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Background: The second victim phenomenon refers to the emotional trauma healthcare professionals experience following adverse events (AEs) in patient care, which can compromise their ability to provide safe care. This issue has significant implications for patient safety, with AEs leading to substantial human and economic costs. Analysis: Current evidence indicates that AEs often result from systemic failures, profoundly affecting healthcare workers. While patient safety initiatives are in place, the psychological impact on healthcare professionals remains inadequately addressed. The European Researchers' Network Working on Second Victims (ERNST) emphasizes the need to support these professionals through peer support programs, systemic changes, and a shift toward a just culture in healthcare settings. Policy Options: Key options include implementing peer support programs, revising the legal framework to decriminalize honest errors, and promoting just culture principles. These initiatives aim to mitigate the second victim phenomenon, enhance patient safety, and reduce healthcare costs. Conclusion: Addressing the second victim phenomenon is essential for ensuring patient safety. By implementing supportive policies and fostering a just culture, healthcare systems can better manage the repercussions of AEs and support the wellbeing of healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions. Conclusions: The mental healthcare labour market has a number of features that make it prone to shortages and other distortions. These include: the labour-intensive nature of healthcare work;, long-training periods; that traditional policy levers like pay are only partially effective; as well as other challenges in retaining and recruiting mental health nurses and psychiatrists, especially in public mental health services. Further research is needed to develop and evaluate effective interventions. [ABSTRACT FROM AUTHOR]

Background: To make the best use of health resources, it is crucial to understand the healthcare needs of a population—including how needs will evolve and respond to changing epidemiological context and patient behaviour—and how this compares to the capabilities to deliver healthcare with the existing workforce. Existing approaches to planning either rely on using observed healthcare demand from a fixed historical period or using models to estimate healthcare needs within a narrow domain (e.g., a specific disease area or health programme). A new data-grounded modelling method is proposed by which healthcare needs and the capabilities of the healthcare workforce can be compared and analysed under a range of scenarios: in particular, when there is much greater propensity for healthcare seeking. Methods: A model representation of the healthcare workforce, one that formalises how the time of the different cadres is drawn into the provision of units of healthcare, was integrated with an individual-based epidemiological model—the Thanzi La Onse model—that represents mechanistically the development of disease and ill-health and patients' healthcare seeking behaviour. The model was applied in Malawi using routinely available data and the estimates of the volume of health service delivered were tested against officially recorded data. Model estimates of the "time needed" and "time available" for each cadre were compared under different assumptions for whether vacant (or established) posts are filled and healthcare seeking behaviour. Results: The model estimates of volume of each type of service delivered were in good agreement with the available data. The "time needed" for the healthcare workforce greatly exceeded the "time available" (overall by 1.82-fold), especially for pharmacists (6.37-fold) and clinicians (2.83-fold). This discrepancy would be largely mitigated if all vacant posts were filled, but the large discrepancy would remain for pharmacists (2.49-fold). However, if all of those becoming ill did seek care immediately, the "time needed" would increase dramatically and exceed "time supply" (2.11-fold for nurses and midwives, 5.60-fold for clinicians, 9.98-fold for pharmacists) even when there were no vacant positions. Conclusions: The results suggest that services are being delivered in less time on average than they should be, or that healthcare workers are working more time than contracted, or a combination of the two. Moreover, the analysis shows that the healthcare system could become overwhelmed if patients were more likely to seek care. It is not yet known what the health consequences of such changes would be but this new model provides—for the first time—a means to examine such questions. [ABSTRACT FROM AUTHOR]

Background: Prior studies suggest that physician assistants/associates (PAs) are more likely than physicians to work in underresourced areas. However, data characterizing the current PA workforce in health professional shortage areas (HPSAs) and medically underserved areas (MUAs) are lacking. Methods: We analyzed the 2022 cross-sectional dataset from a comprehensive national database to examine the demographic and practice characteristics of PAs working in HPSAs/MUAs compared to those in other settings. Analyses included descriptive and bivariate statistics, along with multivariate logistic regression. Results: Nearly 23% of PAs reported practicing in HPSAs/MUAs. Among PAs in HPSAs/MUAs, over a third (34.6%) work in primary care settings, 33.3% identify as men, 15.6% reside in rural/isolated areas, and 14.0% are from an underrepresented in medicine (URiM) background. Factors associated with higher odds of practicing in a HPSA/MUA included residing in rural/isolated settings, URiM background, and speaking a language other than English with patients. Conclusions: As the PA profession grows, knowledge of these attributes may help inform efforts to expand PA workforce contributions to address provider shortages. [ABSTRACT FROM AUTHOR]

This introduction to a special section brings together three papers first presented at a panel, 'Medical Professions in South Asia: Historical and Contemporary Analyses', at the 26th European Conference on South Asian Studies, held in Vienna, Austria and online, in July 2021. All three papers deal with aspects of the professionalisation of biomedical doctors in India since its independence in 1947. The authors bring together historical and sociological approaches to illuminate the growth of specialisms, patterns of practitioner–patient interactions and efforts to maintain occupational closure and maintain status in the face of growing challenges. The introduction concludes with a discussion of the relevance of these papers for the sociology of health and illness in India and beyond. [ABSTRACT FROM AUTHOR]

There have been growing concerns about the well-being of staff in inpatient mental health settings, with studies suggesting that they have higher burnout and greater work-related stress levels than staff in other healthcare sectors. When addressing staff well-being, psychological safety can be a useful concept. However, there is no measure of psychological safety that is suitable for use in inpatient mental health settings. Edmondson (1999) is the most commonly used measure of psychological safety, but it was designed for use in general physical healthcare settings. As inpatient mental health settings are unique environments, transferability of knowledge from physical to mental healthcare settings cannot be assumed. We sought to develop questionnaire items that capture psychological safety among healthcare staff working in acute inpatient mental healthcare settings. We used the nominal group technique, a consensus method involving rounds of discussion, idea generation, and item rating/ranking to identify priorities. Twenty-eight stakeholders participated, including 4 who had lived experience of mental health problems, 11 academics and 18 healthcare professionals (8 participants identified with more than 1 category). The study involved a workshop with three parts: (i) an overview of current research and limitations of the Edmondson (1999) measure as outlined above, (ii) discussion on what items should be retained from the Edmondson (1999) measure, and (iii) discussion on what items should be added to the Edmondson (1999) measure. Twenty-one items were generated and retained to capture psychological safety in inpatient mental health settings. These measure professionals' sense of being valued by their team and organization, feeling supported at work, feeling physically safe and protected from physical harm, and knowing they can raise concerns about risk and safety. This is the first study to generate questionnaire items suitable for measuring staff psychological safety in mental health settings. These have been generated via a consensus method to ensure stakeholders' views are reflected. Further research is needed to evaluate factor structure, internal reliability, and convergent validity. [ABSTRACT FROM AUTHOR]

