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Lean Six Sigma (LSS) implementation follows a structured approach called define-measure-analyze-improve-control (DMAIC). Earlier research about its application in emergency healthcare services shows that it requires organizational transformation, which many healthcare setups find difficult. The Kotter change management model facilitates organizational transformation but has not been attempted in LSS settings till now. This study aims to integrate the LSS framework with the Kotter change management model to come up with an integrated framework that will facilitate LSS deployment in emergency health services.

Two-stage Delphi method was conducted by using a literature review. First, the success factors and barriers of LSS are investigated, especially from an emergency healthcare point of view. The features and benefits of Kotter's change management models are then reviewed. Subsequently, they are integrated to form a framework specific to LSS deployment in an emergency healthcare set-up. The elements of this framework are analyzed using expert opinion ratings. A new framework for LSS deployment in emergency healthcare has been developed, which can prevent failures due to challenges faced by organizations in overcoming resistance to changes.

The eight steps of the Kotter model such as establishing a sense of urgency, forming a powerful guiding coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing still more change, institutionalizing new approaches are derived from the eight common errors that managers make while implementing change in the institution. The study integrated LSS principles and Kotter’s change management model to apply in emergency care units in order to reduce waste and raise the level of service quality provided by healthcare companies.

The present study could contribute knowledge to the literature by providing a framework to integrate lean management and Kotter's change management model for the emergency care unit of the healthcare organization. This framework guides decision-makers and organizations as proper strategies are required for applying lean management practices in any system.

The proposed framework is unique and no other study has prescribed any integrated framework for LSS implementation in emergency healthcare that overcomes resistance to change.

Enormous numbers of people suffer from the effects of disasters and humanitarian crises in Africa, including medical and healthcare emergencies. International response to the 2014–2016 Ebola pandemic in West Africa and COVID 19 pandemic vividly demonstrates the need for efficient and effective logistics and supply chain systems in bringing succor to impacted and vulnerable communities. This paper critically reviews the academic literature on logistics models for sourcing, delivery and distribution of medical and healthcare products for humanitarian emergencies in Africa from 1990 to 2018. The paper suggests areas for further research and proposes an effective logistics model useful for international and national humanitarian organizations as well as public health authorities in Africa and developing areas.

The viewpoint paper draws upon a structured comprehensive and critical review of the academic literature on logistics and supply chain management and a qualitative analysis of the literature in 13 leading academic databases covering over 5,550 articles.

The paper finds significant gaps in the body of logistics and supply chain management research on practical deployable logistics models for sourcing, delivery, and distribution of medical and healthcare products for humanitarian emergencies. The paper suggests a model worthy of consideration by humanitarian and disaster response stakeholders as well as public health authorities in developing countries.

This is a critical literature review paper based on a comprehensive literature research and analysis for the period from 1990 to 2018 from which a viewpoint is formed.

This paper advocates for further research on appropriate models of logistics for the sourcing, delivery and distribution of medical and healthcare products to enhance the basic human rights and dignity of vulnerable people in developing countries.

The paper contributes directly to policy on logistics, humanitarian aid, disaster management, public health and health security policy in the developing world including Africa.

Emergency services are critical for high‐quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (US) acute care hospital staff's ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers.

Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5,000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities.

US acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, US emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staff's ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state‐of‐the‐art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement.

This research uses the AHA annual surveys, which represent self‐reported data by individual hospital staff. However, the AHA expends significant resources to validate reported information and the annual survey data are widely used for hospital research.

The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure.

This article has important information on US emergency service availability in the hospital industry.

The purpose of this study is to create a knowledge base for decision-making in healthcare design by seeking, analyzing and discussing the preferences of facility managers of healthcare facilities regarding floor finishes and their selection criteria. The goal is to enable a simplified and holistic selection of floor finishes based on multiple criteria. The authors studied floor finish selection in three healthcare units: emergency, surgery and in-patient units.

The authors completed a literature review to identify types of floor finishes currently used in healthcare facilities and the criteria applied for their selection. Using the literature survey results, a questionnaire was designed and administered to healthcare facility managers. The descriptive statistical analysis and the Friedman and Wilcoxon signed-ranks tests were used for reporting and analyzing the survey data.

The top five floor finishes used in the healthcare sector were identified as vinyl flooring, vinyl composite tile (VCT), rubber, linoleum and ceramic flooring. The top five selection criteria for floor finishes were durability, infection control, ease of maintenance, maintenance cost and user safety. The non-parametric test results show that the floor finish rankings and selection criteria were similar in the three healthcare units under study.

The most significant contribution of this research is to the design decision-making process of healthcare facilities. These results offer an understanding of what floor finishes are preferred by healthcare facility managers and why. This knowledge is crucial for designers and facility managers to make informed choices and floor finish manufacturers to keep their product line relevant to the industry.

The study aimed to (1) determine on what bases paramedics in this context have defined themselves as feeling safe or at risk while serving on the front lines and (2) develop recommendations to support paramedics in their critical public health emergency response role.

This qualitative study consisted of 21 semi-structured interviews with primary care paramedics (PCPs), advanced care paramedics (ACPs) and critical care paramedics (CCPs) with first-hand experience responding to the COVID-19 pandemic in Ontario. Qualitative research is best suited to the research objectives of gaining detailed and nuanced understandings of paramedics' experiences during this public health emergency, and identifying in paramedics' accounts what changes to policy and practice might strengthen their sense of safety in future infectious disease outbreaks (Bowling, 2002; Chafe, 2017). Data collection occurred over the course of 3.5 months, from June 2020 until September 2020.

