As malpractice liability increases, physicians order more and more diagnostic tests/procedures to avoid potential lawsuits. Given the waste/costs of defensive medical practices, some U.S. states enacted tort reform to reduce malpractice liability. As key healthcare providers, hospitals face significant malpractice liability. Despite the fact that a vast amount of medical malpractice occurs in hospitals, the effects of tort reform on hospital performance have not been studied. This study examined tort reform’s effects on four hospital cost/efficiency related measures (defensive medicine (DM) costs, occupancy rate (OR), operating cost (OC), and full-time equivalent (FTE) employees/bed) and two patient-centered measures (experiential quality (EQ) and patient satisfaction (PS)). Considering both cost and quality measures enabled an examination of whether a trade-off arises under tort reform – a trade-off uniquely relevant at the hospital-level. The research applied difference-in-differences (DID) methodology to longitudinal data from multiple sources and addressed methodological weaknesses in prior studies preventing causal attribution. The results showed that tort reform reduced DM costs, with an average savings of $372 per patient stay and a savings of $238 million for an average-sized hospital, decreased hospitals' OC, with an average savings of $664 per patient stay and $4.23 million for an average-sized hospital and is associated with 0.22 fewer FTEs per bed. However, tort reform’s reduction in OR was not statistically significant. The findings indicate that conclusions drawn from single medical specialty studies do not necessarily translate to hospitals with a full spectrum of healthcare services. With respect to the patient-oriented measures, experiential quality and patient satisfaction fell by 3.53% and 5.63%, respectively. The study is particularly germane given the challenges hospitals face in meeting both the cost and quality mandates of the Affordable Care Act’s (ACA’s) Value-based Purchasing (VBP) program and provides valuable insights for policymakers (at both government and hospital levels) for improving hospital performance.

In the context of healthcare systems, evaluating hospital performance usign appropriate quantitative models is essential. This paper introduces a novel approach for assessing hospital performance in uncertain environments. In this study, we applied an additive star network data envelopment analysis (star-NDEA) model to evaluate the interdepartmental efficiency of 26 hospitals whithin Isfahan University of Medical Sciences (MUI) using visual analytis tools. The analysis, based on data from 2019 to 2022, utilized 44 indicators (12 inputs, 17 outputs, 14 links), which were carefully selected as model variables. The relevance and suitability of these indicators were assessed through a systematic two-stage process, RESULTS: This study indicated that the additive star-NDEA model identifies the specific sources of inefficiency and more accurately captures the inefficiencies of hospitals, reflecting the internal parameters of departmental-level performance evaluation. Across all the studied hospitals, the logistics department consistently had the highest efficiency score (approximately 0.9) among the eight departments evaluated over the four years. The highest efficiency scores for specific departments were recorded as follows: surgical inpatient wards in 2019 (0.64), imaging department in 2020 (0.56), clinic department in 2021 (0.59) and surgical inpatient wards again in 2022 (0.63). In contrast, the departments with the lowest efficiency scores were, the internal inpatient ward in 2019 (0.43), the clinic department in 2020 (0.33), and, the imaging department in both 2021 and 2022 (around 0.40). Overall, the efficiency scores derived from additive star-NDEA model were lower than those obtained using the classical additive DEA model. The model presented in this study is well-suited for assessing the efficiency of hospitals and their internal departments. These findings highlight the importance of hospitals adopting advanced quantitative models to improve to enhance performance, optimize resource utilization, plan targeted interventions, improve service delivery and ultimately increase overall technical efficiency.