Background: Implementing appropriate shift work schedules can help mitigate the risk of sleep impairment and reduce fatigue of healthcare workers, reducing occupational health and safety risks. In Australia, the organisation has a responsibility to make sure all reasonable measures are taken to reduce fatigue of staff. Therefore, it is important to assess what the current rostering processes is for staff responsible for creating the rosters for nurses. Aim: The aims of the project were to understand (1) who creates the rosters and what the process is, (2) what training and knowledge these staff have in establishing rostering schedules that optimise the sleep and wellbeing of staff, and (3) what the benefits and limitations are of current rostering practices. Methods: Findings were generated through semi-structured interviews, using cluster coding to form categories. Twenty four nurses responsible for rostering staff were interviewed from three different sites in Victoria (one metropolitan and two regional/rural hospitals). Data was analysed using selected grounded theory methods with thematic analysis. Results: The common themes that came out of the interviews were that rostering staff were under prepared, unaware of fatigue and safety guidelines and polices from governing bodies and had not received any education or training before taking on the role. The most common rostering style was self-rostering, where staff could submit preferences. However, there were concerns about staff fatigue but were divided as to who should be responsible, with many saying it was up to staff to preference shifts that they could cope with. The final theme was cultural barriers to change. Conclusion: While self-rostering resulted in staff having more freedom and flexibility, shift preferences may be influenced more so by a need to fit with lifestyle rather than to minimise fatigue and increase safety in the workplace. Greater consideration of the impact of shift work schedules on fatigue is required to ensure that the layers of clinical governance in health care organisations minimise the risk of occupation health and safety issues for employees delivering direct patient care. [ABSTRACT FROM AUTHOR]

Healthcare staffing shortages in the US were exacerbated by the COVID-19 pandemic. This article explores the multifaceted challenges and their impact on healthcare organizations, and proposes a framework rooted in Maslow's, hierarchy of needs to guide healthcare organizations in mitigating these shortages and improving patient safety and quality of care. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017–2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic. Methods: We analyzed individual- and healthcare system-level data from 19,894 primary care HCWs in 139 healthcare systems in 2020. We modeled potential relationships between individual-level burnout and turnover intent as outcomes, and individual-level employee engagement, perceptions of workload, leadership, and workgroups. At healthcare system-level, we assessed prior-year levels of burnout and turnover intent, COVID-19 burden (number of tests and deaths), and the extent of virtual care use as potential determinants. We conducted multivariable analyses using logistic regression with standard errors clustered by healthcare system controlled for individual-level demographics and healthcare system complexity. Results: In 2020, 37% of primary care HCWs reported burnout, and 31% reported turnover intent. Highly engaged employees were less burned out (OR = 0.57; 95% CI 0.52–0.63) and had lower turnover intent (OR = 0.62; 95% CI 0.57–0.68). Pre-pandemic healthcare system-level burnout was a major predictor of individual-level pandemic burnout (p = 0.014). Perceptions of reasonable workload, trustworthy leadership, and strong workgroups were also related to lower burnout and turnover intent (p < 0.05 for all). COVID-19 burden, virtual care use, and prior year turnover were not associated with either outcome. Conclusions: Employee engagement was associated with a lower likelihood of primary care HCW burnout and turnover intent during the pandemic, suggesting it may have a protective effect during stressful times. COVID-19 burden and virtual care use were not related to either outcome. Future research should focus on understanding the relationship between engagement and burnout and improving well-being in primary care. [ABSTRACT FROM AUTHOR]

Background: Physicians appear to vary in their motivation towards using virtual care, but to what extent is unclear. To better understand this variance, which is important for supporting physician wellbeing and therefore patient care, the authors used self-determination theory's (SDT) framework. According to SDT, different types of motivation exist, ranging from controlled to autonomous, that lend to differences in engagement, performance, and wellbeing. The authors aimed to determine: (a) if there were distinct groups of physicians based on their quality of motivation towards using virtual care, and if so, (b) how these groups varied in fulfillment of basic psychological needs (autonomy, competence, and relatedness) in the workplace. Methods: In March-August 2022, the authors collected quantitative, survey-based data from a cross-section of 156 family physicians in Alberta, Canada. The survey contained existing scales that measure types of motivation (autonomous vs. controlled) and basic psychological need satisfaction/frustration at work. Cluster analysis was used to explore profiles of physician motivation towards using virtual care, and analysis of variance was used to determine how each profile differed with respect to workplace need fulfillment. Results: With motivation towards using virtual care, three higher-order profiles of physician motivation were identified: autonomous (19% family physicians), controlled (16% of family physicians), and ambivalent (66% of family physicians). The three profiles differed significantly in terms of psychological need fulfillment at work. Conclusions: This study identifies specific profiles that family physicians currently fall into when it comes to motivation towards using virtual care. In line with SDT, findings suggest that basic psychological needs are fundamental nutrients for physicians to internalize and endorse the value of using virtual care in their practices. Implications for physician wellbeing are discussed. [ABSTRACT FROM AUTHOR]

Increased awareness of oral health disparities in the United States has highlighted the need to expand the workforce and access to both primary and preventive dental care. Achieving oral health equity will require new dental team members with appropriate clinical skills dedicated to reaching historically marginalized populations through intra and interprofessional practice. Collective efforts by health care advocates in Minnesota led to legislation that created a dental hygiene-based workforce model inspired by the vision and foresight of the American Dental Hygienists' Association's "Advanced Dental Hygiene Practitioner." In July 2023, there were 141 licensed dental therapists and 99 certified advanced dental therapists, with the majority being dual-licensed dental hygienists/dental therapists, providing primary care services in a variety of settings throughout the state. Current data confirm their contributions to increasing access to primary oral health care services for Minnesotans across the lifespan. While surmountable challenges remain, new opportunities are emerging for dental therapists within Minnesota's transforming health care system. The purpose of this paper is to describe the implementation of this new workforce model in Minnesota, its challenges and successes to assist other states in developing new models for intraprofessional dental team members. [ABSTRACT FROM AUTHOR]

Abstract As the United States (U.S.) moves toward the post-pandemic landscape, there remains a heightened need to increase the nursing workforce. The population continues to age, chronic illnesses are further exacerbated, and the highlight of the shortage of nurses weighed heavier while navigating care during Covid-19. This article examines nursing workforce improvement policies in a policy system where outcomes are either predicated by incremental decision-making or by punctuated changes. Punctuated Equilibrium Theory (PET) is posited to explain nursing policy trends and outcomes. Covid-19 created a punctuation in the healthcare system, leading to the “great resignation,” the increase of travel nurses, and nurses working remotely via tele-health tools. What remains is the impact on nurse staffing policy and what will be done to provide nursing services moving into the future. [ABSTRACT FROM AUTHOR]

The hospital workforce is experiencing overwork and burnout in response to COVID-19. It is imperative to identify those experiencing mental duress and determine protective factors to promote mental wellness and workforce retention. Our research aim was to identify the mental wellness and professional quality of life among hospital staff working during a global health pandemic, and to determine if age or years of experience served as protective factors. We electronically surveyed hospital staff in North Dakota during Summer 2021. Participants reported demographic data and completed clinically validated behavioral health screening tools assessing anxiety, depression, perceived stress, and work-related quality of life. The survey was administered to all 47 hospitals in North Dakota and received 771 complete responses. All hospital staff ages 18 and older were invited to participate. Age and years of experience were collected categorically in line with research on the topic. Years of experience had a significant influence (p< 0.05) on compassion satisfaction, burnout, and perceived stress. Compassion satisfaction was lowest for those who had worked 5–10 years, and then began to increase incrementally every 10 years thereafter. Hospital staff with 21–30 years of experience reported the highest mean score for both perceived stress and depression. Age had a significant influence (p< 0.05) on scores for anxiety, depression, compassion satisfaction, burnout, secondary traumatic stress, and perceived stress. Those closest to retirement (the oldest and those with the greatest years of experience) reported higher compassion satisfaction, while the youngest cohorts reported experiencing greater stress and burnout and may subsequently leave the profession. This may impact access to, and quality of, care. This study demonstrates the need to implement interventions with a focus on defending healthcare workers from the psychological effects of their caring profession. [ABSTRACT FROM AUTHOR]

