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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.

The authors aimed to investigate whether the competencies of public servants (self-competence, teamwork competence, change competence, communication competence (CC) and ethical competence) influence their organizational commitment and indirectly their job satisfaction.

Based on a structural model from the literature, the authors conducted a survey with 463 Brazilian public servants using a questionnaire, and the authors evaluated the measurement model through confirmatory component analysis (CCA). Then, the authors used partial least squares structural equation modeling (PLS-SEM) to analyze the structural model.

The authors' results showed that the ethical competence construct tends to have a direct positive influence on the organizational commitment construct and indirectly influences the job satisfaction of public servants. On the other hand, the authors found that the self-competence, teamwork competence, change competence and CC constructs did not impact organizational commitment or job satisfaction indirectly.

The authors conclude that developing ethical competence in public servants is likely to increase their organizational commitment and indirectly positively affect their job satisfaction. This research tested the five dimensions of competencies under a new focus, public service, seeking to evidence their relationships with the organizational commitment and job satisfaction of public servants, filling a gap in the literature.

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.