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Healthcare provision is costly, and patient expectations are increasing. Lean implemented within healthcare settings is one possible solution for dealing with this issue, with much of the current research in this respect mostly focused on developed countries. The research examines the applicability of lean in the healthcare sector of a developing country, specifically Oman.

Interviews were conducted with 32 individuals representing four public sector hospitals, along with two major hospital suppliers and the Ministry of Health. The readiness of lean thinking was assessed against seven criteria. Data were then analyzed thematically.

The authors found that Oman's healthcare sector is strong on leadership support, understanding value and customer groups, ability to undertake an end-to-end process view and engaging in the required training for lean. Interviewees showed awareness of the challenges, including aligning lean with the strategic agenda of healthcare settings, aligning measurement and reward systems to lean thinking and matching demand and capacity levels. The authors conclude that Oman's healthcare sector is ready for widespread application of lean, and if executed successfully, will generate strong strategic and operational outcomes.

This paper provides evidence of the applicability of lean in a very different context to the one that has been generally reported in the literature. The authors propose that lean thinking can be applied in countries and regions with similar cultural contexts such as the Middle East.

The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature.

A comprehensive review of literature focussing on lean and lean healthcare was conducted.

Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings.

The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study.

The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed.

To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

Nowadays, organizations have to resist the rising competition more effectively than their competitors and take a step closer to excellence in offering the product to customer demands. To do this, organizations need agile leaders in order to implement agility principles and practices. Especially in the health sector, health managers must be agile because of the specific characteristics of health services. From this view, this chapter aims to develop a theoretical agile leadership model in healthcare organizations. First, the authors define agile leadership and its sub-dimensions based on previous literature. Then, the antecedents and outcomes of agile leadership have been analyzed. “Drivers of agile leadership,” “organizational factors affecting agile leadership” and “individual factors affecting agile leadership” are identified as the antecedents of agile leadership. “Organizational outcomes” and “individual outcomes” are determined as the outcomes of agile leadership in the health sector.

Autistic children and their family caregivers are impacted widely by the social arrangements, which bring up a variety of problems and make their caregiving duties even more difficult. One of the main troubles family caregivers struggle with is the “Autism stigma” that eventually leads to social exclusion. This study aims to identify shreds of evidence of Autism stigma experienced by family caregivers of autistic children. The study also aims to present some general comparison between the findings in Iran and a few other countries’ available respective data to the “Autism stigma.”

This study is an inductive qualitative content analysis. Twelve family caregivers were purposefully selected. Data were gathered exercising semi-structured, in-depth interviews and scrutinized using content analysis method.

In the interviews with the participants, a new category called “Autism stigma” was discerned. This category includes three subcategories: “Diagnosis process,” “Lack of awareness” and “Presence in the society.”

In Iran, Autism is considered a kind of social stigma. It mainly happens due to a lack of public awareness about this psychological disorder. The family caregivers in the community suffer from the stigma of autism, which leads them to distance themselves from society. This paper aims to improve the social awareness in regard to the negative impacts of Autism stigma.

The purpose of this study is to evaluate the relationship between sleep disturbances, gastrointestinal (GI) problems and eating behaviors in children who are diagnosed with autistic disorder (AD) and pervasive developmental disorder not otherwise specified (PDD-NOS).

This study was conducted with 102 children who were diagnosed with autism spectrum disorder (ASD). Sleeping and GI (abdominal pain, constipation, diarrhea, vomiting, difficulty swallowing) problems in children were obtained by asking their parents using a questionnaire. The feeding assessment survey (FAS), brief autism mealtime behavior inventory (BAMBI) and food consumption frequency were used to obtain information about the children’s eating habits.

The BAMBI total score, food refusal and features of autism subscale scores of those with AD were higher than those in the PDD-NOS group (p < 0.05). Sleeping, GI and eating problems are seen in those with AD more commonly than in those diagnosed with PDD-NOS.

To the knowledge, this is the first study that compares GI, sleeping and eating problems in children with AD and PDD-NOS. Sleeping, GI and eating problems may be more frequent in children with AD than in those with PDD-NOS. The GI problem rate is higher in children with autism with sleeping problems than without sleeping problems.

Children diagnosed with autism spectrum disorder (ASD) and their families especially their mothers face numerous and pervasive challenges. Difficulties to access quality care, financial burden, issues of adulthood and their child’s behaviors may produce significant stressors to mothers. This study aims to assess perceived stress among mothers of children with ASD in Egypt.

A cross-sectional study was conducted in Mansoura University Hospital, Egypt on 94 mothers of children with ASD using a structured questionnaire of the socio-demographic and clinical features of the studied mothers and their children and the perceived stress scale (PSS).

The mean total PSS score of mothers was 31.97 ± 12.39 and the level of autism had a statistically significant relation with stress perceived by the studied mothers.

The findings in this study were based on caregivers’ self-reporting. As such, inaccurate reporting might have biased the findings. The main limitations of this study include non-participation and dropout. During data collection, some mothers declined to participate in the study. Also, the current study was conducted in one hospital. This represents a loss of valuable information and may weaken the generalizability of the current study findings. Another limitation is the use of a convenience sample in the study. With the use of convenience sampling, there is an increased risk of bias, as study participants may not accurately reflect the characteristics of the total population.