Participants described several factors that heightened their feeling exposed to risk particular to working on the front lines of the COVID-19 public health response. These factors include stress connected to personal protective equipment (PPE) and equipment access, risks of infection to self and family, communications and feelings of being systematically under-considered. Recommendations from this research include, but are not limited to, ensuring a more equitable distribution of protective equipment to paramedics across unevenly funded services, and recognizing paramedics face unique and additional stressors in public health emergencies.

A key limitation of this study was the relatively small sample, with 50% of potential participants deciding not to engage in an interview. The authors suspect this is likely a result of timing, as this was conducting during significant periods of the COVID-19 pandemic in Ontario. The study identifies and begins to shed light on the way in which feelings of compromised safety and specific stressors in a public health emergency context connect to one another and potentially increase risks of burnout for this healthcare provider group. This study's documentation of paramedics feeling uncertainty about their own and their family's safety, combined with feeling occupational pressure, decisional pressure within constrained frameworks of care delivery, a lack of autonomy and a lack of consideration within their healthcare system in general and within its pandemic response in particular, is important in and of itself. These stressors can have serious implications for the ability of paramedics to sustain their integral role in public health emergency response.

A series of pandemic-specific and generalizable recommendations emerged from this research and in collaboration with community-based medical leadership. (1) Consult paramedics on effectiveness of screening questions and equipment. Be sure to illicit and respond to paramedic feedback in a timely manner. (2) Implement operational changes during pandemics in the form of donning and doffing stations, disposable gowns, decontamination teams at hospitals, infectious disease paramedic (IDP) truck, anti-fog sprays for goggles, and safe and controlled areas for eating and taking breaks. (3) Develop an emergency pandemic plan that is resourced and maintained as part of EMS strategic planning. Involve EMS in decisions related to health system emergency planning and sustainability of EMS practice. (4) Establish equitable distribution of resources, such as ensuring PPE is distributed equitably and applying pandemic pay equally to all essential workers. (5) Validate and respect EMS, as they are essential workers. Recognize the expertise of paramedics and community healthcare providers. Finally, an overarching recommendation at the core of this research is the consideration for paramedic knowledge as expertise given their role as critical front line healthcare specialists and the protection of this crucial human resource as it relates to their resilience and mental wellbeing.

Evidence-based awareness and improved understanding of paramedic stress during the pandemic is a first step to developing strategies to reduce that stress. This is essential in ensuring access to this essential service during emergencies and the safety of the communities they serve.

Findings from this study can inform development of supports to sustain paramedic wellbeing during public health emergencies, during the ongoing pandemic, in Ontario and beyond.

Outpatient care delivery is one of the key revenue sources of a hospital which plays a salient role in timely care delivery. The key purpose of the study is to propose a multi-objective simulation-based decision support model that considers the cost of care delivery and patient dissatisfaction as its two key conflicting objectives. Patient dissatisfaction considers service fairness. Patient idiosyncrasies such as no-show, unpunctuality and balking have been considered in the model involving multiple classes of patients.

A model has been designed using data collected from field investigations. In the first stage, queuing theory based discrete event simulation model has been developed. Genetic algorithm has been used to solve the scalarized problem and obtain actionable insights. In the second stage, non-dominated sorting genetic algorithm II (NSGA-II) has been involved to achieve the Pareto optimal fronts considering equal priority of the two objectives.

The computational results considering various parameter settings can help in efficient resource planning while ensuring better care delivery. The model proposed in the study provides structural insights on the business strategy of healthcare service providers on optimizing the dual goals of care delivery cost and service fairness.

The study is one of the early works that helps to improve the care delivery process by taking into consideration the environmental factors as well as service fairness. The study demonstrates the usage of simulation-based multi-objective optimization to provide a more sustainable patient centric care delivery.

The purpose of this study is to explore the potential impacts of visibility on face-to-face communication among medical staff in community hospital emergency departments (EDs). Also, the researchers investigated how different types of visibility can increase/decrease the efficiency of EDs’ medical staff.

This study used an exploratory approach to investigate the role of visibility in enhancement of medical staff communication in four EDs within the same hospital system. Overall, 12 semi-structured interviews and 48 h of observation were manually conducted.

The findings suggest that communication among medical staff can be improved by enhancement of different types of visibility (general and staff-to-staff) in EDs. Also, visibility facilitates patient assessments, overall supervision, comfort and asking for help while reducing stress and distractions.

The results of this investigation can inform hospital managers and healthcare designers about one of the important ways to improve registered nurses and physicians’ performance through environmental architectural design in the enhancement of communication.

Understanding the importance of visibility as a design element would provide a crucial principle for future ED designs. Although research has been conducted with different focuses and methods in other hospital departments, nothing similar to the current study in EDs was available in the healthcare design published literature.

The purpose of this paper is to describe research, the objective of which was the development of models, methodologies, and tools for the realization of the multimedia platform for emergency management in technological systems.

This objective was achieved through the operationalization of the following major tasks: the theoretical research on the specific characteristics of emergency management system structure and processes; definition of educational structures, processes, and subjects for emergency management; development of models and software tools for the analysis of emergency development; development of information (web) services to support the collaborative decision making.

A model of multimedia platform for emergency management in technological systems has been developed, which defines emergency services with appropriate information infrastructure, the structure and characteristics of the interoperability system and their mutual communication.

Further research should result in: the concrete structure and processes of virtual organisation for emergency management in technological systems; software for the support of collaborative decision making; models for emergency management education and training based on multimedia technologies. The limitations are primarily related to model implementation, since there are no suitable emergency databases.

The platform can be used by: industrial companies, companies that provide building maintenance, public services, insurance companies, educational institutions, local authorities (by an adequate upgrade of models and software).

This paper presents the information flow identified in emergency management and the structure of a multimedia platform which, by creating favourable environment for collaborative decision making, enables effective and efficient emergency management in technological systems, as well as emergency management education and training.