Search results

1 – 10 of over 2000
Article
Publication date: 11 April 2023

Hesham Metwalli Mousli, Iman El Sayed, Adel Zaki and Sherif Abdelmonem

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

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

The TQM Journal, vol. 36 no. 2
Type: Research Article
ISSN: 1754-2731

Keywords

Article
Publication date: 25 March 2024

Angela Crocker, Jill Titterington and Michelle Tennyson

This study aims to evaluate the quality of a speech and language therapy (SLT) swallow service provided to adults with intellectual disability (ID) by exploring the process and…

Abstract

Purpose

This study aims to evaluate the quality of a speech and language therapy (SLT) swallow service provided to adults with intellectual disability (ID) by exploring the process and outcome factors; to explore the process of what is done to and for the patient including identifying dysphagia, choking and pneumonia risk, typical interventions and management; examine clinical outcomes; and explore the relationship of outcomes with risk factors, satisfaction with the service and the impact of the service on the number of choking incidents and admissions to acute hospital with swallow concerns.

Design/methodology/approach

There were three specific work packages: (1) collecting and scrutinising patient data from the clinical record for adults with ID referred to the SLT swallow service over a six-month period. The researcher created aims, defined the limits to achieve the aims, designed a standardised data collection form, set out where data was in the clinical record, piloted, set limits for collection and trained reviewers; (2) gathering experience and satisfaction surveys from patients, caregivers and referrers over the six-month study period; and (3) monitoring choking adverse incident reports and hospital admission with swallow concerns for the whole ID population.

Findings

Choking and hospital admission were the main reasons for referral, and pneumonia risk significantly predicted dysphagia impairment. The research highlighted common dysphagia risk factors, interventions and recommendations for this population. The SLT swallow service is a quality service that is highly valued by patients, their caregivers and referrers. The service achieves significant clinical improvements, helps identify dysphagia and provides management to reduce associated risks.

Research limitations/implications

This study found common dysphagia risk factors, interventions and recommendations; it also found that the therapy outcome measures/Royal College of Speech and Language Therapy online outcome tool was a meaningful outcome measure, and that pneumonia risk significantly predicted dysphagia impairment, all of which could inform the identified dysphagia research priorities for this population.

Practical implications

Naming usual care in treatment and recommendations could help ensure a fair service and could help form quality indicators. People with ID, their caregivers and staff generated valuable ideas for improvement, and further involvement work could create a logic model for the service. Other future work could explore the use of screening tools, increase multidisciplinary team working, improve access to instrumental assessments, raise awareness of swallowing and promote important oral health and medication reviews. By using this information to shape quality improvement work and policies, one can work toward addressing high health-related inequalities and preventable deaths associated with dysphagia in this vulnerable population.

Social implications

It may be useful to raise awareness that adults with ID age earlier and that one should not exclude them from older people’s services because of an age threshold, often set higher than their life expectancy. This study highlighted a possible inequality of access issue for adults with ID who do not have direct care or day care staff. There is a need to increase access to awareness training so caregivers and general practitioners can recognise swallow difficulties and know how to make a referral for a swallow assessment.

Originality/value

Overall, the evaluation of the swallow service to adults with ID suggests that SLT have a quality service for adults with ID that is highly valued and provides significant clinical improvements. By building on these strengths, SLT could extend the reach, influence and impact of their services to help those adults with ID who have emerging swallow difficulties or who do not access the service.

Details

Tizard Learning Disability Review, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1359-5474

Keywords

Open Access
Article
Publication date: 13 February 2024

Felipa de Mello-Sampayo

This survey explores the application of real options theory to the field of health economics. The integration of options theory offers a valuable framework to address these…

Abstract

Purpose

This survey explores the application of real options theory to the field of health economics. The integration of options theory offers a valuable framework to address these challenges, providing insights into healthcare investments, policy analysis and patient care pathways.

Design/methodology/approach

This research employs the real options theory, a financial concept, to delve into health economics challenges. Through a systematic approach, three distinct models rooted in this theory are crafted and analyzed. Firstly, the study examines the value of investing in emerging health technology, factoring in future advantages, associated costs and unpredictability. The second model is patient-centric, evaluating the choice between immediate treatment switch and waiting for more clarity, while also weighing the associated risks. Lastly, the research assesses pandemic-related government policies, emphasizing the importance of delaying decisions in the face of uncertainties, thereby promoting data-driven policymaking.