This paper presents a comprehensive development plan for advancing precision medicine in the autonomous province of South Tyrol, Italy, a region characterized by its bilingual population and unique healthcare challenges. This study highlights the need to address the shortage of healthcare professionals proficient in language for person-centered medicine, the lag in healthcare sector digitalization, and the absence of a local medical university, all within the context of an initiated pharmacogenomics program and a population-based precision medicine study known as the "Cooperative Health Research in South Tyrol" (CHRIS) study. The key strategies for addressing these challenges and integrating CHRIS study findings into a broader precision medicine development plan are discussed, including workforce development and training, investment in digital infrastructure, enhanced data management and analytic capabilities, collaboration with external academic and research institutions, education and capacity building, securing funding and resources, and promoting a patient-centered approach. This study emphasizes the potential benefits of implementing such a comprehensive development plan, including improved early detection, personal ized treatment, and prevention of chronic diseases, ultimately leading to better healthcare outcomes and overall well-being in the South Tyrolean population. [ABSTRACT FROM AUTHOR]

What alternatives can be imagined for the future of medical care in Thailand? The aim of this research is to draw lessons from the shortages in the healthcare workforce during the Covid-19 pandemic by analyzing these shortages using Critical Realism philosophy. Using retroduction as a methodology, this article explains how the causal links of the trends, individually and collectively, impact structure, agency and culture—enabling responses to healthcare policy. The results portray the continuous interaction and impact of structure, agency and culture, and highlight their tendential powers in saving Thai citizen during the health crisis. The results also provide insights into the context of institutions, organizations, and individuals for future plans and strategies. [ABSTRACT FROM AUTHOR]

Diversity, equity, and inclusion (DEI) efforts at academic medical centers (AMCs) began prior to 2020, but have been accelerated after the death of George Floyd, leading many AMCs to recommit their support for DEI. Institutions crafted statements to decry racism, but we assert that institutions must make a transparent, continuous, and robust financial investment to truly show their commitment to DEI. This financial investment should focus on (1) advocacy efforts for programs that will contribute to DEI in health, (2) pipeline programs to support and guide minoritized students to enter health professions, and (3) the recruitment and retention of minoritized faculty. While financial investments will not eliminate all DEI concerns within AMCs, investing significant financial resources consistently and intentionally will better position AMCs to truly advance diversity, equity, and inclusion within healthcare, the community, and beyond. [ABSTRACT FROM AUTHOR]

Background: China has a shortage of physicians and nurses in primary care and rural health. This study explores factors that influence the choices of medical and nursing students in China to select a career in primary care, or in rural health. Methods: A total of 3826 medical students and 1771 nursing students were surveyed in China. Data were analysed using descriptive statistics, Chi-squared tests, and logistic regression models. Results: The majority of medical and nursing students were willing to practice primary care (55% and 59%, respectively). Yet, only 16% and 5% of medical and nursing students, respectively, desired to work in a village or small city. The most common reasons cited to not practice primary care is the lack of opportunities for clinical skills improvement, academic and personal development, and networking. Medical students who were living in a rural residence between ages 1 and 15 years were more likely to report a willingness to work in a rural location (OR: 2.18, 95% CI: 1.33–3.58) or in primary care (OR: 1.72, 95% CI: 1.31–2.25). Conclusion: More efforts are needed to understand how preferences among medical and nursing students influence their career choices and change in choices over time. Understanding the concerns of students can help to tailor interventions in healthcare education and training to increase student satisfaction with their career choice and enrolment counts in medical and nursing fields. There is scant literature available to highlight the factors that influence China's medical and nursing workforce from the student perspective. This study highlights a number of implications and opportunities for improvement for medical and nursing recruitment and education in China. To address the challenges that make it difficult to choose primary care and rural health as first-choice career paths, more efforts are needed to better understand these barriers from the medical and nursing students' points of view. [ABSTRACT FROM AUTHOR]

The healthcare sector is ubiquitously plagued by workforce shortages in economies around the globe. The fragility of this structural shortage becomes apparent when external shocks, such as the COVID-19 pandemic, exacerbate the lack of workers in clinical practice. In this article, we summarize current trends in healthcare workforce development across the globe, review theoretical concepts of workforce shortages, and discuss policies to address them. In practice, developed countries often address workforce shortages with targeted migration policies. However, targeted workforce migration policies only intensify workforce shortages in low-and middle-income countries. Theoretical macroeconomic models suggest that supply shortages may result from too low wages, supply lagging behind demand, and social perception. Changes in the wage rate cannot sufficiently increase the supply of health professionals as scholars find inelastic wages for physicians and nurses. Nonpecuniary factors such as working conditions, job satisfaction, and intrinsic motivation are at least equally important as financial incentives. In conclusion, increased wages can only be part of a heterogeneous policy plan to address shortages. Migration and retirement levels of health professionals can temporarily mitigate workforce shortages but rarely change the underlying systemic issues. Increasing the number of places available in medical and nursing schools while also improving, both, financial and nonfinancial incentives for employees are long-term structural policy options. [ABSTRACT FROM AUTHOR]

