Service Continuity Research Articles

Continuity in public transport provision during the Covid-19 pandemic – responding to organisational and health challenges facing workers

PurposeThis paper explores and analyses the major challenges faced by both customer-facing and office-based public transport employees during the early stages of the Covid-19 pandemic and the responses of their employers to their concerns.Design/methodology/approachQualitative semi-structured interviews and focus groups were carried out, involving 39 employees and directors representing a wide range of professionals working in the transport sector in three European countries, Poland, Ireland and the UK. Data were analysed through thematic analysis and the emerging issues explored.FindingsMajor employee challenges included: access to resources for safe working; worker mental health and well-being; and the effects of changing working practices, particularly flexible working, on their wider household circumstances and work–life balance (especially combining childcare responsibilities with work). First, physical health safety measures (such as PPE) were put in place for all workers, although sometimes with delays. Second, concerning practical support for mental health and well-being at work, the findings highlight that their employers’ practical support was considered limited by some customer-facing participants. In contrast, participants working from home were offered considerably greater employer support for their well-being, including increased and regular communication regarding work and non-work-related topics to tackle isolation and lack of social interactions. Third, work–life balance, and especially childcare were significant issues for those working from home. To improve organisational resilience, employer support for workers needs to better reflect employees’ job role, work setting and location, as well as their household demands such as childcare.Practical implicationsThe lessons learned from this study contribute to future employer responses and practices and their organisational resilience, both in times of major crises and also for improving mental-health and childcare support in normal times.Originality/valueThe study considers the role of employee perspectives on organisational resilience and service continuity in public transport during a crisis and in three countries. Importantly, the data were gathered contemporaneously during the early stages of the pandemic, and so are not influenced by retrospective rationalisation or uncertain recollections.

Self-adjusting resilient control plane for virtual software-defined optical networks

Optical networks must promptly respond to failures and efficiently handle dynamic traffic in order to fulfill their role as a critical infrastructure. Leveraging network softwarization and virtualization, virtual software-defined networks offer sufficient flexibility towards this goal by sharing the physical infrastructure among multiple tenants whose traffic must traverse the network hypervisor. In a resilient optical control plane each switch must be assigned to a primary and backup hypervisor instance through short control paths, which challenge will be addressed in this paper. First, we propose an intelligent greedy hypervisor placement heuristic which maximizes acceptance ratio for current, and preparedness for future requests. Secondly, we introduce a graph neural network model that can be seamlessly integrated with either our integer linear program or heuristic method to yield high-quality placements in significantly less time compared to our prior solutions. This enhancement renders our approach applicable to larger networks, significantly expanding its practical utility. Finally, we propose a self-adjusting hypervisor migration strategy, which continuously adapts the placement to the dynamically changing virtual network requests, thus, ensuring service continuity by avoiding frequent control plane reconfigurations. Through simulations we show that our hypervisor placement and migration strategies provide a balanced control load while they can handle a wide variety of changes.

Healthcare performance for patients with heart failure in Iran: addressing the tip of the iceberg.

Chronic diseases, such as heart failure with reduced ejection fraction (HFrEF), remain significant factors in the healthcare burden in Iran. Healthcare systems must have comprehensive data on the current usage, costs, and quality of care to tackle these challenges and formulate strategic plans effectively. The study included 209 patients with a mean age of 58 years (SD = 16.5) who met the inclusion criteria of having an ejection fraction of less than 40% and a confirmed diagnosis of HFrEF. This study used nationally representative data to assess the healthcare usage, costs, and quality of HFrEF management in Iran. The most used services were medication dispensing (76%) and outpatient visits (53%), while rehabilitation (3%) and homecare (2%) were used less frequently. The annual per-patient direct medical cost was $1,464, with $308 (21%) paid out-of-pocket (OOP). Hospitalization accounted for most of the total cost (68%), and pharmacy expenses comprised the largest portion of OOP payments (46%). Echocardiography was performed for 91.1% of patients upon admission. Only 71.6% of patients had arrangements for a cardiology visit within seven days following hospital discharge. Additionally, only 67.5% of patients received prescriptions for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and 85% were prescribed beta-blockers. Patients with heart failure in Iran face challenges in accessing adequate cardiac care, including a lack of care continuity and advanced cardiac services. The study provided an essential benchmark for future healthcare reform.

