Purpose The aim of this qualitative study is to describe the expectations of occupational health physicians and nurses regarding managerial support in evidence-based practice in occupational health care. Design/methodology/approach Qualitative data were collected from Finnish physicians and nurses working in occupational health services in Finland (n = 126). The data were analysed using inductive content analysis. Findings As a result, three main categories were revealed: (1) knowledge management in occupational health care, (2) management of operative processes in occupational health care and (3) supportive human resource management in occupational health care. Originality/value In conclusion, supporting evidence-based practice in occupational health care requires investment in the development of staff competence. Evidence-based occupational health should be integrated into a culture at an attitudinal and practical level. Clear evidence-based guidelines, uniform processes and compliance with these play a key role. Promoting evidence-based occupational health involves knowledge management, operative process management and supportive human resource management skills.
PURPOSE:This exploratory study examined pet-related barriers to healthcare among emergency department patients and evaluated whether demographic characteristics and pet attachment were associated with these barriers. DESIGN/METHODOLOGY/APPROACH:Current and former pet owners seeking care at the emergency department completed anonymous surveys assessing pet attachment and barriers to healthcare. Barriers were measured using the Pet-Related Barriers to Healthcare (PRBH) index and attachment was measured using the Comfort from Companion Animals Scale (CCAS) and Inclusion of Other in Self (IOS) scale. Associations with PRBH scores were evaluated using linear regression, with ordinal logistic regression for sensitivity analysis. Concordance correlations between the two attachment measures were also examined. FINDINGS:Among 108 participants, 24% reported previously experiencing at least one pet-related barrier to healthcare, and 48% anticipated that pet responsibilities could affect future healthcare access. In multivariable analyses, higher PRBH scores were associated with ages older than 30 years, White race, household income below $75,000, and reported barriers to veterinary care. These factors remained associated with PRBH scores after adjusting for attachment scores. Both attachment measures were associated with PRBH scores. These exploratory findings identify relationships that should be confirmed in larger studies and may inform the future development of targeted interventions. ORIGINALITY/VALUE:This study applies a recently developed measure of pet-related healthcare barriers together with two established attachment measures in an emergency department population, an understudied setting for examining how pet responsibilities may influence healthcare access.
PURPOSE:We examine the topics and the dimensions of patient satisfaction and their implications for Greek public hospitals. DESIGN/METHODOLOGY/APPROACH:We measure patient satisfaction through the sentiment analysis of the relative ratings and commendation submitted to Google reviews for 45 Greek public hospitals. We collect the data submitted over a period of years, that is from 2013 to 2024. FINDINGS:We find that visitors of public hospitals are discouraged and disappointed mainly by the behavior of doctors, nurses and management-managerial staff as well as the building infrastructure and medical equipment that is outdated or absent. We also find a relatively underreport of reviews that denounce instances of informal payments to physicians. However, we find that doctors' scientific capabilities and knowledge significantly contribute to patient satisfaction. Our findings suggest that the Stimulus-Organism-Response (S-O-R) framework, normalization framework and institutional theories that link patient satisfaction with environmental triggers, are relative to the Greek healthcare environment as well. ORIGINALITY/VALUE:Our study is driven by the relatively limited research on sentiment analysis in hospitals and particularly by invites for research on the patients' opinion as to what really is satisfactory healthcare, by contributing a specific country case study to the limited previous research in this area.
