ABSTRACT In Hong Kong’s higher education landscape, where traditional academic pathways prevail, recent reforms seek to address skills gaps and align vocational education with industry demands through the establishment of Universities of Applied Sciences (UASs). However, the adaptation of international UAS models to Hong Kong’s unique socio-economic context remains underexplored. While policy borrowing is widely discussed in the literature, there is a notable lack of systematic approaches for selecting and adapting role models in vocational higher education, especially for regions like Hong Kong. This study addresses these gaps by proposing a theoretically grounded framework for role model identification in higher education reform. The framework integrates Busemeyer and Trampusch’s Vocational Training Systems Typology with Steiner-Khamsi’s policy borrowing model. A comparative analysis of 13 countries, with a focus on South Korea and Finland, highlights the suitability of Statist Skill Formation Systems – characterized by strong state leadership and selective industry collaboration – for Hong Kong. The findings contribute to international policy borrowing discourse and provide actionable insights for overcoming societal stigma associated with vocational education. This research emphasizes the importance of context-sensitive solutions and outlines a pathway for developing Hong Kong’s UAS system in alignment with its dynamic socio-economic landscape.

Multidisciplinary practices in pediatrics clinics: A meta-synthesis of qualitative research.

Leave no one behind: An African perspective on the first World Health Organization Global Status Report on Drowning Prevention.

To classify Italian home care models based on structural characteristics, process factors and stakeholder perceptions. This is a secondary analysis of the AIDOMUS-IT multicentre cross-sectional study, conducted in Italy between July 2022 and December 2023. Data were collected via online surveys completed by 33 Local Health Authority Nursing Directors, home care nurses and patients. Hierarchical cluster analysis was used to classify different organisational models based on structural and process-related factors. Nurses' and patients' perceptions of care were described for each identified cluster. The analysis identified three distinct organisational home care models: The 'multidisciplinary model', in which nurses reported high dissatisfaction due to organisational complexity and excessive workloads. In the 'nurse-centred model', characterised by publicly employed nurses, strong leadership, and a supportive work environment, patients reported high levels of satisfaction. The 'performance-based model', which operated with a lower nurse-to-patient ratio, reduced service hours, and greater reliance on external professionals. Nurses in this model reported high job satisfaction but also a greater intention to leave, while patient satisfaction was lower. This study underscores the importance of leadership, resource management, and a supportive work environment in influencing both job satisfaction and patient outcomes in home care settings. Policymakers could use these findings to refine care models and improve service delivery. Limited research has examined the organisational structures of home care services, which are important for professionals' organisational well-being, patient safety, and quality of care. This study identified three distinct organisational home care models that could be used to refine care approaches and improve service delivery. This study respects the EQUATOR guideline for observational studies (STROBE). This study did not include patient or public involvement in its design, conduct, or reporting.

There is much untapped potential for large-scale, community-based clinical trials in primary and community care; realising that potential is an important endeavour. To understand what steps lead to readiness for clinical trial delivery in routine practice in primary and community care. Scoping review of sources involving UK primary and community care settings and written in English. Three databases (Medline All, Embase and Web of Science Core Collection), grey literature and reference lists of relevant sources were searched for all types of literature available in English on the readiness of primary and community care within the UK to conduct clinical trials research. These sources underwent screening which was conducted according to relevance as judged by two independent researchers. Thematic analysis was then undertaken. Thirteen sources met the inclusion criteria. These sources covered a variety of primary and community care settings including general medical practice, general dental practice and carehomes. Themes identified for clinical trial readiness were: a supportive research culture, strong leadership, adequate infrastructure and targeted training, all underpinned by streamlined governance processes and appropriate incentives. This scoping review highlights that the readiness of primary and community care as a clinical research setting is shaped by a complex interplay of organisational, cultural, and structural factors. To realise the full potential, sustained investment and policy attention is needed to embed these elements into routine practice across diverse care environments.