Background The China National Stroke Screening Surveys (CNSSS), a decade-long national public health initiative, aims to reduce stroke morbidity and mortality through early detection and intervention. This study develops a novel evaluation model to systematically assess the performance of base hospitals (BHS) participating in the CNSSS program in Sichuan Province, China. Methods Sixteen BHS in Sichuan Province participated in the CNSSS program in 2024. We utilized eleven performance indicators to develop the evaluation model. Subjective weights were derived from scores assigned to indicators, while objective weights were calculated using the Entropy Weight Method (EWM). A Multiplicative Synthesis with Normalization (MSN) method was adopted to generate combined weights. Based on the subjective, objective, and combined weights, we generated weighted data matrices, determined the corresponding BHS rankings separately, and compared BHS performance in CNSSS implementation across these three ranking systems. Results Among the evaluation indicators, Task Completion Rate received the highest subjective weight (0.3125), whereas Intervention Rate dominated both objective (0.1594) and combined (0.2303) weights. Notable weight changes were observed: Task Completion Rate exhibited the largest reduction (−92.45%) from subjective to objective weights, followed by Age Deviation Degree (−76.11%), Follow-up Completion Rate (−73.31%), and Hypertension Awareness Rate (−3.31%). Conversely, Diabetes Detection Rate displayed the most significant increase (+313.65%), followed by Dyslipidemia Detection Rate (+249.44%), Hypertension Detection Rate (+227.79%), Stroke High-Risk Detection Rate (+119.52%), Stroke High-Risk Intervention Rate (+107.90%), Intervention Rate (+48.77%), and Risk Factor Control Rate (+42.52%). BHS A and B ranked top 3 across all weighting methodologies. BHS A ranked first under original, subjective and combined weights, while BHS D led in the objective ranking. Compared to the original methodology, the combined weighting methodology has the highest discrimination degree (0.1166). Conclusions Weighting methodologies significantly influence BHS performance evaluations. Subjective approaches emphasize expert expertise, whereas objective methods prioritize data variability. Compared to single weighting method, combined weighting effectively balances discrepancies between expert subjective priorities and data-driven objectivity, thereby addressing limitations of single-method designs. For the CNSSS program, our model underscores the need to shift quality focus from high-risk screening to targeted management, including timely post-screening interventions and effective risk factor control. These targeted interventions are expected to significantly reduce stroke incidence, recurrence, and mortality among screened populations, while enhancing the overall quality of the CNSSS program in the region.

Plumbing systems are a critical infrastructure in hospitals, directly linked to hygiene, patient care, and operational efficiency. At Muhimbili Orthopaedic Institute (MOI), frequent plumbing failures, leakages, and service interruptions have affected effective service delivery due to inadequate maintenance practices. This study aimed to develop a comprehensive maintenance management model designed to enhance the performance and reliability of the plumbing system at MOI. The research employed a mixed-methods approach using structured questionnaires distributed to 48 MOI technical staff, comprehensive field assessments, and detailed analysis of maintenance records spanning five years (2019-2024). Data collection included systematic plumbing condition surveys, stakeholder interviews with facility managers and maintenance personnel, and economic analysis of maintenance costs and system downtime impacts. Research results showed that ageing infrastructure (RII=0.80), proper installation techniques (RII=0.78), lack of skilled personnel (RII=0.75), high user population (RII=0.74), and environmental conditions (RII=0.73) were primary factors contributing to poor plumbing system performance. A detailed maintenance management model was developed combining these dependent and independent variables through multiple linear regression analysis. Statistical validation included residual analysis, multicollinearity testing, and cross-validation procedures to ensure model robustness. The regression model achieved an R² value of 0.717, explaining 71.7% of the variance in plumbing system performance. Model validation using Mean Absolute Error (MAE) of 7% confirmed its predictive accuracy and practical applicability for hospital settings. The study concludes that implementing the proposed model can reduce system failures by 35%, minimise leakages by 40%, extend the lifespan of plumbing systems by 25%, and increase overall efficiency while reducing annual maintenance costs by an estimated 30%.

To construct a quality evaluation indicator system for intravenous therapy nursing and identify deficiencies in clinical practice. Based on the structure-process-outcome framework, we developed through literature review, semi-structured interviews, and Delphi consultation (n = 22 experts). We used the analytic hierarchy process determined indicator weights. Validation included an empirical evaluation across 30 public hospitals using TOPSIS and RSR methods. The finalized system comprises 3 first-level, 15s-level, and 49 third-level indicators. Expert authority coefficients were 0.903/0.898; Kendall's W = 0.321/0.329 (P < 0.01). Hospital performance: total score = 84.09 ± 8.63 (structure = 14.90 ± 2.73; process = 33.77 ± 4.39; outcome = 35.42 ± 2.95). TOPSIS-RSR analysis identified H13, H3, and H27 as top performers and H4, H1, and H20 as needing improvement. The validated system effectively identifies clinical weaknesses and provides actionable insights for quality enhancement. Not applicable.