PURPOSE:Patient satisfaction is widely recognized as a key indicator of healthcare quality and system responsiveness, particularly in low- and middle-income countries pursuing Universal Health Coverage. In Ghana, despite expanded access through initiatives such as the National Health Insurance Scheme, challenges in service delivery persist. This study examined how administrative processes, clinical interactions and waiting times influence patient satisfaction and perceived quality of care. The findings seek to extend Donabedian's framework by positioning patient satisfaction as a mediating mechanism linking structural and process factors to quality outcomes. The study also examines the implications for interpersonal-centric care theories, suggesting that relational care must be supported by effective administrative and infrastructural systems, and proposes a context-specific, multidimensional model of patient satisfaction for Ghana's health system. DESIGN/METHODOLOGY/APPROACH:A mixed-methods approach was adopted, combining quantitative surveys with qualitative interviews. The study was carried out in both public and private facilities across Ghana's three ecological zones, capturing perspectives from both urban and rural settings. A total of 385 respondents participated, including 245 patients and 140 healthcare workers. Quantitative data were analyzed using multiple linear regression to identify predictors of satisfaction, while qualitative data were analyzed thematically to draw out key insights from patients and providers. FINDINGS:The results showed that the facility environment (ß = 0.553, p < 0.001) and access convenience (ß = 0.400, p < 0.001) were the strongest predictors of patient satisfaction. Waiting time negatively influenced satisfaction (ß = -0.215, p = 0.013), while administrative processes and staff attitudes also had significant effects. Qualitative findings reinforced these results, highlighting themes such as cleanliness, respectful communication, cost transparency and frustrations with delays. Interestingly, technical quality of care was not a significant predictor, pointing to a potential disconnect between professional standards and patient perceptions of quality. RESEARCH LIMITATIONS/IMPLICATIONS:The study was conducted at selected health facilities in Ghana, and although it included diverse facility types (public, private and community-based), the findings may not fully capture the entire heterogeneity of Ghana's healthcare system. Differences across regions, facility levels and socioeconomic contexts could influence perceptions of satisfaction and quality. PRACTICAL IMPLICATIONS:The study highlights key strategies for improving patient satisfaction through targeted service quality improvements. Administrative efficiency emerged as the strongest predictor of satisfaction, underscoring the importance of streamlined workflows, transparent communication and staff training in customer service. Quality of care remains essential, with emphasis on clinical competence, compassionate care, continuous professional development and patient-centered models. Although waiting times showed a modest influence, patient experience during delays can be improved through queue management, triage systems and waiting-area amenities. Gender differences in satisfaction suggest the need for tailored services and feedback mechanisms. Overall, policymakers and managers should prioritize administrative efficiency, quality enhancement, patient experience during waiting periods and inclusive, demographic-responsive strategies. ORIGINALITY/VALUE:This study provides an in-depth, evidence-based understanding of the multiple factors shaping patient satisfaction in Ghana. It emphasizes the need to address both operational inefficiencies and interpersonal care to improve patient experience. The findings contribute to ongoing health sector reforms aimed at strengthening administrative systems, enhancing staff-patient interactions and upgrading healthcare infrastructure, especially in resource-limited settings.
PURPOSE:This study aims to investigate how hospital environmental stimuli influence inpatients' pleasure, trust in physicians and behavioral intentions (revisit and recommendation) in a large public-private partnership (PPP) city hospital in Türkiye. Drawing on the stimulus-organism-response (SOR) framework, the study conceptualizes hospital environmental stimuli as a multidimensional service environment comprising physical, functional and interpersonal cues experienced during hospitalization. The study specifically examines whether these environmental perceptions shape behavioral intentions directly and indirectly through pleasure and trust in physicians. DESIGN/METHODOLOGY/APPROACH:This cross-sectional study was conducted between August 2021 and March 2022 with 404 adult inpatients from the obstetrics and gynecology and physical therapy and rehabilitation units of Ankara Bilkent City Hospital. Relationships among environmental stimuli, pleasure, trust in physicians and behavioral intentions were analyzed. Scale validity and reliability were assessed using exploratory and confirmatory factor analyses, and structural equation modeling tested direct and mediating effects within the SOR framework. FINDINGS:Hospital environmental stimuli advanced technology, safety, ambience, layout and accessibility and physician and/or nurse care had significant direct effects on pleasure, trust in physicians and behavioral intentions. Pleasure and trust partially mediated the relationship between environmental stimuli and behavioral intentions, indicating that emotional and cognitive responses are critical pathways shaping patient behavior. RESEARCH LIMITATIONS/IMPLICATIONS:Several limitations of this study should be acknowledged. First, the sample consisted only of inpatients from the Gynecology and Obstetrics Hospital and the Physical Therapy and Rehabilitation Hospital of Ankara Bilkent City Hospital because survey permission was granted only for these units. Consequently, the findings may not reflect the experiences of patients treated in other departments. Second, purposive sampling was employed, which may have introduced selection bias and limited the representativeness of the sample. Third, the study was conducted in a single city hospital in Türkiye, limiting the generalizability of the findings to other city hospitals, healthcare organizations or different national contexts. PRACTICAL IMPLICATIONS:Given the relatively novel nature of city hospitals, healthcare managers and policymakers need a clearer understanding of how environmental stimuli shape patients' perceptions of service quality, emotional responses, trust in physicians and behavioral intentions. The findings suggest that investments in hospital environments should extend beyond functional infrastructure to include patient-centered design features that enhance comfort, accessibility, safety and overall service experience. By improving these environmental dimensions, hospital administrators can strengthen patients' trust in physicians, increase perceived service quality and encourage favorable behavioral intentions, such as positive word-of-mouth and revisit intentions. These findings provide practical guidance for managers and policymakers seeking to optimize patient experience and improve the effectiveness of large-scale healthcare facilities. ORIGINALITY/VALUE:This study contributes to the literature by testing an established SOR-based framework in the organizationally distinctive context of a PPP city hospital in Türkiye, where evidence on patient experience mechanisms remains limited. Its value lies in demonstrating that hospital environmental stimuli are linked not only to behavioral intentions directly but also indirectly through inpatients' pleasure and trust in physicians, thereby offering an empirically grounded explanation of patient responses in a complex hospital setting.
