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This paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks (PCNs) to lead system improvement together. It identifies programme impact at micro and meso system levels; a leadership impact continuum that can be used by individuals and teams to evidence impact of improvements in PCN practices; the learning and development strategies that were effective and proposes implications for other networks.

Mixed methods underpinned by practice development methodology were used to explore the impact of the programme on two practitioner cohorts across 16 PCNs. Data were collected at the start, mid-point and end of the eight-month programme.

Results illustrate an innovative approach to collective leadership development. A continuum of impact created with participants offers insight into the journey of transformation, recognising that “change starts with me”. The impact framework identifies enablers, attributes and consequences for measuring and leading change at micro, meso and macro levels of the health-care system. Participants learned how to facilitate change and collaboratively solve problems through peer consulting which created a safe space for individuals to discuss workplace issues and receive multiprofessional views through action learning. These activities enabled teams to present innovative projects to commissioners for service redesign, enabling their PCN to be more effective in meeting population health needs. The authors believe that this programme may provide a model for other PCNs England and other place-based care systems internationally.

This study offers insight into how to enable a journey of transformation for individuals and PCN teams to enhance team effectiveness and collective leadership for system-wide transformation required by the National Health Service Long Term Plan (2019).

This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University.

Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes.

Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – “The Light Between Us as interactions in our relationships”, “Seeing People’s Inner Light”, “Kindling the Spark of light and keeping it glowing”, “Lighting up the known and the yet to be known” and “Constellations of connected stars”.

This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families.

The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool.

Whilst policymakers note the increasing importance of leadership in facilitating the culture change needed to support health and care systems to adopt sustainable change at pace, there is still a prevailing focus on traditional approaches to individual leadership development as opposed to collective leadership across teams, services and systems. If this paper fails to understand how to transform leadership policy and education, then it will be impossible to support the workforce to adapt and flex to the increasingly complex contexts they are working in. This will serve to undermine system integration for health and social care if the capacity and capability for transformation are not attended to. Whilst there are ambitious global plans (WHO, 2015) to enable integrated services to be driven by citizen needs, there is still a considerable void in understanding how to authentically engage with people to ensure the transformation is driven by their needs as opposed to what the authors think they need. There is, therefore, a need for systems leaders with the full skillset required to enable integrated services across place-based systems, particularly clinicians who are able to break down barriers and silo working across boundaries through the credibility, leadership and facilitation expertise they provide.

The realist evaluation with additional synthesis from key stakeholders has provided new knowledge about the principles of effective NMAHP leadership in health and social care, presented in such a way that facilitates the use of the five guiding lights to inform further practice, education, research and policy development.

Social media facilitates consumer exchanges on product opinions and provides comprehensive knowledge of online products. The interaction between consumers and e-retailers evolves into a collective set of dynamics within a complex system. Agent-based modeling is well suited to stimulate such complex systems. The purpose of this paper is to integrate agent-based model and technique for order performance by similarity to ideal solution (TOPSIS) to simulate decision behaviors of e-retailers in competitive online markets.

An agent-based network model using the TOPSIS driven by actual price data is developed. The authors ran an experimental model to simulate interactions between online consumers and e-retailers and to record simulation data. A nonparametric test is used to conduct data analysis and evaluate the sensibility of parameters.

Simulation results showed that different profits could be obtained for various brands under different social network structures. E-retailers could achieve more profits through cross-selling than single-selling; however, the highest profits can be achieved when some adopt cross-selling, whereas others use single-selling. From a game perspective, the equilibrium for price-adjustment frequency can be determined from the simulation data. Thus, price adjustment differences significantly affect e-retailer profit.

This study provides new insights into the evolutionary dynamics of online markets. This work also indicates how to build an integrated simulation model with an agent-based model and TOPSIS and how to use an integrated simulation model and interpret its results.

Current centralized humanitarian aid deployment practices may encourage urbanization thereby weakening short- and long-term resiliency of lower-income countries receiving aid. The purpose of this paper is first, to explore these shortcomings within the peer-reviewed literature and, second, propose a starting point for a solution with a decentralized humanitarian aid deployment (DHAD) framework.

