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Background: Abortion complications are the leading causes of maternal death in low and middle-income countries, including Ethiopia. Providing quality and comprehensive abortion care services is crucial for improving the health of women and increased their satisfaction. Evaluating a client's satisfaction with abortion care is clinically relevant since women's satisfaction with health services is one of the key indicators of high-quality healthcare services. Therefore, this study aimed to assess women's satisfaction with comprehensive abortion care services and associated factors. Methods: An institution-based cross-sectional study was implemented among 333 women in Central Gondar Zone public primary hospitals from October 1, 2022, to April 30, 2023. Eligible participants were selected using a systematic random sampling technique. The data was collected using an intervieweradministered semi-structured, and pretested questionnaire. STATA version 17 and SPSS version 25 software were used for data entry and analysis respectively. Bivariable and multivariable logistic regression models were used to identify factors associated with clients' satisfaction with comprehensive abortion care services. A P-value of ≤0.05 with a 95% confidence interval was the cutoff point for determining statistical significance. Results: This study revealed that the level of client satisfaction with comprehensive abortion care services was 60.4% (95% CI: 55.0%, 66.0%). The use of abortion medication (AOR = 4.41, 95% CI: 2.59, 7.48), women's age 20-24 years (AOR = 2.94, 95% CI: 1.02, 8.48), and being a student (AOR = 2.88, 95% CI: 1.10, 7.51) were significantly associated with women's satisfaction with comprehensive abortion care services. Conclusions: Women's satisfaction with comprehensive abortion care services was relatively low, and it was strongly correlated with the method of abortion, age, and occupation. To improve women's satisfaction requires a comprehensive understanding of women's values and perspectives, providing sexual and reproductive health education, and quality abortion care services are recommended. [ABSTRACT FROM AUTHOR]

Objective To understand the current status of work stress among full -time research staff in public hospitals, analyze the problems in research management, and propose the targeted countermeasures and suggestions. Methods In August 2022, the full -time research staff in six public hospitals in Shanghai, chosen by a purposive sampling method, were surveyed with a self-designed Work Stress Source Scale for Full-time Research Staff in Public Hospitals. The work stress status and differences among the above staff with different characteristics were analyzed, and the correlation between the scores in various dimensions was examined. Results 231 questionnaires were distributed, and 212 valid questionnaires were obtained, with an effective recovery rate of 91.8%. The scores in various dimensions of the scale were as follows: the highest score was (4.02 ± 0.81) for workload pressure, followed by (4.01 ± 0.70) for work difficulty, (3.70 ± 0.81) for assessment pressure, (3.46 ± 0.86) for role ambiguity, and (3.42 ± 0.94) for job recognition. The overall work stress score was (3.72 ± 0.62), and on the overall score of work stress. Staff who had undertaken provincial or ministerial -level research projects had higher stress scores (P < 0.01); the higher the education level, the higher the scores in workload and work difficulty dimensions (both P < 0.01). There were statistically significant differences in the scores of workload and work difficulty dimensions among full-time research staff in different positions (P < 0.05 or P < 0.01), with the highest stress levels among research staff. The higher the professional title, the higher the workload dimension score (P < 0.05). There were statistically significant differences in the role ambiguity dimension scores among full -time research staff in different departments (P < 0.05), with clinical department staff scoring the highest, followed by staff in central laboratories, both higher than those in research institutes or research parks. Staff who had undertaken provincial or ministerial -level research projects had higher scores in workload, work difficulty, and job recognition dimensions (all P < 0.01). There were positive correlations between scores in various dimensions of the scale (r = 0.348 to 0.613, all P < 0.01). Conclusions Full-time research staff in public hospitals experienced significant work stress. Relevant hospital departments should actively take measures to reduce the workload of research staff, reasonably allocate work difficulty, improve job recognition, and alleviate the pressure of role ambiguity. [ABSTRACT FROM AUTHOR]