PURPOSE:Optimizing operating room (OR) utilization is critical for enhancing healthcare delivery and minimizing costs. Poor teamwork and communication are significant barriers to OR efficiency. This study aims to determine the effect of a TeamSTEPPS® mobile-based learning intervention on key OR effectiveness indicators. DESIGN/METHODOLOGY/APPROACH:This study employed a quasi-experimental, pre-test/post-test design to measure the efficiency of ORs before and after an intervention in 2023. The research sample included all ORs and 105 OR staff members from six medical education centers of Iran University of Medical Sciences. The research tool included demographic characteristics and a researcher-made form to determine OR efficiency. To conduct the research, participants received the TeamSTEPPS® training content via links sent through Short Message Service (SMS) over five weekly sessions. Then, the data related to the efficiency of the OR were collected for two months before and two months after the educational intervention from the medical records archive unit. Finally, the data collected before and after the intervention were compared. Statistical analysis was performed using a paired t-test. The significance level was set at 0.05. FINDINGS:The results revealed a statistically significant improvement in the start time of the first surgery(p = 0.05). However, no significant changes were observed in other key indicators, including the rate of surgery cancellation (p = 0.09), case duration accuracy (p = 0.08) or turnover time (p = 0.67). RESEARCH LIMITATIONS/IMPLICATIONS:This study's findings should be interpreted in light of its pragmatic design, which balanced scientific rigor with the logistical and ethical realities of research in active clinical settings. Key limitations inform specific recommendations for future work. The study's participant scope was intentionally restricted to nursing and technical staff to ensure consistent intervention exposure amidst the scheduling complexities of a multidisciplinary team. This focus, however, narrows the generalizability of the findings. Future research should prioritize multidisciplinary inclusion, engaging surgeons, anesthesiologists and administrative staff to foster a shared mental model and assess the collective impact of teamwork training. The intervention employed a passive, text-based modality (SMS link to a PDF) to maximize scalability and minimize clinical disruption. While practical, this approach limited the ability to measure engagement. Subsequent studies should enhance training modalities by using interactive mobile-learning platforms with video, gamification and simulation to deepen learning and monitor outcomes. Methodologically, the quasi-experimental design and short-term follow-up were necessary for feasibility. To strengthen causal inferences and assess long-term impact, future work should adopt more rigorous study designs, such as stepped-wedge trials and implement longitudinal evaluation over extended periods (e.g. 6-18 months). Finally, while the standardized curriculum ensured consistency, a hybrid "core-plus-flex" training model that balances a standard core with locally adapted modules, integrated with organizational support mechanisms, is recommended to enhance relevance and translate learning into systemic improvements. PRACTICAL IMPLICATIONS:This paper aims to enhance the effectiveness of TeamSTEPPS® training, healthcare institutions should actively involve all critical OR personnel - including surgeons and anesthesiologists - in both training and evaluation phases. In-person, simulation-based sessions with real-time feedback may better reinforce team behaviors than mobile-only formats. Embedding training within broader organizational reforms - such as leadership support, performance-based incentives and infrastructure improvements - can drive sustainable change. Hospitals should also tailor training content to their specific cultural and operational contexts to improve staff engagement and program relevance. Finally, implementing long-term follow-up and monitoring mechanisms is essential for measuring true behavioral and operational impacts over time. SOCIAL IMPLICATIONS:Although the TeamSTEPPS® mobile-based training did not yield measurable improvements in OR efficiency, its broader social implications remain significant. Enhancing team communication and collaboration in surgical settings can contribute to safer patient experiences, reduced interpersonal conflicts and improved job satisfaction among healthcare professionals. These outcomes, even if not immediately quantifiable, support a culture of mutual respect and shared responsibility. Promoting inclusive and context-sensitive training interventions can also help reduce hierarchical barriers and empower diverse staff roles, ultimately fostering a more equitable and resilient healthcare environment that benefits both patients and providers in the long term. ORIGINALITY/VALUE:While a focused improvement was noted, this passively delivered, mobile-based training targeting a subset of OR staff did not yield widespread gains in operational effectiveness. The findings suggest that more interactive, inclusive and sustained training approaches may be necessary to achieve a broader impact on the complex dynamics of OR efficiency.