Background: Ethiopia is a country with high endemicity in Hepatitis B (HepB) virus infection. However, only 14% of healthcare workers (HCWs) are currently immunized via a non-mandatory strategy in the country. Hence, this study aimed to estimate the cost-effectiveness of the current vaccination coverage and increasing coverage among HCWs in Ethiopia. Methods: Based on current practice, the study considered a monovalent HepB vaccine, which has a 90% protection rate with a complete three-dose series for lifelong protection. Markov model for current coverage (14%) and expanding vaccination coverage to 80% (as per World Health Organization (WHO) recommendation) was simulated based on the data got from both primary and secondary data. Secondary data, particularly cost and effectiveness data, were gained from published articles, WHO guidelines, and Ethiopian Federal Ministry of Health documents. Cost-related data for vaccination and chronic HepB treatment were also gathered by interviewing expertise from Tikur Anbesa specialized hospital. We conducted the study from a healthcare payer perspective, with a 3% discount rate of cost and health outcome as recommended by the WHO. The primary health outcome was measured by the Incremental Cost-Effectiveness Ratio (ICER). We employed deterministic analysis and tornado diagrams to manage parameter uncertainty and show a plausible range of cost and effectiveness of variables. Results: Current vaccination program is more expensive (USD 29.99) with a more additional cost of USD 1.32 and with reduced effectiveness of 0.08 Life Years (LYs) compared to the expanded HepB vaccination strategy which costs USD 28.67 and gives a relatively high total LY gain of 28.62. The resulting ICER was USD-16.23 per LYs gained. The negative ICER shows that the expanded HepB vaccination strategy dominated the current vaccination strategy. A one-way sensitivity analysis also revealed that the current vaccine coverage was dominated by an increase in the risk of infection among unvaccinated individuals. Conclusions: Expanded vaccination coverage (to 80%) was found the most cost-effective strategy in Ethiopian HCWs compared to the current non-mandatory vaccine coverage (14%). In addition, the results of one-way and two-way sensitivity analysis reveal the robustness of our model conclusion. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has emerged by the end of 2019 and spread as pandemic on March 2020 worldwide. Subsequently, it has universally disturbed the medical education and health systems. It leads to lethal circumstances, which become encounters for medical education. Therefore, there is a need to ensure the integrity and firmness of the medical education process and safe lecture delivery. Also, it is essential to re-examine structuring the workforce capacity with the condition of the swiftly altering healthcare system globally and worldwide requirements. A narrative review was conducted to reveal the critical aspects of medical education that need to be reinforced during the post-COVID-19, focusing on building an effective healthcare workforce. It included and examined the relevant papers using search terms in PubMed and Web of Science. The COVID-19 pandemic crisis has unlocked a creative horizon in accepting an appropriate educational methodology to convey safe health professionals, with the human-centered ethical value of professional skill and expertise embedded with humane behavior. A direct, hands-on scientific practice should be sustained with the usual methods to develop graduates' skills and experience and ensure the quality of medical education. However, to combat the crisis of the COVID-19 pandemic, medical schools and other health profession education institutions globally must adjust their curriculum and educational strategies through innovative distant learning modes, including extended reality technology, e-learning tools, and simulation amenities. From experience gained through a pandemic, medical schools should perform best practices for a dynamic shift to blended learning and assessment. Moreover, medical educators should develop practical guidelines or protective actions to conduct clinical teaching without negotiating safety, health, and quality of medical education. [ABSTRACT FROM AUTHOR]

Every year on International Nurses Day (IND), the International Council of Nurses (ICN) releases a report with resources that can be used by nurses around the world. This year's report responds to the World Health Organization's (WHO) latest strategy for nursing and midwifery, and the findings of the State of the World's Nursing report. In this article, ICN Chief Executive Officer Howard Catton describes the main points of the IND report and recommends that nurses everywhere read it, alongside the WHO strategy, and use that information to increase their knowledge of the global nursing workforce and influence global healthcare policy. It is a toolkit that can assist nurses, other healthcare providers, governments and international organisations to turn global strategy into meaningful local action and improved clinical practice on the ground. [ABSTRACT FROM AUTHOR]

Background: UK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations.Aim: To better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups.Methods: The study was informed by critical theory and the authors' interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers.Results: Recruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches.Conclusion: These accounts from 12 recruiting managers give a 'backstage' view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to 'raise the curtain on the equality theatre' and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities. [ABSTRACT FROM AUTHOR]

Background: To support its ageing population and the increasing need for chronic care in the community, Singapore needs to boost the number of doctors in its primary care workforce. To better understand how to improve doctor retention and build a more robust primary care system, we conducted a cross-sectional survey with doctors in general practice and family medicine to explore their career satisfaction, their career plans, factors related to their plans to leave, and their view on retaining GPs in primary care. Methods: An anonymous online survey was distributed to general practitioners working in the public and private sectors. The survey contained questions on career satisfaction, career plans in the next 5 years, and factors important for retaining doctors in primary care. In addition, there were open-ended questions for respondents to elaborate on retention initiatives and other factors that may improve engagement among primary care doctors. Quantitative data was analyzed with descriptive statistics, principal component analysis, χ2 tests, t-tests, and Pearson's correlations; qualitative data was analyzed thematically. Results: The survey was attempted by 355 general practitioners and completed in full by 303. The respondents were most satisfied with rapport with patients and their current professional role; they were least satisfied with the amount of paperwork and the status of general practice in society. In terms of their career plans in the next 5 years, 49/341 (14.4%) of the respondents plan to leave general practice permanently, 43/341 (12.6%) plan to take a career break, and 175/341 (51.3%) plan to reduce their clinical hours. Higher remuneration, recognizing general practice and family medicine as a medical specialty, and reducing the litigious pressures on medical practice were rated as the most important factors for retaining primary care. Free-text responses also revealed a growing dissatisfaction with the Third-Party Administrators that manage insurance arrangements. Conclusion: While the proportion of doctors who intend to leave is smaller than that reported in overseas studies, our findings highlight an urgent need for targeted interventions to engage and retain primary care doctors. Increasing recognition and support for general practitioners and their professional practice may contribute to strengthening community care for the ageing population. [ABSTRACT FROM AUTHOR]

Background: The emergence of coronavirus disease 2019 (COVID-19) disrupted how primary care physicians (PCPs) and their staff delivered team-based care. Objective: To explore PCPs' perspectives about the impact of stay-at-home orders and the increased use of telemedicine on interactions and working relationships with their practice staff during the first 9 months of the pandemic. Design: Qualitative research. Participants: Participants included PCPs from family and community medicine, general internal medicine, and pediatrics. Approach: One-on-one, semi-structured video interviews with 42 PCPs were conducted between July and December 2020. Physicians were recruited from 30 primary care practices in Massachusetts and Ohio using a combination of purposeful, convenience, and snowball sampling. Interview questions focused on work changes and work relationships with other staff members during the pandemic as well as their experiences delivering telemedicine. All interviews were audio-recorded, transcribed verbatim, and coded using deductive and inductive approaches. Key Results: Across respondents and states, the context of the pandemic was reported to have four major impacts on primary care teamwork: (1) staff members' roles were repurposed to support telemedicine; (2) PCPs felt disconnected from staff; (3) PCPs had difficulty communicating with staff; and (4) many PCPs were demoralized during the pandemic. Conclusions: The lack of in-person contact, and less synchronous communication, negatively impacted PCP-staff teamwork and morale during the pandemic. These challenges further highlight the importance for practice leaders to recognize and attend to clinicians' relational and work-related needs as the pandemic continues. [ABSTRACT FROM AUTHOR]

This study examined the association between adding nurse aides and patient mortality in acute care settings. We conducted a retrospective cohort study using a national healthcare administrative claims database. We identified patients who underwent planned surgery for six types of cancer from 2010 to 2017. Multivariable logistic analyses were used to examine the association between the nurse aide staffing level and patient outcomes. The primary outcomes were failure to rescue and 30‐day hospital mortality. We examined 330 666 in‐hospital patients. The median number of nurse aides per 100 occupied beds was 6.60 (interquartile range, 4.61–8.43). In the multivariable analysis, nurse aide staffing level was not significantly associated with failure to rescue or 30‐day hospital mortality. The Japanese government provides economic incentives to hospitals that hire more nurse aides, expecting that a higher nurse aide staffing level will help licensed nurses concentrate on the tasks that need their specialties. However, our findings suggest that adding nurse aides may not be associated with lower rates of failure to rescue or 30‐day hospital mortality in acute care settings. [ABSTRACT FROM AUTHOR]

