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Background: Integrating hospital pharmacists into primary care settings can enhance the quality of patient care. However, the challenges vary across countries. China has piloted such collaborations between hospital pharmacists and primary care practitioners in recent years, but research on this subject is limited. This study aims to examine the integration of hospital pharmacists into primary care settings in Shenzhen, China, and identify the perceived barriers and facilitators. Methods: From May 1 to November 30, 2022, a qualitative study gathered key informant interviews and on-site observations at three community health centers (CHCs) in Shenzhen. Two researchers collected the data, and all interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic approach. Results: Seventeen key informants were recruited (eight hospital pharmacists, six GPs, and three health administrators), most of whom were women (n = 11). Hospital pharmacists mainly conduct medication reviews and consultations in clinics or pharmacies of CHCs and engage in home visits with GPs in a few cases. Barriers to their integration include pharmacists' inadequate competency, a lack of patient recognition, GPs' resistance, and insufficient technological support. Patient needs, incentive systems, administrative leadership, social media use, and colocation were identified as facilitators of integration. Conclusion: While unique opportunities may exist for primary care settings to improve patient care by integrating hospital pharmacists, it is essential to address the barriers stemming from individuals and the health system. Efforts should focus on the targeted training of pharmacists' practical skills, strategic campaigns to raise awareness among the public and healthcare providers, and policy-led efforts to foster technological progress. [ABSTRACT FROM AUTHOR]

In Kenya, persons insufficiently engaged in HIV Testing Services (HTS) are often treated in emergency departments (ED). There are limited data from healthcare workers on ED-HTS. A qualitative study was completed to understand challenges and facilitators for ED-HTS and HIV self-testing (HIVST). Data were collected via six focus groups of healthcare workers. Data were inductively analyzed and mapped to the Capability–Opportunity–Motivation Behavioral Model. Focus groups were completed with 49 healthcare workers: 18 nurses, 15 HIV counselors, 10 physicians and 6 administrators. HTS challenges included staff burdens, resources access, deficiencies in systems integration and illness severity. HTS facilitators included education of healthcare workers and patients, services coordination, and specific follow-up processes. HIVST challenges included accuracy concerns, follow-up barriers and psychosocial risks. HIVST facilitators were patient autonomy and confidentiality, resource utilization and ability to reach higher-risk persons. Mapping to the Capability–Opportunity–Motivation Behavioral Model interventions within the domains of knowledge, decision processes, environmental aspects, social influences and professional identities could support enhanced ED-HTS with integrated HIVST delivery. This study provided insights into challenges and facilitators on ED-HTS and identifies pragmatic approaches to improve healthcare workers' behaviors and abilities to provide services to persons already in contact with healthcare. [ABSTRACT FROM AUTHOR]

Purpose: Rural-dwelling stroke survivors have unmet rehabilitation needs after returning to community-living. Virtual rehabilitation, defined as the use of technology to provide rehabilitation services from a distance, could be a viable and timely solution to address this need, especially within the COVID-19 pandemic context. There is still a minimal understanding of virtual rehabilitation delivery within rural contexts. This study sought to explore the perceptions of rural stakeholders about virtual stroke rehabilitation. Methods: Following an interpretive description approach, 17 qualitative interviews were conducted with stroke survivors (n = 5), caregivers (n = 2), clinicians (n = 7), and health administrators (n = 3), and analyzed to understand their experiences and perceptions of virtual stroke rehabilitation. Results: We identified three overarching themes from the participant responses (1) The Root of the (Rural) Problem considered how systemic inequities impact stroke survivors' and caregivers' access to stroke recovery services; (2) Common Benefits, Different Challenges identified the unique benefits and challenges of delivering virtual rehabilitation within rural contexts; and (3) Ingredients for Success described important considerations for implementing virtual rehabilitation. Conclusion: Virtual rehabilitation is generally accepted by all stakeholders as a supplement to in-person services. Addressing the unique barriers faced by rural clinicians and stroke survivors is necessary to provide successful virtual rehabilitation. IMPLICATIONS FOR REHABILITATION: Understanding the perceptions of virtual rehabilitation from various stakeholders may contribute to more effective provision of stroke services. Understanding unique rural practice challenges faced by clinicians may inform future protocols for virtual rehabilitation. The need for additional support for clinicians and stroke survivors is a determining factor for successful virtual rehabilitation. Incorporating virtual rehabilitation as an adjunct to face-to-face services is accepted by all stakeholders. [ABSTRACT FROM AUTHOR]

The article discusses the Virtual Rural Generalist Service (VRGS), a hybrid virtual model of care designed to improve health access and outcomes in rural and remote communities, particularly in Western NSW, Australia. The VRGS aims to provide medical support to rural hospitals with limited onsite medical staff or no local doctors available, integrating patient-centered care, rural proofing, safety and quality measures, leadership and governance structures, service resilience, and digital maturity. The VRGS was launched before the COVID-19 pandemic and played a crucial role in stabilizing the medical workforce during the pandemic, adapting rapidly to meet the increased demand for medical care. The article highlights the positive impact of the VRGS in addressing rural workforce shortages and providing cost-effective, quality medical care in rural and remote areas. [Extracted from the article]

Social risks refer to individuals' social and economic conditions shaped by underlying social determinants of health. Health care delivery organizations increasingly screen patients for social risks given their potential impact on health outcomes. However, it can be challenging to meaningfully address patients' needs. Existing frameworks do not comprehensively describe and classify ways in which health care delivery organizations can address social risks after screening. Addressing this gap, the authors developed the Social Risk ACTIONS framework (Actionability Characteristics To Inform Organizations' Next steps after Screening) describing 4 dimensions of actionability: Level of action, Actor, Purpose of action, and Action. First, social risk actions can occur at 3 organizational levels (ie, patient encounter, clinical practice/institution, community). Second, social risk actions are initiated by different staff members, referred to as "actors" (ie, clinical care professionals with direct patient contact, clinical/institutional leaders, and researchers). Third, social risk actions can serve one or more purposes: strengthening relationships with patients, tailoring care, modifying the social risk itself, or facilitating population health, research, or advocacy. Finally, specific actions on social risks vary by level, actor, and purpose. This article presents the Social Risk ACTIONS framework, applies its concepts to 2 social risks (food insecurity and homelessness), and discusses its broader applications and implications. The framework offers an approach for leaders of health care delivery organizations to assess current efforts and identify additional opportunities to address social risks. Future work should validate this framework with patients, clinicians, and health care leaders, and incorporate implementation challenges to social risk action. [ABSTRACT FROM AUTHOR]

