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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.

Particles bed binding by selective cement activation (SCA) method is a computer-aided manufacturing (CAM) technique used to produce cementitious elements. A computer-aided design file is sliced to generate G-codes before printing. This paper aims to study the effect of key input parameters for slicer software on the final properties of printed products.

The one factor at a time (OFAT) methodology is used to investigate the impact of selected parameters on the final properties of printed specimens, and the causes for the variations in outcomes of each variable are discussed.

Finer aggregates can generate a more compact layer, resulting in a denser product with higher strength. Fluid pressure is directly determined by voxel rate (r_V); however, high pressures enable better fluid penetration control for fortified products; for extreme r_Vs, residual voids in the interfaces between successive layers and single-line primitives impair mechanical strength. It was understood that printhead movement along the orientation of the parts in the powder bed improved the mechanical properties.

The design of experiment (DOE) method assesses the influence of process parameters on various input printing variables at the same time. As the resources are limited, a fractional factorial plan is carried out on a subset of a full factorial design; hence, providing physical interpretation behind changes in each factor is difficult. OFAT aids in analyzing the effect of a change in one factor on output while all other parameters are kept constant. The results assist engineers in properly considering the influence of variable variations for future DOE designs.

Using data from a continuous and ongoing cross-sectional web survey on hospitalisation service experiences in two Italian regions, the authors used multilevel and multivariate logistic regression models to identify factors related to users' demographics, emotional and informative support, technical and physical aspects of the provision, influencing satisfaction and willingness-to-recommend, before and during a crisis.

The value-in-use, defined in terms of a positive or negative value given by the experience with services, can be evaluated by users and influenced by the context of provision. The authors tested whether and how the value-in-use of services changed in a context of crisis. This study is applied to the healthcare sector during the coronavirus disease 2019 (COVID-19) epidemic, by evaluating the impact of the pandemic on hospitalisation experience.

Overall, analyses of 8,712 questionnaires found a greater value after the pandemic spread. In a time of crisis, technical and informative aspects of care were found to be most valued by patients that may recognise the extraordinary professionalism of workers during the crisis.

This study empirically suggests that context can affect the evaluation of value-in-use by patients during unprecedented circumstances, producing additional value-in-context.

These findings imply that during critical periods where there is less scope for expressions of gratitude and appreciation towards front-line workers, user-reported data can be used for motivating professionals and increase resilience. These results reiterate the need to continue collecting and reporting the service users' voices, including as activity within plans for managing challenging situations.

The level of healthcare system distress, due to the COVID-19 epidemic, positively affects patients' propensity to recommend, which the authors suggest is driven by healthcare services' feelings of reverse compassion. These findings imply that during critical periods where there is less scope for expressions of gratitude and appreciation towards front-line workers, user-reported data can be used for motivating professionals and increase resilience, which can have positive social implications. These results reiterate the need to continue collecting and reporting the service users' voices, including as activity within plans for managing challenging situations.

Research based on the intersection of theoretical and empirical research regarding value-in-use, value-in-context and service quality measured through user experience is scarce, in particular in the healthcare sector. The authors' findings set the direction for future research on the influence of context on value creation and value creation's perception by users, on the concept of reverse compassion and on reverse compassion's impact on organisational well-being, particularly in times of crisis.

Value-based healthcare suggested using patient-reported information to complement the information available in the medical records and administrative healthcare data to provide insights into patients' perceptions of satisfaction, experience and self-reported outcomes. However, little attention has been devoted to questions about factors fostering the use of patient-reported information to create value at the system level.

Action research design is carried out to elicit possible triggers using the case of patient-reported experience and outcome data for breast cancer women along their clinical pathway in the clinical breast network of Tuscany (Italy).

The case shows that communication and engagement of multi-stakeholder representation are needed for making information actionable in a multi-level, multispecialty care pathway organized in a clinical network; moreover, political and managerial support from higher level governance is a stimulus for legitimizing the use for quality improvement. At the organizational level, an external facilitator disclosing and discussing real-world uses of collected data is a trigger to link measures to action. Also, clinical champion(s) and clear goals are key success factors. Nonetheless, resource munificent and dedicated information support tools together with education and learning routines are enabling factors.

Current literature focuses on key factors that impact performance information use often considering unidimensional performance and internal sources of information. The use of patient/user-reported information is not yet well-studied especially in supporting quality improvement in multi-stakeholder governance. The work appears relevant for the implications it carries, especially for policymakers and public sector managers when confronting the gap in patient-reported measures for quality improvement.

Although the Net Promoter Score (NPS) index is simple, NPS has weaknesses that make NPS's interpretation misleading. The main criticism is that identical index values can correspond to different levels of customer loyalty. This makes difficult to determine whether the company is improving/deteriorating in two different years. The authors describe the application of statistical tools to establish whether identical values may/may not be considered similar under statistical hypotheses.

