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This study aims to describe how the Army and the Army Medical Department matured as a learning organization (LO) during the period after the 2014 Military Health System Review through the incorporation of changes aimed at improving patient safety, data transparency and becoming a high-reliability organization (HRO). This study explores the relationship between HRO and LO concepts by adding to the body of knowledge in both disciplines.

Four large-scale system changes are presented and evaluated against the principles of the LO. Metric data were collected longitudinally and presented as submitted to several nationally-recognized organizations in healthcare quality and safety. Post initiative observations are paired with a corresponding LO principle to assess US Army Medical Command’s (MEDCOM’s) maturation as a LO. System changes/improvements and the advancement of LO principles are discussed.

System improvements, analyzed critically alongside paired LO principles, show strong correlation between high-reliability and LO principles. Despite inherent institutional barriers, this study demonstrates that, when leveraged effectively, the leadership hierarchy and command culture can accelerate transformation into an LO.

This study explores changes implemented in MEDCOM, as it evolved as a stronger LO. It demonstrates how healthcare organizations and other high-risk industries that embrace high-reliability concepts will become better LOs and expands current knowledge on how LO concepts in healthcare can affect better system accountability and improved patient safety. Organizations can learn from MEDCOM’s journey changes that can hasten progress toward adoption of LO principles, especially in hierarchical organizations.

Combat Stress, a charity that aims to meet the needs of veterans with psychological disability, often related to their service, is seeing growing demand for the care it offers. This paper explores the impact of post‐traumatic stress disorder on veterans. In many cases, this is associated with subsequent substance misuse. In describing Combat Stress's approach to helping these individuals, it argue that mainstream and other non‐statutory service providers should develop their screening and assessment services to help meet veterans' needs.

The aims of this study are to (1) evaluate physicians and nurses' perspectives on patient safety culture amid the COVID-19 pandemic and (2) integrate the emotional exhaustion of physicians and nurses into an evaluation of patient safety culture to provide insights into appropriate implications for medical care.

Patient safety culture was assessed with the Chinese version of the Safety Attitudes Questionnaire. Confirmatory factor analysis was conducted to validate the structure of the data (i.e. reliability and validity), and Pearson's correlation analysis was performed to identify relationships between safety-related dimensions.

Safety climate was strongly associated with working conditions and teamwork climate. In addition, working conditions was highly correlated with perceptions of management and job satisfaction, respectively. It is worth noting that the stress and emotional exhaustion of the physicians and nurses during this epidemic were high and needed attention.

For healthcare managers and practitioners, team-building activities, power of public opinions, IoT-focused service, and Employee Assistance Programs are important implications for inspiring the patient safety-oriented culture during the period of the COVID-19 pandemic.

This paper considers the role of emotional state into patient safety instrument, a much less understood but equally important dimension in the field of patient safety.

This paper identifies the challenges during a recent disaster relief operation in a developing country where the humanitarian response is dominated by national actors, with international actors having a minor role.

A case study design is used; the main data sources are semi-structured interviews with 43 informants involved in the 2017 Kermanshah earthquake relief operation.

The findings suggest that humanitarian practitioners deal with multiple challenges during disaster relief operations. One group of challenges relates to humanitarian logistics (HL) like needs assessment, procurement, warehousing, transportation and distribution, all widely discussed in the literature. Another involves the growing use of social media, legitimacy regulations and the engagement of new humanitarian actors (HAs) like social media activists and celebrities. These factors have not been extensively studied in the literature; given their growing influence, they require more scholarly attention.

The findings will help humanitarian practitioners and policymakers better understand the challenges involved in disaster relief operations conducted by multiple actors and thus help them improve their practices, including the creation of proper regulations, policies and logistics strategies.

The study uses primary data on a recent disaster to assess and extend the findings of previous studies regarding HL challenges. It also elaborates on the critical non-logistical challenges that influence aid delivery in emergency responses, including the growth of social media, regulations and the engagement of new HAs. The results may motivate future empirical and modelling studies to investigate the identified challenges and identify practices to mitigate them.

The empirical analysis dealt in this paper emphasizes on the impact of military expenditures on out of pocket (OOP) healthcare payments. A sizeable body of defence economics literature has investigated the trade-off between military and public health expenditure, by testing the crowding-out or growth-stimulating hypothesis; does military expenditure scaling up crowd-out or promote governmental resources for social and welfare programs, including also state health financing?

In this study, panel data from 2000 to 2018 for 129 countries is used to examine the impact of military expenditure on OOP healthcare payments. The dataset of countries is categorized into four income-groups based on World Bank's income-group classification. Dynamic panel data methodology is applied to meet study objectives.

The findings of this study indicate that military expenditure positively affects OOP payments in all the selected groups of countries, strongly supporting in this way the crowding-out hypothesis whereby increased military expenditure reduces the public financing on health. Study econometric results are robust since different and alternative changes in specifications and samples are applied in our analysis.

Under the economic downturn backdrop for several economies in the previous decade and on the foreground of a potential limited governmental fiscal space related to the Covid-19 pandemic adverse economic effects, this study provides evidence that policy-makers have to adjust their government policy initiatives and prioritize Universal Health Coverage objectives. Consequently, the findings of this study reflect the necessity of governments as far as possible to moderate military expenditures and increase public financing on health in order to strengthen health care systems efficiency against households OOP spending for necessary healthcare utilization.

