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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.

The scope of this study is to explore and summarize the pool of dimensions, models and measurement techniques of service quality used in healthcare services and to propose a comprehensive conceptual model for practitioners and researchers.

This research employs a comprehensive review of available literature by using multiple keywords on different electronic repositories using the recommendations of the PRISMA approach for the selection of articles. A critical analysis of available studies helped in compiling a list of core service quality dimensions in healthcare services.

This paper presents a comprehensive account of different dimensions and their measurement items used by various researchers to assess service quality in healthcare systems. Most of the researchers have used SERVQUAL model either in its original or modified form while the others have proposed and used totally different dimensions to assess the service quality in healthcare. Many dimensions are just an existing dimension of SERVQUAL that has undergone a name change while others are completely new. The dimensions used by many researchers have items drawn from more than one dimension of SERVQUAL model. The availability of so many dimensions and models adds to the confusion that researchers and practicing managers experience when determining the appropriate model to be used in their work. To mitigate this confusion, there is a need to develop a comprehensive model; the current work is an attempt to meet this need. Through our analysis, we identify four major service quality dimensions: clinical quality, infrastructural quality, relationship and managerial quality and propose a model named CIRMQUAL.

After exploring all available models in the domain of healthcare, this research presents the best possible areas to enhance the quality of healthcare services. It also enhances the research insights for academicians and working professionals by developing and proposing a comprehensive model for measuring healthcare service quality. The proposed model covers almost all of the service quality dimensions used by other researchers and will make the choice of dimensions/model easy for the future researchers/practitioners interested in measuring and improving the quality of services offered by their healthcare units. Such a comprehensive model has not been developed by any researcher thus far.

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

Total quality management is a valuable approach to continuously improve the quality of organizations; however, scholars debate its applicability to services, which require specific best practices that are different from those related to manufacturing. Moreover, digitization is pervading all kinds of services, but little has been written about total quality service practices in digital-based companies. For this purpose, the authors provide a holistic model of total quality service that reflects the peculiarities of such companies, guided by the question: how do total quality service practices change in digital-based service organizations?

The authors conduct an illustrative case study on Healthware Group, a global integrated digital health organization, to evaluate theoretical assumptions about total quality service practices in the digital environment.

The findings allow to validate the model provided. In addition, the study enables them to observe the changes the authors are witnessing in service provision in the digital era and the consequent transformation of best practices. To be accurate, the authors cannot refer to a full transformation in digital-based companies but rather to the enrichment and extension of TQS practices. The best illustration of these conclusions has been summarized in a set of propositions corresponding to seven of the key levers of a TQS model.

The paper represents the first attempt to discuss the relationship between total quality service and digitalization, offering a set of propositions for academics and insights for practitioners. The model can be used as a tool to visualize the different levers that successful implementation of TQS in digital-based services companies can rely on.

The purpose of the study is to measure the performance of Indian hospitals, both operationally and financially, by using hospital KPI's. The assessment is predominantly done by linking it to the existing Lean practices in Indian hospitals.

An empirical study based on cross-sectional survey of hospital managers and specialists in various private healthcare facilities across India was conducted to validate the proposed Lean framework. From an extensive literature survey, the authors identified quality, delivery, efficiency, accessibility and patient centeredness to be the main operational performance (OP) indicators for hospitals. Business or financial performance was measured based on parameters which are average revenue per occupied bed (ARPOB), earnings before interest, tax, depreciation and amortization (EBITDA) and operating revenue. Confirmatory Factor Analysis (CFA) was carried out using a specialized technique, called Structural Equation Modelling(SEM) and an explicit factor structure was hypothesized.

Management commitment towards Lean in hospitals is statistically proven to have impacted operational and financial performance. However, leanness in technology and business processes showed no statistical significance on either operational or financial performance parameters. Hospital stakeholders showed statistical significance on though it had no impact on the financial performance. Results obtained from the statistical analysis indicate a positive impact of hospital Lean practices on timely delivery of services and improved service quality. Efficiency, accessibility of services and patient centered behavior in hospital operations could not be statistically proven to have impacted the financial performance.

Effectiveness of Lean management (LM) principles in improving hospital operations is largely dependent on patient centered behavior. Empowered employees who are trained to add value from a customer view point, make hospital operations safe and improved. Properly trained and communicated employees who are committed to quality improvements can make a positive impact on patients' quality of life and thus positively impact the society. The study lists ways to attain the required outcomes.

This paper is among the very few that has attempted to suggest ways to link implementation of Lean practices more effectively in Indian hospitals to improve hospital performance at operational and financial levels.

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.

