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The healthcare sector faces new financial and managerial accountability demands, along with their clinical accountability. Various studies show strong opposition by clinicians to new accountability tools, new structures and new ways of working. Less attention is paid to the innovative roles doctors can play in leading changes that use new managerial tools and techniques. The purpose of this paper is to analyse two original case studies illustrating how general practitioners (GPs) in Germany have led radical change.

The paper draws upon original research in Germany to present two case studies using a qualitative method, which are analysed using Glaser and Strauss' conventions of grounded theory, structured by Wenger's communities of practice framework, supporting a comprehensive literature review.

GPs are found to be able to lead radical change in healthcare delivery models and organisation using entrepreneurial talents developed in their practice businesses and to embrace modernising tools and techniques and in the process redefine their identities to include management process in addition to medical competences.

The paper presents two original case studies of radical change leading to an integration of healthcare services in Germany. The approach adopted by the German GPs reveals important general lessons for practitioners, as does the analytical framework employed in the paper.

This study explores how thinking infrastructures can orchestrate collective sensemaking in unstable and socially contested environments, such as large-scale humanitarian crises. In particular, drawing from recent interest in the role of artifacts and infrastructures in sensemaking processes, the study examines the evaluative underpinnings of prospective sensemaking as groups attempt to develop novel understandings about a desired but ambiguous set of future conditions. To explore these theoretical concerns, a detailed case study of the unfolding challenges of managing a large-scale humanitarian crisis response was conducted. This study offers two contributions. Firstly, it develops a theorization of the process through which performance evaluation systems can serve as thinking infrastructures in the collaborative development of new understandings in unstable environments. Secondly, this study sheds light on the practices that support prospective sensemaking through specific features of thinking infrastructures, and unpacks how prospective and retrospective forms of sensemaking may interact in such processes.

The purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland.

The authors utilized a qualitative research approach and conducted semi-structured interviews (n = 32) with study participants representing five different regions in Finland. Study participants were recruited using purposive and snowball sampling. All study participants had been in management and civil servant positions during the first year of the pandemic, representing municipalities, municipalities' social and healthcare services, hospital districts and regional state administrative agencies. All interviews were completed remotely from April to December 2021 and the recordings transcribed verbatim. The authors coded the transcripts in ATLAS.ti 9.1 using directed content analysis.

The findings highlighted a wide range of localized responses to the pandemic in Finland. Facilitators to health system resilience included active networks of cooperation, crisis anticipation, transitioning into crisis leadership mode, learning how to incorporate new modes of operation, as well as relying on the competencies and motivation of health workforce. The authors found several barriers to health system resilience, including fragmented organization and management particularly in settings where integrated health care systems were not in place, insufficient preparedness to a prolonged crisis, lack of reliable information regarding COVID-19, not having plans in place for crisis communication, pandemic fatigue, and outflux of health workforce to other positions with better compensation and working conditions.

Factors affecting health system resilience are often studied at the aggregate level of a nation. This study offers insights into what resilient responses look like from the perspective of local and regional actors in a decentralized health system. The results highlight that local capacities and context matter greatly for resilience. The authors call for more nuanced analyses on health systems and health system resilience at the sub-national level.

This study examines innovation configurations (i.e. sets of product/service, social and business model innovations) and configuration linkages (i.e. factors that help to combine innovations) across six organizations as contingent upon organizational structure.

Using semi-structured interviews and available public information, qualitative data were collected and examined using content analysis to characterize innovation configurations and linkages in three local/private organizations and three foreign-led/public-private partnerships in Repiblik Ayiti (Haiti).

Organizations tend to combine product/service, social, and business model innovations simultaneously in locally founded private organizations and sequentially in foreign-based public-private partnerships. Linkages for simultaneous combination include limited external support, determined autonomy and shifting from a “beneficiary mindset,” and financial need identification. Sequential combination linkages include social need identification, community connections and flexibility.

The generalizability of our findings for this qualitative study is subject to additional quantitative studies to empirically test the suggested factors and to examine other health care organizations and countries.

Locally led private organizations in low- and middle-income settings may benefit from considering how their innovations are in service to one another as they may have limited resources. Foreign based public-private partnerships may benefit from pacing their efforts alongside a broader set of stakeholders and ecosystem partners.

This study is the first, to our knowledge, to examine how organizations combine sets of innovations, i.e. innovation configurations, in a healthcare setting and the first of any setting to examine innovation configuration linkages.

Saudi Arabia's 2030 vision targets an increase of 34% in non-oil revenue participation in the GDP, thus the need for automation and digital transformation. The Company ER is a market leader producing high-quality dairy products in the Kingdom and is a pioneer in the production industry. The company has recently increased the capacity of its milk factory to meet its vision. An investment was made to automate the pallet handling procedures at the milk factory to provide increased production for daily consumption. The new automation transition in Company ER's milk factory provides a unique opportunity to utilize lean management tools to improve the current automated processes before commercialization.

OEE (overall equipment effectiveness) will monitor losses for different operational losses in the new automated system and indicate system improvements, with 85% as the target. Based on DMADV (design, measure, analyze, design and validate) methodology, this study analyzes the entire automated pallet handling system. It uses lean tools to identify areas for improvement, identify waste elements and propose solutions to achieve Company ER's OEE targets.

In this paper, the outcomes will be presented as documented solutions that address the losses encountered in the production system, showing a 12.8% increase in the system's OEE.

Owing the time and resource constraint, this study only involved automated pallet handling procedures in a milk production facility. Hence, the generalization of the result is slightly limited. More studies in several different processes and sectors are required.

This study provided a valuable tool for researchers for gaining deeper understanding regarding the lean manufacturing and its implementation. For practitioners, it is useful to evaluate the degree of lean manufacturing tools in their material handling systems.

This study is the first attempt to develop lean manufacturing constructs for evaluating the automated pallet handling procedures in a milk production facility.

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. GDM is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. The purpose of this paper is to produce information on prevalence, screening and diagnosis, pathophysiology and dietary, medical and lifestyle management of GDM.

This literature review aimed to document and record the results of the most updated studies published dealing with dietary, medical and lifestyle factors in managing GDM.

The prevalence of GDM differs worldwide based on population characteristics, race/ethnicity and diagnostic criteria. The pathophysiology of GDM is multifactorial and it is likely that genetic and environmental factors are associated with the occurrence of GDM. Medical nutritional therapy remains the mainstay of GDM management and aerobic and resistance physical activities are helpful adjunctive therapy when euglycemia is not attained by the medical nutritional therapy alone. When diet and exercise fail to achieve glycemic control, pharmacological agents such as insulin therapy and oral hypoglycemic medications are prescribed. Plasma glucose measurement is an essential part of glycemic control during pregnancy, as well as glycemic control can be evaluated using indicators of glycemic control such as hemoglobin A1c (HbA1c), glycated albumin and fructosamine.

This review is a comprehensive review that illustrates the effect of healthy diet, medical therapy and lifestyle change on improving GDM condition.