research articles in management

Management Research Review

• Submit your paper
• Author guidelines
• Editorial team
• Indexing & metrics
• Calls for papers & news

Before you start

For queries relating to the status of your paper pre decision, please contact the Editor or Journal Editorial Office. For queries post acceptance, please contact the Supplier Project Manager. These details can be found in the Editorial Team section.

Author responsibilities

Our goal is to provide you with a professional and courteous experience at each stage of the review and publication process. There are also some responsibilities that sit with you as the author. Our expectation is that you will:

• Respond swiftly to any queries during the publication process.
• Be accountable for all aspects of your work. This includes investigating and resolving any questions about accuracy or research integrity .
• Treat communications between you and the journal editor as confidential until an editorial decision has been made.
• Include anyone who has made a substantial and meaningful contribution to the submission (anyone else involved in the paper should be listed in the acknowledgements).
• Exclude anyone who hasn’t contributed to the paper, or who has chosen not to be associated with the research.
• In accordance with COPE’s position statement on AI tools , Large Language Models cannot be credited with authorship as they are incapable of conceptualising a research design without human direction and cannot be accountable for the integrity, originality, and validity of the published work. The author(s) must describe the content created or modified as well as appropriately cite the name and version of the AI tool used; any additional works drawn on by the AI tool should also be appropriately cited and referenced. Standard tools that are used to improve spelling and grammar are not included within the parameters of this guidance. The Editor and Publisher reserve the right to determine whether the use of an AI tool is permissible.
• If your article involves human participants, you must ensure you have considered whether or not you require ethical approval for your research, and include this information as part of your submission. Find out more about informed consent .

Generative AI usage key principles

• Copywriting any part of an article using a generative AI tool/LLM would not be permissible, including the generation of the abstract or the literature review, for as per Emerald’s authorship criteria, the author(s) must be responsible for the work and accountable for its accuracy, integrity, and validity.
• The generation or reporting of results using a generative AI tool/LLM is not permissible, for as per Emerald’s authorship criteria, the author(s) must be responsible for the creation and interpretation of their work and accountable for its accuracy, integrity, and validity.
• The in-text reporting of statistics using a generative AI tool/LLM is not permissible due to concerns over the authenticity, integrity, and validity of the data produced, although the use of such a tool to aid in the analysis of the work would be permissible.
• Copy-editing an article using a generative AI tool/LLM in order to improve its language and readability would be permissible as this mirrors standard tools already employed to improve spelling and grammar, and uses existing author-created material, rather than generating wholly new content, while the author(s) remains responsible for the original work.
• The submission and publication of images created by AI tools or large-scale generative models is not permitted.

Research and publishing ethics

Our editors and employees work hard to ensure the content we publish is ethically sound. To help us achieve that goal, we closely follow the advice laid out in the guidelines and flowcharts on the COPE (Committee on Publication Ethics) website .

We have also developed our research and publishing ethics guidelines . If you haven’t already read these, we urge you to do so – they will help you avoid the most common publishing ethics issues.

A few key points:

• Any manuscript you submit to this journal should be original. That means it should not have been published before in its current, or similar, form. Exceptions to this rule are outlined in our pre-print and conference paper policies .  If any substantial element of your paper has been previously published, you need to declare this to the journal editor upon submission. Please note, the journal editor may use  Crossref Similarity Check  to check on the originality of submissions received. This service compares submissions against a database of 49 million works from 800 scholarly publishers.
• Your work should not have been submitted elsewhere and should not be under consideration by any other publication.
• If you have a conflict of interest, you must declare it upon submission; this allows the editor to decide how they would like to proceed. Read about conflict of interest in our research and publishing ethics guidelines .
• By submitting your work to Emerald, you are guaranteeing that the work is not in infringement of any existing copyright.
• If you have written about a company/individual/organisation in detail using information that is not publicly available, have spent time within that company/organisation, or the work features named/interviewed employees, you will need to clear permission by using the  consent to publish form ; please also see our permissions guidance for full details. If you have to clear permission with the company/individual/organisation, consent must be given either by the named individual in question or their representative, a board member of the company/organisation, or a HR department representative of the company/organisation.
• You have an ethical obligation and responsibility to conduct your research in adherence to national and international research ethics guidelines, as well as the ethical principles outlined by your discipline and any relevant authorities, and to be transparent about your research methods in such a way that all involved in the publication process may fairly and appropriately evaluate your work. For all research involving human participants, you must ensure that you have obtained informed consent, meaning that you must inform all participants in your work (or their legal representative) as to why the research is being conducted, whether their anonymity is protected, how their data will be stored and used, and whether there are any associated risks from participation in the study; the submitted work must confirm that informed consent was obtained and detail how this was addressed in accordance with our policy on informed consent .  
• Where appropriate, you must provide an ethical statement within the submitted work confirming that your research received institutional and national (or international) ethical approval, and that it complies with all relevant guidelines and regulations for studies involving humans, whether that be data, individuals, or samples. Specifically, the statement should contain the name and location of the institutional ethics reviewing committee or review board, the approval number, the date of approval, and the details of the national or international guidelines that were followed, as well as any other relevant information. You should also include details of how the work adheres to relevant consent guidelines along with confirming that informed consent was secured for all participants. The details of these statements should ensure that author and participant anonymity is not compromised. Any work submitted without a suitable ethical statement and details of informed consent for all participants, where required, will be returned to the authors and will not be considered further until appropriate and clear documentation is provided. Emerald reserves the right to reject work without sufficient evidence of informed consent from human participants and ethical approval where required.

Third party copyright permissions

Prior to article submission, you need to ensure you’ve applied for, and received, written permission to use any material in your manuscript that has been created by a third party. Please note, we are unable to publish any article that still has permissions pending. The rights we require are:

• Non-exclusive rights to reproduce the material in the article or book chapter.
• Print and electronic rights.
• Worldwide English-language rights.
• To use the material for the life of the work. That means there should be no time restrictions on its re-use e.g. a one-year licence.

We are a member of the International Association of Scientific, Technical, and Medical Publishers (STM) and participate in the STM permissions guidelines , a reciprocal free exchange of material with other STM publishers.  In some cases, this may mean that you don’t need permission to re-use content. If so, please highlight this at the submission stage.

Please take a few moments to read our guide to publishing permissions  to ensure you have met all the requirements, so that we can process your submission without delay.

Open access submissions and information

All our journals currently offer two open access (OA) publishing paths; gold open access and green open access.

If you would like to, or are required to, make the branded publisher PDF (also known as the version of record) freely available immediately upon publication, you can select the gold open access route once your paper is accepted. 

If you’ve chosen to publish gold open access, this is the point you will be asked to pay the APC (article processing charge) . This varies per journal and can be found on our APC price list or on the editorial system at the point of submission. Your article will be published with a Creative Commons CC BY 4.0 user licence , which outlines how readers can reuse your work.

Alternatively, if you would like to, or are required to, publish open access but your funding doesn’t cover the cost of the APC, you can choose the green open access, or self-archiving, route. As soon as your article is published, you can make the author accepted manuscript (the version accepted for publication) openly available, free from payment and embargo periods.

You can find out more about our open access routes, our APCs and waivers and read our FAQs on our open research page. 

Find out about open

Transparency and Openness Promotion (TOP) Guidelines

We are a signatory of the Transparency and Openness Promotion (TOP) Guidelines , a framework that supports the reproducibility of research through the adoption of transparent research practices. That means we encourage you to:

• Cite and fully reference all data, program code, and other methods in your article.
• Include persistent identifiers, such as a Digital Object Identifier (DOI), in references for datasets and program codes. Persistent identifiers ensure future access to unique published digital objects, such as a piece of text or datasets. Persistent identifiers are assigned to datasets by digital archives, such as institutional repositories and partners in the Data Preservation Alliance for the Social Sciences (Data-PASS).
• Follow appropriate international and national procedures with respect to data protection, rights to privacy and other ethical considerations, whenever you cite data. For further guidance please refer to our  research and publishing ethics guidelines . For an example on how to cite datasets, please refer to the references section below.

Prepare your submission

Manuscript support services.

We are pleased to partner with Editage, a platform that connects you with relevant experts in language support, translation, editing, visuals, consulting, and more. After you’ve agreed a fee, they will work with you to enhance your manuscript and get it submission-ready.

This is an optional service for authors who feel they need a little extra support. It does not guarantee your work will be accepted for review or publication.

Visit Editage

Manuscript requirements

Before you submit your manuscript, it’s important you read and follow the guidelines below. You will also find some useful tips in our structure your journal submission how-to guide.

Submit your manuscript

There are a number of key steps you should follow to ensure a smooth and trouble-free submission.

Double check your manuscript

Before submitting your work, it is your responsibility to check that the manuscript is complete, grammatically correct, and without spelling or typographical errors. A few other important points:

• Give the journal aims and scope a final read. Is your manuscript definitely a good fit? If it isn’t, the editor may decline it without peer review.
• Does your manuscript comply with our research and publishing ethics guidelines ?
• Have you cleared any necessary publishing permissions ?
• Have you followed all the formatting requirements laid out in these author guidelines?
• If you need to refer to your own work, use wording such as ‘previous research has demonstrated’ not ‘our previous research has demonstrated’.
• If you need to refer to your own, currently unpublished work, don’t include this work in the reference list.
• Any acknowledgments or author biographies should be uploaded as separate files.
• Carry out a final check to ensure that no author names appear anywhere in the manuscript. This includes in figures or captions.

You will find a helpful submission checklist on the website Think.Check.Submit .

The submission process

All manuscripts should be submitted through our editorial system by the corresponding author.

The only way to submit to the journal is through the journal’s ScholarOne site as accessed via the Emerald website, and not by email or through any third-party agent/company, journal representative, or website. Submissions should be done directly by the author(s) through the ScholarOne site and not via a third-party proxy on their behalf.

A separate author account is required for each journal you submit to. If this is your first time submitting to this journal, please choose the Create an account or Register now option in the editorial system. If you already have an Emerald login, you are welcome to reuse the existing username and password here.

Please note, the next time you log into the system, you will be asked for your username. This will be the email address you entered when you set up your account.

Don't forget to add your  ORCiD ID during the submission process. It will be embedded in your published article, along with a link to the ORCiD registry allowing others to easily match you with your work.

Don’t have one yet? It only takes a few moments to register for a free ORCiD identifier .

Visit the ScholarOne support centre  for further help and guidance.

What you can expect next

You will receive an automated email from the journal editor, confirming your successful submission. It will provide you with a manuscript number, which will be used in all future correspondence about your submission. If you have any reason to suspect the confirmation email you receive might be fraudulent, please contact the journal editor in the first instance.

Post submission

Review and decision process.

Each submission is checked by the editor. At this stage, they may choose to decline or unsubmit your manuscript if it doesn’t fit the journal aims and scope, or they feel the language/manuscript quality is too low.

If they think it might be suitable for the publication, they will send it to at least two independent referees for double anonymous peer review.  Once these reviewers have provided their feedback, the editor may decide to accept your manuscript, request minor or major revisions, or decline your work.

This journal offers an article transfer service. If the editor decides to decline your manuscript, either before or after peer review, they may offer to transfer it to a more relevant Emerald journal in this field. If you accept, your ScholarOne author account, and the accounts of your co-authors, will automatically transfer to the new journal, along with your manuscript and any accompanying peer review reports. However, you will still need to log in to ScholarOne to complete the submission process using your existing username and password. While accepting a transfer does not guarantee the receiving journal will publish your work, an editor will only suggest a transfer if they feel your article is a good fit with the new title.

While all journals work to different timescales, the goal is that the editor will inform you of their first decision within 60 days.

During this period, we will send you automated updates on the progress of your manuscript via our submission system, or you can log in to check on the current status of your paper.  Each time we contact you, we will quote the manuscript number you were given at the point of submission. If you receive an email that does not match these criteria, it could be fraudulent and we recommend you contact the journal editor in the first instance.

Manuscript transfer service

Emerald’s manuscript transfer service takes the pain out of the submission process if your manuscript doesn’t fit your initial journal choice. Our team of expert Editors from participating journals work together to identify alternative journals that better align with your research, ensuring your work finds the ideal publication home it deserves. Our dedicated team is committed to supporting authors like you in finding the right home for your research.

If a journal is participating in the manuscript transfer program, the Editor has the option to recommend your paper for transfer. If a transfer decision is made by the Editor, you will receive an email with the details of the recommended journal and the option to accept or reject the transfer. It’s always down to you as the author to decide if you’d like to accept. If you do accept, your paper and any reviewer reports will automatically be transferred to the recommended journals. Authors will then confirm resubmissions in the new journal’s ScholarOne system.

Our Manuscript Transfer Service page has more information on the process.

If your submission is accepted

Open access.

Once your paper is accepted, you will have the opportunity to indicate whether you would like to publish your paper via the gold open access route.

