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This paper aims to discover and analyze the challenges hampering blockchain technology’s (BT’s) implementation in the Indian health-care sector. A total of 18 challenges have been prioritized and modeled based on an extensive literature search and professional views.

An integrated multi-criteria decision-making approach has been used in two phases. Best worst method (BWM) is used in the first phase to prioritize the challenges with sensitivity analysis to validate the findings and eliminate a few challenges. In the second phase, interpretive structural modeling is applied to the remaining 15 challenges to obtain relative relationships among them with cross-impact matrix multiplication applied to classification analysis for their categorization.

The study’s results reveal that limited knowledge and expertise, cost and risk involved, technical issues, lack of clear regulations, resistance to change and lack of top management support are the top-ranked or high-intensity challenges according to the BWM. Interpretive structural modelling findings suggest that the lack of government initiatives has been driving other challenges with the highest driving power.

This work has been conducted in the Indian context, so careful generalization of the results is needed.

This work will give health-care stakeholders a better perspective regarding blockchain’s adoption. It will help health-care stakeholders, service providers, researchers and policymakers get a glimpse of the strategies for eradicating mentioned challenges. The analysis will help reduce the challenges’ impact on blockchain’s adoption in the Indian health-care sector.

The adoption of BT is a novel concept, especially in developing countries such as India. This is one of the few works addressing the challenges to BT adoption in the Indian health-care sector.

Sharing patient health information (PHI) among hospitals has been much slower than the adoption of health record systems. This paper aims to investigate if privacy regulation (PR) or security measures (SMs) influence hospitals’ use of health information exchange (HIE) to share PHI with other providers (e.g. physicians, labs, hospitals). The study specifically focuses on how multiple PRs can impede and a strong national security infrastructure (NSI) can support HIE.

The study uses secondary data from a multi-national and multi-hospital survey administered by the European Union. The multi-level structure of the cross-sectional panel data is used to test the influence of both hospital-level (e.g. PR) and national-level variables (e.g. NSI) on HIE. A total of nine types of HIE, three types of PRs, nine SMs and other relevant control variables are considered. This study uses a two-level random intercept generalized linear model to test the hypothesis proposed in the study.

The study finds that national-level PRs (NLPR) have the strongest positive influence on HIE in comparison to regional (RLPR) and hospital-level (HLPR) PRs. Moreover, the study finds evidence that the presence of RLPR and HLPR, on average, decreases the positive impact of NLPR by 264%. The SMs also have a significant and positive impact on HIE. Adoption of an additional SM can increase the odds of engaging in a certain type of HIE between 21% and 61%. On the other hand, a strong NSI can also amplify the positive impact of SM on certain types of HIE.

This study extends prior research on the role of PRs in enabling HIE by considering the complexities brought up by adopting multiple PRs. NLPRs have the strongest impact on HIE in comparison to RLPRs or HLPRs. Moreover, public infrastructure initiatives such as those related to secure communications can also complement SMs adopted by the providers by encouraging HIE.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

In developing countries, how risk management technologies influence management accounting and control (MAC) practices is under-researched. By drawing on insights from institutional studies, this study aims to examine the multiple institutional pressures surrounding an entity and influencing its risk-based management control (RBC) system – that is, how RBC appears in an emerging market attributed to institutional multiplicity.

The authors used qualitative case study research methods to collect empirical evidence from a privately owned Egyptian insurance company.

The authors observed that in the transformation to risk-based controls, especially in socio-political settings such as Egypt, changes in MAC systems were consistent with the shifts in the institutional context. Along with changes in the institutional environment, the case company sought to configure its MAC system to be more risk-based to achieve its strategic goals effectively and maintain its sustainability.

This research provides a fuller view of risk-based management controls based on the social, professional and political perspectives central to the examined institutional environment. Moreover, unlike early studies that reported resistance to RBC, this case reveals the institutional dynamics contributing to the successful implementation of RBC in an emerging market.

This study aimed to investigate the sensemaking strategies employed by early-career employees working within organizationally constrained environments.

Grounded in the sensemaking-as-accomplishment framework, a longitudinal multi-case study was conducted, involving three early-career employees. These participants were interviewed multiple times concerning tasks they themselves identified as anomalous and ambiguous.

The study's findings illuminate how early-career employees utilize sensemaking strategies to accomplish anomalous-ambiguous tasks. These strategies are interwoven with deliberate efforts to mitigate organizational constraints that exist in the organization or arise during the execution of complex tasks.

Notable limitation pertains to the time gap between task completion and the interviews. Conducting real-time interviews concurrently with task execution or immediately afterward was not feasible due to constraints in participant availability. This research has implications for organizational learning initiatives, particularly those encompassing employee-driven self-learning components. Insights derived from studies like this can inform the development of effective self-learning schemes within organizations.

Previous sensemaking research focused on what takes place in high-reliability organizations. This study explored sensemaking strategies in workplaces that are organizationally constrained.

This study investigates the observed resurgence in religious beliefs seen across many societies during the COVID-19 pandemic. Using the economic theory of religious clubs, the author models religious participation during the pandemic as a mechanism for alleviating the financial distress associated with the health distress from the pandemic.

Using data from the COVID-19 National Longitudinal Phone Survey (NLPS) in Nigeria, the author investigates the economic motivation for religious intensity during the COVID-19 pandemic. To address endogeneity concerns, the author exploits geographic variables of temperature and longitudes as sources of COVID-19 risk.