Purpose This viewpoint examines how changing social norms and evolving organisational culture in healthcare, particularly within clinical laboratories and quality management systems, have reshaped conceptions of acceptable practice. Drawing a parallel with cultural reckonings in reality TV, the paper contends that healthcare's progression from “that is how it was done” to “this is how we improve” reflects not simply procedural updating but a deeper cultural transformation. Using the New Zealand (NZ) clinical lab sector as a case study, it explores how structural reform, accreditation systems, workforce change and safety reporting mechanisms have collectively redefined the normative landscape, making a shift from hierarchy to psychological safety and from compliance-driven to value-driven quality approaches. Design/methodology/approach This viewpoint synthesises concepts from organisational sociology, quality improvement literature and healthcare safety research. The discussion integrates theoretical perspectives (e.g. Mannion and Davies on organisational culture, Edmondson on psychological safety and Westrum's safety culture taxonomy) with empirical developments from the NZ context. The case study draws on doctoral research, accreditation history, legislative analysis under the Health Practitioners Competence Assurance (HPCA) Act 2003, workforce studies and Health Quality and Safety Commission documentation. Findings Healthcare organisations experience sustained normative change. Practices once considered routine are increasingly viewed as inconsistent with contemporary expectations of safety and equity. This shift reflects a broader movement from compliance-driven models toward value-driven quality cultures. The NZ lab sector illustrates these dynamics. Structural reform altered governance arrangements; accreditation institutionalised expectations of quality; protected reporting mechanisms supported psychological safety; workforce change introduced new values; and mandatory reporting embedded systematic safety surveillance. Key themes include the centrality of psychological safety for learning, the influence of leadership behaviour in cultural change and the importance of structural interventions that reinforce professional values. Cultural transformation emerges as both a quality imperative and an ethical progression. Research limitations/implications As a conceptual viewpoint, the article synthesises existing literature and policy development rather than presenting primary empirical data. While the NZ case offers a rich illustration, findings may not be directly transferable to systems with different regulatory and funding arrangements. Further research should integrate organisational culture metrics into quality assessment frameworks, examine how cultural variables influence improvement outcomes and explore interactions between structural reform and professional agency over time. Practical implications Sustainable quality improvement requires attention to culture as well as procedure. Creating psychological safety demands intentional leadership behaviours. Accreditation and regulatory bodies should consider cultural indicators alongside compliance measures. Structured reporting mechanisms, generationally responsive workforce strategies and protected quality assurance (QA) activities can strengthen learning environments. The NZ experience suggests that legislative design can embed safety culture institutionally. Social implications Normative evolution in healthcare reflects broader societal shifts in expectations of dignity, safety and accountability. Just as public tolerance for exploitation or humiliation in media has diminished, healthcare systems are increasingly oriented toward transparency, equity and psychological safety. Professional norms do not develop in isolation; they evolve alongside changing social values. Healthcare organisations therefore both respond to and contribute to wider moral progress. Originality/value This viewpoint offers three contributions. First, it introduces a novel parallel between media-based cultural reckoning and normative change in healthcare. Second, it presents an integrated account of structural reform, accreditation development, protected reporting and workforce transformation within the NZ lab sector as a cohesive case study in organisational culture change. Third, it synthesises organisational sociology, safety and quality improvement scholarship to argue that the shift from “that's how it was done” to “this is how we improve” reflects substantive normative evolution within healthcare practice.
PURPOSE:This study investigated how hospital infrastructure and environmental cleanliness influence patient satisfaction through the mediating pathway of patient perception in tertiary healthcare institutions. Drawing upon the Donabedian structure-process-outcome framework, the study examined the structural healthcare quality factors that shape patient perceptions and service evaluations. DESIGN/METHODOLOGY/APPROACH:The data were gathered using cross-sectional survey and by deploying non-probability purpose sampling using a structured questionnaire assessing hospital infrastructure, environmental cleanliness, patient perception and patient satisfaction. A total of 578 valid responses were subjected to exploratory, confirmatory factor analysis to test the structural relationships among the constructs and structural equation modeling (SEM) was used to test the hypotheses. FINDINGS:The findings reveal that hospital infrastructure and environmental cleanliness significantly influence patient perceptions of healthcare service quality. Patient perception in turn positively and significantly predict patient satisfaction. The mediating results reveal that patient perception positively and significantly mediates the relationship between structural service factors and patient outcomes. The findings underscore the fact that physical healthcare environments play a critical role in shaping patient experiences and satisfaction levels. RESEARCH LIMITATIONS/IMPLICATIONS:The study is limited to a single tertiary healthcare institution and cross-sectional survey data. Future research could employ longitudinal designs and multisource data samples to improve generalizability. PRACTICAL IMPLICATIONS:Healthcare administrators should prioritize investments in hospital infrastructure and environmental hygiene as strategic predictors of patient perceptions. Improving structural service quality can strengthen patient trust, enhance satisfaction and contribute to better healthcare service outcomes. SOCIAL IMPLICATIONS:Healthcare policymakers should invest more in hospital infrastructure and environmental hygiene as these ae strategic predictors of patient perceptions. Improving structural service quality can strengthen patient trust, enhance satisfaction and contribute to better healthcare service outcomes. ORIGINALITY/VALUE:The study advances the healthcare quality literature quality literature by empirically integrating environmental healthcare factors with the Donabedian quality framework and demonstrating the mediating role of patient perception in shaping satisfaction outcomes within hospital service environments.