If you’ve chosen to publish gold open access, this is the point you will be asked to pay the APC (article processing charge).  This varies per journal and can be found on our APC price list or on the editorial system at the point of submission. Your article will be published with a Creative Commons CC BY 4.0 user licence , which outlines how readers can reuse your work.

For UK journal article authors - if you wish to submit your work accepted by Emerald to REF 2021, you must make a ‘closed deposit’ of your accepted manuscript to your respective institutional repository upon acceptance of your article. Articles accepted for publication after 1st April 2018 should be deposited as soon as possible, but no later than three months after the acceptance date. For further information and guidance, please refer to the REF 2021 website.

All accepted authors are sent an email with a link to a licence form.  This should be checked for accuracy, for example whether contact and affiliation details are up to date and your name is spelled correctly, and then returned to us electronically. If there is a reason why you can’t assign copyright to us, you should discuss this with your journal content editor. You will find their contact details on the editorial team section above.

Proofing and typesetting

Once we have received your completed licence form, the article will pass directly into the production process. We will carry out editorial checks, copyediting, and typesetting and then return proofs to you (if you are the corresponding author) for your review. This is your opportunity to correct any typographical errors, grammatical errors or incorrect author details. We can’t accept requests to rewrite texts at this stage.

When the page proofs are finalised, the fully typeset and proofed version of record is published online. This is referred to as the EarlyCite version. While an EarlyCite article has yet to be assigned to a volume or issue, it does have a digital object identifier (DOI) and is fully citable. It will be compiled into an issue according to the journal’s issue schedule, with papers being added by chronological date of publication.

How to share your paper

Visit our author rights page  to find out how you can reuse and share your work.

To find tips on increasing the visibility of your published paper, read about  how to promote your work .

Correcting inaccuracies in your published paper

Sometimes errors are made during the research, writing and publishing processes. When these issues arise, we have the option of withdrawing the paper or introducing a correction notice. Find out more about our  article withdrawal and correction policies .

Need to make a change to the author list? See our frequently asked questions (FAQs) below.

Frequently asked questions

• Lerong He State University of New York at Geneseo - USA [email protected]
• Jay J. Janney University of Dayton - USA [email protected]

Editorial Assistant

• Chunghui Kuo Individual researcher - USA [email protected]
• Chloe Campbell Emerald Publishing - UK [email protected]

Journal Editorial Office (For queries related to pre-acceptance)

• Shrushti Gupta Emerald Publishing [email protected]

Supplier Project Manager (For queries related to post-acceptance)

• Nitesh Shetty Emerald Publishing [email protected]

Editorial Advisory Board

• Steven H. Appelbaum John Molson School of Business, Concordia University - Canada
• Elisa Arrigo University of Milano-Bicocca - Italy
• Muhammad Awais Bhatti King Faisal University - Saudi Arabia
• Timothy Bartram RMIT University - Australia
• Gary Chaison Graduate School of Management, Clark University - USA
• Stewart Clegg University of Technology Sydney - Australia
• James J Cordeiro Department of Business Administration & Economics, SUNY at Brockport - USA
• Matteo Cristofaro University of Rome Tor Vegata - Italy
• J. Barton Cunningham University of Victoria - Canada
• Alison Dean Newcastle Business School - Australia
• Behnam Fahimnia University of Sydney - Australia
• Piyali Ghosh Indian Institute of Management Ranchi - India
• Anna Graziano Link Campus University - Italy
• Maria Hayu Agustini Soegijapranata Catholic University - Indonesia
• Barry Hettler Ohio University - USA
• Faizul Huq College of Business, Ohio University - USA
• Peter Jones University of Gloucestershire Business School - UK
• Boris Kabanoff School of Management, Queensland University of Technology - Australia
• Anastasia Katou University of Macedonia - Greece
• Lisa A Keister Duke University - USA
• Sascha Kraus Free University of Bozen-Bolzano - Italy
• Darren Lee-Ross James Cook University - Australia
• Frank Lefley University of Hradec Králové - Czech Republic
• Laura Meade M J Neeley School of Business, Texas Christian University - USA
• Boniface Michael California State University, Sacramento - USA
• Armando Papa University of Salerno - Italy
• R D Pathak School of Social & Economic Development, The University of South Pacific - Fiji
• Ken Peattie Cardiff University - UK
• Rajesh K. Pillania Management Development Institute, Gurgaon - India
• Abdul A. Rasheed University of Texas at Arlington - USA
• Elena Revilla Instituto de Empresa - Spain
• Hazel Rosin York University - Canada
• Kanti Saini NL Dalmia Institute of Management Studies and Research - India
• Joseph Sarkis Worcester Polytechnic Institute, USA
• Tara Shankar Shaw Indian Institute of Technology, Bombay - India
• Clive Smallman University of Western Sydney - Australia
• R P Sundarraj Indian Institute of Technology Madras - India
• Srinivas Talluri Eli Broad Graduate School of Management, Michigan State University - USA
• Vas Taras University of North Carolina at Greensboro - USA
• Greg Teal School of Management, University of Western Sydney - Australia
• Diego Vazquez-Brust University of Portsmouth, Portsmouth Business School - UK
• Karen Yuan Wang School of Management, University of Technology, Sydney - Australia
• Cherrie Jiuhua Zhu Monash University - Australia

Citation metrics

CiteScore 2023

Further information

CiteScore is a simple way of measuring the citation impact of sources, such as journals.

Calculating the CiteScore is based on the number of citations to documents (articles, reviews, conference papers, book chapters, and data papers) by a journal over four years, divided by the number of the same document types indexed in Scopus and published in those same four years.

For more information and methodology visit the Scopus definition

CiteScore Tracker 2024

(updated monthly)

CiteScore Tracker is calculated in the same way as CiteScore, but for the current year rather than previous, complete years.

The CiteScore Tracker calculation is updated every month, as a current indication of a title's performance.

2023 Impact Factor

The Journal Impact Factor is published each year by Clarivate Analytics. It is a measure of the number of times an average paper in a particular journal is cited during the preceding two years.

For more information and methodology see Clarivate Analytics

5-year Impact Factor (2023)

A base of five years may be more appropriate for journals in certain fields because the body of citations may not be large enough to make reasonable comparisons, or it may take longer than two years to publish and distribute leading to a longer period before others cite the work.

Actual value is intentionally only displayed for the most recent year. Earlier values are available in the Journal Citation Reports from Clarivate Analytics .

Publication timeline

Time to first decision

Time to first decision , expressed in days, the "first decision" occurs when the journal’s editorial team reviews the peer reviewers’ comments and recommendations. Based on this feedback, they decide whether to accept, reject, or request revisions for the manuscript.

Data is taken from submissions between 1st June 2023 and 31st May 2024

Acceptance to publication

Acceptance to publication , expressed in days, is the average time between when the journal’s editorial team decide whether to accept, reject, or request revisions for the manuscript and the date of publication in the journal. 

Data is taken from the previous 12 months (Last updated July 2024)

Acceptance rate

The acceptance rate is a measurement of how many manuscripts a journal accepts for publication compared to the total number of manuscripts submitted expressed as a percentage %

Data is taken from submissions between 1st June 2023 and 31st May 2024 .

This figure is the total amount of downloads for all articles published early cite in the last 12 months

(Last updated: July 2024)

This journal is abstracted and indexed by

• British Library
• Business Source Alumni Edition/Complete/Government Edition/Corporate Plus/Elite/Premier
• Cabell's Directory of Publishing Opportunities is Management and Marketing
• Current Abstracts (EBSCO)
• Emerging Sources Citation Index
• OCLC's Electronic Collections Online
• ReadCube Discover
• TOC Premier (EBSCO)

This journal is ranked by

• Association of Business Schools (ABS) Academic Journal Quality Guide
• ANVUR Class A (Italy)
• Australian Business Deans Council (ABDC) Quality Journal List
• BFI (Denmark)
• Federation of Management Societies of China (FMS)
• JourQUAL 2.1 (Germany)
• NSD (Norway)
• Polish Scholarly Bibliography (PBN)
• QUALIS (Brazil)
• The Publication Forum (Finland)

Reviewer information

Peer review process.

This journal engages in a double-anonymous peer review process, which strives to match the expertise of a reviewer with the submitted manuscript. Reviews are completed with evidence of thoughtful engagement with the manuscript, provide constructive feedback, and add value to the overall knowledge and information presented in the manuscript.

The mission of the peer review process is to achieve excellence and rigour in scholarly publications and research.

Our vision is to give voice to professionals in the subject area who contribute unique and diverse scholarly perspectives to the field.

The journal values diverse perspectives from the field and reviewers who provide critical, constructive, and respectful feedback to authors. Reviewers come from a variety of organizations, careers, and backgrounds from around the world.

All invitations to review, abstracts, manuscripts, and reviews should be kept confidential. Reviewers must not share their review or information about the review process with anyone without the agreement of the editors and authors involved, even after publication. This also applies to other reviewers’ “comments to author” which are shared with you on decision.

Resources to guide you through the review process

Discover practical tips and guidance on all aspects of peer review in our reviewers' section. See how being a reviewer could benefit your career, and discover what's involved in shaping a review.

More reviewer information

Thank you to the 2022 Reviewers of Management Research Review

The publishing and editorial teams would like to thank the following, for their invaluable service as 2022 reviewers for this journal. We are very grateful for the contributions made. With their help, the journal has been able to publish such high...

Thank you to the 2021 Reviewers of Management Research Review

The publishing and editorial teams would like to thank the following, for their invaluable service as 2021 reviewers for this journal. We are very grateful for the contributions made. With their help, the journal has been able to publish such high...

Literati awards

Management Research Review - Literati Award Winners 2023

We are pleased to announce our 2023 Literati Award winners. Outstanding Paper From conventional to digital leadership: explo...

Management Research Review - Literati Award Winners 2022 

We are pleased to announce our 2022 Literati Award winners. Outstanding Paper Arresting fake news sharing on...

Management Research Review - Literati Award Winners 2021

We are pleased to announce our 2021 Literati Award winners. Outstanding Paper Virtuous leadership: a source ...

Management Research Review (MRR) publishes high-quality quantitative and qualitative research in the field of general management with a viewpoint to emphasize executive and managerial practice implications.

Aims and scope

Management Research Review (MRR) publishes a wide variety of articles outlining the latest management research. We emphasize management implications from multiple disciplines. We welcome high-quality empirical and theoretical studies, literature reviews, and articles with important tactical implications.

Published 12 times a year, the journal prides itself on quick publication of the very latest research in general management. The key issues featured include:

• Business Ethics and Sustainability
• Corporate Governance
• Entrepreneurship and Small Business Management
• Industrial Relations
• Knowledge and Innovation Management
• International Business
• Human Resource Management
• Management in Practice
• Marketing Management
• Organizational Behavior
• Organizational Theory
• Production and Operations Management
• Strategic Management
• General Management
• Other Management Related Topics

Latest articles

These are the latest articles published in this journal (Last updated: July 2024)

Multilevel study of transformational leadership and work behavior: job autonomy matters in public service

The role of perceived knowledge on key brand community constructs of trust, involvement and engagement, unveiling the potential of perceived authentic leadership to enhance followers' moral intentions: a self-determination theory perspective, top downloaded articles.

These are the most downloaded articles over the last 12 months for this journal (Last updated: July 2024)

Framework for sustainable value creation: a synthesis of fragmented sustainable business model literature

High-performance work systems and firminnovation: themoderating role of digital technology and employee participation. evidence fromeurope, driving sustained work engagement- moderating role of leadership and organizational support for remote work.

These are the top cited articles for this journal, from the last 12 months according to Crossref (Last updated: July 2024)

Start-up sustainability: Does blockchain adoption drives sustainability in start-ups? A systematic literature reviews

The human side of entrepreneurship: an empirical investigation of relationally embedded ties with stakeholders.

This title is aligned with our responsible management goal

We aim to champion researchers, practitioners, policymakers and organisations who share our goals of contributing to a more ethical, responsible and sustainable way of working.

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This journal is part of our Business, management & strategy collection. Explore our Business, management & strategy subject area to find out more.  

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Management Research Paper Topics

The field of management is an extremely broad discipline that draws upon concepts and ideas from the physical and social sciences, particularly mathematics, philosophy, sociology, and psychology. Within business, the field of management includes research paper topics and ideas also common to marketing, economics, finance, insurance, transportation, accounting, computer technologies, information systems, engineering, and business law.

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Get 10% off with 24start discount code, 300 management research paper topics, corporate planning and strategic management.