One of the industries that is expanding is higher education, and it is seeing more and more competition. Strong leadership and the use of artificial intelligence technologies are viewed as the keys to raising higher education's effectiveness and competitiveness. In order to better understand how leadership, artificial intelligence, and higher education technology work together to improve higher education's competitive advantage, this study examines the relationships between artificial intelligence, leadership, and higher education competitiveness. It also takes into account the potential influence of higher education's performance as moderation. Using a sample of 250 students from five private higher education institutions in Bandung that provide recognized B Management study programs, this study employed the Purposive Sampling approach. SEM PLS (Partial Least Square) is the approach used for data analysis in this study. The findings demonstrate a strong, direct, and beneficial relationship between leadership and artificial intelligence and the effectiveness and competitiveness of higher education. It is anticipated that the study's conclusions will offer executives, employees, and practitioners in higher education insightful information. Finding the important variables that influence the competitiveness of higher education, such as the ways in which artificial intelligence and good leadership can work together, can help with strategic decision-making for the growth of long-lasting institutions.

<p>Social-emotional competence (SEC) refers to educators’ capacity to regulate emotions, sustain psychological resilience, and cultivate constructive relationships with students, colleagues, and school leadership. Elevated levels of SEC among teachers are strongly associated with enhanced well-being, emotionally supportive classrooms, and improved student engagement and achievement. Despite growing attention to SEC development initiatives, critical gaps remain regarding demographic variability in outcomes, optimal implementation strategies, and enduring institutional barriers. This systematic review, conducted in accordance with PRISMA guidelines, screened 1519 studies published between 2012 and 2024, yielding 16 peer-reviewed articles that met the inclusion criteria. Findings demonstrate that SEC interventions reliably enhance educators’ emotional regulation, mindfulness, and overall psychological well-being, irrespective of gender, professional experience, or cultural context. However, the long-term sustainability of these benefits is contingent upon enabling school environments, strong leadership, continuous professional development, and adequate resource allocation. Implementation challenges — including time constraints, inconsistent program fidelity, and varying levels of teacher readiness — underscore the need for adaptive, context-sensitive models. This review provides evidence-based recommendations for the effective design, integration, and sustained impact of SEC programs across diverse educational settings.</p>

Background/Objectives: University Department of Rural Health (UDRH) programs were created to address the disparities in rural Australian communities. A large proportion of Aboriginal and Torres Strait Islander people live in rural communities, and the UDRHs work closely with communities to improve outcomes for Indigenous Australians. This narrative review examines the nature of the intervention papers in Australian Indigenous health published by UDRHs and identifies key learnings to improve interventions in Australian Indigenous health. Methods: Intervention papers were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Thirty-three papers were included in the review. Thematic analysis identified four overarching themes from the key learnings identified in the papers: (1) principles of engagement and design; (2) considerations for improving healthcare systems; (3) considerations for improving healthcare workforce; and (4) the sustainability of interventions and improvements in outcomes. Most of the studies employed qualitative or mixed-methods designs. Conclusions: These findings provide practical guidance for strengthening Indigenous health interventions. Effective Indigenous health interventions require meaningful community engagement and co-design, culturally safe practice supported by workforce training, and multicomponent approaches that address social determinants and barriers to access. Sustained impact depends on adequate resourcing, strong organisation leadership and embedding programs within healthcare systems with clear pathways for ongoing care and capacity building. UDRHs should reflect on current and future projects to ensure that engagement principles, system-level considerations, health workforce development, and long-term sustainability are embedded within intervention design and implementation.

