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The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

The purpose of this study is to examine the effectiveness of two intervention strategies – identifying the global letter of Navon letters and verbally describing a face – in improving face recognition abilities of adolescents with autism spectrum disorder (ASD).

A total of 15 adolescents with ASD and 15 typically developing (TD) adolescents participated in this study, which consisted of three experimental conditions: verbalization, Navon and control. Participants were presented with a target face for a short period of time, then completed a task specific to the condition in a counterbalanced order, followed by a face recognition task.

The results of this study showed no significant interaction effects between groups and conditions, either in accuracy or reaction time. However, TD adolescents performed better than ASD adolescents in terms of accuracy. In addition, the verbalization condition resulted in better performance with slower response times compared to the control condition.

These findings suggest that verbalization may be a useful strategy to enhance face recognition abilities in ASD and TD individuals.

The purpose of this study is to examine the impact of corporate social responsibility (CSR) expenditure and business responsibility report (BRR) on a firm’s financial performance. Additionally, the study explores whether CSR expenditure and firm performance are related linearly or otherwise. The study also assesses the influence of mandating CSR expenditure on a firm’s performance.

The study is set in India and uses a nine-year data set from 165 companies listed on the Bombay Stock Exchange. Data compilation and analysis are done by using content analysis and panel data regressions.

The main findings of the study are that the effect of CSR expenditure on firm performance in India is non-linear and can be characterized as parabolic for investigated firms. While some performance indicators suggest a U-shaped relationship, others show an inverted U-type pattern, making a definitive conclusion elusive in either direction. BRR scores themselves have a positive impact on firm performance. Mandatory CSR expenditure affects the financial performance negatively, but the market performance improves in general.

The study provides new insights on the relationship between CSR expenditure, BRR scores and firm performance from India, which is not only a notable emerging market but also has other gripping characteristics. It has a prolific history of philanthropy, and yet, it is the first country in the world to mandate CSR expenditure in recent times. The equation between reported economic progress and general quality of life remains intriguing, and yet the number of studies on the effects of CSR expenditure on firm performance are no match to the volume of ongoing and completed works in more developed markets. This study attempts to trim the gap and provide some useful insights for managers, policymakers and stakeholders, apart from prompting further research.

This study aims to facilitate access to vascular disease screening for low-income individuals living in remote and conflict areas based on the results of a pilot trial in Colombia. Also, to increase the amount of diagnosis training of vascular surgery (VS) in civilians.

The operation method includes five stages: strategy development and adjustment; translation of the strategy into a real-world setting; operation logistics planning; strategy analysis and adoption. The operation plan worked efficiently in this study’s sample. It demonstrated high sensibility, efficiency and safety in a real-world setting.

The authors developed and implemented a flow model operating plan for screening vascular pathologies in low-income patients pro bono without proper access to vascular health care. A total of 140 patients from rural areas in Colombia were recruited to a controlled screening session where they underwent serial noninvasive ultrasound assessments conducted by health professionals of different training stages in VS.

The plan was designed to be implemented in remote, conflict areas with limited access to VS care. Vascular injuries are critically important and common among civilians and military forces in regions with active armed conflicts. As this strategy can be modified and adapted to different medical specialties and geographic areas, the authors recommend checking the related legislation and legal aspects of the intended areas where we will implement this tool.

Different sub-specialties can implement the described method to be translated into significant areas of medicine, as the authors can adjust the deployment and execution for the assessment in peripheral areas, conflict zones and other public health crises that require a faster response. This is necessary, as the amount of training to which VS trainees are exposed is low. A simulated exercise offers a novel opportunity to enhance their current diagnostic skills using ultrasound in a controlled environment.

Evaluating and assessing patients with limited access to vascular medicine and other specialties can decrease the burden of vascular disease and related complications and increase the number of treatments available for remote communities.

It is essential to assess the most significant number of patients and treat them according to their triage designation. This management is similar to assessment in remote areas without access to a proper VS consult. The authors were able to determine, classify and redirect to therapeutic interventions the patients with positive findings in remote areas with a fast deployment methodology in VS.

Access to health care is limited due to multiple barriers and the assessment and response, especially in peripheral areas that require a highly skilled team of medical professionals and related equipment. The authors tested a novel mobile assessment tool for remote and conflict areas in a rural zone of Colombia.

The purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan.

This was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data.

Three main themes emerged from data analysis namely compliance with the surgical safety checklist, the impact of surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus to accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist, and help enhance awareness about its importance.

While steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges for consistent, complete and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.

The purpose of this study is to observe the practice of integrated reporting (IR) and investigate the impact of board characteristics on IR in three South Asian economies: Bangladesh, India and Sri Lanka.