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EMERGING TOPICS IN MANAGEMENT

Activity-Based Costing Affirmative Action Angel Investors and Venture Capitalists Artificial Intelligence Assessment Centers B2B B2E Management Balanced Scorecard Bar Coding and Radio Frequency Identification Business Process Reengineering Cafeteria Plan—Flexible Benefits Cellular Manufacturing Chaos Theory Coalition Building Communities of Interest/Communities of Practice Complexity Theory Concurrent Engineering and Design Consulting Contingency Approach to Management Continuing Education and Lifelong Learning Trends Corporate Governance Corporate Social Responsibility Customer Relationship Management Decision Support Systems Diversity Electronic Commerce Electronic Data Interchange and Electronic Funds Transfer Empowerment Enterprise Resource Planning Entrepreneurship Environmentalism and Sustainability Ethics Expatriates Expert Systems Five S Framework Flexible Spending Accounts Futuring Handheld Computers Health Savings Accounts Human Resource Information Systems Innovation Instant Messaging Intellectual Property Rights Intrapreneurship Knowledge-Based View of the Firm Leadership in Energy and Environmental Design Metadata or Meta-Analysis Mobile Commerce Multiple-Criteria Decision Making Non-Compete Agreements Outsourcing and Offshoring Paradigm Shift Popular Press Management Books Quality of Work Life Results-Only Work Environment Robotics Social Networking Spirituality in Leadership Succession Planning Telecommunications Vendor Rating Virtual Corporations Women and Minorities in Management

ENTREPRENEURSHIP

Angel Investors and Venture Capitalists Balance Sheets Brainstorming Break-Even Point Budgeting Business Plan Business Structure Cafeteria Plan—Flexible Benefits Case Method of Analysis Cash Flow Analysis and Statements Competitive Advantage Consumer Behavior Cost Accounting Customer Relationship Management Diversification Strategy Domestic Management Societies and Associations Due Diligence Economics Economies of Scale and Economies of Scope Effectiveness and Efficiency Financial Issues for Managers Financial Ratios First-Mover Advantage Futuring Gap Analysis Generic Competitive Strategies Income Statements Initial Public Offering Innovation Intellectual Property Rights International Business International Management Societies and Associations Intrapreneurship Inventory Management Joint Ventures and Strategic Alliances Knowledge Management Knowledge Workers Leveraged Buyouts Licensing and Licensing Agreements Location Strategy Macroenvironmental Forces Make-or-Buy Decisions Market Share Marketing Concept and Philosophy Marketing Research Miles and Snow Typology Mission and Vision Statements New Product Development Non-Compete Agreements Organizational Development Outsourcing and Offshoring Patents and Trademarks Planning Poison Pill Strategies Popular Press Management Books Porter’s Five Forces Model Pricing Policy and Strategy Problem Solving Process Management Product Design Product Life Cycle and Industry Life Cycle Profit Sharing Research Methods and Processes Scenario Planning Securities and Exchange Commission Shareholders Stakeholders Strategic Planning Tools Strategy Levels Succession Planning SWOT Analysis Synergy Technology Transfer Value Creation Venture Capital Virtual Organizations

FINANCIAL MANAGEMENT AND ACCOUNTING

Activity-Based Costing Angel Investors and Venture Capitalists Balance Sheets Balanced Scorecard Break-Even Point Budgeting Capacity Planning Cash Flow Analysis and Statements Corporate Social Responsibility Cost Accounting Cost-Volume-Profit Analysis Debt vs. Equity Financing Domestic Management Societies and Associations Due Diligence Economics Electronic Data Interchange and Electronic Funds Transfer Employee Benefits Employee Compensation Executive Compensation Exit Strategy Financial Issues for Managers Financial Ratios Flexible Spending Accounts Health Savings Accounts Income Statements Initial Public Offering Insider Trading Internal Auditing International Management Societies and Associations International Monetary Fund Inventory Types Leveraged Buyouts Licensing and Licensing Agreements Long Tail Make-or-Buy Decisions Management Control Nonprofit Organizations Opportunity Cost Patents and Trademarks Profit Sharing Purchasing and Procurement Risk Management Securities and Exchange Commission Stakeholders Succession Planning Venture Capital Zero-Based Budgeting

GENERAL MANAGEMENT TOPICS

Aggregate Planning The Art and Science of Management Autonomy B2B B2E Management Balanced Scorecard Barriers to Entry Best Practices Black Friday Brainstorming Budgeting Business Plan Business Structure Communication Competitive Advantage Competitive Intelligence Contingency Approach to Management Continuous Improvement Corporate Governance Corporate Social Responsibility Delegation Disaster Recovery Diversity Divestment Downsizing and Rightsizing Economics Effectiveness and Efficiency Electronic Commerce Empowerment Financial Issues for Managers Financial Ratios Forecasting Generic Competitive Strategies Globalization Goals and Goal Setting Human Resource Management Innovation International Management Knowledge-Based View of the Firm Knowledge Management Leadership Styles and Bases of Power Leadership Theories and Studies Line-and-Staff Organizations Logistics and Transportation Management Control Management Functions Management Information Systems Management Science Management Styles Management Thought Managing Change Mission and Vision Statements Motivation and Motivation Theory Operations Management Organization Theory Organizational Analysis and Planning Organizational Behavior Organizational Chart Organizational Culture Organizational Learning Organizational Structure Organizational Development Organizing Paradigm Shift Participative Management Patents and Trademarks Paternalism Pioneers of Management Planning Process Management Quality and Total Quality Management Request for Proposal/Quotation Social Networking Strategic Integration Strategy Formulation Strategy Implementation Strategy in the Global Environment Strategy Levels Subject Matter Expert Succession Planning Training Delivery Methods Trends in Organizational Change

HUMAN RESOURCE MANAGEMENT

Affirmative Action Artificial Intelligence Assessment Centers Autonomy Nonverbal Communication Brainstorming Cafeteria Plan—Flexible Benefits Coalition Building Communication Continuing Education and Lifelong Learning Trends Discrimination Diversity Downsizing and Rightsizing Electronic Data Interchange and Electronic Funds Transfer Employee Assistance Programs Employee Benefits Employee Compensation Employee Evaluation and Performance Appraisals Employee Handbook and Orientation Employee Recruitment Employee Screening and Selection Employment Law and Compliance Empowerment Executive Compensation Flexible Spending Accounts Group Dynamics Health Savings Accounts Human Resource Information Systems Human Resource Management Japanese Management Job Analysis Knowledge-Based View of the Firm Knowledge Workers Mentoring Morale Motivation and Motivation Theory Nepotism Non-Compete Agreements Organizational Behavior Organizational Chart Organizational Culture Performance Measurement Personality and Personality Tests Privacy, Privacy Laws, and Workplace Privacy Quality of Work Life Reinforcement Theory Results-Only Work Environment Safety in the Workplace Scalable or JIT Workforce Sensitivity Training Social Networking Stress Succession Planning Sweatshops Task Analysis Teams and Teamwork Theory X and Theory Y Theory Z Time Management Training Delivery Methods Virtual Organizations Women and Minorities in Management

INNOVATION AND TECHNOLOGY

Artificial Intelligence Bandwidth Bar Coding and Radio Frequency Identification Communication Competitive Intelligence Complexity Theory Computer Networks Computer Security Computer-Aided Design and Manufacturing Computer-Integrated Manufacturing Content Management System Data Processing and Data Management Decision Rules and Decision Analysis Decision Support Systems Delegation Electronic Commerce Electronic Data Interchange and Electronic Funds Transfer Environmentalism and Sustainability Experience and Learning Curves Expert Systems Forecasting Fuzzy Logic Handheld Computers Information Assurance Innovation The Internet Knowledge Centers Knowledge Management Knowledge Workers Leadership in Energy and Environmental Design Management Information Systems Manufacturing Control via the Internet Metadata or Meta-Analysis Mobile Commerce Nanotechnology Product Design Project Management Robotics Service-Oriented Architecture Technology Management Technology Transfer Telecommunications Virtual Corporations Virtual Organizations Web 2.0 WiMax

INTERNATIONAL AND GLOBAL MANAGEMENT

B2B Competitive Advantage Diversity European Union Expatriates Exporting and Importing First-Mover Advantage Franchising Free TradeAgreements and Trading Blocs Futuring Globalization International Business International Management International Management Societies and Associations International Monetary Fund International Organization for Standards Japanese Management Licensing and Licensing Agreements Location Strategy Macroenvironmental Forces Outsourcing and Offshoring Patents and Trademarks Popular Press Management Books Profit Sharing Strategy in the Global Environment Sweatshops Transnational Organization Value-Added Tax Vendor Rating Virtual Organizations World-Class Manufacturer

LEADERSHIP RESEARCH TOPICS

The Art and Science of Management Assessment Centers Best Practices Communication Contingency Approach to Management Corporate Governance Corporate Social Responsibility Delegation Domestic Management Societies and Associations Entrepreneurship Executive Compensation Expert Systems Goals and Goal Setting Human Resource Management International Management Societies and Associations Japanese Management Job Analysis Joint Ventures and Strategic Alliances Knowledge Management Knowledge Workers Leadership Styles and Bases of Power Leadership Theories and Studies Line-and-Staff Organizations Management and Executive Development Management Functions Management Levels Management Styles Management Thought Managing Change Mechanistic Organizations Mentoring Mission and Vision Statements Morale Motivation and Motivation Theory Open and Closed Systems Operant Conditioning Organizational Culture Paradigm Shift Participative Management Personality and Personality Tests Pioneers of Management Problem Solving Reinforcement Theory Sensitivity Training Span of Control Spirituality in Leadership Strategy Formulation Succession Planning Teams and Teamwork Theory X and Theory Y Theory Z Women and Minorities in Management

LEGAL ISSUES

Affirmative Action Cafeteria Plan—Flexible Benefits Computer Networks Computer Security Corporate Governance Corporate Social Responsibility Discrimination Diversity Downsizing and Rightsizing Due Diligence Electronic Data Interchange and Electronic Funds Transfer Employee Assistance Programs Employee Benefits Employee Compensation Employee Evaluation and Performance Appraisals Employee Recruitment Employee Screening and Selection Employment Law and Compliance Ethics Executive Compensation Human Resource Management Insider Trading Intellectual Property Rights Job Analysis Leveraged Buyouts Management Audit Management Control Mergers and Acquisitions Nepotism Non-Compete Agreements Patents and Trademarks Personality and Personality Tests Privacy, Privacy Laws, and Workplace Privacy Quality of Work Life Risk Management Safety in the Workplace Stress Succession Planning Sunshine Laws Sweatshops Technology Transfer Whistle Blower Women and Minorities in Management

MANAGEMENT INFORMATION SYSTEMS

Balanced Scorecard Bandwidth Bar Coding and Radio Frequency Identification Barriers to Entry Complexity Theory Computer Networks Computer Security Computer-Aided Design and Manufacturing Computer-Integrated Manufacturing Content Management System Data Processing and Data Management Decision Rules and Decision Analysis Decision Support Systems Distribution and Distribution Requirements Planning Electronic Commerce Electronic Data Interchange and Electronic Funds Transfer Service-Oriented Architecture Statistical Process Control and Six Sigma Systems Design, Development, and Implementation Technology Management Technology Transfer

MANAGEMENT SCIENCE AND OPERATIONS RESEARCH

Bar Coding and Radio Frequency Identification Business Process Reengineering Computer-Aided Design and Manufacturing Concurrent Engineering and Design Decision Rules and Decision Analysis Decision Support Systems Distribution and Distribution Requirements Planning Expert Systems Location Strategy Logistics and Transportation Maintenance Make-or-Buy Decisions Manufacturing Resources Planning Models and Modeling Multiple-Criteria Decision Making New Product Development Operating System Operations Management Operations Scheduling Operations Strategy Product Design Production Planning and Scheduling Productivity Concepts and Measures Product-Process Matrix Project Management Purchasing and Procurement Quality and Total Quality Management Research Methods and Processes Reverse Supply Chain Logistics Scenario Planning Service Operations Service Process Matrix Simulation Statistical Process Control and Six Sigma Statistics Subject Matter Expert Systems Analysis Systems Design, Development, and Implementation Technology Transfer Warehousing and Warehouse Management World-Class Manufacturer

PERFORMANCE MEASURES AND ASSESSMENT

Activity-Based Costing Balance Sheets Balanced Scorecard Benchmarking Best Practices Break-Even Point Budgeting Cash Flow Analysis and Statements Continuous Improvement Cost Accounting Cost-Volume-Profit Analysis Cycle Time Debt vs. Equity Financing Due Diligence Effectiveness and Efficiency Executive Compensation Financial Issues for Managers Financial Ratios Forecasting Gap Analysis Goals and Goal Setting Management Audit Management Control Management Information Systems Market Share Multiple-Criteria Decision Making Nepotism Order-Winning and Order-Qualifying Criteria Performance Measurement Pricing Policy and Strategy Profit Sharing Simulation Stakeholders Value Analysis Value Chain Management Value Creation Vendor Rating Zero-Based Budgeting Zero Sum Game

