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The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

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.

This study aims to evaluate the dementia assessment and diagnosis care provided to adults with intellectual disability. The authors selected recommendations from the National Institute for Health and Care Excellence (NICE) standards which could be evidenced in clinical notes and aimed to identify characteristics which may be associated with improved adherence to these recommendations.

The study population was adults with an intellectual disability who were diagnosed with dementia between January 2019 and December 2022 by a UK-based intellectual disability service. Data to demonstrate adherence to selected recommendations and demographic and clinical characteristics were extracted from electronic patient records.

The authors identified 41 individuals. A mean of six of the eight recommendations were adhered to. There was low adherence with structural imaging to support dementia subtype diagnosis (9 individuals, 22%). This may be linked with the low percentage of people diagnosed with vascular dementia (1 individual, 2%) despite a national figure of 20%. No demographic or clinical characteristics were associated with level of adherence recorded. The authors found incomplete recording of diagnostic clinical coding in electronic patient records. This may disadvantage this population, as they cannot be readily identified for post diagnostic support or resource allocation.

To the best of the authors’ knowledge, this is the first study to examine adherence to these NICE guidelines in this population.

The massive expansion of digital platform has been responsible for the widespread progressive engagement created amongst learners and educators. The practice of requiring student feedback on online learning services ensures that teacher education continues to advance its strategic approach to online learning. This paper aims to examine the level of accessibility and adaptability of digital technology with particular focus on Malaysia, by elaborating the value of superior learning service and practical adaptability of online learning during the pandemic era.

This study was conducted using qualitative approach of data collection, namely via structured interview. The listed respondents included 30 higher learners who participated in the study by providing feedback on the issues encountered during the research process.

The findings revealed that the strategic enhancement of digital accessibility continued with digital adaptability to sources of learning services would contribute to advancing achievement of digital learning pathway.

Increasing accessibility to digital platforms in digital learning system can help to shape the digital environment. Digital expansion can create unlimited boundaries for online knowledge acquisition.

The social implication refers to acquiring the abilities developed through online engagement with peers by actualising and exploring information together with continuous inter-connectedness of sharing pathway in online platform. The instructor would need to give a proportional gateway to make learners experience the digital environment for future education.

This study aims to assess the value of developing accessibility of digital technology for students' online learning services during the pandemic and beyond. A well-structured plan would enable digital learning capabilities and mutual accessibility amongst learners. This can allow digital abilities to be transformed into collaborative teamwork amongst learners.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

This study aims to co-develop a Frailty, Health and Care Needs Assessment (FHCNA) questionnaire for people experiencing homelessness and explore the feasibility of its use by non-clinical staff in homeless hostels.

The FHCNA, aimed at identifying frailty and other health and care priorities for people experiencing homelessness, was co-designed in workshops (online and in person) with homelessness and inclusion health staff. Its feasibility was tested by staff and their clients in two hostels, with pre- and post-study focus groups held with hostel staff to gain input and feedback.

The FHCNA was co-developed and then used to collect 74 pairs of resident and key worker inputted data (62% of eligible hostel residents). The mean age of clients was 48 years (range 22–82 years). High levels of unmet need were identified. Over half (53%) were identified as frail. Common concerns included difficulty walking (46%), frequent falls (43%), chronic pain (36%), mental health issues (57%) and dental concerns (50%). In total, 59% of clients reported difficulty in performing at least one basic activity of daily living, while only 14% had undergone a Care Act Assessment. Hostel staff found using the FHCNA to be feasible, acceptable and potentially useful in facilitating explorations of met and unmet health and social care needs of hostel clients. By identifying unmet needs, the FHCNA has the potential to support staff to advocate for access to health and social care support.

To the best of the authors’ knowledge, this is the first study to co-develop and feasibility test a questionnaire for use by non-clinically trained staff to identify frailty and other health and care needs of people experiencing homelessness in a hostel setting.

The aim of this study was to conduct a comprehensive investigation into declining and emerging occupations and job titles and to develop a national career progression pathway for the tourism and hospitality (T&H) sector.

Anchored on the Social Cognitive Career Theory, this study used face to face in-depth interviews of 33 industry stakeholders: policymakers, trade association, training providers and beneficiaries (T&H).

The finding reveals that only the “watchman” occupation was identified as the declining job while majority of the emerging jobs were more related to information technology and environmental occupations (website designers, digital marketers, data analysts, hygienists, and safety and hazard experts).

The findings provide a valuable signal for the growing number of jobs in security services, hygiene and information technology-oriented occupations, which the Ministry of Tourism, Arts and Culture including practitioners including HR directors and general managers should respond timely to and to these growing needs in order to remain competitive in the sector.