Caregivers’ education programs through media and press should be developed for mothers of children with ASD to help those who experience levels of stress by presenting knowledge about ASD and treatment and training on adaptive coping methods and teaching communication and problem-solving. Recognizing levels of stress and parent counseling may be a useful strategy. Regular periodic meetings should be conducted between mothers and hospital personnel to promote proper communication. One key policy implication, this paper can derive from this study is the need for cooperation between the Ministry of Health, social welfare and other relevant governmental and non-governmental organizations to provide support for families of individuals with ASD such as financial aids. It is also recommended that future study would benefit a larger sample to enhance external validity. As well, future qualitative research is recommended to more fully understand the lived experience of mothers of children with ASD.

This study provides evidence that mothers of children with ASD experienced high perceived stress. Caregivers’ education programs through media and press should be developed in Egypt for mothers of children with ASD.

This paper aims to identify, analyze and categorize the major readiness factors for implementing Lean Six Sigma (LSS) in health-care organizations using total interpretive structural modelling technique. The readiness factors are identified would help the managers to recognize the areas that lack and provide importance to the successful implementation of LSS in those areas. The paper further intends to understand the hierarchical interrelationships among the readiness factors identified using dependence and driving power.

In total, 16 readiness factors are identified from the literature review and expert opinions are collected from hospitals. The scheduled interview is conducted based on a questionnaire survey in hospitals in the Indian context to identify the relevance of the relations among the readiness factors. The expert opinions are used in the initial reachability matrix and interpretative interaction matrix. Matrix impact cross multiplication applied to classification (MICMAC) analysis uses dependence and driving power to understand the hierarchical relationship among the readiness factors identified.

The result indicates that customer-oriented and goal management cultures are the key readiness factors for LSS. The execution technique and training are given according to the current demand of customers and goal change of organization. The manager needs to concentrate more on readiness factors to formulate the execution process of LSS for continuous improvement of the health-care organization. The readiness level helps the manager to identify the target area for LSS execution.

This research focuses mainly on readiness factors for the implementation of LSS in the health-care industry.

This study would be useful for researchers and practitioners to understand the readiness factors before starting the implementation process of LSS.

Many research studies are being done on the success and failure rate of implementation of factors. The present study identifies the readiness factors related to LSS, especially for the health-care industry.

This study aims to compare recent topics on value-added tax (VAT) in the European Union (EU) and Gulf Cooperation Council (GCC), understand the differences in VAT discourses between the two regions and explore the connection between research agendas, institutional legacies and semantic output in the field of VAT in each territory.

A bibliometric study was conducted using R programming. The data were gathered from the Scopus database, which contains 99 English-language publications with publication dates ranging from 1996 to 2022 (87 of which are from the EU and 12 from the GCC). Information about publications, journals, authors and citations is gathered, validated, cross-referenced and analyzed using bibliometric metrics.

The results highlight two ideal research contexts for studying VAT: the EU countries approach VAT research with a centralized, pluralistic and quantitative focus, while the GCC countries adopt a centralized, qualitative and practically oriented approach, highlighting distinct research goals, collaboration styles and institutional legacies. The authors extend their result findings to broader discussions on competing knowledge systems in VAT, the significance of the state and the level of autonomy within tax governance after identifying the most popular issues among scholars working in GCC and EU countries.

Although the focus of this analysis is restricted to the GCC and EU, it includes theoretical recommendations for broadening its application to other nations. Researchers from the GCC and the EU may benefit from this study by gaining more about VAT and being encouraged to share their research with young researchers. The study’s findings are relevant and important for comprehending the comparative state of research on VAT in GCC and EU countries, tax fields, publications and institutions.

This study analyzes the VAT systems of the GCC and the EU while identifying the intellectual structure of the field from each author’s point of view, revealing the scientometrics and informetrics intellectual structures in detail.

This paper aims to “identify,” “analyse” and “categorise” the readiness factors of lean sustainability in health-care organisation using total interpretive structural modelling (TISM).

To obtain the data, a closed-ended questionnaire was used in addition to a scheduled interview. To identify how the factors interact, the TISM approach was used, and the matriced’ impacts croise’s multiplication applique’e a UN classement (MICMAC) analysis was used to rank and categorise the lean sustainability readiness factors.

This study identified ten lean sustainability readiness factors for health-care organisation. The identified factors are resources utilization practice (F1), management commitment and leadership (F2), operational flexibility (F3), workforce engagement and time commitment (F4), sustainability motivational factors (F5), awareness of lean and sustainable practice (F6), hospital design (F7), energy efficiency practices in hospitals (F8), responsible autonomy (F9) and new system adoptability training (F10). The key/driving factors are identified in this study are operational flexibility, sustainability motivational factors, management commitment and leadership, new system adoptability training.

The study focussed primarily on lean sustainability factors for the health-care sector.

This research will aid key stakeholders and academics in the better understanding the readiness factors that influence lean sustainability in health-care organisation. This study emphasises the factors that must be considered when applying lean sustainable practices in health care as a real-world application in a health-care organisation. These readiness factors for lean sustainability can be used by an organization to comprehend more about the concept and the components that contribute to health-care lean sustainability.

This study proposes the TISM technique for health care, which is a novel attempt in the subject of lean sustainability in this sector.