PERSONAL GROWTH AND DEVELOPMENT FOR MANAGERS

The Art and Science of Management Brainstorming Coalition Building Communication Consulting Contingency Approach to Management Continuing Education and Lifelong Learning Trends Continuous Improvement Customer Relationship Management Delegation Diversity Employee Assistance Programs Empowerment Entrepreneurship Facilitator Feedback Goals and Goal Setting Group Dynamics Intrapreneurship Knowledge Workers Leadership Styles and Bases of Power Managing Change Mentoring Morale Motivation and Motivation Theory Multimedia Organizing Participative Management Personality and Personality Tests Planning Popular Press Management Books Problem Solving Profit Sharing Safety in the Workplace Sensitivity Training Spirituality in Leadership Strategic Planning Tools Stress Succession Planning SWOT Analysis Teams and Teamwork Time Management Trends in Organizational Change Value Creation

PRODUCTION AND OPERATIONS MANAGEMENT

Activity-Based Costing Aggregate Planning Bar Coding and Radio Frequency Identification Benchmarking Break-Even Point Business Process Reengineering Cellular Manufacturing Computer-Aided Design and Manufacturing Computer-Integrated Manufacturing Concurrent Engineering and Design Continuous Improvement Cost-Volume-Profit Analysis Decision Rules and Decision Analysis Decision Support Systems Distribution and Distribution Requirements Planning Domestic Management Societies and Associations Five S Framework Flexible Manufacturing Forecasting Industrial Relations International Management Societies and Associations Inventory Management Inventory Types Japanese Management Layout Lean Manufacturing and Just-in-Time Production Location Strategy Logistics and Transportation Long Tail Maintenance Make-or-Buy Decisions Management Awards Manufacturing Control via the Internet Manufacturing Resources Planning Market Share New Product Development Operations Management Operations Scheduling Operations Strategy Order-Winning and Order-Qualifying Criteria Outsourcing and Offshoring Participative Management Poka-Yoke Popular Press Management Books Porter’s Five Forces Model Production Planning and Scheduling Productivity Concepts and Measures Product-Process Matrix Project Management Purchasing and Procurement Quality Gurus Quality and Total Quality Management Reverse Supply Chain Logistics Robotics Safety in the Workplace Scalable or JIT Workforce Service Factory Service Industry Service Operations Service Process Matrix Simulation Statistical Process Control and Six Sigma Statistics Strategic Integration Supply Chain Management Synergy Teams and Teamwork Technology Management Technology Transfer Theory of Constraints Time-Based Competition Upselling Warehousing and Warehouse Management World-Class Manufacturer

QUALITY MANAGEMENT AND TOTAL QUALITY MANAGEMENT

Communication Customer Relationship Management Domestic Management Societies and Associations Five S Framework Gap Analysis Goals and Goal Setting Innovation International Management Societies and Associations Japanese Management Management Awards Manufacturing Resources Planning Marketing Research Operations Strategy Opportunity Cost Order-Winning and Order-Qualifying Criteria Outsourcing and Offshoring Participative Management Popular Press Management Books Productivity Concepts and Measures Quality Gurus Quality and Total Quality Management Quality of Work Life Statistical Process Control and Six Sigma Strategic Planning Tools Teams and Teamwork Value Analysis Value Creation Vendor Rating World-Class Manufacturer

SUPPLY CHAIN MANAGEMENT

Activity-Based Costing Business Process Reengineering Capacity Planning Cellular Manufacturing Coalition Building Communication Competitive Advantage Competitive Intelligence Computer Networks Computer-Integrated Manufacturing Conflict Management and Negotiation Customer Relationship Management Cycle Time Decision Support Systems Distribution and Distribution Requirements Planning Economies of Scale and Economies of Scope Effectiveness and Efficiency Electronic Commerce Electronic Data Interchange and Electronic Funds Transfer Enterprise Resource Planning Expert Systems Fulfillment Group Dynamics Industrial Relations Inventory Management Inventory Types Joint Ventures and Strategic Alliances Lean Manufacturing and Just-in-Time Production Location Strategy Logistics and Transportation Long Tail Make-or-Buy Decisions Manufacturing Resources Planning Market Share Multiple-Criteria Decision Making New Product Development Operations Management Operations Scheduling Operations Strategy Organic Organizations Organizing Poka-Yoke Problem Solving Process Management Product Design Product Life Cycle and Industry Life Cycle Production Planning and Scheduling Productivity Concepts and Measures Product-Process Matrix Purchasing and Procurement Quality and Total Quality Management Reverse Auction Reverse Supply Chain Logistics Risk Management Span of Control Stakeholders Teams and Teamwork Vendor Rating Warehousing and Warehouse Management

TRAINING AND DEVELOPMENT

Artificial Intelligence Assessment Centers Autonomy Concurrent Engineering and Design Conflict Management and Negotiation Consulting Contingency Approach to Management Continuing Education and Lifelong Learning Trends Continuous Improvement Corporate Social Responsibility Delegation Domestic Management Societies and Associations Downsizing and Rightsizing Employee Evaluation and Performance Appraisals Employee Handbook and Orientation Goals and Goal Setting Group Decision Making Human Resource Management Innovation Instant Messaging International Management Societies and Associations Job Analysis Knowledge Management Knowledge Workers Management and Executive Development Management Audit Marketing Communication Mission and Vision Statements Morale Motivation and Motivation Theory Multimedia Multiple-Criteria Decision Making Organizational Culture Organizational Learning Organizing Participative Management Personality and Personality Tests Popular Press Management Books Problem Solving Project Management Safety in the Workplace Sensitivity Training Simulation Stress Succession Planning SWOT Analysis Teams and Teamwork Training Delivery Methods Virtual Organizations Women and Minorities in Management

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Navigating the storm: how managers’ decisions shape companies in crisis

• Original Paper
• Published: 28 August 2024

Cite this article

• J. Ulpiano Vázquez-Martínez   ORCID: orcid.org/0000-0002-7300-9546 1 ,
• Javier Morales-Mediano   ORCID: orcid.org/0000-0003-1797-9211 2 ,
• Antonio L. Leal-Rodríguez   ORCID: orcid.org/0000-0002-4403-9658 3 &
• Carla Pennano-Villanueva   ORCID: orcid.org/0000-0001-9351-9781 4  

This research aims to examine how managers responded and behaved in the highly chaotic environment generated by the COVID-19 crisis. Understanding their response is important because each decision taken impacted differently and significantly on their companies’ performance. The first part of the study uses topic modeling to interprets text from 113 interviews with executives published in general media. The second part analyzes responses from 518 managers across 15 countries using PLS-SEM. The survey was conducted during the most severe stage of the pandemic (2020), ensuring real-time opinions from managers rather than relying on recollections. The study’s main finding reveals that managers made strategic/operational and financial decisions, which helped companies adapt and survive in this new environment. However, they had a negative effect on firm performance. These findings delineate significant theoretical implications for managerial decision-making amidst chaotic contexts, as well as guiding practitioners in facing future crises.

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Conclusion: Management Theory in Crisis

The effect of management control systems in managing the unknown: Does the market appreciate the breadth of vision?

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Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program

Margae knox.

1 School of Public Health, University of California, Berkeley, Berkeley, California, USA

Emily E Esteban

2 Contra Costa Health Services, Martinez, California, USA

Elizabeth A Hernandez

Mark d fleming, nadia safaeinilli, amanda l brewster, associated data.

No data are available. Data are not publicly available to protect potentially sensitive information. For data inquiries, please contact the corresponding author.

Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers.

Case management program for high-risk, complex patients run by an integrated, county-based public health system.

Participants

30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March–November 2019.

Primary and secondary outcome measures

The analysis intended to identify characteristics of success working with patients.

Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients’ mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics.

Conclusions

Themes emphasise the importance of compassion for complexity in patients’ lives, and success as a step-by-step process that is built over longitudinal relationships.

What is already known on this topic?

• Case management programs to support health and social needs have demonstrated promising yet mixed results. Underlying mechanisms and shared definitions of successful case management are underdeveloped.

What this study adds?

• Case managers emphasised building trust over time and individual, patient-defined objectives as key markers of success, a contrast to commonly used quantitative evaluation metrics.

How this study might affect research, practice or policy?

• Results suggest that lighter touch case management interventions face limitations without an established patient relationship. Results also support a need for alternative definitions of case management success including patient-centered measures such as trust in one’s case manager.

Introduction

Health system efforts to address both health and social needs are expanding. In the USA, some state Medicaid programmes are testing payments for non-medical services to address transportation, housing instability and food insecurity. Medicaid provides healthcare coverage for lower income individuals and families, jointly funded by federal and state governments. Similarly, social prescribing, or the linking of patients with social needs to community resources, is supported by the UK’s National Health Service and has also been piloted by Canada’s Alliance for Healthier Communities. 1

A growing evidence base suggests promising outcomes from healthcare interventions addressing social needs. In some contexts, case managers or navigators providing social needs assistance can improve health 2 and reduce costly hospital use. 3–5 Yet systematic reviews also report mixed results for measures of health and well-being, hospitalisation and emergency department use, and overall healthcare costs. 6–9 Notably, a randomised trial of the Camden Care Coalition programme for patients with frequent hospitalisations due to medically and socially complex needs 10 found no difference in 180-day readmission between patients assigned to a care transitions programme compared with usual hospital postdischarge care. In the care transition programme, patients received follow-up from a multidisciplinary team of nurses, social workers and community health workers. The team conducted home visits, scheduled and accompanied patients to follow-up outpatient visits, helped with managing medications, coached patients on self-care and connected patients with social services and behavioural healthcare. The usual care group received usual postdischarge care with limited follow-up. 11 This heterogeneity of early evidence indicates a need for more nuanced explorations of how social needs assistance programmes work, and how to holistically assess whether programmes are successful. 12 13

Social needs case management may lead to health and well-being improvements through multiple pathways involving both material and social support. 14 15 Improvements are often a long-term, non-linear process. 16 17 At the same time, quality measures specific to social needs assistance programmes currently remain largely undefined. Studies often analyse utilisation and cost outcomes but lack granularity on interim processes and markers of success.

In order to translate a complex and context-dependent intervention like social needs case management from one setting to another, these interim processes and outcomes need greater recognition. 18–20 Early efforts to refine complex care measures are underway and call out a need for person-centred and goal-concordant measures. 21 Further research on how frontline social needs case managers themselves define successes in their work could help leaders improve programme design and management and could also inform broader quality measure development efforts.

Our in-depth, qualitative study sought to understand how case managers defined success in their work with high-risk patients. Case managers were employed by CommunityConnect, a large-scale health and social needs care management programme that serves a mixed-age adult population with varying physical health, mental health and social needs. Each case manager’s workflow includes an individualised, regularly updated dashboard of operational metrics. It is unclear, however, whether or how these operational factors relate to patient success in a complex care programme. Thus, the case managers’ perspectives on defining success are critical for capturing how programmes work and identifying essential principles.

Study design and setting

In 2017, the Contra Costa County Health Services Department in California launched CommunityConnect, a case management programme to coordinate health, behavioural health and social services for County Medicaid patients with complex health and social conditions. The County Health Services Department serves approximately 15% (180 000) of Contra Costa’s nearly 1.2 million residents. CommunityConnect enrollees were selected based on a predictive model, which leveraged data from multiple county systems to identify individuals most likely to use hospital or emergency room services for preventable reasons. Enrollees are predominantly women (59%) and under age 40 (49%). Seventy-seven per cent of enrollees have more than one chronic condition, particularly hypertension (42%), mood disorders (40%) and chronic pain (35%). 22 Programme goals include improving beneficiary health and well-being through more efficient and effective use of resources.

Each case manager interviewed in this study worked full time with approximately 90 patients at a time. Case managers met patients in-person, ideally at least once a month for 1 year, although patients sometimes continue to receive ongoing support at the case manager’s discretion in cases of continued need. Overall, up to 6000 individuals at a time receive in-person case management services through CommunityConnect, with approximately 200–300 added and 200–300 graduated per month. At the time of the study, CommunityConnect employed approximately 70 case managers trained in various public health and social work disciplines (see table 1 , Interview Sample). Case managers and patients are matched based on an algorithm that prioritises mental health history, primary language and county region.

Interview sample

Although case managers bring unique experience from their respective discipline, all are expected to conduct similar case management services. Services included discussing any unmet social needs with patients, coordinating applicable resources and partnering with the patient and patient’s care team to improve physical and emotional health. The programme tracks hospital and emergency department utilisation as well as patient benefits such as food stamps, housing or transportation vouchers and continuous Medicaid coverage on an overall basis. Each case manager has access to an individualised dashboard that includes operational metrics such as new patients to contact, and frequency of patient contacts, timeliness for calling patients recently discharged from the hospital, whether patients have continuous Medicaid coverage, and completion of social risk screenings.

Study recruitment

Semistructured interviews were conducted with 30 field-based case managers as part of the programme’s evaluation and quality improvement process. Participants included four mental health clinical specialists, five substance abuse counsellors, six social workers, nine public health nurses, four housing support specialists and two community health worker specialists. Case managers were recruited by email and selected based on purposive sampling to reflect membership across disciplines and experience working with CommunityConnect for at least 1 year. Three case managers declined to participate. Interviews ended when data saturation was achieved. 23

Interview procedures

Interviews were conducted by five CommunityConnect evaluation staff members (including EEE), who received training and supervision from the evaluation director (EH), who also conducted interviews. The evaluation staff were bachelor and masters-level trained. The evaluation director was masters-level trained and held prior experience in healthcare quality and programme planning.