The purpose of this study is to explore the literature of healthcare service quality for identifying and analyzing the healthcare service quality models and dimensions and to present future research insights pertaining to the applications of these models and dimensions.

A literature review of healthcare service quality has been performed on 59 relevant studies after applying inclusion and exclusion criteria. Google Scholar and Scopus are the primary sources to find the relevant documents. Search was limited to keywords of “service quality,” “healthcare,” “models” and “dimensions.”

The results revealed that different models and dimensions have been evolved and developed after SERVQUAL in healthcare service quality literature. There is still a need to develop new models, add new contextual dimensions and items in existing models on different aspects of healthcare services. There is also a need to incorporate the perspective of service providers as respondents. Moreover, healthcare service quality models can be devolved or narrowed down at department and individual levels.

This study presents valuable research insights for the researchers and practitioners in ways that healthcare service quality models and dimensions can be developed, modified and tested further in different research contexts and settings. Besides, the literature on healthcare services can be enhanced and enriched.

The aim of this research is to determine the impact of a learning organisation (LO) on developing quality improvement practices (QIPs) and to propose knowledge-sharing (KS) as a moderator which is anticipated to support the beneficial effect of a LO on QIP. A further objective is to establish whether training provision raises the abilities of healthcare organisations (HCOs) to attain greater standards of QIP via a LO and KS.

A total of 240 responses, obtained from employees working at private HCOs in Jordan, comprised the valid dataset. Structural equation modeling (SEM) was utilised for data analysis. Multigroup analysis (MGA) was performed to compare the impact of workers who had or had not undergone training.

The findings indicated that QIP was significantly enhanced by LO. HCOs with the objective of converting a KS-moderated LO could attain improved QIP standards, but within the surveyed establishments, this effect was only appreciated at modest degrees. By performing MGA, no variations were identified in the impact of workers.

Managers should place more emphasis on training and learning within HCOs. However, respondents did indicate that their establishments had notable degrees of KS, suggesting a potential strength that could be used positively by the managerial hierarchy.

This study encompasses an original contribution to contemporary scholarship in the field of knowledge management and quality through its examination of the moderating effect of KS on LO and QIP.

This study investigates the effects of top management commitment (TMC) and Kaizen on quality management practices (QMP) and how the latter influence the performance of Jordanian public hospitals in the aftermath of COVID-19.

A survey-based questionnaire was employed to collect data from 222 practitioners and professionals working in public hospitals in Jordan. Partial least squares structural equation modeling (PLS-SEM) was undertaken to analyze data.

Significant and positive effects of TMC and Kaizen (continuous improvement) on QMP are highlighted by the results. The findings also show that QMP has a positive and significant impact on public hospitals' performance. Furthermore, the effects of TMC and Kaizen on performance were also found to be significant.

Practitioners and researchers will gain a greater understanding of how implementing QMP can enhance the performance of public hospitals in the context of the COVID-19 outbreak. The results underline the important role of Kaizen and TMC in the success of QMP and their effect on performance. This research is a cross-sectional study, and there is a need to conduct further empirical investigation based on secondary data or objective measurement of performance.

This research is one of the first studies to investigate the effects of QMP on public hospitals' performance following the COVID-19 outbreak. This study is one of the empirical examinations of QMP and Kaizen in developing countries by investigating Jordanian public hospitals.

The complexity and uncertainty of healthcare operations increasingly require agility to safeguard a high quality of care. Using a microfoundations of dynamic capabilities perspective, this study investigates the effects of nurses' implicit voice theories (IVTs) on the behaviors that influence their individual agility.

This research uses quantitative survey data collected from 2,552 Canadian nurses during the fourth wave of the Covid-19 pandemic in the fall of 2021. Structural equation modeling is used to test a conceptual model that hypothesizes the effects of three different IVTs on nurses' creativity, spontaneity, agility and the quality of care they deliver to patients.

The results reveal that voice-inhibiting cognitions (like “suggestions are criticisms for higher-ups”, “I first need a solution or solid data”, and “speaking up has negative repercussions”) negatively impact nurses' creativity and spontaneity in crafting solutions to problems they face daily. In turn, this affects nurses' individual agility as they attempt to adapt to changing circumstances and, ultimately, the quality of care they provide to their patients.

Even if organizations have little control over employees' pre-held beliefs regarding voice, they can still reverse them by developing and nurturing a voice-welcoming culture to boost their workers' agility.

This study combines two theoretical frameworks, voice theory and dynamic capabilities theory, to study how individual-level factors (cognitions and behaviors) contribute to nurses' individual agility and the quality of care they provide to their patients. It answers the recent calls of scholars to study the mechanisms through which healthcare operations can develop and sustain dynamic capabilities, such as agility, and better face the “new normal”.