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This paper explores Lean Six Sigma principles and the DMAIC (define, measure, analyze, improve, control) methodology to propose a new Lean Six Sigma 4.0 (LSS 4.0) framework for employee occupational exams and address the real-world issue of high-variability exams that may arise.

This study uses mixed methods, combining qualitative and quantitative data collection. A detailed case study assesses the impact of LSS interventions on the exam management process and tests the applicability of the proposed LSS 4.0 framework for employee occupational exams.

The results reveal that changing the health service supplier in the explored organization caused a substantial raise in occupational exams, leading to increased costs. By using syntactic interoperability, lean, six sigma and DMAIC approaches, improvements were identified, addressing process deviations and information requirements. Implementing corrective actions improved the exam process, reducing the number of exams and associated expenses.

It is important to acknowledge certain limitations, such as the specific context of the case study and the exclusion of certain exam categories.

The practical implications of this research are substantial, providing organizations with valuable managerial insights into improving efficiency, reducing costs and ensuring regulatory compliance while managing occupational exams.

This study fills a research gap by applying LSS 4.0 to occupational exam management, offering a practical framework for organizations. It contributes to the existing knowledge base by addressing a relatively novel context and providing a detailed roadmap for process optimization.

The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons.

In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described.

The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce.

The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice.

The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork.

To the best of the authors’ knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt.

Since the success of online communities depend on physicians' participation, understanding factors that influence community participation and content contribution are critical for online health communities (OHCs). Drawing on the self-determination theory (SDT), an empirical model was proposed to explore the effects of social returns and economic returns on physicians' community participation, private content contribution and public content contribution, and the moderating effect of their online seniority. This paper aims to address these issues.

Empirical data of 4,343 physicians were collected from a Chinese OHC, and ordinary least squares (OLS) and negative binomial regression models were employed to verify the proposed theoretical model.

The authors’ results indicate that both social and economic returns have a positive effect on physicians' community participation and private content contribution, and their online seniority strengthens the positive effects of economic returns on community participation and private content contribution.

The authors’ research extends physicians' community participation by dividing content contribution into private and public, and enhances our understanding of the determinants of physicians' participation in OHCs by exploring the effects of social and economic returns, as well as the moderating effect of online seniority. Their findings contribute to the literature on e-Health and user participation, and provide management implications for OHC managers.

The peer review history for this article is available at https://publons.com/publon/10.1108/OIR-11-2021-0615/

This study aims to increase awareness and educate the reader about health-care fraud targeting seniors in the USA to help stakeholders better understand, recognize and prevent this type of fraud.

This paper collects statistics on the current state of health care frauds committed against seniors, and examines related cases and laws.

The authors find this type of fraud is highly prevalent and expected to increase. Current laws preventing this fraud from occurring are multifold and complex. While prevention strategies through law enforcement have been somewhat successful, a reduction in resources may put seniors at an increased risk in the years to come.

Without additional prevention strategies, the problem will likely escalate with a growing population of older adults. This study encourages further research into effective prevention strategies and methods to fight health-care fraud against seniors.

Health-care fraud and its associated costs pose a significant threat to the society and economy of the USA. Reducing this fraud will not only reduce the costs to the US economy but also improve the physical and mental well-being of senior victims, reduce their mortality and hospitalization rates and improve the public trust placed to health-care providers.

This study highlights how health-care fraud is committed against seniors. With the projected trend of an aging US population, educating stakeholders, increasing awareness and applying tools to protect seniors will be important to reduce the absolute scope of this problem in the future.

New Public Management-informed pay-for-performance policies are common in public sectors internationally but can be controversial with delivery agents. More attention is needed on contingent forms of bottom-up implementation of challenging policies, in emerging market economies, for professionals who face tensions between policies and their codes of practice. Street-level bureaucrats (SLBs) mediate policy implementation through discretionary practices; health professionals have enhanced space for discretion based on autonomy derived from professional status. The authors explore policy implementation, adaptation and resistance by physicians, focusing on payments for health workers in Turkey.

The researchers conducted semi-structured qualitative interviews with 12 physicians in Turkish hospitals and thematic analysis of interview transcripts, using a blended (deductive and inductive) approach.

The policy fostered discretionary behaviours such as cherry-picking (high volume, low risk procedures) and pro-social rule-breaking (e.g. “upcoding”), highlighting clinical autonomy to navigate within policy restrictions. Respondents described damage to relationships with patients and colleagues, and dissonance between professional practice and perverse policy incentives, sometimes leading to disengagement from clinical work. Policymakers were perceived to be detached from the realities experienced by SLBs. Tensions between the policy and professional values risked alienating physicians.

This study utilises participant self-reported perceptions of discretionary behaviours. Further work may adopt alternative methods to explore the relationship between self-reporting and observed practice.

The authors contribute to research on differentiated, contingent roles of groups with high scope for discretion in bottom-up implementation, pointing to the potential for policy-professional role conflicts between top-down P4P policies, and the values and codes of practice of professional SLBs.