The evaluation team drafted the interview guide to ask about a variety of work processes and experiences with the goal of improving programme operations including staff and patient experiences. Specific questions analysed for this study were (1) how case managers define success with a patient and (2) examples where case managers considered work with patients a success.

Interviews took place in-person in private meeting rooms at case managers’ workplace from March 2019 – November 2019. Interviews lasted 60–90 min and only the interviewer and case manager were present. All interviewers were familiar with CommunityConnect yet did not have a prior relationship with case managers. Case managers did not receive compensation beyond their regular salary for participating in the study and were allowed to opt out of recruitment or end the interview early for any reason. All interviews were audio recorded, transcribed and entered into Nvivo V.12 for analysis.

Patient and public involvement

This project focused on case manager’s perspectives and thus did not directly involve patients. Rather, patients were involved through case manager recollections of experiences working with patients.

Data analysis

We used an integrated approach to develop an initial set of qualitative codes including deductive coding of programme processes and concepts, followed by inductive coding of how case managers defined success. All interviews were coded by two researchers experienced in qualitative research (EEE and MK). Themes were determined based on recurrence across interviews and illustrative examples and being described by more than one case manager type. The two researchers identified preliminary themes independently, then consulted with one another to achieve consensus on final themes. Themes and supporting quotes were then presented to the full author team to ensure collective agreement that key perspectives had been included. Preliminary results were also shared at a staff meeting attended by case managers and other staff as an opportunity for feedback on study findings. This manuscript addresses the Standards for Reporting Qualitative Research, 24 and the Consolidated Criteria for Reporting Qualitative Research checklist is provided as an appendix. 25

All case manager participants provided informed consent. Research procedures were approved by the Contra Costa Regional Medical Center and Health Centers Institutional Review Committee (Protocol 12-17-2018).

Case managers frequently and across multiple roles mentioned three characteristics of success when working with patients: (1) establishing trust; (2) fostering change in patients’ mindset or initiative and (3) promoting stability and independence. Across these characteristics, case managers expressed that success is patient-defined, with individualised and often incremental progress—a contrast with external perceptions of success and common operational or productivity metrics (see figure 1 ).

Illustration of key themes.

Success is establishing trust

Trusting relationships were the most widely noted characteristic of success. Trust was described as both a product of case managers’ consistent follow-up and helpfulness over time and a foundational step to enable progress on patient-centred goals. To build trust, case managers explained, patients must feel seen and heard, and understand the case managers’ desire to help: ‘Success is to know that she knows me very well…I look for her on the streets, and I’m waiting for her to call me back. Hopefully she knows that when she’s ready I will be there at least to provide that resource for her and so it’s that personal relationship that you build’ (Case manager 11, social worker). Case managers also highlighted the longitudinal relationship required to establish trust, distinguishing success as more than one-time information delivery or navigating bureaucratic processes to procure services.

Case managers also identified trust as foundational to provide better support for patients: ‘So they’re as honest with me as they can be. That way I have a clear understanding about realistically what I can do to help them coordinate their care or link them to services.’ (Case manager 2, mental health clinician specialist). Establishing trust was essential to improve communication with patients and produced an amplifying effect. That is, a case manager’s initial help and follow-up builds trust so that patients can be more open, and open communication helps the case manager know what specific services can be most useful. This positive feedback loop further cements trust and builds momentum for a longitudinal relationship.

Permission to have a home visit was mentioned as a valuable indicator of early success in building trust: ‘(Your home is) your sanctuary’, expressed one case manager (Case manager 29, public health nurse), acknowledging the vulnerability of opening one’s home to an outsider. For another case manager, regular home visits in the context of a trusting relationship made the case manager aware of and able to address a difficult situation: ‘Every time I was going to her home, I was noticing more and more gnats flying around… She said it’s because of the garbage…’ After establishing trust, the patient allowed the case manager access to the bedroom where the case manager uncovered numerous soiled diapers. The case manager arranged professional cleaning and sanitation through CommunityConnect, after which, ‘there was room for a dance floor in her bedroom. There was so much room, and the look on her face, it was almost as if her chest got proud, just in that day. She didn’t seem so burdened…So that’s a success’ (Case manager 4, substance abuse counsellor). Across multiple examples, case managers expressed trust as a critical element for effective patient partnerships.

However, the pathways to building trust are less clear cut. Quick wins through tangible support such as a transportation voucher to a medical appointment could help engage a patient initially. Yet case managers more frequently emphasised strategies based on relationships over time. Strategies included expressing empathy (putting yourself in the patient’s shoes), demonstrating respect (especially when the patient has experienced disrespect in other health system encounters), keeping appointments, following through on what you say you will do, calling to check in and ‘being there’. Overall, case managers expressed that trust lets patients know they are not alone and sets the stage for future success.

Success is fostering a change in patients’ mindset or initiative

Case managers described a change in patients’ mindset or initiative as evidence of further success. One case manager explained, ‘Really (success) could be a switch in mind state… If I can get someone to consider addressing an issue. Or just acknowledging an issue. That’s progress’ (Case manager 24, substance abuse counsellor). Another case manager spoke to the importance of mindset by stating, ‘what I try to do is not just change the surface of life’. This case manager elaborated, ‘You help (a patient) get their housing and they’re gonna lose it again, unless they change; something changes in their mindset, and then they see things differently.’ (Case manager 6, mental health clinician specialist). Some case managers suggested that the supportive resources they provide are only band-aid solutions if unaccompanied by a changed mindset to address root causes.

Case managers reported that shared goals and plans are essential, in contrast to solutions identified by case managers without patient involvement. ‘I can’t do everything for them’, expressed one case manager (Case manager 21, public health nurse), while others similarly acknowledged that imposing self-improvement goals or providing resources for which a patient may not be ready may be counterproductive. Rather, one case manager emphasised, ‘I think it’s really important to celebrate people’s ideas, their beliefs, their own goals and values’. (Case manager 4, substance abuse counsellor). As an example, the case manager applauded a patient’s ideas of getting a driver’s license and completing an education certificate. In summary, case managers viewed success as a two-way street where patient’s own ideas and motivation were essential for long-term impact.

Success is promoting stability and independence

Case managers also identified patients’ stability and independence as a characteristic of success. One case manager stated, ‘I define success as having them be more independent in their just manoeuvring the system…how they problem solve’ (Case manager 30, public health nurse). Relative to the other characteristics of success, stability and independence more closely built on resources and services coordinated or procured by the case manager. For example, CommunityConnect provides cell phones free-of-charge to patients who do not currently have a phone or continuous service, which has helped patients build a network beyond the case manager: ‘Once we get them that cell phone then they’re able to make a lot of connections … linking to services on their own. They actually become a lot more confident in themselves is what I’ve seen’. (Case manager 23, substance abuse counsellor). In another example, a case manager helped a patient experiencing complex health issues to reconcile and understand various medications. For this patient stability means, ‘when he does go into the emergency room, it’s needed. … even though he’s taking his medication like he’s supposed to… it’s just his health gets bad. So, yea I would say that one (is a success)’ (Case manager 8, social worker). Thus, stability represents maintained, improved well-being, supported by care coordination and resources, even while challenges may still be present.

As a step further, ‘Absolute success’, according to one case manager, ‘(is when a patient) drops off my caseload and I don’t hear from them, not because they’re not doing well but because they are doing well, because they are independent’ (Case manager 12, social worker). Patients may still need periodic help knowing who to contact but can follow through on their own. This independence may arise because patients have found personal support networks and other resources that allow them to rely less and less on the case manager. While not all patients reach this step of sustained independence and stability, it is an accomplishment programmatically and for case managers personally.

Success is patient-defined, built on individualised and incremental progress

Case managers widely recognised that success comes in different shapes and sizes, dependent on their patient’s situation. Irrespective of the primary concern, many identified the patient’s own judgement as the benchmark for success. One case manager explained, ‘I define success with my patients by they are telling me it was a success. It’s by their expression, it’s just not a success until they say it’s a success for them’ (Case manager 7, social worker). In a more specific example, a case manager highlighted checking in with a patient instead of assuming a change is successful: ‘It’s not just getting someone housed or getting someone income. Like the male who we’re working towards reconciliation with his parents… that’s a huge step but if he doesn’t feel good about it… then that’s not a success.’ The same case manager elaborated, ‘it’s really engaging with the knowing where the patient him or herself is at mentally, for me. Yeah. That’s a success’ (Case manager 18, homeless services specialist). This comment challenges the current paradigm where, for example, if a patient has a housing need and is matched to housing, then the case is a success. Rather, case managers viewed success as more than meeting a need but also reciprocal satisfaction from the patient.

Often, case managers valued individualised, even if seemingly small, achievements as successes: ‘Every person’s different you know. A success could be just getting up and brushing their teeth. Sometimes success is actually getting them out of the house or getting the care they need’ (Case manager 28, social worker). Another case manager echoed, ‘(Success) depends on where they’re at … it runs the gamut, you know, but they’re all successes’ (Case manager 10, public health nurse). CommunityConnect’s interdisciplinary focus was identified as an important facilitator for tailoring support to individualised client needs. In contrast with condition-specific case management settings, for example, a case manager with substance abuse training noted, ‘whether someone wants to address their substance use or not, they still have these other needs, and (with CommunityConnect) I can still provide assistance’ (Case manager 24).

However, the individualised and incremental successes are not well captured by common case management metrics. One case manager highlighted a tension between operational productivity metrics and patient success, noting, ‘I get it, that there has to be accountability. We’re out in the field, I mean people could really be doing just a whole lot of nothing… (Yet), for me I don’t find the success in the numbers. I don’t think people are a number. Oh, look I got a pamphlet for you, I’m dropping it off… I don’t think that that is what’s really going to make this programme successful’ (Case manager 8, social worker). One case manager mentioned change in healthcare utilisation as a marker of success, but more often, case managers offered stories of patient success that diverge from common programme measures. For example, one case manager observed, ‘The clear (successes) are nice: when you apply for Social Security and they get it that’s like a hurrah. And then there’s other times it’s just getting them to the dentist’ (Case manager 28, social worker). Another case manager elaborated, ‘It’s not always the big number—the how many people did I house this year. It’s the little stuff like the fact that this 58-year-old woman who believes she’s pregnant and has been living outside for years and years, a victim of domestic violence, has considered going inside. Like that is gigantic’ (Case manager 18, homeless services specialist). Overwhelmingly, case managers defined success through the interpersonal relationship with their patients within patients’ complex, daily life circumstances.

Case managers’ definitions of success focused on establishing trust, fostering patients change in mindset or initiative, and, for some patients, achieving independence and stability. Examples of success were commonly incremental and specific to an individual’s circumstances, contrasting with programmatic measures such as reduction in hospital or emergency department utilisation, benefits and other resources secured, or productivity expectations. Study themes heavily emphasise the interpersonal relationship that case managers have with patients and underscore the importance of patient-centred and patient-defined definitions of success over other outcome measures.

Our results complement prior work on clinic-based programmes for complex patients. For example, interdisciplinary staff in a qualitative study of an ambulatory intensive care centre also identified warm relationships between patients and staff as a marker of success. 26 In another study interviewing clinicians and leaders across 12 intensive outpatient programmes, three key facilitators of patient engagement emerged: (1) financial assistance and other resources to help meet basic needs, (2) working as a multi-disciplinary care team and (3) adequate time and resources to develop close relationships focused on patient goals. 27 Our results concur on the importance of a multi-disciplinary approach, establishing trusting relationships, and pursuing patient-centred goals. Our results diverge on the role of resources to meet basic needs. Case managers in our study indicated that while connections to social services benefits and other resources help initiate the case manager-patient relationship, lasting success involved longer-term relationships in which they supported patients in developing patients’ own goal setting skills and motivation.

An important takeaway from case managers’ definitions of success is the ‘how’ they go about their work, in contrast to the ‘what’ of particular care coordination activities. For example, case managers emphasise interpersonal approaches such as empathy and respect over specific processes and resource availability. Primary care clinicians, too, have expressed how standard HEDIS or CAHPS quality metrics fail to capture, and in some cases disincentivise, the intuitions in their work that are important for high quality care. 28 29 Complex care management programmes must also wrestle with this challenge of identifying standards without extinguishing underlying quality constructs.

Strengths and limitations

This study brings several strengths, including bringing to light the unique, unexplored perspective of case managers working on both health and social needs with patients facing diverse circumstances that contribute to high-risk of future hospital or emergency department utilisation. The fact that our study explores perspectives across an array of case manager disciplines is also a strength, however a limitation is that we are unable to distinguish how success differed by discipline based on smaller numbers of each discipline in this study sample. Other study limitations include generalisability to other settings, given that all case managers worked for a single large-scale social needs case management programme. Comments around productivity concerns or interdisciplinary perspectives on ways to support patients may be unique to the infrastructure or management of this organisation. In addition, at the time of the study, all case managers were able to meet with patients in-person; future studies may explore whether definitions of success change when interactions become virtual or telephonic as occurred amidst COVID-19 concerns.