Despite the fact that a sizeable body of defence economics literature has extensively examined the impact of military spending on total and public health expenditures, nevertheless to the best of our knowledge there is no empirical evidence of any direct effect of national defence spending on the main private financing component of health systems globally; the OOP healthcare payments.

The purpose of this paper is to see whether it is possible to learn any lessons from the application of simulation and modeling in the defense sector to be applied in the healthcare sector.

Two comprehensive reviews are conducted within two domains of “Military & Aerospace” and “Healthcare”. A general search framework with common features is developed, while allowing rooms for customization for each domain. A common objective is set to cover a wide scope of simulation methods and application areas. Further, reviews are not restricted to a limited number of journals or conferences; rather the relevant databases are searched while using some filtering mechanisms.

It is found that simulation has been commonly used in the defense sector(s). However, inconsistency in terms of the level of implementation in both the sectors is quite vivid. There is clear evidence that healthcare lags behind other sector(s), particularly in terms of stakeholder engagement and, consequently, in terms of implementation of simulation outcomes.

Owing to confidential nature of the defense sector, grey literature (which in this case is likely to include a considerable corpus of classified material) has not yet been reviewed. The paper speculates on the impact this has on the appreciation of the uptake of modelling and simulation in this sector and could form part of future research.

This paper provides key insights into some challenges of applying simulation methods in healthcare, whilst presenting an up‐to‐date overall picture of simulation in two main sectors from an academic point of view.

This paper examines how the properties and patterns of a collaborative “networked hierarchy” incident command system (ICS) archetype can provide incident command centres with extra capabilities to manage public service delivery during COVID-19.

The paper illustrates the case of Sri Lanka's COVID-19 administration during its “first wave” (from 15 February to 1 September 2020). Primary data were collected through in-depth interviews with government officials who were directly involved in the administration of the COVID-19 outbreak. Secondary data sources were government publications and web sources. The data were analysed and interpreted by using narrative analysis and archetype theory respectively.

The findings highlight how Sri Lanka's public sector responses to COVID-19 have followed a collaborative “networked hierarchy” ICS archetype. More specifically, the government changed its normative ICS “properties” by incorporating a diverse group of intergovernmental agencies such as the police, the military, the health service and administrative services by articulating new patterns of collaborative working, namely, organisational values, beliefs and ideas that fit with the Sri Lankan public service context.

In responding to high magnitude healthcare emergencies, the flexibility of a collaborative networked ICS hierarchy enables different balances of organisational properties to be incorporated, such as hierarchy and horizontal networking and “patterns” in public service provision.

Current discussions around the lack of progress towards the Millennium Development Goals tend to emphasize deficiencies in governance as a major contributory factor. While agreeing with this assessment, this paper takes issue with the conventional understanding of what “governance” implies. Using Burma as an illustration, it suggests the current focus on purely administrative and organizational concerns must be broadened to encompass the wider political context in which these Goals are to be pursued. Authoritarian political structures must be confronted and challenged, if these worthy Goals are to have any realistic chance of being attained.

In 2012, Headquarters 17 Combat Service Support Brigade (HQ 17 CSS Bde) implemented a clinical governance framework. The framework is intended as a quality improvement tool through which excellence in deployed healthcare is achieved. The purpose of this paper is to describe the implementation of this clinical governance framework to 17 CSS Bde and present feedback provided by users on their application of the clinical governance framework.

An electronic survey was disseminated to the four 17 CSS Bde deployable health battalions (n=1,061). Qualitative data were analysed using descriptive statistics and qualitative data using thematic analysis.

In total, there were 105 responses providing valid data for analysis. The data identified mixed understanding and awareness of clinical governance amongst participants, and pinpointed aspects of the framework that needed refinement.

The results highlight important challenges implementing a clinical governance framework for deployable health units. The authors propose embedding clinical governance education in all army soldier and officer health courses to remedy deficits in knowledge and understanding. Recommendations for further development of the clinical governance framework are also made with particular emphasis on education, clinical risk and clinical evaluation.

This paper offers unique insight into the implementation of a clinical governance framework to the 17 CSS Bde, Australian Army. The results suggest that levels of understanding and awareness of clinical governance are stalling its translation through the military hierarchy. The data identify that implementation of a clinical governance framework is not easy, even within a military environment where the culture is to follow orders and obey the chain of command.

The purpose of this paper is to present management techniques in the healthcare sector through lean office.

A case study approach is adopted, with data collected in the Brazilian military organization.

The findings identify several ways to apply lean concepts outside manufacturing. From this, a future lean office health state design will be proposed.

The lean office health proposal has to be tested in other organizations to confirm this case study. While this may limit the generalization of the findings, there is value in demonstrating the benefits modern lean office techniques can bring to the developing world healthcare.

The paper shows that lean office health techniques can provide benefits to healthcare in developing countries' hospitals and others.

The value of the paper arises from providing a detailed analysis of a healthcare lean office in the developing world. There have been only a small number of other studies published in the literature about lean office health.