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Objectives The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs). Methods The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted. Findings Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist‐led systems. Due to a lack of country‐specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries. Discussion and conclusion Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.

Background & Aim The study describes the experiences and opinions of Serbian physicians regarding workforce management during the COVID‐19 pandemic. Materials & Methods A total of 1553 licensed physicians (65% males; average age 44.0 years) responded to an online survey in September 2020. Differences in the respondents' general data and attitudes regarding workforce management and outbreak preparedness in Serbia were analysed in relation to their engagement during the COVID‐19 pandemic (Pearson χ2 and the independent samples t‐test, p

Objective: To explore the impact of the Covid-19 pandemic on the stress levels and experience of academic surgeons by training status (eg, housestaff or faculty). Background: Covid-19 has uniquely challenged and changed the United States healthcare system. A better understanding of the surgeon experience is necessary to inform proactive workforce management and support. Methods: A multi-institutional, cross-sectional telephone survey of surgeons was conducted across 5 academic medical centers from May 15 to June 5, 2020. The exposure of interest was training status. The primary outcome was maximum stress level, measured using the validated Stress Numerical Rating Scale-11 (range 0–10). Results: A total of 335 surveys were completed (49.3% housestaff, 50.7% faculty; response rate 63.7%). The mean maximum stress level of faculty was 7.21 (SD 1.81) and of housestaff was 6.86 (SD 2.06) (P = 0.102). Mean stress levels at the time of the survey trended lower amongst housestaff (4.17, SD 1.89) than faculty (4.56, SD 2.15) (P = 0.076). More housestaff (63.6%) than faculty (40.0%) reported exposure to individuals with Covid-19 (P < 0.001). Subjects reported inadequate personal protective equipment in approximately a third of professional exposures, with no difference by training status (P = 0.557). Conclusions: During the early months of the Covid-19 pandemic, the personal and professional experiences of housestaff and faculty differed, in part due to a difference in exposure as well as non-work-related stressors. Workforce safety, including adequate personal protective equipment, expanded benefits (eg, emergency childcare), and deliberate staffing models may help to alleviate the stress associated with disease resurgence or future disasters.

Since the spread of the coronavirus disease 2019 (COVID-19) was designated as a pandemic by the World Health Organization, health care systems have been forced to adapt rapidly to defer less urgent care during the crisis. The United States (U.S.) has adopted a four-phase approach to decreasing and then resuming non-essential work. Through strong restrictive measures, Phase I slowed the spread of disease, allowing states to safely diagnose, isolate, and treat patients with COVID-19. In support of social distancing measures, non-urgent studies were postponed, and this created a backlog. Now, as states transition to Phase II, restrictions on non-essential activities will ease, and radiology departments must re-establish care while continuing to mitigate the risk of COVID-19 transmission all while accommodating this backlog. In this article, we propose a roadmap that incorporates the current practice guidelines and subject matter consensus statements for the phased reopening of non-urgent and elective radiology services. This roadmap will focus on operationalizing these recommendations for patient care and workforce management. Tiered systems are proposed for the prioritization of elective procedures, with physician-to-physician communication encouraged. Infection control methods, provision of personal protective equipment (PPE), and physical distancing measures are highlighted. Finally, changes in hours of operation, hiring strategies, and remote reading services are discussed for their potential to ease the transition to normal operations., Highlights • Different regional networks of care are moving past peak demand for medical services to treat COVID-19. • A phased and triaged approach to resuming care for deferred urgent cases and non-urgent care must be implemented and communicated to clients. • This approach should include infection control methods, management of medical staff and be prepared for subsequent rounds of disease peaks.

Objective: The main aim of this study was to analyse the supply and demographic characteristics of the dentists’ population in Kenya prior to the 2013 decentralization of health workforce management to the County governments. Methods: This was a cross-sectional study of Kenyan dentists who were practising as at 2013. Demographic data was obtained from the Kenya Medical Practitioners and Dentists’ Board and the Ministry of Health annual retention registers. These data were integrated and analysed in Microsoft Excel 2016. Results: The number of dentists in Kenya has exponentially risen over the years although the growth seems to have slowed down in the last decade. Majority are male, but the gender gap is rapidly decreasing. Most of the dentists studied were below the age of 40 years (M=39.8, SD=11.9); were general practitioners (79.3%) with local undergraduate training (76%) and were predisposed towards private practice. The results show a chronically deficient, relatively aging dental specialist population (M=46.4years, SD=9.1). Discussion: The supply of dentists and dental specialist in Kenya, especially in the public sector is still deficient. This has impeded accessibility to quality oral health care services in a population experiencing a rise in oral disease. Studies have also shown that gender differences have an impact on dental practice. Conclusion: There is urgent need to develop strategies that will increase and retain the number of qualified dentists and specialists in government facilities. It remains to be seen whether devolution will fast track the desirable changes in oral health service delivery.

IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

AimTo evaluate the preparedness and adherence of Brazilian long-term care facilities (LTCFs) to the World Health Organization (WHO) infection prevention and control (IPC) guidance and examine the association of LTCF size with adherence to recommendations.MethodsWe conducted a cross-sectional study of LTCF managers for 12 consecutive weeks from May 5, 2020. We developed and pre-tested a 46-item questionnaire based on WHO IPC guidance that included multiple-choice and dichotomous questions as well as an open-ended question on the main difficulties encountered by the facility in tackling the pandemic. Using a global adherence score based on the adoption of 20 recommendations, we classified preparedness as (1) excellent for LTCFs following ≥14 recommendations, (2) good for those following 10-13 recommendations, and (3) poor for those following ResultsOf 362 facilities included in the study, 308 (85.1%) adhered to 14 or more recommendations; 3 were classified as poorly adherent. Regarding LTCF size, we found a lower adherence to screening visitors for COVID-19 signs and symptoms (p=0.037) and to isolating patients until they have 2 negative laboratory tests (p=0.032) in larger facilities than in medium and small facilities.ConclusionsPreparedness for mitigating COVID-19 in Brazilian LTCFs was considered excellent for most of the proposed recommendations, regardless of LTCF size. Difficulties and problems with infrastructure and/or resident care were much less commonly reported than those related to maintenance of a sufficient stock of materials, workforce management, and financial distress.

AimsTo highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic.BackgroundIn acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses.DesignDiscursive paper.FindingsNursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures.ConclusionCOVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive.Relevance to clinical practiceObjective measures commonly fail to capture the complexity of the critical care nurses' role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.