Aim: Although relationships among positive psychological capital (PsyCap), compassion fatigue, compassion satisfaction, and burnout have been reported, causal relationships among these variables have not been identified. This study examined the influence of positive PsyCap on burnout and confirmed the mediating effects of compassion fatigue and satisfaction among public hospital nurses. Methods: This study adopted a correlational cross‐sectional design. We recruited 237 nurses working at a public hospital, using convenience sampling. Results: The fit of the hypothetical model was adequate. Positive PsyCap directly affected compassion fatigue and satisfaction, and burnout. It had an indirect effect on burnout. Compassion fatigue and satisfaction directly affect burnout. This finding indicates that compassion fatigue and satisfaction partially mediate between positive PsyCap and burnout. In addition, the mediating effect of compassion fatigue was greater than that of compassion satisfaction on the relationship between positive PsyCap and burnout. Finally, positive PsyCap, compassion fatigue, and compassion satisfaction explained 70.4% of the total variance in burnout scores. The effect size (f2) was 2.38 (large effect size). Conclusions: Burnout should be assessed with positive PsyCap, compassion fatigue, and compassion satisfaction among public hospital nurses. Given that the mediating effect of compassion fatigue was greater than that of compassion satisfaction, interventions for compassion fatigue may be a strategy to reduce burnout, especially among public hospital nurses with low levels of positive PsyCap. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to investigate the humanistic care ability among surgical nurses in China and identify its statistically significant influencing factors. Design: A cross‐sectional, descriptive and correlational design was used. Methods: A total of 210 surgical nurses were recruited from a tertiary public hospital in Wuhu, Anhui Province. Four with incomplete responses were excluded, leaving 206 participants for data analysis. Variables were measured using the general questionnaire, caring ability inventory (CAI), and General Self‐Efficacy Scale (GSES). Multivariate linear regression analyses were performed to identify the statistically significant influencing factors of participants' humanistic caring ability. Results: The overall average score of the CAI was 190.14 (SD = 19.24), and the average scores for the three dimensions of cognitive, courage, and patience were 70.46 (SD = 7.77), 62.12 (SD = 8.47) and 57.56 (SD = 6.02), respectively. The overall average score of the GSES was 26.05 (SD = 5.77). Professional attitude, perceived care from the department head nurse, perceived care from colleagues and self‐efficacy were the statistically significant factors influencing the humanistic care ability of surgical nurses (R2 = 0.45, adjusted R2 = 0.44, F = 40.64, p < 0.001). [ABSTRACT FROM AUTHOR]

Introduction: Public-Private Partnerships (PPPs) are viewed as a solution for gaps in healthcare access, quality and affordability. Operational Cooperation (OC) is a common practice in haemodialysis services at regional hospitals in Indonesia. Aim: To analyse the implementation of OC for haemodialysis services at Regional Public Service Agency (RPSA) hospitals from the perspective of collaborative governance. Materials and Methods: This qualitative research utilised interviews, focus groups, and document analysis to explore the implementation of OC from a collaborative governance perspective. The study was conducted at Regional Hospitals, Regional Government Offices, the Ministry of Health, the Ministry of Home Affairs, Medical Device Companies, and the Association of Regional Hospitals of Indonesia from December 2021 to March 2022. Data were collected from indepth interviews and Focus Group Discussions (FGDs) with 15 informants, including policymakers, hospital managers, and partner companies. Other data included nine national-level and 29 regional-level policy documents. NVivo software was used for coding and to ensure data validity through triangulation. The parameters evaluated included system context, drivers, collaborative processes, and collaboration outcomes according to Emerson's collaborative governance framework. Results: The implementation of PPP for haemodialysis services at regional hospitals is driven by the need for these services and limited resources. Despite the incomplete policy framework, regional hospitals are taking steps to establish collaboration. Hospitals are streamlining operational process flows, creating a domino effect for other services. Even without a feasibility study, the implementation of PPP in regional hospitals in Indonesia has successfully addressed the community's need for access to haemodialysis services. Conclusion: The implementation of PPPs in the form of OC has successfully expanded access to haemodialysis services. However, challenges related to policy, human resources, and corruption pose significant obstacles to the implementation of OC. [ABSTRACT FROM AUTHOR]

Antimicrobial stewardship programmes are a critical tool for addressing the rising threat of antimicrobial resistance. To determine changes in patterns of antimicrobial use in Queensland public hospitals following introduction of the National Safety and Quality Health Service antimicrobial stewardship standard. A retrospective pre/post intervention study was conducted across Queensland public hospitals at the ecological level using Queensland Health's MedTRx database. An interrupted time-series analysis was performed using linear regression models to determine rates of antimicrobial use by quarterly aggregated defined daily dose per 1000 patient-days, for groups of hospitals stratified by peer group classification. Pre-defined time-periods for antimicrobial stewardship programme implementation in response to the introduction of the standard were analysed. In the post-intervention period, there was a decrease in overall use of systemic antimicrobials, glycopeptides, carbapenems and fluoroquinolones in principal referral and public acute group A hospitals. A decrease in overall use was also observed for smaller regional and remote public acute group C and D hospitals; however, increases in glycopeptide and fluoroquinolone use were observed. Third-generation cephalosporin use was unchanged for all hospital peer groups. The proportion of overall use that was accounted for by narrow-spectrum penicillin was low for all facilities, with modest improvements in the post-intervention period observed in principal referral facilities only. These findings add to current knowledge on the effectiveness of legislative quality standards on antimicrobial stewardship at the macro level and highlight gaps to target for future programmes. [ABSTRACT FROM AUTHOR]