Findings

Three different real options models are presented in this study to illustrate their applicability and value in aiding decision-makers. (1) The first evaluates investments in new technology, analyzing future benefits, discount rates and benefit volatility to determine investment value. (2) In the second model, a patient has the option of switching treatments now or waiting for more information before optimally switching treatments. However, waiting has its risks, such as disease progression. By modeling the potential benefits and risks of both options, and factoring in the time value, this model aids doctors and patients in making informed decisions based on a quantified assessment of potential outcomes. (3) The third model concerns pandemic policy: governments can end or prolong lockdowns. While awaiting more data on the virus might lead to economic and societal strain, the model emphasizes the economic value of deferring decisions under uncertainty.

Practical implications

This research provides a quantified perspective on various decisions in healthcare, from investments in new technology to treatment choices for patients to government decisions regarding pandemics. By applying real options theory, stakeholders can make more evidence-driven decisions.

Social implications

Decisions about patient care pathways and pandemic policies have direct societal implications. For instance, choices regarding the prolongation or ending of lockdowns can lead to economic and societal strain.

Originality/value

The originality of this study lies in its application of real options theory, a concept from finance, to the realm of health economics, offering novel insights and analytical tools for decision-makers in the healthcare sector.

Details

Journal of Economic Studies, vol. 51 no. 9
Type: Research Article
ISSN: 0144-3585

Keywords

Article
Publication date: 26 December 2023

Barney G. Pacheco and Marvin H. Pacheco

The global impact of the COVID-19 pandemic has been well documented, but there is still limited insight into the complex interaction of factors that determine its longer-term…

Abstract

Purpose

The global impact of the COVID-19 pandemic has been well documented, but there is still limited insight into the complex interaction of factors that determine its longer-term effects on the most vulnerable sectors of society. The current study therefore develops an integrated conceptual framework to investigate how consumers' fear of mortality and the perceived risk of severe illness associated with COVID-19 act as critical determinants of consumer food choices and perceived well-being.

Design/methodology/approach

An online survey was utilized to collect data from a sample of 407 adult, low-income consumers across Trinidad and Tobago. The PROCESS macro was used to empirically test the hypothesized relationships in a moderated mediation model.

Findings

The results confirm that an increase in the perceived risk of severe illness has a significant negative effect on the consumption of healthy foods and perceived well-being. Moreover, consumers' choice of healthy foods mediates the negative relationship between consumers' perceived risk of severe COVID-19 illness and subjective well-being. Finally, the negative relationship between perceived risk of illness and healthy food choice weakens as an individual's fear of pandemic-related mortality increases.

Originality/value

This research integrates multiple related theoretical constructs to provide a more nuanced understanding of the lingering impact that risk perceptions and fear have on consumer food choices and associated well-being among a vulnerable Caribbean population. The changes identified have important implications for researchers interested in consumer food preferences as well as policymakers seeking to promote a healthy lifestyle among individuals coping with psychologically stressful circumstances.

Details

British Food Journal, vol. 126 no. 4
Type: Research Article
ISSN: 0007-070X

Keywords

Abstract

Details

Understanding Intercultural Interaction: An Analysis of Key Concepts, 2nd Edition
Type: Book
ISBN: 978-1-83753-438-8

Article
Publication date: 27 February 2024

Zhiyu Dong, Ruize Qin, Ping Zou, Xin Yao, Peng Cui, Fan Zhang and Yizhou Yang

The occupational health risk associated with the production of prefabricated concrete components is often overlooked. This paper will use a damage assessment and cyclic mitigation…

27

Abstract

Purpose

The occupational health risk associated with the production of prefabricated concrete components is often overlooked. This paper will use a damage assessment and cyclic mitigation (DACM) model to provide individualized exposure risk assessment and corresponding mitigation management measures for workers who are being exposed.

Design/methodology/approach

The DACM model is proposed based on the concept of life cycle assessment (LCA). The model uses Monte-Carlo simulation for uncertainty risk assessment, followed by quantitative damage assessment using disability-adjusted life year (DALY). Lastly, sensitivity analysis is used to identify the parameters with the greatest impact on health risks.

Findings

The results show that the dust concentration is centered around the mean, and the fitting results are close to normal distribution, so the mean value can be used to carry out the calculation of risk. However, calculations using the DACM model revealed that there are still some work areas at risk. DALY damage is most severe in concrete production area. Meanwhile, the inhalation rate (IR), exposure duration (ED), exposure frequency (EF) and average exposure time (AT) showed greater impacts based on the sensitivity analysis.