Objective To identify core practices for workforce management of communication and swallowing functions in coronavirus disease 2019 (COVID-19) positive patients within the intensive care unit (ICU). Design A modified Delphi methodology was used, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included. Setting Electronic modified Delphi process. Participants Speech-language pathologists (SLPs) (N=35) from 6 continents representing 12 countries. Interventions Not applicable. Main Outcome Measures The main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: 0=strongly disagree, 10=strongly agree). Prioritization rank order of statements in a fourth round was also conducted. Results SLPs with a median of 15 years of ICU experience, working primarily in clinical (54%), academic (29%), or managerial positions (17%), completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance. Conclusions A set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focused on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic.

Objectives The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. Design Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. Setting and Participants Residents and staff in care settings such as nursing homes and long-term care facilities. Methods PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. Results Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. Conclusions and Implications High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.

AIMS To examine performance differences among different writers of the National Council Licensure Examination-Registered Nurse (NCLEX-RN) examination in Canada; to compare Canadian and U.S. writer pass rate data; and to identify if changes in the Canadian nursing workforce can be related to the introduction of NCLEX-RN. BACKGROUND In January 2015, the entry-to-practice licensing examination changed from the Canadian Registered Nurse Examination to the NCLEX-RN, and pass rates declined. METHODS This comparative analytic study examined NCLEX-RN pass rate data for 2015, 2016 and 2017 using publicly available data. The Canadian data were compared with that from U.S. nurses taking the examination. RESULTS Overall year-end pass rates among Canadian writers appeared to improve significantly in 2016 (95% to 96.3%, p

District nurse numbers in the UK are rapidly declining. To overcome this severe staff shortage, one community trust in a rural county appointed ‘case managers’ (nurses without Specialist Practice Qualifications in district nursing [SPQDN]) in band 6 leadership roles that were traditionally held by district nurses. Here, we aimed to establish the value of the SPQDN to determine if there is a future for the conventionally accepted DN role, instead of case managers. The study used an exploratory mixed-methods design. Using the classic e-Delphi technique, data were collected over 5 months from 10 purposively sampled senior nurse managers employed by the community trust who formed an expert panel. In round one, the panellists provided three responses each to the question ‘what is the future for district nurse specialist practitioner qualifications in [the trust] for band 6 leadership roles?’ In rounds two and three, they answered a close-ended questionnaire using a 3-point Likert scale. The core findings suggest that SPQDN and the district nurse role are considered extremely valuable (both achieving 100% consensus). Additional findings are linked to four core themes, namely, (1) SPQDN, (2) clinical practice educators, (3) workforce and (4) leadership. This study recommends continued investment in SPQDN and the district nurse role with the use of succession planning for workforce management.

Background A high performing physician workforce is critical to attain nationally set health sector goals. Ethiopia has expanded training of medical doctors. However, little is known about junior doctors’ performance. Understanding medical practice is essential to inform medical education and practice, establish licensure examination and guide workforce management decisions. We conducted a practice analysis study to identify gaps in Ethiopian medical education and practice, and to determine composition of subjects in national licensing examination. Methods We conducted a cross-sectional study with national representative sample of junior doctors. After calculating a sample size of 198, we used a two-stage stratified cluster sampling method to select study participants. We collected data using a structured questionnaire comprising 222 tasks. Study participants reported in interviews on frequency of, competence at, and importance of doing each task for improved health outcome. We developed proportions, averages, graphs and tables. Using the results of practice analysis and experts’ ratings, relative weights of subjects in the national licensing examination for medical undergraduates were determined. Results A total of 191 junior doctors participated. Most were males (74.6%) and had less than 2 years of experience (69.8%). Junior doctors frequently performed tasks of internal medicine and pediatrics. Their participation in obstetrics and gynecology, ophthalmology, psychiatry and dentistry services was infrequent. Junior doctors had competency gaps to conduct clinical procedures, research and health programming tasks. Practice analysis results and expert ratings generated comparable recommendations for composition of a national licensing examination, with more than three-quarters of the items focusing on internal medicine, pediatrics, surgery, obstetrics and gynecology, and public health. Conclusion Junior doctors in Ethiopia rarely managed psychiatry, ophthalmology and dental patients. They had competence gaps in clinical procedures, research and health programming skills. The findings have implications for establishing licensing examination, and reviewing curriculum, continuing professional development, placement and rotation policy, and distribution of responsibilities.

The recent budget cuts have compelled armed forces to reduce their workforce size while enhancing their operational availability. These goals can be realized by implementing effective workforce management plans. To recruit, train, and retain skilled workforce are ongoing challenges for military workforce, with serious implications on force capability and national security. In this study, we focus on strategic military workforce planning, which has long-term impacts on both the efficiency and the future structure of the workforce. Strategic military workforce planning includes decisions regarding recruitment, attrition, promotion, training, and retention policies. It is usually difficult to anticipate how the system, over time, will respond to the combined effects of these strategies Thus, we develop a simulation-optimization approach by coupling a system dynamics (SD) simulation model and a genetic algorithm (GA) to find the best long-term workforce decision(s). GA seeks the optimal workforce flow between different ranks (including promotion strategies) while the SD model simulates the career progression of the workforce from recruitment, throughout the interim separation, and retirement. The numerical experiments show that the developed simulation optimization approach finds strategies yielding reduced costs and improved operational availability.

Aim/Background Workforce management is one of the biggest NHS challenges and the largest expenditure. Workforce recruitment/retention is a growing concern; there is need to better support workforce and flexible working preferences. Better use of technology is seen by many as a route to addressing this. The NHS have mandated electronic rostering by 2021. Birmingham Children’s Hospital Emergency Department (BCH ED) depends on a 24 hour multi-disciplinary team with differing work contracts/patterns. Historically they depended on rudimentary paper/spreadsheet systems that were error prone, with potential impact on staff experience, service cover and patient care; managed by clinicians, taking approximately 20 hours/week. BCH ED partnered with Lantum, an app and cloud based workforce management platform, aiming to: Develop a robust, automated, transparent rota system Improve efficiency Reduce expenditure Increase staff satisfaction Methods Following clear definition of challenges and goals, a pilot bespoke digital rota system was launched in April 2019. A partnership approach with regular communication, user testing and feedback sessions ensured assessment of impact and iterative product development to meet the ED’s needs. Results Transparent, simple digital rota system accessible for staff anywhere, in real time All staff onboarded, including bank workers, within 4 weeks Complete replacement of the old system within 2 months Earlier detection of and response to rota gaps Improved shift fill rate (total 20,350 hours filled; average shift fill rate >92% over 6 months ) increasing over time to 97%) Better engagement with workforce through: Improved communication via the platform Better user experience Real–time remote access Cost savings via optimising workforce utilisation and shift fill rates (reduced agency fees) and streamlined administration –> one consultant PA freed up (>£8500pa saving) Increased staff satisfaction Conclusion Development of diagnostic technology is often prioritised above overcoming organisational problems, but the latter can help improve clinician productivity to allow more time for patient care and improve staff satisfaction. Innovative, technological partnerships can facilitate workforce management to the benefit of both staff and organisations. Involving clinicians to co-develop these helps ensure effective solutions, particularly in workforces such as paediatrics with high demand for flexible working.