Background/Objectives: Evidence-based information is crucial for policymakers and providers of mental health and psychosocial services (MHPSS) for unaccompanied asylum-seeking children (UASC). However, there is a scarcity of national-level studies investigating the MHPSS needs of UASC and how these are addressed in Greece. The research objectives of this study were to explore: (a) the psychosocial and mental health needs of UASC living in Greek long-term accommodation facilities as perceived by MHPSS providers, and (b) the range of services across the country, highlighting gaps and best practices in service delivery. Method: An exploratory, predominantly quantitative design was adopted to map UASC's psychosocial difficulties, mental health problems, and MHPSS delivery. Purposive sampling was implemented, with 16 of 17 NGOs operating long-term accommodation facilities for UASC and 16 child and adolescent mental health services (CAMHS) participating. The sample included 79 participants (34 facility coordinators, 28 field psychologists, and 16 CAMHS directors). A 5-W mapping tool (Who, Where, What, When, and Which) was used for data collection, through an online survey. Data analysis involved quantitative and qualitative methods (content analysis). Results: Of 798 minors, almost 59% showed signs of behavioral or emotional disturbance, with over half referred for psychiatric assessment and 27.7% needing inpatient care. Aggression, disruptive behaviors, self-harm, and suicidal ideation were the most challenging issues. CAMHS directors reported a high rate of crisis-driven responses, with 42.1% of UASC needing emergency psychiatric evaluation. Psychosocial support was hindered by communication difficulties, lack of a shared care philosophy, understaffing, job insecurity, and limited resources. Conclusions: Our findings highlight the mental health needs of UASC, and the challenges faced by facility coordinators, psychologists, and community mental health specialists. Future research should focus on the institutional and organizational factors influencing service delivery to improve support for UASC. [ABSTRACT FROM AUTHOR]

Introduction: Studying surgical services and the workforce in sub-Saharan Africa is crucial for enhancing access to quality surgical care in the region. Despite many recommendations to produce evidence based on reliable data on this subject to guide policymakers, there is still a knowledge gap on this topic. The aim of this nationwide survey was to describe the organization of abdominal emergency surgical care across healthcare services in Senegal. Methodology: This was a cross-sectional nationwide survey. The study period was between October 1st, 2023, and January 20th, 2024. The target population included all registered healthcare facilities in Senegal offering emergency surgical services. A structured questionnaire was designed to gather infrastructure-related data, surgical activities, and human resources. Results: All 33 identified healthcare facilities responded to the survey (100%). Emergency abdominal surgery services were available for 96.7% of the surveyed structures. The teams were mainly composed of surgeons and residents (45.2%) or surgeons and medical trainees (48.8%). The average bed capacity of the services was 21.9, with a standard deviation of 13.9. The absence of a dedicated hospitalization section for patients requiring special monitoring was found in 69.6% of the facilities. Operating rooms dedicated to emergency abdominal digestive surgery were present in 54.6% of the services. On average, the services performed 17.6 scheduled surgical interventions with a standard deviation of 11.5 and 29.7 emergency surgical interventions with a standard deviation of 16.8 per month. Morbidity and mortality conferences were not routinely held in the majority of departments (only 27.3%). Professional development programmes were present only in 24.2% of departments. Most of the departments did not have adequate human resources (69.6%). A total of 70 surgeons were identified, resulting in a national ratio of 0.39 general surgeons per 100,000 inhabitants. The strategies employed to address staff shortages included additional working hour by staff (54.5%), temporary workers (30.3%) or the use of trainee doctors or nurses (12.1%). Conclusion: This research shows that significant deficiencies are present in the essential physical and human resources needed to conduct fundamental life-saving surgical procedures. These findings suggest potential areas for improvement in the delivery of emergency surgical care in the region. [ABSTRACT FROM AUTHOR]

Background: Hospital culture significantly influences healthcare delivery. Effective teamwork among healthcare professionals, along with strong leadership and management, is crucial for providing high-quality services. This study explores the impact of leadership competence and organizational culture on the quality of healthcare services. Methods: We employed a rigorous methodology in this cross-sectional analytical study, conducted in 2024 at Velayat Hospital in Damghan. Data were collected from too randomly selected nurses using Denison's Organizational Culture Questionnaire, the Standard Leadership Competency Questionnaire based on the Stroud model (2009), and the SERVQUAL scale by Parasuraman et al. (1988). The analysis was conducted using advanced techniques such as structural equation modeling (SEM) and Pearson correlation, facilitated by SPSS 26 and EQS 6.2 software, ensuring the reliability and validity of our findings. Results: Among the participants, 68% were women. The overall average scores were 115.56 ± 18.8 for organizational culture, 74.84 ± 23.12 for leadership competence, and 194 ± 16.17 for healthcare service quality. A significant positive correlation was found between organizational culture and leadership competence (P < 0.05, r = 0.633). The relationships between healthcare service quality and both organizational culture (r = 0.274, P > 0.05) and leadership competence (r = 0304, P > 0.05) were positive, suggesting promising potential for future research. The structural equation model demonstrated a reasonably good fit (RMSEA = 0.24). Conclusions: The findings of this study are significant for healthcare professionals and hospital managers. They emphasize the importance of leadership competence, supported by a strong organizational culture, in enhancing the quality of nursing services. The study also highlights the urgent need to foster leadership skills and cultivate a positive organizational culture, as these factors are essential for improving healthcare outcomes. This call to action should inspire and motivate all stakeholders to work toward creating a more effective and positive healthcare environment. [ABSTRACT FROM AUTHOR]

In 2020 it is estimated that 281 million people were international migrants. Migrants constitute a potentially vulnerable population in terms of facing discrimination, poor living and housing conditions, and insufficient access to healthcare services. Due to the armed conflict in Ukraine in 2022, almost 10 million people crossed the Polish border within a year of the outbreak of the conflict. The objective of this paper is to present the use of primary healthcare services by people migrating from Ukraine to Poland and identify the barriers in access to healthcare by this group of persons. This study used a qualitative research technique in the form of an expert interview using individual in-depth interviews (IDI). The study group consisted of professionally active primary healthcare providers (doctors, nurses, and facility managers) in Poland. Research was carried out in the areas regarding the availability of healthcare, the potential threats and challenges, and possible system solutions. The results showed that the most common cause for doctor's appointments among migrants are respiratory infections, including COVID-19. Many cases were related to back pain, mainly resulting from the physical work of the patients. Additionally, some barriers to access and the provision of healthcare services for patients from Ukraine were identified. The majority (75%) of respondents indicated language as a significant barrier when providing services. Based on the study results, we recommend creating a dedicated website and telephone hotline for this group of persons as well as the use of traditional media to distribute information about access to healthcare services. It is also essential to focus on assistance for older people, since they may experience more difficulties with language and navigating the healthcare system. [ABSTRACT FROM AUTHOR]