Purpose of the study: The purpose of this study is to analyze the causes and impacts of low competence among village officials from the perspective of knowledge mastery, skills, mental attitude, and leadership in Gebog District, Kudus Regency. This study also aims to identify the supporting and inhibiting factors affecting the performance and competency improvement of village officials. Furthermore, the research seeks to formulate strategic policies for improving and developing the competencies of village officials through a Fishbone analysis approach, in order to enhance the effectiveness of public services and administrative performance at the village level. Materials and methods: This study employed a qualitative descriptive research design to analyze the competence of village officials from the perspectives of knowledge mastery, skills, mental attitude, and leadership. The research was conducted in villages across Gebog District, Kudus Regency. Data were collected through in-depth interviews with key informants, including district and village government officials, village facilitators, local village assistants, and community members who utilize village administrative services. Informants were selected purposively based on their role and relevance to the research objectives. The collected data were analyzed using qualitative analysis supported by the Fishbone (cause-and-effect) diagram to identify root causes of competence-related problems, as well as supporting and inhibiting factors affecting performance improvement. Data credibility was ensured through triangulation of sources and techniques. Results: The results show that the low competence of village officials in Gebog District is influenced by both internal and external factors across the dimensions of knowledge, skills, mental attitude, and leadership. Supporting factors for competency improvement include government support, adequate budgeting, availability of technology and infrastructure, and strong leadership commitment. On the other hand, limited resources, resistance to change, insufficient development opportunities, and bureaucratic constraints hinder improvement efforts. The Fishbone analysis highlights the need for integrated strategies focusing on training and education, supervision and evaluation, incentive enhancement, bureaucratic reform, and the effective use of technology to improve overall competency. Conclusions: This study reveals that village officials' competencies are influenced by internal and external factors related to knowledge, skills, mental attitude, and leadership. Strengthening training, leadership commitment, and technological utilization are essential to improve performance, service quality, and sustainable governance effectiveness at the village level.

Purpose The Management System Standard ISO/IEC 17025 aims to enhance the performance, service quality, accuracy and credibility of measurements in accredited testing and calibration laboratories. This study focuses on modeling the critical success factors (CSFs) that contribute to the implementation of ISO/IEC 17025, categorizing them into cause-and-effect groups and determining their causal relationships to support successful adoption of the standard. The study also compares the viewpoints of technical personnel and laboratory managers to identify potential differences in how these expert groups form the underlying cause-effect structure of the CSFs. Design/methodology/approach To address the study objectives, Decision Making Trial and Evaluation Laboratory analysis was applied separately to the 2 groups of experts, using data from 23 questionnaires collected in Greece across three types of laboratories: civil engineering, chemical and calibration. The analysis focused on a set of CSFs, which were drawn from a classification developed through a systematic literature review and validated by domain experts. Findings The key causal factors for successfully implementing ISO/IEC 17025 include strong leadership and strategic commitment, motivation for accreditation, regulatory compliance, customer focus and adequate financial and organizational resources. These elements form the foundation for the successful adoption of the standard. Conversely, the primary effect factors (i.e. those that are driven by the causal factors) include the core technical requirements set by ISO/IEC 17025 – such as quality assurance and control, method verification and measurement traceability and technical resources – in addition to performance management and improvement. Comparing the perspectives of the two expert groups in the study, while both largely agree on the key cause-and-effect factors that optimize laboratory performance, they perceive the dynamics driving these relationships differently. Managers tended to emphasize the regulatory framework, customer needs, and strategic planning related to the laboratory's sustainability and financial objectives. In contrast, technical personnel placed stronger emphasis on the standard's technical aspects as the primary effect factors and highlighted leadership and motivation for accreditation as the most critical causal influences. Notably, the factor operational integrity and impartiality was identified as significant factors by both groups; however, technical personnel viewed them primarily as causal and mediating factors, while managers considered them mainly as effect factors. The overarching conclusion of this study is that accreditation alone does not ensure a laboratory's credibility, as the technical requirements of ISO/IEC 17025 are influenced by a combination of managerial factors, as well as organizational integrity and independence. Practical implications The findings of this study encourage laboratory management to treat ISO/IEC 17025 as a strategic framework rather than a technical checklist, emphasizing leadership commitment and the effective allocation of resources to support reliable measurement results. Social implications Public policymakers can use the insights of this study to refine regulatory oversight and procurement practices, reinforcing the independence and quality culture needed to protect public safety and the integrity of tested materials. Originality/value This study is the first to systematically model the CSFs for implementing ISO/IEC 17025 while also comparing the resulting structures between technical personnel and laboratory managers.

