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The purpose of this study is to investigate how two types of drivers, namely, executive compensation and market competition, can affect hospital quality in the USA. Recently, patients, insurers and regulators have increasingly focused on hospital quality. Understanding the interplay of incentives in this industry is important because in 2019, hospital treatment contributed $1.161bn to health-care costs in the USA. This study answers the call for more studies in the so-called “mixed” industry, where ownership differences can affect organizational objectives and operating constraints.

This study explores the roles of hospital executive compensation and industry competition as determinants of health-care quality. Specifically, the study probes the heterogeneity in the factors that influence quality across hospital types in the USA.

Using California hospital data from 2006 through 2020, the findings show that the effects of compensation and competition on hospital quality differ by ownership type. Executive compensation is positively associated with quality in for-profit hospitals but is not associated with that of nonprofit hospitals, suggesting for-profit hospitals are more likely to use higher levels of compensation to attract managers with higher ability, whereas the utility function for nonprofit managers may be multidimensional. Within the nonprofit hospital group, competition is more positively associated with quality for religious nonprofits relative to secular nonprofits, suggesting that competition provides more monitoring for religious hospitals.

Taken together, the findings provide evidence that the drivers of quality vary across hospitals in ways consistent with differences in constraints and objectives across ownership types. The findings are important for regulators seeking to incentivize higher quality. For example, Medicare in the USA has incorporated quality measures into its new hospital reimbursement scheme (value-based purchasing) to incentivize quality. This study proposes that regulators should consider differences across ownership types when evaluating the best ways to incentivize hospital quality.

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.

The importance of consumer experience in service industries, particularly healthcare, is widely acknowledged as it captures the intricacies of quality management. In tandem with the emerging research trends that evaluate service excellence through user experience, this study renders a performance analysis of the dimensions of consumer experience that individually or collectively shape healthcare consumers’ perceptions of service quality.

A cross-sectional study was conducted across 13 mid-tier corporate hospitals to collect data from 438 patients. The data was processed through factor analysis in SPSS to confirm sample adequacy and factor extractability. Further, two independent multi-criteria decision-making (MCDM) tools, Fuzzy Technique for Order Performance by Similarity to Ideal Solution (F-TOPSIS) and Grey Relational Analysis (GRA), were executed to render performance analysis of identified factors.

Using F-TOPSIS, factors such as “information” and “hospital environment” received higher performance ratings, while items related to “communication with doctors” and “humanistic care” received lower rankings. Minor yet anticipated deviations were observed while verifying performance scores using GRA. Nonetheless, both outcomes exhibited a strong correlation coefficient of 97.14%, confirming analytical consistency.

Hitherto, such usages of hybrid MCDM techniques have rarely been executed to convey a clear understanding of consumers’ experiences in healthcare services. Moreover, the findings provide a clear insight into consumers’ key response areas, which can further be translated to maximize consumer gratification, thus assisting healthcare managers in improving service performance and clinical decision-making.

This study examines the relationship between economic policy uncertainty (EPU) and managers' ex ante strategic choice on firms’ fixed and variable costs structure, i.e. cost rigidity and the moderating effect of government contracts and political connections.

Using a sample of 4,162 US firms during 2003–2019 and EPU measure from Baker et al. (2016), the authors examine the association between EPU and cost rigidity using multivariate regression analysis. The authors also examine the moderating effects of government customers and political connections using the subsampling method.

This study finds that increases in EPU leads to higher cost rigidity, suggesting that managers tend to look ahead and make an ex ante commitment to invest more in fixed costs to avoid congestion costs in anticipation of future product demand during EPU. The study also finds that the presence of government customers and political connections moderates the need for adopting greater cost rigidity.

This study measures firms' cost rigidity based on archival data. Future studies could utilize managers' cost structure choices using firms' internal management cost structure forecasts data to measure cost rigidity to examine the relationship between cost rigidity and EPU.

This study demonstrates that managers tend to make a proactive commitment to invest in fixed inputs when facing demand uncertainty from EPU to avoid congestion costs. This study also highlights the value of having government contracts and political connections by demonstrating that managers are less concerned about the congestion costs, hence weakening the impact of EPU on cost rigidity when they have government as major customers and/or political connections.