Background: Developing public health educational programs that provide workers prepared to adequately respond to health system challenges is an historical dilemma. In India, the focus on public health education has been mounting in recent years. The COVID-19 pandemic is a harbinger of the increasing complexities surrounding public health challenges and the overdue need to progress public health education around the world. This paper aims to explore strengths and challenges of public health educational institutions in India, and elucidate unique opportunities to emerge as a global leader in reform.Methods: To capture the landscape of public health training in India, we initiated a web-based desk review of available offerings and categorized by key descriptors and program qualities. We then undertook a series of in-depth interviews with representatives from a purposively sample of institutions and performed a qualitative SWOT analysis.Results: We found that public health education exists in many formats in India. Although Master of Public Health (MPH) and similar programs are still the most common type of public health training outside of community medicine programs, other postgraduate pathways exist including diplomas, PhDs, certificates and executive trainings. The strengths of public health education institutions include research capacities, financial accessibility, and innovation, yet there is a need to improve collaborations and harmonize training with well-defined career pathways. Growing attention to the sector, improved technologies and community engagement all hold exciting potential for public health education, while externally held misconceptions can threaten institutional efficacy and potential.Conclusions: The timely need for and attention to public health education in India present a critical juncture for meaningful reform. India may also be well-situated to contextualize and scale the types of trainings needed to address complex challenges and serve as a model for other countries and the world. [ABSTRACT FROM AUTHOR]

Objective: Burnout, or job-related stress, affects more than half of all US physicians, with primary care physicians (PCPs) experiencing some of the highest rates in medicine. Our study analyzes national survey data to identify and prioritize workplace climate predictors of burnout among PCPs within a large integrated health system. Design: Observational study of annual survey data from the Veterans Health Administration (VHA) All Employee Survey (AES) for 2013–2017. AES response rate ranged from 56 to 60% during the study period. Independent and dependent variables were measured from separate random samples. In total, 8,456 individual-level responses among PCPs at 110 VHA practice sites were aggregated at the facility level by reporting year. We used the semi-automated LASSO procedure to identify workplace climate measures that were more influential in predicting burnout and assessed relative importance using the Shapely value decomposition. Participants: VHA employees that self-identify as PCPs. Main measures: Dependent variables included two dichotomous measures of burnout: emotional exhaustion and depersonalization. Independent measures included 30 survey measures related to dimensions of workplace climate (e.g., workload, leadership, satisfaction). Results: We identified seven influential workplace climate predictors of emotional exhaustion and nine predictors of depersonalization. With few exceptions, higher agreement/satisfaction scores for predictors were associated with a lower likelihood of burnout. The majority of explained variation in emotional exhaustion was attributable to perceptions of workload (32.6%), organization satisfaction (28.2%), and organization support (19.4%). The majority of explained variation in depersonalization was attributable to workload (25.3%), organization satisfaction (22.9%), and connection to VHA mission (20.7%). Conclusion: Identifying the relative importance of workplace climate is important for the allocation of health organization resources to mitigate and prevent burnout within the PCP workplace. In a context of limited resources, efforts to reduce perceived workload and improve organization satisfaction may represent the biggest leverage points for health organizations to address physician burnout. [ABSTRACT FROM AUTHOR]

A strong nursing workforce is integral to quality healthcare. Nursing is an important aspect of healthcare outcomes and plays a critical role in patient safety. Nursing students are key to ensuring an adequate pipeline of nursing professionals. An exploratory cross-sectional online survey was conducted with a convenience sample of 158 students in nurse education programs leading to a Bachelor's Degree in New York State. The current study sought to identify the motivation to pursue a career in nursing, including a career as a Registered Nurse (RN). Personal motivators (primarily the desire to help others) ranked as the main reason for choosing the profession (60.1%). Employment motivators (including job, benefits and monetary reasons) ranked second (26.8%), and Lifestyle motivators (including hours and schedules) ranked third (13.1%). Statistical analysis revealed consistent priorities regarding primary motivators across subgroups of nursing students. Results also indicated that students who have their RN license while pursuing a Bachelor's Degree are a unique subset of students in nursing programs. Each of the following findings were significant at p < 0.001: Nursing students enrolled in a Bachelor's Degree program who already hold an RN license are more likely to; be over 30 years of age, attend school part-time, attend fully online classes (pre-pandemic mode), already have an Associate's Degree in Nursing and attend a public university. Understanding the motivations of students in nursing programs can inform both academia and employers to recruit and retain future nursing professionals. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objective: To document COVID-19 sero-prevalence, prior testing, symptom experiences, and risk factors in a sample of community health center (CHC) workers. Methods: Descriptive statistics and log-binomial regression were used to analyze an electronic employee survey linked with COVID-19 antibody results. The sample included 378 employees who completed the survey; 325 had complete lab data. Results: The sero-positivity rate was 15.4%. One third of sero-positive participants had no previous COVID-19 symptoms or were unsure. Working on-site only and/or with direct patient contact was not associated with sero-positivity. Employees in their 20s were more likely to test positive than employees ages 50+, controlling for sex, race, and region (PR = 2.96; P  < 0.05). Conclusions: With CHCs central to COVID-19 response and vaccination efforts, public health messaging should remind CHC workers, especially younger employees, of their risks of community-based exposure. [ABSTRACT FROM AUTHOR]

After 20 years of hard work, family medicine (FM) is flourishing in Mozambique, but the challenges are immense in a context of multiple health needs. This study aimed to describe strengths, opportunities, weaknesses and threats of the current scenario that can influence the development of FM and primary health care (PHC) in Mozambique. Case study of a series of virtual world-café meetings using the World Health Organization's Operational Framework for primary health care as a theoretical model. There is a young generation of Family Physicians (FPs) eager to improve PHC in Mozambique - a result of the reactivation of the Maputo Residency Programme and the creation of the Mozambican College of FP in 2010. The current Ministry of Health has taken this agenda forward, inviting medical societies (including FM) to jointly design plans to expand training of human resources for healthcare. This plan aims to create new training sites in five different provinces hoping that it will increase the number of FP in remote areas, fixing the unequal distribution of specialists in the country. The small number of FP practicing today and the limited financial resources of the National Government are important threats to this plan. We have many strengths already conquered and the current situation opens an opportunity for the expansion of FM in Mozambique. Hopefully, it will help PHC in our country move from verticalised and selective health programmes towards a more comprehensive, efficient and person-centred care. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal endoscopy (GIE) is not routinely accessible in many parts of rural Africa. As surgical training expands and technology progresses, the capacity to deliver endoscopic care to patients improves. We aimed to describe the current burden of gastrointestinal (GI) disease undergoing GIE by examining the experience of surgical training related to GIE. Methods: A retrospective review was conducted on GIE procedures performed by trainees with complete case logs during 5-year general surgery training at Pan-African Academy of Christian Surgeons (PAACS) sites. Cases were classified according to diagnosis and/or indication, anatomic location, intervention, adverse events, and outcomes. Comparisons were performed by institutional location and case volumes. Analysis was performed for trainee self-reported autonomy by post-graduate year and case volume experience. Results: Twenty trainees performed a total of 2181 endoscopic procedures. More upper endoscopies (N = 1,853) were performed than lower endoscopies (N = 325). Of all procedures, 546 (26.7%) involved a cancer or mass, 267 (12.2%) involved a report of blood loss, and 452 (20.7%) reported pain as a component of the diagnosis. Interventions beyond biopsy were reported in 555 (25%) procedures. Esophageal indications predominated the upper endoscopies, particularly esophageal cancer. Trainees in high-volume centers and in East Africa performed more interventional endoscopy and procedures focused on esophageal cancer. Procedure logs documented adverse events in 39 cases (1.8% of all procedures), including 16 patients (0.8%) who died within 30 days of the procedure. Self-reported autonomy improved with both increased endoscopy experience and post-graduate year. Conclusions: GIE is an appropriate component of general surgery residency training in Africa, and adequate training can be provided, particularly in upper GI endoscopy, and includes a wide variety of endoscopic therapeutic interventions. [ABSTRACT FROM AUTHOR]