Purpose: The devolution of Governance in Kenya granted counties the authority to mobilize revenues from hospital to enhance public health care delivery. However, persistent disparities in health outcomes among Level 5 public hospitals raise concerns about the role of governance of hospital-generated revenue in health service delivery. This study investigated the influence of governance of internally generated revenue on delivery of health services in Kenya's Level 5 public hospitals, and examined the moderating effect of leadership principles on this relationship. Materials and Methods: A descriptive cross-sectional design employing quantitative data was used to collect data from 252 healthcare personnel across 13 Level 5 public hospitals in 10 counties in Kenya. Respondents included nurse practitioners, pharmacists, doctors, physical therapists, medical technologists, and administrators. Qualitative data was also collected from patients and key informants to corroborate the quantitative findings. Descriptive statistics and regression analyses were employed for quantitative data analysis. Findings: The findings revealed a statistically significant but modest positive correlation between governance of hospital-generated revenue and healthcare service delivery, and a strong positive correlation between leadership principles and service delivery. Governance quality explained 25.3% of the variation in health service delivery outcomes when controlling for other factors. Critically, leadership principles significantly moderated this relationship, with strong leadership amplifying the positive effect of governance on service delivery, while weak leadership rendered governance efforts counterproductive. At mean leadership levels, governance showed no significant effect. Nonetheless, the study showed that challenges including operational inefficiencies, transparency deficits, and inequitable revenue allocation persist. Unique Contribution to Theory, Practice, and Policy: The study concludes that effective governance of hospital-generated revenue, when coupled with strong leadership principles and equitable resource allocation, is essential for strengthening healthcare infrastructure, sustaining services, and ensuring efficient, high-quality care. The study recommends strengthening transparency mechanisms, implementing tiered leadership development, adopting equity-weighted budgeting, and reforming revenue retention frameworks to optimise local revenue mobilisation and service delivery outcomes. Keywords: Governance of Hospital-Generated Revenue, Health Service Delivery, Devolution, Public Health Financing, Leadership Principles, Level 5 Hospitals, Kenya

This study explores primary school teachers’ perceptions of the implementation of the Independent Curriculum using a qualitative descriptive approach. The research was conducted in selected primary schools in Ciamis, Indonesia. Participants were purposively selected and consisted of teachers who had experience implementing the Independent Curriculum. Data were collected through semi-structured interviews and supported by observations and document analysis. Thematic analysis was employed to identify key patterns and meanings from participants’ experiences. The findings reveal that teachers generally hold positive perceptions of the Independent Curriculum, viewing it as a progressive reform that promotes instructional flexibility and student-centered learning. Teachers reported increased opportunities to address diverse student needs through project-based activities and formative assessment. However, significant challenges were also identified, particularly limited understanding of differentiated instruction, difficulties with authentic assessment, and increased administrative workload. These constraints often resulted in partial curriculum implementation. Institutional support emerged as a critical factor influencing teachers’ confidence and adaptability. Teachers who received continuous professional development and leadership support demonstrated greater readiness to apply innovative teaching strategies. In contrast, disparities in training opportunities and learning resources contributed to uneven implementation across schools. To address these challenges, teachers adopted adaptive strategies such as peer collaboration, joint lesson planning, and self-directed learning. The study concludes that while teachers largely embrace the philosophy of the Independent Curriculum, effective implementation requires sustained professional development, reduced administrative burden, equitable resource distribution, and strong school leadership. These findings highlight the importance of context-sensitive support systems to ensure meaningful curriculum transformation at the primary education level.

