Lorena G. Barberia, Gilmar Masiero, Iana Alves de Lima, Luciana Santana and Tatiane C. Moraes de Sousa
Governments faced formidable challenges in coordinating public health responses to the COVID-19 pandemic. This study aims to enhance the understanding of effective organizational…
Abstract
Purpose
Governments faced formidable challenges in coordinating public health responses to the COVID-19 pandemic. This study aims to enhance the understanding of effective organizational leadership during crises by investigating the factors influencing the turnover of health leaders during the COVID-19 pandemic in Brazil.
Design/methodology/approach
Using primary data encompassing all appointments and dismissals of federal and state health secretaries, this paper conducted a quantitative analysis of the relational and reputational factors that contributed to leader turnover during the COVID-19 pandemic. This paper also examined whether leaders’ management and public health experience increase the duration of tenure.
Findings
States encountered significant challenges in retaining experienced and effective leadership during the health emergency, primarily due to political conflicts in policymaking and, to a lesser extent, allegations of corruption. Furthermore, leaders with expertise in public health were found to be less likely to be removed from office. However, managerial experience did not prolong the tenure of state health secretaries during the emergency.
Research limitations/implications
Since most health leaders have public health and management experience, the contributions of each factor to the duration of a secretary’s tenure are difficult to separate and analyze separately.
Practical implications
This study provides empirical insights into what factors drive health leader turnover during major health emergencies.
Social implications
During major health emergencies, health leaders often strongly disagree with elected officials on the response. This paper test how crisis leadership theories help explain state health leaders’ duration in one of the world’s largest public health systems during the COVID-19 pandemic. This paper find that policy disagreements contributed to significant turnover.
Originality/value
To the best of the authors’ knowledge, this paper is the first that are aware of that uses novel primary data on public health executive leader characteristics and turnover causes in the context of the COVID-19 pandemic. It provides empirical evidence contributing to the crisis leadership literature by examining health leader turnover in one of the world’s largest public health systems.
Details
Keywords
Luciana Teixeira Lot, Alice Sarantopoulos, Li Li Min, Simone Reges Perales, Ilka de Fatima Santana Ferreira Boin and Elaine Cristina de Ataide
This paper aims to address problems in patient flow and identify the reasons behind extensive wait time at a public liver transplant outpatient clinic in an education and research…
Abstract
Purpose
This paper aims to address problems in patient flow and identify the reasons behind extensive wait time at a public liver transplant outpatient clinic in an education and research hospital through the use of Lean health-care theories.
Design/methodology/approach
This paper opted for the application of Lean thinking and action research strategy. Data were collected through personal observations, interviews with users and team brainstorming. A value stream map was developed, improvement possibilities were identified and non-value-added activities were attempted to be eliminated.
Findings
Significant problems were identified and improvements were implemented and measured. The major remedial measures were: change the scheduling pattern, create a flow chart and a Kanban visual guide for medical students. In addition, an institutional change in the medical appointment scheduling software collaborated in the reduction of time and in the patient’s displacement. The waiting time was reduced by 4.5 h, and the per cent complete and accurate increased by 50 per cent.
Practical implications
The flow was redesigned, and a culture of continuous improvement was introduced. Visiting the place where work was being done, leaders identified and created more value to the process without significant costs. The Gemba Walk was a powerful tool, interacting with people and processes in a Kaizen spirit.
Originality/value
Public health services in developing countries are one of the most deprived social needs of good practice. It will be useful for those who need examples about how to apply Lean tools in health care.
Details
Keywords
Mônica M. Costa, Daniel R. Diniz‐Santos, José S. Santana and Luciana R. Silva
Given the importance of education‐based approaches in stimulating breastfeeding, the paper aims to investigate the feasibility and efficacy of discussing breastfeeding with school…
Abstract
Purpose
Given the importance of education‐based approaches in stimulating breastfeeding, the paper aims to investigate the feasibility and efficacy of discussing breastfeeding with school children..
Design/methodology/approach
Two workshops about breastfeeding and on the view of the human being as a mammal were carried out in schools in Brazil. Children were invited to express their views of breastfeeding based on what they had learned. Questionnaires were applied immediately before and 15 days after the workshops to assess the impact on children's knowledge.
Findings
There was on average a low level of knowledge about breastfeeding previous to the interventions. The interventions increased children's self‐perception as mammals, and managed to enhance their knowledge about several important issues regarding breastfeeding.
Research limitations/implications
There was a fairly small number of participants and a restricted age range. More studies with other age ranges are warranted.
Practical implications
Educative interventions on breastfeeding targeting young school children can have very positive results, suggesting that school could successfully include breastfeeding.
Originality/value
This is the first study to demonstrate the impact of this innovative approach on school children's awareness on breastfeeding and it demonstrates this pedagogic approach to be effective.
Details
Keywords
Yaou Hu and Songjun Xu
Repeat tourists are invaluable to tourist destinations. However, their perceptions and reactions toward unfavorable destination changes remain underexplored. This paper aims to…
Abstract
Purpose
Repeat tourists are invaluable to tourist destinations. However, their perceptions and reactions toward unfavorable destination changes remain underexplored. This paper aims to answer two important and unresolved questions: how do repeat tourists react to perceived unfavorable changes? and what are the main unfavorable destination changes for repeat tourists?