Nursing home (NH) residents have high psychosocial needs related to illness, disability, and changing life circumstances. The staff member with the most expertise in addressing psychosocial needs is the social worker. However, federal regulations indicate that only NHs with 120+ beds need hire a social services staff member and that a "qualified social worker" need not have a social work degree. Therefore, two-thirds of NHs are not required to employ a social services staff member and none are required to hire a degreed social worker. This is in stark contrast to NASW professional standards. Reporting findings from this nationally representative sample of 924 social services directors, we describe the NH social services workforce and document that most NHs do hire social services staff, although 42% of social services directors are not social work educated. 37% of NHs have a degreed and licensed social worker at the helm of social services. The odds of hiring a degreed and licensed social workers are higher for larger NHs, especially if not-for-profit and not part of a chain. NH residents deserve psychosocial care planned by staff with such expertise. Quality of psychosocial care impacts quality of life. [ABSTRACT FROM AUTHOR]

Providing nursing home psychosocial care to persons with serious mental illnesses (SMI) requires understanding of comorbidities and attention to resident rights, needs and preferences. This quantitative study reports how 924 social service directors (SSDs) taking part in the National Nursing Home Social Service Director survey identified their roles and competence, stratified by the percentage of residents with SMI. More than 70% of SSDs, across all categories of homes, reported the social services department was "always" involved in conducting depression screening, biopsychosocial assessments and PASRR planning. SSDs in homes with lower concentrations of residents with SMI reported less involvement in anxiety screening. Those employed in homes with higher concentrations of residents with SMI reported lower involvement conducting staff interventions for resident aggression or making referrals. More than one-fifth of SSDs lacked confidence in their ability to compare/contrast dementia, depression, and delirium or to develop care plans for residents with SMI. SSDs' perceived competence in developing care plans for residents with SMI was associated with education and involvement in care planning. About one-quarter of social services directors reported not being prepared to train a colleague on how to develop care plans for residents with SMI. Training in SMI could enhance psychosocial care. [ABSTRACT FROM AUTHOR]

The slower pace of growth for Broadband internet access has had a cascading effect on more rural areas causing slower growth and creating barriers to access the world wide web of information. This article examines Jones County, a rural county in eastern North Carolina, as an example of how we could possibly grow people where they live and grant internet access to rural citizens. One way to do this is with creative internet access in areas that are underserved to grow rural workforces in place. The article also examines growing the rural workforce, improving rural health, and improved telemedicine. [ABSTRACT FROM AUTHOR]

Purpose: Assess effectiveness of Primary Care 2.0: a team-based model that incorporates increased medical assistant (MA) to primary care physician (PCP) ratio, integration of advanced practice clinicians, expanded MA roles, and extended the interprofessional team.Methods: Prospective, quasi-experimental evaluation of staff/clinician team development and wellness survey data, comparing Primary Care 2.0 to conventional clinics within our academic health care system. We surveyed before the model launch and every 6-9 months up to 24 months post implementation. Secondary outcomes (cost, quality metrics, patient satisfaction) were assessed via routinely collected operational data.Results: Team development significantly increased in the Primary Care 2.0 clinic, sustained across all 3 post implementation time points (+12.2, +8.5, + 10.1 respectively, vs baseline, on the 100-point Team Development Measure) relative to the comparison clinics. Among wellness domains, only "control of work" approached significant gains (+0.5 on a 5-point Likert scale, P = .05), but was not sustained. Burnout did not have statistically significant relative changes; the Primary Care 2.0 site showed a temporal trend of improvement at 9 and 15 months. Reversal of this trend at 2 years corresponded to contextual changes, specifically, reduced MA to PCP staffing ratio. Adjusted models confirmed an inverse relationship between team development and burnout (P <.0001). Secondary outcomes generally remained stable between intervention and comparison clinics with suggestion of labor cost savings.Conclusions: The Primary Care 2.0 model of enhanced team-based primary care demonstrates team development is a plausible key to protect against burnout, but is not sufficient alone. The results reinforce that transformation to team-based care cannot be a 1-time effort and institutional commitment is integral. [ABSTRACT FROM AUTHOR]

Background: The scope of care coordination in VA primary care increased with the launch of the Veterans Choice Act, which aimed to increase access through greater use of non-VA Community Care. These changes may have overburdened already busy providers with additional administrative tasks, contributing to provider burnout. Our objective was to understand the role of challenges with care coordination in burnout. We analyzed relationships between care coordination challenges with Community Care reported by VA primary care providers (PCPs) and VA PCP burnout.Methods: Our cross-sectional survey contained five questions about challenges with care coordination. We assessed whether care coordination challenges were associated with two measures of provider burnout, adjusted for provider and facility characteristics. Models were also adjusted for survey nonresponse and clustered by facility. Trainee and executive respondents were excluded. 1,543 PCPs in 129 VA facilities nationwide responded to our survey (13 % response rate).Results: 51 % of our sample reported some level of burnout overall, and 46 % reported feeling burned out at least once a week. PCPs were more likely to be burned out overall if they reported more than average challenges with care coordination (odds ratio [OR] 2.04, 95 % confidence interval [CI] 1.58 to 2.63). These challenges include managing patients with outside prescriptions or obtaining outside tests or records.Conclusions: VA primary care providers who reported greater than average care coordination challenges were more likely to be burned out. Interventions to improve care coordination could help improve VA provider experience. [ABSTRACT FROM AUTHOR]

Objective: To measure the prevalence of burnout among healthcare workers (HCWs) in primary care during the COVID- 19 pandemic and to understand the association between burnout, job-person fit, and perceptions of the pandemic. Methods: We surveyed 147 HCWs (73% response rate) in two clinics in the summer of 2020 on their burnout, job-person fit, perceptions of the pandemic, and demographic/job characteristics. Logistic regression analyses were conducted to explore relationships between these variables. Results: Forty-three percent of HCWs reported burnout. Lower HCW burnout was associated with better job-person fit in the areas of recognition or appreciation at work (odds ratio [OR] 0.26, 95% confidence interval [CI] 0.10 to 0.67) and congruent worker-organization goals and values (OR 0.30, 95% CI 0.11 to 0.76). Conclusions: Working environments with better job-person fit may be key to reducing HCW burnout even after the current crisis. [ABSTRACT FROM AUTHOR]

