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In a globalized world where emerging markets are more important than ever, there is an increasing pressure on international businesses and governments to work together. The set of facilities known as commercial diplomacy combines the interests of both by highlighting new markets and investment opportunities.

In this chapter, we present a literature review based on 56 relevant publications to assess what we currently know of this important activity.

The results indicate that research on commercial diplomacy consists of many subtopics, resulting in a patchy understanding of the topic as a whole.

We discuss why integrative research focusing on the business–government relationship and the organization and the value of commercial diplomacy are needed from an international business perspective.

Admissions planning decides on the number of patients admitted for a specialty each day, but also on the mix of patients admitted. Within a specialty different categories of patients can be distinguished on behalf of their requirement of resources. The type of resources required for an admission may involve beds, operating theatre capacity, nursing capacity and intensive care beds. The mix of patients is, therefore, an important decision variable for the hospital to manage the workload of the inflow of patients. In this paper we will consider the following planning problem: how can a hospital generate an admission profile for a specialty, given a target patient throughput and utilization of resources, while satisfying given restrictions? For this planning problem, we will develop an integer linear programming model, that has been tested in a pilot setting in a hospital. The paper includes an analysis of the planning problem, a description of the model developed, an application of a specialty orthopaedics, and a discussion of the results obtained.

Until recently, it was uncommon to ask professionals to give objective evidence to non‐professionals regarding the quality of their work. Nowadays, however, professionals, their health‐care processes and their health‐care organisations have to face assessments concerning organisation, control and content of the work. Meanwhile, health‐care organisations generate improvement programmes to mutually match activities of individual professionals and to redesign health‐care processes within or between health‐care organisations. In all these situations information is required on the current and sometimes the improved stage of the health‐care process. Often performance indicators are mentioned to generate this information. In this paper we present a framework of performance indicators and related measuring instruments to monitor and evaluate health‐care processes. It is based on a literature scan and on empirical research in two general hospitals and one mental hospital. The literature scan was guided by the three case studies and in the case studies the framework was tested.

This research aims to explore the fine-grained relationships between nurse staffing and hospital operational performance with respect to care quality and operating costs. The authors also investigate the moderation effect of competition in local hospital markets on these relationships.

A six-year panel data is assembled from five separate sources to obtain information of 2,524 USA hospitals. Fixed-effect (FE) models are used to test the proposed hypotheses.

First, nurse staffing is initially associated with improved care quality until nurse staffing reaches a turning point, beyond which nurse staffing is associated with worse care quality. Second, a similar pattern applies to the relationship between nurse staffing and operating costs, although the turning point is at a much lower nurse staffing level. Third, market competition moderates the relationship between nurse staffing and care quality so that the turning point of nurse staffing will be higher when the degree of competition is higher. This shift of turning point is also observed in the relationship between nurse staffing and operating costs.

The study identifies three ranges of nurse staffing in which hospitals will likely experience simultaneous improvements, a tradeoff or simultaneous decline of care quality and operating costs when investing in more nursing capacity. Hospitals should adjust nurse staffing levels to the right directions to achieve better care or reduce operating costs.

Nurses constitute the largest provider group in hospitals and profoundly impact care quality and operating costs among all health care professionals. Optimizing the level of nurse staffing, therefore, can significantly impact the care quality and operating costs of hospitals.

Commercial diplomacy within the EU is currently a matter for the individual EU member states (MS). This results in different policies and practices. But to what extent do they really differ? This chapter presents the results of a comparative study on EU MS commercial diplomacy policies and practices. The policy goals and practices of all 27 MS were assessed via document analysis and interviews with commercial diplomats. The findings show considerable differences in terms of the responsible ministry, the policy focus, the network of foreign posts and the work performed at the foreign post. However, countries that entered the EU first seem to have similar commercial diplomacy policy and practices characteristics, as do the countries that entered the EU after 2003. Furthermore, the results of statistical tests show that countries that entered first are similar in size, wealth, share of EU trade, number of embassies inside the EU, number of employees at the foreign post and the activism of the foreign post. These similarities apply as well for the countries that entered the EU after 2003. Overall, this study concludes that home country characteristics (size, culture, government), host country characteristics (institutions, culture, regime) and the relationship between a home country and a host country affect the commercial diplomacy policies and practices.

Hospitals struggle to integrate the planning from different departments; resulting in unacceptable waiting times for patients. The literature mainly addresses general, organizational factors inhibiting or enabling integration and omits important factors stemming from the care delivery process. Therefore, the purpose of this paper is to uncover operational antecedents and to assess their effect on the integration of hospital planning.

The study is based on a three-hospital multi-case study. The main findings stem from over 40 in-depth interviews with specialists, nurses, planners, and managers of four specialties that are all involved in the orthopedic internal supply chain.

This study identifies five critical operational antecedents: performance management, shared resources, information technology, process visibility, and uncertainty/variability. The latter two are of specific importance in a healthcare context. Three distinctive roles are identified; initiating (performance management and process visibility), facilitating (information technology), and inhibiting (shared resources and uncertainty/variability).

The authors address how integration can be achieved, rather than merely prescribing integration as a means to improve performance. The identification of specific operational antecedents and their role help managers to find tangible ways to effectively integrate hospital planning which increases hospital performance.