ANALISIS KETERSEDIAAN DAN KEBUTUHAN AIR BAKU DISTRIK BONGGO KABUPATEN SARMI

The development of an area will cause the demand for water to continue to increase along with thepopulation growth rate. The fulfillment of food needs and the activities of the population are always closely relatedto the need for water. The demands are unavoidable but must be predicted and planned for optimal utilization.The tendency that often occurs is the imbalance between water availability and water demand. To achieve abalance between water demand and availability in the future, efforts are needed to assess the components of rawwater availability and demand as clean water sources. The source of clean water for the people of Bonggo District, Sarmi Regency, comes from borehole pumps,shallow wells (pumps), and rainwater. The analysis results on the need for domestic and non-domestic clean waterin the Bonggo District in 2023 show a total requirement of 210.38 liters/day or 0.0024 m3/second. The need forclean water is expected to increase by 2043, with the total requirement for domestic and non-domestic clean waterreaching 285,820 liters/day or 0.0033 m3/second. The availability and need for clean water sourced from rawwater that can be utilized as clean water comes from pump bore wells as a suitable raw water source. In terms ofquantity, it is available 24 hours a day and throughout the year. The investigation results of the pump bore wellraw water source meet the clean water quality requirements according to Government Regulation No. 82 of 2001,Level II. This is supported by groundwater, obtained through the analysis of geological conditions, land cover,morphology, and river flow, which have a high to very high groundwater potential score, located in the northernpart of Bonggo District. Economically, in terms of quantity, rainwater can be used as clean water due to its sufficientavailability, with high rainfall (104,775 mm/year) and year-round service (continuity), and in terms of quality, theresults of rainwater quality tests meet the clean water standards according to quality standards.

Towards integration of care in Portugal: Expansion of a new management model for the NHS

Abstract Introduction In 1999, the first Local Health Unit (LHU) was created in the Northern region of Portugal to improve management, share resources and integrate care. The LHU integrated a National Health Service (NHS) hospital and primary healthcare (PHC) services located within the same geographic area and became responsible for public health activities and the provision of care. Over the next few years, 7 LHUs were created, the last one in 2012. In 2024, the government expanded this model to the entire territory, creating 39 LHUs. This research analyses the objectives, characteristics and expected outcomes of the scale-up of LHUs. Methods This study utilised a mixed methods approach based on the 6 Ps - Problem, People (policy stakeholders), Process (policy development), Price tag (Resource allocation), Paper (policies, laws, regulations), Programmes (policy implementation); and the political, social and economic setting of the Policy Circle Framework. Findings A 2015 assessment revealed that LHUs did not differ from non-LHUs in terms of access, waiting times, clinical excellency, patient safety or patient centeredness. The degree of integration of care in LHUs seemed lower compared with non-LHUs. However, there was no systematic evaluation of the creation of the first LHU. Despite this, the government announced the intention to expand LHUs to the entire national territory, which culminated with the creation of 39 LHUs in 2024 to deliver integrated care, with an emphasis on the proximity and continuity of health services and promotion. Conclusions Despite the existing knowledge gap on the impacts of LHUs in health outcomes and management efficiency, LHUs can provide opportunities to advance integrated and patient-centred care and develop strategies for managing scarce resources, including the health workforce. Nevertheless, the integration of hospitals and PHC can threaten the centrality of primary health care both in terms of delivery of care and resource allocation.