This study extends the management accounting literature by documenting that cost rigidity is related to EPU and that the relationship between cost rigidity and EPU also depends on whether the firm has government as major customers and/or political connections or not.

Despite increasing public attention and media coverage of the Covid-19 pandemic, little research was conducted on how the crisis affected accountability practices in the not-for-profit sector. This study focusses on international non-governmental organisations (INGOs) that operate in emerging economies worldwide but are registered in England and Wales and examines how their online accountability practices changed after the Covid-19 pandemic. The purpose of this paper is to address these issues.

The authors use the theoretical lens of the situational crisis communication theory (SCCT) and a contingency approach to not-for-profit governance in order to assess how accountability practices have been shaped by the response given by INGOs to preserve their reputation which is argued to be damaged by the COVID-19 pandemic. They use Dumont's (2013) nonprofit virtual accountability index (NPVAI) for statistical analysis. They examine whether the five dimensions of the NPVAI have changed significantly as a policy of response to the Covid-19 pandemic. They also examine the documents used to disclose information on performance, governance and mission to understand if their content was affected by the pandemic.

The authors found two of the NPVAI dimensions: accessibility and engagement to be statistically different compared to before the pandemic. They also examined the documents used to disclose information on performance, governance and mission in order to understand if their content were affected by the pandemic. Their findings suggest that INGOs focussed on keeping their donors' attention and their fund flow rather than informing how they performed and how their governance has changed as a result of the pandemic. No statistically significant change was found regarding the dimensions of performance, governance and mission.

INGOs which focus on humanitarian relief and crises management mainly in emerging economies were also affected by the pandemic. However little attention has been given to how accountability was being shaped by the Covid-19 pandemic. An analysis of how not-for-profit sector accountability practices were affected by the pandemic is, therefore, needed. Due to the nature of the pandemic online accountability practices is an area where research could focus on, until now few studies have been conducted on online accountability. The study contributes methodologically by assessing the applicability of the NPVAI for comparisons across different time periods rather than across different types of organisation at a specific point in time. The authors conclude that the NPVAI must be supplemented by some analysis of the content of key online documents and other material.

The authors’ findings provide important implications for crisis management and its effect on accountability practices in INGOs that operate in emerging economies and the not-for-profit sector in general. The findings suggest that the crisis led to only limited changes in mission and governance as changes in these dimensions tend to occur over the long term. Although they expected the pandemic to lead to more performance information being released, this did not happen. The enhancement of online accountability practice in the engagement and accessibility dimensions shows that INGOs focussed more on maintaining their fund flow rather than on actions to target the pandemic. This is especially apparent as regardless of size the donation and fundraising links have increased throughout the pandemic. Overall, the study provides important findings specific to the effects of the Covid-19 pandemic on online accountability practices in the not-for-profit sector. The study's empirical contribution is to assess how not-for-profit organisations shape their online accountability practices to preserve their reputation and legitimacy.

The authors have expanded the discussion of the paper's contribution to theory, methodology and knowledge about online accountability and crisis management in the conclusion section of the paper. They found that INGOs have reacted to the pandemic by becoming more anxious about their ability to generate funds, and content analysis showed that there was little additional information about how INGOs' performance had been affected by the pandemic, which suggests that INGOs need to pay more attention to how they manage accountability in times of crisis.

The authors construct a conceptual framework using theories that have the potential to explain how external factors such as the Covid-19 pandemic can affect online accountability practices. Their paper also responds to the call for studies of the effectiveness of various accountability mechanisms in NGOs (Unerman and O’ Dwyer, 2006). Unlike previous studies they did not compare various sectors at a single point in time, but rather they assessed the impact of the Covid-19 pandemic and the reaction of INGOs by comparing online disclosures across time. This is a novel use of Dumont's NPVAI and therefore provides an important contribution to the literature.

There is a renewed interest among economists and policymakers in striking a perfect balance between the market, state, and the community for equitable and sustained development. Inclusive development is the need of the hour and healthcare cooperatives provide the perfect means to deliver that. The cooperatives can and should have an important role to play in this scenario. However, there is an important need to provide an enabling environment for the genesis and growth of Healthcare Cooperatives in India and to learn from the best models and practices across the world. The chapter discusses the effectiveness of healthcare cooperatives.

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.