This study explores primary school teachers’ perceptions of the implementation of the Independent Curriculum using a qualitative descriptive approach. The research was conducted in selected primary schools in Ciamis, Indonesia. Participants were purposively selected and consisted of teachers who had experience implementing the Independent Curriculum. Data were collected through semi-structured interviews and supported by observations and document analysis. Thematic analysis was employed to identify key patterns and meanings from participants’ experiences. The findings reveal that teachers generally hold positive perceptions of the Independent Curriculum, viewing it as a progressive reform that promotes instructional flexibility and student-centered learning. Teachers reported increased opportunities to address diverse student needs through project-based activities and formative assessment. However, significant challenges were also identified, particularly limited understanding of differentiated instruction, difficulties with authentic assessment, and increased administrative workload. These constraints often resulted in partial curriculum implementation. Institutional support emerged as a critical factor influencing teachers’ confidence and adaptability. Teachers who received continuous professional development and leadership support demonstrated greater readiness to apply innovative teaching strategies. In contrast, disparities in training opportunities and learning resources contributed to uneven implementation across schools. To address these challenges, teachers adopted adaptive strategies such as peer collaboration, joint lesson planning, and self-directed learning. The study concludes that while teachers largely embrace the philosophy of the Independent Curriculum, effective implementation requires sustained professional development, reduced administrative burden, equitable resource distribution, and strong school leadership. These findings highlight the importance of context-sensitive support systems to ensure meaningful curriculum transformation at the primary education level

Purpose Entrepreneurs seek to increase their influence and foster consumer engagement by generating content on social media platforms that expresses certainty. However, the impact of the expressive certainty of entrepreneur-generated content (EGC) on consumer engagement is unclear. Through a field study and controlled experiment, this study aims to reveal how the expressive certainty of EGC affects consumer engagement. Design/methodology/approach The proposed research model was empirically tested by analysing the content generated by 220 entrepreneurs on Sina Weibo over the past four years and conducting a randomised controlled experiment in the laboratory. Negative binomial regression and an analysis of variance were used to examine the proposed research model. Findings The results show that the expressive certainty of EGC increases consumer engagement by influencing consumers’ perceptions of leadership. Specifically, EGC with a higher level of expressive certainty makes entrepreneurs appear more confident and powerful and leads consumers to perceive them as stronger leaders, thereby positively influencing consumer engagement. In addition, EGC with a higher level of certainty stimulates more positive consumer engagement when generated via mobile devices than when generated via non-mobile devices. The authors also found that the positive effect of perceived leadership on consumer engagement is moderated by power distance. Among consumers with high power-distance, the indirect effect of expressive certainty on consumer engagement is stronger. Research limitations/implications This study is subject to several constraints that could be solved through future research. Firstly, the field study only focuses on Sina Weibo, a well-known Chinese social media platform and the experimental study focuses only on Twitter, which may limit the generalisation of this research’s results to other social media platforms. Secondly, a more sophisticated approach to data analysis could be considered for future research to ascertain some of the most effective certainty words in EGC, such as text mining and machine learning. Finally, future research could examine the impact of EGC’s expressive certainty on other significant marketing effectiveness variables, such as consumer attitudes and brand loyalty. Practical implications The results suggest that using certainty in content is a way to help entrepreneurs project a high leadership profile. The positive impact of expressive certainty on perceived leadership suggests that entrepreneurs should use more certainty expressions on social media and other communication channels (e.g. brand launches) to make themselves appear more confident and influential, which is beneficial to stimulate consumer engagement with EGC. Specifically, entrepreneurs should generate more EGC with a higher level of certainty via mobile devices, as doing so will increase consumers’ perceptions of authenticity and trust in certainty information, increasing their engagement. Originality/value This study provides a valuable complement to previous research on information dissemination and consumer engagement on social media by exploring the mechanisms by which the expressive certainty of EGC and generating devices affects consumer engagement from the perspective of perceived leadership and indicates practical guidelines for developing EGC on social media.

ABSTRACT Political theology, as a means of legitimizing power structures, persists in contemporary Liberal systems. Liberalism can be seen as a civil religion committed to supposedly universal values and ideals (e.g., human rights, democracy, rule of law) while in reality producing inequality, suppressing genuine democracy and human rights, and masking power structures and their operations. The paper focuses on what appears as a paradox: the proclaimed Liberal opposition to autocracy, authoritarianism, and colonialism, alongside Liberal elites' support for colonial rule and the concentration of virtually absolute power in a single office – of the “High Representative” in Bosnia and Herzegovina – lacking any democratic legitimacy. Liberalism turns out to be an ideology hostile both to autocracy and democracy, sacralizing private property, promoting capitalism, privileging elites, and favoring technocratic, depoliticized management over democratic deliberation. Liberalism's drive to depoliticize politics fosters recurring calls for “strong leaders,” producing authoritarian decisionism in moments of crisis.