FROM SERVICE TO SUPERIORITY: UNVEILING THE IMPACT OF ARTIFICIAL INTELLIGENCE ON CUSTOMER EXPERIENCE IN GIANT HYPERMARKETS, KLANG VALLEY, MALAYSIA

The integration of Artificial Intelligence (AI) in retail has redefined customer experience, offering new opportunities for personalisation, service quality enhancement, and continuous service delivery. This study investigates the impact of AI on customers’ experience at Giant Hypermarkets in Klang Valley, Malaysia, focusing on four key areas: personalisation, service quality, hassle-free service, and customer service. Using quantitative methods, data were gathered from 365 respondents to assess the influence of AI-driven services on customer experience. The findings reveal that hassle-free service significantly enhances customer experience, while personalisation, service quality, and customer service show no significant impact. These results suggest that while AI is effective in streamlining operations and reducing customer effort, it may fall short in providing the emotional engagement needed to enhance the overall customer experience. This study highlights the importance of balancing AI efficiency with human interaction, particularly in relational services. This research offers valuable insights for retailers, academics, and small business owners, emphasizing the need to adopt AI technologies that focus on customer convenience and experience while maintaining a personal touch. This study clearly highlights the implications for the retail industry, demonstrating that AI can significantly enhance customer experience, but its strategic integration is crucial to address both operational efficiency and emotional engagement.<p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0735/a.php" alt="Hit counter" /></p>

Strategic Vigilance in Sports Clubs: Insights and Practices

Objectives: This study explores the reality of strategic vigilance practices in sports clubs in Oman. Methods: A questionnaire was administered to a random sample of 162 participants which included members of boards of directors, club managers, sports activity directors, coaches, and players in Oman. Result: Institutions show significant gaps in competitor analysis and communication with authorities, leading to a shortage of technological expertise that negatively impacts service promotion. Sports institutions prioritize continuous service development to retain existing clients and attract new ones. Conclusions: The study revealed a need to promote a culture of strategic vigilance among all employees in sports institutions in Oman. It emphasizes the necessity of engaging marketing specialists to address weaknesses within the institutions and contribute to the development of marketing vigilance

Navigating urban congestion: A Comprehensive strategy based on an efficient smart IoT wireless communication for PV powered smart traffic management system.

Egypt faces extreme traffic congestion in its cities, which results in long travel times, large lines of parked cars, and increased safety hazards. Our study suggests a multi-modal approach that combines critical infrastructure improvements with cutting-edge technologies to address the ubiquitous problem of traffic congestion. Assuring vehicles owners of their timely arrival, cutting down on fuel usage, and improving communication using deep learning approach and optimization algorithm within the potential of IoT enabled 5G framework are the main goals. The traffic management system incorporates detection cameras, Raspberry Pi 3 microcontroller, an Android application, cloud connectivity, and traditional traffic lights that are powered using PV modules and batteries to secure the traffic controllers operation in case of grid outage and assure service continuity. The model examines the difficulties associated with Internet of Things (IoT) communication, highlighting possible interference from device-to-device (D2D) devices and cellular user equipment. This all-encompassing strategy aims to reduce fuel consumption, increase road safety and improve traffic efficiency. The model predicts a significant increase in Egypt's urban mobility by utilizing the possibilities of IoT and 5G technologies, which would improve Egypt's towns' livability and efficiency. The goal of this paper is to modernize Egypt's traffic management system and bring it into compliance with global guidelines for intelligent transportation networks.

