in healthcare. Inviting a radical reconceptualization of healthcare organization, its potential applications include: mapping healthcare processes, understanding the role of artifacts in healthcare work, analyzing the relationship between content, context and implementation, program theory development and providing a comparative framework for supporting cross-sector learning.

Poor coordination and collaboration are well-recognized weaknesses in modern healthcare systems and represent important risks to quality and safety. While the organization and delivery of healthcare has been widely studied, and there is an extensive literature on team and inter-professional working, we lack readily accessible theoretical frameworks for analyzing collaborative work practices. TMT addresses this gap in understanding.