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Older patients are at high risk of hospital readmission, which has led to an increasing number of screening and intervention programs. Knowledge on implementing screening tools for preventing readmissions in emergency department (ED), where the primary focus is often the present-day flow of patients, is scant. The purpose of this paper is to explore whether a new screening tool for predicting readmissions and functional decline in medical patients>65 years of age could be implemented and its influence on cross-continuum collaborations between the primary and secondary sectors.

The study took place in an ED in Denmark, in collaboration with the surrounding municipalities. An evaluation workshop with nurses and leaders from the ED and the surrounding municipalities took place with the aim of investigating the organizational changes that occurred in daily practice after the implementation of the screening tool. The workshop was designed and analyzed using cultural historical activity theory (CHAT).

The results showed that it was possible to develop collaboration between the two sectors during the test period. However, the screening tool created different transformations for the municipality employees and in the ED. The contradictions indicated that the screening tool did not mediate a general and sustained transformation in the cross-continuum collaboration.

Screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context and sectors. CHAT offers a perspective to understand the collective object when working with organizational transformations and implementation.

The study have shown that screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context. This is called adaption process. This adaption requires time and resources that should be taken into consideration from the beginning of introduction of new screens.

This paper contributes with knowledge about CHAT which offers a way to understand the leading collective object when working with organizational transformations and implementation. CHAT focuses not only on the structural changes but also on the cultural aspects of organizational changes, which is important if we want to reach a sustained change and implement the new screening tool in different sectors.

The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.

A qualitative instrumental collective case study design was used. Data were gathered using qualitative interviews (n = 36) and observations (n = 46) in three English acute hospital trusts. Normalisation process theory provided the theoretical lens and informed data collection and analysis.

While each organisation faced the same translational problem, there was variation between settings regarding adoption and implementation. Successful change was dependent on participants' ability to manage and shape contexts and the work this involved was reliant on individual capacity to create a new, receptive context for change. Managing contexts to facilitate the move from research into clinical practice was a complex interactive and iterative process.

The paper advocates a move away from contextual factors influencing change and adoption, to contextual patterns and processes that accommodate different elements of whole systems and the work required to manage and shape them.

The paper addresses important and timely issues of change in healthcare, particularly for new regulatory and service-oriented processes and practices. Insights and explanations of variations in implementation are revealed which could contribute to conceptual generalisation of context and implementation.

This study aims to elucidate the health care organization, management and policy barriers and facilitators associated with implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain.

Seven focus groups were conducted with 49 health professionals from six primary care centers participating in the Prescribing Healthy Life program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management and policy.

The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow and (3) available resources to carry out the program. Specific barriers in these areas related to lack of financial and political support, consultation time constraints and difficulty managing competing day-to-day demands. Other barriers and facilitators were related to the constructs networks and communication, culture, relative priority and leadership engagement. A set of six specific barrier-facilitator pairs emerged.

Implementation science and, specifically, the CFIR constructs were used as a guide. Barriers and facilitators related to the implementation of a health promotion program in primary care were identified. Healthcare managers and policy makers can modify these factors to foster a more propitious implementation environment. These factors should be appropriately monitored, both in pre-implementation phases and during the implementation process, in order to ensure effective integration of health promotion into the primary care setting.

The imperative to conserve resources and minimize operational expenses has spurred a notable increase in the adoption of lean manufacturing within the context of the circular economy across diverse industries in recent years. However, a notable gap exists in the research landscape, particularly concerning the implementation of lean practices within the pharmaceutical industry to enhance circular economy performance. Addressing this void, this study endeavors to identify and prioritize the pivotal drivers influencing lean manufacturing within the pharmaceutical sector.

The outcome of this rigorous examination highlights that “Continuous Monitoring Process for Sustainable Lean Implementation,” “Management Involvement for Sustainable Implementation” and “Training and Education” emerge as the most consequential drivers. These factors are deemed crucial for augmenting circular economy performance, underscoring the significance of management engagement, training initiatives and a continuous monitoring process in fostering a closed-loop practice within the pharmaceutical industry.

The findings contribute valuable insights for decision-makers aiming to adopt lean practices within a circular economy framework. Specifically, by streamlining the process of developing a robust action plan tailored to the unique needs of the pharmaceutical sector, our study provides actionable guidance for enhancing overall sustainability in the manufacturing processes.

This study represents one of the initial efforts to systematically identify and assess the drivers to LM implementation within the pharmaceutical industry, contributing to the emerging body of knowledge in this area.