This is the first study in context that responded to a call by industry players to fill in a practical knowledge gap in examining declining and emerging jobs and job titles in the T&H sector. The study provides vocational insights into mapping the entry level requirements for the jobs allied with occupations in the national technical and vocational educational training qualifications framework of Ghana at the national level.

This paper aims to investigate the interrelated role of relational commitment and dependence as drivers of key performance outcomes. Specifically, the authors provide a conceptual model of the impact of commitment on relationship value dependence and switching cost dependence. The authors further investigate how these dimensions of dependence offer differing noneconomic and economic paths to strategic and financial performance.

Survey data was collected from 296 purchasing agents across multiple industries located in the USA. The conceptual model and accompanying hypotheses were tested via partial least squares structural equation modeling.

The results show that the relational path is driven by affective and normative commitment, which are related to relationship value dependence. Conversely, calculative commitment is related to switching cost dependence. This economic path is related to both strategic and financial performance, whereas the relational path is more closely related to strategic as opposed to financial performance outcomes.

This study extends research on Business-To-Business (B2B) relationships by leveraging social exchange theory to examine the interrelated roles played by two forms of dependence on performance outcomes. Thus, the authors answer Scheer et al.’s (2015) call for research into the two distinct types of dependence – relationship value and switching cost dependence – and their roles in determining B2B relationship outcomes. The findings contribute to the literature by integrating social exchange and relationship marketing concepts to develop a dual pathway approach to B2B partnerships.

The results suggest that dependence is not necessarily negative for firms. Specifically, buyers can and do still exhibit positive performance, both strategic and financial, in relationships with suppliers even when dependent on the relationship. Regardless of whether buyers are dependent due to a relationship or economic factors, both can, in different ways, lead to positive strategic and financial outcomes. Together, the authors contribute to the understanding of B2B partnerships by offering guidelines for both buyers and suppliers in the dyad.

The authors derive a comprehensive model depicting primarily relational and economic paths to performance through different types of commitment and dependence. The authors contribute to the literature by demonstrating that relational and economic paths to success are not the same, highlighting how firms could influence performance even when the relationship is not necessarily characterized by generally positive relational benefits and behaviors.

The dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper aims to provide an overview of the planning and review of a highly efficient and effective dermatology service for a rural island population.

The service includes visiting dermatology consultants, enhanced electronic referral vetting, skin surgery services, a General Practice (GP) with extended role (GPwER) in dermatology, specialist virtual clinics, urgent advice for inpatients at the local district general hospital and remote systemic therapy monitoring. A new phototherapy service has been set up in an island GP practice.

Local GPs and consultant dermatologists find the enhanced vetting service useable, efficient and educational. Between August 2018 and November 2022, there have been 1,749 referrals. Of these referrals, 60% were seen in clinic or a GPwER surgery, with 40% managed remotely by providing advice back to the referring GP. The number of consultations performed by the GPwER has grown over the past 3 years, and in the last year, it accounted for more than 50% of patient appointments. The waiting time has been significantly reduced using this model.

This remote service uses an integrated approach of teledermatology (TD) whilst offering continual in-person services using local capabilities including a GPwER and island general surgeons. New treatment facilities are provided to the island population. Continual educational feedback to the primary care referrer is provided, and it enhances relationships that greatly aid the high-quality dermatology service provided.

Ethical leadership has been recognized as a critical factor in encouraging employees’ moral voices. This study offers a dual-route model to understand this process. The boundary conditions of these two routes are discussed herein.

The data originate from a multiwave, multisource survey study of 212 leader–subordinate dyads in Taiwan drawn from a variety of industry sectors.

The findings validate both the cognitive (moral efficacy) and affective (affective attachment) pathways from ethical leadership to moral voice, influenced by the organizational factor of political climate. While the moral efficacy pathway is more pronounced in a situation of weak political climate, the affective attachment pathway remains effective regardless of the climate’s strength.

Managers need to identify if their organization prioritizes rational professionalism or interpersonal affection. In the former case, they should focus on the learning effects of ethical leadership. Conversely, in the latter, the emphasis should be on the leader-subordinate relationship. Doing so optimizes the effectiveness of ethical leadership in growing moral voices.

Considering both cognitive and affective routes from ethical leadership to moral voice could integrate social learning theory (SLT) and social exchange theory (SET). Identifying factors influencing these two routes resonates with the leader–situation interaction perspective. This research deepens the understanding of ethical leadership's effects on encouraging and protecting employee moral voice.