This study is the first to our knowledge to inquire about holistic patient success from the perspective of case managers in the context of a social needs case management programme. The findings offer important implications for researchers as well as policy makers and managers who are designing complex case management programmes.

Our results identify patient-directed goals, stability and satisfaction, as aspects of social needs case management which are difficult to measure but nonetheless critical to fostering health and well-being. Case managers indicated these aspects are most likely to emerge through a longer-term connection with their patients. Thus, while resource-referral solutions may play an important role in addressing basic needs, 30 our findings suggest that weak patient–referrer rapport may be a limitation for such lighter touch interventions. The need for sustained rapport building is also one explanation why longer time horizons may be necessary to show outcome improvements in rigorous studies. 16

Relatedly, results point to trusting relationships as an under-recognised and understudied feature of social needs case management. Existing research finds that patients’ trust in their primary care physician is associated with greater self-reported medication adherence 31 along with health behaviours such as exercise and smoking cessation. 32 Similar quantitative results have not yet been illuminated in social needs case management contexts, yet the prominence of trusting relationships in this study as well as other sources 26 27 33 34 suggests that measures of trust should be used to complement currently emphasised outcomes such as inpatient and outpatient utilisation. Future research and programme evaluation will need to develop new trust measurement or modify existing trust measures for the social needs case management context. 31 35

In summary, study themes provide waypoints of how to conceptualise programme design, new staff training and potential measurement development for complex case management programmes like CommunityConnect. Despite the broad swath of social needs addressed, case managers coalesced on establishing a trusting relationship as a necessary foundation to appropriately identify needs and facilitate connections. Second, fostering patients’ own ideas, including a change their mindset or initiative, was important to fully make use of programme resources. Third, supporting new-found independence or stability was a gratifying, but not universally achieved marker of success. Commonly, case managers highlighted moments of success with mindfulness toward small victories, illuminating that success is non-linear with no certain path nor single end point. Themes emphasise the importance of bringing compassion for the complexity in patients’ lives and developing collaborative relationships one interaction at a time.

Acknowledgments

The authors would like to thank the CommunityConnect evaluation team for their support conducting and transcribing interviews and applying preliminary coding, especially Gabriella Quintana, Alison Stribling, Julia Surges and Camella Taylor.

Contributors: MK coded and analysed qualitative data, identified key themes and related discussion areas, and drafted and critically revised the manuscript. EEE conducted interviews, coded and analysed qualitative data, and drafted and critically revised the manuscript. EH developed the study instrument, conducted interviews, supervised data collection, contributed to the data interpretation and critically revised the manuscript. MDF contributed to the interpretation and critically revised the manuscript. NS contributed to the interpretation and critically revised the manuscript. ALB contributed to the design and interpretation and critically revised the manuscript. All authors approve of the final version to be published.

Funding: MK was supported by the Agency for Healthcare Research and Quality (AHRQ) under the Ruth L. Kirschstein National Research Service Award T32 (T32HS022241). MDF was supported by the Agency for Healthcare Research and Quality, grant # K01HS027648.

Disclaimer: Its contents are solely the responsibility of the authors and do not necessarily represent the official views of AHRQ. Funding had no role in the study’s design, conduct or reporting.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

Ethics statements, patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants and was approved by Contra Costa Regional Medical Center and Health Centers Institutional Review Committee (Protocol 12-17-2018). Participants gave informed consent to participate in the study before taking part.

• Open access
• Published: 26 August 2024

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study

• Alireza Shafiei 1 ,
• Narges Arsalani 2 ,
• Mehdi Beyrami Jam 3 &
• Hamid Reza Khankeh   ORCID: orcid.org/0000-0002-9532-5646 4  

BMC Emergency Medicine volume  24 , Article number:  153 ( 2024 ) Cite this article

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Introduction

Hospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response.

All nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the “Hospital Emergency Response Checklist” was used to measure hospital disaster preparedness and response before and after the intervention.

The overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including “command and control”, “triage”, “human resources”, “communication”, “surge capacity”, “logistics and supply”, “safety and security”, and “recovery”, but had not much impact on the “continuity of essential services” component.

The research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness.

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Hospitals, as the main providers of healthcare services, play an essential role in managing and reducing the suffering of injured people in emergencies and disasters [ 26 ]. Most of the definitive, life-saving and emergency care for injured people are carried out in hospitals. Therefore, the preparedness of hospitals is essential in moderating and decreasing the negative health consequences of disasters [ 29] . From an international perspective, the Sendai Framework for Disaster Risk Reduction 2015–2030 and World Health Organization (WHO), highlights the need for disaster preparedness and risk reduction measures in hospitals [ 30 , 31 ]. Based on WHO, the preparedness and well-trained hospital personnel is the main factor in minimizing the casualties and damages resulting from disasters. Therefore, assessing and improving hospitals’ capacity and preparedness for disasters is a crucial first step toward effective disaster response and achieving the objectives outlined in the Sendai Framework 2015–2030 [ 30 , 32 ].

In Iran, efforts to enhance hospitals’ disaster preparedness began in the winter of 2009 with the creation of the National Hospital Disaster Preparedness Plan (NHDPP) by the Health Research Center on Disasters at the University of Social Welfare and Rehabilitation Sciences. This initiative, serving as a national guideline, received backing from the Secretariat of the Disaster Health Working Group in the Ministry of Health and was communicated to all hospitals across the country [ 1 ]. Furthermore, in the third phase of Iran’s hospital accreditation program, criteria for disaster risk management were added in the form of seven standards and thirty-seven measurements, directly addressing the hospital’s preparedness and response to emergencies and disasters [ 2 ].

To effectively address disasters, a hospital needs a thorough preparedness strategy, necessary tools, equipment, sufficient space, skilled staff, and, in essence, enough surge capacity [ 33 ]. Surge capacity refers to the ability to acquire additional resources during a disaster or emergency. It is the ability to provide quickly the usual functions beyond the increased demand for experienced staff, medical care, and social health services. Surge capacity has three core components including staff, stuff, and structures [ 3 ].

Nurses are one of the major groups of healthcare providers in hospitals(staff) [ 4 ]. They have the most contact with patients and provide the most care [ 5 ]. Along with other disaster management teams, they also play crucial roles in planning, education and training, response, and recovery for hospital disaster preparedness [ 6 , 7 ].

Experiences have shown that training and exercises before the occurrence of disasters can significantly increase the ability of people to face critical situations such as natural disasters [ 4 , 6 ]. Therefore, providing effective disaster training for nurses has a crucial role in increasing hospital preparedness and capacity for response to disasters. Previous studies have demonstrated inadequate training for nurses on preparedness and response to emergencies and disasters [ 2 , 4 , 5 , 6 ]. Moreover, despite numerous investigations assessing the preparedness of Iranian hospitals for disasters [ 8 , 9 , 10 ], to the best of our knowledge, only a limited number of interventional studies have explored the impact of disaster training for nurses on enhancing hospital disaster preparedness in Iran. Hence, recognizing the crucial contributions of nurses to the development of hospital capacity, this research aimed to examine the effects of training of surge capacity enhancement for the nursing managers on the emergency and disaster preparedness of Motahari Hospital in Iran.

Study design and settings

The current investigation utilized a pretest-posttest interventional design, conducted at Shahid Motahari Burn Hospital, affiliated with Iran University of Medical Sciences in Tehran, Iran. This hospital is the first and only main and specialized center providing medical services to burn patients in the center of the country and plays an essential role in the management of the injured during disasters and emergencies, especially fires.

Population and sampling

Aligned with the study’s goals, we employed a census sampling method to select all nursing managers at Shahid Motahari Hospital in Tehran. The eligibility criteria encompassed individuals within the nursing profession, such as nursing managers, supervisors, and head nurses, who held a minimum of a bachelor’s degree and possessed a minimum of one year of managerial experience. Those who expressed unwillingness to participate in the study were excluded.

The data was collected using the Persian version of the Hospital Emergency Response Checklist developed by Khankeh et al. (2013) [ 34 ]. The checklist was used to estimate the current state of preparedness of hospitals and healthcare centers. The original version of this tool was formulated by the World Health Organization [ 35 ]. The checklist measures 9 key components including command and control (7 items), triage (10 items), human resources (15 items), communication (9 items), surge capacity (13 items), logistics and supply management (10 items), safety and security (10 items), continuity of essential services (8 items) and post-disaster recovery (8 items). The reliability and validity of the Persian version of the tool have been confirmed by Karimian et al. (2013) [ 14 ]. They confirmed the validity of the tool (CVI = 0.86) and its reliability with Cronbach’s alpha of 0.83. The items in the checklist are rated on a 3-point scale (1 = due for review, 2 = in progress, and 3 = completed).

Moreover, the hospital surge capacity guideline was used to examine the current situation, weaknesses, problems, and target actions and develop a hospital surge capacity training program. This guidance was formulated by the Health in Emergency and Disaster Research Center at the University of Social Welfare and Rehabilitation Sciences and approved and disseminated by the Iranian Ministry of Health [ 34 ].

Intervention

This intervention study adopted a participatory action research approach as the participants were involved in problem identification and intervention to improve the process. Research in action is a type of study used by people to change unfavorable situations into relatively favorable situations and finally improve procedures in their workplace [ 11 ]. Action research is a type of study that attempts to learn and understand purposeful interventions meant to bring about desired changes in the organizational environment [ 12 ]. Action research simultaneously promotes problem-solving and expands scientific knowledge, as well as strengthens the skills of research participants [ 13 ].

In general, in action research, participants are involved in all stages of the research, from identifying the problem and collecting the data to planning, implementation, and evaluation. The engagement of participants in all stages of the research will encourage their participation in the research procedure and make them interested in the research topic [ 7 ].

This study adopted Streubert Speziale and Carpenter’s five-step action research method [ 7 ]. These steps include (1) defining the problem (explaining the current situation), (2) collecting, analyzing, and interpreting data, (3) planning, (4) implementing, and (5) evaluating. In this research, nurses actively engaged in elucidating the issue, gathering and analyzing data related to hospital surge capacity, devising and executing capacity-enhancing strategies based on their training, and assessing these measures to enhance hospital disaster preparedness and response.

To collect the data, the required permits were obtained from the hospital managers and officials. Besides, some instructions about the research procedure and data gathering were provided in a briefing session for the participants. The researcher and the participants made the required arrangements and plans for conducting the training intervention. In the next step, the items on the instruments (the Hospital Emergency Response Checklist) were completed by the participants(pre-test). When completing the checklist, the officials and managers of the hospital were also interviewed to better identify the problems and challenges related to the surge capacity. After that, topics and concepts related to increasing surge capacity and hospital disaster preparedness were taught to the participants during a two-day workshop, and they did round table exercises. Following the National Hospital Emergency Preparedness and Response Instructions [ 1 ], the content of the workshop included hospital risk and hazard assessment, incident command system, early warning system, response plan, and enhancing hospital capacity in response to emergencies and disasters with emphasis on solving problems and weaknesses identified in the pre-intervention stage. After completing the training workshop, the participants were given a six-month opportunity to carry out interventions and transfer the training to other staff and nurses. During this period, the participants and other members of the disaster risk management committee attended meetings held every two weeks. In these meetings, the necessary actions for the next two weeks were set, and the officials to manage each action were specified. In addition, in each meeting, the extent to which the goals of the previous meeting were achieved and the reasons for not fulfilling them were discussed. Finally, the items in the Hospital Emergency Response Checklist were completed for the second time (post-test) and the collected data was analyzed.

Ethical considerations

To comply with ethical protocols, this research project was approved with the code of ethics of the Ethics Committee of the University of Rehabilitation Sciences and Social Health. Moreover, informed consent was obtained from all the participants. The participants completed the checklists anonymously and, they were assured that their participation was voluntary and had no impact on their evaluation procedure.

