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The aim of this study is to investigate the roles of psychiatric mental health nurses during their work experiences in inpatient clinical settings.

A focus group of 10 graduate psychiatric nurses with more than two years’ practice in inpatient psychiatric settings reflected on their last six months’ work placements and continuous employment. The transcripts and field notes were analyzed through thematic analysis of inductive data.

Two main themes emerged: management roles and clinical roles. The participants reflected on caring activities and obstacles encountered in fulfilling their professional roles.

Multiple practice issues emerged. The participants perceived that psychiatric nurse specialists are required to perform more caring functions than practicable in the inpatient setting due to an excess of noncaring duties, structural minimization of the caring role and inadequate training. They felt that many of the functions performed were not within their expectations of the caring role of a psychiatric nurse specialist and believed that changes in nurse education and attention to clarification of nurses’ roles might enhance the role they play in patient care.

The purpose of this research is to develop a better understanding of the hurdles in implementing Lean Six Sigma (LSS) for operational excellence in digital emerging technology companies.

We have conducted case studies of LSS implementations in six US-based companies in the digital emerging technology industry.

Critical success factors (CSF) for LSS implementations in digital emerging technology companies are: (1) organizational leadership that is engaged to the implementation, (2) LSS methodology that is rebranded to fit existing shared values in the organization, (3) restructuring of the traditional LSS training program to include a more incremental, prioritized, on-the-job training approach and (4) a modified LSS project execution methodology that includes (a) condensing the phases and tools applied in LSS projects and (b) adopting more iterative project management methods compared to the standard phased LSS project approach.

The qualitative nature of our analysis and the geographic coverage of our sample limit the generalizability of our findings.

Implications comprise the awareness and knowledge of critical success factors and LSS methodology modifications specifically relevant for digital emerging technology companies or companies that share similarities in terms of focus on product development, innovation and growth, such as R&D departments in high-tech manufacturing companies.

Research on industry-specific enablers for successful LSS implementation in the digital emerging technology industry is virtually absent. Our research informs practitioners on how to implement LSS in this and alike industries, and points to aspects of such implementations that are worthy of further attention from the academic community.

The purpose of this paper is to empirically evaluate the mediating role of learning capability on the relationship between technological capability, relational capability and small and medium enterprises (SMEs) performance in developing economy of Africa.

A quantitative survey design was employed to collect the data from owner/manager of manufacturing SMEs in Nigeria. Partial least square structural equation model was used in the evaluation of both the measurement and structural models to determine the reliability and validity of the measurement and test the hypotheses, respectively.

The statistical result indicates a positive relationship between technological capability, learning capability and SMEs performance. Equally, relational capability significantly and positively relates to SMEs learning capability. However, relational capability negatively relates to SMEs performance, while technological capability also negatively relates to learning capability. Furthermore, learning capability mediates the negative relationship of relational capability and SMEs performance to significant positive relationship, while it does not mediate the relationship of technological capability and performance.

The analysis of this study is restricted to only resource-based view and dynamic capability theory. Data of the study were collected once a time on a self-reported technique. The study contributed significantly to the body literature on technological and relational capabilities and performance. It also demonstrated the need for SMEs manager to recognize and appreciate the roles of these strategic capabilities in achieving sustainable competitive position.

Through relational capability SMEs develops efficient collaborative relationship to acquire new techniques, knowledge. This is specifically, essential for SMEs firms from less developing and emerging economies as they are lagging behind at the global competitive platform, and that the possession of specific advantage locally may not be adequately enough to help penetrate the global markets. Similarly, technological capability enable firms to identify acquire and apply new external knowledge to develop operational competencies which may lead to the attainment of superior performance.

Government policies and programs designed to support technological development and innovation must be adjusted to consider the peculiar nature of SMEs firms in terms of technology and innovativeness that enhances competitive position and performance.

This study empirically examined the relationship of technological and relational capabilities and the SMEs learning capability and performance.

Patient length of stay (LOS) is an important indicator of emergency department (ED) performance. Investigating factors that influence LOS could thus improve healthcare delivery and patient safety. Previous studies have focused on patient-level factors to explain LOS variation, with little research into service-related factors. This study examined the association between LOS and multi-level factors including patient-, service- and organization-level factors.

This study uses a retrospective observational design to identify a cohort of patients from arrival to discharge from ED. A year-long data regarding patients flow trhoguh ED were analyzed using analytics techniques and multi-regression models. The response variable was patient LOS, and the independent variables were patient characteristics, service-related factors and organizational variables.

The findings of this study showed that older patients, middle triage and hospitalization were all associated with longer LOS. Service-related factors such as complexity of care provided, initial ward designation and ward transfer had a significant impact as well. Finally, prolonged LOS was associated with a higher ratio of patients per medical doctor and per nurse. In contrast, a higher number of residents in the ED were associated with longer patient LOS.

Previous studies on patient LOS have focused on patient-level factors, with little research on service-related factors. This study has addressed that gap by examining the association between LOS and multi-level factors including patient-, service- and organization-level factors. Patient-level factors included demographics, acuity, arrival shift, arrival mode and discharge type. Service-level factors consisted of first ward, ward transfer and complexity of care provided. Organizational factors consisted of three ratios: patients per MD, patients per nurse and patients per resident. The results add to the current understanding of factors that increase patient LOS in EDs and contribute to the body of knowledge on ED performance, operation management and quality of care. The study also provides practical and managerial insights that could be used to improve patient flow in EDs and reduce LOS.

Emergency care delivery is a process requiring input from various healthcare professionals within the hospital. To deliver efficient and effective emergency care, professionals must integrate rapidly at multiple interfaces, working across functional, spatial and professional boundaries. Yet, the interdisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. This study aims to question what boundaries exist at the level of professionals and explores how these boundaries may come to influence integration and operational performance.

To provide a more holistic understanding of the inherent challenges to integration at the level of professionals and in contexts where professionals play a key role in determining operational performance, the authors carried out an in-depth case study at a busy, Level 1 trauma center in The Netherlands. In total, 28 interviews were conducted over an 18-month period.

The authors reveal the existence of structural, relational and cultural barriers between (medical) professionals from different disciplines. The study findings demonstrate how relational and cultural boundaries between professionals interrupt flows and delay service processes.

This study highlights the importance of interpersonal and cultural dynamics for internal integration and operational performance in emergency care processes. The authors unveil how the presence of professional boundaries creates opportunity for conflict and delays at important interfaces within the emergency care process, and can ultimately accumulate, disrupting patient flow and increasing lead times.