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The purpose of this paper is to study how budgetary constraints can have ethical implications on patient treatment options.

By applying a qualitative methodological approach (interviews) and participant observation, this paper studies the behaviour of surgeons in scenarios of financial restriction.

The empirical findings show that despite the conflict between the economy and the leges artis, surgeons maintain the ethical and deontological principles of their profession with fair rules of orientation.

The importance of this study can be realised by its continuity. One of the authors is already implicated on a wider research to investigate the influence of the economic scarcity of resources on general surgeons’ ethical behaviours.

This paper is a contribution to understanding the rules that restrain the activities of surgeons. Politicians sometimes do not have a full understanding of the pressures that the medical profession faces in their day-to-day activities. Currently, with the addition of problems relate to COVID-19, politicians and populations seem to better understand the importance of the Serviço Nacional de Saúde (SNS), This paper hopes that this understanding will be not only a conjectural moment.

In conjunction with the economic recession that began in the first decade of this century, health institutions have long faced budgetary constraints that condition their material and human resources and correspondingly shape the scope of health professional activities. Until now, it has not been studied the impact of economic crises on the ethical behaviour of Portuguese surgeons. Therefore, this research is a first step and a useful contribution to understanding the rules that can restrain (or not) the ethical conduct of these health professionals.

Using financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands.

41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory.

After the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride.

Interviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.

This study explores how a hospital works, which is important for further enhancing hospital performance. Following the introduction of a Hospital Planning Centre (HPC), changes are explored in a hospital in terms of integration (the coordination and alignment of tasks), differentiation (the extent to which tasks are segmented into subsystems), rules, coordination mechanisms and hospital performance.

A case study was conducted examining the hospital’s social network, rules, coordination mechanisms and performance both before and after the introduction of the HPC. All planning and execution tasks for surgery patients were studied using a naturalistic inquiry and mixed-method approach.

After the introduction of the HPC, the overall network structure and coordination mechanisms and coordination mechanisms remained largely the same. Integration and certain rules changed for specific planning tasks. Differentiation based on medical discipline remained. The number of local rules decreased and hospital-wide rules increased, and these remained largely in people’s minds. Coordination mechanisms remained largely unchanged, primarily involving mutual adjustment and standardization of work both before and after the introduction of the HPC. Overall, the hospital’s performance did not change substantially. The findings suggest that integration seems to “emerge” instead of being designed. Hospitals could benefit, we argue, from a more conscious system-wide approach that includes collective learning and information sharing.

This exploratory study provides in-depth insight into how a hospital works, yielding important knowledge for further research and the enhancement of hospital performance.

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.

Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use.

The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method.

Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability.

This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.

The purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway.

The study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way.

Both decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.

Decision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions.

This paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.

The purpose of this paper is to conceptualise our understanding of public value accounting (PVA) by studying the use and usefulness of performance measurements (PM) as a management tool. The authors do this from a perspective in which they address the complexity of various (sometimes conflicting) assessments of performance measurement and management (PMM) by different stakeholders.

An interpretative case study using qualitative methods. The paper is based on 30 interviews conducted in 2018 and 2019 with respondents working with PMM at different levels, such as politicians, officials and health-care professionals. The study context was Region Stockholm (RS) in Sweden and its health-care division.

PMs become an instrumental tool for PMM, which led to output being promoted above outcome. The authors show that there is a conceptual shortcoming in the discussion of PVA, as the effort needed to achieve outcome-based information might exceed the ability of an organisation to deliver it. The authors address the importance of studying the interaction among different stakeholders, including politicians, the public and media, in research on PVA, as well as possible power relationships among stakeholders.

The authors contribute to the growing research on PVA and its call for more empirical research by offering a more nuanced interpretation of PVA activities. The authors do this by studying PMM and the nature of these activities in a public sector organisation from a multiple-stakeholder perspective.

Digital transformation affected modern society influencing how businesses cooperate and produce value. In this context, Artificial Intelligence plays a critical role. This study aims to explore the role of Artificial Intelligence in organisational positioning within the market, influencing firms' competitiveness. In this vein, this research seeks to respond to the following research question: How does AI impact the competitive advantage of healthcare organizations?.

To tackle the research question, an explorative analysis using the case study method to investigate an international healthcare center in Dubai was conducted. Nine semi-structured interviews were conducted with the head and the members of the robotic surgery team in CMC Dubai to thoroughly understand what the components of the robotic approach are and how the arrangement before the introduction of this innovative technique while shedding light on the added value and the advantages of adopting such technique on both patient safety and patient satisfaction. Additionally, archival data and online documentation (e.g. industry reports, newspaper articles and internal documents) were analyzed to obtain data triangulation.

The results highlight three primary outcomes influenced by implementing AI in organizational processes: clinical, financial and technological outcomes. The study will offer interesting non-studied insights about the implementation of Artificial Intelligence tools in the healthcare sector and specifically robotic surgeries, and to which extent this will contribute and represent a competitive advantage. Results will hopefully insert a brick in the wall of the impact of AI tools on the quality and the results of surgical operations while emphasizing the benefits of integrating AI in surgical practice.

This study offers interesting theoretical and practical implications. It opens a new perspective to understand and manage AI tools in service. This research is not without limits providing valuable insights for future research.

Emergency care delivery is a process requiring input from various healthcare professionals within the hospital. To deliver efficient and effective emergency care, professionals must integrate rapidly at multiple interfaces, working across functional, spatial and professional boundaries. Yet, the interdisciplinary nature of emergency care presents a challenge to the optimization of patient flow, as specialization and functional differentiation restrict integration efforts. This study aims to question what boundaries exist at the level of professionals and explores how these boundaries may come to influence integration and operational performance.

To provide a more holistic understanding of the inherent challenges to integration at the level of professionals and in contexts where professionals play a key role in determining operational performance, the authors carried out an in-depth case study at a busy, Level 1 trauma center in The Netherlands. In total, 28 interviews were conducted over an 18-month period.

The authors reveal the existence of structural, relational and cultural barriers between (medical) professionals from different disciplines. The study findings demonstrate how relational and cultural boundaries between professionals interrupt flows and delay service processes.

This study highlights the importance of interpersonal and cultural dynamics for internal integration and operational performance in emergency care processes. The authors unveil how the presence of professional boundaries creates opportunity for conflict and delays at important interfaces within the emergency care process, and can ultimately accumulate, disrupting patient flow and increasing lead times.