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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.

Healthcare provision in Denmark reflects some of the key principles of the welfare state. By securing relatively easy and equal access for all Danish residents regardless of income via general tax financing, the Danish healthcare system has strong ethical merits. All residents are entitled to comprehensive healthcare services. The Danish healthcare system is also relatively efficient. Total healthcare expenditures – including public and private – amount to 10% of GDP, above the OECD 8.8% average but well below the costs in the other Nordic countries, Germany, Switzerland and the United Stated. Notwithstanding its merits, healthcare in Denmark shares key predicaments with other OECD countries, primarily how to improve health outcomes while containing care expenditures. All of the OECD countries aim to improve population life expectancy and health quality. Yet their ageing and increasingly obese populations are exacerbating the demands on their respective healthcare systems. This chapter examines changes in how Denmark has managed these challenges. The main argument is that the healthcare system performance on managing health outcomes and costs improved remarkably from the 1990s to the early 2020s, although outcome inequalities remain. Notable changes in the system were targeted innovations in treatment procedures and expansion of municipal rehabilitation and preventive efforts, along with strict budget controls.

Although healthcare and healthy living are integral to the Sustainable Development Goals (SDGs) for 2030, the coronavirus epidemic has dealt a devastating blow to these efforts. As governments and policymakers were compelled to shift their focus to lockdowns, sustenance, procurement, and distribution of vaccines, the momentum for health initiatives slowed, and the already fragile health systems of emerging markets were subjected to additional shocks. However, in many underserved regions of the globe, the introduction of technology has greatly facilitated the distribution and adoption of healthcare services.

This chapter highlights mini-cases from four emerging nations: Bangladesh, Nigeria, Vietnam, and the Philippines. Although the countries are emerging, each one of them are in a distinct stage of development and face a unique set of healthcare-related challenges. The chapter showcases how four different organizations based in these countries leveraged the use of technology to take healthcare services to underserved populations. In doing so, they addressed the key challenges of imparting healthcare: geographic accessibility, availability, financial accessibility, and acceptability.

This chapter concludes with a discussion of the implications of expanding healthcare industries leading to increased healthcare waste. To prevent mass population exposure to hazardous substances, the emergence of intelligent healthcare waste collection and disposal systems will be an absolute necessity. Hence, with the development of healthcare services, governments and policymakers need to mechanize smart waste management systems to safeguard humans, animals, and the environment.

It would not be an exaggeration to say that healthcare is the most crucial one in today's perspective. The healthcare sector, in general, is engaged in working on various dimensions simultaneously like the safety, care, quality and cost of services, etc. Still, the desired outcomes from this sector are far away, and it becomes pertinent to address all such issues associated with healthcare on a priority basis for sustaining the outcomes in a long-term perspective. The present study aims to explore the healthcare sector and list out the directly associated enablers contributing to increasing the viability of the healthcare sector. Besides, the interrelationship among the enlisted enablers needs to be studied, which further helps in setting-out the priority to deal with individual enablers based on their impedance in the contribution towards viability increment.

The authors have done an extensive review to list out the enablers of the healthcare sector to perform efficiently and effectively. Further, the attempt has been made on the enablers to rank them by using the modified Total Interpretative Structure Modelling (m-TISM) approach. The validation of the study reveals the importance of enablers based on their position in the hierarchical structure. Further, the MICMAC analysis on the identified enabler is performed to categorize the identified enablers in the different clusters based on their driving power and dependence.

The research tries to envisage the importance of the healthcare sector and its contribution towards national development. The outcomes of the m-TISM model in the present study reveal the noteworthy contribution of the organizational structure in managing the healthcare facilities and represented it as the perspective of future growth. The well-designed organizational structure in the healthcare industry helps in establishing better employee–employer cooperation, workforce coordination and inter-department cooperation.

Every research work has limitations. Likewise, the present research work also has limitations, i.e. input taken for developing the models are from very few experts that may not reflect the opinion of the whole sector.

The healthcare sector is the growing sector in the present-day scenario, and it is essential to keep the quality of treatment in check along with the quantity. The present study has laid down the practical foundations for improvement in the healthcare sector viability. Besides, the study emphasized on accountability of the healthcare sector officials to go with the enablers having the strong driving power for effective utilization of all the resources. This would further help them in customer (patients) satisfaction.

Despite an increase in demand for good quality healthcare facilities worldwide, the growth of this sector is bounded by the economic, demographic, cultural and environmental concerns, etc. The present study proposed a unique framework that provides a better understanding of the enablers. It would further help in playing a key role in increasing the viability of the healthcare sector. The hierarchy developed with the help of m-TISM and MICMAC analysis will help the viewers to recognize the important enablers based on their contribution to the viability improvement of the healthcare sector.

The access to high quality, a reliable and affordable basic healthcare service is one of the key challenges facing the rural and semi‐urban population lying at base of the pyramid (BoP) in India. Realizing this as a social challenge and an economic opportunity (shared value), there has been an emergence of healthcare service providers who have bundled entrepreneurial attitude and passion with available scarce resources to design and implement cost‐effective, reliable and scalable market solutions for the BoP. The purpose of this research paper is to understand the underlying operating principles of these self‐sustainable business models aimed at providing healthcare services to the BoP segment in India.