The study identifies the gap in the understanding of how employee resistance to change (RTC) could impact different stages of the process of innovation. To address this research gap, the paper introduces a new model, which theorizes three moderating effects of RTC on the different elements of absorptive capacity (ACAP).

This study empirically tests the proposed model, using survey data collected from healthcare organizations in the United States of America.

First, the study reveals that RTC could damage the critical “connectedness” between potential absorptive capacity (PACAP) and realized absorptive capacity (RACAP), thus limiting the organization's ability to exploit new knowledge. Second, the findings also reveal that RTC can reduce the positive effect of acquisition (ACQ) on assimilation – the function responsible for decoding the meaning and for assimilating new valuable information incoming from the market.

Research limitations of this study are discussed further.

The paper presents specific practical implications for managers.

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This paper advances past research and practice by revealing two new mechanisms. When employees resist new changes initiated in the organizations, the resistance of employees will hinder the process of innovation in the following ways. (1) At the beginning of the process, employees can oppose and reject new valuable ideas incoming from the market. (2) At the stage of the implementation, such employees can engage in behavior that will weaken the organization's ability to successfully implement new process improvements that could otherwise increase organizational effectiveness.

Health Information Exchange (HIE) is essential for the efficient and cost-effective delivery of health-care services. The provider’s administrative structure and external environment can substantially influence adopting technologies involving inter-organizational linkages, such as HIE. Using the theoretical lens of institutional theory, this study aims to compare how public and private hospitals' engagement in HIE is influenced by corruption and government online services or e-government usage.

The study uses the positivist research design of secondary data analysis to test the six hypotheses proposed. Data from multiple third-party reliable sources, including the European Commission and World Bank, are combined into the final dataset consisting of observations from 1,442 hospitals across 30 countries in Europe. A multilevel modeling approach is used to associate country and hospital-level variables and test the hypothesis.

The study finds that, on average, a 10% increase in corruption leads to a 6.3% decrease, while a 10% increase in e-government leads to a 7% increase in the probability of HIE engagement for a hospital. The negative impact of corruption on average is 18% more in public than private hospitals, while the positive impact of e-government is 75% stronger in public in comparison to private hospitals. The study also finds that HIE engagements in health systems with predominantly public hospitals are more sensitive to corruption and e-government.

To the best of the authors’ knowledge, the study is one of the first to use the institutional view to test the influence of government actions and public providers' concentration on HIE engagement. The comparison of public and private institutions enriches our understanding of promoters and inhibitors of HIE.

The main purpose of this study is to investigate Ishikawa’s statement that “95% of problems in processes can be accomplished using the 7 Quality Control (QC) tools” and explore its validity within the health-care sector. The study will analyze the usage of the 7 QC tools in the health-care service sector and the benefits, challenges and critical success factors (CSFs) for the application of the 7 QC tools in this sector.

In order to evaluate Ishikawa’s statement and how valid his statement is for the health-care sector, an online survey instrument was developed, and data collection was performed utilizing a stratified random sampling strategy. The main strata/clusters were formed by health-care professionals working in all aspects of health-care organizations and functions. A total of 168 participants from European health-care facilities responded to the survey.

The main finding of this study is that 62% of respondents were trained in the 7 QC tools. Only 3% of participants in the health-care sector perceived that the seven tools of QC can solve above 90% of quality problems as originally claimed by Dr Ishikawa. Another relevant finding presented in this paper is that Histograms, Cause and Effect diagrams and check sheets are the most used tools in the health-care sector. The least used tools are Stratification and Scatter diagrams. This paper also revealed that the 7 QC tools proposed by Dr Ishikawa were most used in hospital wards and in administration functions. This work also presents a list of CSFs required for the proper application of the 7 QC tools in healthcare.

This research was carried out in European health-care facilities – and there is an opportunity to expand the study across global health-care facilities. There is also an opportunity to study the use of the tools and their impact on hospital performance using the Action Research methodology in a health-care organization.

To the best of the authors’ knowledge, this is the very first research within the health-care sector that focused on investigating the usage of all the 7 basic tools and challenging Dr Ishikawa’s statement: “95% of problems in processes can be accomplished using the 7 Quality Control (QC) tools” from his book “What is Quality Control?” The results of this study represent an important first step toward a full understanding of the applicability of these tools in the health-care sector.