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Hospital length of stay (LOS) is not only a function of patient- and disease-related factors, but is also determined by other health system-wide variables. Managers and clinicians strive to achieve the best possible trade-off between patients’ needs and efficient utilisation of hospital resources, while also embracing ethical decision making. The purpose of this paper is to explore the perceptions of the hospital’s major stakeholders as to what affects the duration of LOS of inpatients.

Using a data-triangulated case study approach, 50 semi-structured interviews were performed with management, doctors, nurses and patients. Additionally, the hospitals’ standard operating procedures, which are pertinent to the subject, were also included in the thematic analysis.

This study shows that LOS is a multi-dimensional construct, which results from a complex interplay of various inputs, processes and outcomes.

The findings emerging from a single case study approach cannot be generalised across settings and contexts, albeit being in line with the current literature.

The study concludes that a robust hospital strategy, which addresses deficient organisational processes that may unnecessarily prolong LOS, is needed. Moreover, the hospital’s strategy must be sustained by providing good primary care facilities within the community set-up, as well as by providing more long-term care and rehabilitation beds to support the hospital turnover.

The subject of LOS in hospitals has so far been tackled in a fragmented manner. This paper provides a comprehensive and triangulated account of the complexities surrounding the duration in which patients are kept in hospital by key stakeholders, most of whom were hands-on in the day-to-day running of the hospital under study.

Tertiary hospitals have registered an incremental rise in expenditure mostly because of the increasing demands by ageing populations. Reducing the length of stay (LOS) of patients within tertiary hospitals is one of the strategies, which has been used in the last decades to ensure health care systems’ sustainability. Furthermore, LOS is one of the key performance indicators, which is widely used to assess hospital efficiency. Hence, it is crucial that policy makers use evidence-based practices in health care to aim for optimal LOS. The purpose of this paper is to identify and summarize empirical research that brings together studies on the various variables that directly or indirectly impact on LOS within tertiary hospitals so as to develop a LOS causal systems model.

This scoping review was guided by the following research question: “What is affecting the LOS of patients within tertiary-level health care?” and by the guidelines specified by Arksey and O’Malley (2005), and by Armstrong et al. (2011). Relevant current literature was retrieved by searching various electronic databases. The PRISMA model provided the process guidelines to identify and select eligible studies.

An extensive literature search yielded a total of 30,350 references of which 46 were included in the final analysis. These articles yielded variables, which directly/indirectly are linked to LOS. These were then organized according to the Donabedian model – structure, processes and outcomes. The resultant LOS causal model reflects its complexity and confirms the consideration by scholars in the field that hospitals are complex adaptive systems, and that hospital managers must respond to LOS challenges holistically.

This paper illustrates a complex LOS causal model that emerged from the scoping review and may be of value for future research. It also highlighted the complexity of the construct under study.

Does having things make people happy; does buying, consuming, or giving bring happiness? In an increasingly materialistic era, it seems that people might believe so. Despite our consumption culture, research tells us that the desire for material possessions relates more to unhappiness than to happiness (Belk, 1985; Burroughs & Rindfleisch, 2002; Csikszentmihalyi, 2000; La Barbera & Gürhan, 1997; Mick, 1996; Richins, 1987; Sirgy et al., 1998). Economists find that subjective well-being increases, then levels off as national levels of discretionary income increase (Csikszentmihalyi, 1999; Diener, 2000; Meyers, 2000). Furthermore, many economists cite correspondence between happiness and relative income (Blanchflower & Oswald, 2004; Solnick & Hemenway, 1998; Stutzer, 2003) to explain the stagnation of average happiness despite rises in national incomes. Increasing one person's income relative to others decreases the others’ happiness so that pursuing money to achieve happiness becomes a zero-sum affair; average national happiness does not change (Lee, 2006).