The participants in this study were 20 nursing managers and supervisors at Motahari Burn Hospital in Iran. The study participants had an average age of 38 years (30 to 52 years old) and an average work experience of 16 years (4 to 25 years). Most of the participants were female (15 persons), married (18 persons), had a bachelor’s degree (12 persons), and had served in managerial positions (9 persons). Table No. 1 Shows other demographic characteristics of the participants. The surge capacity enhancement strategies that were recognized and put into practice by the participants throughout the study(6 months) included: 1- Executing a memorandum with retired personnel and reactivating them when necessary, Executing a memorandum with the Iran University of Medical Sciences to hire students if needed, drafting instructions for requesting staff from the relevant authorities such as the Emergency Operations Center (EOC) of the Ministry of Health, in the realm of enhancing “staff” capacity. 2- Preparing and reserving medications and essential equipment for a minimum duration of 72 h, signing a memorandum with other hospitals and nearby health centers to provide equipment in emergencies, and also creating more water storage volume to be used in emergencies and disasters, in the realm of enhancing “stuff” capacity. 3- Identifying suitable non-clinical and clinical spaces in the Motahhari Hospital to place beds and admit patients during disasters and emergencies, concluding an agreement with a school near the hospital to provide physical space for the hospital, creating a new rehabilitation department in the hospital, enlarging the space of the emergency department in the realm of increasing “space” capacity. And, 4- developing plans and instructions necessary to manage the risk of emergencies and disasters, doing training and practice in the hospital, in the realm of enhancing “system” capacity. The data showed that hospital disaster preparedness was at an average level (184) before the intervention and reached the optimal level (216) after the intervention. Also, the results also demonstrated that, except for “continuity of essential services”, the intervention improved the hospital’s disaster preparedness score across all dimensions. Most notably, the intervention enhanced “surge capacity” by 10 units and “staff” by 6 units. For detailed information on the intervention’s effects on hospital preparedness dimensions, please refer to Table No. 2 .

This study aimed to examine how providing action research training to nursing managers enhances surge capacity and contributes to improving hospital disaster preparedness. Many hospitals may face numerous challenges due to inadequate preparedness in the face of disasters and the increased demand for healthcare services [ 36 , 37 ]. The results of this study indicated that implementing the surge capacity enhancement intervention for nursing managers and officials led to a 32-unit improvement in disaster preparedness at Motahari Hospital. This improvement was expected because surge capacity is one of the most important components of hospital disaster preparedness and response.

Regarding the impact of the intervention on enhancing hospital disaster preparedness, various studies have been conducted in Iran, each employing distinct approaches to bolster preparedness.

In a study conducted by Karimiyan et al. (2013), it was found that hospital preparedness training aligned with the national plan significantly enhanced the hospital’s preparedness to address emergencies and disasters [ 14 ]. Delshad et al. (2015) showed early warning system training improved the preparedness of Motahari Hospital in emergencies and disasters [ 15 ]. Also, Salawati et al. (2014) in another study, examined the effect of teaching and applying non-structural hospital safety principles for nurses on the preparedness of medical departments of several private and public hospitals in Tehran during disasters [ 16 ]. The findings indicated that the safety score of two non-structural and functional parts of the hospital safety index increased after the intervention. The authors concluded that teaching and applying non-structural safety principles to nurses improves hospital safety and preparedness [ 16 ].

Like numerous other hospitals in Iran [ 17 , 18 , 19 ], Motahari Hospital’s disaster preparedness status was assessed as moderate before the intervention. Nevertheless, some studies have indicated inadequacies in the preparedness level of the examined hospital. For example, both the investigation conducted by Hekmatkhah et al. [ 20 ] and that of Ojaghi et al. [ 21 ] revealed insufficient preparedness in the hospitals under examination.

The current study demonstrated that enhancing the hospital’s response capacity and hospital’s disaster preparedness across various components can be achieved through capacity-building training for nursing managers through action research. The greatest effect of the intervention in this study was on “surge capacity” and the “human resource” dimension(staff). This outcome can be primarily attributed to instructing the hospital surge capacity-building principles for participants in the training workshop. Additionally, due to steps were taken to augment capacity in terms of “human resources”, “medication, and equipment”. Two studies conducted in Iran have identified a shortage of human resources and equipment as a primary factor contributing to the limited preparedness of hospitals in dealing with disasters [ 22 , 23 ]. In this research, the re-employment of retired employees and the use of university students were among the most important strategies that were adopted to increase the hospital capacity and preparedness in the human resource dimension. Similarly, Dowlati et al. (2021) reported that the preparation of a list of employers from other hospitals and medical centers, including clinics and health students, is one of the most important strategies to increase the capacity of hospital staff to respond to chemical, biological, and nuclear hazards and disasters [ 38 ].

The results of this study show that the intervention improved the hospital preparedness scores in the “triage” and “command and control” dimensions. In this context, the educational intervention on triage by Rahmati and colleagues enhances the preparedness of the emergency department, as highlighted in their study [ 24 ]. Also, Delshad et al. conducted a study where actions such as designating an external location for triage and formulating a strategy for the postponement of elective surgeries contributed to an improvement in the hospital preparedness score [ 15 ].

The results of this study emphasize that enhancing hospital preparedness can be achieved through conducting a needs assessment, recognizing gaps within the organization as identified by study participants, and effectively communicating and raising awareness among hospital managers. In this context, Karimian et al. (2013) underscored the importance of providing additional training for officials, managers, and hospital staff concerning emergency preparedness and response in hospitals [ 14 ].

The data in the present study indicated the intervention had a smaller impact on the components of “continuity of essential services”, “logistics and supply”, and “safety and security” compared to other components of hospital preparedness. Perhaps one of the main reasons was the restricted timeframe of the study and limited financial resources to carry out capacity-building and preparedness measures in these dimensions. As stated earlier, measures to increase the surge capacity and improve preparedness were formulated and followed up during the meetings of the emergency and disaster risk committees. Since these meetings were held every two weeks, the 6-month timeframe of the study did not leave an opportunity to carry out measures to improve the mentioned components. Furthermore, the limited financial resources can be considered one of the main reasons for not carrying out the actions planned by the committee. The findings of the “logistics” and “essential services” are consistent with the findings of the study by Ingrassia et al. (2016). This study showed that hospital preparedness in these dimensions was poor [ 25 ]. The findings concerning the " logistics and supply” as well as the “countiniuty of essential services “dimensions in this research align with the outcomes observed in Ingrassia et al.‘s (2016) study, highlighting the inadequate preparedness of the hospital in these aspects [ 25 ].

Limitations

The study was constrained by a limited duration of 6 months and insufficient financial resources, restricting the ability to implement further measures to enhance hospital preparedness. Future investigations could overcome these limitations by extending the study period to at least one year and ensuring adequate financial resources. Furthermore, as this study solely assessed the impact of the intervention on the disaster preparedness level of a single hospital, statistical analysis could not be conducted due to the absence of mean and standard deviation data. The alterations were solely presented descriptively.

This study examined the effect of surge capacity training using an action research plan on disaster preparedness and response at Shahid Motahari Hospital in Tehran. The results showed that surge capacity enhancement training for nursing managers and officials increased their sensitivity to the importance of hospital emergency preparedness and response. Furthermore, their proactive involvement in recognizing capacities, deficiencies, problems, and weaknesses with appropriate tools and taking measures to address them can improve hospital emergency preparedness and response. The findings indicated that senior managers within the hospital can instigate changes through the provision of financial backing and the implementation of mandatory protocols.

Data availability

The datasets that were used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to express their acknowledgments to the staff at the Department of Postgraduate Studies in the University of Social Welfare and Rehabilitation Sciences and appreciate the sincere cooperation of hospital managers, officials, and staff of Shahid Motahhari Hospital for their contributions to conducting this research project.

This study was conducted as part of a master’s thesis at the University of Social Welfare and Rehabilitation Sciences.

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Alireza Shafiei

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Narges Arsalani

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Shafiei, A., Arsalani, N., Beyrami Jam, M. et al. The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study. BMC Emerg Med 24 , 153 (2024). https://doi.org/10.1186/s12873-024-00930-1

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How C-suite leaders can choose better managers and avoid this major pitfall, according to a new study

Overconfidence can be a manager’s biggest downfall. 

Researchers from Harvard Kennedy School, the University of Gothenburg, the University of Warwick, and the Lahore University of Management Sciencesexamined how advancing to a managerial position through either self-promotion or external promotion affects the promotee’s job performance and leadership ability. The study found that managers who are self-promoted perform worse due to hubris, especially over their social skills. 

While traits like extraversion and self-confidence increase are lauded among those who want to become leaders—and for good reason—the study found that they can also create a blindspot for managers. As a result, C-suite leaders should take a holistic approach to promoting managers and consider those who have yet to raise their hand for the role. As for could-be managers, they should be mindful of how their confidence can narrow their vision and hamper their leadership performance.

The study split 555 managers into two groups: those who proactively expressed interest in becoming managers and those who were told they would become managers. Managers were then asked to lead four different teams of three to solve puzzles over three hours. 

After completing the puzzles, managers rated how well they felt they performed. Fifty-five percent of self-promoted managers described their performance as “better” or “much better” than all managers participating in the study, but in actuality they performed worse than lottery managers. Only 38% of lottery managers however rated themselves as “better” or “much better” than their peers.

In examining both groups of people, the study found that lottery managers did a better job at reading other people and had better social skills, in comparison to those who were self-promoted and overconfident in how well they were doing as a leader.  

The next step for this research is to bring it into the real world to see the extent to which the study is predictive of managerial performance, measuring it against other ways in which companies might assess their managers, such as their 360 reviews and other performance metrics. 

Ben Weidmann, corresponding author for this study and director of research at Harvard Kennedy School’s Skills Lab, says the typical management selection is suboptimal and riddled with biases because leaders often appoint managers with whom they share similarities or they erroneously believe that those who are eager to be managers make for good leaders; that isn’t the case. 

“I think it would be a step in the right direction if people were able to cast the net much more widely and do these broad skill assessments to see prospectively who might be good managers,” Weidmann says. A better metric for promoting managers, he says, is to seek out individuals who display strong economic decision-making skills, such as their ability to smartly allocate time and team resources.

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Researcher discusses two measures that predict effective managers

by Liz Mineo, Harvard Gazette

Good managers are hard to find. Most companies pick managers based on personality traits, age, or experience—and according to a recent National Bureau of Economic Research working paper , they may be doing it wrong.

Co-authored by David Deming, Isabelle and Scott Black Professor of Political Economy at Harvard Kennedy School, the study concludes that companies are better off when they select managers based on two measures highly predictive of leadership skills .

The Gazette talked to Deming about the study's findings. This interview has been edited for length and clarity.

What are the qualities that make a good manager, and why is it so hard to find them?

Being a good manager requires many different qualities that often don't exist in the same person. First is the ability to relate well to others, to create what Amy Edmondson and others have called psychological safety, meaning the ability to make people feel stable and secure in their role so they are comfortable with critical feedback. That's a key component of being a good manager.

Communication skills are also essential. As a manager, you should know that there's not one good way to deliver feedback to your workers because the words you use and the way you frame your statements also matter.

At the same time, you must also be analytically minded and open to different ways of doing things and be able to take a step back and reassess whether your team or organization is working as well as it could be.

Overall, being a good manager requires both interpersonal skills and analytical skills. You also need to have a strategic vision—which is something that our study does not capture. Managers must have a sense of what their organization is trying to accomplish. Any one of those skills is hard to find. Having all three, and knowing when to use them, is even more difficult.

One of the paper's most surprising findings is that people who self-nominate to be managers perform worse than those randomly assigned. Why is that?

In the study, we randomly assign the role of manager. That was half of the experiment. In the other half, we asked people which role they wanted, and we assigned the role of manager to the people with the greatest preferences for being in charge.

We found that people with the greatest preference for being in charge are, on average, worse than randomly assigned managers. It's hard to know exactly why because there are a lot of factors in play, but we show evidence in the paper that they are overconfident in their own capabilities, and they think they understand other people better than they do. We all know people like that.

This was a surprising finding. And it's important, because interest in leadership plays a big role in how companies pick managers. Companies have their own hiring and employee evaluation policies of course—they don't pick managers randomly like we did—but it's surely true that preference for leadership plays a big part in who gets promoted to management.

For example, we find that men are much more likely to prefer being in charge, but they aren't any more effective than women in the role of manager.

The main lesson I take from this finding is that there's a big difference between preferences and skills; just because you want to be a manager doesn't mean you're going to be good at it. Organizations that take more scientific or analytical approaches to identifying good managers are going to come out ahead.

What are the best predictors for selecting a good manager, according to your paper?

It has nothing to do with how a person looks, how they speak, or what their preferences or personality traits are. None of those things are predictive. There are only two things that are: One is IQ as measured by the Raven's Progressive Matrices test, which measures general and fluid intelligence, spatial reasoning, problem-solving , etc.

But the one that's more interesting to me is a measure of what we call economic-decision-making skill, or the ability to allocate resources effectively, that my co-authors and I created in a different paper. We use that very same measure in this experiment, and we found that it is highly predictive of being a good manager.

Why do you think these two tests predict being a good manager, but other traits like age, experience, personality, or gender do not?

If you want to predict who's going to be going to be good at a specific performance task, in this case, managing a team to solve a problem, the best predictors are most closely related to what you're asking someone to do.

What matters is the ability to make decisions about the allocation of resources under time constraints ; how to organize and motivate the members of your team to produce the most output. The lesson for me is that it's a crutch to use personality traits and preferences to predict performance because they're not that closely related to the performance you're interested in.

