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The integration of industry 4.0 has become a priority for many organizations. However, not all organizations are suitable and capable of implementing industry 4.0 because it requires a dynamic and flexible implementation strategy. The implementation of industry 4.0 often involves overcoming several tensions between internal and external stakeholders. This paper aims to explore the paradoxical tensions that arise for health-care organizations when integrating industry 4.0. Moreover, it discusses how a paradox lens can support the conceptualization and proposes techniques for handling tensions during the integration of industry 4.0.

This qualitative and in-depth study draws upon 32 semi-structured interviews. The empirical case concerns how two health-care organizations handle paradoxical tensions during the integration of industry 4.0.

The exploration resulted in six recurring technology tensions: technology invention (modularized design vs. flexible design), technology collaboration (automation vs. human augmentation), technology-driven patient experience (control vs. autonomy), technology uncertainty (short-term experimentation vs. long-term planning), technology invention and diffusion through collaborative efforts among stakeholders (selective vs. intensive collaboration) and technological innovation (market maintenance vs. disruption).

A paradox theory-informed conceptual model is proposed for how to handle tensions during the integration of industry 4.0. To the best of the authors’ knowledge, this is the first paper to introduce paradox theory for quality management, including lean and Six Sigma.

This study demonstrates how becoming a high-reliability institution in health care is a priority, given the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions and functions that create a high-reliability organization (HRO) for safety and improvement but also created a learning organization by spreading the knowledge to other facilities.

The authors instituted a methodology consisting of assessments, training and educational simulations to measure, establish and operationalize activities that identified and prevented harmful events. Visual communication boards were created to facilitate team huddles and discuss improvement ideas. Improvements were then measured and analyzed for purposeful outcomes and return on investment (ROI).

HRO can be operationalized successfully in health care systems. Measurable outcomes verified that psychological safety was achieved through the identification and participation of 3,184 process improvement projects over a five-year period, which yielded a US$2.8m ROI. Documented processes and activities were used for educational teachings, which were disseminated to other Veteran Affairs Medical Center’s through the Truman HRO Academy.

This case study is limited to one hospital in the Veterans Health Administration (VHA) network. As the VHA continues to deploy the methods outlined to other hospitals, the authors will perform incremental data collection and ongoing analysis for further validation of the HRO methods and operations. Hospitalists can adapt the methods in the case study for practical application in a health care setting outside of VHA. Although the model is rooted in health care, the methods may be adapted for use in other industries.

This case study overcomes the limitations within literature regarding operationalizing HRO by providing actual activities and demonstrations that can be implemented by other health care facilities.

Due to its ability to support well-informed decision-making, business intelligence (BI) has grown in popularity among executives across a range of industries. However, given the volume of data collected in health-care organizations, there is a lack of exploration concerning its implementation. Consequently, this research paper aims to investigate the key factors affecting the acceptance and use of BI in healthcare organizations.

Leveraging the theoretical lens of the “unified theory of acceptance and use of technology” (UTAUT), a study framework was proposed and integrated with three context-related factors, including “rational decision-making culture” (RDC), “perceived threat to professional autonomy” (PTA) and “medical–legal risk” (MLR). The variables in the study framework were categorized as follows: information systems (IS) perspective; organizational perspective; and user perspective. In Jordan, 434 healthcare professionals participated in a cross-sectional online survey that was used to collect data.

The findings of the “structural equation modeling” revealed that professionals’ behavioral intentions toward using BI systems were significantly affected by performance expectancy, social influence, facilitating conditions, MLR, RDC and PTA. Also, an insignificant effect of PTA on PE was found based on the results of statistical analysis. These variables explained 68% of the variance (R²) in the individuals’ intentions to use BI-based health-care systems.

To promote the acceptance and use of BI technology in health-care settings, developers, designers, service providers and decision-makers will find this study to have a number of practical implications. Additionally, it will support the development of effective strategies and BI-based health-care systems based on these study results, attracting the interest of many users.

