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This paper explores whether occupational safety and health (OSH) risk perceptions, behaviour and exposure differ among Emergency Department (ED) doctors, nurses and medical secretaries, and whether observed safe working conditions and behaviour in EDs vary across work shifts. Staff from four public hospital-based EDs completed a survey regarding safety climate, risk behavior, work pressure, exposure to and reporting of injuries, violence and threats. Furthermore, safety observations of working conditions (e.g. order and tidiness) and behavior (e.g. discarding hypodermic needles) were carried out during day, evening and night shifts. Rates of self-reported violence and threats in ED doctors and nurses were two to three times greater than rates seen for doctors and nurses at hospitals in general. However, ED respondents perceived a greater managerial focus on certain aspects of the safety climate. Work pressure and lack of time (among doctors and nurses) and social pressure (among medical secretaries) were the primary reasons given for taking OSH risks. If OSH incidents (e.g. injuries or violence) were not reported, it was often because the process was perceived as too laborious, and some incidents were considered ‘part of the job’. Observations of order and tidiness in the EDs showed a gradual lower score in safety conditions from the day to the evening and night shift. Multifaceted and integrated interventions for educating and training ED personnel need to take into account their varying risk exposures, perceptions and behaviors in creating and sustaining an efficient, safe and healthy working environment. [ABSTRACT FROM AUTHOR]

Background Due to an increased focus on productivity and cost-effectiveness, many countries across the world have implemented a variety of tools for standardizing diagnostics and treatment. In Denmark, healthcare delivery packages are increasingly used for assessment of patients. A package is a tool for creating coordination, continuity and efficient pathways; each step is pre-booked, and the package has a well-defined content within a predefined category of diseases. The aim of this study was to investigate how assessment processes took place within the context of healthcare delivery packages. Methods The study used a constructivist Grounded Theory approach. Ethnographic fieldwork was carried out in three specialized units: a mental health unit and two multiple sclerosis clinics in Southern Denmark, which all used assessment packages. Several types of data were sampled through theoretical sampling. Participant observation was conducted for a total of 126 h. Formal and informal interviews were conducted with 12 healthcare professionals and 13 patients. Furthermore, audio recordings were made of 9 final consultations between physicians and patients; 193 min of recorded consultations all in all. Lastly, the medical records of 13 patients and written information about packages were collected. The comparative, abductive analysis focused on the process of assessment and the work made by all the actors involved. In this paper, we emphasized the work of healthcare professionals. Results We constructed five interrelated categories: 1. “Standardized assessing”, 2. “Flexibility”, which has two sub-categories, 2.1. “Diagnostic options” and 2.2. “Time and organization”, and, finally, 3. “Resisting the frames”. The process of assessment required all participants to perform the predefined work in the specified way at the specified time. Multidisciplinary teamwork was essential for the success of the process. The local organization of the packages influenced the assessment process, most notably the pre-defined scope of relevant diseases targeted by the package. The inflexible frames of the assessment package could cause resistance among clinicians. Moreover, expert knowledge was an important factor for the efficiency of the process. Some types of organizational work processes resulted in many patients being assessed, but without being diagnosed with at package-relevant disease. Conclusion Limiting the grounds for using specialist knowledge in structured health care delivery may affect specialists’ sense of professional autonomy and can result in professionals employing strategies to resist the frames of the packages. Finally, when organizing healthcare delivery packages, it seems important to consider how to make the optimal use of specialist knowledge. [ABSTRACT FROM AUTHOR]

Abstract: Objective and methods: The paper aims to develop further insights into the process of implementation of IT in health care by describing findings from a study of a trial implementation of a newly developed electronic medication plan (EMP) in three hospitals in a county in Denmark. A sociotechnical perspective is applied to data acquired by the qualitative methods of participant observation and semi-structured open-ended interviews. Conclusions: The achievement of fit between IT technology and work processes in health care involves the establishment of new organizational structures that cut across the existing divisionalized hospital organization and a detailed alignment of artefact, functionality and work process. This process can be furthered by supporting ‘communities of practice’, i.e. informal groups of engaged clinicians. A sociotechnical perspective is beneficial to the analysis of such processes. [Copyright &y& Elsevier]

Abstract: In the present paper, we report results of surveys in 2003 in Japan and Denmark about patients’ views about adverse events, focusing on the actions of healthcare staff involved in a medical accident. Results show that patients were more likely to indicate negative expectations to a doctor''s reactions after a medical accident when asked in general terms than when asked in relation to concrete case stories. When asked in general terms, 66% (47%) of Japanese (Danish) respondents expected that doctors sometimes hold back on providing information to patients about a medical accident, while 37% (7%) did so when asked about a concrete, mild-outcome case. We examine some possible reasons for the relatively high level of distrust of Japanese patients, and we discuss whether the seemingly lower level of disclosure in Japan than in Denmark and the negative stories in the Japanese press may have an impact. We also suggest some implications for introducing a patient-centred or customer-centred approach to risk management in healthcare and other domains. [Copyright &y& Elsevier]

This paper studies the impact of day-to-day variation in maternity ward crowding on medical procedure use and the health of infants and mothers. Exploiting data on the universe of Danish admissions to maternity wards in the years 2000-2014, we first document substantial day-to-day variation in admissions. Exploiting residual variation in crowding, we find that maternity wards change the provision of medical procedures and care on crowded days relative to less crowded days, and they do so in ways that alleviate their workload. We find very small and precisely estimated effects of crowding on child and maternal health. Thus our results suggest that, for the majority of uncomplicated births, maternity wards in Denmark can cope with the observed inside-ward variation in daily admissions without detectable health risks. [ABSTRACT FROM AUTHOR]

The reductions in cancer morbidity and mortality afforded by population-based cancer screening programmes have led many low-income and middle-income countries to consider the implementation of national screening programmes in the public sector. Screening at the population level, when planned and organised, can greatly benefit the population, whilst disorganised screening can increase costs and reduce benefits. The International Cancer Screening Network (ICSN) was created to share lessons, experience, and evidence regarding cancer screening in countries with organised screening programmes. Organised screening programmes provide screening to an identifiable target population and use multidisciplinary delivery teams, coordinated clinical oversight committees, and regular review by a multidisciplinary evaluation board to maximise benefit to the target population. In this Series paper, we report outcomes of the first regional consultation of the ICSN held in Agartala, India (Sept 5-7, 2016), which included discussions from cancer screening programmes from Denmark, the Netherlands, USA, and Bangladesh. We outline six essential elements of population-based cancer screening programmes, and share recommendations from the meeting that policy makers might want to consider before implementation. [ABSTRACT FROM AUTHOR]