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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.

This paper examines factors that lead consumers to engage in unethical consumer behaviour (UECB) to develop a framework for understanding this phenomenon.

The study data were collected using the qualitative approach by conducting personal interviews with 27 marketers in two Arab countries, Libya and Syria.

The findings indicate that previous models of UECB are applicable to Arab consumers. However, the effects of the examined factors on UECB adoption are influenced by the local environment. Also, the paper explored some newly factors that clearly affect UECB.

This study provides a model of UECB for Arab consumers to help companies to understand Arab consumers’ behaviour. This model determines the influencing factors on this behaviour that companies can use to build their marketing strategies directed at the Libyan and Syrian markets during the reconstruction phase. Moreover, the research results help companies avoid and control UECB.

Almost all studies of UECB have been conducted in Western countries; the present study attempts to address this gap in the ethical decision-making literature, as well as marketing literature, and examine the UECB in Arab countries. Furthermore, previous studies of UECB mostly look at one typical form of UECB; this study provides a broader contribution to the literature on UECB by using a set of scenarios; shoplifting, software piracy and pilfering from hotel rooms.