Health Care Project Research Articles

Computational graph pangenomics: a tutorial on data structures and their applications

Computational pangenomics is an emerging research field that is changing the way computer scientists are facing challenges in biological sequence analysis. In past decades, contributions from combinatorics, stringology, graph theory and data structures were essential in the development of a plethora of software tools for the analysis of the human genome. These tools allowed computational biologists to approach ambitious projects at population scale, such as the 1000 Genomes Project. A major contribution of the 1000 Genomes Project is the characterization of a broad spectrum of genetic variations in the human genome, including the discovery of novel variations in the South Asian, African and European populations—thus enhancing the catalogue of variability within the reference genome. Currently, the need to take into account the high variability in population genomes as well as the specificity of an individual genome in a personalized approach to medicine is rapidly pushing the abandonment of the traditional paradigm of using a single reference genome. A graph-based representation of multiple genomes, or a graph pangenome, is replacing the linear reference genome. This means completely rethinking well-established procedures to analyze, store, and access information from genome representations. Properly addressing these challenges is crucial to face the computational tasks of ambitious healthcare projects aiming to characterize human diversity by sequencing 1M individuals (Stark et al. 2019). This tutorial aims to introduce readers to the most recent advances in the theory of data structures for the representation of graph pangenomes. We discuss efficient representations of haplotypes and the variability of genotypes in graph pangenomes, and highlight applications in solving computational problems in human and microbial (viral) pangenomes.

Dementia and migration: culturally sensitive healthcare services and projects in Germany : Ascoping review.

BackgroundThere are approximately 96,500 people with a migration background (PwM) with dementia in Germany. They and their families face not only dementia-related challenges but also the challenge of having little knowledge about the healthcare system and its services and thus more difficulty in accessing support. Germany’s national dementia strategy recognises these individuals as a risk group and thus aims to expand the provision of culturally sensitive information and healthcare services.ObjectiveTo determine the amount of culturally sensitive information and healthcare services as well as projects on dementia and migration.MethodWith a scoping review the PsycInfo, PsycArticles and Psychology & Behavioral Sciences Collection databases, Google Search, the network map (Netzwerkkarte on the website www.demenz-und-migration.de) and the websites of various research funding bodies were used to find culturally sensitive information and healthcare services as well as current projects on dementia and migration.ResultsListed are 45 care services as well as 3 additional projects that deal with dementia and migration at the local level. The geographical distribution of the offers shows that most of the services can be found in federal states where most PwM with dementia live.DiscussionIt is necessary to provide information and healthcare services in all regions and to adapt them to PwM. Different aspects and culturally sensitive measures are important when informing PwM with dementia, as such information can enable these individuals to access the healthcare system and help to provide them with care. It is important to bring together relevant stakeholders to provide access and services that improve the situation of PwM with dementia and their families.

Design, Development, and Validation of an Augmented Reality-Enabled Production Strategy Process

The Production Strategy Process (PSP) is an integral part of production planning and control as it defines how production processes are structured and designed and outlines how production will be executed. PSP involves massive information transfer and communication among project participants. While BIM can improve the flow of information, the paradox of designing 3D models in 2D space remains. This paradox indicates that new visualization technologies are needed to leverage the use of information in the PSP. As Industry 4.0, the fourth industrial revolution, continues to evolve, it is imperative that construction firms seek, find, and adopt new technologies. This research employed Augmented Reality (AR) as a new user interface in the PSP. The current state of practice of PSP was investigated and current challenges are identified. The opportunities to integrate AR were defined, and an AR-enabled future state was proposed. Next, an AR-enabled PSP prototype using the Microsoft HoloLens was implemented and validated on a real-world healthcare project. Usability testing was then conducted using a one-on-one protocol to validate the prototype with 20 participants. Surveys were the deployed to qualitatively assess the impact of integrating AR into PSP. The difference between the traditional PSP and the AR-enabled PSP was tested through a series of hypotheses comparing both processes. The results demonstrate that the AR-enabled PSP offers significant benefits over the Traditional PSP: improved collaboration, reduced miscommunication, increased quality and detection of errors, enhanced decision-making, better documentation, better information access, improved information flow, increased input accuracy, and increased integration of safety considerations. Additionally, the technology, software, and hardware were also evaluated, and, on average, the findings demonstrated the potential of AR in production planning.

Value-Based Healthcare Project Implementation in a Hierarchical Tertiary Hospital: Lessons Learned.

