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Green transformation is more than simply a trend; it is a way of life, a set of habits, a field of knowledge and a dedication to resource conservation. Going green is surely a creative and transformative process for both individuals and organizations. This paper aims to “identify,” “analyse” and “categorise” the readiness factors for green transformation process in health care using total interpretive structural modelling (TISM) and neutrosophic-MICMAC.

To address the study objectives, the study used TISM and neutrosophic-MICMAC analysis. To identify the readiness factors, a literature study was conducted, and the factors were face-validated by the healthcare experts. The factors influence on one another were captured by using a scheduled interview with a closed ended questionnaire. The TISM addressed the identification and analysing of factors and the categorization and ranking the readiness factors is addressed by using neutrosophic-MICMAC analysis.

This study identified 11 green transformation process readiness factors for healthcare organizations. The study states that the key factors or driving factors are awareness of green governance principle, environment leadership and management, green gap analysis, information and communication technology and innovation dynamics.

The factor ranking is sensitive to the respondents’ ratings. The study relied on the past literature and experts’ opinion may result in the subjective biases. The complex nature of healthcare ecosystem challenges to capture all the factors. The study focussed on Indian hospitals.

Study significantly impacts the healthcare practitioners, academicians and policymakers by providing critical insights into the readiness factors required for the healthcare green transformation process. The study offers a better understanding of the crucial or key or driving factors that aid in embracing green and sustainable practices.

Identifying a gap in conceptual and theoretical frameworks for green transformation readiness factors in healthcare organizations and in Indian context. The study addresses this gap by aiming to create a thorough theoretical framework and highlighted by its focus on Indian hospitals.

The fourth industrial revolution and digital transformation have caused paradigm changes in the procedures of goods production and services through disruptive technologies, and they have formed new methods for business models. Health and medicine fields have been under the effect of these technology advancements. The concept of smart hospital is formed according to these technological transformations. The aim of this research, other than explanation of smart hospital components, is to present a model for evaluating a hospital readiness for becoming a smart hospital.

This research is an applied one, and has been carried out in three phases and according to design science research. Based on the previous studies, in the first phase, the components and technologies effecting a smart hospital are recognized. In the second phase, the extracted components are prioritized using type-2 fuzzy analytic hierarchical process based on the opinion of experts; later, the readiness model is designed. In the third phase, the presented model would be tested in a hospital.

The research results showed that the technologies of internet of things, robotics, artificial intelligence, radio-frequency identification as well as augmented and virtual reality had the most prominence in a smart hospital.

The innovation and originality of the forthcoming research is to explain the concept of smart hospital, to rank its components and to provide a model for evaluating the readiness of smart hospital. Contribution of this research in terms of theory explains the concept of smart hospital and in terms of application presents a model for assessing the readiness of smart hospitals.

Facilities management (FM) activities affect citizens’ health and safety, long-term urban environmental sustainability and the relationships between the built and natural environments of cities. This study aims to comprehend the status of smart FM tools application, how they are used to improve the delivery of FM services and the barriers to their implementation.

To investigate the current smart solutions that leverage the quality of FM service, a case study based on the FM practice in Hong Kong was carried out. The case study was conducted in two phases of data acquisition based on a qualitative research methodology. After conducting in-depth interviews to determine the application of smart FM tools in different types of properties and to identify the initiatives and barriers to smart FM tool application, three workshops were conducted to validate the findings and further investigate the influence of FM professionals on smart FM tools application in Hong Kong.

The findings of the case study revealed, firstly, that four types of smart FM tools – user-centric, safety and hygiene, maintenance and sustainability-oriented – are used to assist the delivery of FM services. Secondly, smart FM tools are shown to be useful in assisting FM activities. Thirdly, the existing barriers to smart FM tool application manifest differently in shopping malls, office buildings and residential buildings. Fourthly, smart FM tools are used to address the four attributes of user needs: comfort, health and wellbeing, convenience and information to occupants.

The value of this study lies in its focus on the industry level (FM industry) and the application process of smart FM tools in different types of property, revealing the benefits, initiatives and barriers to their future application. This study provides a comprehensive picture of the current status and elaborates the barriers to smart FM tool application, which will help FM practitioners to make strategic decisions on selecting and developing smart FM tools. Also, this study will facilitate smart FM tool application policy development.

The digitalization of archival management has rapidly developed with the maturation of digital technology. With data's exponential growth, archival resources have transitioned from single modalities, such as text, images, audio and video, to integrated multimodal forms. This paper identifies key trends, gaps and areas of focus in the field. Furthermore, it proposes a theoretical organizational framework based on deep learning to address the challenges of managing archives in the era of big data.

