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Workflow optimisation is crucial for establishing a viable acute stroke (AS) intervention programme in a large tertiary care centre. This study aims to utilise Lean Six Sigma (LSS) principles to enhance the hospital's workflow.

The Action Research methodology was used to implement the project and develop the case study. The study took place in a large tertiary care academic hospital in India. The Define-Measure-Analyse-Improve-Control approach optimised the workflow within 6 months. Lean tools such as value stream mapping (VSM), waste audits and Gemba were utilised to identify issues involving various stakeholders in the workflow. Sigma-level calculations were used to compare baseline, improvement and sustainment status. Additionally, statistical techniques were effectively employed to draw meaningful inferences.

LSS tools and techniques can be effectively utilised in large tertiary care hospitals to optimise workflow through a structured approach. Sigma ratings of the processes showed substantial improvement, resulting in a five-fold increase in clinical outcomes. Specifically, there was a 43% improvement in outcome for patients who underwent acute stroke revascularisation. However, certain sigma ratings deteriorated during the control and extended control (sustainment) phases. This indicates that ensuring the sustainability of quality control interventions in healthcare is challenging and requires continuous auditing.

The article presents a single case study deployed in a hospital in India. Thus, the generalisation of outcomes has a significant limitation. Also, the study encounters the challenge of not having a parallel control group, which is a common limitation in quality improvement studies in healthcare. Many studies in healthcare quality improvement, including this one, are limited by minimal data on long-term follow-up and the sustainability of achieved results.

This study pioneers the integration of LSS methodologies in a large Indian tertiary care hospital, specifically targeting AS intervention. It represents the first LSS case study applied in the stroke department of any hospital in India. Whilst most case studies discuss only the positive aspects, this article fills a critical gap by unearthing the challenges of applying LSS in a complex healthcare setting, offering insights into sustainable quality improvement and operational efficiency. This case study contributes to the theoretical understanding of LSS in healthcare. It showcases its real-world impact on patient outcomes and process optimisation.

The paper investigates how the engagement of a group of actors (the volunteers), previously unexplored in service ecosystems literature, contributes to generating new co-creation activities and well-being outcomes in the healthcare service ecosystem (HSE). Moreover, the study analyses how the provision and integration of volunteers’ resources help to explain the HSE self-adjustment favouring the re-humanisation of service.

The article zooms in on the volunteers’ activities in an HSE. A qualitative approach is adopted, and an empirical investigation is grounded in data gathered from Kids Kicking Cancer (KKC) Italia, a volunteer association operating in the paediatric oncology ward of Italian hospitals. Data are collected and triangulated through in-depth interviews, volunteers’ diaries and observations. The analysis is conducted by adopting an interpretative thematic analysis technique.

The study provides a conceptual framework explaining how volunteers’ value co-creation activities influence the HSE’s self-adjustment by leading to a re-humanisation of services. The paper also contributes to the state of knowledge by identifying seven categories of volunteers’ value co-creation activities, two of which are completely new in the literature (co-responsibility and empowerment).

The paper contributes to the service research literature by identifying empirically grounded value co-creation activities extending the understanding of self-adjustment and re-humanisation of the service ecosystem.

This study aims to explore whether seeking recommendations for doctors from offline word-of-mouth or online reviews influences patient satisfaction after treatment, and how the source of recommendation affects this effect.

Using a unique dataset of more than three million reviews from a popular Chinese online health community, this study used the coarsened exact matching method and built fixed-effect models to conduct empirical analysis.

The results suggest that selecting doctors according to recommendations can improve patient satisfaction and mitigate their dissatisfaction when encountering service failures. However, online recommendations were found to be less effective than offline sources in improving patient satisfaction.

This study provides important insights into patient satisfaction and doctor-patient relationships by revealing the antecedents of satisfaction and the potential for improving this relationship. It also contributes to the understanding of how recommendations in the healthcare context can improve patient satisfaction and alleviate the negative impact of service failures.

This study investigated two key aspects: (1) how a hospital bundles limited resources for preventive care performance and (2) how to develop IS capabilities to enhance preventive care performance.

A case study method was adopted to examine how a hospital integrates its limited resources which leads to the need for resource bundles and an understanding of IS capabilities development to understand how they contribute to the delivery of preventive care in a Malaysian hospital.

This research proposes a comprehensive framework outlining resource-bundling and IS capabilities development to improve preventive care.

We acknowledge that the problem of transferring and generalizing results has been a common criticism of a single case study. However, our objective was to enhance the reader’s understanding by including compelling, detailed narratives demonstrating how our research results offer practical examples that can be generalized theoretically. The findings also apply to similar-sized public hospitals in Malaysia and other developing countries, facing challenges like resource constraints, HIS adoption levels, healthcare workforce shortages, cultural and linguistic diversity, bureaucratic hurdles, and specific patient demographics and health issues. Further, lessons from this context can be usefully applied to non-healthcare service sector domains.