Objectives: Increased life expectancy results in greater challenges posed to healthcare. Concurrently, a shortage of healthcare workforce, including nurses, has been observed. Thus, an urgent need exists to implement improvements in healthcare services based on sufficient evidence. The aim of the study was to evaluate the influence of the relative number of nurses/midwives on life expectancy, and the influence of selected economic variables: gross domestic product (GDP), health expenditure as a percentage of GDP, and health expenditure per capita, on this number. The aim of the study was to evaluate the influence of the relative number of nurses/midwives on life expectancy, and the influence of select economic variables: GDP, health expenditure as a percentage of GDP, and health expenditure per capita on this number.Material and Methods: A retrospective analysis based on data from 46 countries was performed. Correlations between the relative number of nurses/midwives and life expectancy as well as economic variables were evaluated. To trace the differences between the countries with different relative numbers of nurses/ midwives, the countries were divided into groups as follows - group 1: <5 nurses and midwives/1000 nurses inhabitants, group 2: 5-10 nurses and midwives/1000 inhabitants, and group 3: >10 nurses and midwives/1000 inhabitants.Results: Correlations were found between the relative number of nurses/midwives and life expectancy (p < 0.001, r = 0.68), and economic variables (p < 0.001, r = 0.82; p < 0.001, r = 0.62, and p < 0.001, r = 0.8, respectively). Life expectancy was higher in group 3 vs. groups 1 and 2 (p < 0.001 and p = 0.036, respectively), and in group 2 vs. group 1 (p = 0.006). Economic variables were higher in group 3 vs. group 1 (p < 0.001 for all) and group 2 (p = 0.016, p = 0.025, p = 0.022, respectively), and in group 2 vs. group 1 (p = 002, p = 0.024, p = 0.002, respectively).Conclusions: The relative number of nurses/midwives correlates with life expectancy and relies on the country's income and level of healthcare system financing. Int J Occup Med Environ Health. 2021;34(4):505-12. [ABSTRACT FROM AUTHOR]

Background: War and armed conflicts severely disrupt all health system components, including the healthcare workforce. Although data is limited on the scale of health care worker (HCW) displacement in conflict zones, it is widely acknowledged that conflict conditions result in the displacement of a significant portion of qualified HCWs from their country of origin. While voluntary HCW return is integral to health system rebuilding in conflict-affected and post-conflict settings, there has been little exploration of the nature of national or international policies which encourage HCW return and reintegration to their home countries in the post-conflict period. Methods: We conducted a systematic review to identify policies and policy recommendations intended to facilitate the return of displaced HCWs to their home countries and acknowledge their contribution to rebuilding the post-conflict health system. We searched three bibliographic databases and a range of organisational and national health agency websites to identify peer-reviewed articles and grey literature published in English or Arabic between 1 January 1990 to 24 January 2021, and extracted relevant information. We classified policies and policy recommendations using an adapted version of the UNHCR 4Rs Framework. Results: We identified nine peer-review articles and four grey literature reports that fit our inclusion criteria, all of which were published in English. These covered issues of repatriation (n = 3), reintegration (n = 2), health system rehabilitation and reconstruction (n = 2); six documents covered several of these themes. Information was available for nine conflict contexts: Afghanistan, Iraq, Kosovo, Lebanon, Namibia, Northern Uganda, South Sudan, Timor Leste, and Zimbabwe. Findings demonstrate that health system rebuilding and rehabilitation serve as precursors and reinforcers of the successful return, repatriation, and reintegration of displaced HCWs. Conclusions: Despite the significant numbers of HCWs displaced by conflict, this study identified few specific policies and limited information explicitly focused on the repatriation and reintegration of such workers to their home country in the post-conflict period. Additional research is needed to understand the particular barriers faced by conflict-displaced HCWs in returning to their home country. Conflict-affected and post-conflict states should develop policies and initiatives that address factors within and beyond the health sector to encourage displaced HCW return and provide sustainable reintegration solutions for those who return to post-conflict health systems. [ABSTRACT FROM AUTHOR]

Background: Cancer remains one of the primary causes of death in Bangladesh. The success of cancer control in rural areas depends on the ability of the health care system and workforce to identify and manage cases properly at early stages. Community Health Workers (CHW) can play a vital role in this process. The present study aims to assess cancer related Knowledge, Attitude, and Practice (KAP) among 2 categories of CHWs - Community Health Care Providers (CHCP) and Health Assistants (HA) in rural Bangladesh.Methods: A descriptive cross-sectional study was conducted using a self-administered questionnaire from July 2019 to June 2020. Multi-stage sampling technique was used to determine the sample. One Upazilla Health Complex (UHC) from each of the eight administrative divisions of Bangladesh were randomly chosen as study sites, from which 325 CHCPs and HAs were in the final sample. Multivariate logistic regression models were developed to determine the association between KAP scores and demographic variables.Results: Our study shows that a modest number of respondents scored above average in the knowledge (54.15%), attitude (58.15%), and practice (65.54%) sections. Majority CHCPs (90.91%) and HAs (96.06%) did not receive govt. training on cancer. Only 20.71% HAs and 25.2% CHCPs knew about the availability of cancer treatment options in Bangladesh. Uncertainty about the availability of relevant treatments or vaccinations at public facilities was also high. Having cancer in the family, income, duration of employment and workplace locations were important predictors of cancer related KAP scores.Conclusion: Healthcare workforce's knowledge gap and unfavorable attitude towards cancer may result in poor delivery of care at the rural level. For many people in rural areas, CHCPs and HAs are the first point of contact with the healthcare system and thus effective cancer control strategies must consider them as key stakeholders. Targeted training programs must be adopted to address the cancer related KAP gaps among CHCPs and HAs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand the physical and psychological impact of high stress clinical environments and contributory factors of burnout in multidisciplinary healthcare workforce during the initial outbreak of COVID-19. In-person qualitative interviews informed by an adaptation of Karasek's Job Demand-control model were conducted with a convenience sample of healthcare workforce from March to April 2020. Themes emerging from interviews coalesced around three main areas: fear of uncertainty, physical and psychological manifestations of stress, and resilience building. Shifting information, a lack of PPE, and fear of infecting others prompted worry for those working with Covid-infected patients. Participants reported that stress manifested more psychologically than physically. Individualized stress mitigation efforts, social media and organizational transparency were reported by healthcare workers to be effective against rising stressors. COVID-19 has presented healthcare workforce with unprecedented challenges in their work environment. With attention to understanding stressors and supporting clinicians during healthcare emergencies, more research is necessary in order to effectively promote healthcare workforce well-being. • Participants reported that organizations struggled with uniform COVID-19 policies. • Infecting others outside hospital setting was among the highest stressors reported. • Availability of personal protective equipment emerged as a controversial stressor. • Stress manifested more psychologically than physically. • Teamwork, transparency, and solidarity across social media alleviated stressors. [ABSTRACT FROM AUTHOR]

