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The purpose of this paper is to ascertain the performance of Indian hospitals in recent past and derive meaningful insights for policy makers and practicing managers in this area.

This paper analyses the technical efficiency of select Indian private hospitals using three related methodologies: data envelopment analysis (DEA), Malmquist Productivity Index (MPI) and Tobit regression. Two output variables (i.e. total income and profit after tax) and four input variables (i.e. cost of labour, net fixed assets, current assets and other operating expenses) were selected for the purpose of the study.

DEA analysis has shown that 14 out of 37 hospitals are found to be efficient under the Cooper and Rhodes model of DEA and 20 out of 37 hospitals are efficient under the Banker, Charles and Cooper model of DEA. The empirical results pertaining to MPI indicate an overall productivity progress in the private Indian hospital industry during the study period, which is largely due to technological advancement in the industry. Tobit regression demonstrates that chain affiliated, specialized and multi-city located hospitals exhibit a higher technical efficiency.

This study has a limitation with reference to the unavailability of data on the input and output parameters of the model. The data related to the number of beds, number of doctors, number of nurses, etc., were not available for the period under consideration.

This study seems to be one of the few studies applying productivity and performance analysis using DEA, MPI and Tobit regression for the Indian private hospital industry.

Hospital structures serve to protect and improve public health; however, they are recognized as a major source of environmental degradation. Thus, an effective performance evaluation framework is required to improve hospital sustainability. In this context, this study presents a holistic methodology that integrates the sustainability balanced scorecard (SBSC) with fuzzy Delphi method and fuzzy multi-criteria decision-making approaches for evaluating the sustainability performance of hospitals.

Initially, a comprehensive list of relevant sustainability evaluation criteria was considered based on six SBSC-based dimensions, in line with triple-bottom-line sustainability dimensions, and derived from the literature review and experts’ opinions. Then, the weights of perspectives and their respective criteria are computed and ranked utilizing the fuzzy analytic hierarchy process. Subsequently, the hospitals’ sustainable performance values are ranked based on these criteria using the Fuzzy Technique for Order of Preference by Similarity to Ideal Solution.

A numerical application was conducted in six public hospitals to exhibit the proposed model’s applicability. The results of this study revealed that “Patient satisfaction,” “Efficiency,” “Effectiveness,” “Access to care” and “Waste production,” respectively, are the five most important criteria of sustainable performance.

The new model will provide decision-makers with management tools that may help them identify the relevant factors for upgrading the level of sustainability in their hospitals and thus improve public health and community well-being.

This is the first study that proposes a new hybrid decision-making methodology for evaluating and comparing hospitals’ sustainability performance under a fuzzy environment.

Social entrepreneurs create novel approaches to social problems such as poverty. But scaling these approaches to the dimension of the problem can be a difficult task. In the social enterprise sector, the subject of scaling has become a key dimension of organizational performance. This chapter advances the scholarly literature on the scaling of social enterprises, a literature which is currently in an embryonic stage and characterized by conceptual ambiguity and fragmented perspectives.

We engage realist philosophy of science to develop mechanism-based causal explanations of the scaling performance of social enterprises. We also develop a coding scheme to guide systematic empirical analysis and highlight the explanatory power of counterfactuals. Counterfactuals have been largely neglected in empirical research as they represent mechanisms that are enabled but remain unobservable – in a state of suppression or neutralization of their effects.

We question the ability of organizations to “socially engineer” desired outcomes and introduce a new construct – organizational closure competence. Anchored in realism, this construct provides a basis for productive approaches to social engineering. We elaborate on the importance of organizational closure competencies for scaling, derive a series of propositions, and develop ideas for future research and for practice.

Applying a realist lens allows us to add empirical rigor to research on social enterprises and scaling. Our approach constitutes a move from rich narratives to causal models and informs the way we design and evaluate efforts to address important societal challenges.

This chapter demonstrates how to operationalize realist philosophy of science for causal explanations of complex social phenomena and better utilize its theoretical and practical value.

This case, “One Mission, Multiple Roads: Aravind Eyecare System in 2009” is a sequel to the earlier case, “Aravind Eyecare System: Giving Them the Most Precious Gift” (BP 0299). It describes the new challenges facing AECS in 2009. It presents the strategic choices facing a mission driven organization like AECS. For its future growth it had the option of several paths. Following any of these paths would not dilute its mission and yet it could not pursue all of them at the same time. It would have to prioritize them. The case encourages participants to develop criteria for this prioritization.