Objectives. To determine the percentage of US outpatient substance use treatment facilities that offer HIV preexposure prophylaxis (PrEP). Methods. We used a retrospective cross-sectional design with data from the National Substance Use and Mental Health Services Survey, which was administered to directors of US outpatient substance use treatment facilities in 2021. We evaluated the percentage of outpatient substance use treatment facilities offering PrEP and factors associated with the likelihood of offering PrEP. Results. We included 12 182 outpatient substance use treatment facilities. Of these, 637 (5.2%) offered PrEP. Offering HIV treatment (adjusted odds ratio [AOR] = 45.3; 95% confidence interval [CI] = 36.0, 56.9) and offering programs for LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) people (AOR = 1.3; 95% CI = 1.0, 1.6) were associated with higher likelihoods of offering PrEP. Conclusions. PrEP is highly effective and recommended for patients at risk for HIV from injection drug use. Nearly 95% of US outpatient substance use treatment facilities did not offer PrEP—a missed opportunity for harm reduction through primary HIV prevention. Public Health Implications. Diversification of the array of available HIV PrEP options and the ongoing HIV and opioid use epidemics require outpatient substance use treatment facilities to expand PrEP availability. (Am J Public Health. 2024;114(8):833–837. https://doi.org/10.2105/AJPH.2024.307699) [ABSTRACT FROM AUTHOR]

A study of service quality in government hospitals and patient satisfaction in Mumbai holds significant importance, particularly due to the critical role these institutions play in serving the city's large and diverse population. Government hospitals cater to the healthcare needs of low-income and underprivileged sections of society, where access to affordable medical care is a priority. Assessing service quality in areas such as timely medical assistance, hygiene standards, behavior of healthcare staff, and the availability of essential medicines can provide valuable insights into how well these hospitals are functioning. It also highlights whether they meet the expectations and needs of the patients they serve. Furthermore, understanding patient satisfaction is essential for improving healthcare delivery in government hospitals. Patient feedback can identify areas for improvement, such as reducing wait times, improving communication between staff and patients, or enhancing the overall hospital infrastructure. This study could serve as a valuable tool for healthcare administrators and policymakers to drive reforms, improve resource allocation, and ultimately elevate the standard of care in government hospitals. Enhancing service quality would lead to better patient outcomes and contribute to the overall health and wellbeing of Mumbai's population. [ABSTRACT FROM AUTHOR]

Governing boards and executive leaders play important roles ensuring that their organizations work toward their missions and maintain their visions, while also meeting compliance and performance goals. The level of executive involvement in hospital governing boards varies across organizations, with little evidence to suggest whether and to what degree executive involvement influences hospital performance. The aim of this study is to determine the influence of executive involvement in governance on health system performance. The sample analyzed in this study were organizations responding to The Governance Institute's (TGI) Biennial Survey of Hospital and Health Systems in 2017. Bivariate and multivariate analyses were used to examine associations between self-reported executive leadership team involvement in governing boards and a composite metric of health system performance calculated by Truven Analytics as part of the "Top 100" program. Results indicate executive involvement is associated with several organizational characteristics, including whether an institution was defined as a hospital or health system, whether or not the board was appointed by the parent/system, and whether the board was accountable to the parent/system board. Although no significant direct relationship was found between executive team involvement in governance and overall health system performance, several promising pathways for future study were identified and are discussed, including examining specific organizational performance outcomes rather than composite measures. [ABSTRACT FROM AUTHOR]

In Australia, there are only two publicly reported disciplinary cases against specialist medical administrators. In the most recent decision of Medical Board of Australia v Gruner, the Victorian Civil and Administrative Tribunal confirmed that specialist medical administrators owe patients and the public the same professional obligations as medical practitioners with direct patient contact. More controversially, the Tribunal also held that medical administrators have a professional obligation only to accept roles with clear position descriptions that afford them sufficient time and resources to ensure the safe delivery of health services. We argue that this imposes unrealistic expectations on medical administrators engaged by rural, regional, or private health services that already struggle to attract and retain specialist medical expertise. This may exacerbate existing health inequalities by disincentivising specialist medical administrators from seeking fractional appointments that assist under-funded areas of workforce shortage. [ABSTRACT FROM AUTHOR]

PURPOSE: Implementation of patient-reported outcomes (PROs) collection is an important priority in cancer care. We examined perceived barriers toward implementing PRO collection between centers with and without PRO infrastructure and administrators and nonadministrators. PATIENTS AND METHODS: We performed a multinational survey of oncology practitioners on their perceived barriers to PRO implementations. Multivariable regression models evaluated for differences in perceived barriers to PRO implementation between groups, adjusted for demographic and institutional variables. RESULTS: Among 358 oncology practitioners representing six geographic regions, 31% worked at centers that did not have PRO infrastructure and 26% self-reported as administrators. Administrators were more likely to perceive concerns with liability issues (aOR, 2.00 [95% CI, 1.12 to 3.57]; P =.02) while having nonsignificant trend toward less likely perceiving concerns with disruption of workflow (aOR, 0.58 [95% CI, 0.32 to 1.03]; P =.06) and nonadherence of PRO reporting (aOR, 0.53 [95% CI, 0.26 to 1.08]; P =.08) as barriers. Respondents from centers without PRO infrastructure were more likely to perceive that not having access to a local PRO expert (aOR, 6.59 [95% CI, 3.81 to 11.42]; P <.001), being unsure how to apply PROs in clinical decisions (aOR, 4.20 [95% CI, 2.32 to 7.63]; P <.001), and being unsure about selecting PRO measures (aOR, 3.36 [95% CI, 2.00 to 5.66]; P <.001) as barriers. Heat map analyses identified the largest differences between participants from centers with and without PRO infrastructure in agreed-upon barriers were (1) not having a local PRO expert, (2) being unsure about selecting PRO measures, and (3) not recognizing the role of PROs at the institutional level. CONCLUSION: Perceived barriers toward PRO implementation differ between administrators and nonadministrators and practitioners at centers with and without PRO infrastructure. PRO implementation teams should consider as part of a comprehensive strategy including frontline clinicians and administrators and members with PRO experience within teams. Admins perceive different barriers to PRO implementation vs nonadmins; those at centers with PRO infrastructure perceived less barriers. [ABSTRACT FROM AUTHOR]