Existing research evidence shows a fragmented understanding of the roles of first-line employees (FLEs) as essential factors for successful lean implementation in small- and medium-sized enterprises (SMEs), provoking recent calls for additional research on the identification of enablers and barriers for lean acceptance among workers. Therefore, this paper aims to identify related enablers and barriers to lean implementation among FLEs and determine future research avenues for improving the understanding of lean methodology implementation in SMEs.

Relying on a systematic literature review methodology, the authors aimed to synthesize and evaluate available peer-reviewed papers on the role of FLEs in lean implementation in SMEs. General descriptive and thematic analysis comprehensively depicted the selected research topic and identified the main themes within collected papers and potential future research questions.

The authors identified four main themes related to FLEs’ role in lean implementation: cultural change factors, employee characteristics, management involvement and lean job design. Within each theme, the authors present a comprehensive overview of FLE-related factors and associated enablers and barriers that should be considered for a successful lean implementation in SMEs.

The research outcomes are important to practicing managers in SMEs, helping them facilitate lean acceptance and enhance the likelihood of successful lean implementation.

The insights from this study present building blocks in developing a lean implementation model for SMEs that considers the FLEs’ role more comprehensively.

Building on the routine dynamics literature, this paper aims to expand our philosophical, practical and infrastructural understanding of implementing lean production. The authors provide a process view on the interplay between lean operating routines and continuous improvement (CI) routines and the roles of different actors in initiating and establishing these routines.

Using data from interviews, observations and document analysis, retrospective comparative analyses of three embedded case studies on lean implementations provide a process understanding of enacting and patterning lean operating and CI routines in manufacturing SMEs.

Incorporating the “who” and “how” next to the “what” of practices and routines helps explain that rather than being implemented in isolation or even in conjunction with each other, sustainable lean practices and routines come about through team leader and employee enactment of the CI practices and routines. Neglecting these patterns aligned with unsustainable implementations.

The proposed process model provides a valuable way to integrate variance and process streams of literature to better understand lean production implementations.

The process model helps manufacturing managers, policy makers, consultants and educators to reconsider their approach to implementing lean production or teaching how to do so.

Nuancing the existing lean implementation literature, the proposed process model shows that CI routines do not stem from implementing lean operating routines. Rather, the model highlights the importance of active engagement of actors at multiple organizational levels and strong connections between and across levels to change routines and work practices for implementing lean production.

Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation.

A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases.

Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases.

This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS).

To analyse these multi-level dynamics, the authors blend Rogers’ diffusion of innovations theory (DoIT) with Webster’s sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts.

Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application – in particular speed, ease of use, reliability and flexibility and levels of readiness – were highly relevant but their influence was modulated through interaction with complex structural and relational issues.

Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of “co-construction” between designers and end-users.

The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

This study aims to analyze how the interplay between hard and soft elements of total quality management (TQM) produces the conditions for sustaining success in the quest for quality.

A qualitative analysis (Gioia method) was carried out on an original dataset collected through both direct and indirect methods (i.e. archival sources, interviews and observations) to generate a new interpretive framework.

The interpretative framework identifies four categories of elements: trigger elements create the starting conditions for a quality virtuous cycle; benchmarking tools set the standards of performance; improvement tools enable exploration of the space of possible alternative practices and finally, catalytic forces allow the institutionalization of effective techniques discovered in this search process into new standards.

The findings the authors present in this paper are derived by a single case study, limiting the generalizability of our results in other settings.

This study has three implications: first, the design of trigger elements is critical for the success of any TQM initiative; second, the interplay of improvement and benchmarking tools at several levels should be coherent and third, to exploit the potential of TQM, efforts should be devoted to the dissemination of new effective practices by means of catalyzing elements.

The model provides a more specific understanding of the nature and purpose of the hard and soft elements of TQM and the dynamic interaction between the two classes of elements over time.

To improve the academic integrity of online examinations, digital proctoring systems have recently been implemented in higher education institutions (HEIs). The paper aims to understand how digital proctoring has been practised in higher education (HE) and proposes future research directions for studying digital proctoring in HE.

A systematic literature review was conducted. The PRISMA procedure was adapted for the literature search. The topics were identified by topic modelling techniques from 154 relevant publications in seven databases.

Seven widely discussed topics in literature were identified, including solutions for detecting cheating and student authentication, challenges/issues of uptakes and students' performance in different proctoring environments.

This paper provides insights for academics, policymakers, practitioners and students to understand the implementation of digital proctoring in academia, its adoption by HEIs, impacts on students' and educators' performance and the rapid increase in its use for digital exams in HEIs, with particular emphasis on the impacts of the systems on digitalising examinations in HE.

This review paper has systematically and critically described the state-of-the-art literature on digital proctoring in HE and provides useful insights and implications for future research on digital proctoring, and how academic integrity in online examinations can be enhanced, along with digitalising HE.