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Effective strategic analysis of existing and potential services requires a framework which is relevant and understandable to both clinicians and senior managers. Our work with NHS trusts has developed a framework based on analysis of services into four principal service streams ‐ emergency general hospital, non‐emergency general hospital, specialist general hospital and tertiary. Relating service streams to clinical specialties provides a matrix which can provide a basis for an initial analysis of the current and prospective clinical services portfolio, allowing drilling down into the detail and back up to the overall picture. Portfolio effectiveness is assessed by considering overall viability consisting of three interrelated elements ‐ clinical, market and financial viability. The inter‐relationship of service streams, clinical specialties and viability allows the trust board and key clinicians to share insights into the current and potential systemic linkages between these three elements and to develop a vision of future strategic direction.

The purpose of this paper is to describe the Italian state of art of Health Lean Management (HLM) and to analyze the Italian projects that connect this approach with clinical risk management (CRM).

After introducing Italian healthcare system and its main challenges, relevant Italian experiences have been searched investigating regional health plans (RHPs), managerial reports, books, workshops, conference proceedings and hospital web sites. The degree of experience of each Italian region has been first studied. Further, field of applicability, objectives, tools, practices and results of the projects with first signs of HLM and CRM integration have been analyzed.

Although interest in new managerial approaches is spreading in almost all the territory and new managerial solutions are fostered in many RHPs, HLM projects are implemented patchy in Italy. For what regards HLM projects with CRM connections, the Italian context seems aligned with the international one, apart from few features. First indications for the implementation of HLM projects with CRM connections emerged.

Healthcare systems are facing multiple challenges in a context where public funds decrease but quality of care must be guaranteed. Combining different managerial approaches could solve these issues. In this research, for the first time, a map about Italian HLM adoption has been drawn, and Italian HLM projects with CRM connections have been analyzed. The results constitute one of the first contributions useful to develop guidelines for the implementation of projects pursuing efficiency, quality and safety objectives.

To assess the effect of diagnostic testing for coronary artery disease (CAD) on motivation for change, and on lifestyle change for patients with chest pain.

This observational study followed patients with chest pain suggestive of CAD for three years. Constructs of autonomous and controlled motivation for lifestyle change, autonomous orientation, and autonomy support from self‐determination theory were assessed. Self‐reported tobacco use, physical activity, and diet were assessed at baseline and three years later. Physician rating of pre‐ and post‐test probability of CAD were also assessed. CAD diagnosis was established after three years.

Physicians' autonomy‐supportive style and patients' autonomous orientations both predicted greater patient autonomous motivation, which in turn predicted improved diet, more exercise, and marginally less smoking. High probability of CAD also led patients to become more autonomously motivated for lifestyle change.

The observational nature of the study and the self‐report measures of health behaviors preclude causal conclusions from this study. Findings from this study suggest that patient motivation and risk behavior are affected by results of cardiac testing, by physicians' support of autonomy, and by patients' personalities.

Physicians may be effective in motivating behavior change around time of testing for CAD.

The self‐determination theory model for health behavior change accounted for change in patient health risk behavior change around the time of testing for CAD. Physicians and researchers might use these results to design and test interventions for practitioners to effectively motivate behavior change around the time of medical tests.

The purpose of this paper is to explore the demand-side factors that influence the inbound medical tourists’ (MTs) decision to travel abroad for medical treatment/surgery.

The researchers conducted thematic analysis of in-depth interviews in India with 24 foreign MTs’ to generate the themes, identify factors and propose a model with hypothesis for future quantitative survey.

The findings conclude that patients ranked in ascending order less waiting time for surgery, healthcare quality and accreditation, staff/surgeons expertise, healthcare information, hospital facilities and services, patient safety, travel risk, surgical costs and holiday opportunity as important factors that influence the decision to travel abroad for medical treatment/surgery.

Foreign patients from six private hospitals were willing to be interviewed with the permission of the hospital. Due to confidentiality and privacy policy, many hospitals declined interviews with foreign patients.

The findings are generalised in case of foreign patients as MTs and all private hospitals treating foreign patients in India and other global healthcare destinations. Policy implications suggest that private hospitals in developing countries need to provide first-class quality of healthcare as foreign patients look for internationally accredited quality, no waiting time, patient safety, qualified and experienced surgeons, healthcare workers education and experience hospital facilities and post-surgery care with positive healthcare outcomes.

There is little empirical research on the views of inbound MTs, about factors influencing their decision to travel abroad for surgery to India.

This study aims to develop a hierarchical model that uncovers the relationships between challenges confronting Africa's organ transplant supply chain systems.