This study aims to analyze the influence of transformational leadership, digital transformation, supply chain collaboration, and innovation on collaborative advantage and the performance of type C hospitals in Java, with government subsidies as a moderating variable. Using a quantitative approach and PLS-SEM analysis on 50 hospitals, the results show that most direct relationships between variables are insignificant, except for the influence of innovation on collaborative advantage and the influence of collaborative advantage on hospital performance, which are proven to be significant. In addition, government subsidies only play a significant role in strengthening the relationship between supply chain collaboration and collaborative advantage. These results confirm that collaborative advantage is a key factor in improving hospital performance, with innovation as its main driver. Meanwhile, transformational leadership and digital transformation have not shown a strong direct influence due to bureaucratic limitations and implementation readiness. These findings also indicate that government subsidies are more effective in the early stages of establishing collaborations, rather than directly improving performance. This study highlights the importance of external collaboration strategies and innovation in improving the competitiveness of public hospitals, as well as the importance of adapting global theories to the local context in developing health policies in Indonesia.

The purpose of this literature review is to identify Conflict Management factors on Team performance and conflict management solutions in the nursing workplace, and the variables that influence the success of conflict resolution. The results of the study indicate that conflict in the workplace is often caused by differences in interests, ineffective communication, and high work pressure. However, with the implementation of appropriate conflict management strategies, such as open communication, fair mediation, and strengthening a collaborative work culture, conflict can be transformed into an opportunity to improve team dynamics and innovation. Good conflict management also contributes to creating a more harmonious work environment, increasing job satisfaction, and strengthening employee loyalty to the organization.

Background: Failure to rescue (FTR), or death after a surgical complication, is an important indicator of surgical quality and outcomes. The likelihood of FTR is closely associated with the hospital in which surgery took place, even when accounting for patient-specific characteristics. As a result, FTR is considered a primary driving factor explaining differences in postoperative surgical mortality between institutions 1 suggesting that FTR may be a function of different hospital processes of care. It's been shown that socioeconomic distress, as measured by the Distressed Community Index (DCI), is in fact associated with FTR in cardiac surgery. 2 Research Question: The study objective was to examine the association between DCI and FTR in a diverse, multi-institutional cardiac surgical network. Methods: A total of 40,661 patients undergoing one of the seven index cardiac surgical operations across 12 affiliate institutions from 2012-2019 were included. Of these patients, 5,229 experienced at least one of the following complications: prolonged ventilation, stroke, renal failure, or unplanned reoperation. The primary outcome was FTR, defined as operative mortality in patients experiencing one of these complications. Socioeconomic distress was determined using the DCI score (0-100) by zip codes. Multivariable mixed-effects logistic models assessed the association of DCI with FTR while adjusting for patient risk using the Society of Thoracic Surgeons (STS)-PROM score with hospital as a random effect. Results: Patients from the most socioeconomically distressed communities had higher unadjusted rates of complications (16.2% vs. 10.8%, p&lt;0.001) and FTR (19.6% vs. 14.5%, p=0.0167) compared to those from the least distressed communities ( Figure 1) . However, after adjusting for STS-PROM, patient DCI was not significantly associated with FTR. Additionally, hospital neighborhood socioeconomic distress was not correlated with hospital-level FTR rates ( Figure 2) . Notably, patients treated at hospitals in the highest DCI neighborhoods had lower risk-adjusted FTR rates compared to those treated in hospitals in more affluent areas ( Figure 3) . Conclusions: In this multi-institutional study, socioeconomic distress was associated with higher unadjusted FTR rates but not with risk-adjusted FTR. Moreover, hospitals in more distressed neighborhoods demonstrated lower FTR rates, underscoring the importance of hospital processes of care in mitigating socioeconomic disparities.