This paper examines how policy capacity shapes collaborative governance in mobility transitions through a qualitative case study of Delhi’s 2020 Electric Vehicle (EV) Policy. It addresses the policy problem of why collaborations around ambitious, high-visibility transition policies are difficult to sustain over time, despite strong early leadership and political support. This is important because governments increasingly rely on multi-actor arrangements to deliver low-carbon mobility, yet often overlook the underlying capacities required to maintain them. The study finds that collaboration in Delhi’s EV policy was initially enabled by strong analytical and political capacities concentrated in a small group of senior bureaucrats and an atypical state think tank, working closely with non-state knowledge organizations. These actors designed structured forums, attracted capable partners, and established early interest. Over time, however, limited operational capacity in line departments, fragmented and weakly organized industry representation, and missing systemic analytical capacities in road transport sector, eroded the collaborative momentum. The paper concludes that sustaining collaboration in emerging policy domains requires more than early champions and external expertise. It argues for deliberate investments in mid-level public managers within core agencies, stronger organization and analytical roles for industry and civil society, and the development of systemic data and research infrastructures. These recommendations speak directly to policymakers seeking to govern mobility transitions through durable, capacity-aware collaborative arrangements.

Financial sustainability of the matching grant-supported farming enterprise post-matching grant period for smallholder farmers has been a concern for both international development agencies and the government, considering the financial investment involved. This study explores how farmers and government implementers perceive and construct the sustainability of smallholder enterprises following the conclusion of matching grant support. Data was collected through semi-structured interviews and focus group discussions from 19 Participants consisting of farmers and government staff who participated in the implementation of the matching grant program in Chipili district of Zambia. The Participants were selected using purposive sampling, and the data were analysed using thematic analysis. Findings indicate that farmers’ constructions of sustainability are shaped by a combination of social, organizational, and economic factors, including Clearly Defined Tangible Benefits for members, Reliable Markets, Sense of ownership, Strong Leadership and Cohesive Group Dynamics, Effective Capacity Building and Knowledge Transfer, Proactive Reinvestment and Diversification, Robust Market Linkages, Value Addition, Meaningful beneficiary contributions, Financial Literacy, Post-Grant Mentorship and Continuous Support. The study underscores the importance of understanding sustainability not merely as a financial outcome but as a socially constructed process, influenced by collective practices, knowledge sharing, and an ongoing support mechanism. The study recommends that farming enterprise supported by the matching grant to be successful and sustainable post-grant, the Ministry of Agriculture should continue to offer post-grant mentorship, enhance market linkages, while international organisations should have a clear project exit strategy and sustainability plan agreed upon by both the government and farmers.

This research examines the perceived effects of digitalization on construction productivity in the Finnish construction industry. The study is motivated by the sector’s ongoing productivity challenges and the widespread expectation that digital tools can offer solutions. The aim of the paper is to assess the perceived benefits and challenges of digitalization in the Finnish construction industry by combining insights from literature with an online survey (n = 40) and semi-structured interviews (n = 10) with Finnish construction professionals. As the study is based on self-reported perceptions and experiences, the findings do not represent direct measurements of productivity outcomes. The findings reveal that digitalization is already perceived to deliver tangible productivity benefits, particularly through improved collaboration, enhanced quality, fewer errors and more effective project management. However, these benefits are not considered to be equally distributed among the stakeholders, highlighting uneven value distribution across the AEC value chain. On the other side, digitalization is perceived to have increased the workload and costs of the design phase, while contractors and clients benefit from the efficiency gains enabled by digitalization and advanced models. Challenges such as interoperability issues, poor data quality, lack of standards, skills gaps, and resistance to change continue to hinder adoption and full utilisation. Overall, benefits are not perceived to spring only from the adoption of digital tools, but from the integration of tools into more unified processes that require skilled professionals, clear standards, and strong leadership. The results also show that the benefits of digitalization are often considered to be indirect, stemming from process improvements rather than direct cost savings. The findings suggest that realizing the full potential of digitalization requires organizational leadership, a fairer distribution of benefits, systematic training, and industry-wide progress in standards and productivity measurement.

