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Patient satisfaction and quality care are important indicators for the success of any health care enterprise. The critical nature of health care operations entails that some excess capacity is stored in the system to provide the necessary flexibility of response. To prepare health care organizations to deliver high quality services at lower costs, this paper aims to report a lean health care (LEAN‐HC) transformation model that integrates queuing theory and lean methodology to improve the dynamic performance of the health care system.

This paper reviews and evaluates an emergency department health care system that adopts a system dynamic model, redesigned the process using value stream mapping to eliminate non‐value‐added activities to achieve just‐in‐time (JIT) services. This study was conducted at SD Mission Hospital, India. The LEAN‐HC model includes three steps. First, the patient arrival flow is assessed and adjusted, using physicians at the front of the queue to separate patients at triage into major, medium, and minor injury classes. Second, a cross‐functional team consisting of process, information and clinical experts maps the hospital's current state to identify and eliminate wasteful non‐value‐added activities. Third, the process is continually de‐bottlenecked using a variety of lean techniques, such as 5S visual management, one‐piece‐flow to reduce service lead time, and adoption of standard operating procedures.

The authors' results reveal that a lean integration to queuing methodology frees up capacity in the health care system, providing necessary flexibility of response. The implementation of the LEAN‐HC model resulted in the following improvement. First, an improved process flow and increased capacity. Second, emergency department length of stay for all patient classes decreased. Third, value stream mapping was found to be useful in detecting opportunities to decrease patient turnaround. Fourth, the service bottleneck could be identified and shifted to where it could be most easily controlled, adhering to the principle of one piece flow. No changes in resource availability and safety or quality issues occurred during the implementation of lean methodology.

This study demonstrates how to apply lean methodology in conjunction with the queuing modeling in the health care industry, particularly with regards to the patient wait time and reduction in medical errors. The LEAN‐HC model delivers more efficient service by increasing hospital capacity while reducing non‐value‐added times and overhead costs.

The purpose of this study was to determine the rate of concordance and discordance between clinical diagnosis and post‐mortem findings in patients admitted to the hospitals of the Saskatoon Health Region.

A retrospective record review of the medical and autopsy charts was carried out for all the deceased adult in‐patients admitted during calendar years 2002, 2003 and 2004. A total of 3416 in‐patient deaths were registered during the study period. Autopsies were performed on 206 of the deceased resulting in an autopsy rate of 6 percent. In accordance with selection criteria, 158 cases were included for this study. The mean age of subjects was 66.6±15.3 years with a range of 16‐94 years. The study group consisted of 92 males (58.2 percent) and 66 females (41.8 percent) with an average length of stay at the hospital of 12.9±10.9 days.

The concordance rate between clinical and autopsy diagnosis was found to be 75.3 percent. The discordance rate was 20.9 percent and in 3.8 percent of the study population a conclusive clinical or autopsy diagnosis was not finalized.

These results suggest that despite of the technical advances in medical and diagnostic modalities, diagnostic discrepancies in the present day health care system remain prevalent.

The authors encourage residents and physicians to continue using autopsy as an important tool to extend understanding of disease processes.

The purpose of this paper is to empirically study the impact of product patent regime on the productivity of different categories such as ownership, R&D, size and product-wise of Indian pharmaceutical firms using non-parametric data envelopment analysis.

The present study has applied Ray and Desli’s Malmquist productivity index and its decomposition to measure total factor productivity (TFP) change, pure technical efficiency change, scale efficiency change and technical change under variable returns to scale (VRS) technology assumption for 141 Indian pharmaceutical firms during 2000-2001 to 2014-2015.

The study found the negligible impact of product patent regime on productivity. The technological change has played a positive role in the growth of productivity, whereas technical efficiency change depicts the judicious utilization of resources for improving performance. From the results, it is found that R&D intensive firms depict better stability in the TFP than the non-R&D firms. However, Granger causality between R&D and productivity found no relationship. Productivity is more directly affected by investment in fixed assets rather than in R&D, which focusses on incremental value additions in a largely branded/plain generic product market. In case of ownership, private foreign firms found to have registered progress in TFP while others have recorded marginal regress, which probably could be attributed to the superior marketing and management skills of the foreign firms, besides possessing proprietary technology. Both small and large firms have shown positive growth in the new regime as compared to the pre-patent regime. These small firms are able to compete with large firms because of their up-gradation of the technological base by improving access to better foreign technology. TFP growth for all the firms can be attributed to improvement in technology, and innovation in terms of high capital-output ratio. Further, the paper tried to identify the determinants of productivity from panel random effect regression, and it is found that export intensity, age and the new patent regime have negative and significant relationship with productivity, whereas other variables such as R&D, ownership, size and capital imports are insignificant. In the end, the results of sensitivity analysis have confirmed the validity of the selected variables.

The results suggest that Indian pharmaceutical firms need substantive improvement in TFP by improving managerial and scale efficiency. Indian pharmaceutical industry (IPI) needs to improve productivity across the network and drive cost excellence initiatives across the spend base through operational excellence and digital initiatives. The results of this paper can be applied in framing policies for future growth and improvement in the productivity of IPI.

The paper aims to make several new contributions to the existing literature. Most of the research papers only analysed TFP of the industry as a whole and detailed firm-wise analysis is needed to capture the true impact at a unit level. This study has analysed the impact of different categories such as ownership, R&D, size and product-wise, and determinants of productivity. The study has used a broader time period and larger panel data to predict the better picture.

The chapter explores how gender has been an integral part of the nation building project in post-liberalisation Hindi cinema, popularly, known as Bollywood.

This chapter is based on primary data gathered through interviews with prominent members of the Hindi film industry along with a detailed content analysis of commercially successful post-liberalisation mainstream Hindi films.

It highlights how the representation of gender has been a central axis around which the tension between tradition and modernity has been played out in Hindi Cinema. The construction of Indianness post-liberalisation has questioned gender politics but proposed easy resolutions which fit into the larger nationalist narrative. In doing so, it has used the diaspora as a category to produce a nationalist account which is simultaneously essentialised and transnational in the quest for projecting India’s aspirations on the global platform.

The chapter provides important insights into the role of popular Hindi cinema, often brushed off as frivolous, in contributing to the mainstream discourse on nationalism post-liberalisation.