Aim: To describe managers' and professionals' views on the management of digital competence sharing in health care. Design: A qualitative descriptive study. Method s : Managers (n = 22) and professionals (n = 12) from two public primary, one public special and one private health care organization in Finland participated in semi‐structured individual interviews between February and May 2022. Data were analysed using inductive content analysis. Results: Managers' and professionals' views formed six main categories: providing resources and opportunities for digital competence sharing, creating methods and practices for digital competence sharing, managing digital competence, implementing intergenerational learning, creating a friendly and safe digital organizational atmosphere, and promoting digital competence sharing through leadership. Conclusion: The support of management is significant in promoting the sharing of digital competence in health care organizations. The management of digital competence sharing requires a both resources and a commitment to continuous training and development. It also requires the creation of a collaborative culture to promote mutual learning between professionals and people of different generations. Impact: Due to rapid technological advancements and the resulting load, it is important to focus on the development and sharing of digital competence among health care professionals. The study indicated that managers should have the ability to identify the strengths of professionals' digital competence and be able to utilize them in promoting digital competence sharing. It also highlighted the specific competency requirements for managers in this context. The results can be applied to the training of health care managers and professionals, particularly around digital competence. Patient or Public Contribution: No patient or public contribution. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in the reporting. [ABSTRACT FROM AUTHOR]

An interview with 2024 American College of Healthcare Executives (ACHE) Gold Medal Award recipient Anne M. Swap is presented. She explains why she decided to pursue a career in healthcare administration in the military. She discusses the differences on the key issues in healthcare delivery in the military and the private sector. She explains her leadership strategies in various situations.

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Background: Home-based medical care services (HMCS) play a crucial role in China's response to an aging population. Given the scarcity of quantitative research on motivating medical staff in relevant institutions, this study aimed to explore the impact of institutional support on motivating the provision of HMCS. Methods: The medical staff involved in this study originated from seven community health service centers in Beijing. We utilized a self-designed questionnaire to conduct the survey, gathering socioeconomic information, institutional support for service delivery, as well as the frequency and types of services the respondents provided. Statistical analysis involved the one-way tests and multivariate regressions, and structural equation modeling (SEM) was employed to enhance the results obtained from the regression analysis. Results: A total of 673 valid questionnaires were considered, with 66.12% of respondents indicating their involvement in offering HMCS services and 51.86% reporting the provision of home-based treatment and care services. Upon adjusting for all covariates, multiple regression results highlighted that the establishment of a clear service pathway significantly influenced the motivation to provide services. Furthermore, the results obtained from SEM validated the findings derived from the regression analysis. Conclusion: Standardized institutional support is an essential means of bolstering the motivation of medical staff to provide HMCS and deserves heightened attention from health administrators. [ABSTRACT FROM AUTHOR]

A growing body of research focuses on developing and testing interventions that leverage mental health-related mobile health (mHealth) services for patients with schizophrenia and other schizophrenia-spectrum disorders. Yet, most formative research has focused on patient perspectives, with little attention paid to clinical stakeholders. This qualitative study aimed to explore clinical stakeholders' (i.e., administrative supervisors, support staff, and clinicians) perspectives on what might help or hinder the use of mHealth, particularly when patients transition from inpatient to outpatient care. In-depth individual qualitative interviews were conducted with 18 stakeholders from inpatient and outpatient psychiatric settings. Four key themes were identified: (a) adherence challenges; (b) role of mobile technology in patient care; (c) clinical professionals' receptiveness to adjunctive mHealth services; and, (d) costs related to implementation of mHealth services. Overall, stakeholders agree with extant data showing that supportive networks are important in facilitating patients' return to the community following hospitalization. Stakeholders welcome mHealth services but suggest they should be appropriately tailored to the population, both in terms of usability and connection to ongoing traditional treatments. Demonstration of added value will likely facilitate wider implementation of mHealth services in the care of patients with schizophrenia and other schizophrenia-spectrum disorders. [ABSTRACT FROM AUTHOR]

Background: Quality improvement collaboratives (QICs) have facilitated cross-organizational knowledge exchange in health care. However, the local implementation of many quality improvement (QI) initiatives continues to fail, signaling a need to better understand the contributing factors. Organizational context, particularly the role of social networks in facilitating or hindering implementation within organizations, remains a potentially critical yet underexplored area to addressing this gap. Purpose: We took a dynamic process perspective to understand how QI project managers' social networks influence the local implementation of QI initiatives developed through QICs. Methodology: We explored the case of a QIC by triangulating data from an online survey, semistructured interviews, and archival documents from 10 organizations. We divided implementation into four stages and employed qualitative text analysis to examine the relationship between three characteristics of network structure (degree centrality, network density, and betweenness centrality) and the progress of each QI initiative. Results: The progress of QI initiatives varied considerably among organizations. The transition between stages was influenced by all three network characteristics to varying degrees, depending on the stage. Project managers whose QI initiatives progressed to advanced stages of implementation had formed ad hoc clusters of colleagues passionate about the initiatives. Conclusion: Implementing QI initiatives appears to be facilitated by the formation of clusters of supportive individuals within organizations; this formation requires high betweenness centrality and high network density. Practice Implications: Flexibly modifying specific network characteristics depending on the stage of implementation may help project managers advance their QI initiatives, achieving more uniform results from QICs. [ABSTRACT FROM AUTHOR]

Purpose: The role of healthcare leaders is becoming increasingly complex, and carries great responsibility for patients, employees, and the quality of service delivery. This study explored the barriers and enablers that department leaders in nursing homes encounter when managing the dual responsibilities in Health, Safety and Environment (HSE) and Quality and Patient Safety (QPS). Methodology: Case study design with data collected through semi structured interviews with 16 department leaders in five Norwegian municipalities. We analyzed the data using qualitative content analysis. Results: Data analysis resulted in four themes explaining what department leaders in nursing homes experience as barriers and enablers when handling the dual responsibility of HSE and QPS: Temporal capacity: The importance of having enough time to create a health-promoting work environment that ensures patient safety. Relational capacity: Relationships have an impact on work process and outcomes. Professional competence: Competence affects patient safety and leadership strategies. Organizational structure: Organizational frameworks influence how the dual responsibilities are handled. Conclusion: Evidence from this study showed that external contextual factors (eg, legislations and finances) and internal factors (eg, relationships and expectations) are experienced as barriers and enablers when department leaders are enacting the dual responsibility of HSE and QPS. Of these, relationships were found to be the most significant contributor. [ABSTRACT FROM AUTHOR]