To the best of the author’s knowledge, this is one of the first studies that integrates the UTAUT model with three contextual factors (RDC, PTA and MLR) in addition to examining the suggested framework in a developing nation (Jordan). This study is one of the few in which the users’ acceptance behavior of BI systems was investigated in a health-care setting. More specifically, to the best of the author’s knowledge, this is the first study that reveals the critical antecedents of individuals’ intention to accept BI for health-care purposes in the Jordanian context.

While digital transformation holds immense promise, organizations often fail to realize its benefits. This study aims to address how policies for digital transformation benefits realization are translated into practice.

The authors apply a qualitative, comparative case study of two large, public-sector health care organizations in Sweden. Through document and interview data, the authors analyze the process of translation.

The study finds that practice variation is primarily caused by two types of decoupling: policy-practice and means-ends. Contrary to previous studies, coercion in policy compliance is not found to decrease practice variation.

The limitations primarily stem from the empirical selection of two large public health-care organizations in Sweden, affecting the study’s generalizability. Reducing practice variation is more effectively achieved through goal alignment than coercion, leading to implications for the design of governance and control.

Policymakers should, instead of focusing on control-related compliance, work to align organizational objectives and policies to decrease practice variation for successful benefits realization.

The study contributes to better benefits realization of digital transformation initiatives in health care. As such, the authors contribute to a better functioning and more transformative health care in times of increased demand and decreased supply of health-care services.

The study challenges conventional wisdom by identifying that coercion is less effective than goal alignment in reducing practice variation, thereby enhancing the understanding of policy implementation dynamics in health-care settings.

Turnover intention (TOI) has become a severe issue in Saudi Arabia’s health-care system as health professionals leave their organizations. Saudi Arabia’s health-care professionals’ TOI affects the organizations and the patients’ human rights. Therefore, this study aims to assess the factors that affected Saudi Arabia’s health-care professionals’ TOI.

This study based its findings on quantitative cross-sectional data. This study’s respondents were health-care professionals working in Saudi Arabia’s public and private health-care institutions.

By using path analysis, this study’s findings reveal that, on the one hand, job stress (JS), psychological distress (PD) and perceived work exhaustion (PWE) have positive and significant effects on TOI. On the other hand, perceived organizational support (POS) is a positive and significant predictor of TOI.

This study’s findings will help the Saudi Arabian Ministry and policymakers develop policies to encourage health professionals’ perseverance through reducing their JS, PD and PWE and by enhancing POS for health-care staff. Moreover, by controlling the increasing turnover ratio among Saudi Arabia’s health-care professionals, this study’s findings assist in overcoming the violations of human rights.

This study’s findings empirically confirm the development of TOI through JS, PD and PWE among Saudi Arabia’s health-care professionals.

Health care systems aspire to adopt integration strategies shifting the focus from acute care to a broader focus on community-based health and social services. Real-world examples demonstrating effective delivery of integrated care are essential.

In this article, we introduce UHN Connected Care Hub, an innovative model of care comprising an interdisciplinary team designing sustainable, shareable practices across the continuum of care alongside community and health organization partnerships.

We describe UHN Connected Care Hub’s ability to identify patients from high-risk population and collaborate to delivery timely care, in detailing the real world experience of this model of care in the organization of a centralized system of micro-clinics to administer a therapeutic for pre-exposure prophylaxis against COVID-19 (Tixagevimab/cilgavimab [Evusheld]) in a population of immunocompromised patients.

Having a centralized system of micro-clinics for care delivery presents opportunities for increased adaptability, patient accessibility, enhanced community partnerships and integratedness. Expansion in the scope of services could also create new opportunities in preventative therapies for optimizing the cost effectiveness and quality of health care provided at the population level.

There is limited evidence on how to efficiently deliver integrated care, particularly to vulnerable and co-morbid patients. We discuss how dynamic organizations with proper infrastructure and a network of healthcare partnerships may allow a more fluid response to rapidly changing policies and procedures and facilitate preparedness for future health care crises or pandemics.

Contrary to want-based services, customer participation has got lesser attention in high-credence services like health care. Customer participation for patients with chronic illnesses could be life-threatening and goes beyond the service organization’s physical environment. Realizing the importance of transformative service research in health-care services, this study aims to propose and validate the conceptualization of customer participation for patients with chronic illnesses.

