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Overcrowding continues to afflict emergency departments (EDs), and its attendant consequences are becoming increasingly severe. The burden of the COVID-19 pandemic is further escalating the situation worldwide. One of the most critical questions is how to adequately quantify what constitutes overcrowding and determine implications for operations management in improving service efficiency. This paper aims to discuss the aforementioned.

The authors propose the time and class complexity measures for ED service systems, taking into account important patient-level and system characteristics. Using an extensive data set from a Canadian ED, the authors investigate the performance of complexity-based measures in predicting service delays.

The authors find that the complexity measure is potentially more important than some well-known crowding metrics. In particular, EDs can improve service efficiency by managing the level of complexity within a desirable interval. Furthermore, complexity exposes how the interplay between demand-side behavioral changes and supply-side responses affects operational performance. Moreover, the results suggest that arrival patterns—the number of patients of each class arriving per time and times between events (arrivals and service completions)—increase the risk of service delays more than the demand volume.

This paper is the first to provide an extensive investigation into the application of the complexity-based measure for ED crowding. The study demonstrates potential values to be gained in ED service systems if complexity measure is incorporated into their operations management decisions.

The distinction between formality and informality has been a topic central for many scholarly fields. Without rejecting the usefulness of this distinction, the authors argued that instead of analyzing an empirical situation in terms of what is formal and what is informal, it could sometimes be fruitful to focus on what is stable and what is fluid.

This paper reports the results of review and analysis of secondary sources on the distinction between formality and informality, followed by a conceptualization of an alternative distinction between fluidity and stability. This conceptualization was inspired by a science and technology studies (STS) understanding of relations, and was assessed through applying it to a case of patient organizations’ participation in patient councils in Russia.

Stability and fluidity do not map neatly into formality and informality; rather, the stability and fluidity cut across these categories. The authors propose a view of both stability and fluidity as kinds of relations between elements of the societal fabric. The distinction proposed here could be especially fruitful when applied to analyses of (1) complex bureaucracies where formal requirements are extensive and potentially in conflict with each other and (2) oppressive situations where significant power imbalances exist.

Instead of providing yet another line of demarcation between formality and informality, this paper proposes a shift in attention to what is stable and what is fluid. This novel distinction can help not only in discerning how things actually work but also in bringing to the fore hitherto unnoticed forms of creativity, responsiveness and inclusion.

The purpose of this paper is to investigate how and why some service ecosystems are more resilient and, consequently, more sustainable than others during turbulent times, and how resilience can be cultivated to enable pathways to service ecosystem sustainability.

This work integrates disparate literature from multiple service and sustainability literature streams, iterating through constant comparison with findings from 44 semistructured interviews conducted in the context of primary health care clinic service ecosystems.

The authors offer a novel conceptual framework comprising pillars (shared worldview, individual actor well-being and multiactor interactions), changing practices to cultivate resilience through resilience levers (orchestrators, individual actor effort, actor inclusivity and digitaltech–humanness approach), and pathways to service ecosystem sustainability (volume vs value, volume to value, volume and value). The authors demonstrate that service ecosystems need to change practices, integrating resources differently in response to the turbulent environment, emphasizing the importance of a shared worldview across the ecosystem and assessing different pathways to sustainability.

This paper offers new insights into the important intersection of service marketing, sustainability and health care. The authors provide guidance to practitioners aiming to cultivate resilience in service ecosystems to achieve pathways to sustainability in primary health care clinics. Finally, implications for theory are discussed, and directions to guide future service research offered.

In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for physicians while practicing patient-centered medicine and controlling health-care costs. This paper aims to examine the effect of task shifting to nurses and discuss its usefulness from the perspective of health-care value co-creation.

This paper analyzes task shifting to nurses in acute care hospitals in Japan as a solution for the shortage of anesthesiologists. The authors discuss how the value was created from the perspective of the health-care ecosystem, with conceptual consideration of the value co-creation mechanism through patient-centered practices.

The study showed that task shifting initiatives in Japan can improve the motivation of nurses through human resource development while maintaining high quality. The study also suggested that task shifting from physicians to nurses may contribute to improving net income and maintaining the health-care system.

The findings are highly reproducible and can be immediately applied to initiatives at other medical institutions in Japan. Furthermore, it is suggested that these findings might provide some perspective on the realignment of fragmented healthcare in the USA.

It was confirmed in practical terms that micro-level initiatives have an impact on the macro level as well. In addition, the academic presentation of the concept has contributed to the deepening of value research.

The purpose of this paper, intended primarily for practitioners, is to demonstrate how features of psychological capital (PsyCap) may be combined with manager efforts to collaborate with an employee on an action learning project. In reciprocal action learning, manager and employee create a partnership to learn, achieve work-focused goals and advance their relationship. Initiatives aimed at positively stimulating employee assets and psychological or behavioral attributes can overlay the action learning process.

A narrative synthesis was used to examine three sources of empirical research from organizational psychology and human resource management: reciprocity, action learning and PsyCap. Information was integrated to create a guide, a model for managers for use in considering options about how to structure employee and self-learning, as well as options for use in stimulating employee assets and PsyCap.

The approach presented may serve as a practical guide for manager consideration. Research identifies several types of behaviors and activities intended to positively stimulate and reinforce the learning of both participants. The literature on PsyCap offers many initiatives for a manager to consider in assisting an employee to develop talent and positive attitudes. Such efforts have to be carefully tailored to the individual employee, the tasks at hand and the manager’s own learning needs.

The value of action learning is supported by a relatively large research base. The significance of PsyCap also has substantial support. Innovatively, this paper offers guidance to a manager in consideration of combining the attributes of both concepts to maximize positive effects on learning, personal growth, skill development and work achievement.