Adolescents living with HIV (ALHIVs) are considered a priority population in the fight against HIV, requiring dedicated services. The COVID-19 pandemic and subsequent disruptions deprived ALHIVs on antiretroviral therapy (ART) of the care and social support essential for treatment adherence and positive treatment outcomes. This study describes health managers' and healthcare workers' responses to the impact of COVID-19 on service delivery to ALHIVs in HIV treatment in the Cape Town Metropole. A descriptive qualitative design was employed, where semi-structured individual interviews (n = 13) were conducted with senior and programme managers as well as healthcare workers between April and October 2023. Inductive thematic analysis was performed using Atlas.ti version 23. Two main themes emerged from these interviews: "HIV service delivery to adolescents during the COVID-19 pandemic" and "Lessons learnt—the way forward". The de-escalation of health services at primary health facilities and the disruption of HIV services resulted in disengagement from care by ALHIVs, increasing mental health and treatment challenges. This warrants the restoration of psychosocial support services and the re-engagement of ALHIVs. The findings from this study can function as a guide for health systems and healthcare providers to navigate future pandemics to ensure that vulnerable populations such as ALHIVs continue to receive care and treatment. [ABSTRACT FROM AUTHOR]

This study explores team leaders' and directors' perceptions of the facilitators and barriers to effective mental health care to meet the needs of culturally and linguistically diverse (CALD) clients in the public mental health system across greater Brisbane, Australia. This is critical given Australia's cultural diversity and treatment limitations and gaps for CALD clients. A purposive sample of decision-makers working in the public mental health system (N = 6) completed semi-structured interviews. A thematic analysis was undertaken to identify dominant themes. Participants discussed planning, delivery, and evaluation of culturally inclusive and effective mental health care. When planning for culturally appropriate services, collaboration with internal services, such as multicultural specialist services, was the most frequently discussed facilitator, while limited resources were the most identified barrier. Clinicians' cultural sensitivity and biases were identified as an important influence on service delivery. Participants identified significant gaps in evaluation and limited data collection to support the evaluation of cultural safety within services. The findings provide insight into systemic factors affecting culturally inclusive and safe practices in an Australian public mental health setting. Implications for research, policy, and practice are discussed. What is already known about this topic: Managers' directly and indirectly promote values, norms, and biases from a top-down manner, which influence culturally safe care (Aggarwal et al., 2016; Mollah et al., 2018; Smedley et al., 2003). Managers perceive culturally sensitive practitioners who adopt the client's cultural conceptualisation of illness and organisations that provide cultural safety training, are all facilitators to culturally safe care (Aggarwal et al., 2016; Colucci et al., 2015). Managers perceive limited time, large workloads, client's fear of stigma, and a complex healthcare system as barriers to culturally safe care (Aggarwal et al., 2016; Colucci et al., 2015). What this topic adds: Managers highly value collaboration with, and outreach into, local communities, however, this is not translating into practice due to barriers outside of managerial control. An organisational and system level approach is required to effectively reduce barriers in service planning. Mental health services are not consistently collecting data and utilising feedback from multiple respondents to inform future planning, enhance client access, and guide intervention. Further work is needed to identify how this can be done more comprehensively and effectively within busy mental health services. A coordinated national approach is required to examine funding models, the effectiveness of cultural safety training, the efficacy of national standards and benchmarks of care, and quality assurance processes. [ABSTRACT FROM AUTHOR]

Healthcare leaders are faced with increased financial pressures to yield the best results in reducing average length of stay (ALOS), readmission rates, and operating costs. These priorities require a continuous assessment of systematic processes using data-driven decisions and hospital-based interventions to predict associated risks. The purpose of this study is to provide a framework for early careerists to improve quality of care for patients by: (1) identifying predictors of increased LOS among patients hospitalized for surgical and medical treatments; and (2) implementing systematic processes to improve efficiency. To assess predictors of ALOS, we reviewed 1,563 records, which included de-identified data from hospital stays of a multi-site health network located in a Midwestern, rural state. Pediatric patients were excluded. Results showed distance in miles was a statistically significant predictor of ALOS, p<0.01. Mean length of stay was 6.529±5.96 days. Identifying patients at greater risk, reducing rates of avoidable readmissions, coordinating efficient discharge planning, and improving clinical outcomes, are shared priorities among hospital-based administrators and useful strategies for early careerists as they aim to improve the quality of patient care. The presented management strategy or framework should be a consideration in moving towards such an aim. [ABSTRACT FROM AUTHOR]

Navigating the healthcare conundrum in the Blue Zone of Loma Linda, California, requires understanding the unique factors that make this region stand out in terms of health and longevity. But more important is understanding the healthcare system sustaining the Blue Zone in Loma Linda, California. In an era marked by soaring healthcare costs and diminishing reimbursement rates, hospitals and physicians face an unprecedented challenge: providing excellent patient care while maintaining financial sustainability. This leadership perspective publication paper delves into the multifaceted struggles encountered by healthcare and hospital leaders, exploring the root causes, implications, and potential solutions for this complex issue. As we examine the evolving healthcare landscape, we aim to shed light on the critical need for innovative approaches to sustain the future of healthcare excellence in one of the five original Blue Zones. [ABSTRACT FROM AUTHOR]

A national nursing value workgroup convened over the past 10 years constructed a model to measure nursing value and discovered gaps in data available for interoperable information. An action plan is proposed to adopt standard nursing language to measure nursing value. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the physical structure, design, management, and organization of two emergency hospitals built in Istanbul within 45 days in the COVID-19 pandemic and the role played by these hospitals during the pandemic. A further aim was to determine the advantages and disadvantages of the emergency hospitals by comparing them with similar organizational models in other countries. The pandemic hospitals established for the COVID-19 pandemic in Istanbul were investigated in a multi-faceted manner. The parameters investigated were physical structure, bed, and intensive care capacity, mechanics and infrastructure, medical equipment, personnel, organizational structures and management, and the medical services provided by both emergency hospitals during the outbreak. The pandemic hospitals were built on an open area of 125.000 m2 as a hospital building of 75.150 m2. Each hospital has a total bed capacity of 1008, with 576 being clinical and 432 being intensive care beds. The management of the pandemic hospitals is connected to two different hospital management structures, which are experienced in disasters and have all kinds of training, research clinics and academic personnel in this regard. The healthcare services provided by both the pandemic hospitals fulfilled the purpose of those hospitals during the pandemic. As it is most likely that the world will face other serious disasters and epidemics in the future, the construction of multi-purpose and permanent emergency hospitals instead of emergency temporary hospitals would be more advantageous in terms of economy, medical service, and environment. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to determine the influence of the role of hospital leaders, the COVID-19 budget and health service facilities at regional general hospitals (RSUDs) to Indonesia on hospital responses in overcoming the COVID-19 pandemic, moderated by hospital class level. Design/methodology/approach: This research was designed as quantitative research using partial least square-structural equation modeling (PLS-SEM) to test hypotheses. Findings: Using a sample of 185 RSUDs, it was found that the role of hospital leaders, the COVID-19 budget and health service facilities in RSUDs had a positive and significant effect on the hospital's response to the COVID-19 pandemic. The findings show that the role of hospital leaders, in this case, the RSUD director, is essential in improving health services during the COVID-19 pandemic. The COVID-19 budget and health service facilities at RSUD can run effectively during the COVID-19 pandemic if the RSUD director issues appropriate policies during the COVID-19 pandemic crisis. Originality/value: This study is the first to determine the influence of hospital leaders, the health budget for COVID-19 and hospital health service facilities simultaneously on the hospital's response to the COVID-19 pandemic. This study also provides empirical evidence regarding the idea of stewardship theory, which suggests the role of leaders in supervising organizations to achieve organizational goals effectively in times of crisis. [ABSTRACT FROM AUTHOR]