Fundholding (the opportunity to hold a budget at practice level) has given general practitioners (GPs) purchasing power for medical services within the reformed UK National Health Service (NHS). This new purchasing power equates to financial leverage with the NHS consultants in hospitals. Argues that fundholding is presented as an opportunity for GPs to engage in a “turf battle” with the hospital consultants without this battle becoming publicly visible. Fundholding as an accounting‐based intervention masked the nature of the professional challenge which GPs launched against the consultants and, hence, allowed territorial claims to be renegotiated through the medium of contracting. This circumvented the damage to medical professional ideologies which would have ensued if intra‐professional conflicts had become overt. The empirical study which is referred to indicates that GPs are using contracts to improve processes of case management at the hospital interface (an area where consultants have failed to communicate with GPs) and to have an input into the setting of quality standards within the hospitals. The increased financial flexibility conferred through holding budgets is also enabling GPs to expand in‐house services for primary care. Theorizes the changing power relations between GPs and consultants through exploring four dimensions of intra‐professional differentiation: task specialization; client differentiation; organization of work; and career pattern. Concludes that budgets have constituted a catalyst for professional development through reconnecting the monetary bonds between the polarized professionals in British medicine. This study indicates that, as fundholding progresses, the boundary between primary and secondary care is becoming blurred; that lead fundholding GPs are being managerialized; and that the purchasing dialogue between the GPs and the Trusts is marginalizing the role of the Health Boards (bodies which had previously held sole responsibility for the co‐ordination and delivery of health care but which now have a more limited purchasing/commissioning role).

To investigate ethnographically how patient experience data, as a named category in healthcare organisations, is actively “made” through the co-creative interactions of data, people and meanings in English hospitals.

The authors draw on fieldnotes, interview recordings and transcripts produced from 13 months (2016–2017) of ethnographic research on patient experience data work at five acute English National Health Service (NHS) hospitals, including observation, chats, semi-structured interviews and documentary analysis. Research sites were selected based on performance in a national Adult Inpatient Survey, location, size, willingness to participate and research burden. Using an analytical approach inspired by actor–network theory (ANT), the authors examine how data acquired meanings and were made to act by clinical and administrative staff during a type of meeting called a “learning session” at one of the hospital study sites.

The authors found that the processes of systematisation in healthcare organisations to act on patient feedback to improve to the quality of care, and involving frontline healthcare staff and their senior managers, produced shifting understandings of what counts as “data” and how to make changes in response to it. Their interactions produced multiple definitions of “experience”, “data” and “improvement” which came to co-exist in the same systematised encounter.

The article's distinctive contribution is to analyse how patient experience data gain particular attributes. It suggests that healthcare organisations and researchers should recognise that acting on data in standardised ways will constantly create new definitions and possibilities of such data, escaping organisational and scholarly attempts at mastery.

A project aiming to study the delineation of responsibilities between hospitals in Paris, with a view to improving administration of patients' admission and transfer led to the restructuring of problems and the discovery of problems not fully realised prior to this, i.e. in addition to mismatches between formal responsibilities and real patient arrivals, and inertia in patient transfer, issues such as which care is to be given priority; precise role of emergency reception services; allocation of beds to specialities, and so on. More and more facets of the problem were uncovered: material resources; organisational issues; individual matters and taboos and culture. When everyone has agreed the problem the study will end.

This study aims to explore the empirical correlation between patient flow issues, quality of green health services and patient satisfaction in specialist medical department factors from patients’ perspectives as service consumers.

This research is a type of nonintervention empirical research that uses an open survey to explore the views and experiences of users of specialist medical department services. The targeted population is hospital patients included in the top five national PERSI (Indonesian Hospital Association) Award 2022 Green Hospital Category, with a total number of respondents of 572 people. This study uses the partial least square-structural equation modeling analysis method with the SmartPLS application.

Patient flow problems generally affect the quality of eco-friendly health services, except for the waiting time problem, which affects service quality. It should be understood as a top priority for patients to receive services from medical specialists without risking time as a core service aspect from the patient’s perspective. In addition, all variables in eco-friendly hospital services affect patient satisfaction, except in the case of visits to specialist medical departments, which do not affect medical support services and hospital practices that are responsive to the delivery of care services resulting from medical support services that are inseparable in integrated services as well as health care following medical ethics.

This study has a novelty in understanding the implications of green practice in determining patient satisfaction in medical specialist department as the epicenter of hospital services and the main object of assessment for the quality of hospital services.