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This study aims to determine the factors and dynamic systems behaviour of essential medicine stockout in public health-care supply chains. The authors examine the constraints and effects of mental models on medicine stockout to develop a dynamic theory of medicine availability towards saving patients’ lives.

This study uses a mixed-method approach. Starting with a survey method, followed by in-depth interviews with stakeholders within five health-care supply chains to determine the dynamic feedback leading to stockout and conclude by developing a network mental model for medicines availability.

The authors identified five constraints and developed five case mental models. The authors develop a dynamic theory of medicine availability across cases and identify feedback loops and variables leading to medicine availability.

The need to include mental models of stakeholders like manufacturers and distributors of medicines to understand the system completely. Group surveys are prone to power dynamics and bias from group thinking. This survey’s quantitative output could minimize the bias.

This study uniquely uses a mixed-method of survey method and in-depth interviews of experts to assess the essential medicine stockout in Nigeria. To improve medicine availability, the authors develop a dynamic network mental model to understand the system structure, feedback and behaviour driving stockouts. This research will benefit public policymakers and hospital managers in designing policies that reduce medicine stockout.

The 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study is to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout.

A single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019.

In total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout.

This paper explores a previously under researched area on stressors and potential burnout in 999 call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers.

Evidence of overprescribing of psychotropic medicines to manage challenging behaviour in people with intellectual disabilities has led to national programmes within the UK to promote deprescribing, such as stopping the overprescribing of medication in people (with learning disabilities, autism or both). To successfully implement deprescribing initiatives, we need to understand how to engage stakeholders in the process.

In a published systematic review, we reported evidence about the process of deprescribing psychotropic medicines for people of all ages with intellectual disabilities and challenging behaviour. As a part of the original review, we searched for evidence about stakeholders’ experiences of the psychotropic deprescribing process, which was synthesised and reported within the current study.

Six studies were identified. Involving carers and people with intellectual disabilities, providing ongoing support and improving access to non-pharmacological interventions, including positive behaviour support, may contribute to successful outcomes, including reducing or stopping psychotropic medicines and improving quality of life. Implementing psychotropic deprescribing requires a multidisciplinary collaborative care approach and education for stakeholders.

There have been no previous reviews of stakeholder experiences of deprescribing psychotropic medications for people with intellectual disabilities and challenging behaviour. The existing literature is scant, and further research is needed.

In the COVID-19 outbreak periods, people's life has been deranged, leading to disrupt the world. Firstly, the number of deaths is growing and has the potential to surpass the highest level at any time. Secondly, the pandemic broke many countries' fortified lines of epidemic prevention and gave people a more honest view of its seriousness. Finally, the pandemic has an impact on life, and the economy led to a shortage in medical, including a lack of clinicians, facilities and medical equipment. One of those, a simple ventilator is a necessary piece of medical equipment since it might be useful for a COVID-19 patient's treatment. In some cases, the COVID-19 patients require to be treated by modern ventilators to reduce lung damage. Therefore, the addition of simple ventilators is a necessity to relieve high work pressure on medical bureaucracies. Some low-income countries aim to build a simple ventilator for primary care and palliative care using locally accessible and low-cost components. One of the simple principles for producing airflow is to squeeze an artificial manual breathing unit (AMBU) iterative with grippers, which imitates the motion of human fingers. Unfortunately, the squeezing angle of grippers is not proportional to the exhaust air volume from the AMBU bag. This paper aims to model the AMBU bag by a mathematical equation that enables to implement on a simple controller to operate a bag-valve-mask (BVM) ventilator with high accuracy performance.

This paper provides a curvature function to estimate the air volume exhausting from the AMBU bag. Since the determination of the curvature function is sophisticated, the coefficients of the curvature function are approximated by a quadratic function through the experimental identification method. To obtain the high accuracy performance, a linear regression model and a least square method are employed to investigate the characteristic of the BVM ventilator's grippers angle with respect to the airflow volume produced by the AMBU bag.

This paper investigates the correlation between the exhausting airflow of the AMBU bag and the grippers angle of the BVM ventilator.

The experimental results validated that the regression model of the characteristic of the exhausting airflow of the AMBU bag with respect to the grippers' angle has been fitted with a coefficient over 98% within the range of 350–750 ml.

Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.

This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.

The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.

This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.

Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.

This study investigates into how organizations enable the compatibility between intermediary role of conventional systems with disintermediary potentials of blockchain toward the coordination of multiple actors in operations management.

The data were collected from 31 interviewees of the case organizations. We conduct an in-depth case study of successful BC implementation in operations management, by using affordance-actualization (A-A) theory as the theoretical lens.

This study identifies the incompatibility between the affordances of conventional systems and blockchain in coordination/operations management and offers a process model in which a fusion phase enables the affordances to be compatible and then to be actualized. The fusion phase extends A-A theory by transposing and connecting in the context of operations management. The result also shows that blockchain technology has decentralized potentials to address the issues caused by centralized organizations or information systems, while not to replace the intermediary roles of centralized organizations or information systems.

This study makes important theoretical contributions to the literature on blockchain used in operations management, the roles of blockchain enablement and affordance-actualization theory. The findings can also help IT practitioners to implement BC-based applications effectively.