Background: While predictive models that leverage artificial intelligence (AI) have been proposed to improve clinical outcomes, it is essential to examine the current landscape of their dissemination and integration at US hospitals. Aim: To evaluate the national patterns of use of AI-enabled prediction tools at US hospitals, and their association with hospital features and performance on cardiovascular outcome measures. Methods: We leveraged the 2023 American Hospital Association (AHA) Annual IT Supplement. This included a national survey of US hospitals querying whether hospitals use EHR-integrated AI predictive models in care processes. We used AHA survey to identify a range of hospital characteristics, and linked the data to the CMS Hospital Quality Reports (2020–2023) to evaluate whether hospitals adopting these technologies represented those leading or lagging in cardiovascular performance measures, including risk-standardized 30-day mortality and readmission rates for acute myocardial infarction (AMI) and heart failure (HF). To assess these relationships, we used multivariable linear regression models adjusting for hospital characteristics. Results: Among 2,885 hospitals in the AHA IT Survey, 1,085 (37.6%) reported using EHR-integrated AI-based predictive models, while 866 reported using only non-AI tools. The most common clinical applications of AI included predicting inpatient health trajectories (97.2%) and identifying high-risk outpatients for follow-up care (91.6%) ( Figure 1 ). AI use was highest among hospitals with bedsize ≥300 (44.3% vs 37.2% in &lt;100 beds), those located in the Northeast (42.5% vs 33.3% in the West), teaching (52.2% vs 36.2% non-teaching), and private hospitals (40.9% vs 23.1% government owned) ( Figure 2 ). Hospitals with integrated AI technology, on average, reported a lower 30-day mortality rate for both AMI and HF, as well as modestly lower readmission rates for HF, but not AMI ( Figure 3A ). Hospitals reporting use of AI tools specifically for outpatient follow-up and treatment recommendation had lower readmission rates for both AMI and HF ( Figure 3B ). Conclusions: Only a 3rd of US hospitals that participated in a national survey about health IT reported the use of EHR-integrated AI tools, with differential uptake across hospitals and use cases. There is a need for a national strategy to integrate and monitor health AI care systematically.

Despite extensive research on Human Resource Development (HRD), few studies have examined how socio-demographic factors influence the effectiveness of HRD practices on employee performance in private hospitals within emerging healthcare systems. This study investigates the relationship between HRD practices and employee performance at Assured Best Care Hospital, using a descriptive–correlational design with 50 participants selected through simple random sampling. Data were collected using a structured questionnaire and analyzed with SPSS. Results reveal no significant difference in performance across educational levels (p = .629) and tenure groups (p = .230), yet positive correlations were found between updated training (r = .48, p &lt; .05), supervisor support (r = .45, p &lt; .05), learning climate (r = .43, p &lt; .05), and career growth opportunities (r = .41, p &lt; .05) with employee performance. These findings support the Human Capital Theory and Social Exchange Theory by demonstrating that HRD enhances performance through capability building and reciprocal motivation. The study extends HRD scholarship by contextualizing these mechanisms within resource-constrained hospital settings. Practically, the results emphasize the need for continuous, competency-aligned training, effective coaching, and transparent career development to sustain engagement and performance. The findings inform hospital administrators about the strategic importance of HRD in achieving service excellence.

ABSTRACT This study explores the unique dynamics of Karen’s Diner, a themed restaurant that subverts traditional hospitality norms by centering deviance as a performance spectacle. Rather than positioning customers as the focus of hospitality, Karen’s Diner invites them to participate in a scripted inversion of frontstage and backstage behaviours. The findings reveal how this commodification of deviance relies on the interplay between performativity and kayfabe, where customers co-create the experience through a shared social contract of deviance admiration. However, deviations from this script – whether excessive or inconsistent – can lead to customer dissatisfaction, underscoring the delicate balance required in such service models. By examining the tensions between hospitality norms, performance, and consumer expectations, this study not only extends the literature on themed restaurants but also raises important questions about the viabillity of such extreme service concepts in a competitive hospitality market.