The authors conducted a focused, qualitative review of available and relevant literature.

The literature reviewed demonstrates that current centralized humanitarian aid deployment models lack meaningful engagement of local assets while indicating a plausible connection between these same models and disaster urbanization. Next, the literature shows introducing a new decentralized model could represent a sustainable aid deployment standard for that country’s specific response, recovery, mitigation and planning opportunities and constraints.

The next step is to develop a working DHAD model for a lower-income country using a multi-layered, GIS analysis that incorporates some or all of the socioeconomic and environmental variables suggested herein.

The practical potential of the DHAD framework includes establishing the impacted country in the lead role of their own recovery at the moment of deployment, no longer relying on foreign logistics models to sort it out once aid has arrived.

This paper discusses a topic that much of the literature agrees requires more research while suggesting a new conceptual framework for aid deployment best practices which is also largely absent from the literature.

The purpose of this paper is to systematically review published literature for the research question “what issues are considered (and changes made) for vulnerable groups as part of the chemical, biological, radiological, nuclear or explosive (CBRNe) response for casualty collection, decontamination, triage and casualty clearing processes?”.

Seven-stage framework from the PRISMA statement for research question, eligibility (definition), search, identification of relevant papers from title and abstract, selection and retrieval of papers, appraisal and synthesis. Data sources: Medline, Embase, Cochrane Library, Web of Science, Scopus (Elsevier), Chemical Abstracts, Assia (Proquest), Sociological abstracts (Proquest), Cinahl, HMIC, Health business elite, PsycInfo (ebsco), PILOTS (Proquest) and supplemented by other search strategies (e.g. exploding reference lists). The included references were critically appraised using the mixed methods appraisal tool (MMAT).

Results: 1,855 papers were returned from the literature search, of which 221 were screened by abstract and 48 by full paper. In total, 11 papers were included for appraisal, of which three achieved a quality score of 50 per cent or over. The papers were categorised into three phases on CBRNe response; evacuation, triage and decontamination.

The limitations of the search process included the use of emerging exclusion criteria. This may have excluded research that would provide more information in some topic areas but it was felt necessary to set a high publication standard for inclusion to generate trustworthy results and recommendations. The MMAT appraisal tool has been validated for different study types and provided a useful categorisation approach for critical appraisal, albeit resulting in only three included studies. Future reviews could include papers published in a wider range of languages to include research from non-English sources.

These evidence-based results should be used by practitioners to review current operational policies for vulnerable people and plan future improvements. Evacuation accessibility can be described as characteristics for exit, route and obstacles. This takes a systems approach to consider how building planning and layout can have implications for safety critical but low frequency events. Decontamination recommendations include: at least one additional re-robe section per mass decontamination unit and adaptations to the decontamination plan including accessible equipment for non-ambulatory individuals; and additional (specialist) staff in the decontamination team (sign language, interpreters and physical therapists).

Although very little new medium/high quality research is available, the findings are summarised as considerations for building design (route choice and information), communication (including vision, hearing and language differences) and the composition of the response team. It is suggested that evidence-based practice from other care domains could be considered (patient movement and handling) for fire service and ambulance guidelines.

The last few years have seen a stronger emphasis on patient-centred care within the international healthcare setting. Patient-centred care is clearly perceived to be important to optimise the satisfaction and well-being of patients. The purpose of this paper is to review current patient-centred practices for outpatients in both private clinics and public hospitals in Dubai. Such a comparison contributes to the identification of best management practices as a means of enhancing healthcare delivery.

This study is based on an independent survey consisting of self-administered questionnaires, in which patients were asked to rate several aspects of private clinics or government hospitals in Dubai. The questionnaire used has been drawn from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey, Version 3.0. Responses from 420 patients form a data set that is analysed quantitatively.

