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In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.

Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.

Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.

Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.

The purpose of this paper is to enhance understanding of the conceptualisation and operationalisation of public value in practice by applying Moore's (1995) strategic triangle as an analytical framework to study strategic management and management control practices in relation to public value.

The paper uses an interpretative longitudinal case study approach including qualitative methods of document studies and interviews between 2017 and 2019.

In the strategic triangle, the three nodes of authorising environment, public value creation and operational capacity are interdependent, and alignment is a necessity for a strategy to be successful. But this alignment is vulnerable. The findings suggest three propositions: (1) strategic alignment is vulnerable to management control practices having a strong focus on performance measurements, (2) strategic alignment is vulnerable to standardised management control practices and (3) strategic alignment is vulnerable to politically driven management control practices.

With the strategic triangle as a base, this paper tries to understand what kind of management control practices enable and/or constrain public value, as there has been a call for this kind of research. In this way it adds to earlier research on public value, to the growing interest in the strategic triangle as an analytical framework in analysing empirical material and to the request for more empirical studies on the subject. The strategic triangle also embraces political factors, government agendas and political leadership for which there has also been a call for more research.

Lean implementations in hospitals tend to be lengthy or lack the desired results. In addressing the question, how can lean be implemented effectively in a hospital-wide setting, this paper aims to examine two opposing approaches.

The authors studied two Dutch university hospitals which engaged in different lean implementation approaches during the same four-year period: top-down vs bottom-up. Inductive qualitative analyses were made of 49 interviews; numerous documents; field notes; 13 frontline meeting observations; and objective hospital performance data. Longitudinally, the authors depict how the sequential events unfolded in both hospitals.

During the six implementation stages, the roles played by top, middle and frontline managers stood out. While the top managers of one hospital initiated the organization-wide implementation and then delegated it to others, the top managers of the other similar hospital merely tolerated the bottom-up lean activities. Eventually, only the hospital with the top-down approach achieved high organization-wide performance gains, but only in its fourth year after the top managers embraced lean in their own daily work practices and had started to co-create lean themselves. Then, the earlier developed lean infrastructure at the middle- and frontline ranks led to the desired hospital-wide lean implementation results.

Change-management insights, including basic tenets of social learning and goal-setting theory, are shown to advance the knowledge of effective lean implementation in hospitals. The authors found lean implementation “best-oiled” through role-modeling by top managers who use a phase-based process and engage in close cross-hierarchical or co-creative collaboration with middle and frontline managerial members.

The purpose of this study had two aims: (1) to extend insight regarding the challenges of implementing standardised work, via care pathways, in a healthcare setting by considering interactions with other operational (i.e. resource sharing, portfolio alignment) and professional (i.e. autonomous expertise) dependencies and (2) to develop novel insights regarding a specific flow mechanism, the stroke nurse practitioner, a form of flow “pilo” or guide.

This was a longitudinal case study of implementing the acute stroke care pathway in a National Health Service hospital in England based on 185 hours of non-participant observations and 68 semi-structured interviews. Archival documents were also analysed.

The combined flow, operational and professional dependency lens extends operations management understanding of the challenge of implementing standardised work in healthcare. One observed practice, the process pilot role, may be particularly valuable in dealing with these dependencies but it requires specific design and continuous support, for which the authors provide some initial guidance.

The research was a single case study and was focussed on a single care pathway. The findings require replication and extension but offer a novel set of insights into the implications of standardised work in healthcare.

In addition to confirming that a multidependency lens adds conceptual and practical insight to the challenges of implementing standardised work in a healthcare setting, the findings and recommendations regarding flow “pilots” are novel. The authors' analysis of this role reveals new insights regarding the need for continued improvisation in standardised work.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

The paper aims at enriching the knowledge of the application of lean management (LM) in emergency department (ED), structuring the methodology for implementing LM projects and summarizing the relevant dimensions of LM adoption in ED.

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature review has been performed, extracting a database of 34 papers. To answer the research purpose, a descriptive and content analyses have been carried out.

The descriptive analysis demonstrates that the dealt topic is worldwide emerging and multidisciplinary as it arouses interest by medical and engineering communities. Despite the heterogeneity in the adopted methodology, a framework can be grasped from the literature review. It points out the phases and activities, the tools and techniques and the enablers to be considered for guiding the developing of LM project in ED.

This paper provides a comprehensive overview on how to adopt LM in ED, contributing to fill in the gap emerged in the literature. From a practical perspective, this paper provides healthcare managers with a synthesis of the best managerial practices and guidelines in developing a LM project in ED.

This study aims to document students’ supply chain solutions developed through the internship hackathon program. The study profiled innovative solutions developed by university students in Kenya to solve health supply chain logistics challenges during and beyond COVID-19. This is done by exploring students’ experience in developing sustainable logistics and supply chain management capacity-building programs in a low-middle-income country (LMIC).

This study used a qualitative approach to explore the experiences and perceptions of students and mentors who participated in a hackathon program. The study followed a cross-sectional descriptive survey design, collecting data from the participants through online questionnaires. The data were analyzed and presented using thematic analysis and narrative techniques.

Findings provide preliminary evidence for narrowing the gap between theory and practice through a hackathon internship blended with a mentorship program. Assessment of this program provides evidence for developing solutions toward ensuring the availability of essential medicine in LMICs during a pandemic such as COVID-19 by students. The profiled solutions demonstrate a broader perspective of innovative solutions of university students, mentors and potential opportunities for a triple helix approach to innovation for health supply chain system strengthening.