This study provides a succinct strategy for enhancing preventive care in Malaysian public hospitals, focusing on system integration and alignment with hospital strategy, workforce diversity through recruitment and mentorship, and continuous training for health equity and inclusivity. This approach aims to improve resource efficiency, communication, cultural competence, and healthcare outcomes.

Efficiently using limited resources through HIS investment is essential to improve preventive care and reduce chronic diseases, which cause approximately nine million deaths annually in Southeast Asia, according to WHO. This issue has significantly impacted the socioeconomic development of developing countries.

This research refines resource orchestration theory with new mechanisms for resource mobilization, extends IS literature by identifying how strategic bundling forms specialized healthcare IS capabilities, enriches preventive care literature through actionable resource-bundling activities, and adds to HIS literature by advocating for an integrated, preventive care focus from the alignment of HIS design, people and institutional policies to address concerns raised by other research regarding the utilization of HIS in improving the quality of preventive care.

This study aims to investigate the conceptual relationship between full-range leadership theory (FRLT) and patient safety culture in primary care settings, aiming to understand how leadership styles influence the development and sustainability of a culture prioritizing patient safety.

Using a conceptual analysis approach, the study builds a theoretical framework that integrates FRLT – which includes transformational, transactional and laissez-faire leadership styles – with the elements of patient safety culture. This framework serves as the basis for a comprehensive literature review, allowing for the formulation of hypotheses regarding the impact of each leadership style on patient safety culture.

The analysis demonstrates that transformational leadership bolsters patient safety culture by fostering open communication, encouraging error reporting and facilitating continuous improvement. Transactional leadership yields mixed effects, effectively supporting compliance and operational outcomes but showing limitations in promoting a proactive safety culture. Conversely, laissez-faire leadership is associated with negative outcomes for patient safety culture, mainly due to its passive and detached approach.

The originality of this study is rooted in its focused examination of FRLT’s impact on patient safety culture within primary care settings, the development of a unique conceptual framework and its contribution of actionable insights for health-care leadership. These elements collectively advance the understanding of how leadership can enhance patient safety culture, providing a solid foundation for future research and practical application in primary care environments.

Depression and anxiety are the most common comorbidities in TB patients, adversely impacting TB treatment outcomes. The purpose of this study is to assess the effect of lay counselling in reducing symptoms of depression and anxiety and TB treatment completion.

The study used a pre-post interventional research design. Patients were screened for depression and anxiety. All symptomatic TB patients were followed up and offered four to six or more lay counselling sessions whenever necessary. The authors assessed changes in depression and anxiety symptoms before lay counselling intervention and after fourth lay counselling session or the completion of TB treatment, whichever occurred the last.

Approximately 6,974 TB patients were screened for symptoms of depression and anxiety. The mean age was 36.7 ± 14.7 years. Total 25.9% patients were symptomatic. About 99.8% were provided lay counselling and received at least one to two follow-up sessions, while two patients who screened with severe depression were referred to a mental health specialist. Nearly 96.9% TB patients did not report symptoms of depression or anxiety after four lay counselling sessions, and TB treatment completion rate was higher among symptomatic TB patients who completed at least four counselling sessions (92.5%).

Lay counselling services delivered by field coordinators offer a promising approach to address mental health comorbidities among TB patients in resource-limited settings.

It explores a novel approach – lay counselling delivered by field coordinators – in tackling depression and anxiety among TB patients, which is a potentially scalable solution in resource-limited settings.

The outbreak of the COVID-19 pandemic has significantly impacted healthcare systems, presenting unforeseen challenges that necessitated the implementation of change management strategies to adapt to the new contextual conditions. This study aims to analyze organizational changes within the total hip replacement (THR) surgery pathway at multiple levels, including macro, meso and micro. It employs data triangulation from various sources to gauge the complexity of the change process and comprehend how multi-level decision-making influenced an unexpected shift.

A multicentric, single in-depth case study was conducted using a mixed-methods approach. Data sources included patient-reported outcome measures specific to the THR pathway and carefully structured in-depth interviews administered to managers and clinicians in two healthcare organizations serving the same population.

Decisions made at the macro level resulted in an overall reduction in surgical activities. Organizational changes at the meso level led to a complete cessation or partial reorganization of activities. Micro-level actions for change and adaptation revealed diverse and fragmented change management strategies.

Organizations with segmented structures may require a robust and structured department for coordinating change management responses to prevent the entire system from becoming stuck in the absorptive phase of change. However, it is important to recognize that absorptive solutions can serve as a starting point for genuine innovations in change management.