In total, 420 respondents took part in this survey. The results of the survey show that there is a considerable difference between the expectation levels of patients from government hospitals and patients from private clinics. Patients from government hospitals consistently show that time is a critical aspect of the service received, with 68 per cent of the respondents reporting this issue. Additionally, poor customer care, as reported by 14 per cent of the respondents, is also a critical issue. Timely service and appointments are among the main factors that contribute to patient satisfaction. Patients in private clinics, instead, particularly value clear explanations from doctors and nurses – this is corroborated by the fact that 11 per cent of the respondents reported appreciation of this type of service.

This paper draws attention to a patient-centric perspective of healthcare, and highlights the importance of educating patients through clear explanations.

Little evidence exists on the standards of healthcare in Dubai. The authors explore this area and present direct evidence on quality standard implementation, identify implementation shortcomings and make recommendations for future research and practice.

This paper introduces a schema for the product assembly feature data in an object-oriented and module-based format using Unified Modeling Language (UML). To link production with product design, it is essential to determine at an early stage which entities of product design and development are involved and used at the automated assembly planning and operations. To this end, it is absolutely reasonable to assign meaningful attributes to the parts’ design entities (assembly features) in a systematic and structured way. As such, this approach empowers processes such as motion planning and sequence planning in assembly design.

The assembly feature data requirements are studied and definitions are analyzed and redefined. Using object-oriented techniques, the assembly feature data structure and relationships are modeled based on the identified requirements as five UML packages (Part, three-dimensional (3D) models, Mating, Joint and Handling). All geometric and non-geometric design data entities endorsed with assembly design perspective are extracted or assigned from 3D models and realized through the featured entity interface class. The featured entities are then associated (used) with the mating, handling and joints features. The AssemblyFeature interface is realized through mating, handling and joint packages related to the assembly and part classes. Each package contains all relevant classes which further classify the important attributes of the main class.

This paper sets out to provide an explanatory approach using object-oriented techniques to model the schema of assembly features association and artifacts at the product design level, all of which are essential in several subsequent and parallel steps of the assembly planning process, as well as assembly feature entity assignments in design improvement cycle.

The practical implication based on the identified advantages can be classified in three main features: module-based design, comprehensive classification, integration. These features help the automation and solution development processes based on the proposed models much easier and systematic.

The proposed schema’s comprehensiveness and reliability are verified through comparisons with other works and the advantages are discussed in detail.

The purpose of this paper is to present and develop an ontology-based approach for automatic generation of assembly sequences.

In this approach, an assembly sequence planning ontology is constructed to represent the structure and interrelationship of product geometry information and assembly process information. In the constructed ontology, certain reasoning rules are defined to describe the knowledge and experience. Based on the ontology with reasoning rules, the algorithm for automatically generating assembly sequences is designed and implemented.

The effectiveness of this approach is verified via applying it to generate the assembly sequences of a gear reducer.

The main contribution of the paper is presenting and developing an ontology-based approach for automatically generating assembly sequences. This approach can provide a feasible solution for the issue that mathematics-based assembly sequence generation approaches have great difficulty in explicitly representing assembly experience and knowledge.

The purpose of this paper is to investigate whether air pollution has significant impact on corporate cash holdings and financial leverage.

The data of 199 firms listed on Istanbul Stock Exchange during the period 2009–2020 is analyzed by using pooled ordinary least squares and two-step system generalized method of moments models.

The results indicate that firms in regions with high air pollution tend to increase cash level. In addition, the positive effect of air pollution on cash level is stronger and more significant for environmentally sensitive firms and firms with low operational and distress risk. The results also show insignificant effect of air pollution on financial leverage.

Firms in regions with high air pollution should conduct proactive environmental protection procedures and enhance their eco-efficiency instead of holding excess cash that could negatively affect financial performance. In this context, policymakers should provide financial facilities to firms located in regions with high air pollution and that have low ability to finance environmental investments. On the other hand, the environmental laws and regulations introduced by regulatory authorities can enhance the economic development and firm performance by decreasing the adverse influences of air pollution on corporate financial policies.

To the best of the author’s knowledge, this research is one of few that examines the impact of air pollution on corporate cash holdings and financial leverage in emerging markets.