Purpose: This article expands literature on user innovation by exploring the mechanisms that support user innovations in the context of a public organisation. Research has hitherto documented support mechanisms for user innovation in producer companies, where users contribute in early or temporary innovation phases as external non-employees or lead-users engaged by the producer. Complementarily, this paper explores a lesser known area of support mechanisms, those that support internal user innovations in a public sector setting. Design/methodology/approach: Employing a qualitative study of a Norwegian public hospital at the interface between users (personnel and patients) and organisational support (facilitators who orchestrate user innovations), this article analyses in-house user innovation based on observations, text documentation and interviews over a four-year period. Findings: In this public hospital, holistic organisational facilitation of "public user innovators" formed the key support mechanism built on "people" (facilitating co-creation), "process" (facilitating ideas, project realisation and implementation) and "coordination" (facilitating systems and communication). The findings show that public and producer organisational mechanisms both resemble and differ in many respects, as illustrated by the framework developed to describe these characteristics, such as that producers insource users, while the public organisation outsources production. Originality/value: The originality of the article lies in the identification and description of "public user innovation", a new term developed from this study of a public organisation in contrast to the dominant literature on producer companies. This article contributes new insights by differentiating the roles of user innovators and the mechanisms that support such innovations. New implications are drawn from the public side of organisational support in user innovation research. [ABSTRACT FROM AUTHOR]

Introduction: Public-Private Partnerships (PPPs) are viewed as a solution for gaps in healthcare access, quality and affordability. Operational Cooperation (OC) is a common practice in haemodialysis services at regional hospitals in Indonesia. Aim: To analyse the implementation of OC for haemodialysis services at Regional Public Service Agency (RPSA) hospitals from the perspective of collaborative governance. Materials and Methods: This qualitative research utilised interviews, focus groups, and document analysis to explore the implementation of OC from a collaborative governance perspective. The study was conducted at Regional Hospitals, Regional Government Offices, the Ministry of Health, the Ministry of Home Affairs, Medical Device Companies, and the Association of Regional Hospitals of Indonesia from December 2021 to March 2022. Data were collected from in-depth interviews and Focus Group Discussions (FGDs) with 15 informants, including policymakers, hospital managers, and partner companies. Other data included nine national-level and 29 regional-level policy documents. NVivo software was used for coding and to ensure data validity through triangulation. The parameters evaluated included system context, drivers, collaborative processes, and collaboration outcomes according to Emerson’s collaborative governance framework. Results: The implementation of PPP for haemodialysis services at regional hospitals is driven by the need for these services and limited resources. Despite the incomplete policy framework, regional hospitals are taking steps to establish collaboration. Hospitals are streamlining operational process flows, creating a domino effect for other services. Even without a feasibility study, the implementation of PPP in regional hospitals in Indonesia has successfully addressed the community’s need for access to haemodialysis services. Conclusion: The implementation of PPPs in the form of OC has successfully expanded access to haemodialysis services. However, challenges related to policy, human resources, and corruption pose significant obstacles to the implementation of OC.

Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age (± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: −0.67 [−0.98, −0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches. [ABSTRACT FROM AUTHOR]

This study explores the influence of Diagnosis-Related Groups (DRG) payment reform on hospital cost control and offers pertinent cost management strategies for public hospitals. It situates the research by elucidating the significance of the DRG payment method and comparing its advantages and drawbacks with the traditional ‘pay per project’ model. The primary aim is to assess the impact of DRG payment reform on hospital cost control and propose effective cost management strategies for public hospitals. The objective is to provide insights into DRG payment implications and attempt practical recommendations for its implementation in the public healthcare sector. Employing a comprehensive approach, the study analyzes DRG payment, delineates advantages and drawbacks, and proposes cost management strategies. Methods include staff training, an information management platform, disease analysis, and optimized cost accounting. The study highlights the potential for improved medical diagnosis and treatment through industry-finance integration. Findings reveal advantages and limitations of DRG payment, emphasizing strategies for optimizing hospital operations. Enhanced medical diagnosis and treatment procedures through industry-finance integration contribute to overall cost control effectiveness. The study serves as a practical guide for implementing DRG payment reforms, offering valuable insights for policymakers and healthcare professionals in navigating the complexities of cost control in public healthcare. [ABSTRACT FROM AUTHOR]