The study uses the content analysis approach to measure the integrated reporting index (IRI) based on a structured checklist. To examine the impact of board characteristics (board size, board independence and gender diversity) on IRI, a multivariate analysis using pooled ordinary least square with panel-corrected standard error (PCSE) model has been conducted.

The content analysis findings show that the disclosure practice of IR is highest in India, followed by Sri Lanka and Bangladesh. The regression result indicates that all the proxies of board characteristics have a positive and significant impact on IRI.

The study’s outcomes may not be generalised for every region due to the differences in institutional contexts.

The findings of this study will assist the policymakers in understanding the importance of effective boards in enhancing the IR practice in their respective countries where the adoption of IR is still a voluntary requirement.

To the best of the authors’ knowledge, this is the first study in the field of existing literature to conduct a comparative analysis of IR practice among three South Asian countries. It shows how an effective board improves IR practice using a broader institutional context by underpinning the agency theory and legitimacy theory.

This paper highlights a crucial public safety issue due to falling objects from tall residential buildings in Singapore. A systematic façade inspection regime and a system of evaluation of severity for the detection and assessment of potential falling objects from tall buildings are presented.

The research uses qualitative case study approach with 450 tall residential buildings sampled for the study. The common materials, elements, components with high risk of falling objects, the nature and type of the falling, the critical factors affecting the falling, the respective level of severity, and the effectiveness of various diagnostic techniques and protocols, are summarised.

Façade for tall residential buildings in Singapore comprises mainly cementitious materials cast in situ or precast, with fixtures and architectural features, all of which have potential of falling. The common anomalies arising from each material and fixture/features are identified, the causes evaluated and their implications to future design, construction and maintenance analysed.

This study provides original and significant information to a crucial public safety issue, setting design and construction criteria that will serve as a benchmark for new and existing facades, applicable to all cities dominated by tall buildings. The paper presents original figures, checklists and guides as a basis for readers' consideration to use according to their respective unique conditions.

The building commissioning (BCx) phase is a critical stage in a building's lifecycle. It is also a complex process that involves a large number of actors and activities. While the use of building information modeling (BIM) in the commissioning phase of building equipment and systems could be beneficial, few studies have investigated the processes behind its implementation. The research presented in this paper aims to investigate the implementation of BIM for the commissioning phase within a general contracting company through action-research.

Through direct involvement with the research partner, a large general contractor, a diagnosis on the current limitations of the commissioning process was conducted. An action plan to implement BIM for commissioning was developed and implemented in two pilot projects. Evaluation was performed through on-site observations and informal discussions with field staff. Learning was specified through the development of a formal protocol for BIM-enabled BCx.

This action-research project helped the partner organization identify the challenges and a way forward to formalize its BIM-enabled BCx process. The action plan aimed at countering the lack of knowledge about the status of equipment and system commissioning as well as the lack of standardization. The research team co-developed and tested a formal protocol, including BIM-enabled processes and technologies to address these observed problems. A complete implementation ecosystem was structured and deployed. Preliminary feedback indicated that improvements were obtained using a BIM-enabled approach over a traditional approach.

While past studies have investigated the BCx process, this study identified current challenges considering recent advances in BIM and focused on a large general contractor. This work provides an in-depth account of a large general contractor attempting to streamline its BCx process. The results of the study could help guide practitioners in implementing more streamlined BIM-enabled BCx processes.

According to the Project Management Institute, 70% of projects fail globally. The causes of project failure in many instances can be identified as non-technical or behavioral in nature arising from interactions between participants. These intangible risks can emerge in any project setting but especially in project settings having diversity of cultures, customs, beliefs and traditions of various companies or countries. This paper provides an objective framework to address these intangible risks.

This paper presents a structured approach to identify, assess and manage intangible risks to enhance a project team’s ability to meet its objectives. The authors propose a user-friendly framework, Intangible Risk Assessment Methodology for Projects (IRAMP), to address these risks and the factors that cause them. Meta-network (e.g., a network of networks) simulation and established social network analysis (SNA) measures provide a quantitative assessment and ranking of causal events and their influence on the intangible behavior centric risks.

The proposed IRAMP and meta-network approach were utilized to examine the project delivery process of an international energy firm. Data were gathered using structured interviews, surveys and project team workshops. The use of the IRAMP to highlight intangible risk areas underpinned by the SNA measures led to changes in the company’s organizational structure to enhance project delivery effectiveness.

This work extends the existing project risk management literature by providing a novel objective approach to identify and quantify behavior centric intangible risks and the conditions that cause them to emerge.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.