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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.

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.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

The recent increase in the number of infections and mortality rates in many regions has emphasized the cyclical nature of this pandemic, with new variants emerging constantly. Understanding what has been done by efficient administrations to contain the outbreak is essential while new immunization developments for the new variants are not available.

This work adapts the traditional Banker, Charnes and Cooper (BCC) Variable Returns to Scale model for including panel data on the Brazilian Federal Government spending over the first pandemic months in Pernambuco to identify efficient municipalities and conduct a benchmark on the best practices, reactions and implications that can serve as a guide for the post-Covid recurrence era.

The results provide an interesting panorama of municipal response to the pandemic and some quantitative and qualitative prospects on potentials for improvements from the perspective of efficient and inefficient cities. Only one administration (São Bento do Una) was identified as efficient for the entire period. The authors’ benchmark and discussion are focused on this municipality.

The authors believe this work has two innovative components. The first is a robust and systematic methodology integrating the advances in testing convexity and returns to scale in the construction of a production frontier based on panel data. The second is a discussion on what drives efficiency (benchmarking of best practices) in addition to how to quantitatively attain such efficiency prospects. To the best of the authors’ knowledge, both methodological and empirical implications are original to the present manuscript.

This study aims to benchmark the operational efficiency of fifty-eight public hospitals across Mexico between 2015 and 2018 and identifies the most critical inputs affecting their efficiency. In doing so, the study analyzes the impact of policy changes in the Mexican healthcare system introduced in recent years.

To measure the operational efficiency of Mexican public hospitals, data envelopment analysis (DEA) window analysis variable returns to scale (VRS) methodology using longitudinal data collected from the National Institute for Transparency and Access to Information (IFAI). Hospital groups are developed and compared using a categorization approach according to their average and most recent efficiency.

Results show that most of the hospitals in the study fall in the moving ahead category. The hospitals in the losing momentum or falling behind categories are mostly large units. Hospitals with initially low efficiency scores have either increased their efficiency or at least maintained a steady improvement. Finally, the findings indicate that most hospitals classified as moving ahead focused on a single care area (cancer, orthopedic care, child care and trauma).

This study examined the technical efficiency of the Mexican healthcare system over a four-year period. Contrary to conventional belief, results indicate that most public Mexican hospitals are managed efficiently. However, recent changes in public and economic policies that came into effect in the current administration (2018) will likely have long-lasting effects on the hospitals' operational efficiency, which could impact the results of this study.

To the best of authors’ knowledge, this is the first study that examines the efficiency of the complex Mexican healthcare system using longitudinal data.

Drawing upon the stimulus-organism-response model, this study aims to explore the impact of soft aspects of service quality on revisit intention through the mechanism of perceived empathy.

For the examination of the hypothesized relationships, the study adopts structural equation modelling to analyse the data of 562 respondents (i.e. 281 family members and 281 inpatients).

The empirical results suggest that service quality increased family member empathy perception, which, in turn, improved inpatients’ revisit intentions.

Past studies have focused on the roles of overall service quality. The authors have extended the literature by examining the specific but important aspect of service quality and its effects on emotional response. Importantly, the study explains that the affective reactions of a patient’s family, fastened with perceived empathy, have a central role in influencing the patients’ subsequent reactions. Moreover, the prior studies collected the data either from hospital employees or patients. However, in the present study, the authors used a unique sample (family members as well as patients) to have a deeper understanding. Thus, the study enhances the literature on the stimuli-response (i.e. service quality – revisit intentions) relationship in the context of service marketing in general and health care in specific. Important academic and managerial contributions and recommendations for future research are discussed.

This study aims to explore the intellectual connections of mission statement research to identify the influential domains of source knowledge and emergent areas of research for future studies.

The authors deployed bibliometric methods, namely, citation, co-citation and network analysis. The authors collected data from the Scopus and Web of Science databases and analyzed the connections of the most influential articles.

The authors identified four knowledge domains that informed the mission statements literature: guidance on mission statement development, the value of mission statements, mission statements and organizational issues, mission statement content and communication. And the authors spotted four opportunities for knowledge advancement based on theoretical frameworks, performance measures, content and context.

Practitioners should think beyond the immediate benefits of mission statements, such as performance and legitimacy improvement. Instead, they should focus on long-term benefits, information advantages and democratizing the development phase of mission statements.

Mission statements have attracted scholarly attention over the past 40 years. Despite the formation of a considerable body of knowledge, intellectual connections of mission statement research have been largely neglected. Previous studies had a narrow focus or insufficient coverage of the literature. To the best of the authors’ knowledge, this is the first full-scale bibliometric study on the intellectual connections of the mission statements literature.

This paper aims to examine the perspectives of auditors, regulators and financial report preparers on the effects of key audit matters (KAMs) reporting on audit effort, fees, quality and report transparency.

The authors conducted 21 semi-structured interviews with stakeholders (13 Audit Partners, 5 Chief Financial Officers and 3 regulators) and thematically analysed the interviews. They use the frame of “Paradox of Transparency” to explain the findings.

Auditors perceive that the overall quality control of their audits has improved both in the planning and execution stages, and such improvement can mostly be attributed to the coercive pressures from professional bodies and regulators. Nevertheless, audit fee remains unchanged. Auditors disclose industry generic items and descriptions of KAMs, sometimes masking the real problem areas of the clients. Even after improving the performative audit quality, transparency of audit reporting has not improved. Issues that warrant going concern qualifications or audit report modifications are now reported as KAMs. Hence, KAMs reporting might make the audit report less transparent.

Localised audit environments and institutions affect the transparency of KAMs reporting. Without attention to corporate governance and auditors’ independence issues, paradoxically, performative improvement in audit quality (due to the KAMs reporting requirement) does not enhance the transparency of audit reports.

To the best of the authors’ knowledge, this study is the first to provide field-level evidence in Bangladesh and other developing countries about the perceptions of auditors, financial report preparers and regulators on the effects of KAMs reporting on audit efforts, fees, quality and report transparency.

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.