This original study provides evidence for advancing contribution to developing innovative solutions through partnerships between investors, universities and industry practitioners interested in mentoring students in the health-care supply chain during COVID-19 in LMICs. Specifically, contingency factors that affect the implementation of innovative programs during and beyond global pandemics such as COVID-19 by students’ innovators are identified, and implications for policy action are discussed based on the praxis of sensemaking.

This study examines a novel approach that combines internship, mentorship and hackathon projects for logistics and supply chain students in LMICs. The approach aims to bridge the gap between theory and practice and to create innovative solutions for essential medicines during and after COVID-19. The study urges more resources for supporting such programs, as they benefit both academia and industry. The study also argues that hackathon internship programs can help the logistics and supply chain industry adapt to the post-pandemic era. The study offers insights for investors, universities and practitioners in the health-care industry.

This study shows how to develop innovative solutions for the health-care supply chain during COVID-19 in an LMIC through partnerships between investors, universities and industry practitioners who mentor students. The study identifies the contingency factors that influence the success of such programs during and beyond global pandemics such as COVID-19 and discusses the policy implications based on the sensemaking praxis of the student innovators.

To better understand the reality of living with the diseases and conditions that its drugs and therapies are developed to treat, the Novartis leadership determined a need for more meaningful insights into patients’ lives. They sought to develop a systematic, creative methodology – informed by the psychology of insightful rather than analytical thinking – to properly integrate and deploy the research commissioned into its day-to-day business decision-making. For it is well established that better understanding of the patient reality drives both compliance and adherence “beyond the pill”. The purpose of this paper is to bring the novel methodology of creativity to a wider audience and ensure that many others – notably in patient advocacy organizations – can benefit from this approach.

A core team of Insight and Analytics and Patient Engagement leads from various therapeutic area teams worked in partnership with a psychologist and practitioner in the field of insightful thinking, to develop an effective methodology that could reliably surface and articulate genuine patient insights. This methodology – the i4i Insights Discovery™ process – was developed, piloted, refined and codified in 2020 and implemented across the company in 2021–2022. It uses a combination of convergent and divergent thinking techniques – human rather than artificial intelligence, combining diverse research outputs – to understand patients’ lives better. With enhanced understanding, the insights then shape educational and behavioral strategies to drive adherence and compliance.

At a time of tightening budgets and demands to deliver enhanced impact from research budgets, i4i Insights Discovery™ has enabled Novartis teams to turn existing research outputs into profound and useful understandings of what it means to live with specific diseases and develop evidence-based patient engagement strategies; insight-driven decision-making around the lifecycle of any compound. i4i Insights Discovery™ has been applied across Novartis’s diverse areas of expertise, from heart disease to cancer, from organ transplantation to dermatology, from food allergy to ophthalmology.

The i4i Insights Discovery™ process enables Novartis teams to gain deeper understanding of patients’ lives without the need to commission additional research; to do more with less. These insights enable cross-functional Novartis teams to develop better-informed strategies that better address the needs of patients and their care partners, of health-care professionals and health-care systems. The team creating the process is looking to make the i4i Insights Discovery™ approach a gold standard of insight discovery, both for pharma and health care and in other categories, too.

The i4i Insights Discovery™ process is a practical, novel application of well-established principles in the psychology of insightful thinking to address a clear business imperative. By repurposing and reinterpreting existing research outputs using creative verbal and visual exercises, it delivers a more human and empathetic understanding of the patient reality. It moves teams from “So what?” – this is what the data mean – to “Now what?” – this is what we should do as a result.

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

Bureaucracy to a large extent entrenches orderliness and productive means of achieving goals in both public and private organisations across the world. However, bureaucracy is not suitable in the management of hospitals due to its peculiar nature of operations. This study investigates the conundrum of bureaucratic processes and health-care service delivery in government hospitals in Nigeria.

The study surveyed 600 outpatients and attendees visiting tertiary and government hospitals in Nigeria using descriptive design to obtained data from the respondents. A research instrument, questionnaire, was used to gather data. Out of the 600 outpatients visiting the 20 hospitals in government and tertiary hospitals, 494 responses were returned from the attendees. The study employed random sampling strategy to collect the information.

The findings of this study were that service delivery in government hospitals were in adverse position on all the four constructs of bureaucratic dimensions as against quality of service delivery in hospitals in Nigeria. It discovered that bureaucratic impersonality cannot impact on the quality of service delivery in government hospitals in Nigeria. Separation and division of labour among health workers have no significant effect on quality service delivery in government hospitals. Formal rules and regulations (administrative procedure, rules, and policies) prevent quality service delivery in government hospitals in Nigeria. Also, patient’s waiting time was not significant to the quality of service delivery in government hospitals.

The results are constrained with dimensions of bureaucratic processes. Thus, the implication of this study is that bureaucracy in the Nigerian public hospitals is an unnecessary marriage which should be carefully separated and de-emphasised for quality service delivery in the hospitals to thrive.

Largely, this study is practical essential as it unearths the irrelevant operations procedure that hinder progress in Nigerian hospitals.

The study accomplishes recognised importance to survey how bureaucracy impedes quality service delivery in government hospitals. This study has provided a vital clue to elements that will bring rapid attention to patients’outcome in Nigerian hospitals and health-care facilities which hitherto has not been emphasised. The study has contributed to the existing body of knowledge associated to healthcare service quality in developing country.