PUBLIC ADMINISTRATION POLICY IN THE HEALTHCARE SECTOR UNDER MARTIAL LAW

The article analyzes the main directions of public administration in the field of health care of Ukraine during martial law. The main focus is on the adaptation of the legislative framework and the modernization of management approaches, which allow to ensure the effective functioning of the health care system in crisis situations. The issue of creating mobile medical teams and hospitals, which are the main tool for providing medical care in front-line and de-occupied areas, was considered. The contribution of international organizations to the support of the Ukrainian medical system in terms of supplying medical equipment, medicines and providing financial assistance is analyzed. The key normative legal acts, which were adopted from 2022 and contributed to the adaptation of the medical system to new challenges, were studied. Features of the functioning of the Resolution of the Cabinet of Ministers No. 302, No. 683, No. 1078 and others are given. Particular attention is paid to the digitization of health care, the implementation of electronic medical records in order to ensure the prompt provision of medical services. The problems of medical institutions in the front-line zones, including the destruction of more than 700 hospitals, and ways to solve the logistical problems of the supply of medicines were considered. A conclusion was made regarding the further development of public administration in the field of health care based on the integration of international and national resources, improvement of digital technologies and modernization of medical infrastructure. Ensuring adequate funding of the health care system, which includes the health insurance program, emergency and specialized medical care, is revealed, which is a priority in the 2023 budget. The article examines the influence of international humanitarian organizations on the support of the Ukrainian health care system in the conditions of military operations. The basis for the development of long-term strategies for the recovery of medical facilities after destruction and their equipment with modern technologies is proposed. Aspects of integration of digital solutions to ensure the continuity of medical services in the most difficult conditions have been studied.

Latency‐Sensitive Service Function Chains Intelligent Migration in Satellite Communication Driven by Deep Reinforcement Learning

ABSTRACTSatellite communication technology solves the problem that the traditional wired network infrastructure is difficult to achieve global communication coverage. However, factors such as satellite orbits introduce frequent changes to the network topology, and challenges like satellite failures and communication link interruptions are prevalent. In the face of these issues, service function chain (SFC) migration becomes a crucial method for swiftly adjusting SFCs during faults, maintaining service continuity and availability. This article proposes a latency‐sensitive SFC migration algorithm tailored to satellite networks. The algorithm first models the satellite network as a multi‐domain virtual network, capturing the constraints faced during SFC migration. Subsequently, a deep reinforcement learning algorithm integrated attention mechanism is designed to more accurately capture and understand the complex network environment and dynamic satellite network topology and derive optimal SFC migration strategies for superior performance. Finally, through experimentation and evaluation of the deep reinforcement learning‐driven latency‐sensitive service function chain intelligent migration algorithm (LS‐SFCM) in satellite communication, this study validates the effectiveness and superior performance of the algorithm in latency‐sensitive scenarios. It provides a new avenue for enhancing the service quality and efficiency of satellite communication networks.

Transitional Infrastructures Extending Access to Safe Water in Informal Settlements: A Cross-Sectional Study in Nairobi, Kenya.

There is a pressing need for transitional water infrastructures in rapidly growing cities where conventional infrastructures lag behind human settlement expansion. In Kenya, sectoral innovations have addressed local socioeconomic challenges, but empirical evidence on their efficacy (combining quantitative indicators of safety and continuity) is lacking. We addressed this gap by comparing different water infrastructures in their ability to provide constant access to safe water in informal settlements in Nairobi, Kenya. We conducted a cross-sectional survey including 1,147 households in two informal settlements. Water infrastructures were categorized based on their distribution system: 1) piped to premises; 2) piped to a neighboring compound; 3) public tap/dispenser; and 4) street vendor. We tested associations between these systems with two outcomes: constant water availability and diarrhea (stratified by age group). We used adjusted odds ratios (AORs) to test associations between distribution systems and the selected outcomes, while accounting for confounders. Obtaining water from public taps/dispensers or street vendors was associated with service continuity (AOR = 1.45, 95% confidence interval [CI]: 1.06-1.99; AOR = 11.16, 95% CI: 2.45-50.82). Piped sources were associated with service disruption, especially when obtained from a neighboring compound (AOR = 0.45, 95% CI: 0.28-0.70). Public taps/dispensers were the only system consistently associated with lower odds of diarrhea, notably in children under the age of 5 years (AOR = 0.47, 95% CI: 0.29-0.79). Hence, in cities with a high prevalence of informal settlements and limited financial resources, public taps and dispensers hold promise as transitional water infrastructures.