Purpose The objective of this study was to examine whether and to what extent Quality 5.0 approaches, with an emphasis in the study on the combination of advanced technologies, humanistic principles of leadership and sustainability, would influence key organizational outcomes. Whereas Quality 4.0 primarily focused on the role of automation and digital tools, Quality 5.0 is concerned with ethical use of artificial intelligence, staff commitment and engagement, along with associated responsibility to the environment, thus operating in close alignment with the Industry 5.0 framework. This study investigated the effects of three Quality 5.0 enablers – technological factors (TF), human-centric and managerial factors (HCMF) and sustainability and customer experience factors (SCEF) – on four outcome constructs: quality and performance outcomes (QPO), customer-centric outcomes (CCO), business and financial impact (BFI) and sustainability and ethical impact (SEI). Design/methodology/approach The study employs structural equation modeling (SEM) using SmartPLS to evaluate the relationships among Quality 5.0 variables. Data were collected through a structured survey administered across Indian organizations from diverse sectors, including manufacturing, services and education. Findings The results confirm that TF, HCMF and SCEF have a positive and significant influence on all four outcome variables (QPO, CCO, BFI and SEI). This demonstrates that the effective implementation of Quality 5.0 requires not just technological adoption but also strong leadership, employee engagement and sustainability-focused strategies. Research limitations/implications The results are contextually anchored in the Indian organization context and may impede the generalizability in other spaces; hence, the findings offer an empirical basis for practical application of Quality 5.0 initiatives for real-world quality management frameworks. The results suggest that technology in its own right is not sufficient and that the human and ethical dimensions play an essential role in quality transformation. Originality/value This study is among the first to propose and empirically validate an integrated Quality 5.0 framework. It contributes both theoretically and practically by linking digital, human-centric and sustainability drivers to multi-dimensional quality outcomes, offering organizations a strategic roadmap for responsible and future-ready quality management.

Background Globally, the 7-1-7 target (detect within 7 days, notify within 1 day, respond within 7 days) was introduced to improve outbreak response. South Sudan adopted the 7-1-7 framework in August 2023. This study aimed to describe the process and challenges of adopting the 7-1-7 framework, assess the performance of outbreaks in the animal and human sector against the 7-1-7 target, and explore the challenges for 7-1-7 adoption in humanitarian settings. Methods This mixed-methods study comprised a checklist-based assessment of 7-1-7 adoption at national and subnational levels, extraction of dates and bottlenecks from the 7-1-7 consolidated spreadsheet for outbreaks that occurred before (2013-July 2023) and after (August 2023-July 2025) 7-1-7 adoption, and in-depth interviews and focus group discussions among key stakeholders to explore the challenges in 7-1-7 adoption. Results 7-1-7 was successfully adopted at the national level and in four of ten states and three administrative areas, facilitated by strong leadership, and project funding and technical support from the 7-1-7 Alliance. Due to lack of funds, 7-1-7 was not adopted nation-wide. Data for applying the 7-1-7 framework was available in 9/25 (36%) and 9/9 (100%) outbreaks that occurred before and after adoption, respectively. None of the five outbreaks from the animal sector had complete data for assessing the target. Of 18 outbreaks assessed, 44% met all targets with 50%, 91% and 56% achieving detection, notification and response targets, respectively. Delayed health seeking, poor internet connectivity, and inadequate resources were bottlenecks for timely detection, notification, and response, respectively. Non-functional health facilities and competing priorities were major barriers to adopting the 7-1-7 framework in humanitarian settings. Conclusion South Sudan successfully adopted 7-1-7 at the national-level. Sustainable funding is required to expand 7-1-7 to all states, including humanitarian settings, establish a surveillance information system for the animal sector and improve timely outbreak response.