Originality/value

Based on the comparison, the DACM model can determine that the potential occupational health risk of prefabricated concrete component (PC) factory and the risk is less than that of on-site construction. It synthesizes field research and simulation to form the entire assessment process into a case-base system with the depth of the cycle, which allows the model to be continuously adjusted to reduce the occupational health damage caused by production pollution exposure.

Details

Engineering, Construction and Architectural Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0969-9988

Keywords

Article
Publication date: 3 November 2023

Xubu Ma, Yafan Xiang, Chunxiu Qin, Huigang Liang and Dongsu Liu

With the worldwide open government data (OGD) movement and frequent public health emergencies in recent years, academic research on OGD for public health emergencies has been…

Abstract

Purpose

With the worldwide open government data (OGD) movement and frequent public health emergencies in recent years, academic research on OGD for public health emergencies has been growing. However, it is not fully understood how to promote OGD on public health emergencies. Therefore, this paper aims to explore the factors that influence OGD on public health emergencies.

Design/methodology/approach

The technology–organization–environment framework is applied to explore factors that influence OGD during COVID-19. It is argued that the effects of four key factors – technical capacity, organizational readiness, social attention and top-down pressure – are contingent on the severity of the pandemic. A unique data set was created by combining multiple data sources which include archival government data, a survey of 1,034 Chinese respondents during the COVID-19 outbreak and official COVID-19 reports.

Findings

The data analysis indicates that the four factors positively affect OGD, and pandemic severity strengthens the effects of technical capacity, organizational readiness and social attention on OGD.

Originality/value

This study provides theoretical insights regarding how to improve OGD during public health emergencies, which can guide government efforts in sharing data with the public when dealing with outbreak in the future.

Details

The Electronic Library , vol. 42 no. 1
Type: Research Article
ISSN: 0264-0473

Keywords

Open Access
Article
Publication date: 1 February 2024

Marta Postula, Krzysztof Kluza, Magdalena Zioło and Katarzyna Radecka-Moroz

Environmental degradation resulting from human activities may adversely affect human health in multiple ways. Until now, policies aimed at mitigating environmental problems such…

Abstract

Purpose

Environmental degradation resulting from human activities may adversely affect human health in multiple ways. Until now, policies aimed at mitigating environmental problems such as climate change, environmental pollution and damage to biodiversity have failed to clearly identify and drive the potential benefits of these policies on health. The conducted study assesses and demonstrates how specific environmental policies and instruments influence perceived human health in order to ensure input for a data-driven decision process.

Design/methodology/approach

The study was conducted for the 2004–2020 period in European Union (EU) countries with the use of dynamic panel data modeling. Verification of specific policies' impact on dependent variables allows to indicate this their effectiveness and importance. As a result of the computed dynamic panel data models, it has been confirmed that a number of significant and meaningful relationships between the self-perceived health index and environmental variables can be identified.

Findings

There is a strong positive impact of environmental taxation on the health index, and the strength of this relationship causes effects to be observed in the very short term, even the following year. In addition, the development of renewable energy sources (RES) and the elimination of fossil fuels from the energy mix exert positive, although milder, effects on health. The reduction of ammonia emissions from agriculture and reducing noise pollution are other health-supporting factors that have been shown to be statistically valid. Results allow to identify the most efficient policies in the analyzed area in order to introduce those with the best results or a mix of such measures.

Originality/value

The results of the authors' research clearly indicate the health benefits of measures primarily aimed at improving environmental factors, such as environmental taxes in general. The authors have also discovered an unexpected negative impact of an increase in the share of energy taxes in total taxes on the health index. The presented study opens several possibilities for further investigation, especially in the context of the rapidly changing geopolitical environment and global efforts to respond to environmental and health challenges. The authors believe that the outcome of the authors' study may provide new arguments to policymakers pursuing solutions that are not always easily acceptable by the public.

Details

Central European Management Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2658-0845

Keywords

Article
Publication date: 9 February 2024

Neelesh Kumar Mishra, Poorva Pande Sharma and Shyam Kumar Chaudhary

This paper aims to uncover the key enablers of an agile supply chain in the manufacturing sector amidst disruptions such as pandemics, trade wars and cross-border challenges. The…

Abstract

Purpose

This paper aims to uncover the key enablers of an agile supply chain in the manufacturing sector amidst disruptions such as pandemics, trade wars and cross-border challenges. The study aims to assess the applicability of existing literature to manufacturing and identify additional industry-specific enablers contributing to the field of supply chain management.