Design/methodology/approach
This research builds on the strategic memory protection theory. This paper consists of two studies (a quantitative one and a qualitative one) conducted in China. The quantitative study proposed and tested a structural equation model linking perceived unfavorable changes, tainted memories, revisit satisfaction and destination loyalty. Data were collected via a questionnaire distributed on an online survey platform with 416 valid responses. The qualitative study was conducted to determine the unfavorable destination changes that repeat tourists perceive. Ninety-five valid responses were used for analysis.
Findings
This research empirically shows that perceived unfavorable changes diminish repeat tourists’ destination loyalty by tainting their initial memories and reducing revisit satisfaction. This full mediation confirms the importance of personal memories and psychology in tourism experiences. This research further uncovers two main types of unfavorable destination changes: destination mismanagement (i.e. overcommercialization, insufficient facilities, poor destination management, excessive prices and a decline in service qualities) and negative environmental changes (overtouristification, changes to natural and social environments and changes in tourist sites and activities).
Originality/value
This research adds to the destination loyalty literature by unveiling actual repeat tourists’ revisit perceptions and psychological processes toward unfavorable destination changes. This research also identifies the typical unfavorable changes perceived by repeat tourists.
研究目的
重游游客对旅游目的地来说极其重要。然而, 他们对不利的目的地变化的看法和反应仍未得到充分探讨。本研究旨在回答两个重要且未解决的问题:重游游客如何对感知到的不利变化做出反应? 对重游游客来说, 不利的目的地变化主要有哪些?
研究设计与方法
本研究以策略性记忆保护理论为理论基础, 包括两项在中国开展的研究(一项定量研究和一项定性研究)。定量研究提出并验证了一个将感知的不利变化、记忆破坏、重游满意度和目的地忠诚度相关联的结构方程模型。定量研究数据通过在线问卷平台收集, 共有 416份有效数据。定性研究的开展旨在确定重游游客所感知的不利目的地变化的类型, 共有95份有效访谈数据用于定性分析。
研究结果
本研究通过实证分析表明, 感知到的不利变化会破坏重游游客最初的记忆和降低重游满意度, 进而降低了他们的目的地忠诚度。这种完全中介效应证实了个人记忆和心理在旅游体验中的重要性。本研究进一步揭示了两种主要的目的地不利变化类型:目的地管理不善(即过度商业化、设施不足、目的地管理缺位、价格过高、服务质量下降)和负面环境变化(过度旅游化、自然和社会环境变化、旅游景点和活动变化)。
原创性/价值
本研究通过揭示真实的重游游客的重游感知和对不利目的地变化的心理过程, 丰富了目的地忠诚度研究的文献, 同时还总结了重游游客所感知的典型的不利的目的地变化的类型。
Propósito
Los turistas que repiten son muy valiosos para los destinos turísticos. Sin embargo, sus percepciones y reacciones ante los cambios desfavorables en el destino han sido poco exploradas. Esta investigación tiene como objetivo responder dos preguntas importantes y no resueltas: ¿Cómo reaccionan los turistas que repiten un destino ante los cambios desfavorables percibidos? ¿Cuáles son los principales cambios desfavorables en el destino para los turistas que repiten?
Diseño/metodología/enfoque
Esta investigación se fundamenta en la teoría de la protección estratégica de la memoria. Consta de dos estudios (uno cuantitativo y otro cualitativo) realizados en China. El estudio cuantitativo propuso y evaluó un modelo de ecuación estructural que vincula los cambios desfavorables percibidos, los recuerdos contaminados, la satisfacción de la revisita y la lealtad al destino. Los datos se recopilaron a través de un cuestionario distribuido en una plataforma de encuestas en línea con 416 respuestas válidas. El estudio cualitativo se realizó para determinar los cambios desfavorables en el destino que perciben los turistas. Se utilizaron noventa y cinco respuestas válidas para el análisis.
Resultados
Esta investigación demuestra empíricamente que los cambios desfavorables percibidos disminuyen la lealtad de los turistas que repiten un destino, al empañar sus recuerdos iniciales y reducir la satisfacción de la revisita. Esta mediación total confirma la importancia de los recuerdos personales y la psicología en las experiencias turísticas. Esta investigación descubre, además, dos tipos principales de cambios desfavorables en el destino: mala gestión del destino (es decir, comercialización excesiva, instalaciones insuficientes, mala administración, precios excesivos y disminución de la calidad del servicio) y cambios ambientales negativos (turistificación excesiva, cambios en los entornos naturales y sociales, y cambios en los sitios y actividades turísticas).
Originalidad/valor
Esta investigación contribuye a la literatura sobre la lealtad al destino, al desvelar las percepciones de los turistas que repiten visita, y sus procesos psicológicos hacia los cambios desfavorables en los destinos. También identifica los cambios desfavorables típicos percibidos por los turistas que vuelven a un destino.