Introduction: Nursing services are a key determinant of healthcare quality and significantly influence patient satisfaction, especially among BPJS (Indonesia’s National Health Insurance) users. Inadequate nursing care has been associated with low satisfaction levels, impacting service utilization and hospital performance. Objective: This study aimed to examine the relationship between nursing services and patient satisfaction among BPJS users in the polyclinic of Dr. A. Dadi Tjokrodipo Regional General Hospital, Bandar Lampung. Method: A quantitative approach with a cross-sectional design was employed. The population included all BPJS patients in the polyclinic room in 2024. A purposive sampling technique was used to select 99 respondents who met the inclusion criteria. Data were collected using a validated structured questionnaire and analyzed using univariate and bivariate statistical methods, including the Chi-square test. Result: The majority of respondents rated the nursing services as good and expressed satisfaction with the services received. Among those who perceived nursing services as good, most reported being satisfied. Conversely, patients who perceived the services as not good tended to be dissatisfied. A significant relationship was found between nursing services and patient satisfaction (p-value = 0.000). Conclusion: There is a significant association between the quality of nursing services and the level of patient satisfaction among BPJS users. Improving nursing care is essential to enhance patient experiences and promote service utilization. Future studies should explore other contributing factors such as patient feedback, infrastructure, and facility availability to provide a more comprehensive understanding of healthcare quality determinants.

This study explores how Green Human Resource Management (GHRM) practices influence the performance of hospitals. It looks at several key areas, including green HR techniques, policies, and philosophies; the attitudes and roles of HR professionals toward environmental issues; and the development of a green organizational culture. The goal is to understand how these practices enhance hospital efficiency, employee satisfaction, and environmental sustainability. To gather data, the researchers used both surveys and interviews, collecting responses from 350 employees across six hospitals: both public and private. The findings reveal a strong positive relationship between GHRM practices and improved hospital performance. Among the various initiatives, digital HR systems, such as paperless operations, received the most support. While recycling and energy-saving efforts are present, they are not as widely implemented. Many hospitals also try to recruit employees who value environmental responsibility. However, the study also notes several challenges, including limited budgets, hectic work schedules, and insufficient managerial support for green initiatives. To address these issues, the researchers recommend that hospitals strengthen their GHRM policies, provide more environmental training, and foster a culture that embraces sustainability at all levels. This research is especially significant because it highlights GHRM practices within Oman’s healthcare sector, an area that has received little attention so far. Moreover, it offers practical guidance for hospitals aiming to contribute to Oman’s Vision 2040, particularly in achieving sustainable development goals.

Globally, healthcare has experienced unsustainable cost inflation. Therefore, innovative approaches must be considered to curb these ever-increasing costs. Hospitals, which play a central role in every healthcare system, contribute significantly to cost increases, largely through the acceleration of operational complexity. Such evolutionary phenomena have rendered Hospital Performance Assessments (HPA) vitally important to healthcare leaders, health service researchers, and policymakers, especially amid the current global revolution in value-based payments. This study aimed to examine the growing importance of HPA in hospital and healthcare system management and to propose the development of a comprehensive HPA framework. We conducted a comprehensive literature review considering the historical and current frameworks and operational HPAs. This includes an overview of the most common quantitative methods, global and national health databases, and methodological integration into hospital performance assessments. We propose a new comprehensive framework to develop more effective HPAs. This study proposes a comprehensive framework that captures the intricate complexities of healthcare evolution that encompasses service area attributes, Hospital Attributes, the Organizational Processes and Managerial Technologies in place, and the measured Domains of Hospital Performance. There is a critical need to develop innovative HPAs and associated assessment frameworks to facilitate researchers and leaders in studying and managing healthcare systems worldwide.