The study uses sequential exploratory research design with mixed method research. The first phase is a qualitative exploration of the nature and meaning of customer participation by synthesizing theory and insights from semi-structured interviews (N = 75) with doctors, patients and paramedical staff. Next, survey data (N = 690) of patients with chronic illnesses is used to validate the proposed conceptualization. Finally, nomological validity was also tested on an additional survey data set (N = 362) using SEM and FsQCA.

The findings reveal that health-care customer participation is a three-dimensional behavioral construct in which a customer can participate by sharing information, involving in decision-making and ensuring compliance. The study also demonstrates that customer participation is a critical driver of satisfaction with life and perceived control on illness.

The research provides policy guidelines for owners and operators of health-care organizations in developing frameworks for collecting participation data, which can be used in strategies for seeking customer participation.

The research conceptualizes and validates “customer participation” as a multidimensional higher-order construct for patients with chronic illnesses, rarely focused in services marketing and management research on health care.

This study aims to assess the effects of green supply chain management (GSCM) strategies on health-care organizations’ environmental performance (EP). It also assesses that green innovation (GI), including green technology innovation (GTI) and green management innovation (GMI), plays mediating roles in the connection between GSCM and EP.

In total, 375 health-care sector employees in the Chattogram division of Bangladesh provided opinions in the questionnaire survey. PLS-SEM was used to verify the data’s validity and reliability and assess the hypotheses.

The findings reveal that GSCM practices significantly positively impact GI and EP. Moreover, GTI and GMI mediate the relationship between GSCM and EP in Bangladesh’s health-care sector.

The current findings could promote environmental sustainability in Bangladesh’s health-care industry by fostering environmental collaboration.

The detection of the mediation effect of GTI and GMI on GSCM and EP is a unique contribution of this study that enriches the present GSCM and GI literature, particularly in the Bangladeshi health-care sector.

This study aims to explore the management learning during a long-term crisis like a pandemic. The paper addresses both what health-care managers have learnt during the COVID-19 pandemic and how the management learning is characterized.

The paper is based on a qualitative case study carried out during the COVID-19 pandemic at two different public hospitals in Sweden. The study, conducted with semi-structured interviews, applies a combination of within-case analysis and cross-case comparison. The data were analyzed using thematic deductive analysis with the themes, i.e. sensemaking, decision-making and meaning-making.

The COVID-19 pandemic was characterized by uncertainty and a need for continuous learning among the managers at the case hospitals. The learning process that arose was circular in nature, wherein trust played a crucial role in facilitating the flow of information and enabling the managers to get a good sense of the situation. This, in turn, allowed the managers to make decisions meaningful for the organization, which improved the trust for the managers. This circular process was iterated with higher frequency than usual and was a prerequisite for the managers’ learning. The practical implications are that a combined management with hierarchical and distributed management that uses the normal decision routes seems to be the most successful management method in a prolonged crisis as a pandemic.

The gained knowledge can benefit hospital organizations, be used in crisis education and to develop regional contingency plans for pandemics.

This study has explored learning during the COVID-19 pandemic and found a circular process, “the management learning wheel,” which supports management learning in prolonged crises.

This study aims to advance the understanding of humble leadership (HL) in health care.

This study presents a scoping review to explore and synthesize the existing knowledge in the literature. The search process encompassed three main online databases, PubMed, Scopus and Web of Science. Due to the novelty of the topic of HL in health care and the lack of research in this area, all articles published until the end of February 2023 were considered in this study.

A total of 18 studies were included. The results showed that in the period of 2019–2023 more attention was paid to HL in health care than in previous years. The research design used in these articles included quantitative (n = 13) and qualitative (n = 5) methods and the statistical population included nurses, hospital employees and health-care department managers. Based on the results obtained, the definition of HL can be divided into two general approaches, including self-evaluation and the way one treats others. In addition, humble leaders in the health-care sector should exhibit certain behavioral characteristics and finally, the results indicated that HL has several positive consequences; however, little attention has been paid to the factors influencing HL in health care.

This research will help practitioners gain a deeper understanding of the various applications of HL in health care.

To the best of the authors’ knowledge, no comprehensive research review has yet been conducted on the application of HL in health care.