Via a comprehensive systematic literature review, the authors investigate the field of multimodal archive resource organization and the application of deep learning techniques in archive organization. A systematic search and filtering process is conducted to identify relevant articles, which are then summarized, discussed and analyzed to provide a comprehensive understanding of existing literature.

The authors' findings reveal that most research on multimodal archive resources predominantly focuses on aspects related to storage, management and retrieval. Furthermore, the utilization of deep learning techniques in image archive retrieval is increasing, highlighting their potential for enhancing image archive organization practices; however, practical research and implementation remain scarce. The review also underscores gaps in the literature, emphasizing the need for more practical case studies and the application of theoretical concepts in real-world scenarios. In response to these insights, the authors' study proposes an innovative deep learning-based organizational framework. This proposed framework is designed to navigate the complexities inherent in managing multimodal archive resources, representing a significant stride toward more efficient and effective archival practices.

This study comprehensively reviews the existing literature on multimodal archive resources organization. Additionally, a theoretical organizational framework based on deep learning is proposed, offering a novel perspective and solution for further advancements in the field. These insights contribute theoretically and practically, providing valuable knowledge for researchers, practitioners and archivists involved in organizing multimodal archive resources.

This paper aims to investigate how value drivers of internet medical business model affect value creation through a configurational approach. The internet medical business model (IMBM) is such a business model that integrates online and offline medical services with the driving force of internet technologies covering prediagnosis, in-diagnosis and postdiagnosis. The outbreak of COVID-19 and the support of national policies have boosted the development of internet health care. However, there are still many challenges in practice, such as the unclear innovation path, as well as difficulties in landing and profiting. Academic research has not yet provided sufficient theoretical insights. Therefore, to better explain and guide practice, it is urgent to clarify the innovation path and mechanism of value creation for IMBM.

Based on the sample of 58 internet medical firms in China, this paper adopts fuzzy-set qualitative comparative analysis (fsQCA) to explore the configurational effects of IMBM’s value drivers on value creation.

Building on the business model canvas and the characteristics of internet health care, five value drivers of IMBM are identified, namely, functional value proposition, emotional value proposition, user involvement, resource capabilities and connection properties. And the five value drivers form three configurations, which are, respectively, labeled as resource-driven configuration, user-operated configuration and product-combined configuration. From the perspective of the integration of traditional and emerging theories, such as resource-based view, internet economics and value cocreation, each configuration leads to value creation and improves value results with different mechanisms behind it.

First, combined with the business model canvas and the characteristics of internet health care, this paper identifies five value drivers of IMBM, thus improving the relevant research on internet health care. Second, based on the configurational effects, this paper discusses the mechanism behind the configurational effects of IMBM’s value drivers on value creation, thus expanding relevant research on the value creation of business models. Third, applying fsQCA and combining the advantages of qualitative research and quantitative research, this paper adds to the configurations of IMBM’s value drivers that achieve high-value results.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.

A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.

Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.

Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

Organizational change is a key mechanism to ensure the sustainability of healthcare systems. However, healthcare organizations are persistently difficult to change, and literature is riddled with examples of failed change endeavors. In this chapter, we attempt to unravel the underlying causes for failed organizational change. We distinguish three types of change with different levels of depth that require different change approaches. Transformations are the deepest forms of change where beliefs and principles need to be modified to successfully influence routines. Renewals are deep forms of change where principles need to be modified to successfully influence routines. Improvements are shallow forms of change where only modifications at the level of routines are needed. Using deoxyribonucleic acid (DNA) as our metaphor, we propose a theory of “organizational DNA” to understand organizations and these three types of organizational changes. We posit that organizations are made up of a double helix consisting of a so-called “social string,” which contains the “soft” interaction or communication among the organization's members, and a so-called “technical string,” which contains “hard” organizational aspects such as structure and technology. Ladders of organizational nucleotides (i.e., Routines, Principles, and Beliefs) connect this double helix in various combinations. Together, the double helix and accompanying nucleotides make up the DNA of an organization. Without knowledge of the architecture of organizational DNA and whether a change addresses beliefs, principles, and/or routines, we believe that organizational change is constrained and based on luck rather than change management expertise. Following this metaphor, we show that organizational change fails when it attempts to change one part of the DNA (e.g., routines) in a way that renders it incompatible with the connecting components (e.g., principles and beliefs). We discuss how the theory can be applied in practice using an exemplar case.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.