An important innovation in healthcare is the value-based healthcare (VBHC) framework, a way to solve health services' sustainability problems and ensure continuous improvement of healthcare quality. The Quality and Safety Unit at the Hospital Universitario 12 de Octubre has been since May 2018 coordinating the implementation of several healthcare innovation projects within the paradigm of VBHC. Implementing innovations in a complex institution, such as a tertiary hospital, is a challenge; we present here the lessons learned in the last 4 years of work. We detail exclusively the aspects related to continuous improvement and value addition to the process. In summary, for any VBHC project implementation, we found that there are five main issues: (1) adequate data quality; (2) development of data recording and visualization tools; (3) minimizing healthcare professional's effort to record data; (4) centralize governance, coordination, and transparency policies; (5) managerial's implication and follow-up. We described six steps key to ensure a successful implementation which are the following: testing the feasibility and complexities of the entry process; establishing leadership and coordination of the project; developing patient-reported outcomes and experience measurements; developing and adapting the data recording and data analysis tools; piloting in one or more medical conditions and evaluating the results and project management. The implementation duration can vary depending on the complexity of the Medical Condition Clinical Process and Patient Pathways. However, we estimate that the implementing phase will last a minimum of 18 and a maximum of 24 months. During this period, the institution should be capable of designing and implementing the proposed innovations. The implementation costs vary as well depending on the complexity, ranging from 90,000 euros to 250,000 euros. Implementation problems included the resistance to change of institutions and professionals. To date, there are few successful, published implementations of value-based healthcare. Our quality of care and patient safety methodological approach to the implementation has provided a particular advantage.

Federated Learning for Smart Healthcare: A Survey

Recent advances in communication technologies and the Internet-of-Medical-Things (IOMT) have transformed smart healthcare enabled by artificial intelligence (AI). Traditionally, AI techniques require centralized data collection and processing that may be infeasible in realistic healthcare scenarios due to the high scalability of modern healthcare networks and growing data privacy concerns. Federated Learning (FL), as an emerging distributed collaborative AI paradigm, is particularly attractive for smart healthcare, by coordinating multiple clients (e.g., hospitals) to perform AI training without sharing raw data. Accordingly, we provide a comprehensive survey on the use of FL in smart healthcare. First, we present the recent advances in FL, the motivations, and the requirements of using FL in smart healthcare. The recent FL designs for smart healthcare are then discussed, ranging from resource-aware FL, secure and privacy-aware FL to incentive FL and personalized FL. Subsequently, we provide a state-of-the-art review on the emerging applications of FL in key healthcare domains, including health data management, remote health monitoring, medical imaging, and COVID-19 detection. Several recent FL-based smart healthcare projects are analyzed, and the key lessons learned from the survey are also highlighted. Finally, we discuss interesting research challenges and possible directions for future FL research in smart healthcare.

Enhancing Healthcare Project Definition with Lean-Led Design

Decisions regarding project definition have a significant impact on client value generation. However, although this phase is of utmost importance, traditional management practices are inadequate, as the focus is rather on budget and technical aspects leaving aside the functional ones. Neglecting the functional aspects could have serious consequences on the operation and thus quality of workspace, especially in complex projects including hospitals that involve multiple clients and with a high degree of uncertainty of change. The Lean-led Design approach provides a participative solution which involves the main project clients, namely the users (doctors, patients, etc.), project managers, and the government, with the intention of delivering facilities with a better fit for purpose and use. The main objective of the paper is to develop a framework that summarizes the steps leading to the implementation of such an approach during the project definition of a new hospital. The methodology chosen is a case study and the main contribution is to develop theoretical knowledge regarding its implementation. This may support managers in their decisions when coordinating project definitions.

Remote and Technology-Based Dialogic Development during the COVID-19 Pandemic: Positive and Negative Experiences, Challenges, and Learnings

This study aimed to analyze the challenges, learning experiences, and effects of the COVID-19 pandemic in a social, healthcare, and special education development project financed by the European Social Fund. The theoretical framework of the project relied on the theories of dialogic development and leadership. The method was participatory action research using data collected from various assessments and a questionnaire. Reports of neutral, negative, and positive experiences among two participant groups of the project—the implementers and pilot organizations—in remote work, devices and applications, and remote and technology-based development processes, were recorded. Both participant groups reported increased pressure at work, social isolation, professional loneliness, and improved work control and efficiency. The pilots have learned the development method, and development has been able to continue by utilizing technology despite the pandemic. Development through technology was more difficult, and new dialogic interaction tools have been created. The project was most effective with regard to leadership, teams, renewal, and information flow. There is a need for wide-ranging dialogues with various working life actors when outlining the ways in which future work will be carried out and to reflect on how remote work, technology, and digitalization affect well-being at work, social relations, and leadership.