Background The COVID-19 pandemic is a serious threat to public health worldwide. Therefore, a coordinated global response is needed to prepare health care systems to face this unprecedented challenge. Proper human resource management can increase nurses’ productivity and quality of care. Therefore, the present study aims to explore the nursing managers’ perception of nursing workforce management during the outbreak of COVID-19. Methods This is a qualitative study with conventional content analysis using Granheim and Landman approach. In this study, 15 nursing managers were selected by purposeful sampling method. Data were collected using in-depth semi-structured interviews. Ethical considerations were applied to all stages of the study. In this study, MAXQDA software version 10 was used to help manage the data. Results 66% of the participants (10/5) were female. The mean age of participants was 44 years, mean work experience of 19 years, and mean management experience of 9 years. Three categories and seven sub-categories emerged from the data analysis: 1) management of workforce recruitment (volunteer workforces, non-volunteer workforces), 2) management of workforce arrangement (flexible work schedule, rearrangement of the workforce), and 3) management of workforce retention (preventive measures, motivational measures, and psychological support). Conclusion Management in critical situations requires the use of flexible and situational management principles to recruit, arrange and retain workforce, and also to compensate for the lack of manpower.

Coronavirus disease 2019 (COVID-19) has disrupted lives and indelibly impacted the practice of medicine since emerging as a pandemic in March 2020. For neurosurgery departments throughout the United States, the pandemic has created unique challenges across subspecialties in devising methods of triage, workflow, and operating room safety. Located in New York City, at the early epicenter of the COVID-19 crisis, the Weill Cornell Medicine Department of Neurological Surgery was disrupted and challenged in many ways, requiring adaptations in clinical operations, workforce management, research, and education. Through our department's collective experience, we offer a glimpse at how our faculty and administrators overcame obstacles, and transformed in the process, at the height of the COVID-19 pandemic.

Background There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well-being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia-related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. Aims To establish the current practices of SLTs managing dementia-related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. Methods & procedures An anonymous, cross-sectional web-based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open-ended questions were analysed using conventional content analysis. Outcomes & results A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self-rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. Conclusions & implications The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well-being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper adds What is already known on the subject Research indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice. What this paper adds to existing knowledge This paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints. What are the potential or actual clinical implications of this work? These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia-related dysphagia and mealtime difficulties effectively.

ObjectivesContinuing medical education (CME) and work commitment are important for rural healthcare workers (RHWs) and rural medical work. The significant association between continuing education and work commitment has been reported in many studies from several different industries. However, very few studies have analysed the association of CME with work commitment among healthcare workers, let alone among RHWs. This study aimed to identify the significance of CME for the work commitment of RHWs (doctors and nurses) in China.Design and settingThe cross-sectional study interviewed RHWs from 11 western provinces in China.ParticipantsIn total, 4118 RHWs, consisting of 2490 doctors and 1628 nurses who were working clinically, were included in the study.Primary outcome measuresWork commitment (ie, the relative importance of work to one’s sense of self) focussing on the affective component was the dependent variable, and it included four subdomains: pride, concern, and dedication, extracted by exploratory factor analysis of a 5-point Likert scale, and turnover intent, measured by a dichotomous question. CME (ie, a variety of educational and training activities to maintain, develop or increase knowledge, skills and professional performance and relationships) was the independent variable, including three subdomains: opportunity, participation and expectation, measured by three dichotomous questions.ResultsOf the 4118 respondents, 91.2% reported insufficient opportunities for CME, 21.3% had never participated in CME and 83.3% had a high expectation of CME. The mean scores of pride in, concern for and dedication to work were 3.54, 3.81 and 3.61 (out of a maximum of 5), respectively, and 30.6% presented turnover intent. After adjusting for gender, age, marriage, education, technical title, income and type of rural healthcare organisation, the multivariate analyses suggested that there was a significant positive association between CME and work commitment among RHWs. RHWs who had a significant high-level work commitment were those who reported a sufficient opportunity for CME (β and 95% CI for pride in, concern for and dedication to work: 0.33, 0.23 to 0.43; 0.19, 0.09 to 0.28; and 0.25, 0.15 to 0.35), had participated in CME (β and 95% CI for pride in, concern for and dedication to work: 0.11, 0.04 to 0.19; 0.09, 0.02 to 0.15; and 0.10, 0.03 to 0.17) and had a high expectation of CME (β and 95% CI for pride in, concern for and dedication to work: 0.22, 0.15 to 0.30; 0.21, 0.13 to 0.28; and 0.28, 0.20 to 0.36), and having sufficient opportunities for CME significantly increased the odds of having no turnover intent (OR and 95% CI: 1.70, 1.26 to 2.28). Age, marriage, education, technical title, income and type of rural healthcare organisation were significantly associated with the work commitment of RHWs. Differences were observed between rural doctors and nurses in the association of CME with work commitment.ConclusionsCME has a significant positive association with the work commitment of RHWs in China. RHWs’ work commitment should be further improved in future rural health workforce management. In addition, governments, healthcare organisations and professional associations should establish a professional and complete CME system in China to provide sufficient opportunities for CME for RHWs, encourage them to participate and meet their expectations.

UK national guidelines state deteriorating or at risk hospital ward patients should receive care from trained critical care outreach personnel. In most tertiary hospitals this involves a team led by an Intensive Care Unit (ICU) registrar. The ICU registrar must also review patients referred for possible ICU admission. These two responsibilities require work away from the ICU. To our knowledge the burden of this work has not been described, despite its importance in ICU workforce management and patient safety. A 12-month, prospective, observational study was carried out. The primary outcome measure was ICU registrar time spent on and off-unit. The study participants were senior and junior registrars on the rota of the 16 bed, Adult Intensive Care Unit at the John Radcliffe Hospital in Oxford. To measure their work patterns, this study used AeroScout ‘T2’ Real Time Location Device (RTLD) tags (Stanley Healthcare, Swindon). In our hospital, senior and junior ICU registrars spend roughly one-fifth of their time off-unit, half of which is spent in ED. This workload combines to leave the unit unattended at night up to 10% of the time. RTLDs provide a reliable, automated method for quantifying ICU registrar off-unit work patterns. This method may be adopted for quantifying other clinical staff work patterns in suitably equipped hospital environments.

