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This study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.

A cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.

A systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.

This study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.

In their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.

This is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.

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.

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.

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.

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

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.

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.

Lean distributed manufacturing (LDM) is being considered as an enabler of achieving sustainability and resilience in manufacturing and supply chain operations. The purpose of this paper is to enhance the understanding of how LDM characteristics affect the resilience of manufacturing companies by drawing upon the experience of food manufacturing companies operating in the UK.

The paper develops a conceptual model to analyse the impact of LDM on the operational resilience of food manufacturing companies. A triangulation research methodology (secondary data analysis, field observations and structured interviews) is used in this study. In a first step, LDM enablers and resilience elements are identified from literature. In a second step, empirical evidence is collected from six food sub-sectors aimed at identifying LDM enablers being practised in companies.

The analysis reveals that LDM enablers can improve the resilience capabilities of manufacturing companies at different stages of resilience action cycle, whereas the application status of different LDM enablers varies in food manufacturing companies. The findings include the development of a conceptual model (based on literature) and a relationship matrix between LDM enablers and resilience elements.

The developed relationship matrix is helpful for food manufacturing companies to assess their resilience capability in terms of LDM characteristics and then formulate action plans to incorporate relevant LDM enablers to enhance operational resilience.

Based on the literature review, no studies exist that investigate the effects of LDM on factory’s resilience, despite many research studies suggesting distributed manufacturing as an enabler of sustainability and resilience.

This paper aims to investigate simultaneously the causality and the dynamic links between exchange rates and stock market indices. It attempts to identify the short- and long-term effect of the US dollar on major stock market indices of Brazil, Russia, India, China and South-Africa (BRICS) nations.

This paper applies a new methodology combining the panel generalized method of moments model and the panel auto-regressive distributed lag (ARDL) method to investigate the existence of a causal short-/long-run relationships and dynamic dependence among all stock market returns and exchanges rates changes of BRICS countries.

Results show that exchange rate changes have a significant effect on the past and the current volatility of the BRICS stock indices. Besides, ARDL estimations reveal that exchange rate movements have a significant effect on short- and long-term stocks market indices of all BRICS countries

The findings have implications for policymakers and market participants who try to manage the exchange rate will have a different dose of intervention if they know that the effects of currency depreciation are different than appreciation. These results have important implications that investors should take into account in frequency-varying exchange rates and stock returns and regulators should consider developing sound policy measures to prevent financial risk.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

Open access (OA) is often considered as particularly beneficial to researchers in the global south. However, research into awareness of and attitudes to OA has been largely dominated by voices from the global north. A survey was conducted of 507 researchers from the developing world and connected to INASP's AuthorAID project to ascertain experiences and attitudes to OA publishing. The survey revealed problems for the researchers in gaining access to research literature in the first place. There was a very positive attitude to OA research and OA journals, but when selecting a journal in which to publish, OA was seen as a much less important criterion than factors relating to international reputation. Overall, a majority of respondents had published in an OA journal and most of these had paid an article processing charge. Knowledge and use of self-archiving via repositories varied, and only around 20% had deposited their research in an institutional repository. The study also examined attitudes to copyright, revealing most respondents had heard of Creative Commons licences and were positive about the sharing of research for educational use and dissemination, but there was unease about research being used for commercial purposes. Respondents revealed a surprisingly positive stance towards openly sharing research data, although many revealed that they would need further guidance on how to do so. The survey also revealed that the majority had received emails from so called “predatory” publishers and that a small minority had published in them.

This study aims to examine the influence of service quality, satisfaction, trust, value and commitment on hotel customers’ attitudinal and behavioural loyalty.

The purpose of this paper is to determine the role of service quality (SQ), trust and commitment to customer loyalty (CL) for telecom service users. Further, the moderating role of gender, marital status and connection type within the model was tested.

A measurement model was created based on valid 615 responses from Indian TSUs for SQ, trust, commitment and loyalty with the help of partial least squares structural equation modeling (PLS-SEM). Multi-group analysis (MGA) was conducted to understand the moderating effect of marital status, gender and connection type within the model.