Purpose This study assesses how collaboration between Lebanon's Ministry of Public Health (MoPH), Agence Française de Développement (AFD) and ESA Business School (ESA) strengthened the pharmaceutical regulatory framework during severe crises. It reviews the design and outcomes of reforms in governance, pharmacovigilance and quality assurance; identifies key enabling and limiting factors and draws lessons for other low- and middle-income countries (LMICs). Design/methodology/approach A descriptive-qualitative approach combined a desk review of technical documents, reports, and outputs with triangulated semi-structured interviews involving key institutional actors. Data were thematically analyzed and compared with international literature to generate evidence-based insights. Findings Results show that well-governed partnerships can sustain reform momentum during instability. Sustainability requires costed financial roadmaps, domestic co-financing and value-for-money disciplines to reduce dependence on fluctuating external funding. Long-term capacity building, institutional ownership and adaptive policy design are vital to safeguard regulatory and supply-chain quality. The MoPH–AFD–ESA case demonstrates a triple-helix model aligning government, donor support and academic expertise to deliver durable institutional capacity and effective regulatory institutionalization. Originality/value The study provides rare empirical evidence from a fragile context, contributing to limited literature on government–donor–academia cooperation and offering a transferable model for resilient, locally led and financially integrated regulatory reform.
PURPOSE:To apply a two-phase statistical process control (SPC) framework to monitor ICU Day-2 glycemic performance, detect SPC-defined glycemic instability, and identify clinical predictors of out-of-control Day-2 glycemic patterns in a tertiary hospital ICU in Egypt's Delta region. DESIGN/METHODOLOGY/APPROACH:A prospective observational cohort study was conducted in an adult mixed medical-surgical ICU. Phase I data included 300 patients, each with four glucose measurements on ICU Day-2, and were used to estimate empirical x̄-chart control limits. Phase II surveillance applied the fixed Phase I limits to 1,000 additional patients, each with four ICU Day-2 glucose measurements. Nelson Rules 1 and 2 were used as pre-specified operational signal-detection criteria to identify extreme excursions and sustained unit-level process shifts. Multivariable logistic regression was used to explore clinical factors associated with SPC-defined out-of-control Day-2 glycemic status. FINDINGS:In Phase II, 505/1,000 (50.5%) patient subgroups signaled "out-of-control" by the union of Nelson rules. Rule-1 limit exceedances occurred in 150 subgroups, while Rule-2 shift signaling affected 413 subgroups (35 distinct run events). In adjusted analyses, higher illness severity (APACHE II), sepsis, older age, higher baseline HbA1c, vasopressor use, corticosteroid use, and comorbidity burden (CKD and/or liver disease) increased the odds of "out-of-control" status; higher caloric intake was associated with lower odds. BMI, sex, and surgical admission type were not significant predictors. RESEARCH LIMITATIONS/IMPLICATIONS:Observational design precludes causal inference and assessment of real-time SPC impact. Excluding DKA/HHS and stays <48 h may limit generalizability. Subgrouping (n = 4) favors shift detection but may mask very short-term variability. Single-center results may not generalize to ICUs with different nutrition/sedation and glycemic management practices. PRACTICAL IMPLICATIONS:A combined SPC-and-regression framework can provide early operational surveillance of ICU Day-2 glycemic instability and may support targeted, data-driven quality-improvement interventions. However, prospective interventional studies are required to determine whether SPC-guided glycemic management improves clinical outcomes. ORIGINALITY/VALUE:This study combines Phase-I-derived SPC limits with Phase II surveillance and multivariable risk modeling to measure and explain Day-2 glycemic special-cause variation in a resource-relevant tertiary ICU environment.