First, the identified operational antecedents are essential supplementary factors to more common organizational and behavioral antecedents. Second, in contrast to earlier contributions the authors show the effects of antecedents on three different stages of integration, rather than on integration in general.

The patient flow performance achievable by care pathways is constrained by competing flow and resource efficiency, which can negatively impact improvements. This paper probes the divergence between resource and flow efficiency and how care pathways can lead to improved patient flow. By framing the problem through the lens of paradox theory, a set of design principles is proposed to assist decision-makers in care pathway implementation. Implications are derived for research and practice.

The authors used conceptual research to develop design principles for care pathways based on a systematic review of relevant care pathway research. The initial search contained 515 unique articles, resulting in a final sample of 56 studies.

When applying care pathways, patient flow may be negatively affected in relation to the dimensions of bottlenecks, non-value-adding activities, and variability. However, the findings also indicate methods that can be applied to manage organizational paradoxes, which can contribute to more efficient patient flow along each of the three dimensions.

The study is limited to care pathways and therefore could have missed relevant studies in similar fields, such as care coordination.

Health care managers, politicians, and IT developers can apply the proposed design principles when developing, implementing, and improving care pathways and supporting technologies.

While existing research has studied care pathways from a medical perspective, this is the first paper to the author’s knowledge that addresses care pathways directly by considering paradox theory and in light of the operations management literature.

The purpose of this paper is to present a conceptual framework that would enable the effective application of time based competition (TBC) and work in process (WIP) concepts in the design and management of effective and efficient patient processes.

This paper discusses the applicability of time‐based competition and work‐in‐progress concepts to the design and management of healthcare service production processes. A conceptual framework is derived from the analysis of both existing research and empirical case studies.

The paper finds that a patient episode is analogous to a customer order‐to‐delivery chain in industry. The effective application of TBC and WIP can be achieved by focusing on through put time of a patient episode by reducing the non‐value adding time components and by minimizing time categories that are main cost drivers for all stakeholders involved in the patient episode.

The paper shows that an application of TBC in managing patient processes can be limited if there is no consensus about optimal care episode in the medical community.

In the paper it is shown that managing patient processes based on time and cost analysis enables one to allocate the optimal amount of resources, which would allow a healthcare system to minimize the total cost of specific episodes of illness. Analysing the total cost of patient episodes can provide useful information in the allocation of limited resources among multiple patient processes.

This paper introduces a framework for health care managers and researchers to analyze the effect of reducing through put time to the total cost of patient episodes.

The aim of this paper is to investigate which integrative planning and control practices are used in hospitals and what their effects are on patient flow.

The study is based on a three‐hospital multi‐case study carried out in The Netherlands. The main findings are based on over 40 in‐depth interviews and the analysis of detailed patient flow data. The analysis of the flow data is used to explore the effects of integrative practices on lead times and patient flow.

Based on the various patient groups examined in the different hospitals, four integrative practices stand out: sharing waiting list information, sharing planning information, cross‐departmental planning, and combining appointments. In line with earlier studies, the overall level of integration in hospitals was found to be low. However, patient flow performance is significantly better in those hospitals that employ more of the above‐mentioned integrative practices.

The study was limited to three major patient groups within the orthopedic supply chain. The deliberate choice for these patients groups was based on the expectations that integration in hospitals is relatively low and that the highest levels of integration would be found in high volume – low variety patient groups. Further research should include patient groups with less favorable characteristics such as lower volumes and/or greater variety.

This study provides clear support for the value of integration initiatives in healthcare operations. The performance of hospitals, in terms of patient flows, benefits from cooperation between the various members of an internal supply chain. Hospital administrators and medical professionals could learn from these results and attempt to abandon their silo mentality and start integrating for and their patients' and their own benefit.

Despite the importance of integration in hospitals, little is known about the integrative practices hospitals actually employ. Most existing studies on patient flows are confined to a single stage in the care process. In this study, the effects of integration in the internal supply chain from the first visit to the end of treatment are examined.

Improving hospital patient flow has become a policy priority, to effectively balance the increasing demands of an unknown and variable volume of patients with limited available hospital resources. A systematic literature review was conducted in order to identify actions, actors involved and enablers in improving hospital patient flow. The paper aims to discuss this issue.

Searches were conducted in Scopus, Web of Science, MEDLINE and The Cochrane Library for quantitative and qualitative empirical primary studies with patients (adults) receiving inpatient acute hospital care. The study protocol was based on PRISMA-P guidance. A critical appraisal of included studies was performed by using the Quality Improvement Minimum Quality Criteria Set.

In total, 38 key papers were identified. A wide range of actions are reported, but most studies focus on one or a few departments instead of a whole hospital. Process efficiency is most often used as a performance indicator, clinical outcomes are poorly analyzed, and patients’ expectations and experience are rarely considered. Top-management commitment and front-line staff involvement are considered key factors for the success of implementations. Patient involvement in the process improvement is rarely mentioned.

Achieving improvements in hospital patient flow requires the design and implementation of complex, multifaceted and coordinated interventions. This study may be of value to healthcare managers, helping them to act effectively in their context, and to researchers of future studies including the different variables and the patient’s perspective.