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This study aims to validate a model to assess the level of lean maturity of Brazilian hospitals based on the adaptation of the SAE J4000/2021 standard.

The methodology was divided: (1) adaptation of the standard to the health context, (2) application of the questionnaire through a survey, and (3) comparison of the results of the level of maturity in the standard and by the clustering technique, using Minitab.

The research presents two contributions: (1) validation of a model to assess the level of lean maturity based on the SAE J4000/2021; (2) insights into the level of maturity of Brazilian hospitals. It was observed that only 10% of the sample was classified at maturity level 3 and 75% at level 2. Private and large hospitals showed greater maturity compared to the others.

This includes the limited number of hospitals that participated in the survey, given the difficulty of adherence to due constraints of time and staffing from hospitals, during the COVID-19 pandemic.

This article presents a lean maturity assessment proposal, adapting a consolidated standard in the automobile industry to the health context. Insights on the lean maturity of Brazilian hospitals can contribute to the development of policies to encourage the implementation of the lean philosophy directed to each specific environment.

This study serves as a guide for public agents interested in monitoring the quality of hospital indicators through the SAE J4000/2021 standard. From this lean maturity analysis, hospital managers can understand their opportunities for improvement in both human and organizational aspects. This favors the improvement of service delivery to society that depends on health services.

Due to the lack of research that validates lean maturity level assessment models in Brazilian hospitals, this study can be considered a pioneer in this Brazilian research by validating the SAE J4000/2021 standard in its updated version in the health context.

Hospital building maintenance management constitutes a pertinent issue of global concern for all healthcare stakeholders. In Malaysia, the maintenance management of hospital buildings is instrumental to the Government’s goal of providing efficient healthcare services to the Government's citizenry. However, there is a paucity of studies that have comprehensively explored all dimensions of hospital building defects in relation to maintenance management. Consequently, this study seeks to evaluate the defects of hospital buildings in Malaysia with the aim of proffering viable solutions for the rectification and prevention of the issue.

The study utilised a quantitative approach for data collection.

The findings indicated that cracked floors, floor tile failures, wall tiles failure, blocked water closets, and damaged windows were some of the flaws that degrade hospital buildings. The study’s outcomes reveal that defects not only deface the aesthetic appearance of hospital buildings but also inhibit the functionality of the buildings and depreciate the overall satisfaction.

Considering the indispensable role of hospital buildings in the grand scheme of healthcare service provision and ensuring the well-being of people, the issue of defects necessitates an urgent re-evaluation of the maintenance management practices of hospital buildings in Malaysia. Previous studies on the maintenance management of hospital buildings in Malaysia have focused primarily on design, safety, and construction.

This is particularly important because defects in hospital buildings across the country have recently led to incessant ceiling collapses, fire outbreaks, ceiling, roof collapses, and other structural failures. These problems are typically the result of poor maintenance management, exacerbated by poor design and construction. These disasters pose significant risks to the lives of hospital building users.

This study offers invaluable insights for maintenance organisations and maintenance department staff who are genuinely interested in improving hospital buildings’ maintenance management to optimise staff's performance and enhance the user satisfaction of hospital buildings in Malaysia and globally.

Strategic orientation is one of the critical principles affecting the marketing and strategy selection of an organization’s activities, reflecting the strategic tendencies implemented by the organization to create behaviours, leading to organizational efficiency and better employee performance. Therefore, this paper aims to study the relationship between strategic orientation and performance in Qazvin teaching hospitals through green supply chain management (SCM) to improve employees' performance.

This was a descriptive– analytical and cross-sectional study. The total number of employees in medical centres was 2,256 people. According to Morgan’s table, the required number of samples was 328, including 10% of the sample loss. The questionnaire was given to 365 staff in different hospitals in proportion to the number of staff. Two statistical software, SPSS24 and AMOS23, were used to evaluate the results.

All three variables were relatively moderate in the hospitals. The results of evaluating the structural model of the research showed that all the studied hypotheses were significant, except for the relationship between organizational performance and strategic orientation hypothesis. The results also show that this model had a good fit.

The findings can lead to saving the environment, creating a better social image and reducing costs and profitability, allowing managers to know the strategic orientations rather than depending on institutional pressure issues and monitoring guidelines.

Considering the significant relationship between the dimensions of green SCM and the hospitals’ performance, the authors suggest: establishing multilateral co-operation in environmental issues, improving the environmental status of hospitals, reducing waste rates and paying attention to social responsibility of hospitals. In addition, the findings help hospital management to comprehensively understand the strategies for implementing green SCM procedures.

The primary aim of this research was to investigate the mediating effect of the decision-making structure on the relationship between perceived environmental uncertainty and hospital performance.