Objective Reducing risk of coronavirus disease 2019 (COVID-19) infection among healthcare personnel requires a robust occupational health response involving multiple disciplines. We describe a flexible informatics solution to enable such coordination, and we make it available as open-source software. Materials and Methods We developed a stand-alone application that integrates data from several sources, including electronic health record data and data captured outside the electronic health record. Results The application facilitates workflows from different hospital departments, including Occupational Health and Infection Control, and has been used extensively. As of June 2020, 4629 employees and 7768 patients and have been added for tracking by the application, and the application has been accessed over 46 000 times. Discussion Data captured by the application provides both a historical and real-time view into the operational impact of COVID-19 within the hospital, enabling aggregate and patient-level reporting to support identification of new cases, contact tracing, outbreak investigations, and employee workforce management. Conclusions We have developed an open-source application that facilitates communication and workflow across multiple disciplines to manage hospital employees impacted by the COVID-19 pandemic.

Public health, social work, and psychological counselling professions in South Korea are facing challenges of human resource shortage and shortage of professionals who can provide multilingual services. The purpose of this study was to explore and understand why public health, social work, and psychological counselling services degree graduates and professionals with multilingual skills in South Korea decide to leave their professional field to the hospitality and business industries, particularly for those who completed their initial training at one of the international universities. Based on the approach of the Social Cognitive Career Theory, individuals&rsquo, self-efficacy, outcome expectations, interests, and goals were examined and considered. The data were collected from 12 participants with the methodology of interpretative phenomenological analysis. The general inductive approach was employed to categorize the themes for reporting. The results indicated that public health, social work, and psychological counselling services-related positions are not available, modelling from peers, and lack of career development skills are the primary difficulties of public health, social work, and psychological counselling services graduates. The completion of this study provides clear recommendations to educators, policymakers, school leaders, human resource planners, and university administrators to improve their curricula and school counselling for public health, social work, and psychological counselling services graduates and the next generation.

The COVID-19 pandemic has stretched health care resources to a point of crisis throughout the world. To answer the call for care, health care workers in a diverse range of specialties are being retasked to care for patients with COVID-19. Consequently, specialty services have had to adapt to decreased staff available for coverage coupled with a need to remain available for specialty-specific emergencies, which now require a dynamic definition. In this Invited Commentary, the authors describe their experiences and share lessons learned regarding triage of patients, staff safety, workforce management, and the psychological impact as they have adapted to a new reality in the Department of Neurosurgery at Montefiore Medical Center, a COVID-19 hot spot in New York City.

Speech Pathologists (SPs) are under increasing workforce pressures as a result of an ageing population and greater prevalence of chronic conditions. Considering this increasing workforce demand, within the context of limited health resources, workforce flexibility such as the consideration of task delegation is increasingly being encouraged within the literature and government policy. Though the use of delegation models within speech pathology has received some attention, particularly in the management of paediatric speech and language disorders, there is a paucity of evidence to support the use of delegation models in dysphagia management. This presents a significant gap, as dysphagia management is an integral part of the SP’s role in the inpatient hospital setting and accounts for a significant proportion of workload demand in that context.Delegation of dysphagia related tasks to a trained Allied Health Assistant (AHA) offers a means to address increased workforce demand, while potentially improving workforce efficiency. Appropriate delegation of ‘low value’ tasks to another professional group may support the SP; to dedicate more time to high risk caseloads; increasing intensity of intervention; and contributing to quality and innovation initiatives. Hence the overall objective of this thesis was to generate new knowledge regarding the design, clinical implementation and evaluation of AHA delegation models in the clinical area of dysphagia management. Two specific aims were identified to achieve this. The first was to design, develop, implement and evaluate AHA delegation models for two key dysphagia related tasks, (mealtime observations and dysphagia screening), to establish accuracy and feasibility of task completion. The second aim was to evaluate stakeholder perceptions regarding implementation of AHA delegation models in the clinical area of dysphagia. Three studies resulting in four manuscripts were conducted to achieve these aims.Study 1 (Chapter 2) involved a mixed method design including a document review of 13 policy documents on AHA delegation and a survey of 44 speech pathology managers regarding current delegation models. Despite policy support for AHA delegation, and 77% of managers reporting that they used delegation models, only 26% of managers reported using delegation fairly often/very often in dysphagia management. To facilitate greater delegation, both document analysis and survey findings supported the importance of AHA training, however, the nature of training remained unclear. Chapter 2 therefore provides context for delegation in the clinical area of dysphagia by demonstrating both policy and stakeholder support.While Chapter 2 demonstrated that emerging support exists for the delegation of dysphagia related tasks to trained AHAs, an evaluation of accuracy and validity of task completion in these models of care has not been undertaken. To address this evidence gap, two separate studies were conducted resulting in Chapters 3, 4 and 5. Chapter 3 involved a mixed method design to explore validity of AHA completed mealtime observations of 50 adult inpatients using a structured observation form. The results of this study identified that exact agreement between AHAs and SPs on the overall pass/fail criteria was high (94%). Where exact agreement was not achieved, the AHA had made a more conservative decision, thus still ensuring patient safety. Qualitative interviews conducted as part of the mealtime observation study (Chapter 3) identified that both SPs and AHAs perceived multiple positive personal and service benefits of delegated mealtime observations. High levels of agreement between the SP and the AHA were also identified in Chapter 4 which utilised a prospective cohort study to examine feasibility and validity of AHA delegation in dysphagia screening. Validity testing in this study confirmed exact agreement between AHAs and SPs on overall pass/fail screening criteria for the first 51 patients to be 100%. Furthermore, the delegation of ‘low risk’ dysphagia screening to a trained AHA was identified to remove approximately 40% of these referrals from the SP’s caseload. Thus, providing evidence to support improved efficiency in workforce management when introducing AHA delegation.In Chapter 5 the perceptions of stakeholders regarding the implementation of delegated dysphagia screening was conducted. The service implementation experience was examined using the Consolidated Framework for Implementation Research (CFIR) analysis framework. Results of this study provided an overview of barriers and facilitators to implementation, which provide vital direction to future services wishing to introduce innovative models, such as AHA delegation in dysphagia management. Chapter 5 also highlighted variation between direct patient delegation and blanket delegation, which was explored in more detail in Chapter 6.The final chapter of this thesis (Chapter 6) provided a summary of the thesis findings, limitations and areas for future research. In conclusion, delegation of dysphagia related tasks to trained AHAs is safe and effective and may provide opportunity for efficiency increases, cost reduction and workforce flexibility in the area of dysphagia management. While training provided for the tasks included in this thesis appeared adequate given the high agreement and accuracy of task completion, variation in context and delegation practices highlight areas of future research.