Designers’ perspective on the use of automation to support regulatory compliance in healthcare building projects

Automation has been long explored to improve regulatory compliance during building design. Despite substantial research efforts on developing means to enable this process, there has been limited success in practical implementations. Designers’ inputs are often undervalued in such developments, leading to solutions that are not effectively incorporated into the design process. This issue is even more difficult in healthcare projects due to their complexity and convoluted regulatory frameworks. In this paper, we describe how designers perceive the use of automation to support regulatory compliance in healthcare projects, through the analysis of a series of semi-structured interviews. We found that regulatory documents have a large influence on design and their compliance often consists of an unformalised process in practice. Furthermore, we identified that subjectivity is perceived in requirements as needed due to the creativity involved in design, whereas automation can be understood as liberating in this context depending on how it is used. Improvement needs focussing on the revision of the regulatory framework as well as on software development have been highlighted by participants during the interviews, which led to the proposition of recommendations to help achieve their benefits in practice.

Mandatory CSR expenditure and stock market liquidity

We investigate the nexus between corporate social responsibility (CSR) and firms' stock market liquidity. Using actual firm-level CSR expenditure data and a quasi-natural experiment setup of a mandated CSR regulation in India, we find that firms complying with the mandate experience significantly higher stock market liquidity, relative to non-CSR firms in the post-CSR mandate period. This effect seems to be more pronounced among CSR firms not affiliated to business groups, with concentrated promoter ownership, with low institutional ownership, with foreign sales and having operations in multiple locations. Further, we find that firms spending more on education and healthcare projects as part of their mandatory CSR engagement have higher stock market liquidity. Our results are in line with the conjecture that mandatory CSR regulation could lead to reduced information asymmetry and improved social and reputational capital, and thus improve the stock market liquidity of CSR firms. Finally, we show that mandated CSR firms, having superior stock market liquidity, obtain higher market valuations in the long run.

Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh.

Background“Contracting Out” is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor’s retention both in managerial as well as service provision level in the contracted-out setting.MethodologyIn this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation.ResultsThe most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion.ConclusionsAn adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

Implementation of Public-Private Partnership in the Healthcare Management System

This article states that the private sector and the government can resolve contradictions and bridge interaction gaps through a public-private partnership due to complementing each other functionally. The study aims to determine the elements of public-private partnership development in healthcare and primary conditions for further forming an effective environment for implementing the principles of public-private partnership in healthcare management. This investigation examined the public-private partnership state worldwide and in Ukraine and the prospects for its development in the context of healthcare reform. It was noted that cooperation between the public and private sectors is becoming increasingly social. However, the current practice does not show effectiveness in achieving certain goals. The properties and differences in realizing social public-private partnership projects were investigated. The risks and problems in the implementation of public-private partnerships in healthcare were identified. The authors developed the structural and target model for ensuring the development of public-private partnerships in healthcare. It was determined that the basic conditions contributing to the successful implementation of public-private partnership projects in healthcare should include the factors as follows: political willpower to promote the development and support of public-private partnership; legislative and regulatory system to attract private sector funding; availability of feasible and effective projects and mechanisms for their selection; availability of information and staff needed for project implementation. The findings substantiated that state budget support is essential in reducing the risks of a private partner at the initial stage of public-private partnership development. The world experience showed that state funding of public-private partnership projects in healthcare might vary depending on the project life cycle stage. Given the importance of improving the funding of public-private partnerships, especially in terms of state budget funding for health projects, key elements and possible areas for improvement were identified.

Using systems thinking to investigate the sustainability of digital fabrication projects in the humanitarian and development sector

Recently, designers have started using digital fabrication to create new solutions to meet global challenges. However, many technology projects in the humanitarian and development sector have been criticised for failing to deliver sustainable solutions. This study responds to these concerns by investigating the sustainability of digital fabrication projects in the humanitarian and development sector. A systems approach is used to synthesise knowledge from 14 digital fabrication projects in healthcare, education and water and sanitation. Causal loop diagrams are created to investigate the relationships between the drivers and barriers to sustainability. Several systems archetypes are also identified revealing potential leverage points for driving more sustainable solutions. The paper contextualises these findings by drawing on theories from participatory development and cosmopolitan localism. It concludes that digital fabrication presents an opportunity for more local and participatory design; however, sustainability is being undermined by a tendency to seek short-term solutions.