Since 2020, when the Covid-19 pandemic and police violence against Black Americans made undeniably visible inequities in health outcomes based on race, health professionals have issued calls for their colleagues to practice antiracism. Yet few studies have qualitatively described the experiences of health professionals who have implemented antiracist interventions to identify the factors that make them successful. I conducted semi-structured interviews with 51 health professionals and administrators who had introduced changes in their clinical practices explicitly to address health inequities based on race. The interventions focused on removing barriers to access for patients who lack the linguistic, economic, or cultural resources to navigate a complicated health care system. Interprofessional collaboration, leadership support, and community trust facilitated the success of the interventions. Restrictive insurance reimbursement policy was the most cited barrier. The experiences of these health professionals illustrate possibilities for implementing antiracist interventions at the point of care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Black patients are three times more likely to die of pregnancy-related causes than White patients in the United States, and Alabama has the third worst maternal mortality rate in the nation. We sought to identify health care practitioner and maternity service factors contributing to disparities in Alabama, as well as potential strategies to address these contributors. METHODS: We conducted key informant interviews with obstetricians, nurses, doulas, lactation counselors, health system administrators, and representatives of professional organizations who deliver maternity care to racially and ethnically diverse patients in Alabama. The interview guide was developed using Howell’s conceptual framework on racial and ethnic disparities in severe maternal morbidity and mortality. Adopting a thematic analysis approach, we coded and analyzed transcripts using NVivo 12 software. Open coding and selective coding were conducted to identify themes related to health care practitioner– and maternity services–level determinants. RESULTS: Overall, 20 health care practitioners or administrators were interviewed. Primary themes related to health care practitioners included implicit bias and explicit racism, lack of communication and lack of positive patient–health care practitioner relationships, lack of cultural sensitivity, and variation in clinical knowledge and experience. Primary themes related to maternity services included lack of accessibility, inadequate quality and content of care, lack of continuity of care, discriminatory facility policies, and workforce shortages and lack of diversity. Strategies suggested by participants to address these factors included bias trainings for health care practitioners, improvements in racial and interdisciplinary diversity in the maternity workforce, and evidence-based interventions such as group prenatal care, disparities dashboards, simulation trainings, early warning signs criteria, and coordinated care. CONCLUSION: We gained diverse perspectives from health care practitioners and administrators on how maternity health care practitioner and maternity health services factors contribute to inequities in maternal health in Alabama. Strategies to address these contributing factors were multifaceted. [ABSTRACT FROM AUTHOR]

Introduction: Decision-makers are constantly confronted with the need of balancing limited resources while establishing rationing criteria in health care system. However, there is an emerging trend in involving citizens in rationing debates as mechanism to assuring legitimacy in the decision-making process. This paper aims to explore citizens' opinions on priority setting in health care access in comparison with the perspectives of managers. Methods: An online questionnaire was used to collect the data. A logistic regression was applied to evaluate factors that shape the prioritisation of groups in access to health care services. The collected data comprehends 400 individuals, aged 18 years old and over living in continental Portugal. Results: The study results reveal that managers and the general public, in the context of limited resources, both agree with the need to prioritise some groups over others in access to health care services. The priority groups would include the elderly, children, and people with chronic conditions. The most outstanding finding is that managers prefer children as their first priority group against the general public who has considered as top priority the elder ones. Discussion: This study identified which stakeholders are prone to be included in decision-making processes for effective priority-setting models in the health care systems and evaluated their preferences. [ABSTRACT FROM AUTHOR]

An interview with Paul B. Hoffman, a public health professional and recipient of the American College of Healthcare Executives (ACHE) Lifetime Service and Achievement Award, is presented. Hoffman tells about his journey of healthcare leadership and recalls his objections to a hospital president's proposal to use a portion of the net income for purposes unrelated to patient care. He shares ideas to increase the likelihood of patients being the beneficiaries of hospitalization.

Purpose: Identifying the perception of competition between public and private providers in the national hospital market can help authorities to develop appropriate management strategies applicable to the hospital sector and increase the efficiency of public hospital institutions. Design/methodology/approach: A mixed selective descriptive study including quantitative and qualitative components was carried out on in the Republic of Moldova between 12/2021 and 03/2022. The study included all hospitals in the country. The study revealed the hospital manager's perception of the hospital's competition as respondents to the questionnaire were only the directors and managers of hospital institutions. The concept of evaluation of the perception of competition was carried out through the lens of "Porter's 5 forces" from "Competitive strategies" by Michael E. Porter. The authors used a questionnaire as an instrument for studying the perception of competition. All study participants responded to both the quantitative and qualitative questionnaire. Findings: Interhospital competition perceived by managers using model framework of "Porter's 5 forces" reveals high danger from service providers and high perception of rivalry; hospital directors perceived as low: the patient's bargaining power; the danger of new competitors entering the market; the danger of substitution, which constitutes competitive advantages; the lack of autonomy in the selection of services and patients and legislative barriers are the main perceived dissensions. The perception of competition between public and private hospitals is one with high rivalry, especially in the country's municipalities. Originality/value: The national public hospital system takes up to 65% of the health budget being extremely expensive, a fact that indicates a rather low competitiveness of them. The European average indicates figures of 30–40%. The private hospital sector is less developed compared to most European countries, being represented by 17 institutions, in comparison Romania has 104 private hospitals representing about 25% of the market share. Private hospitals also occupy a considerable part of the European hospital healthcare market, continuing to increase, reaching over 30% in Germany. [ABSTRACT FROM AUTHOR]

The article discusses the importance of manpower in healthcare settings and the significance of self-sustainability for healthcare institutions in India. It introduces the Workload Indicators of Staffing Need (WISN) tool released by the World Health Organization in 1998 and updated in 2023, which helps hospitals align staffing levels with service demands. The WISN tool calculates a ratio to assess staffing adequacy, with ratios above 1 indicating overstaffing and below 1 indicating understaffing. The tool has been used in various healthcare settings to determine staffing requirements and improve operational efficiency, although challenges such as accurate workload data and dynamic staffing needs exist. [Extracted from the article]