Leveraging Digital Health Data to Transform the United Nations Systems for Palestine Refugees for the Post Pandemic Time

ABSTRACT The COVID-19 pandemic presented a grave threat to the continuity of health services that UNRWA provides to 5.9 million Palestine Refugees in the Near East. UNRWA runs 140 primary health care clinics, providing approximately nine million medical consultations a year. During the pandemic, UNRWA’s e-Health system (and other digital health tools) were crucial in maintaining health services. The e-Health system enabled the identification of at-risk patients and transformed UNRWA’s services for sustainability and efficiency. Innovations like telemedicine and two smartphone applications (e-NCD and e-MCH) enhanced service delivery and staff management. To evaluate the effectiveness of digital health integration in UNRWA’s services during and after the pandemic, the team analyzed reports, events, and e-Health data from 2019–2022. Results show that digital tools, like e-NCD and e-MCH applications, helped reduce COVID-19 among Palestine Refugees, enabling remote care and continuous access to essential health services. Digital health has now become essential in UNRWA’s post-pandemic operations. This paper offers a paradigm for future outbreak responses. By harnessing the power of digital health, UNRWA’s e-Health system served as a beacon of hope, demonstrating how innovative approaches can empower patients, enhance health care outcomes, and ensure equitable access to health care services during crisis situations and beyond.

Lessons from the Department of Veterans Affairs: A continuum of age-friendly care for older adults.

With almost 90% of Americans expressing a desire to age in place in their home, many health systems and communities are challenged to provide the right resources, at the right time, to support What Matters to older adults. In the Department of Veterans Affairs (VA), approximately 50% of Veterans enrolled in VA health care are aged 65 and older, driving an imperative to provide timely, Age-Friendly care through a broad continuum of services. VA has taken a multifaceted approach to shift Long-Term Services and Supports to promote aging in place through innovation pilots, expansion of Home and Community Based Services (HCBS) and adoption of Age-Friendly Health Systems (AFHS) practices [or "framework"]. VA is spreading geriatrics knowledge throughout the clinician and trainee workforce, improving skills and practices across all disciplines and care settings. The framework of AFHS creates a shared language to support transitions across ambulatory, hospital, emergency department, home care, and nursing home settings. Through these efforts, VA is reimagining geriatrics, providing an example of the type of care all older adults want and deserve. Since March 2020, 375 care settings across 132/139 (95%) VA parent facilities have earned AFHS recognition. By incorporating AFHS into the infrastructure of the healthcare system, clinicians are prepared to address What Matters across clinical settings and address common geriatric syndromes. Leaders in a variety of health systems can learn from VA efforts to provide a continuum of Age-Friendly programs and services that promote independence, function, well-being and aging in place.

Service specification for senior care workers with traditional Chinese medicine specialty

Abstract Senior care workers specializing in traditional Chinese medicine (TCM) healthcare have become an indispensable force in institutional care, community care, and home care. The first Chinese nursing service team aimed to improve the health of the elderly by providing continuous services for physical and mental well-being, disease prevention, physical amelioration, and overall health enhancement using TCM concepts, methods, and technologies. The primary purpose of formulating this TCM health and elderly care worker service specification was to standardize services within the TCM elderly care industry, ensuring that the elderly receive better health and elderly care services supported by technical expertise. This specification outlined the basic requirements for TCM health and elderly care workers, including standards for service content, service quality control, service evaluation, and improvement. It primarily focused on the content and requirements of TCM health and elderly care services, such as constitution identification, life care, acupoint healthcare, and TCM auxiliary nursing for elderly individuals with chronic diseases. This specification is applicable to TCM health and elderly care personnel at various levels of hospitals and healthcare institutions and is noted for its strong applicability and effectiveness.

Communication, Socialization, and Literacy for Adults With Developmental Disabilities: An Interview Study of Parents' Perspectives and Experiences.