Online and manual survey questionnaires were used to collect data in this study. The target population of this study consists of all middle managers within 11 COVID-19 referral hospitals in Surabaya. A total of 189 responses were collected, however, 27 incomplete responses were excluded from the final dataset. Data was analyzed using SEM-PLS.

The study's findings indicate that decision-making structure plays a role in mediating the link between perceived environmental uncertainty and hospital performance assessed via the Balanced Scorecard, highlighting the significance of flexible decision-making processes during uncertain periods. Moreover, based on our supplementary test, respondents' demographic characteristics influence their perceptions of hospital performance.

Hospital administrators can consider the significance of decision-making structures in responding to environmental uncertainties like the COVID-19 pandemic. By fostering adaptable decision-making processes and empowering middle managers, hospitals may enhance their performance and resilience in challenging situations. Additionally, based on supplementary tests, it is found that differences in the perception of the three Balanced Scorecard perspectives imply that hospitals categorized as types A, B, C, and D should prioritize specific areas to improve their overall performance.

This research adds substantial originality and value to the existing body of knowledge by exploring the interplay between decision-making structures, environmental uncertainty, and hospital performance. It contributes to the literature by specifically focusing on the Covid-19 pandemic, a unique and unprecedented global crisis.

Evaluating the operational outcomes of hospitals is critical concerns for hospital managers. The realization of these evaluations through the principles of Total Quality Management (TQM) is important so that decision-makers can base their decisions on rational grounds. To achieve TQM principles, hospitals need innovative processes that can adapt to changing patient expectations. Innovation activities that will lead to business excellence can be achieved with the strategic planning awareness of healthcare professionals. In this study, it is aimed to evaluate the effect of organizational innovation on business excellence and to reveal the role of strategic planning awareness in this relationship in hospitals.

The data were collected using a quantitative questionnaire to 450 healthcare professionals working in private hospitals operating in Istanbul (Turkey). The data were analyzed using the AMOS (Analysis of Moment Structures) 23.0 and SPSS (Statistical Package for the Social Sciences) for Windows 25.0 program. In addition to the reliability analysis, confirmatory factor analysis was performed using the AMOS program to test the construct validity of the scales. The model established in line with the research hypotheses was tested with path analysis and mediator role analysis.

The results confirm that organizational innovation has a statistically significant and positive effect on strategic planning awareness and business excellence. In addition, it has been determined that strategic planning awareness has a statistically significant and positive effect on business excellence. Moreover, the research model confirms that strategic planning awareness plays a mediating role in the relationship between organizational innovation and business excellence.

The limitation of the study is that it was conducted only in private hospitals. A comparative study that includes the public health sector can further strengthen the research framework.

Hospitals that invest in innovative activities can get the reward of their efforts as business excellence. However, this is affected by the strategic planning awareness of healthcare professionals. Research results present the role of strategic planning awareness on the way to business excellence led by organizational innovation. Achieving business excellence in complex and constantly changing environmental conditions depends on an appropriate strategic plan for hospitals. In order to achieve these goals included in the strategic plans, the education of healthcare professionals that contributes to their strategic perspectives should be supported and their participation in decision-making processes should be ensured.

The research contributes to the literature on the relationship between organizational innovation and business excellence in the health sector. In addition, revealing the role of strategic planning awareness of healthcare professionals in this relationship is the originality of the research. In addition, the research supports the literature that allows performance evaluation in hospitals to be carried out with a business excellence model based on TQM.

Health tourism is a relatively new branch of international tourism that has developed more rapidly than other tourism sectors in recent years. This study aimed to investigate the effect of government supports on health tourism development by considering the mediating role of internal and external infrastructures.

The study population consisted of all experts of two hospitals in Iran, which are frequently visited by foreign tourists (N = 151). A questionnaire, developed by combining standard and researcher-made questionnaires, was used to collect the data. The confirmatory factor analysis (CFA) model was developed in SmartPLS 3 to test the hypotheses.

The main hypothesis test results indicated that government supports positively affect the development of health tourism. Internal and external infrastructures were also found to mediate the relationship between government supports and health tourism development. In addition, the sub-hypothesis test results showed that internal and external infrastructures are positively affected by government supports, which puts forth the development of health tourism. As the results explained, the most important aspects of internal infrastructures affected by government support were health service quality, cost of health services and applying advanced medical technologies, respectively. Also, different aspects of external infrastructures affected by government supports are as follows: economic, infrastructures and cultural factors.

This study is the first of its kind to examine the impact of both medical and non-medical factors on health tourism and signifies the crucial role of governments in the development of health tourism.

The most challenging aspect of hospital design is the creation of an environment that heals rather than the one acting as a barrier to healing. Much has not been done in the aspect of ascertaining the level of impact “indoor environmental quality (IEQ)” has on building occupants in healthcare facilities. Therefore, this study aims to investigate the impact of IEQ on patients' health and well-being.