Background. Care home managers' leadership is recognised as directly influencing the care received by people living with dementia. What enables care home managers to promote and sustain person-centred care for residents is less well understood. Method. A mixed-methods systematic review synthesised evidence on care home managers' leadership on the delivery of person-centred care for people living with dementia. Electronic databases (PubMed, Scopus, Cochrane Library, CINAHL, and Google Scholar) were searched between 2009-2021. Thematic synthesis identified commonalities, facilitators, and barriers to managers enabling person-centred care. Results. Twenty-one studies met the inclusion criteria. Approaches demonstrated by care home managers that enabled person-centred care for people living with dementia included valuing and recognising staffs' work; involving residents and relatives in decision making; providing feedback to staff; promoting a positive work environment and care culture; and involving staff in organisational changes. Barriers to person-centred care were a lack of organisational support for care home managers; staff shortages; managers not having time to work with staff; manager-staff turnover; limited access to dementia training; and a lack of leadership education and training for care home managers. Conclusion. Care home managers are central to the delivery of person-centred care for people living with dementia. The review identified key resources and activities that support this work. The wide variation in leadership approach and a persistent lack of detail about the frequency of educational and organisational support demonstrate a need to explore what enables care home managers to support their staff to deliver person-centred care. [ABSTRACT FROM AUTHOR]

After the onset of the COVID-19 pandemic, the use of family planning services decreased, but there are limited data on how safety net providers were affected. Between November 2020 and March 2021, we conducted in-depth interviews with administrators at health departments, federally qualified health centers, and specialized family planning organizations across Texas about pandemic-related changes in family planning services. We analyzed interview transcripts using an inductive thematic approach. Administrators at the 19 participating organizations described pervasive service disruptions. Some organizations closed for 6–8 weeks at the pandemic's onset owing to safety uncertainties and difficulty interpreting Texas' March 2020 executive order prohibiting "nonessential" medical services; others later suspended services after staff exposures. Health departments and federally qualified health centers commonly decreased family planning services to focus on COVID-19 response, leaving specialized family planning organizations to absorb displaced reproductive health care clients. Some of the advantages of service delivery modifications—including telehealth, curbside and drive-through prescription pickup, and medication by mail—were difficult to realize; barriers included low reimbursement, necessary patient examinations, and clients' confidentiality concerns and lack of technological resources. Texas' diverse network of family planning organizations illustrated a range of responses to the pandemic, and organizations often focused on their core missions—public health, primary care, or family planning. [ABSTRACT FROM AUTHOR]

Patients are uniquely positioned to identify issues and to provide innovative solutions to problems impacting their care. Yet, patient engagement in quality improvement (QI) and health care governance remains limited and underexplored. In the Veterans Health Administration, the work of women's health managers (WHMs) includes engaging women veterans, a numerical minority with unique health care needs, in QI. We aimed to understand the extent to which WHMs engage women veterans along a continuum, highlight challenges to engagement, and identify potential strategies to facilitate multilevel patient engagement. Data were generated from a multisite evaluation to improve delivery of comprehensive women's health care in Veterans Health Administration primary care sites. We conducted 39 semistructured interviews with WHMs across 21 sites. Guided by Carman et al.'s patient engagement framework, we analyzed the interviews using rapid-qualitative and content analysis methods. When effectively engaged, women veterans were important champions and partners in QI activities to improve the structure and delivery of care. However, most WHMs engaged women veterans in mainly informal or passive ways—that is, solicited feedback through comment cards, surveys, focus groups, and townhall meetings—and did not report pursuing more in-depth or long-term forms of engagement. WHMs also identified a variety of facilitators and challenges to engaging women veterans in QI. There may be unanticipated benefits to health care policy from engaging patients in QI, especially for patients with unique health care needs who represent a minority within the health care system. However, managers require training and workflow integration of patient engagement tasks to increase their efficiency and allow for meaningful patient engagement. [ABSTRACT FROM AUTHOR]

Background: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system. Methods: Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine's framework of learning health systems. Results: In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice. Conclusion: Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had an immediate and enduring impact on society at-large and specifically on health administration education. Initially, the priority was to survive the pandemic by abandoning all levels of normalcy, and then, rather quickly, it shifted to finding new ways to maintain some level of normalcy as the higher education community transitioned to remote and hybrid modalities. The effects of this shift on health administration students were captured by Louis et al. (2021), and similar effects have been captured on health administration faculty as well (Brooks et al., 2021). But, as we have adapted to new ways of living during a pandemic, other societal forces and phenomena have begun to emerge that may prove to have durable effects on health administration education for decades to come. The following is the result of a discussion of a brain trust of health administration faculty, representing various health administration program levels (undergraduate, graduate, and executive) from various regions of the United States, who have enumerated areas of concern (and opportunity) for health administration education over the next 10 years. The topics discussed include (a) course delivery and modalities; (b) diversity, equity, inclusion and justice; (c) wellness and well-being; and (d) the evolving professional field of health administration in an effort to understand what the future may hold for health administration education. [ABSTRACT FROM AUTHOR]

Background: Patients can play an essential role in improving patient safety by becoming actively involved in their health care. The present study aimed to qualitatively explore healthcare providers' (HCPs) and managers' perceptions on patient participation in patient safety processes. Methods: This qualitative study carried out in three teaching hospitals in Tehran, Iran. The data were collected through semi-structured interviews with 31 HCPs and managers working at public teaching hospitals, medical universities and the Ministry of Health. The data were analyzed using thematic analysis. Results: Three main themes and 21 sub-themes emerged from the interviews. Participants believed that patients and their families can play an effective role in maintaining and improving patient safety through different roles. However, a variety of barriers were identified at patients, providers, and system levels hindering patient participation in delivering safe care. Conclusion: The participants identified facilitators and barriers to patient engagement in safety-orientated activities at multiple patients, providers, and system levels, indicating that complex, multifaceted initiatives must be designed to address the issue. This study encourages further research to enhance the understating of the problems and solutions to patient involvement in safety initiatives in the Iranian healthcare setting. [ABSTRACT FROM AUTHOR]