PURPOSE:This study examines how highly "hotelized" hospital servicescapes may unintentionally weaken procedural compliance and patient safety by reshaping patients' role perceptions from "patient" to "guest." More specifically, it explores whether the over-optimization of comfort, hospitality and experiential design can generate behavioral dissonance and activate hospitality-consistent scripts that conflict with institutional healthcare norms. The paper introduces "experiential over-softening" as a provisional boundary condition of servicescape theory, suggesting that experiential enhancement and procedural integrity may relate in a non-linear manner within high-reliability service contexts. DESIGN/METHODOLOGY/APPROACH:The study adopts an interpretivist, abductive qualitative design grounded in narrative inquiry. Empirical material derives from a single theoretically revelatory retrospective narrative involving a patient who unintentionally bypassed formal hospital discharge procedures in a luxury hospital environment. The analysis combines abductive narrative interpretation with cognitive dissonance mapping to reconstruct a theoretically plausible mechanism linking servicescape cues, symbolic role reinterpretation and protocol deviation. Rather than testing causal relationships, the study seeks analytical generalization and hypothesis generation through iterative dialogue between empirical material and competing theoretical lenses. FINDINGS:The findings suggest that highly hospitality-oriented hospital environments may reorganize the salience of competing role-consistent cognitions, amplifying "guest" scripts while attenuating institutional "patient" norms. Within this symbolic configuration, the patient's autonomous exit became situationally coherent rather than consciously deviant. The analysis indicates that environmental cues may function not only as experiential stimuli, but also as carriers of institutional meaning capable of reshaping role expectations and behavioral intelligibility. The study therefore proposes "experiential over-softening" as a provisional boundary condition of servicescape theory, highlighting a possible non-linear relationship between experiential enhancement and procedural compliance in high-reliability contexts. ORIGINALITY/VALUE:The originality of this study lies in identifying and theorizing a previously underexplored paradox within experiential service design: the possibility that excessive experiential enhancement may weaken procedural integrity in high-reliability systems. The paper advances servicescape theory by introducing "experiential over-softening" as a hypothesis-generating boundary condition and by conceptualizing the servicescape as a carrier of institutional meaning rather than merely an affective stimulus. It also offers a novel abductive integration of servicescape theory, hospitality healthscapes, institutional logics and cognitive dissonance to explain how environmental cues may render protocol deviation situationally intelligible.
PURPOSE:Patients' informed consent is recognized as a fundamental pillar of medical ethics and patient rights. Failure to acknowledge or adequately implement informed consent carries serious consequences for the integrity and effectiveness of the healthcare system. This study aims to analyze the systematic relationships among factors influencing patients' informed consent. DESIGN/METHODOLOGY/APPROACH:This descriptive-analytical cross-sectional study was conducted at a private hospital in Tehran in early 2025. A sample of 11 specialist physicians and nurses was selected using purposive and snowball sampling methods. Data were collected using a pairwise comparison matrix questionnaire. Descriptive data analysis was performed using SPSS 26.0, and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was applied using MATLAB software. FINDINGS:The results showed that in the interactive model and systematic relationship analysis among components influencing the obtaining of informed consent from patients, interpersonal and individual factors belong to the group of influential factors, while organizational and environmental fact ors belong to the group of influenced factors. Interpersonal and environmental factors were identified as the most influential and most influenced factors, respectively. ORIGINALITY/VALUE:The DEMATEL-based model identified interpersonal and individual factors as key influencers of informed consent, while organizational and environmental factors were primarily influenced. This suggests that improving communication quality and patient understanding may generate system-wide benefits. However, findings reflect a single private hospital context and should be considered exploratory. The model provides a hypothesis-generating foundation for future validation and targeted interventions in similar Iranian healthcare settings.
Purpose This study investigates the relationship between customers' intention to purchase health insurance in Northern India and perceived behavioral control (PBC), which is based on the decomposed theory of planned behavior (DTPB). Three core dimensions of PBC are identified: social influence, perceived ease of access and financial affordability, discovered through the use of exploratory factor analysis (EFA). The study further investigates how gender and marital status moderate these relationships to inform targeted marketing strategies. Design/methodology/approach Convenience sampling was used to gather primary data through an online poll with 400 participants. The three PBC dimensions were extracted and validated using EFA, and their direct impacts on purchase intention were then tested using partial least squares structural equation modeling (PLS-SEM). Moderation effects by marital status and gender were investigated using multi-group analysis (MGA), which produced strong t-statistics and p-values. Findings PLS-SEM reveals perceived ease of access is the best predictor of purchase intention (t = 6.070, p < 0.001), followed by social influence (t = 4.400, p < 0.001) and financial affordability (t = 5.486, p < 0.001). Financial affordability and social influence have a greater impact on women, whereas perceived ease of access had a greater impact on males, according to MGA, which shows significant gender-based moderation. These associations are also moderated by marital status; married people react more strongly to accessibility, whereas single people are more impacted by affordability and social influence. Research limitations/implications These results offer practical applications for lawmakers and insurance companies undertaking business in developing nations. The study makes recommendations for future longitudinal and cross-cultural research while acknowledging the drawbacks of convenience sampling and a cross-sectional approach. Originality/value This study examines the dimensional structure of PBC in relation to health insurance purchase intention in a developing-nation situation by integrating PLS-SEM and EFA in a novel way inside the TPB framework. It fills a major vacuum in culturally nuanced consumer Behavior research in emerging nations and provides actionable data for insurers looking to segment their marketing strategies by revealing innovative moderations based on gender and marital status.