Equal NPSs with a “similar” component composition should have a two-way table satisfying marginal homogeneity hypothesis. The authors compare the marginals using a cumulative marginal logit model that assumes a proportional odds structure: the model has the same effect for each logit. Marginal homogeneity corresponds to null effect. If the marginal homogeneity hypothesis is rejected, the cumulative odds ratio becomes a tool for measuring the proportionality between the odds.

The authors propose an algorithm that helps managers in their decision-making process. The authors' methodology provides a statistical tool to recognize customer base compositions. The authors suggest a statistical test of the marginal distribution homogeneity of the table representing the index compositions at two times. Through the calculation of cumulative odds ratios, the authors discriminate against the hypothesis of equality of the NPS.

The authors' contribution provides a statistical alternative that can be easily implemented by business operators to fill the known shortcomings of the index in the customer satisfaction's context. This paper confirms that although a single number summarizes and communicates a complex situation very quickly, the number is ambiguous and unreliable if not accompanied by other tools.

The study aims to analyze for the Spanish context the influence of the involvement of several generations in the firm's management on family firm internationalization. The authors also respond to the call in the literature to consider the influence of SEW on family firm internationalizations by analyzing the moderating effect of the importance family managers attach to each of the socioemotional wealth (SEW) dimensions – enrichment, continuity and prominence on the relationship between multiple generations involved in management and family firm internationalization.

The information was obtained by means of a questionnaire sent to the CEOs of family businesses. The authors’ sample consists of 147 Spanish family firms.

The authors find that the involvement of multiple generations in management is positively related to the internationalization of family firms. Furthermore, the importance that family CEOs attribute to the enrichment dimension of SEW reduces the intensity of the effect of the involvement of several generations in management on family firm internationalization.

The authors’ results, for the Spanish context, complement previous studies (Meneses et al., 2014) showing that the entry of new generations into the family business opens a window of opportunity for the internationalization of the family business. Furthermore, their study shows that the diverse family objectives by CEOs can have different, even conflicting effects on the internationalization decision. These results suggest that the enrichment dimension, which focuses on the short-term family goals may restrain the internationalization of the family business. However, continuity and prominence dimensions, which are related with long term family objectives and jointly enable the fulfillment of nonfamily stakeholders’ objectives, do not influence the internationalization of the family firms analyzed.

Polymer laser powder bed fusion (PBF-LB/P) is an additive manufacturing technology that is sustainable due to the possibility of recycling the powder multiple times and allowing the fabrication of gears without the aid of support structures and subsequent assembly. However, there are constraints in the process that negatively affect its adoption compared to other additive technologies such as material extrusion to produce gears. This study aims to demonstrate that it is possible to overcome the problems due to the physics of the process to produce accurate mechanism.

Technological aspects such as orientation, wheel-shaft thicknesses and degree of powder recycling were examined. Furthermore, the evolving tooth profile was considered as a design parameter to provide a manufacturability map of gear-based mechanisms.

Results show that there are some differences in the functioning of the gear depending on the type of powder used, 100% virgin or 50% virgin and 50% recycled for five cycles. The application of a groove on a gear produced with 100% virgin powder allows the mechanism to be easily unlocked regardless of the orientation and wheel-shaft thicknesses. The application of a specific evolutionary profile independent of the diameter of the reference circle on vertically oriented gears guarantees rotation continuity while preserving the functionality of the assembled mechanism.

In the literature, there are various studies on material aging and reuse in the PBF-LB/P process, mainly focused on the powder deterioration mechanism, powder fluidity, microstructure and mechanical properties of the parts and process parameters. This study, instead, was focused on the functioning of gears, which represent one of the applications in which this technology can have great success, by analyzing the two main effects that can compromise it: recycled powder and vertical orientation during construction.

When improving business processes, process analysts can use data-driven methods, such as process mining, to identify improvement opportunities. However, despite being supported by data, process analysts decide which changes to implement. Analysts often use process visualisations to assess and determine which changes to pursue. This paper helps explore how process mining visualisations can aid process analysts in their work to identify, prioritise and communicate business process improvement opportunities.

The study follows the design science methodology to create and evaluate an artefact for visualising identified improvement opportunities (IRVIN).

A set of principles to facilitate the visualisation of process mining outputs for analysts to work with improvement opportunities was suggested. Particularly, insights into identifying, prioritising and communicating process improvement opportunities from visual representation are outlined.

Prior work focuses on visualisation from the perspectives – among others – of process exploration, process comparison and performance analysis. This study, however, considers process mining visualisation that aids in analysing process improvement opportunities.