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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.

Applying the value-attitude-behavior (VAB) model, this study investigated how perceived utilitarian and hedonic values (i.e. novelty and emotion) affect individuals' attitudes toward medical hotels and how these attitudes, in turn, influence their intentions to stay at medical hotels. The current study also explored the moderating impact of overall health status on the relationships between perceived utilitarian, novelty and emotional values and attitudes toward medical hotels.

The data collected from 351 individuals who spent a night in a hospital to undergo medical treatment was used in conducting structural equation modeling to evaluate the research model and test the study hypotheses.

The study results revealed that perceived utilitarian, novelty and emotional values exerted a positive influence on individuals’ attitudes toward medical hotels, consequently enhancing their intention to stay. Additionally, significant moderating impacts of overall health status on the associations between perceived utilitarian, novelty and emotional values and attitudes toward medical hotels were observed.

The study findings provide useful guidance for professionals, such as operators, marketers and managers in medical hotels. These insights can improve operational and marketing strategies, benefiting both the industry and healthcare accommodation seekers.

This study is among the first to empirically assess a theoretical model that explored the influence of individuals' value perceptions within the realm of medical hotel establishments.

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.

The purpose of this review paper was identifying barriers to the use of telemedicine systems in primary health-care individual level among professionals.

This study used Scopus and PubMed databases for scientific records identification. A systematic review of the literature structured by PRISMA guidelines was conducted on 37 included papers published between 2009 and 2019. A qualitative approach was used to synthesize insights into using telemedicine by primary care professionals.

Three barriers were identified and classified: system quality, data quality and service quality barriers. System complexity in terms of usability, system unreliability, security and privacy concerns, lack of integration and inflexibility of systems-in-use are related to system quality. Data quality barriers are data inaccuracy, data timeliness issues, data conciseness concerns and lack of data uniqueness. Finally, service reliability concerns, lack of technical support and lack of user training have been categorized as service quality barriers.

This review identified and mapped emerging themes of barriers to the use of telemedicine systems. This paper also through a new conceptualization of telemedicine use from perspectives of the primary care professionals contributes to informatics literature and system usage practices.

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.

A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.

Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.

Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

The involvement of clients in service encounters and service development has become a central principle for contemporary health and social care organizations. However, in day-to-day work settings, the shift toward client involvement is still in progress. We examined how health and social care professionals, together with clients and managers, co-develop their conceptions of client involvement and search for practical ways in which to implement these in organizational service processes.

The empirical case of this study was a developmental intervention, the client involvement workshop, conducted in a Finnish municipal social and welfare center. The cultural-historical activity theory (CHAT) framework was used to analyze the development of client involvement ideas and the modes of interaction during the intervention.

Analysis of the collective discussion revealed that the conceptions of client involvement developed through two interconnected object-orientations: Enabling client involvement in service encounters and promoting client involvement in the service system. The predominant mode of interaction in the collective discussion was that of “coordination.” The clients' perspective and contributions were central aspects in the turning points from coordination to cooperation; professionals crossed organizational boundaries, and together with clients, constructed a new client involvement-based object. This suggests that client participation plays an important role in the development of services.

The CHAT-based examination of the modes of interaction clarifies the potential of co-developing client-involvement-based services and highlights the importance of clients' participation in co-development.

Coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented mental health repercussions in the lives of every individual including university students. Therefore, study on students’ psychological state and its associated factors during the pandemic are of importance. This study aims to discuss the aforementioned issue.

An online survey was done on a total of 207 university students of Pakistan to collect information on socio-demographic characteristics, concerns or fears amidst COVID-19 and mental distress. Validated tools; Perceived Stress Scale (PSS), Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9)-Depression were used to assess stress, anxiety and depression, respectively.

Around 14% of the university students were experiencing severe stress and anxiety, while 8.2% had severe depression. The authors found that stress among university students was related to psychiatric illness or symptoms (OR = 5.1: 1.1, 22.9) and unpredictability due to the pandemic (OR = 3.7: 1.2, 11.2). The significant determinants of anxiety were psychiatric illness/symptoms (OR = 6.6: 3.4, 12.9), implementation of public health measures (OR = 3.7: 1.1, 11.6), employed mothers (OR = 2.4: 1.1, 5.0) and lack of support from university administration (OR = 2.2: 1.0, 5.0). While the factors associated with depression included psychiatric illness or symptoms (OR = 8.4: 3.3, 21.5), unpredictability due to pandemic (OR = 6.8: 2.2, 20.7), impaired social support system (OR = 3.7: 1.3, 10.4) and studying without a scholarship (OR = 2.1: 1.0, 4.4).