This letter is in response to the article "Enhancing India's Health Care during COVID Era: Role of Artificial Intelligence and Algorithms". While the integration of AI has the potential to improve patient outcomes and reduce the workload of healthcare professionals, there is a need for significant training and upskilling of healthcare providers. There are ethical and privacy concerns related to the use of AI in healthcare, which must be accompanied by rigorous guidelines. One solution to the overburdened healthcare systems in India is the use of new language generation models like ChatGPT to assist healthcare workers in writing discharge summaries. By using these technologies responsibly, we can improve healthcare outcomes and alleviate the burden on overworked healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals are experiencing unprecedented levels of occupational stress and burnout. Higher stress and burnout in health professionals is linked with the delivery of poorer quality, less safe patient care across healthcare settings. In order to understand how we can better support healthcare professionals in the workplace, this study evaluated a tailored resilience coaching intervention comprising a workshop and one-to-one coaching session addressing the intrinsic challenges of healthcare work in health professionals and students.Methods: The evaluation used an uncontrolled before-and-after design with four data-collection time points: baseline (T1); after the workshop (T2); after the coaching session (T3) and four-to-six weeks post-baseline (T4). Quantitative outcome measures were Confidence in Coping with Adverse Events ('Confidence'), a Knowledge assessment ('Knowledge') and Resilience. At T4, qualitative interviews were also conducted with a subset of participants exploring participant experiences and perceptions of the intervention.Results: We recruited 66 participants, retaining 62 (93.9%) at T2, 47 (71.2%) at T3, and 33 (50%) at T4. Compared with baseline, Confidence was significantly higher post-intervention: T2 (unadj. β = 2.43, 95% CI 2.08-2.79, d = 1.55, p < .001), T3 (unadj. β = 2.81, 95% CI 2.42-3.21, d = 1.71, p < .001) and T4 (unadj. β = 2.75, 95% CI 2.31-3.19, d = 1.52, p < .001). Knowledge increased significantly post-intervention (T2 unadj. β = 1.14, 95% CI 0.82-1.46, d = 0.86, p < .001). Compared with baseline, resilience was also higher post-intervention (T3 unadj. β = 2.77, 95% CI 1.82-3.73, d = 0.90, p < .001 and T4 unadj. β = 2.54, 95% CI 1.45-3.62, d = 0.65, p < .001). The qualitative findings identified four themes. The first addressed the 'tension between mandatory and voluntary delivery', suggesting that resilience is a mandatory skillset but it may not be effective to make the training a mandatory requirement. The second, the 'importance of experience and reference points for learning', suggested the intervention was more appropriate for qualified staff than students. The third suggested participants valued the 'peer learning and engagement' they gained in the interactive group workshop. The fourth, 'opportunities to tailor learning', suggested the coaching session was an opportunity to personalise the workshop material.Conclusions: We found preliminary evidence that the intervention was well received and effective, but further research using a randomised controlled design will be necessary to confirm this. [ABSTRACT FROM AUTHOR]

Chinese adults are the biggest users of healthcare services, and understanding current trends in disability profiles is relevant to planning healthcare workforce infrastructure. We investigated the trends over time for disability and physical functional limitations from 2011 to 2015 among Chinese adults and identified the factors associated with these limitations. We used nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS); the CHARLS participants were followed up every 2 years as they moved from work to retirement with an emphasis on their health status and functional abilities. Participants aged ≥50 years from three waves of the CHARLS were included. Data were collected on physical functioning limitations, disabilities in activities of daily living (ADLs) and disabilities in instrumental activities of daily living (IADLs). Multilevel logistic regression models were used to test for changes and factors associated with limitations and disabilities between 2011 and 2015 adjusting for sociodemographic, medical history and health measures. There were 44,447 eligible participants (mean age: 63 years; standard deviation [SD], 9 years; 51% female). After adjustment, there was no significant increase in reporting of ADLs or IADLs in the 2015 survey compared with the 2011 survey. After adjustment, there was a 26% significant increase in reporting of physical functioning limitations in the 2015 survey compared with the 2011 survey (odds ratio: 1.26; 95% confidence interval, 1.17 to 1.35). Factors associated with ADL disability were being female, being older, minimal education, no alcohol intake in the previous year, falls, fractured hip, feeling depressed and being obese. Factors associated with IADL disabilities were being female, being older, minimal education and feeling depressed. Chinese health agencies should consider the growing need for sufficient community services infrastructure to maximise independence, particularly in the context of ageing populations. • Compared with the 2011 CHARLS survey, there was a 26% significant increase in reporting of physical functioning limitations in the 2015 CHARLS survey. • Factors associated with disabilities related to ADL and IADL included being female, being older and having minimal education. • Health agencies should consider the growing need for sufficient community services infrastructure. [ABSTRACT FROM AUTHOR]

Background: The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease.Methods: This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences.Results: Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed.Conclusions: This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn.Trial Registration: ClinicalTrials.gov: NCT02150603. Registered 30 May 2014. [ABSTRACT FROM AUTHOR]

Background: In the face of the medical workforce shortage, several countries have promoted the opening of medical schools and the expansion of undergraduate and specialization education in medicine. Few studies have compared the characteristics and effects of expanding the supply of general practitioners and specialist physicians between countries. Brazil and Spain, two countries with distinct historical processes and socioeconomic scenarios, yet both with universal public health systems and common aspects in training and medical work, have registered a significant increase in the number of physicians and can be used to understand the challenges of strategic planning for the medical workforce.Methods: This study provides a descriptive approach using longitudinal data from official databases in Brazil and Spain from 1998 to 2017. Among the comparable indicators, the absolute numbers of physicians, the population size, and the physician's ratio by inhabitants were used. The number of medical schools and undergraduate places in public and private institutions, the supply of residency training posts, and the number of medical specialists and medical residents per 100 000 inhabitants were also used to compare both countries. Seventeen medical specialties with the highest number of specialists and comparability between the two countries were selected for further comparison.Results: Due to the opening of medical schools, the density of physicians per 1 000 inhabitants grew by 28% in Spain and 51% in Brazil between 1998 and 2017. In that period, Spain and Brazil increased the supply of annual undergraduate places by 60% and 137%, respectively. There is a predominance of private institutions providing available undergraduate places, and the supply of medical residency posts is smaller than the contingent of medical graduates/general practitioners each year.Conclusion: Both countries have similar specialist densities in cardiology, dermatology, and neurosurgery specialties. However, family medicine and community in Spain has 91.27 specialists per 100 000 inhabitants, while in Brazil, the density is only 2.64. The comparative study indicated the complexity of the countries' decisions on increasing the medical supply of general practitioners and specialist physicians. Research and planning policies on the medical workforce must be aligned with the actual health needs of populations and health systems. [ABSTRACT FROM AUTHOR]

Background: The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team's division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly.Methods: The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically.Results: The roles were occupationally specialized: "Assessment and Diagnosis" tasks consumed the largest proportion of doctors' (51.1%) and NPs' (38.1%) time, and "Organization of Care" tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients' needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses.Conclusion: Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to "be flexible" (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients' needs within its organizational context. The study's findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work. [ABSTRACT FROM AUTHOR]

Supporting gender equity for women working in geriatrics is important to the growth of geriatrics across disciplines and is critical in achieving our vision for a future in which we are all able to contribute to our communities and maintain our health, safety, and independence as we age. Discrimination can have a negative impact on public health, particularly with regard to those who care for the health of older Americans and other vulnerable older people. Women working in the field of geriatrics have experienced implicit and explicit discriminatory practices that mirror available data on the entire workforce. In this position article, we outline strategic objectives and accompanying practical recommendations for how geriatrics, as a field, can work together to achieve a future in which the rights of women are guaranteed and women in geriatrics have the opportunity to achieve their full potential. This article represents the official positions of the American Geriatrics Society. J Am Geriatr Soc 67:2447–2454, 2019 [ABSTRACT FROM AUTHOR]