Overall, health distress stimulates religious intensity. Consistent with the economic theory of religious clubs, adverse health shocks stimulate financial distress, and the effect is stronger among religious participants. Similarly, people see God and not the government as a source of protection against COVID-19.

The study’s model sees religious organizations as public goods providers, especially when governments and markets are inefficient.

The study’s recommendations support an expanded role for religious networks in healthcare delivery and more public funding to attenuate the post-pandemic resurgence of social violence in economically distressed regions.

Despite the research interest in the COVID-19 pandemic, the long-term implications, many of which relate to social behavior adjustments that cause individuals to identify more closely with their social group, need greater understanding. Suppose religious intensity is linked to economic distress. In that case, this is a major source of worry for countries whose economies are subject to higher fluctuations and where the governments and markets are inefficiently organized. These regions may be more susceptible to a resurgence in religious fundamentalism associated with the economic shocks from the pandemic. Consequently, these regions would require more public funding to attenuate the potential for costly activities like organized violence, suicide attacks and terrorist activities in the aftermath of the pandemic.

Prompted by the observation of the increase in religious identity through religious intensity during the pandemic, the author contributes by developing theoretically-based hypotheses that are incentive-compatible to provide a rational justification for the observation. The author empirically validates the hypothesis by taking advantage of the COVID-19 National Survey in Nigeria by specifically using survey rounds 4 and 7 which have more comprehensive religious items included.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-11-2022-0719

The COVID19 crisis has thrown wide open the debate on Europe’s Economic and Monetary Union’s (EMU) future. Next Generation EU (NGEU) has broken the stalemate over a central fiscal capacity. The open question is whether NGEU is a one-off or a first step. The suspension of the Stability and Growth Pact has given new urgency to the debate on reforming EMU’s fiscal rules.

There is no debate as yet about how these two prospects relate to each other. This paper argues that a permanent fiscal capacity and revised rules should be seen as alternatives.

This study makes two claims: first, a fiscal capacity renders a reformed pact unnecessary and second, that is an optimal solution politically. A fiscal capacity would provide an efficient asymmetric shock absorber and therefore reduce the need for pre-emptive action against negative cross-border externalities. It would also provide an abundant supply of an EU-wide safe asset around which to structure the EU’s financial system, thus rendering unnecessary the backstopping of member states' debts.

This would restore democratic accountability while eliminating moral hazard and enforcement problems.

As public awareness of the concept of sustainable development has increased, a new investor market has appeared. These investors will only make investments in sustainable financial instruments. Yet, how corporate managers can effectively exploit this new financing concept to make their companies risk resilient remains unaddressed. This study, a conceptual research, aims to examine the impact of sustainable finance (SF) on business risk resilience (BR) and the impact of SF on risk management infrastructure (RI). It also addresses the impact of RI on BR and the mediating effect of the former between SF and BR in the corporate world. Finally, this research explores the moderating effect of managerial capability (MC) and firm technology-focused innovation capability (IC) between SF and RI.

This study incorporates both theoretical and empirical works in the sustainability, innovation, risk management and HRM fields. Afterwards, it constructs a conceptual model alongside suppositions that can be tested in further studies.

This study proposes that SF will enhance BR and RI. Moreover, RI will promote BR and positively intervene between SF and BR. Furthermore, MC and IC will reinforce the SF–RI impact such that the SF–RI impact will be strengthened for companies whose MCs and ICs are high than low.

This research affords suggestions for researchers in multidisciplinary fields. It reinforces BR and RI by introducing SF, MC and IC as tactical devices. It also serves as a reference point for forthcoming academics to investigate this conceptual model, empirically, in diverse industries worldwide.

Practical lessons for finance, investment and risk managers, as well as corporate investors are discussed.

This study provides a new research model that demonstrates how SF can be exploited to promote BR and build RI. It also shows how RI can bolster BR and how RI can connect SF to BR. This new model also exhibits how MC and IC moderate the impacts of SF and RI. Thus, it attempts to advance existing knowledge and theoretical frameworks.

This study aims to analyse the strategic moves used by major tobacco corporations to thwart the ratification of the World Health Organization’s Framework Convention on Tobacco Control (FCTC) in Brazil.

The authors conducted a detailed historical case study spanning 1988–2005 and encompassing the period leading up to Brazil’s FCTC ratification. The authors collected qualitative data from various sources to triangulate and develop a comprehensive historical account.

The historical analysis identified three distinct phases. First, the acquisition of a Brazilian cigarette factory, Souza Cruz, by British American Tobacco dramatically altered power dynamics, strengthening the position of the tobacco industry. The second phase regards the era of dictatorship and the efforts of various actors advocating against smoking and the tobacco industry. The third phase involved Brazil’s re-democratisation and the challenges of securing FCTC ratification, during which fierce industry opposition had to be overcome. Throughout these phases, the authors identified four key strategies used by multinational corporations (MNCs) in Brazil to uphold unsustainable practices and products that contradicted public interests instead of reforming them: shaping collective memory, dissimulation, re-presentation and redirecting attention.

This study contributes to critical international business research on emerging economies by examining how Brazil’s position in the global capitalist system has influenced its dependency and how MNCs produce and maintain cycles of poverty and unsustainable practices through the exploitation of power dynamics within the country.