НЕДЕРЖАВНЕ ПЕНСІЙНЕ ЗАБЕЗПЕЧЕННЯ ЯК ЧИННИК РОЗВИТКУ ЛЮДСЬКОГО ПОТЕНЦІАЛУ В УКРАЇНІ

Approaches to measuring social development in society are summarized, inter alia, through the Human Development Index and its three pillars (health, education and well-being). An analysis of the possible social impact of private pension provision on human development was carried out. The relationship between indicators covering GDP per person, gross fixed capital formation (investment), selected components of the Human Development Index, the sum of private pension assets was analyzed to identify common trends for some of the world’s largest non-state pension funds and, by comparison, for Ukraine. The correlation between private pension assets (PPA) and GDP per person in most developed countries has been high enough to represent a significant contribution of private pension assets to GDP. This impact can be achieved primarily through the investment of private pension assets, as evidenced by the high correlation between the level of PPA and investment figures. A clear time lag between the formation of PPA and investment, which lasts approximately one year, has been revealed. This may mean that pension funds will be allocated to selected investment projects in a year and thus improve the national economy. Similar figures in the case of Ukraine are weakly correlated, which may indicate that there is virtually no impact of still small private pension assets on economic life in general and its humanitarian component in particular. The dependence of average life expectancy at birth on GDP per person based on purchasing power parity (PPP) and the dependence of healthy life expectancy on government spending on health care was simulated. In Ukraine, the relevant indicators differ from the optimal ones and the participation of non-state pension funds in health care projects would be appropriate. Proposals are offered on the development of the private pension insurance, as well as increasing the level of the «long money» component in Ukraine's economy.

Integrated primary health care services in two protracted refugee camp settings at the Thai-Myanmar border 2000-2018: trends on mortality and incidence of infectious diseases.

This study aimed to assess the health outcome of four epidemic-prone infectious diseases, in the context of a Primary Health Care project implemented in a protracted refugee setting along the Thai-Myanmar border. Refugees settled at the Thai-Myanmar border are fully dependent on support for health services, shelter, food, education, water, and sanitation. The Non-Governmental Organization Malteser International developed an integrated Primary Health Care program in close cooperation with trained camp residents over 25 years in the two settlements under its supervision. The project has been funded by the European Commission Civil Protection and Humanitarian Aid Operations (DG ECHO). This was a retrospective primary health care project evaluation. All-cause mortality; morbidity trends in malaria, lower respiratory tract infections (LRTIs), watery diarrhea, and dysentery; and health service utilization covering a time span of 18 years were assessed. Programmatic changes in the Primary Health Care (PHC) project and events with a potential effect on health of the target population were examined. Despite the continuous drain of trained health care workers, the volatile influx of refugees, and the isolated location of the two camps, the initial basic curative health care developed into an integrated and comprehensive PHC project including a SPHERE-compliant water, sanitation, and hygiene program. Malaria, LRTIs, watery diarrhea, and dysentery morbidity dropped twelve, three, two, and fivefold, respectively, over the 18-year period evaluated while the health services utilization dropped from 7.1 to 2.9 consultations per refugee/year. The international community may face situations where integration of refugees into the health services of the host country is not possible. In such a context, integrated and evidence-based PHC adequately funded and implemented by one health agency is an effective and relevant approach to reduce the infectious diseases burden under the constraints of semipermanent living conditions.

Public Health Projects in Ukraine

Public systems are constantly searching for new management approaches to have better performance and be more transparent to society. The public health systems are not an exclusion. Governments in some countries have started to use the project approach in this area. The dominant purpose of this research is to analyze the advantages and disadvantages of operating projects in public health systems worldwide and in Ukraine. Systematization of literary sources and articles connected with a public health projectification indicates that project management has many valuable tools to control and impact public health, including stakeholder management, team management, risk management, and result management. In contrast to the positive impact of using projects, researchers have been concerned about the wrong success factors in the health projects and the unavailability to make long-term programs to make a systematic influence on society. The present study analyzed the domestic and foreign approaches to implementing healthcare projects to analyze public health project fulfilment worldwide and provides the systematization of public health project types in Ukraine, with illustrations of each type of project made by the Center of Public Health by the Ministry of Healthcare. On top of that, the current legal condition of the Ukrainian healthcare system was analyzed due to the strategy of healthcare reformation. The object of the study is the projects implemented by the Center for Public Health by the Ministry of Healthcare as the central institution of public health execution in Ukraine. The author has emphasized that healthcare reformation requires the use of project-management staff since changes in public health are designed to create conditions for the operation of patient-oriented medical institutions. The research results can be helpful for further development of the Ukrainian health system or any other healthcare system or for future research in the projectification of the public sector.