Background Access to an Emergency Medical Communication Centre is essential for the population in emergency situations. Handling inbound calls without delay requires managing activity, process and outcome measures of the Emergency Medical Communication Centre to improve the workforce management and the level of service. France is facing political decisions on the evolution of the organisation of Emergency Medical Communication Centres to improve accessibility for the population. First, we aim to describe the variation in activity between Emergency Medical Communication Centres, and second, to explore the correlation between process measures and outcome measures. Methods Using telephone activity data extraction, we conducted an observational multicentre study of six French Emergency Medical Communication Centres from 1 July 2016 to 30 June 2017. We described the activity (number of incoming calls, call rate per 1000 inhabitants), process measure (agent occupation rate), and outcome measure (number of calls answered within 20 s) by hourly range and estimated the correlation between them according to the structural equation methods. Results A total of 52,542 h of activity were analysed, during which 2,544,254 calls were received. The annual Emergency Medical Communication Centre call rate was 285.5 [95% CI: 285.2–285.8] per 1000 inhabitants. The average hourly number of calls ranged from 29 to 61 and the call-handled rate from 75 to 98%. There are variations in activity between Emergency Medical Communication Centres. The mean agent occupation rate was correlated with the quality of service at 20 s (coefficient at − 0.54). The number of incoming calls per agent was correlated with the mean occupation rate (coefficient at 0.67). Correlation coefficients varied according to the centres and existed between different process measures. Conclusions The activity dynamics of the six Emergency Medical Communication Centres are not identical. This variability, illustrating the particularity of each centre, must be accurately assessed and should be taken into account in managerial considerations. The call taker occupation rate is the leverage in the workforce management to improve the population accessibility.

Objectives Staffing is the single biggest cost component in the critical care budgets. Due to the fluctuation in both bed occupancy and the level of care needs, nursing staff requirement can vary considerably from day to day. This makes the traditional ‘fixed roster’ staffing system inefficient, costly and potentially unsafe. In this study, we used the existing bed occupancy data to test the viability two ‘dynamic’ workforce management models. Research methodology Nursing requirement data were prospectively collected over one year at a thirty-two-bed critical care unit. Using mathematical models, we then tested the concept of two alternative workforce management models and compared the level of staffing, as well as the estimated cost per year. The first was an ‘on-call’ model, which was a two-tier roster with a standard staffing level and an additional on-call component; the second was a ‘predictive’ model, which estimated the staffing requirement based on the bed occupancy a few days prior. Setting Single centre study in a busy district general hospital with a 32-bed critical care unit. Main outcome measures The number of days with safe staffing levels and the cost of the alternative workforce management models. Results Data were collected over 331 days. The on-call model was estimated to cost 16% less per year (£431,320, or 2,630 nurse-shift equivalent) compared to the fixed roster, while fulfilling the adequate staffing standards in 97% of the days. While the predictive model could also be used to improve the workforce efficiency, this was overall less efficient than the on-call model. Conclusion The modelled data suggests that the implementation of an ‘on-call’ model in critical care nursing rostering could potentially improve coverage and appear to be cost effective.

The Democratic Republic of Congo has flagged health workforce management and compensation as issues requiring attention, including the problem of ghost workers (individuals on payroll who do not exist and/or show up at work). Recognising the need for reliable health workforce information, the government has worked to implement iHRIS, an open source human resources information system that facilitates health workforce management. In Kasaï Central and Kasaï Provinces, health workers brought relevant documentation to data collection points, where trained teams interviewed them and entered contact information, identification, photo, current job, and employment and education history into iHRIS on laptops. After uploading the data, the Ministry of Public Health used the database of over 11 500 verified health worker records to analyse health worker characteristics, density, compensation, and payroll. Both provinces had less than one physician per 10 000 population and a higher urban versus rural health worker density. Most iHRIS-registered health workers (57% in Kasaï Central and 73% in Kasaï) reported receiving no regular government pay of any kind (salaries or risk allowances). Payroll analysis showed that 27% of the health workers listed as salary recipients in the electronic payroll system were ghost workers, as were 42% of risk allowance recipients. As a result, the Ministries of Public Health, Public Service, and Finance reallocated funds away from ghost workers to cover salaries (n = 781) and risk allowances (n = 2613) for thousands of health workers who were previously under- or uncompensated due to lack of funds. The reallocation prioritised previously under- or uncompensated mid-level health workers, with 49% of those receiving salaries and 68% of those receiving risk allowances representing cadres such as nurses, laboratory technicians, and midwifery cadres. Assembling accurate health worker records can help governments understand health workforce characteristics and use data to direct scarce domestic resources to where they are most needed.

OBJECTIVES To assess the self-selected asynchronous leadership module-based learning choices of public health professionals participating in the Maternal and Child Health Public Health Leadership Institute (MCH PHLI). METHODS Online module completion and evaluation data were used to determine the topics most utilized by the Fellows; whether the topics and mode of training were acceptable, relevant, and practical; and whether participant characteristics explained any usage patterns. PARTICIPANTS A total of 109 enrolled Fellows in the MCH PHLI program. MAIN OUTCOME MEASURES Module frequency of selection by Fellows; Fellows' rating scores in regard to relevance, practicality, and acceptability of module topics. RESULTS All program titles were highly rated. The 5 most frequently selected module topics were employee engagement (87.2%), talent acquisition strategies (84.4%), employee motivation (79.8%), emotional intelligence (78.9%), and workforce development strategies (68.8%). The least accessed topics focused on cultural competence (15.6%), social marketing (25.7%), effective communication and advocacy (25.7%), family partnerships (25.9%), and creating learning organizations (31.2%). All module topics provided were rated as relevant, practical, and acceptable to these public health leaders. CONCLUSION Self-directed computer-based learning was rated strongly by the MCH public health leaders in this study. Such an approach can be used to customize training to individual needs and interests. These findings suggest that inclusion of skills that enable public health leaders to effectively work with and through others was of core interest in the MCH PHLI. The finding of higher usage of topics related to workforce management can provide guidance for those developing leadership development programs for maternal and child health professionals. In addition, leadership needs and interests should be assessed regularly to ensure that competency-based leadership development guidelines are adapting to the evolving and complex challenges faced by leaders. While these results were tested in MCH professionals, they may be generalizable to other disciplines within the field of public health.

Purpose The purpose of this paper is to explore a novel overarching strategy in tackling the key issues raised by the recent inquiry into bullying, harassment and discrimination in surgical practice and surgical training in Australian and New Zealand hospitals. Design/methodology/approach The approach taken is an analysis of the available evidence-based literature to inform the proposed viewpoint. The theoretical subject scope presented is a discussion of how and why the various strategies put forward in this paper should be integrated into and led from an overarching workforce engagement platform. Findings The key themes isolated from the Inquiry into Australian and New Zealand surgical practice ranged from abuse of power by those in leadership positions, gender inequity in the surgical workforce, opaque and corrupt complaints handling processes, excessive surgical trainee working hours to bystander silence secondary to a fear of reprisal. A workforce engagement perspective has elicited the potential to counter various impacts, that of clinical ineffectiveness, substandard quality and safety, inefficient medical workforce management outcomes, adverse economic implications and the operational profitability of a hospital. Generic strategies grounded in evidence-based literature were able to then be aligned with specific action areas to provide a new leadership framework for addressing these impacts. Originality/value To the author’s knowledge, this is one of the first responses providing a framework on how medical managers and hospital executives can begin to lead a comprehensive and practical strategy for changing the existing culture of bullying, harassment and discrimination in surgical practice by using a staff engagement framework.