Eleven challenges (variables) were identified after a comprehensive review of the existing literature. The contextual interactions among these variables were analysed from the perspectives of health-care stakeholders in two sub-Saharan Africa (SSA) countries (Nigeria and Uganda), using Delphi-interpretive structural modelling-cross-impact matrix multiplication applied to classification (MICMAC) techniques.

The findings reveal that weak regulatory frameworks, insufficient information systems and a lack of necessary skills make it challenging for critical actors to perform the tasks effectively. The interaction effects of these challenges weaken organ supply chains and make it less efficient, giving rise to negative externalities such as black markets for donated organs and organ tourism/trafficking.

This paper establishes a solid foundation for a critical topic that could significantly impact human health and life once the government or non-profit ecosystem matures. The MICMAC analysis in this paper provides a methodological approach for future studies wishing to further develop the organ supply chain structural models.

The study provides valuable insights for experts and policymakers on where to prioritise efforts in designing interventions to strengthen organ transplantation supply chains in developing countries.

This study is one of the first to empirically examine the challenges of organ transplant supply chains from an SSA perspective, including theoretically grounded explanations from data collected in two developing countries.

Strong evidence exists that compliance with the treatment regimen is a major problem for many transplant patients. Noncompliance with the treatment regimen is particularly evident among kidney‐transplanted adolescents. Research has not examined the adolescents' experience of living with a kidney transplant. Provides a review of the literature seeking to explain the causes of noncompliance in the population group. Although the studies referred to here provide insights into the situation, many lack reliability and validity because of methodological limitations. They also point to a gap in understanding the condition from the point of view of the adolescent. A more useful approach, therefore, is to use a qualitative research methodology. Such an approach has been shown to be useful in a study of diabetic adolescents, and offers promise for the greater understanding of kidney‐transplanted adolescents and the impact the medical regimen has on them. With improved understanding comes the ability of health practitioners to better meet their needs in terms of improving the quality of their post‐operative lives.

There is a significant body of literature explaining how a free market for kidneys would eliminate both the economic and the medical shortage of kidneys and thus, in addition to supplying sufficient kidneys for those who become needy in the future, remove the entire backlog of 40,000+ patients waiting for a kidney transplant in the United States. This article is an attempt to fathom the financial and market processes that would evolve were a free market for kidneys to be permitted. Issues addressed include the types of institutions that would likely develop, how transactions would be facilitated, and what would happen to the price of kidneys both in the short and long term.

The paper is targeted to health service management teams as an aid to understanding the relationship between investment in process redesign in a clinical laboratory environment and improved quality of service/increased clinical activity.

An audit of the unit's serum screening capability was performed against the standards of the current UK allocation scheme for cadaveric kidneys. Based on findings of this audit the laboratory's serum screening protocol was redesigned involving development of a new testing strategy and introduction of novel methods. A concurrent review of the effects of this initiative in terms of cadaveric kidney offers received/transplant numbers was undertaken and a cost‐benefit analysis made.

An improved eligibility of the patient cohort for cadaveric kidney offers was obtained together with a reduced unexpected positive crossmatch rate. These factors have together contributed to an increase in transplant numbers at the centre. Significant cost benefits have been achieved

The relevance of the findings relating to patient eligibility for available cadaveric grafts is limited to organ‐sharing schemes in which recipient sensitisation is considered as part of the allocation process.

The experience reported demonstrates the necessity of assessing the clinical impact of changes in practice when judgements are being made regarding the costs of laboratory services. In this respect the paper is the first from within this discipline to make this association.

This paper aims to estimate a supply response to monetary incentives to donate organs using a survey based on Adams, Barnett and Kaserman.

The paper uses bootstrap techniques to estimate the characteristics of individuals and their willingness to accept monetary compensation for an organ donation commitment. It uses the estimates to fuel a simulation that examines the relationship between a market‐clearing price and the usability rate. The usability rate is the proportion of deaths that result in tissues that are viable for transplant.

By analyzing the relationship between usability rate and market‐clearing price, the paper identifies three important ranges. When the usability rate is about 5 percent, a donation‐only system (zero price) should clear the market. At a usability rate between 2 and 5 percent, modest monetary incentives can attract a supply response that will clear the market. When the usability rate is less than 2 percent, supply becomes sufficiently inelastic so that even large monetary incentives will not solve the shortage problem.

If the market mechanism were capable of yielding a greater number of organs for transplantation than the current system, then its adoption would save numerous lives and significantly reduce the cost of treating a variety of serious diseases. Also, it is useful in a benefit‐cost analysis framework designed to measure the social value of refinements in the coordination system.

By relating the market‐clearing price of organs to their usability rates, this paper draws attention on the importance of interdisciplinary studies.