These findings call for an urgent need to develop appropriate interventions and educational programs that could address the psychological needs of students.

The study directs the role of university and faculty in dealing the mental health needs of the student in COVID-19 pandemic time.

Educational programs are important that could address the psychological needs of students in COVID-19 pandemic.

University students reported mental distress during COVID-19 pandemic which shows that younger people are at risk of COVID-19 repercussions. Moreover, several stressors (i.e. impaired social support system and lack of support from universities) were revealed that could be mitigated by implementing appropriate strategies.

This study examines potential ways to break the inequality reproduction circle faced by ethnic minority health workers and sustained by key performance indicators (KPIs)-centred management in the National Health Service (NHS) in England. It does so through the lens of signalling theory.

Three years panel data for 2018–2020 covering 207 hospitals was compiled from the annual NHS staff survey and matched with relevant administrative records. Structural equation modelling was used to test the proposed hypotheses at the organisational level.

The moderated mediating model reveals that persistent racial discrimination by managers and coworkers can disadvantage the career progression of ethnic minority health workers, which in turn reinforces and reproduces economic and health inequalities among them. More importantly, we show how the collective agreement that the senior management team acts (SMTA) on staff feedback can break this vicious circle.

While our research focuses on the not-for-profit health care sector, it opens important opportunities to extend the proposed model to understand organisational inequality and how to address it.

Perceived SMTA can send strong signals to reduce deep-rooted discrimination (race, gender, age, etc.) through resource allocations and instrumental functions. This is also a way to address the current staff burnout and shortage issues in the healthcare sector.

This article reveals why the purpose of organisations that provide public service to reduce social inequality was comprised during their business-like operations and more importantly, how to reflect their foundational purpose through management practice.

This study offers a way forward to resolve one of the unintended consequences of KPI-centred management in the not-for-profit sector through unpacking the process of inequality reproduction and, more importantly, how it is possible to break this vicious circle.

Paramedics became nationally registered in 2018 in Australia. Prior to this, there was no central regulation of the profession with reliance on organisational regulation through employers. As paramedics expanded their scope, role and range of employers, especially outside statutory agencies, there was increasing need to engage in professional regulation. Regulation is more than a legal and bureaucratic framework. The purpose of the paper states that the way paramedics interact with their new regulatory environment impacts and is influenced by the professionalisation of the discipline. Regulation also redefines their positionality within the profession.

Two mixed-method surveys were undertaken. A pre-registration survey occurred in the month prior to regulation commencing (N = 419) followed by the second survey 31 months later (N = 407). This paper reports the analysis of qualitative data from the post-registration survey and provides comparison to the pre-registration survey which has been previously reported. Analysis was undertaken using interpretive phenomenological analysis (IPA).

Themes from the pre-registration survey continued however became more nuanced. Participants broadly supported registration and saw it as empowering to the profession. Some supported registration but were disappointed by its outcome, others rejected registration and saw it as divisive and oppressive.

Paramedics are beginning to come to terms with increasing professionalisation, of which regulation is one component. Changes can be seen in professional identity and engagement with professional practice; however, this is nascent and is deserving of additional research to track the profession as it continues to evolve.

Gamification design is considered an effective way of changing users' health behavior and improving their health management performance. Even though numerous studies have investigated the positive effect of gamification competition on users, little research has considered gamification's ineffectiveness and negative effects. In particular, how gamification competition affects users' technological exhaustion remains unclear.

According to flow theory and related research on gamification, this study discusses the nonlinear relationship between gamification competition and users' technological exhaustion. Furthermore, the authors analyze the moderating effect of user type (socializers and achievers) and users' health condition on this nonlinear relationship. Based on flow theory, the authors propose a series of research hypotheses. To test all research hypotheses, the authors collected information from 407 users via a questionnaire as the data for this study.

The empirical results found a U-shaped relationship between gamification competition and technological exhaustion. Technological exhaustion gradually decreases as competition increases until reaching the lowest point; after that, technological exhaustion gradually increases as competition increases. Further, being a socializer and health condition play a moderating role in the U-shaped relationship between competition and technological exhaustion.

This study's findings not only enrich the related research in flow theory and gamification, but also contribute to the effective design of gamification in health management platforms.