Strategic efforts are needed in Indonesia to implement the recently released human immunodeficiency virus (HIV) Test and Treat policy which promotes increased treatment uptake, known to have important economic benefits. Of Indonesia’s estimated 631,635 people living with HIV (PLHIV) in 2018, only 12% are on treatment. The USAID- and PEPFAR-funded Human Resources for Health in 2030 (HRH2030) Program undertook policy analysis and assessed the available health workforce and service delivery at select sites in Jakarta to identify and anticipate Test and Treat implementation gaps. A mixed methods concurrent triangulation design was used, including policy analysis, key informant interviews, and site-level tools to capture workforce availability, skills, quality, and performance. Results indicate priorities to: define and implement HIV standards of practice for the Test and Treat policy; improve relevance and coordination of pre-service and in-service training programs; and support managers to optimize task and workforce allocation, including allocating lower-skilled workers to routine testing. Additional site-level data are needed from rural and remote sites in Indonesia, where fewer health workers are distributed. Efficiencies can help sustain HIV programs and contribute to epidemic control.Abstrak Upaya strategis dibutuhkan Indonesia untuk implementasi kebijakan Pemeriksaan dan Pengobatan (Test and Treat) HIV, seperti yang diterbitkan oleh USAID dan PEPFAR. Kebijakan ini mendorong peningkatan cakupan pengobatan yangd diyakini penting secara ekonomi. Diperkirakan pada tahun 2018 terdapat 631,635 ODHA di Indonesia dan hanya 12% yang menjalani pengobatan. Program HRH2030 yang didanai oleh USAID dan PEPFAR melakukan analisis kebijakan dan penilaian ketersediaan tenaga kesehatan dan pelayanan HIV di beberapa unit layanan di Jakarta, untuk mengidentifikasi dan mengantisipasi kesenjangan implementasi kebijakan. Kajian menggunakan metode campuran dengan melakukan analisis kebijakan, wawancara informan kunci, dan serangkaian alat asesmen tingkat unit layanan untuk menangkap informasi terkait ketersediaan, keterampilan, kualitas, dan kinerja tenaga kesehatan. Hasil kajian ini memprioritaskan adanya penetapan dan penerapan standar praktik layanan HIV yang sesuai dengan kebijakan Pemeriksaan dan Pengobatan. Peningkatan koordinasi program pendidikan pra-layanan dan pelatihan dalam jabatan dan dukungan kepada manajer unit layanan untuk mengoptimalkan alokasi tugas dan tenaga kesehatan menjadi hal yang penting. Pendekatan ini diharapkan dapat meningkatkan efisiensi layanan dan keberlanjutan program HIV. Data dan informasi tingkat unit layanan dibutuhkan, khususnya dari wilayah pedesaan dan terpencil.

Background Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers. Methods A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified. Results Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers. Conclusion Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical.

To examine the relationships between workplace bladder practices, urinary symptoms, and work productivity.Cross-sectional observational survey.Surveys were distributed June-November 2016 to at least 600 female nurses and midwives at three urban hospitals in New South Wales, Australia. Nurses self-reported restricted workplace access to toilets, delaying voiding, limiting of fluid intakes and urinary symptoms at work. Logistic modelling was used to examine whether nurses' bladder practices impaired their time management, ability to concentrate or perform physical demands.Of 353 useable surveys, one in five nurses (22.4%; N = 79) reported restricted access to toilets at work, most (77.1%; N = 272) delayed voiding and one in four (26.9%; N = 95) limited fluid intakes to delay voiding at work. Almost half the sample had urinary symptoms at work (46.7%; N = 165); delaying voiding increased the likelihood of impaired mental concentration and limiting fluid intakes increased the likelihood of impaired time management.As workplace access to toilets and related bladder practices are modifiable, associated urinary symptoms and productivity loss may be preventable.Nurses' often experience restricted accesses to amenities due to job demands and workplace environments. The impact of nurses' poor bladder practices in the workplace is not known. In this study most nurses delayed voiding and many purposefully limited fluid intakes at work. These behaviours impacted a nurse's ability to manage time and/or concentrate at work. Results have implications for nurses' personal health, the design of workplace environments, workforce management, occupational health policy, and patient care.目的: 研究工作场所膀胱使用习惯、泌尿系统症状和工作效率之间的关系。 设计: 横断面观察调查。 方法: 调查于2016年6月至11月向澳大利亚新南威尔士州的三家城市医院里的至少600名女护士和助产士发放。护士自称工作时上厕所受限,延迟排尿、减少摄入水分以及出现泌尿系统症状。逻辑模型被用来检验护士的膀胱使用习惯是否妨碍了她们的时间管理、注意力集中或满足生理需求的能力。 结果: 在35份可用调查中,五分之一的护士(22.4%; 人数为79人)报告工作时上厕所受到限制,大多数护士(77.1%; 人数为272人)会憋尿,四分之一的护士(26.9%; 人数为95人)会限制水分摄入来延迟排尿。样本中基本一半的护士在工作时出现了泌尿系统症状(46.7%; 人数为165人);延迟排尿增加了注意力不集中的可能性,限制水分摄入增加了妨碍时间管理的可能性。 结论: 因为工作时上厕所的情况和相关的膀胱使用习惯是可改变的,所以相关的泌尿系统症状和生产效率的损失都是可以预防的。 影响: 由于工作需要和工作环境的原因,护士们使用便利设施常常受到限制。护士们在工作场所时的不良的膀胱使用习惯会产生什么影响,现在还不得而知。在本次调查中得知,大多数护士在工作时会延迟排尿,许多护士也会限制摄入水分。这些行为会对护士管理时间的能力产生影响,以及/或影响她们集中注意力。研究结果对护士的个人健康、工作环境的设计、员工管理、职业健康政策和病人护理有一定的指导意义。.