The purpose of this study is to explore the determinants of needle stick injuries (NSIs) suffering in terms of occupational health and safety (OHS) coverage critically for health-care workers’ rights in Pakistan.

This is a qualitative study involving the designing of a questionnaire followed by the World Health Organization’s NSI prevention assessment tool and nationally published reports covering health-care workers’ OHS rights protection. A total of 17 public and private hospitals were surveyed with a two-stage sampling method. Descriptive and inferential statistics (one-way analysis of variance with multiple comparison tests) were applied and significant results were discussed (p = 0.05 & p = 0.01). The results were discussed critically in the context of the OHS rights of health-care workers.

Analysis revealed the following significant relationships: job type and safety behavior; age group of health-care workers and safety management; injection usage per day and safety behavior; past year’s needle sticks injuries cases with safety behavior and occupational exposure; work shift and work experience with safety knowledge, safety awareness and work experience with safety management. It was also found there is no specific OHS law in the country for health-care workers.

This study is limited in terms of sampling size and quantification of NSI burden among health-care workers.

Improved OHS management practices among health-care workers can control NSIs that ultimately ensure their workplace OHS rights. Health-care workers need OHS coverage in terms of awareness about potential workplace hazards and job training accordingly. Findings from extensive studies of a similar kind can give useful policy directions for workplace health management in health-care setup at the national level.

This study highlights the importance of OHS coverage for health-care workers in hospitals. It reports different determinants of NSIs suffering causing health-care worker’s rights violations at the workplace in Pakistan.

Drawing on the pay-for-performance (P4P) and job satisfaction literatures through an analysis of qualitative studies published on the topic, the purpose of this study is to investigate the effect of a P4P-based system on job satisfaction and dissatisfaction among health care workers.

A meta-synthesis of the qualitative literature was conducted to investigate health care workers' opinions, perceptions and behaviors and fully understand what processes generate job satisfaction or dissatisfaction under P4P systems.

The findings suggest that P4P systems impact the job (dis-)satisfaction of health care workers based on the institutional, organizational, geographic and cultural context of reference. Specifically, job satisfaction – and thus motivation, occupational well-being and work engagement – can occur when the context is supportive, whereas job dissatisfaction – and thus work stress and pressure, burnout and work-life balance issues and distraction – is generated in the case of unsupportive contexts. Moreover, the findings suggest a virtuous/vicious circle whereby job satisfaction leads to positive performance and further fuels job satisfaction, while conversely job dissatisfaction generates worse performance, and this further worsens worker satisfaction.

There is a lack of studies comparing and analyzing current evidence on the job (dis-)satisfaction of health care workers operating in different contexts based on the reward system. This is the first research to analyze a significant number of studies with reference to the relation between P4P and job (dis-)satisfaction, which are topics in need of further study and investigation in health care settings around the world.

The prevalence of children with autism spectrum disorder (ASD) is rising. As children with ASD become adults, the need for appropriate physical and mental health care becomes more evident. Lack of knowledge and inadequate training about adult ASD can lead to discomfort in management and service delivery to this population. This study aims to assess knowledge, attitude and practice of health-care providers for patients with adult ASD and to determine the needs of health-care staff to provide convenient care to adult patients with ASD.

This cross-sectional study was conducted in 2019–2020 among health-care professionals in Iran using an online questionnaire.

In this study, 182 health-care professionals (67.6% mental health professionals) participated. A minority of participants mentioned having excellent or very good knowledge about autism (10%) or acceptable access to clinical tools and guidelines (27%). Around 67% of professionals believed that patients with ASD are not cooperative. The most preferred training was training on effective communication strategies with ASD patients (64.8%).

The authors found a gap in knowledge and training of adult ASD diagnosis and management among health-care providers.

This study highlights the significance of empowering professionals with better training to manage adult autism.

The purpose of this study is to explore the information-seeking behavior of Egyptian physicians serving in COVID-19 isolation hospitals.

A sample of 91 physicians serving in Egyptian isolation hospitals answered the study questionnaire.

Demographically, more than half of respondents were males. Over one-third of them are holding Doctor of Medicine (M.D), followed by one-third holding Master of Medicine (MMed). Respondents' age ranged from 30 to 60 years. Internal medicine is the most common specialty, accounting for nearly half of all physicians, followed by chest medicine and intensive care medicine. The information-seeking behavior of these three groups in their regular work is believed to be different, but since all of the participants are working in COVID-19 isolation hospitals, they should have the same information resources, Internet access and the same needs relevant to COVID-19 in order to make accurate clinical decisions. The physicians used traditional and electronic information sources to fulfill their information needs, the most important of which were to make a specific research, find an answer to a specific case, and deliver a medical lecture. Colleagues, coworkers, nurses and pharmacists were the most important channels pursued by Egyptian physicians to obtain information.

This study is the first study that focuses on investigating the information-seeking behavior of Egyptian physicians serving in isolation hospitals. Any findings resulted from this study may serve as a noteworthy reference that may be useful to the Egyptian health sector, experts, researchers, as well as policymakers in establishing strategic decisions for making the understating much better.

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-08-2020-0350