This study aims to explore how young people in child and adolescent mental health services (CAMHS) in the UK, Ireland, The Netherlands and Croatia, experienced leaving CAMHS and identified a range of factors impeding optimal discharge or transition to adult mental health services (AMHS).

Interviews about discharge or transition planning, including what information was provided about their ongoing mental health needs, undertaken with 34 young people aged 17–24, all previous or current attendees of CAMHS. Some interviews included accounts by parents or carers. Data were thematically analysed.

A number of previously well-documented barriers to a well-delivered discharge or transition were noted. Two issues less frequently reported on were identified and further discussed; they are the provision of an adequately explained, timely and appropriately used diagnosis and post-CAMHS medication management. Overall, planning processes for discharging or transitioning young people from CAMHS are often sub-optimal. Practice with regard to how and when young people are given a diagnosis and arrangements for the continuation of prescribed medication appear to be areas requiring improvement.

Study participants came from a large cohort involving a wide range of different services and health systems in the first pan-European study exploring the CAMHS to adult service interface. Two novel and infrequently discussed issues in the literature about young people’s mental health transitions, diagnosis and medication management were identified in this cohort and worthy of further study.

The purpose of this paper is to expose the playout of power dynamics when a new business intelligence (BI) system is implemented in a central pharmacy department in a National Health Service (NHS) hospital. The authors aim to explore the assumptions, experiences and actions of organisational stakeholders and ascertain how different professional groups obtain influence, power and control during this process.

In this research the authors employ structuration theory (ST), to establish how and where domination is achieved. To achieve this, the authors investigate the production and reproduction of structure as part of a longitudinal assessment using interviews and questionnaires.

Constant renewal and evolution are crucial in the implementation of a BI system. During the process of implementation and change many stakeholders resent the change. Disempowering these users leads to new power structures led by BI analysts.

The findings from this paper can help strengthen implications of BI systems implementation and better understand the impact these systems have on wider stakeholders. With coherent communication and an engaged attitude new BI systems can be implemented without alienating the key user stakeholders.

This paper differs from other papers by advocating that new systems and processes alter individual power structures in organisations, disrupting internal dynamics and introducing new aspects of control and dominance.

One of the most important components of healthcare is the timely delivery of pharmaceutical products, such as life-saving medicines. However, disruptions like COVID-19 bring new challenges and risks to the pharmaceutical supply chain (PSC) and healthcare organizations that impact their operational performance. This study focuses on mitigating risks in India's generic medicine supply chain (GMSC) as a result of various disruptions, which can assist policymakers develop appropriate plans and strategies to build resilience in the Jan Aushadhi Scheme (JAS) of micro, small and medium enterprises (MSMEs) in order to improve their overall performance.

Risk-causing vulnerabilities and resilience capabilities are identified from the literature review and expert's opinions. Following that, the vulnerabilities are classified into cause-and-effect vulnerabilities, and supply chain resilient capabilities (SCRCs) are measured using a hybrid fuzzy DEMATEL and best worst method (FDEMATEL-BMW) framework.

The outcome of the study reveals that transportation breakdown, loss of human resources and loss of suppliers are the potential risk-causing vulnerabilities that lead to vulnerabilities like shortages of medicines, loss of in-hand stock qualities and loss of sales/revenue. In addition, the analysis suggests that the sustainability of an organization with maximum weightage is the critical factor for building resilience in GMSC followed by flexibility, agility and visibility.

The integration of resilience into Jan Aushadhi GMSC can help in managing disruptions efficiently and effectively to mitigate risk and optimize MSMEs overall performance.

To the best of the authors’ knowledge, this work will be the first of its kind to model resilience in GMSC of MSMEs using a hybrid framework.

This study presented the experience of improving the nucleic acid sample collection and transportation service in response to the epidemic. The main purpose is that through intelligent path planning, combined with the time scheduling of sample points, the process of obtaining results to determine the state of COVID-19 patients could be speeding up.

The research optimized the process, including finding an optimal path to traverse all sample points in the hospital area via intelligent path planning method and standardizing the operation through the time sequence scheduling of each round of support staff to collect and send samples in the hospital area, so as to ensure the shortest time in each round. And the study examines these real-time experiments through retrospective examination.

The real-time experiments' data showed that the proposed path planning and scheduling model could provide a reliable reference for improving the efficiency of hospital logistics. Testing is a very important part of diagnosis and prompt results are essential. It shows the possibility of applying the shortest-path algorithms to optimize sample collection processes in the hospital and presents the case study that gives the expected outcomes of such a process.

The value of the study lies in the abstraction of a very practical and urgent problem into a TSP. Combining the ant colony algorithm with the genetic algorithm (ACAGA), the performance of path planning is improved. Under the intervention and guidance, the efficiency of hospital regional logistics planning was greatly improved, which may be of greater benefit to critical patients who must go through fever clinic during the epidemic. By detailing how to more rapidly obtain results through engineering method, the paper contributes ideas and plans for practitioners to use. The experience and lessons learned from Tongji Hospital are expected to provide guidance for supporting service measures in national public health infrastructure management and valuable reference for the development of hospitals in other countries or regions.