BACKGROUND Evidence has been limited regarding broader emergency systems assessment in low- and middle-income countries. The aim of the present study was to provide the empirical evidence of Thai emergency department (ED) workforce vis-a-vis workload on a national scale, the availability of services for selected high-priority health burdens, and the governance obstacles in addressing the workforce management. METHOD One hundred thirty public Thai EDs that provide 24-hour emergency medical care were identified across Thailand as meeting the inclusion criteria. The mailed questionnaires were administered to collect data related to the objectives of the research study. RESULT Responses were received from 91 of 130 (70%) hospitals. The median number of patients visiting hospital EDs was 51 221 per year with 32.8% considered nonurgent (ESI levels 4-5). University hospital EDs were staffed with a higher number of ER professionals than EDs of service-based secondary care and tertiary care hospitals under Ministry of Public Health (MOPH). Almost all hospitals expressed concerns about the deficiency of doctors and nurses especially emergency physician (EP) and emergency nurses. The percentage of hospitals reporting the availability of coronary artery catheterization (34%) and thrombolytic infusion for acute thrombotic stroke (24%) was limited. The governance obstacles to manage emergency systems were considered. CONCLUSION ED staffing seems to positively correlate with workloads except university hospitals, in our study, which may suggest the influence of teaching status on the allocation of the human resource. Among the governance obstacles in ED management, a better response to nonurgent patients requires flexibility for hospitals to set financial disincentives or mobilization and management of human resources.

Rationale, aims and objective Accrediting health care organizations against standards is a recognized safety and quality intervention. The credibility of an accreditation programme relies on surveying reliability. We investigated accreditation survey coordinators’ perceptions of reliability issues and their continued relevancy, during a period of national accreditation reform. Method In 2013 and 2014, questionnaire surveys were developed using survey coordinators’ feedback of their experiences and concerns regarding the accreditation process. Each year, a purpose‐designed questionnaire survey was administered during the accrediting agency survey coordinator training days. Results Participants reported that survey reliability was informed by five categories of issues: the management of the accreditation process, including standards and health care organizational issues; surveyor workforce management; survey coordinator role; survey team; and individual surveyors. A new accreditation system and programme did not alter the factors reported to shape survey reliability. However, across the reform period, there was a noted change within each category of the specific issues that were of concern. Furthermore, consensus between coordinators that existed in 2013 appears to have diminished in 2014. Across all categories, in 2014 there was greater diversity of opinion than in 2013. Conclusions The known challenges to the reliability of an accreditation programme retained their potency and relevancy during a period of reform. The diversity of opinion identified across the coordinator workforce could potentially place the credibility and reliability of the new scheme at risk. The study highlights that reliability of an accreditation scheme is an ongoing achievement, not a one‐off attainment.

BackgroundConcerns have long existed about potential shortages in the anesthesiologist workforce. In addition, many changes have occurred in the economy, demographics, and the healthcare sector in the last few years, which may impact the workforce. The authors documented workforce trends by region of the United States and gender, trends that may have implications for the supply and demand of anesthesiologists.MethodsThe authors conducted a national survey of American Society of Anesthesiologists members (accounting for >80% of all practicing anesthesiologists in the United States) in 2007 and repeated it in 2013. The authors used logistic regression analysis and Seemingly Unrelated Regression to test across several indicators under an overarching hypothesis.ResultsAnesthesiologists in Western states had markedly different patterns of practice relative to anesthesiologists in other regions in 2007 and 2013, including differences in employer type, the composition of anesthesia teams, and the time spent on monitored anesthesia care. The number and proportion of female anesthesiologists in the workforce increased between 2007 and 2013, and females differed from males in employment arrangements, compensation, and work hours.ConclusionsRegional differences remained stable during this time period although the reasons for these differences are speculative. Similarly, how and whether the gender difference in work hours and shift to younger anesthesiologists during this period will impact workforce needs is uncertain.

ObjectiveThis study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh.DesignMixed-methods, combining qualitative (eg, document reviews, key informant interviews, in-depth interviews, observations) and quantitative methods (time-motion survey).SettingStudy was conducted in 24 health facilities of Bangladesh. However, UpHCs being the nucleus of primary healthcare in Bangladesh, this manuscript limits itself to reporting the findings from the providers at four UpHCs under this project.Participants18 physicians and 51 nurses, males and females.Primary outcome measuresWorkload components were defined based on inputs from five experts, refined by nine service providers. Using WHO Workload Indicator of Staffing Need (WISN) software, standard workload, category allowance factor, individual allowance factor, total required number of staff, WISN difference and WISN ratio were calculated.ResultsPhysicians have very high (WISN ratio 0.43) and nurse high (WISN ratio 0.69) workload pressure. 50% of nurses’ time are occupied with support activities, instead of nursing care. There are different workloads among the same staff category in different health facilities. If only the vacant posts are filled, the workload is reduced. In fact, sanctioned number of physicians and nurses is more than actual need.ConclusionsIt is evident that high workload pressures prevail for physicians and nurses at the UpHCs. This reveals high demand for these health workforces in the respective subdistricts. WISN method can aid the policy-makers in optimising utilisation of existing human resources. Therefore, the government should adopt flexible health workforce planning and recruitment policy to manage the patient load and disease burden. WISN should, thus, be incorporated as a planning tool for health managers. There should be a regular review of health workforce management decisions, and these should be amended based on periodic reviews.

To explore nurses' and midwives' experiences of urinary symptoms at work.Lower urinary tract symptoms are common in female nurses and midwives. There is limited understanding of the relationship between urinary symptoms, bladder health practices, and work.Qualitative design providing in-depth exploration of nurses' and midwives' experiences of urinary symptoms at work through focus group discussions.Twelve focus groups were held July-September 2016 with 96 Registered Nurses and midwives working at two tertiary-referral hospitals in urban New South Wales, Australia. A semi-structured question schedule was used. An inductive process guided thematic analysis of data using a socioecological framework of health behaviours.Nurses' and midwives' experiences of urinary symptoms at work primarily relate to delaying voiding. This practice is explained by a work culture of "patient-first" care at expense of self-care, relationships in the nursing team, demands of the nursing role, and inadequacy of workplace amenities. The first two themes reflect cultural and social caring dilemmas central to nursing. The second two themes identify issues with workforce management and physical workplace environments.Nurses' and midwives' urinary symptoms and behaviours in response to sensory cues for bladder emptying are dependent on several socioecological influences. Occupational health initiatives in the workforce are required to break cultural norms that deter self-care and to promote work environments that support healthy bladder practices. Workforce management and physical workplace environments are key influences on nurses' timely and dignified access to amenities.目的: 探讨护士和助产士在工作中出现泌尿系症状的经历。 背景: 下尿路症状在女护士和助产士中很常见。 对泌尿系症状、膀胱医疗实践与工作之间的关系了解有限。 设计: 定性设计通过焦点小组讨论,深入探讨护士和助产士在工作中出现泌尿系症状的经历。 方法: 2016年7月至9月举行了12次焦点小组探讨会,其中有96名注册护士和助产士在澳大利亚新南威尔士市区的两所三级转诊医院工作。会上采用了半结构化问题进度表。归纳过程使用健康行为的社会生态框架指导数据的主题分析。 结果: 护士和助产士在工作中出现的泌尿系症状主要与延迟排尿行为有关。这种行为可以用一种以自我护理为代价的”病人至上”的工作文化、护理团队中的人际关系、护理角色的需求、以及工作场所便利设施的不足来对其进行解释。前两个主题反映了护理的核心文化和社会关怀困境。后两个主题确定了与劳动力管理和实际工作环境有关的问题。 结论: 护士和助产士对膀胱排空的感觉提示的泌尿症状和行为取决于多种社会生态影响。 工作人员的职业健康倡议需要打破阻碍自我保健的文化规范,并促进支持健康膀胱实践的工作环境。劳动力管理和实际工作环境是影响护士及时和体面获得便利设施的关键因素。.