ObjectiveThe purpose of this study was to assess the quality of 11–14-week fetal ultrasound images and physician scanning performance in a large general hospital to inform future quality improvement initiatives.MethodsA retrospective audit of ultrasound scans of normal fetuses at 11–14 weeks was conducted from November 2021 to March 2023 at a large tertiary general hospital in Beijing, China. Ten anatomical views were analyzed by two experienced assessors. Scan completeness and view completeness rates ≥ 70%, and logbook quality scores ≥ 42 (i.e., ≥ 70% of the maximum possible score), were considered acceptable.ResultsThe overall scan completeness of 256 logbooks was 77.4%. The scan completeness of 189 logbooks (73.8%) was acceptable. The median image quality score for the 256 logbooks was 37 (interquartile range, 28–46), and 96 logbooks (37.5%) had acceptable image quality, with a score ≥ 42. The scan completeness of 23 sonographers (63.9%) was > 70%. Sonographers with intermediate titles performed a higher average number of fetal ultrasound scans than those with senior titles (148 vs. 115 scans), and their scan completeness and logbook image quality scores were also superior (87% vs. 69% and 43.24 ± 6.38 vs. 31.62 ± 11.28, respectively; both p < 0.05).ConclusionThe majority of sonographers met the expectations of the audit. Sonographers performing more fetal ultrasound scans may have an advantage in terms of scan completeness and image quality.

Abstract Introduction Leicester Hospitals admit over 850 cases of fragility hip fracture annually. 25% of patients will suffer another fracture in the 5 years following their fragility hip fracture. Intravenous Zoledronate is recommended as a first line treatment option to reduce fracture risk. In 2023 our hospitals performance in the National hip fracture database (NHFD) showed we were significantly below the national average in secondary fracture prevention and patient follow-up at 120 days. (UHL data 2023 24.9% vs. national average 45.3%). This project sought to embed the use of intravenous zoledronate in our perioperative pathway and improve 120 day follow up. Method Introduced a new guideline for rapid loading of Vitamin D and administration of intravenous Zoledronate. Conducted teaching sessions and disseminated our guideline with all stakeholders. A standardised checklist was introduced and Royal Osteoporosis Society patient information leaflets given to all patients. Utilised our hospitals new text messaging system (accuryx) to design a post discharge questionnaire to explore patients’ experience of our service. Results Our data from the NHFD has shown a significant improvement from 24.9% of patients in 2023 receiving appropriate bone protection treatment to 69% in 2025. Utilising accuryx we have gained valuable feedback from patients with a response rate of 27%. Conclusion Changing practice required education of staff and the introduction of a new guideline into our established pathway. Patients treated with zoledronate should have a significant reduction in risk of further fractures. Feedback from patients has highlighted areas in need of improvement and that further work is needed to interact with patients who are unable to complete the 120 day text follow-up service.

This study examined the relationship between nursing interventions and patient recovery rates in tertiary hospitals in Maluku, Indonesia. Using a quantitative correlational design, data were collected from 210 inpatients selected through stratified random sampling across medical, surgical, and intensive care units. Nursing interventions were categorized into clinical, educational, and psychosocial activities, while recovery rates were assessed through clinical progress indicators such as length of stay, complications, and discharge status. Data analysis using Pearson correlation and multiple regression revealed significant positive relationships between nursing interventions and patient recovery (r = 0.54, p &lt; 0.001), with clinical interventions emerging as the strongest predictor (β = 0.38, p &lt; 0.001). Variations in recovery outcomes across wards indicated that structured nursing practices contributed to higher recovery rates in surgical patients. The findings highlight that effective and contextually adapted nursing interventions play a strategic role in improving recovery outcomes, optimizing hospital performance, and strengthening healthcare systems in resource-limited regions. Strengthening professional competence, continuous training, and culturally responsive care is essential for enhancing recovery and ensuring sustainable health service delivery in Maluku’s tertiary hospitals.

