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Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

As healthcare continues to become more expensive and complex, considering the voice of the patient in the design and operation of healthcare practices is important. Wound care and rural healthcare scenarios pose additional complexities for providers and patients. This study sought to identify key determinants of patient service quality in wound care.

Patients at the wound care/ostomy clinic (WOC) in a rural hospital were surveyed using the Kano model. The Kano model enables the categorization of quality attributes based on the attributes' contribution to the subject's overall satisfaction (and dissatisfaction). Chi-square goodness-of-fit testing, multinomial analysis and power analysis were then used to determine the Kano categories for each satisfaction-related attribute.

The analyses resulted in 14 one-dimensional attributes and 3 indeterminable attributes. For the one-dimensional attributes, customer satisfaction is directly proportional to the level of performance for that attribute. The one-dimensional attributes included providing correct care on the first, provision of necessary supplies for care, appropriately qualified medical staff and confidence in care provided by medical staff, among others. Understanding the attributes important to the patient drive patient-centered care, which improves positive patient outcomes and recovery. These attributes can then be used by healthcare professionals to design patient-centric processes and services. This research provides a framework for incorporating the voice of the patient into healthcare services.

While the research methodology can be used in other healthcare settings, the findings are not generalizable to other wound care clinics. This research was conducted in one small, rural hospital. In addition, the sample size was small due to the size of the wound clinic; therefore, an analysis of the differences between demographics could not be performed.

Considering the perspectives of rural wound care patients is important, as the patients are an under-served population with unique challenges related to patient care. The research findings detail rural patients' expectations during wound care treatments, which enable the clinic to focus on improving patient satisfaction. This research contributes to understanding the factors that are important to patient satisfaction in wound care. Further, the methodology presented can be applied to other healthcare settings.

While studies exist using the Kano model in healthcare and the literature is sparse in rural healthcare, this is the first case study using the Kano model in wound care to understand patient preferences.

While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators’ perspectives on implementing a transition program for newly graduated nurses.

An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding.

The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation.

This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.

Theory of Constraints (TOC), though a well-established process improvement methodology in manufacturing, is still a novel philosophy for healthcare and an exhaustive review of literature is needed to summarize the key findings of various researchers. Such a review can provide a direction to the researchers and academicians interested in exploring the application of TOC in the healthcare sector. This paper aims to review the existing literature of TOC tools and techniques applied to the healthcare environment, and to investigate motivating factors, benefits and key gaps for identifying directions for future research in the domain of healthcare.

In this paper, different electronic repositories were searched using multiple keywords. The current study identified 36 articles published between January 1999 to mid-2021 to conceptualize and summarize the research questions used in the study. Descriptive analysis along with pictorial representations have been used for better visualization of work.

This paper presents a thorough literature review of TOC in healthcare and identifies the evolution, current trends, tools used, nature of services chosen for application and research gaps and recommends future direction for research. A variety of motivating factors and benefits of TOC in healthcare are identified. Another key finding of this study is that almost all implementations listed in literature reported positive outcomes and substantial improvements in the performance of the healthcare unit chosen for study.

This paper provides valuable insight to researchers, practitioners and policymakers on the potential of TOC to improve quality of services, flow of patients, revenues, process efficiency and cost reduction in different health care settings. A number of findings and suggestions compiled in the paper from literature study can be used for diagnosing, learning and making substantial changes in healthcare. The methodologies used by different researchers were analysed and combined to propose a generic step by step procedure to apply TOC. This methodology will guide the practising managers about the appropriate tools of TOC for their specific need.

Good health is always the first desire of all men and women around the globe. The global aim of healthcare is to quickly cure more patients and ensure healthier population both today and in future. This article will work as a foundation for future applications of TOC in healthcare and guide upcoming applications in the booming healthcare sector. The paper will help the healthcare managers in serving a greater number of patients with limited available resources.

This paper provides original collaborative work compiled by the authors. Since no comprehensive systematic review of TOC in healthcare has been reported earlier, this study would be a valuable asset for researchers in this field. A model has been presented that links various benefits with one another and clarifies the need to focus on process improvement which naturally results in these benefits. Similarly, a model has been presented to guide the users in implementation of TOC in healthcare.

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.

This study aims to explore the empirical correlation between patient flow issues, quality of green health services and patient satisfaction in specialist medical department factors from patients’ perspectives as service consumers.

This research is a type of nonintervention empirical research that uses an open survey to explore the views and experiences of users of specialist medical department services. The targeted population is hospital patients included in the top five national PERSI (Indonesian Hospital Association) Award 2022 Green Hospital Category, with a total number of respondents of 572 people. This study uses the partial least square-structural equation modeling analysis method with the SmartPLS application.

Patient flow problems generally affect the quality of eco-friendly health services, except for the waiting time problem, which affects service quality. It should be understood as a top priority for patients to receive services from medical specialists without risking time as a core service aspect from the patient’s perspective. In addition, all variables in eco-friendly hospital services affect patient satisfaction, except in the case of visits to specialist medical departments, which do not affect medical support services and hospital practices that are responsive to the delivery of care services resulting from medical support services that are inseparable in integrated services as well as health care following medical ethics.

This study has a novelty in understanding the implications of green practice in determining patient satisfaction in medical specialist department as the epicenter of hospital services and the main object of assessment for the quality of hospital services.

The purpose of this paper is to emphasize the need for holistic geriatric health care in rural India. Many older people in Indian villages suffer from chronic ailments without any relief or intervention because of inaccessible and unaffordable health-care services. This paper explores how holistic health care can be assured for older people in Indian villages.