О возможности ЕГИСЗ решать задачи управления

The unified state health information system (UHISZ) is becoming a state-significant information system (IS), which is capable of solving any problems of preserving and strengthening the health of citizens. Purpose of the study is to substantiate the problems of the construction and functioning of the Unified State Health Information System, the solution of which will multiply the capabilities of the Unified State Health Information System to solve the problems of preserving and strengthening the health of citizens and look for new non-traditional ways to improve their health. Results. I n the article, the authors distinguish three levels of problems to be solved. The first level of problems is problems that can be solved at the highest (legislative) level. The second level of problems is the problems that must be solved at the regional level. The third level of problems is the problems faced by ordinary users of the Uniform State Health Information System – doctors and other medical workers. The article initially uses the position – “Any information system is a tool for solving management problems.” The authors trace the stages of creating informatization in the Russian Federation from the complex program “Development and implementation of automated consultative systems for diagnosis, prognosis and choice of treatment tactics in emergency conditions”, which substantiated the development of automated systems for the period 1978–1990 until 2018, when Russia was the National Healthcare Project was launched, which includes the Federal project “Creation of a unified digital circuit in health care based on the unified state health information system (Unified State Health Information System) ”. The article discusses the problem of the privacy of data on the health of a resident of the region and the privacy of knowledge of the factors that determine both the health of a particular resident of the region and those around him. Preserving the complete privacy of a citizen’s “personal space” will lead to the fact that the Unified State Health Information System will have the most general data on the health of a resident of the region. In this case, it will only be possible to solve those problems that characterize the health of the region’s inhabitants, which were solved without any digitalization. The second level of problems is associated with the work of “Uniform State Health Information System” and support programs operating at the level of the regional health care system. The main regional problems associated with “EGISZ” are: problems of licensing of auxiliary programs; problems of accounting for the quantitative parameters of the development of the Uniform State Health Information System and auxiliary programs; problems of control over the work of auxiliary programs; problems of control over the filling of the Uniform State Health Information System; the problem of “user-friendliness of the interface” (especially for departments with cases of “peak work” – emergency departments). Separately, it should be noted the issues that are not problems of the functioning of the Uniform State Health Information System, but more characterize the new opportunities that arise in the presence of the Unified State Health Information System, which has a wide range of knowledge about human health. Uniform State Health Information System allows to solve in a different way the traditional tasks of an informational, organizational, medical, economic, scientific and educational nature that exist in the region. The noted fact prompts to look for new problems of assessing the health of residents of the region and ways to solve them, which were previously unavailable due to the lack of systematized data on the treatment and diagnostic process, other aspects of the activities of medical organizations, as well as information on factors affecting the health of residents of the region. Conclusions. Any information system is a tool for solving management problems. Without eliminating the problems of replenishing the Uniform State Health Information System with data on the factors influencing the health of the inhabitants of the region, it is impossible to effectively solve the problems of preserving and strengthening the health of the citizens of the region. The data, which, in accordance with the Federal Law “On Personal Data”, are included in the list of closed data, are encrypted in the EGIZS. To oblige the regional health authorities to introduce a licensing mechanism for programs interacting with the regional Unified State Health Information System. The development of regional Uniform State Health Information System will lead to a radical change in the view of the traditional tasks of information, organizational, medical, economic, scientific and educational nature, solved in the region.