The study highlights the significance of continuous support and services in communication, socialization, and literacy skills for adults with developmental disabilities (DDs). The aim of the study was to gather in-depth information on the individualized needs, lived experiences, and expectations of adults with DD by interviewing their parents. A total of 14 parents of adults with DD participated in one-on-one semistructured interviews. During the interviews, parents were asked to describe (a) their children's current communication, socialization, reading and writing skills; (b) the types of communication, socialization, and literacy support their children were receiving; and (c) the types of support that their children needed. Interviews were video- and audio-recorded, transcribed, and analyzed qualitatively using thematic analysis. Thematic analysis revealed three main themes and eight subthemes: (1) insufficient support and services for adults with DD (i.e., lack of competent professionals and lack of literacy support), (2) approaches that the parents attempted for their children with DD (i.e., parents' responsibilities, technologies, and pseudoscience), and (3) recommendations for ongoing support and services (i.e., novel technologies, social media, and motivation). The study highlights crucial gaps between the participating parents' desire for individualized, consistent, and innovative support and services for their adult children with DD and scarcity of resources in communication, socialization, and literacy. The dearth of evidence-based support and resources leads to easy access to pseudoscience. Future research is warranted to develop innovative, customized, and highly motivating programs in communication, socialization, and literacy for adults with DD. https://doi.org/10.23641/asha.27214407.

An observational study on menstrual hygiene practices among adolescents girls attending zilla parishad high school at Kommadi village in Visakhapatnam

Under RMNCH+A strategy, adolescent health program is relatively a new concept, particularly for female gender, and has been considered to be a continuum of health services up to adolescent age. The priority interventions among adolescent girls are, nutrition, Adolescent Friendly Health clinics (AFHCs), Counselling, Menstrual hygiene and preventive health checkups. Menstrual hygiene component has been taken for the present study among the adolescent girls in a Zilla Parishad High School aged 10 to 19 years. Rastriya Kishora Swastya Karyakram (RKSK) is broader one including both gender for distinct health services in India. : To study the association of various socio- economic and cultural practices influencing the usage of sanitary napkins by menstruating adolescent school girls. : Cross sectional study among menstruating adolescent girls in a Zilla Parishad High School at Kommadi village. 198 adolescent girls were randomly selected for study using semi structured questionnaire. Each menstruating girl is questioned categorically (yes/no) as per the structured questionnaire covering socio economic status, literacy of mother, awareness about ASHA etc. Appropriate statistical tests like frequencies, percentages and chi-square tests are applied to analyse and interpret the collected data.Socio-demographic factors of the target population in the community from where the adolescent girls attending zilla Parishad High school were subjected to study and found that 19(22%) adolescent girls having white ration card are using sanitary napkin. 46% of sanitary napkin users in our study are aware of using cloth available in the house during menstruation. 39 (52%) adolescent girls using sanitary napkin are aware of ASHA worker visiting their colony. One of the family members, either mother or elder sister being a member in Self Help Group in the colony is influencing the usage of sanitary napkin 46 (50.5%). Habit of Over-the-Counter drugs usage in the family has significantly (55%) influenced the adolescent school girls in using sanitary napkin. School drop-outs 51(62.9%) are also observed among sanitary napkin users during menstruation.: The usage of sanitary napkin replacing the traditional home-made cloth is highly essential for proper menstrual hygiene management among adolescent girls attending the school regularly without drop out. The role of ASHA workers and other paramedical staff in the community cannot be undermined.

The benefits of transformational leadership for addressing workplace emotions after COVID-19 at a large multi-campus university

The COVID-19 pandemic presented a series of challenges to organizations. Among those that successfully continued operating, the subsequent recovery period catalyzed pressure to redefine work structure after social distancing restrictions lifted. Here, we observed the benefits of transformational leadership in this historically unique context of organizational distress by applying an adjusted version of Ashkanasy and Dorris’s (Ashkanasy and Dorris in Annu Rev Organ Psych Organ Behav 4:67–90, 2017) framework for workplace emotions to a large, multi-campus university. We quantitatively content-analyzed semi-structured interviews of more than 300 divisional leaders and their staff from across the organization. Interviews occurred in the months following the first semester of continuous in-person service delivery, when most employees returned to working in employer-operated space. Despite disproportionate emphasis on negative and self-focused emotions, negative emotions clustered in individuals’ empathic recognition of others’ emotions; though efforts to regulate those emotions proved scant. Positive emotions primarily emerged in response to local leadership efforts to mitigate the negative emotions of students, staff, and faculty. This data pattern suggests that individuals experienced negative emotions, recognized others’ negative emotions, and appreciated leaders’ interventions to ameliorate those negative emotions. Strategies reminiscent of transformational leadership therefore productively addressed the negative impact of workplace stress imposed by the pandemic, helping to facilitate compliance and enthusiasm with return-to-work efforts. The findings thus illustrate how a transformational style of leadership can address individuals’ negative experiences during a period of pronounced existential stress.