Objective: The need for residential care services will grow significantly over the coming years as the general population in Australia continues to age. The aim of this study was to assess the adequacy of residential care services across New South Wales (NSW), Australia, in relation to the current and predicted future aging population. Method: This study was a secondary data analysis. Existing datasets were compiled for analysis by creation of a temporal geodatabase, with predicted population data from 2019 to 2029 linked to corresponding geographic zones. Results: Demand for operational places was over capacity in 2019, at 101.5%. From 2019 to 2029, this will grow to 120.2% of 2019 capacity by 2024 and to 135.6% by 2029. An additional 25 800 operational places will be required by 2029 to meet targets. During the previous decade of 2008–18, operational places grew by only 11 502 places. Conclusions: NSW was not providing an adequate level of residential aged care and, under current allocations, this problem will worsen substantially over time, with flow-on impacts for the health sector. With aged care reform a current federal government focus, the results of this study may guide decisions that better support the provision of residential aged care. What is known about this topic?: The recently completed Australian Royal Commission into aged care noted widespread system failure and highlighted the gaps in medical services that older Australians were experiencing. What does this paper add?: This paper reports that demand for residential aged care places in NSW was already over capacity in 2019 and that the availability of places varies considerably across the state. Further, an additional 25 800 operational places are required by 2029 to meet government targets. If the growth rate from the past decade is maintained, this will result in a shortfall of 14 298 aged care places in NSW alone. What are the implications?: Without significant increases in the current rate of growth for aged care places, the mainstream medical and health sectors will face significant additional pressures arising from unmet need in both older patients and their informal carers. [ABSTRACT FROM AUTHOR]

Background: Accountable care organizations (ACOs) are a recent incentive program that are designed to address inefficiencies in the U.S. health care sector. To meet their design objectives, ACO participants must engage in greater electronic health information exchange (HIE) practices both internally and externally with care participants, such as patients and other providers. Purpose: The aim of this study was to examine the relationship between hospital participation in ACOs and electronic HIE practices with different participants of care and how these practices vary differentially across market types. Approach: Grounding our work in the reward-motivational view of organizational action, we proposed hypotheses that linked hospital participation in ACOs to three dimensions of HIE practices (intraorganizational, interorganizational, and provider–patient HIE practices). We tested our hypotheses by analyzing a sample of 1,926 hospitals. Results: Hospital participation in ACOs is associated with greater intraorganizational and provider–patient HIE practices, but not interorganizational HIE practices. We also found that whereas the relationship between ACO participation and intra- and interorganizational HIE practices remains unchanged irrespective of the degree of competition in the health care market, the relationship between ACO participation and provider–patient HIE practices holds true only for hospitals operating in noncompetitive markets. Practice Implications: Our results showed that hospitals participating in ACOs vary in their HIE practices, and attributes of the local market in which ACO participants operate in contribute to this variation. These insights should provide guidance to researchers, policymakers, and hospital administrators who aim to improve the effectiveness of ACOs. [ABSTRACT FROM AUTHOR]

Objective: To investigate geriatricians' views about issues facing geriatric medicine, and the preparedness of the health‐care system during the COVID‐19 pandemic. Methods: An online survey of heads of geriatric medicine departments in hospitals in Australia and New Zealand undertaken in May 2020. Results: The majority of hospitals had admitted one or more patients with suspected COVID‐19. Most geriatricians believed their hospital was 'adequately' or 'well prepared' for the pandemic. Inpatient capacity increased to manage acute, post‐acute and rehabilitative care of older patients with COVID‐19. Non‐inpatient services for older people were reduced and telehealth‐instituted widely. Increases in work hours, on‐call and staffing levels were reported. Geriatricians voiced major concerns about the preparedness of residential aged care facilities to manage the pandemic. Conclusions: The COVID‐19 pandemic impacted on geriatricians and the provision of geriatric medicine services. Many issues that subsequently affected older people were predicted in advance. [ABSTRACT FROM AUTHOR]

The composition of early trainee medical education is highly influential as it shapes the future of medicine and healthcare. Despite being frequently neglected, education about and exposure to hospital administration should be important aspects of medical student learning. Understanding how health systems coordinate and optimize functions of different departments to enhance patient care is a critical component of being a physician. In this Personal View, we share the tangible impact that a short immersive experience with hospital administration can bring to not only enrich medical student education but also influence their future perspectives and interactions within healthcare systems. Early integration of these learning opportunities has the potential to improve the physician-administrator relationship within hospitals and encourage innovative collaboration to provide more patient-centered and financially sustainable healthcare. [ABSTRACT FROM AUTHOR]

Given that the health care system for Indigenous people tends to be complex, fragmented, and multi-jurisdictional, their cancer experiences may be especially difficult. This needs assessment study examined system-level barriers and community strengths regarding cancer care experiences of Indigenous people in Saskatchewan. Guided by an advisory committee including Indigenous patient and family partners, we conducted key informant interviews with senior Saskatchewan health care administrators and Indigenous leaders to identify supports and barriers. A sharing circle with patients, survivors, and family members was used to gather cancer journey experiences from Indigenous communities from northern Saskatchewan. Analyses were presented to the committee for recommendations. Key informants identified cancer support barriers including access to care, coordination of care, a lack of culturally relevant health care provision, and education. Sharing circle participants discussed strengths and protective factors such as kinship, connection to culture, and spirituality. Indigenous patient navigation, inter-organization collaboration, and community relationship building were recommended to ameliorate barriers and bolster strengths. Recognizing barriers to access, coordination, culturally relevant health care provision, and education can further champion community strengths and protective factors and frame effective cancer care strategies and equitable cancer care for Indigenous people in Saskatchewan. [ABSTRACT FROM AUTHOR]

During its last funding cycle from 2018–2020, the Global Fund in collaboration with the Ministry of Health, World Health Organization, and implementing partners Cordaid and Santé Rural (SANRU), implemented a multi-sectoral, contextualized approach to improve the sexual and reproductive health of adolescent girls and young women in two regions in the Democratic Republic of the Congo, which included community-based, school-based and health facility-based actions. This implementation research focuses on the health-facility component. The objective of this research is to evaluate the feasibility, acceptability, and effectiveness of a package of interventions to improve health workers' knowledge, skills, and attitudes in providing sexual and reproductive health services to adolescents, whilst concomitantly creating an enabling work environment for building health workers' motivation. The package includes a combination of job descriptions, training and refresher training, desk reference tools, and collaborative learning. The package did not focus on improving amenities, providing or repairing equipment, or providing medicines and supplies. The underlying theoretical framework informing the project and the implementation research draws from Social Network Theory, Diffusion of Innovations and Normalization Process Theory. Qualitative and quantitative process and outcome data from in-depth interviews and focus group discussions with health workers and health managers, field notes, monitoring reports, costing sheets, and health worker surveys, adolescent mystery client assessments, and exit interviews with adolescents will be collected as part of a time-series study. The findings from this implementation research will be utilized to inform future adaptations and/or scale-up of the package of interventions to improve health worker motivation and performance in the Democratic Republic of the Congo and elsewhere. The findings will also contribute to advancing the use of theoretical approaches within the field of implementation research. [ABSTRACT FROM AUTHOR]