PurposeThis study aims to critically assess the maturity and readiness of artificial intelligence (AI) applications in personalized healthcare and to identify the barriers hindering their clinical integration. Design/methodology/approachAdhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive analysis of 1,290 peer-reviewed studies sourced from PubMed, Scopus, Google Scholar and IEEE Xplore, spanning the years 2019–2024. The ROBINS-I tool was utilized to evaluate bias, and following a rigorous full-text review, 15 studies met the inclusion criteria. A novel maturity model was developed to categorize the studies. FindingsThe vast majority of studies (13/15) are concentrated at Stage 1 (technical validation) and Stage 2 (clinical efficacy), with a complete absence of studies at Stages 4–5. None have achieved full integration into clinical workflows. We identify a critical “implementation chasm” caused by a trust deficit (black box problem), an equity crisis (algorithmic bias) and a governance gap (data privacy and regulatory challenges). Practical implicationsThe field must shift its focus from technical performance to addressing the systemic barriers identified. We propose a maturity model to guide future research and development towards sustainable and equitable integration. Originality/valueThis review moves beyond cataloging benefits and challenges by introducing a maturity model and critically examining the implementation chasm. It provides a novel framework for advancing AI in personalized healthcare.
PURPOSE:One vital concern of health policy globally is to achieve equity in access to health care services for all. This study aims to examine the interconnectedness of health insurance, healthcare utilization and health outcomes in Nigeria. It set out to ascertain how enrollment in health insurance impacts healthcare utilization and health outcomes in Nigeria. DESIGN/METHODOLOGY/APPROACH:The study utilized the latest demographic survey data collected by the National Bureau of Statistics in Nigeria. The data was analyzed using binary logistic regression models. FINDINGS:The study demonstrates that father's education and occupation are positively associated with health outcomes, while age and decision on healthcare utilization have negative associations. It also observed that insurance enrollment does not significantly improve child and maternal health outcomes even though insurance ownership and the type of plan significantly influence health service use in Nigeria. This result is further supported by the ordinary least squares regression result, serving as a robustness check. ORIGINALITY/VALUE:The results provide evidence that investments in health insurance infrastructure, educational attainment (especially among men) and geographic equity in service provision are critical levers for improving population health in Nigeria. The study recommends that strengthening the health system in Nigeria requires multidimensional efforts targeting insurance access, educational empowerment, employment stability and geographical service distribution so as to achieve Sustainable Development Goal 3: "Good Health and Well-Being for all."
Purpose Healthcare quality management frameworks are widely used to strengthen governance, patient safety and organisational accountability in health systems. Although communication is recognised as an important component of safe and effective healthcare, its role within formal quality management frameworks has received limited systematic attention. This study examines how communication is embedded in major international healthcare quality management frameworks and identifies differences in how communication processes are conceptualised across these systems. Design/methodology/approach The study applies a comparative framework analysis of six internationally recognised healthcare quality management systems representing different governance models. The analytical unit of the study is the framework rather than individual documents. A qualitative document analysis was conducted using a structured analytical matrix consisting of seven communication-related dimensions: governance communication, patient communication, team communication, complaint communication, information management, communication training and communication in quality improvement. Findings Communication appears across all analysed frameworks, although the level of formalisation varies between governance models. Accreditation-based frameworks regulate communication most explicitly, particularly in relation to patient engagement, team coordination and complaint management. In contrast, management standards and policy frameworks tend to integrate communication more indirectly within broader governance and quality improvement processes. Research limitations/implications The study focuses on publicly available framework-level standards and guidance documents and does not examine the practical implementation of these frameworks within healthcare organisations. Future research could investigate how communication standards are operationalised in organisational and clinical contexts. Practical implications The findings suggest that healthcare leaders selecting or implementing quality management systems should consider the extent to which communication processes are explicitly integrated within the framework. Originality/value This study contributes to the literature by providing a comparative analysis of communication integration across international healthcare quality management frameworks and by conceptualising communication as an organisational component of healthcare quality governance.