The utilization of data triangulation enables the authors to visualize how specific changes implemented in response to the pandemic have influenced the observed outcomes. From a managerial perspective, it provides insights into how future innovations could be introduced.

Patient safety is a top priority globally. A robust healthcare system requires strategic collaboration between research and development. The author analysed over 300 cases from seven hospitals using the failure modes, effects, and criticality analysis (FMECA) tool to understand the underlying causes of medical errors.

The author studied seven hospitals and 300 cases using FMECA to prioritise activities. The findings showed that high-priority events occurred less frequently but had the potential to cause the most harm. Team members evaluated independently to ensure unbiased evaluations. This approach is useful for setting priorities or assessing difficulties.

Poor communication and lack of coordination among staff in a healthcare organisation caused misunderstandings, ineffective decision-making, delays in patient care, and medical errors. Implementation of effective communication and coordination protocols can help avoid these problems.

The study recommends using FMECA to identify and prioritise failures and conducting in-depth analyses to understand their root causes. It also highlights the importance of interdisciplinary knowledge and soft skills for healthcare staff.

This study reveals the significance of FMECA in healthcare risk management and benchmarking. FMECA helps identify system failures, develop prevention strategies, and evaluate effectiveness against industry benchmarks. It offers healthcare professionals a valuable tool to enhance patient safety and improve healthcare quality.

The study aims to investigate the nurse job enjoyment and their participation in medical affairs to enchance the quality of patient care in Saudi hospitals. In addition, this study also investigates the management team's role in patient care quality through the mediating effects of nurse job enjoyment and participation in medical affairs.

The present study used a self-administered survey questionnaire to collect data from registered nurses in Saudi hospitals. In this study, 600 survey questionnaires were distributed online (Google Forms) and received 266 valid responses (44.33% response rate). In addition, SmartPLS-4.0 was applied to validate the research constructs and test the hypotheses via partial least squares structural equation modelling (PLS-SEM).

The study's findings indicate that the job enjoyment of the nurses and participation in medical affairs have positive and significant effects on the quality of patient care. In addition, the research findings also suggest that the management team of the hospitals has a significant indirect influence on the quality of patient care through the medicating effects of nurse job enjoyment and participation in medical affairs.

The findings of this study also offer various practical implications. This study showed the direct impact of the management team on job enjoyment, medical affairs and patient care quality. Therefore, hospital authorities and policymakers may emphasise clear communication, collaboration, respect and trust for the effective management team in providing higher-quality patient care. The present study suggests that hospital policymakers should strive to create a positive work environment, provide adequate resources, foster team spirit, offer incentives and allow flexible scheduling to ensure higher job enjoyment and increase nurse participation in medical affairs.

This study adds to the growing body of knowledge by investigating the effects of the management team, job enjoyment and nurses' participation in medical affairs on patient care quality. This study also enhances the theoretical depth by exploring the mediating impact of job enjoyment in predicting the relationships between the management team and the quality of care provided to patients. The present study provides guidelines for healthcare service providers or practitioners to focus on the nurses' job enjoyment and their engagement in medical activities to continuously improve the quality of patient care in the hospitals.

Patient safety focuses on minimizing risks that might occur to patients during provision of healthcare. The purpose of this study was to explore healthcare practitioners’ attitudes towards patient safety inside different hospital settings in Jeddah, Kingdom of Saudi Arabia.

A descriptive, cross-sectional study was conducted on a sample of healthcare practitioners in main hospitals in Jeddah. Two main hospitals (one governmental and one private) were selected from each region of Jeddah (east, west, north and south), with a total number of eight out of thirty hospitals. Data were collected through the Attitudes to Patient Safety Questionnaire III that was distributed online. The questionnaire used a 5-point scale. Descriptive statistics were used. Comparisons were made by independent t-test and ANOVA. The statistical significance level was set at p < 0.05.

The study included 341 healthcare practitioners of different sexes and specialties in eight major governmental and private hospitals in Jeddah. “Working hours as error cause” subscale had the highest mean score (4.03 ± 0.89), while “Professional incompetence as error cause” had the lowest mean score (3.49 ± 0.97). The total questionnaire had a moderate average score (3.74 ± 0.63). Weak correlations between the average score of the questionnaire and sex, occupation and workplace were found (−0.119, −0.018 and −0.088, respectively).

Hospitals need to develop targeted interventions, including continuing professional development programs, to enhance patient safety culture and practices. Moreover, patient safety training is required at the undergraduate education level, which necessitates health professions education institutions to give more attention to patient safety education in their curricula.

The study contributed to the existing literature on patient safety culture in hospital settings in Jeddah, Saudi Arabia. The insights generated by the study can inform targeted interventions to enhance patient safety culture in hospitals and improve patient outcomes.