In the corporate world, the business environment is necessitating organizations adopt strategic management practices that give them a competitive edge and lead to improved performance. Strategic management is practiced by every organization irrespective of the size or sector in which they operate. Organizational change is a necessary aspect of an organization’s long-term viability. It may involve transformations in the general culture, structure, and management system of the organization. A private hospital is an institution that provides patients with medical services on funds raised by the owners of entities and fees charged by those patients. The government was largely unable to provide adequate hospitals, resulting in a rapid rise in the number of private hospitals that were mushrooming across the country. It is expected that the services provided at these hospitals will be of high quality while the cost will remain fair as they compete for patients whose demands continue to grow. Not only do private hospitals face intense pressure, they also have to compete with government hospitals whose facilities seem to be improving and offering free treatment for various illnesses and conditions. Therefore, the paper largely focuses upon the various strategic management practices and performance of corporate hospitals in the select region and the methodology of the study is purely based on the primary data by conducting survey to examine the strategic management practices in association with performance of the corporate hospitals of the select region.

BackgroundThe excess readmission ratio (ERR) is currently used to determine penalties for hospitals with excessive readmission rates. To determine whether the effectiveness of alternative measures, such as the Risk-Standardized Readmission Rate (RSRR), or Excess Days in Acute Care (EDAC), or differences between paired measures, would provide comparable or superior assessments.MethodsA retrospective national study on readmission measures. This study analyzed national readmission data from 3,047 hospitals for the fiscal year (FY) 2022. We measured the agreements and disparity scores in hospital performance assessments, as well as the changes in penalty status between the paired readmission measures.ResultsThe ERR and RSRR measures showed a significantly high degree of agreement, ranging from 83.5 to 93.8% across the six applicable conditions/procedures. In contrast, marked differences emerged when comparing EDAC with ERR or RSRR, showing varying levels of disparities. If the EDAC measure were adopted, between 15.9 and 25.2% of hospitals would experience a change in their penalty status. Specifically, using EDAC would reduce financial penalties for 11.4–16.6% of small community hospitals and safety-net hospitals for at least one of the targeted conditions.ConclusionsThese findings suggest that integrating disparity scores into the current ERR-based measurement system could have significant implications for promoting equity and informing policy decisions. By doing so, the evaluation of individual providers and hospital care quality could become more comprehensive, insightful, accurate, and equitable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13690-025-01726-w.

Purpose The purpose of this work was to survey the current body of knowledge on Kaizen events (KEs) in hospitals, which hospitals may use as a Lean Production tool for continuous improvement (CI) in their operations. The study identifies key aspects related to hospital KE practice, the improvement tools applied and the beneficial outcomes achieved. The results can be utilized by hospitals that apply Lean continuous improvement in their pursuit of operational excellence (OE). Design/methodology/approach A systematic literature review (SLR) was conducted to evaluate the current body of knowledge, resulting in an assessment that characterizes the critical content aspects of the research domain. Three primary databases were surveyed for relevant articles, including ProQuest, Web of Science (WOS) and Engineering Village. Findings A total of 64 papers were identified through the SLR. The findings suggest that improvements resulting from KE interventions can support hospital operational goals, enhance stakeholder satisfaction and enhance clinical outcomes, including those related to delivering quality patient-centered care. Furthermore, standardizing practices within this research domain can significantly support the pursuit of OE in hospitals, particularly when leveraging management and improvement science methodologies and tools to generate knowledge and transfer learnings related to critical KE planning, implementation and performance sustainability. The extraction of critical insights to guide the formulation of standards for KE implementation and practice is expected to be of significant value in driving OE. Research limitations/implications This work utilized a limited number of databases (ProQuest, Web of Science and Engineering Village). Future studies could include additional databases, examine other dimensions of KE practice, explore other dimensions of KE-OE and address other key research questions to gain more comprehensive insights into the research topic. Originality/value This study comprehensively evaluates KEs in hospitals by applying a robust systematic process among three scholarly databases. The study seeks to advance the critical knowledge area, particularly for healthcare improvement practitioners, by identifying key hospital KE-OE elements, improvement tools and performance outcomes relevant to advancing hospital operations. The research offers informative insights for standardizing the implementation and practices of KE within hospitals, supporting OE. Advancing operational efficiency at many hospitals is highlighted in numerous success cases. However, the integration of OE with KEs in relation to advancing hospital operations remains underexplored.