A model for measuring distruption risk in the prefabrication supply chain

Use of prefabrication in construction projects is increasing due to the benefits in cost, time, quality, and safety. However, utilizing prefabrication introduces uncertainties inherent with the supply chain of the process. These uncertainties, if not managed, can disrupt the prefabrication process and result in schedule delays and cost overruns. This study proposes a model to measure disruption risks in the prefabrication process. The model was used in measuring the disruption risks of prefabrication of headwalls in patients’ rooms for a healthcare project as a pilot study. The risk model could successfully identify the disruption risks originating anywhere in the supply chain based on input information such as required material quantity, batch sizes of material deliveries, production rates, and batch sizes of transporting the headwall units. Using the model, the project team identified two uncertainties that could lead to possible disruptions: the start of the prefabrication processes and the required production rate to meet the on-site schedule. This is a first step to developing a risk exposure model that can prove valuable to the risk managers to analyse and manage the impact of disruptions. This will help the risk managers in making informed decisions about where to focus their limited resources.

Russian healthcare system digitalization: Opportunities and contradictions

The article is devoted to the opportunities and key contradictions of the Russian state healthcare system digitalization project implementation. The authors analyze various aspects of the system digitalization algorithms in light of the federal project “Creation of the Single Digital Circuit in Healthcare based on the Unified State Health Information System”. The aim of the article was to identify problems within goal-setting, documentation development, and practical implementation of the healthcare system digitalization project, as well as to come up with proposals for eliminating these issues. The analysis showed the inefficiency of the expensive healthcare system digitalization project, which has both objective and subjective reasons for its low effectiveness. The authors come to the conclusion that it is necessary to eliminate a number of contradictions and barriers in the framework of the project implementation in order to increase the efficiency of both the healthcare system itself and the high budget federal project of the economy digitalization as a whole. The practical significance of the article consists in the applicability of proposed approach to making the necessary amendments to the current federal project documentation, which will ensure a focus on real needs within the framework of the initiative implementation. The work may be of interest to civil servants, initiators of projects on the healthcare system digital transformation, governmental bodies, healthcare organizations managers, students, and practitioners.

Health Seekers’ Acceptance and Adoption Determinants of Telemedicine in Emerging Economies

This study investigates health seekers’ acceptance and adoption determinants of telemedicine services in a rural public hospital setting in an emerging economy using an adapted, extended Technology Acceptance Model. The present study pursued synthesising a plethora of existing literature and contextualised the significance of seven broad categories of potential determinants that significantly affect patients’ acceptance and adoption intentions: perceived usefulness, perceived ease of use, self-efficacy, service quality, privacy and data security, social influence, and facilitating conditions. The partial least square structural equation modeling technique was employed to test the conceptual model and research hypotheses. A cross-sectional survey was administered among 500 telemedicine users in randomly selected rural and remote areas of Bangladesh. Excluding self-efficacy and ease of use, five determinants expressively contributed to patients’ acceptance of telemedicine adoption, explaining 65% of the variance (R2) in behavioural Intention. The empirical findings have the quality of rigour obtained from rich data sets in health informatics and can contribute to build telemedicine into an institutionalised health infrastructure in Bangladesh and similar settings. Pertinent implications, limitations and future research directions were recommended to secure the long-term sustainability of telemedicine healthcare projects.

Utilization of Lean & Six Sigma quality initiatives in Indian healthcare sector.

PurposeThe purpose of this paper is to investigate the utilization of Lean & Six Sigma quality initiatives in healthcare sector in India.MethodologyThe survey questionnaires were sent to 454 hospitals through registered postal in all the states of India. The survey questionnaire was designed to assess different quality initiatives; currently implemented in Indian hospitals, factors align with organization’s objectives, reasons for not implementing Lean & Six Sigma and contribution of Lean & Six Sigma projects in healthcare improvement projects etc. A separate section in the questionnaire provides the feedback on implementation of Lean & Six Sigma in various hospitals. The relationships between Lean & Six Sigma and healthcare performance have also been established in this paper.FindingsIt is found that 15 Nos. of hospitals have implemented the Lean tools while 14 Nos. have implemented the Six Sigma tools out of 109 collected responses. This shows the utilization of Lean & Six Sigma in Indian healthcare sector. The ‘Lack of knowledge’ and ‘Availability of resources’ are the major reasons for not implementing Lean & Six Sigma. It is also observed that 22% running projects were related to Lean & Six Sigma out of various improvement projects running in various hospitals.OriginalityThere is lack of evidences of similar studies that determines the utilization of Lean & Six Sigma in Indian healthcare sector at the national level. This paper will provide important breakthrough to academicians and healthcare practitioners, who are involved in Lean & Six Sigma research.Social implicationsThe present study will create awareness among healthcare practitioners across India for utilization of quality tools that will provide direct benefits to the society.