We see this pattern elsewhere. There's a huge amount of research literature on figuring out who's going to be a good teacher in the classroom, and study after study finds that characteristics such as age, gender, education, SAT scores, college major don't do a very good job of predicting who's going to be a good teacher.

Yet if I put you in the classroom for a little bit of time and I see how much you improve student learning, that is a very good predictor, because it's very closely related to the thing you ask people to do. If you want to know who's going to be a good manager, make them manage. Don't just rely on personality characteristics, or whether they raise their hand to say, "I want to do it."

Why is it important to have good managers?

At the broadest level, it's important to have good management because companies, universities, and other organizations face such an open-ended strategic landscape. They must tackle a variety of issues, such as where they should direct their attention, what are the most important things to focus on, and how to deploy resources toward solving certain problems.

If you look at major corporations , they tend to be conglomerates that have many different divisions that do many different things. Google, just to give one example, in the beginning had a core product: a search engine. But now Google is Alphabet, and it still does search, but it also does venture investing, autonomous driving, drug discovery, and many other things.

If you zoom down to the micro level, a manager who leads a team of three or four employees faces the same sort of problems: What should I focus on? Who's going to do what? How do I give people feedback? What are each person's strengths and weaknesses?

To be an effective manager, you must think about how to assign workers to roles to achieve the greatest success, and you must know how to communicate with a person to help them improve. The skill of being a good manager is probably underappreciated. Good managers are not necessarily the most vocal leaders; sometimes they're quiet but effective, like diamonds in the rough.

The paper you and your co-authors wrote came up with a novel method to identify good managers. Can you explain?

It's a hard problem to solve, because part of what makes a good manager is the people they're supervising. If you give a manager a team of workers who aren't very capable, that team is going to do a poor job, and if the workers are all-stars, they will make the manager look good regardless. In other words, when a team succeeds, we don't know how much credit or blame to assign to the manager compared to other members of the team.

To solve that problem, we bring a bunch of people into a controlled lab setting, and we assign them a group task that they must do together. We randomly assign the role of manager to one of the three people on the team, and we ask them to lead their group in the task, and we see how well they do. Then we randomly assign each manager again to another group of workers.

Each time, as a manager, you're getting a different set of people, so we have a way to account for the quality of the workers you're getting. And since we're assigning workers, we can also identify who's a good worker because we can see their performance with different managers.

What do you think the paper's main contributions are to the literature of leadership and management in general?

I think the paper's main contribution is to open the door to the idea that we can be scientific and analytical about selecting managers and that management is not a squishy thing that we can never get our arms around.

We can measure management skill, and measuring it well unlocks huge productivity gains for organizations and for people. We're doing this experiment in a lab; it's not a real-world setting, but we are in talks with several folks to do this in the field. I do think it would work because we're asking people to manage and we're measuring their performance, and we're showing you that there's a repeatable predictive quality to this.

Our contribution is to outline a very simple methodology for measuring who's a good manager, and to say to people that they can use it. Figure it out in your own organization, and you will unlock big productivity gains.

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• Case report
• Open access
• Published: 26 August 2024

Successful conservative management of advanced pyogenic sternoclavicular joint arthritis with osteomyelitis and pulmonary infiltration: a case report

• Takahito Sugihara   ORCID: orcid.org/0009-0008-5351-7448 1 ,
• Yoshifumi Sano 1 ,
• Takashi Ueki 1 ,
• Takao Ishimura 1 ,
• Masashi Takeda 1 ,
• Yosuke Kiriyama 1 ,
• Yu Mori 1 ,
• Nobuhiko Sakao 1 ,
• Shinji Otani 1 &
• Hironori Izutani 1  

Journal of Medical Case Reports volume  18 , Article number:  394 ( 2024 ) Cite this article

89 Accesses

Metrics details

Sternoclavicular joint arthritis is a rare condition that poses considerable diagnostic and therapeutic challenges, leading to severe complications and a high mortality rate. Although surgical interventions are often considered necessary for advanced cases, some reports have suggested that conservative management with antibiotic therapy can be effective in certain cases. However, to our knowledge, there are no reports of successful conservative treatment in cases exhibiting aggressive spread. This report highlights a case of advanced sternoclavicular joint arthritis with bone destruction and pulmonary infiltration, successfully treated conservatively with outpatient antibiotic therapy.

Case presentation

A 58-year-old Japanese male presented with a 1-month history of left-sided shoulder pain. Contrast-enhanced computed tomography showed abscess formation and clavicular bone destruction, with infiltrative shadows suggesting lung involvement. The diagnosis of sternoclavicular joint arthritis was made, and outpatient oral antibiotic therapy was initiated. The patient exhibited a marked reduction in inflammatory marker levels and symptoms, and antibiotic therapy was discontinued after 3 weeks, with no recurrence observed at a 4-month follow-up.

Conclusions

This case highlights that conservative management with antibiotics can be effective for treating advanced sternoclavicular joint arthritis, emphasizing the need for individualized management and further research into non-surgical treatment options.

Peer Review reports

Sternoclavicular joint (SCJ) arthritis is a rare condition requiring prompt and accurate diagnosis and treatment, as delayed diagnosis can result in serious complications, such as osteomyelitis, mediastinitis, and sepsis, which are associated with a high mortality rate of 10% [ 1 ]. The diagnostic criteria for SCJ arthritis are lacking [ 2 ], and its diagnosis is typically based on a thorough history, physical examination, laboratory workup, imaging findings, and arthrocentesis. Although surgical procedures are considered inevitable, conservative management is effective in some cases [ 3 , 4 ]. However, previous reports were limited to patients with mild inflammation. Herein, we report a case of successful conservative outpatient treatment of advanced SCJ arthritis with bone destruction and pulmonary infiltration.

A 58-year-old Japanese male with a history of chronic sinusitis, hyperuricemia, and depression presented with left-sided shoulder pain persisting for 1 month. He was not a smoker and only drank socially. He had no remarkable family medical history, and he worked in the hospitality industry. He had no history of medication use. Computed tomography (CT) performed before presentation revealed a low-density area around the left SCJ, prompting referral to our institution.

Upon examination, the patient was hemodynamically stable, with a body temperature of 36.9 ℃, blood pressure of 133/86 mmHg, and a pulse rate of 78 beats per minute (bpm). Physical examination revealed mild swelling and tenderness around the left SCJ. In addition, no skin breakdown or indwelling prosthetic devices including intravascular catheters and cardiac devices were present. No evidence of dental caries, swollen tonsils, or significant limitation of left-shoulder movement was observed. Laboratory findings revealed a white blood cell (WBC) count of 11,300 cells/mm 3 and a C-reactive protein (CRP) level of 5.16 mg/dL (Table  1 ). Moreover, the levels of tumor markers, including carcinoembryonic antigen, cytokeratin 19 fragment, and squamous cell carcinoma antigen, were within normal ranges.

Contrast-enhanced CT revealed a low-density area extending from the anterior-neck muscles to the posterior sternal region and left clavicle with mild peripheral enhancement, indicating abscess formation, and clavicular bone destruction (Fig.  1 a, b). Furthermore, infiltrative shadows in the left lung apex suggested the spread of inflammation (Fig.  1 c). Neck ultrasonography revealed a hypoechoic area within the muscles of the anterior neck, suggestive of abscess formation.

Contrast-enhanced computed tomography findings at the initial presentation. a Neck abscess (yellow circle), b soft-tissue swelling around the left sternoclavicular joint with clavicular bone destruction (yellow circle), and c infiltrative shadows in the left lung apex suggesting the spread of inflammation to the lung (red circle)

The patient was diagnosed with SCJ arthritis, and oral sulbactam/ampicillin (1125 mg/day) was initiated in an outpatient setting to provide coverage against anaerobic germs. Additionally, ultrasound-guided aspiration of the cervical abscess was performed, and methicillin-sensitive Staphylococcus aureus was detected in the aspirate culture, supporting the continuation of oral antibiotics. Cellular cytology revealed no malignant findings. Weekly follow-ups were conducted, including blood tests, CT, and neck ultrasonography. A total of 1 week after starting treatment, pain, swelling, and inflammatory marker values such as WBC counts and CRP levels showed improvement on examination. The antibiotic was switched to oral levofloxacin (500 mg/day), which showed higher sensitivity on blood culture tests.

A total of 3 weeks after treatment initiation, the inflammatory marker levels normalized, and antibiotic therapy was discontinued (Fig.  2 ). No symptom recurrence was observed at the 4-month follow-up after completing antibiotic treatment (Fig.  3 ). Additionally, the patient had no difficulty with upper limb movement and experienced no residual swelling or pain.

Therapeutic course of sternoclavicular joint arthritis. CRP, C-reactive protein; LVFX, levofloxacin; SBT/ABPC, sulbactam/ampicillin; WBC, white blood cell

Computed tomography 4 months after completing antibiotic treatment. a Complete resolution of the neck abscess and significant improvement in b the soft-tissue swelling around the left sternoclavicular joint and c lung inflammation

Discussion and conclusions

This report presents new findings that conservative treatment with antibiotics and other measures can lead to improvement even in cases of SCJ arthritis with abscess formation and bone destruction, which were previously thought to necessitate surgical intervention. The basis of this approach lies in the advancements in medicine, including antibiotics and other drugs, and the idea that these advancements make new methods, rather than traditional ones, sometimes effective.

The estimated prevalence of SCJ infections is less than 1% of all septic arthritis cases [ 5 ]. Ross et al . [ 6 ] reported 180 cases of SCJ infections, almost half of which were caused by S. aureus , followed by Pseudomonas aeruginosa (10%), and Brucella melitensis (7%). Clinical symptoms included pain around the SCJ (78%), fever (65%), and shoulder-joint pain (24%). Risk factors included frequent use of intravenous drugs (21%), spread of infection from a distant site (15%), diabetes (13%), trauma (12%), and central-venous-line infection (9%). However, 23% of cases occurred in healthy individuals without any identified risk factors [ 6 ]. Although standard diagnostic criteria have not been established, CT-guided arthrocentesis yields a positive culture in over 50% of cases [ 7 ].

Conventionally, SCJ arthritis management includes surgery, ranging from simple incision and drainage to extensive debridement and reconstruction [ 8 , 9 ]. Surgical resection combined with muscle transposition provides effective long-term outcomes. Joint resection combined with intravenous antibiotics effectively and expeditiously eliminates the disease. In particular, en bloc joint resection and bone and soft-tissue debridement are indicated in the case of extensive bony destruction, chest-wall phlegmon or abscess, retrosternal abscess, mediastinitis, or pleural extension [ 10 ]. Although surgical intervention combined with targeted antibiotic therapy is the mainstay of treatment, several cases of SCJ arthritis without life-threatening complications have been successfully treated with antibiotic therapy alone [ 3 , 6 , 11 ]. Surgical intervention is associated with morbidity risks not encountered with antibiotic therapy. Factors such as adverse reactions to anesthesia, postsurgical infections, and the potential need for additional surgeries must be carefully considered before surgical treatment. Furthermore, the instability of the SCJ induced by surgical intervention may lead to impairments in upper limb elevation [ 11 ]. Notably, for patients without severe signs of osteomyelitis or systemic infection, treatment with antibiotics alone should be considered a viable option [ 2 ]. Successful medical management has been reported even in patients with clavicular osteomyelitis. For example, a patient showing early signs of osteomyelitis was successfully treated with a 4-week course of intravenous antibiotics [ 12 ].

In our patient, outpatient antibiotic therapy was selected on the basis of the mild elevation of inflammatory marker levels and absence of high fever despite evidence of inflammatory spread. This case emphasizes substantial improvement in antibiotics and advancements in diagnostic equipment and technologies.

In conclusion, we encountered a rare case of SCJ arthritis with pulmonary extension and osteomyelitis that was successfully treated with antibiotic therapy in the outpatient setting. This report demonstrates that conservative treatment may be effective even in appropriately selected cases of advanced SCJ arthritis.

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Further information about this study is available by contacting the corresponding author.

Abbreviations

C-reactive protein

Computed tomography

Sternoclavicular joint

White blood cell

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We thank Editage ( www.editage.jp ) for English language editing.

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Takahito Sugihara, Yoshifumi Sano, Takashi Ueki, Takao Ishimura, Masashi Takeda, Yosuke Kiriyama, Yu Mori, Nobuhiko Sakao, Shinji Otani & Hironori Izutani

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Conceptualization: T.S. and Y.S.; Investigation: T.S. and Y.S.; Writing—original draft: T.S.; Writing—review and editing: All authors.

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Correspondence to Takahito Sugihara .

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Sugihara, T., Sano, Y., Ueki, T. et al. Successful conservative management of advanced pyogenic sternoclavicular joint arthritis with osteomyelitis and pulmonary infiltration: a case report. J Med Case Reports 18 , 394 (2024). https://doi.org/10.1186/s13256-024-04684-z

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Received : 11 April 2024

Accepted : 05 July 2024

Published : 26 August 2024

DOI : https://doi.org/10.1186/s13256-024-04684-z

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