Sexually transmitted infections (STIs) can be transferred from one person to another through sexual contact. STIs lead to substantial morbidity and mortality and affect many different aspects of human life, including quality of life, sexual health, reproductive health and even the health of newborns and children. Despite of high rates of STIs in prisons, there are not sufficient screening, prevention and treatment programs to control STIs transmission among prisoners in Iran. This study aims to evaluate the prevalence of STIs among incarcerated women in Iran for the first time, using the active case finding strategy.

This is a cross-sectional study conducted on 438 incarcerated women in a prison in Tehran, Iran, from 2017 to 2018. A total of 438 prisoners were screened by active case findings for STI symptoms, then evaluated by complete genital and anal examination, followed by molecular testing.

A total of 189 (43.2%) prisoners announced vaginal discharge, while 194 (44.3%) individuals had vaginal discharge in the genital examination. In the cervical examination, 137 individuals (31.3%) had abnormal findings, of which 83 (18.9%) individuals had cervicitis, 40 (9.1%) individuals had cervical erosion, 38 (8.7%) individuals had cervical prolapse and 17 (3.9%) individuals had bleeding originated from the cervix.

This study showed that it is possible to set up a system in which the diagnosis, follow-up and treatment of prisoners with STIs can be actively performed. Educating prisoners about signs and symptoms, risk behaviors and prevention routes of STIs, as much as regular screening of prisoners, and adequate treatment can help control the STIs prevalence among prisoners and in the general population.

This study aims to appraise and synthesize evidence examining the effects of toxic leadership on the nursing workforce and patient safety outcomes.

This is a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases (SCOPUS, PubMed, Web of Science, CINAHL and Psych INFO) were searched to identify relevant articles. Two independent researchers conducted the data extraction and appraisal. A content analysis was used to identify toxic leadership outcomes.

The initial literature search identified 376 articles, 16 of which were deemed relevant to the final review. Results of the content analysis identified 31 outcomes, which were clustered into five themes: satisfaction with work; relationship with organization; psychological state and well-being; productivity and performance; and patient safety outcomes. Seven mediators between toxic leadership and five outcomes were identified in the included studies.

Organizational strategies to improve outcomes in the nursing workforce should involve measures to build and develop positive leadership and prevent toxic behaviors among nurse managers through theory-driven strategies, human resource management efforts and relevant policy.

The review findings have provided modest evidence suggesting that working under a leader who exhibits toxic behaviors may have adverse consequences in the nursing workforce; however, more research examining if this leadership style influences patient safety and care outcomes is warranted.

This study investigates the effects of top management commitment (TMC) and Kaizen on quality management practices (QMP) and how the latter influence the performance of Jordanian public hospitals in the aftermath of COVID-19.

A survey-based questionnaire was employed to collect data from 222 practitioners and professionals working in public hospitals in Jordan. Partial least squares structural equation modeling (PLS-SEM) was undertaken to analyze data.

Significant and positive effects of TMC and Kaizen (continuous improvement) on QMP are highlighted by the results. The findings also show that QMP has a positive and significant impact on public hospitals' performance. Furthermore, the effects of TMC and Kaizen on performance were also found to be significant.

Practitioners and researchers will gain a greater understanding of how implementing QMP can enhance the performance of public hospitals in the context of the COVID-19 outbreak. The results underline the important role of Kaizen and TMC in the success of QMP and their effect on performance. This research is a cross-sectional study, and there is a need to conduct further empirical investigation based on secondary data or objective measurement of performance.

This research is one of the first studies to investigate the effects of QMP on public hospitals' performance following the COVID-19 outbreak. This study is one of the empirical examinations of QMP and Kaizen in developing countries by investigating Jordanian public hospitals.

This study aims to explore the empirical correlation between patient flow issues, quality of green health services and patient satisfaction in specialist medical department factors from patients’ perspectives as service consumers.

This research is a type of nonintervention empirical research that uses an open survey to explore the views and experiences of users of specialist medical department services. The targeted population is hospital patients included in the top five national PERSI (Indonesian Hospital Association) Award 2022 Green Hospital Category, with a total number of respondents of 572 people. This study uses the partial least square-structural equation modeling analysis method with the SmartPLS application.

Patient flow problems generally affect the quality of eco-friendly health services, except for the waiting time problem, which affects service quality. It should be understood as a top priority for patients to receive services from medical specialists without risking time as a core service aspect from the patient’s perspective. In addition, all variables in eco-friendly hospital services affect patient satisfaction, except in the case of visits to specialist medical departments, which do not affect medical support services and hospital practices that are responsive to the delivery of care services resulting from medical support services that are inseparable in integrated services as well as health care following medical ethics.

This study has a novelty in understanding the implications of green practice in determining patient satisfaction in medical specialist department as the epicenter of hospital services and the main object of assessment for the quality of hospital services.

Given that the relationship between proactive personality and turnover intention is not straightforward in the literature, the authors address two research questions focusing on the nursing profession: does proactive personality negatively influence nurses' turnover intention by alleviating their lack of professional recognition? And does a supervisor’s proactive personality act as a boundary condition for the mediating effects of the lack of professional recognition in the link between proactive personality and turnover intentions?

A moderated mediation model linking proactive personality and turnover intentions was developed and tested on a sample of 579 nurses in 88 work units in general hospitals in South Korea.

The results of multilevel path analysis reveal that proactive personality has a negative indirect relationship with turnover intention via lack of professional recognition. Additionally, the indirect relationship is strengthened when the supervisor’s proactive personality is low.

These findings provide valuable empirical evidence on the inconclusive relationship between proactive personality and turnover intention by highlighting the role of proactive personality in attenuating the influence of negative occupational factors. Moreover, proactive personality as a boundary condition for the aforementioned relationship was empirically examined.