High-Availability Databases in Global Banking : Ensuring Continuous Operations and Data Integrity

This comprehensive article explores the critical role of high-availability (HA) database systems in global banking operations, focusing on their impact on continuous service delivery, data integrity, and regulatory compliance. The article examines the challenges faced by financial institutions in maintaining reliable database systems, including the risks of downtime, data inconsistencies, and the complexities of managing distributed systems across multiple jurisdictions. It provides an in-depth analysis of various HA database architectures, comparing active-active and active-passive configurations, and discussing replication mechanisms and clustering strategies. Through case studies of real-world implementations in trading and core banking systems, the research highlights best practices and common challenges in deploying HA solutions. The article also investigates the broader implications of HA databases on operational resilience and regulatory adherence, particularly in the context of SOX and Basel III requirements. Looking ahead, the article explores emerging trends in HA database technology, including cloud-based solutions, the potential of blockchain for enhancing data integrity, and the role of artificial intelligence in improving system reliability. By synthesizing technical insights with practical applications, this research offers valuable guidance for financial institutions seeking to enhance their database infrastructure to meet the demands of an increasingly digital and interconnected global financial system.

Does Hospital–Physician Integration Improve Hospital Performance? Results from a USA Longitudinal Study

In a dynamic healthcare industry, aligning the goals and objectives of hospitals and physicians through integration has been suggested to influence performance. Physicians’ leadership and active involvement in governance can direct resource usage, Electronic Health Record (EHR) implementation, price negotiation, better coordination, and continuity of services for patients, thus affecting performance. This study aimed to examine the relationship between physician integration and hospital performance, investigating both financial and quality outcomes. We used a longitudinal study design. Our sample was hospital-level data from 2014 to 2019, which contained 6000 U.S. hospital-year observations. The dependent variables were quality outcomes (readmission rates) and financial outcomes (total and operating margins). The independent variable explored three dimensions of integration: high, low, and overall integration. Findings showed no impact of hospital–physician integration on quality outcomes and financial performance. High-integration hospitals did not show any significant relationships with quality outcomes and financial performance compared to hospitals that did not have high integration. Hospital–physician integration may have little potential to bring clinical integration even though vertical integration is present. A commitment to improving quality as a strategic priority may be vital in impacting quality outcomes, followed by financial performance.

Enhancing the efficiency of management of transport enterprises: modern trends and challenges

This research examines the modern trends and challenges in enhancing the efficiency of management in transport enterprises, with a focus on the Ukrainian perspective and the impact of the ongoing war. The study highlights key trends such as digital transformation, sustainability efforts, and the increasing use of data-driven decision-making, which are reshaping the transport industry in Ukraine. The integration of technologies like AI-based route optimization and real-time tracking has become important in overcoming operational challenges caused by the war, including disrupted supply chains, damaged infrastructure, and heightened security risks. These innovations are enabling transport enterprises to minimize costs, optimize routes, and ensure service continuity despite the unstable environment. This paper investigates how Ukrainian transport enterprises are adapting to these modern trends while addressing the complex challenges posed by the war. It emphasizes the need for a flexible and resilient management approach that leverages digital tools, sustainability practices, and data analytics to enhance operational efficiency. The findings highlight that a systemic approach, supported by innovation and adaptability, is essential for overcoming the impact of war and ensuring the long-term viability of transport sector of Ukraine.