The results suggest that, out of five dimensions of SQ, only responsiveness, assurance and empathy have a significant positive relationship with both commitment and trust. Tangibility has a significant positive relationship with trust only. Both commitment and trust have a significant impact on loyalty. It was noticed that both commitment and trust act as mediators between three SQ dimensions (assurance, empathy and responsiveness) and CL. MGA revealed that empathy and responsiveness positively induce trust in telecom users who are single. Whereas, assurance increases commitment toward telecom service providers in married users. Assurance and empathy significantly contribute toward commitment and trust, respectively, in male users as compared to females. Empathy was found important for postpaid users for trust-building, whereas trust was found to be more important for prepaid users to stay loyal to the service provider.

This article contributes toward understanding the role of SQ, trust and commitment to CL moderated by marital status, gender and connection type in an integrated model concerning telecom service.

This study aims to examine the impact of the gameful experience on behavioural outcomes. Drawing from stimulus–organism–response theory, it proposes and tests a new model that investigates the relationship between the gameful experience, brand loyalty and intention to use gamified branded applications in the sports context. In addition, it explores the mediating role of customer–brand engagement (CBE) and the moderating role of self-image congruity (SIC).

A sample of 436 active users of sport-related branded gamified applications was used to test the model. Data was collected from online sports forums, brands’ Facebook communities and during sporting events.

Results indicate that the gameful experience positively and directly impacts behavioural intentions but does not directly influence brand loyalty. This relationship becomes partially significant when mediated by CBE. In addition, results show that users with high levels of SIC are more likely to continue using the gamified application, whereas users with low levels are more likely to engage with the brand.

This study expands the gamification literature in the sports sector by revealing the importance of the gameful experience in driving loyalty, behavioural intentions and CBE. It proposes a new model that sheds light on the emotional aspect of the interaction between a user and a gamified system and the importance of exploring the effects of moderators, such as SIC, in these relationships.

Gamification is a tool with great potential to motivate individuals to increase their physical activity. That is why sport apps for mobile devices, such as Nike+ or Strava, have integrated game elements. There is, however, little evidence of gamification's effectiveness in this field. Therefore, the aim of the present study is to analyze the impact of game elements included in gamified sports' apps on the satisfaction of basic psychological needs (i.e. competence, autonomy and relatedness). Similarly, the research analyzes the impact of these needs on autonomous motivation.

To achieve these goals, data were collected from users of gamified sport apps, using an online questionnaire. The data were analyzed using partial least squares structural equation modeling.

The results showed that interaction in the app with achievement-related game elements satisfied the needs for competence, autonomy and relatedness; social-related elements satisfied the need for relatedness; and immersion-related elements satisfied the needs for competence and autonomy. Similarly, satisfaction of the needs for autonomy and relatedness while using the app is crucial to experience autonomous motivation.

The findings of this study provide guidelines for practitioners and app developers.

Based on self-determination theory, the paper provides new insights into the relationship between game elements included in sport apps and individuals' basic psychological needs and motivation.

遊戲化在推動人們增加其體力活動方面是有極大潛能的。因此，設於流動通訊設施的運動應用程式如耐克(Nike)及Strava等都結合了遊戲的元素。唯遊戲化在這領域的功效方面的證明並不多。因此，本研究的目的，在於分析遊戲化運動應用程式內的遊戲元素，對滿足基本心理需要的影響 (即是說，能力水平、自主及關聯性)。同樣地，本研究分析這些需要對自主積極性的影響。

要達到這些目標，數據以一項網上問卷調查方法取自遊戲化運動應用程式的使用者。數據並以偏最小二乘結構方程模型進行分析。

研究結果顯示、在帶有成就相關的遊戲元素的應用程式內的互動滿足了能力水平、自主和關聯性的需要; 與社交有關的元素滿足了關聯性的需要，而與沉浸相關的元素則滿足了能力水平和自主的需要。同樣地，使用應用程式時，要能體驗自主動機、關鍵在於自主及相關性的需要得到滿足。

本研究結果為執業者及應用程式開發商提供了指引。

以自決理論為基礎，本研究為運動應用程式包含的遊戲元素與個人的基本心理需要和動機之間的關係提供新的見解。