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A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

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.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

Four reputed leaders for the coming years in the field of special education for individuals with emotional and behavioral disorders (EBD) each with a slightly different perspective on the field were asked to respond independently to a prompt asking what does special education mean for students with EBD and what is being done and how do we maintain tradition? The contributors' responses to the prompt are presented and then summarized across the essays. A remarkable consistency emerges across the independent essays. In addition to the tradition of providing a free and appropriate education in the least restrictive environment, the contributors identify needs to support teachers serving this population. Needs in teacher training and the expertise required to meet the needs of individuals with EBD are outlined as well as potential contributions of technology to carry out specific tasks. We conclude with a call for increased advocacy for use of the knowledge that we currently possess and that which will soon be discovered to support students with EBD as well as their teachers. We also note that the contributors' names are listed alphabetically to acknowledge the equality of each person to the final product.

This study aimed to compare mortality rate, length of stay (LOS) and hospitalization costs at different priority levels for a patient admitted to an intensive care unit (ICU) at a public tertiary hospital in Qazvin, Iran. This study also aimed to predict influencing factors on patients’ mortality, ICU LOS and hospitalization costs in different admission groups.

The authors conducted a retrospective cohort study among patients who mainly suffered from internal diseases admitted to an ICU of a public hospital. This study was conducted among 127 patients admitted to ICU from July to September 2019. The authors categorized patients into four groups based on two crucial hemodynamic and respiratory status criteria. The authors used a logistic regression model to predict the likelihood of mortality in ICU admitted patients during hospitalizations for the four prioritization groups. Furthermore, the authors conducted a multivariate analysis using the “enter” method to identify risk factors for LOS.

Results showed a statistically significant relationship between the priority of being admitted to ICU and hospitalization costs. The authors’ findings revealed that age, LOS and levels of consciousness had a predictability role in determining in-hospital mortality. Besides, age, gender, consciousness level of patients and type of the disease were mentioned as affecting factors of LOS.

This study’s findings emphasize the necessity of categorizing patients according to specific criteria to efficiently use available resources to help health-care authorities reduce the costs and allocate the budget to different health sectors.

In an era where complex technological advances increasingly govern service delivery, it is incumbent on service firms to pioneer innovative strategies to sustain customer engagement and cultivate loyalty. This conceptual paper examines the transformative potential of artificial intelligence (AI) in the realm of online customer communities, with a particular focus on its creation, management and enhancement facets. The authors explore how AI can revolutionize the dynamics of customer interaction, feedback mechanisms and overall engagement within the service industry.

This conceptual paper draws from marketing and management literature focusing on customer communities and AI in service and customer engagement contexts with a robust future research agenda.

A classification of online customer community engagement is provided along with a conceptual framework to guide our understanding of the integration of AI into online customer communities.

This exploration underscores the imperative for service firms to embrace AI-driven approaches to online customer community management, not only as a means to optimize their operations but as a vital strategy to stay competitive in the ever-evolving digital landscape. This paper examines the novel combination of AI with online customer communities and provides the framework in the form of an input-process-output (IPO) model for future research into this integration.

This systematic literature review analyzes the academic literature to understand SC risk and resilience across different organizational sizes and industries. The academic literature has well discussed the causes of supply chain (SC) risk events, the impact of SC disruptions, and associated plans for SC resilience. However, the literature remains fragmented on the role of two fundamental elements in achieving SC resilience: the firm's size and the firm's industry as firms' contingent factors. Therefore, it is important to investigate and highlight SC resilience differences by size and industry type to establish more resilient firms.

Building upon the contingent resource-based view of the firm, the authors posit that organizational factors such as size and industry sector have important roles in developing organizational resilience capabilities. This systematic literature review and analysis is based on the structural and systematic analysis of high-ranked peer-reviewed journal papers from January 2000 to June 2021 collected through three global scientific databases (i.e. ProQuest, ScienceDirect, and Google Scholar) using relevant keywords.

This systematic literature review of 230 high-quality articles shows that SC risk events can be categorized into demand, supply, organizational, operational, environmental, and network/control risk events. This study suggests that the SC resilience plans developed by startups, small and mdium-sized enterprises (SMEs), and large organizations are not necessarily the same as those of large enterprises. While collaboration and networking and risk management are the most crucial resilience capabilities for all firms, applying lean and quality management principles and utilizing information technology are more crucial for SMEs. For large firms, knowledge management and contingency planning are more important.

This study provides a comprehensive review of the literature on SC resilience plans across different organizational sizes and industries, offering new insights into the nature and dynamics of startups', SMEs', and large enterprises' SC resilience in different industries. The study highlights the need for further investigation of SC risk and resilience for startups, SMEs, and different industries on a more detailed level using empirical data. This study’s findings have important implications for researchers and practitioners and guide the development of effective SC resilience strategies for different types of firms.

As China has pressed ahead with rural revitalization in recent years, its rural financial sector has also developed rapidly and the financial environment has been greatly improved. But compared with urban areas, the rural financial sector makes rather limited contributions to rural economic development for a variety of reasons, including single types of service providers, narrow coverage, and lack of services and products. The underdevelopment of the rural financial system is closely related to the characteristics of its target customers and the economic system. The deficient rural financial credit system, the low level of IT application, the difficulty in data collection and integration, and the insufficient collateral of farmers pose high costs and huge risks for financial institutions when providing credit and other financial services.

In the present case, fintech and financial innovation complement each other: The application of fintech makes innovation possible, and the need for financial development fuels the development of fintech. Leveraging fintech and new business models, MYbank has overcome the main obstacles in the development of rural finance to provide convenient financial services for farmers and rural MSEs. Fintech is the abbreviation of “financial technology.” It can be understood as the combination of finance and technology for easier understanding, but it is more than that. Fintech refers to the innovation of traditional financial products and services with various technologies to improve efficiency and reduce operating costs. The emergence and development of fintech have led to the creation of new business models, applications, and processes, which have triggered major changes in financial markets, financial institutions, and the ways financial services are delivered, and are reshaping the financial landscapes of countries and even the world.

There are three major problems in the development of rural finance: difficult access to data, difficult risk management, and difficult market penetration. In order to gradually remove the obstacles and guarantee sustainable business development, MYbank has created three new business models with the power of fintech: digital inclusive finance at the county level, industrial finance, and platform finance. With these models, MYbank is searching for a “Chinese solution” to the worldwide problem of rural inclusive finance.