The empirical context involves the use of case study research methodology, where the source of data is published case studies and the company websites of four healthcare organizations who have made a socio‐economic difference in the lives of the rural and semi‐urban population lying at the BoP in India.

The analysis and findings reflect the key operating principles for sustainable healthcare business ventures at the BoP. These include focus on 4A's (accessible, affordable, acceptable and awareness), local engagement, local skills building, learning by experiment, flexible organizational structure, dynamic leadership, technology integration and scalability.

This research study has focused mainly on the published case studies as source of data.

The intent is to understand and bring forth the learning and guiding principles, which act as a catalyst for the future researchers and business ventures engaged in BoP context.

Digital healthcare once again emerges due to pandemic (Covid-19). Digital healthcare can be minimising the issue of accessibility, availability, accuracy and affordability of healthcare service during a pandemic. Digital healthcare playsa significant role to provide healthcare equity during the pandemic. This article presents the current trends and scenario of digital healthcare with a focus on health equity. The main objective of this chapter is to review the four aces of health equity in the digital healthcare literature. The scope and challenges faced by the policymakers to implementation of digital healthcare to improve health equity. This chapter considers the hybrid literature review based on the bibliometric and the systematic literature based on the various theme, sub-theme, concept and context-related health equity through digital healthcare. This study provides the previous and current research trends and preposition for the future researcher, healthcare professional, policymakers and digital healthcare innovators to invent the tool which leads the health equity through the digital healthcare in the healthcare.

The purpose of this paper is to apply quality management tools and practices in the design of an integrated accreditation model for Local Health Trusts, in order to contribute to the sustainability of the Portuguese Primary HealthCare Service. Following the guidelines of the Portuguese Health Quality Strategy, the proposed model is an adaptation of the model from Agencia para la Calidad Sanitaria de Andaluzia.

The development of the integrated accreditation model was based on a literature review, complemented with observation and analysis of the usual working methods in a Local Health Trust (Western Oporto Health Trust).

Local Health Trusts include not only clinical management units but also non-clinical administrative units. Therefore, the National Model for Accreditation of HealthCare Institutions is not easily or directly applicable to them. To overcome this problem, the model proposed in this study incorporates ISO 9001 principles, widely accepted regarding organizational management. The success of the application of this model is highly dependent on the ability of public Primary HealthCare organizations to deal with potential problems such as resistance to change, lack of leadership and inadequate people management and involvement.

The integrated accreditation model proposed in this research is expected to promote the cohesion of Local Health Trust units, encouraging integrated quality management practices and continuous improvement strategies, leading Local Health Trusts, Primary Care and HealthCare in a global perspective toward sustainability.

One of the most important instruments for gathering information and processing data relating to professional and organisational quality in health systems is “healthcare processes classification”. The authors found that a typical problem of many European countries is a lack of reliable information in the field of healthcare, mainly because the development of quality instruments, including healthcare processes classification, is not a priority for medical and other health professions. Additionally, it is difficult to update this instrument coherently with organisational changes and developmental achievements. This article describes the approach used by the University Medical Centre in Ljubjana, Slovenia, to redesign its healthcare processes classification in order to improve the quality of healthcare.

The purpose of this paper is to explore the demand-side factors that influence the inbound medical tourists’ (MTs) decision to travel abroad for medical treatment/surgery.

The researchers conducted thematic analysis of in-depth interviews in India with 24 foreign MTs’ to generate the themes, identify factors and propose a model with hypothesis for future quantitative survey.

The findings conclude that patients ranked in ascending order less waiting time for surgery, healthcare quality and accreditation, staff/surgeons expertise, healthcare information, hospital facilities and services, patient safety, travel risk, surgical costs and holiday opportunity as important factors that influence the decision to travel abroad for medical treatment/surgery.

Foreign patients from six private hospitals were willing to be interviewed with the permission of the hospital. Due to confidentiality and privacy policy, many hospitals declined interviews with foreign patients.

The findings are generalised in case of foreign patients as MTs and all private hospitals treating foreign patients in India and other global healthcare destinations. Policy implications suggest that private hospitals in developing countries need to provide first-class quality of healthcare as foreign patients look for internationally accredited quality, no waiting time, patient safety, qualified and experienced surgeons, healthcare workers education and experience hospital facilities and post-surgery care with positive healthcare outcomes.

There is little empirical research on the views of inbound MTs, about factors influencing their decision to travel abroad for surgery to India.

The purpose of this paper is to contribute to the extant literature regarding the exploitation of digital technologies by illustrating how this type of IT can influence business process improvements in the healthcare industry.

The paper reports an illustrative case study for MSD Italy, the Italian subsidiary of the USA-based company Merck & Co., Inc. The group sells drugs for human use in Italy but is also active in the veterinary (MSD Animal Health) industry, with Vree Health, and in solutions and software-based services for the healthcare industry.

The results show that the adoption of digital technologies could improve the performance of main healthcare business processes, particularly those processes that can be simplified with the adoption of information technology. More specifically, digital technologies could increase efficiency and, at the same time, allow for the delivery of better quality and reduced response times, with many benefits for several stakeholders, such as national health systems, clinicians and patients.

Although some studies report the need for effective business processes for sustainable healthcare systems, there is a lack of literature regarding the specific implications of the adoption of such digital technologies for the business process management of healthcare firms. This paper attempts to fill in this gap.