Purpose This study explores how the integration of lean management (LM) and clinical risk management (CRM) approaches enhances patient safety and operational efficiency by providing an integrated implementation framework.Design/methodology/approach An empirical case study was conducted in a large academic hospital in Northern Italy, focussing on the hospital dietary process. A multiple-data-sources approach was employed for data collection, including participatory observations, surveys, structured interviews and secondary data.Findings The integrated lean-clinical risk management approach increased incident reporting from 7 cases in 2020 to 30 in 2023, reflecting enhanced staff awareness and adverse event reduction. Diet prescriptions documented within 24 h rose from 71% to 99%, while kitchen order variations dropped from 52% to 2%. Patient satisfaction ratings increased by 11 percentage points. Operator time for diet management decreased significantly, from 750 to 47 h monthly.Practical implications The study provides an integrated framework to support healthcare managers in integrating risk management and lean methodologies to boost clinical safety and process efficiency.Originality/value The study fills a literature gap by providing empirical evidence of LM and CRM integration, offering actionable insights for sustainable healthcare quality improvement.
Purpose Effective communication is critical to safety and quality in healthcare. Women with limited English proficiency face barriers to quality communication in anglophone settings, perpetuating health inequities. To inform evidence-based strategies, this study aimed to evaluate and explore women's experiences of cross-cultural communication within a women's health service.Design/methodology/approach Women accessing maternity or gynaecology care at a women's health service in Western Australia were eligible to participate if they had accessed interpretation support in Arabic, Burmese, Farsi, Mandarin or Vietnamese. A total of 68 women completed a cross-sectional questionnaire; 15 women participated in a semi-structured telephone interview. Quantitative and qualitative data underwent descriptive statistical and multilingual reflexive thematic analyses respectively.Findings Participants reported diverse language preferences and skills, most frequently speaking Mandarin, Arabic and Vietnamese. At their most recent visit, most recalled an in-person interpreter present speaking their preferred language. However, less than half were provided with language-concordant written health information resources. Three themes - the role of the interpreter, navigating the health service with uncertainty and a foundation of trust - explore facets of women's experiences, linked by an overarching theme: health is too important not to understand.Originality/value Themes reflect key systemic gaps in the provision of safe quality care for women with limited English proficiency, highlighting the need for proactive service-wide approaches to cross-cultural communication encompassing but not exclusive to clinical encounters. Improved integration of interpretation services, language-concordant information resources and language-concordant support for service navigation are recommended.
Purpose The purpose of this study is to improve the operating theatre workflow in the healthcare sector by integrating Lean and Industry 4.0 AI-based approaches.Design/methodology/approach A qualitative methodology was conducted, involving operational and management professionals selected through purposive sampling, based on predefined inclusion criteria. Thematic analysis was conducted to analyse the data, supported by evidence from a prior scoping review.Findings The study identified key delays in operating theatres, including late patient arrivals, poor team coordination, incomplete pre-operative preparations and inadequate pre-surgery assessment, but AI tools can predict delays with substantial accuracy, enabling proactive scheduling adjustments. The integration of AI and Lean was found to streamline OT workflows, which reduces delays in patient waiting time in healthcare.Research limitations/implications A limitation of this study is a lack of empirical application of Lean and AI, and a current integration gap requires stronger staff training and involvement. However, the study has implications for practice in its recommendations to implement AI and Lean to improve patient flow.Originality/value While Lean 4.0 is gaining popularity in general healthcare management, there remains a paucity of empirical research specifically targeting the intersection of AI- and Lean principles in the operating theatre. This study seeks to bridge that gap by synthesizing expert insights with existing literature to provide a focused framework for implementation.
Purpose The growing population and consequent augmented medicinal needs place an emphasis on effective pharmacovigilance processes. Patient safety may be optimised by further managing risks to prevent adverse drug reactions, which can be associated with significant hospital admissions and proportionate relevant monetary expenditure. Design/methodology/approach In this rapidly changing landscape, under the pressing demand to enhance patient safety, this conceptual paper offers an evidence-based perspective on the need and type of evaluation of the systems used for medicine risk communications. Findings National health products and medicines regulatory bodies/authorities are using approved outlets and distribution modes to communicate medicines safety issues timely and efficiently to healthcare practitioners. However, medicine risk communications need to be periodically evaluated on their effectiveness in achieving the desired patient outcomes regarding the acceptance and adherence by the targeted healthcare professionals. Originality/value The novelty of this study lies in its integration of behavioural science and human factors into the evaluation of medicine risk communication systems, offering a conceptual framework that moves beyond process metrics to include behavioural outcomes critical for patient safety.