The study investigates the hypothesis that four IEQ parameters (thermal quality, acoustic quality, lighting quality and indoor air quality [IAQ]) influence patients' overall satisfaction with the performance of hospital wards. Questionnaire responses were sought from the patients as the main occupants of hospital ward buildings. A proposed weighted structural model for IEQ establishing the relationship between IEQ parameters, patients' overall satisfaction and patients' health outcome was analyzed using structural equation modeling (SEM).

The most influential IEQ parameters on patients' overall satisfaction with IEQ in hospital wards are thermal quality, IAQ and lighting quality. The findings from this study revealed that the parameters of influence on patients' overall satisfaction and health outcomes vary with hospital ward orientation and design configuration.

This study has explored the need for the integration of all factors of IEQ at the building design stage towards providing a hospital environmental setting that reflects occupants' requirements and expectations and also promotes patient healing processes. This should be the focus of architects and healthcare managers and providers.

Indoor environmental quality (IEQ) in buildings has an impact on people’s health, productivity and comfort. Maintaining the highest possible IEQ level in complex buildings, such as health care, is difficult due to economic and organizational constraints. This study aims to categorize the vicinities in a typical health-care facility in terms of importance and criticality in relation to the various IEQ factors, as well as to develop an IEQ assessment procedure.

A comprehensive literature review, established standards and structured interviews with industrial hygiene professionals in health-care settings were used in this study. To test the applicability of the developed IEQ assessment procedure, a pilot study was conducted in an existing health-care facility.

This study categorized health-care facilities into various vicinities and discovered three respondents group had varying IEQ perceptions (facility managers, environmental health specialists and nurses). According to the findings, indoor air quality is the most important and dominant factor influencing overall IEQ in health-care facilities. The trial application of the framework shows that much work is needed to improve the level of response and readiness of facility management and occupants to allow for the effective use of the developed procedure.

Previous research did not include a detailed categorization of vicinities in health-care buildings based on IEQ requirements. The findings of this study will help to close this knowledge gap and guide facility managers and operators in recognizing the relative importance of different IEQ factors, maintaining functional requirements and identifying priorities when developing maintenance and operational procedures and allocating resources.

The study aims to investigate the nurse job enjoyment and their participation in medical affairs to enchance the quality of patient care in Saudi hospitals. In addition, this study also investigates the management team's role in patient care quality through the mediating effects of nurse job enjoyment and participation in medical affairs.

The present study used a self-administered survey questionnaire to collect data from registered nurses in Saudi hospitals. In this study, 600 survey questionnaires were distributed online (Google Forms) and received 266 valid responses (44.33% response rate). In addition, SmartPLS-4.0 was applied to validate the research constructs and test the hypotheses via partial least squares structural equation modelling (PLS-SEM).

The study's findings indicate that the job enjoyment of the nurses and participation in medical affairs have positive and significant effects on the quality of patient care. In addition, the research findings also suggest that the management team of the hospitals has a significant indirect influence on the quality of patient care through the medicating effects of nurse job enjoyment and participation in medical affairs.

The findings of this study also offer various practical implications. This study showed the direct impact of the management team on job enjoyment, medical affairs and patient care quality. Therefore, hospital authorities and policymakers may emphasise clear communication, collaboration, respect and trust for the effective management team in providing higher-quality patient care. The present study suggests that hospital policymakers should strive to create a positive work environment, provide adequate resources, foster team spirit, offer incentives and allow flexible scheduling to ensure higher job enjoyment and increase nurse participation in medical affairs.

This study adds to the growing body of knowledge by investigating the effects of the management team, job enjoyment and nurses' participation in medical affairs on patient care quality. This study also enhances the theoretical depth by exploring the mediating impact of job enjoyment in predicting the relationships between the management team and the quality of care provided to patients. The present study provides guidelines for healthcare service providers or practitioners to focus on the nurses' job enjoyment and their engagement in medical activities to continuously improve the quality of patient care in the hospitals.

Recently, interest and necessity for cloud-based hospital information systems (HISs) have emerged as an appropriate alternative for revitalizing medical information exchange between hospitals, analyzing “big data” medical information and developing the use of new medical technologies. The purpose of this paper is to investigate factors that affect the switching of information systems in existing on-premise environments into cloud-based HISs.

A research model was developed using the push–pull–mooring model based on migration theory. The research model was analyzed using confirmatory factor analysis and path analysis using partial least squares structural equation modeling.

The results of this study showed that low compatibility, perceived value, low cost and inertia influenced the intention to switch to cloud-based HISs; low flexibility and low compatibility influenced dissatisfaction; and low cost, ease of maintenance and ease of managing indicators influenced perceived value.

This study is expected to be used as the basis for developing a research model in subsequent studies to analyze the transition to new innovative technologies. Also, in practice, it is expected to contribute to the activation of cloud computing environments in hospitals.