To aid the Department of Defense in managing its acquisition workforce, this volume provides data and analysis of workforce characteristics, gains, and losses and describes data-based tools to support further analysis.

We find that British and Korean governments have legislated in favour of extended working lives and, hence, the retention of ageing workforces. In the United Kingdom, pension eligibility ages are being increased and in Korea mandatory retirement age has been raised to age 60. While changes to the UK pension systems leave individuals with the (financial) risks associated with extended working lives, the Korean government tries to protect individuals from financial hardship by enabling them to remain longer in their primary career. However, whether and how government regulation plays out depends on how organisations react to it. The Korean discussion, in fact, shows that there might be leeway: organisations might continue to externalise their employees early framed as honourable, or voluntary, early retirement, which might not be in the interest of the individual but very much in the interest of the organisation. It therefore appears as if the retention of ageing staff is not (yet) considered to be of strategic importance by many organisations in these countries.

The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

Drawing upon data from the Deployment Life Study, this article examines whether female military spouses (SPs) are disadvantaged relative to matched civilian peers in terms of hours worked and earnings, paying particular attention to gaps among the highest educated women. Female SPs do earn less than comparable civilian peers in terms of raw dollars and percentage earnings. Moreover, military wives who are part of the labor force work as many hours as their civilian counterparts, but still earn significantly less for that work. Contrary to predictions, the most educated SPs are not disproportionately affected compared to spouses with less education. These results suggest that SPs at all education levels could benefit from employment assistance; in particular, women already participating in the labor force may benefit from support in finding higher paying jobs.

This systematic review synthesizes findings from 19 empirical studies published between 1970 and 2014 that examine the relationship between job burnout and affective, psychological, physiological, and behavioral well-being among human service workers. Study findings point to the detrimental impact of job burnout on the well-being of workers. Studies in this area of research continue to use the Maslach Burnout Inventory as the primary measure of burnout, are largely cross-sectional in design, and focus mostly on affective well-being as an outcome. A discussion on the impact of study findings for human service workforce management and future research is presented.

Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase of national primary care transformation in the Veterans Health Administration.Cross-sectional online surveys of primary care clinicians (PCCs) and staff in 23 primary care clinics within 5 healthcare systems in 1 veterans administration administrative region. We used descriptive, bivariate, and multivariable analyses adjusted for clinic membership and weighted for nonresponse.515 veterans administration employees (191 PCCs and 324 other primary care staff).Outcome is the EE subscale of the Maslach Burnout Inventory. Predictors include clinic characteristics (from administrative data) and self-reported efficacy for change, experiences with transformation, and perspectives about the organization.The overall response rate was 64% (515/811). In total, 53% of PCCs and 43% of staff had high EE. PCCs (vs. other primary care staff), female (vs. male), and non-Latino (vs. Latino) respondents reported higher EE. Respondents reporting higher efficacy for change and participatory decision making had lower EE scores, adjusting for sex and race.Recognition by healthcare organizations of the potential for clinician and staff EE during primary care transformation is critical. Methods for reducing EE by increasing clinician and staff change efficacy and opportunities to participate in decision making should be considered, with attention to PCCs, and women.

Improving individual sleeping habits has huge implications. Small increases in sleep can make big differences to national economies. RAND Europe's novel study quantifies the economic and social costs of insufficient sleep among the global workforce.

The report summarises the existing evidence on the effectiveness of workplace related preventive health programmes, outlining the challenges involved in calculating their return on investment (ROI). The report outlines the drivers of successful workplace health promotion programmes and develops a framework to analyse the ROI of such projects.

It is vital for all healthcare systems to have a sufficient number of suitably trained health professionals including nurses at all levels of health services to deliver effective healthcare. An ethnographic, qualitative method was chosen for this study, which included open-ended, in-depth interviews with a range of stakeholders including student nurses, qualified nurses, nurse managers and lecturers, and the human resource co-ordinator in the Ministry of Health and Population. Available records and policy documents were also analysed. Study findings suggest that there is a severe mal-distribution of the nursing workforce in rural and urban healthcare centres in Nepal. Although there is an oversupply of newly qualified nurses in hospitals in Kathmandu, the staffing situation outside the valley is undesirable. Additionally, the turnover of junior nursing staff remains high in major urban hospitals. Most qualified nurses aspire to work in developed countries, such as the UK, North America, Australia and New Zealand. Between 2000 and 2008, as many as 3000 nurses have left Nepal for jobs in the developed west. There is no effective management strategy in place to retain a nursing workforce, particularly in rural Nepal. This article concludes by proposing some suggestions for a nursing workforce retention policy to address this critical issue.

There is significant need to establish and predict what numbers of district nursing staff are needed to provide quality patient care. This is the first in a series of articles sharing the evidence-based and tested solutions being used in clinical practice across the UK to inform caseload and workforce planning. Stockport NHS Foundation Trust's electronic workload management tool ‘DominiC’ is explored in this article. The tool promotes continuity of patient care, efficient resource allocation and the benchmarking of care. It predicts future service demands and measures these against the staff resources available. Lessons learned from the process of developing and implementing DominiC are shared to help inform clinicians and managers looking for similar workforce planning solutions.

Workplace wellness programs are increasingly popular. Employers expect them to improve employee health and well-being, lower medical costs, increase productivity, and reduce absenteeism. To test whether such expectations are warranted, we evaluated the cost impact of the lifestyle and disease management components of PepsiCo's wellness program, Healthy Living. We found that seven years of continuous participation in one or both components was associated with an average reduction of $30 in health care cost per member per month. When we looked at each component individually, we found that the disease management component was associated with lower costs and that the lifestyle management component was not. We estimate disease management to reduce health care costs by $136 per member per month, driven by a 29 percent reduction in hospital admissions. Workplace wellness programs may reduce health risks, delay or avoid the onset of chronic diseases, and lower health care costs for employees with manifest chronic disease. But employers and policy makers should not take for granted that the lifestyle management component of such programs can reduce health care costs or even lead to net savings.