This paper is based on reflections of the authors who have had experiences as caregivers to older persons within their respective families rooted in the Indian villages. Besides, they interacted with 30 older persons (18 males and 12 females in the age group of 60–80 years) living in the villages in three states of India, namely, Haryana, Rajasthan and Madhya Pradesh to develop a comprehensive viewpoint on the need of geriatric health care in rural India. Relevant reports, newspaper articles and research papers were also reviewed while developing viewpoints on such an important topic.

Geriatric health-care facilities in rural India are abysmal. The older people in the villages cannot leverage health-care facilities that are generally inaccessible, inadequate and unaffordable. Even the government support for medical treatment is minuscule. Furthermore, there is lack of trained health-care professionals at all levels, namely, doctors, nurses and paramedic personnel. Training opportunities in geriatrics are also negligible. The scenario vis-à-vis geriatric health care in rural India can be upturned by increasing public spending on health-care infrastructure, increasing numbers of health-care professionals and expanding training programmes in geriatrics.

This paper is based on the critical reflections of the authors as well as their informal interactions with some of the older people in the Indian villages.

During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs.

We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC.

We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals’ commitment; (2) information technology and the controller’s technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance.

The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.

This study aims to investigate the influence of cognitive and affective trust on the revisit intention of medical tourists to a developing country like India, focusing on the role of country image as a moderator.

This study used partial least square-based structural equation modelling to test the hypotheses using data from 297 medical tourists visiting India from abroad for treatment.

The findings of this study confirmed that all the dimensions of cognitive trust, namely, perceived expertise, performance and reputation of the health-care service providers, have a positive and significant impact on the revisit intention of medical tourists to India. In contrast, none of the two dimensions of affective trust have a significant effect on the revisit intention of medical tourists to India. This study also confirmed that country image significantly moderates the relationship between performance dimensions of cognitive trust and medical tourists’ revisit intention to India.

The study’s findings have significant theoretical and managerial implications as they explore the effect of cognitive and affective trust on medical tourists’ the revisit intention to visit an emerging economy, considering the country’s image as a moderator.

本研究旨在调查认知和情感信任对印度等发展中国家医疗游客重游意愿的影响, 重点关注国家形象的调节作用。

本研究采用基于偏最小二乘的结构方程模型, 使用 297 名从国外到印度接受治疗的医疗游客的数据来检验假设。

本研究的结果证实, 认知信任的所有维度, 即医疗服务提供者的专业知识、绩效和声誉, 对印度医疗游客的重游意愿产生积极且显着的影响。相比之下, 情感信任的两个维度都没有对印度医疗游客的重游意愿产生显着影响。这项研究还证实, 国家形象显着调节认知信任绩效维度与医疗游客重访印度意愿之间的关系。

该研究的结果具有重要的理论和管理意义, 因为他们探讨了认知和情感信任对医疗游客重访新兴经济体的意愿的影响, 并考虑到该国作为调节者的形象。

Este estudio tiene como objetivo investigar la influencia de la confianza cognitiva y afectiva en la intención de volver a visitar a un país en desarrollo como la India por parte de turistas médicos, centrándose en el papel de la imagen del país como moderador.

Este estudio empleó un modelo de ecuaciones estructurales parcial basado en mínimos cuadrados para probar las hipótesis utilizando datos de 297 turistas médicos que visitaron la India desde el extranjero para recibir tratamiento.

Los hallazgos de este estudio confirmaron que todas las dimensiones de la confianza cognitiva, es decir, la experiencia percibida, el desempeño y la reputación de los proveedores de servicios de atención médica, tienen un impacto positivo y significativo en la intención de volver a visitar a la India por parte de los turistas médicos. Por el contrario, ninguna de las dos dimensiones de la confianza afectiva tiene un efecto significativo en la intención de volver a visitar la India por parte de los turistas médicos. Este estudio también confirmó que la imagen del país modera significativamente la relación entre las dimensiones de desempeño de la confianza cognitiva y la intención de los turistas médicos de volver a visitar la India.

Los hallazgos del estudio tienen importantes implicaciones teóricas y administrativas, ya que exploran el efecto de la confianza cognitiva y afectiva en la intención de los turistas médicos de visitar una economía emergente, considerando la imagen del país como moderador.

This study aims to explore factors that affect gendered consumption (male and female), willingness to pay (economic attributes) and the socio-cultural context of Gen-Z consumers towards specialty coffee as compared to other types in Taiwan.

Samoggia and Riedel’s (2018) theoretical framework is adopted to examine the concepts of interest. A mixed method approach comprising interviews and experimental taste tests was used to collect data from Gen-Z specialty coffee consumers in a purposive sampling manner.

The findings suggested the effect of price elasticity of demand where specialty coffee was perceived as an expensive commodity by young consumers, and hence, not a regularly purchased item. Nevertheless, specialty coffee was linked to health benefits, and a signal for conspicuous consumption – where café experiences facilitated self-promotion on sites like Instagram and Facebook. Finally, the findings alluded to a potential gender effect, with more female young consumers likely to consume specialty coffee as compared to their male counterparts.

This study is located within the context of Taiwan, which has been a tea-dominated consumption landscape for numerous decades. The use of an experimental design also presents a unique angle to elucidate sensory elements surrounding specialty coffee as a research design for Gen-Z research projects. The study points to the relevance of social context in the consumers’ behavioural patterns, which has been largely implicit within consumer behaviour scholarship.