Design/methodology/approach

The research methodology is comprehensively described, detailing the utilization of extent literature and semistructured interviews with mid- and top-level executives in a supply chain. The authors ensure the robustness of the data collection process and results interpretation.

Findings

The study identifies six essential dimensions of an agile supply chain: information availability, design robustness, external resource planning, quickness and speed, public policy influencing skills and cash flow management. The study provides valuable insights for industry professionals to develop agile supply chains capable of responding to disruptions in a rapidly changing world.

Research limitations/implications

This study is limited by its focus on the manufacturing sector, and future research may explore the applicability of these findings to other industries. By focusing on these essential dimensions identified in the study, managers can develop strategies to improve the agility and responsiveness of their supply chains. In addition, further research may investigate how these enablers may vary in different regions or contexts.

Practical implications

The COVID-19 pandemic has forced executives to reconsider their sourcing strategies and reduce dependence on suppliers from specific geographies. To ensure business continuity, companies should assess the risk associated with their suppliers and develop a business continuity plan that includes multisourcing their strategic materials. Digital transformation will revolutionize the supply chain industry, allowing for end-to-end visibility, real time insights and seamless integration of business and processes. Companies should also focus on creating a collaborative workforce ecosystem that prioritizes worker health and well-being. Maintaining trust with stakeholders is crucial, and firms must revisit their relationship management strategies. Finally, to maintain business leadership and competitiveness during volatile periods, the product portfolio needs to be diversified and marketing and sales teams must work in tandem with product teams to position new products accordingly.

Social implications

This work contributes substantially to the literature on supply chain agility (SCA) by adding several new factors. The findings result in a more efficient and cost-effective supply chain during a stable situation and high service levels in a volatile situation. A less complex methodology for understanding SCA provides factors with a more straightforward method for identifying well-springs of related drivers. First, the study contributes to reestablish the factors such as quickness, responsiveness, competency, flexibility, proactiveness, collaboration and partnership, customer focus, velocity and speed, visibility, robustness, cost-effectiveness, alertness accessibility to information and decisiveness as applicable factors for SCA. Second, the study suggests a few more factors, such as liquidity management, Vendors’ economic assessment and economic diversity, that are the study’s unique contributions in extending the enablers of SCA. Finally, public policy influencing skills, local administration connects and maintaining capable vendors are the areas that were never considered essential for SCA. These factors have emerged as a vital operational factor during the lockdown, and academicians may consider these factors in the future to assess their applicability.

Originality/value

This study provides new insights for decision-makers looking to enhance the resilience and agility of their supply chains. The identification of unique enablers specific to the manufacturing industry contributes to the existing body of literature on agile supply chains in the face of disruptions.

Details

Journal of Global Operations and Strategic Sourcing, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2398-5364

Keywords

Open Access
Article
Publication date: 5 October 2023

Maria Vincenza Ciasullo, Alexander Douglas, Emilia Romeo and Nicola Capolupo

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are…

Abstract

Purpose

Lean Six Sigma in public and private healthcare organisations has received considerable attention over the last decade. Nevertheless, such process improvement methodologies are not generalizable, and their effective implementation relies on contextual variables. The purpose of this study is to explore the readiness of Italian hospitals for Lean Six Sigma and Quality Performance Improvement (LSS&QPI), with a focus on gender differences.

Design/methodology/approach

A survey comprising 441 healthcare professionals from public and private hospitals was conducted. Multivariate analysis of variance was used to determine the mean scores on the LSS&QPI dimensions based on hospital type, gender and their interaction.

Findings

The results showed that public healthcare professional are more aware of quality performance improvement initiatives than private healthcare professionals. Moreover, gender differences emerged according to the type of hospital, with higher awareness for men than women in public hospitals, whereas for private hospitals the opposite was true.

Research limitations/implications

This study contributes to the Lean Six Sigma literature by focusing on the holistic assessment of LSS&QPI implementation.

Practical implications

This study informs healthcare managers about the revolution within healthcare organisations, especially public ones. Healthcare managers should spend time understanding Lean Six Sigma as a strategic orientation to promote the “lean hospital”, improving processes and fostering patient-centredness.

Originality/value

This is a preliminary study focussing on analysing inter-relationship between perceived importance of soft readiness factors such as gender dynamics as a missing jigsaw in the current literature. In addition, the research advances a holistic assessment of LSS&QPI, which sets it apart from the studies on single initiatives that have been documented to date.

Details

International Journal of Quality & Reliability Management, vol. 41 no. 3
Type: Research Article
ISSN: 0265-671X

Keywords

1 – 10 of over 2000