Introduction: Blood culture contamination remains a dilemma issue in the diagnosis of bloodstream infection. However, to date, there is no national data on blood culture contamination and the common organism isolated in Malaysia. This is a pioneer multi-centre study involving public hospitals with medical microbiologists in Malaysia to determine the blood culture contamination rate and the common organism isolated. Materials and Methods: This retrospective cross-sectional study involved record review of all blood culture results over 9 months period from 1st January 2018 until 30th September 2018 in 27 government hospitals in Malaysia. For each positive culture result, the type of isolated organism was classified to represent true bacteraemia or contamination. Results: We analysed 448,109 blood culture records from the participating hospitals. The blood culture positivity rate was 12.5% (57395 of 448109) and 25.0% (14367 of 57395) of the positive blood culture represents contamination. The national blood culture contamination rate in Malaysia was 3.2%. The contamination rate in the adult population was significantly higher than the paediatric population (3.6% vs. 2.6%; p<0.001). The blood contamination rate by institution ranged from 1.5% to 6.8%. The most frequently isolated microorganisms in the contaminated cultures were coagulase-negative staphylococci (71.0%). Conclusion: Blood culture contamination is a major issue that warrants priority in recognition, and interventions should be implemented to reduce the blood contamination rate in Malaysia. [ABSTRACT FROM AUTHOR]

Supplier-induced demand (SID) is a long-standing concern in health economics and health system studies; however, empirical evidence on SID—critical to the development of health policy—is difficult to obtain, especially from China. This study, therefore, aims to add new evidence on SID in China's public tertiary hospitals and facilitates the development of evidence-based health policies in China and other countries with similar healthcare systems. For this study, we used patient-level electronic medical records (EMRs) collected from the information systems of tertiary hospitals in a western province in China. From 11 tertiary hospitals, we collected 274,811 hospitalization records dated between 15 February and 30 November 2019. Total expenditure on hospitalization and length of admission of each patient were the primary metrics for measuring SID. We constructed a character indicator to measure the high-season or off-season status of hospitals, and log-linear estimations were applied to estimate the "off-season effect" on hospitalized expenditures and length of admission. We find that the cost of hospitalization is indeed higher in the off-season in China's public tertiary hospitals; specifically, expenditures for patients admitted in the off-season increased by an average of 5.3–7.9% compared to patients admitted in the peak season, while the length of admission in the hospital increased by an average of 6.8% to 10.2%. We also checked the robustness of our findings by performing subgroup analyses of EMRs in the city-level hospitals and surgical group. We name this phenomenon the "hospital off-season effect" and suggest that the main reason for it is inappropriate financial incentives combined with a Fee-For-Services payment method. We suggest that China should work to reform inappropriate financial incentives in public hospitals to eliminate SID by changing its payment and financing compensation system. [ABSTRACT FROM AUTHOR]

In recent years, the theory and practice of emergency management in public hospitals have been widely discussed in domestic academic circles. Based on 616 literatures on public health emergency management in public hospitals from 2003 to 2023 in the CNKI journal database, this paper used a scientific bibliometric method to trace the current status, hot spots and development trends of public health emergency management research in Chinese public hospitals. The results showed that the number of research literature in this field has increased in general, with the outbreak of COVID-19 as the separating point to form a period of low stability and explosive growth, and several influential research authors and research institutions emerged. Emergency management, public hospitals, emergencies, emergency capacity, emergency rescue and emergency evaluation have become hot topics in this field. Among them, the construction of emergency management system, emergency capacity evaluation, and emergency response strategies of public hospitals have become the main focus of research. In the future, it is necessary to expand the scope of research themes, strengthen the theoretical system and interdisciplinary research of public health emergency management in public hospitals, enrich research methods and strengthen cooperation. [ABSTRACT FROM AUTHOR]

One could argue that we are living through a period of innovation and change in psychiatry unlike that seen before, with repurposed medications emerging as novel treatments. However, despite evidence of enhanced clinical outcomes and potential medium-term savings, delivering these promising interventions is resource-intensive and perceived as difficult in the public sector. Consequently, they are generally only available in the private sector, often at great cost, effectively making them inaccessible to the 'Have Nots'. The arrival of these paradigm-shifting treatments has inadvertently highlighted a growing mental health inequity. The Royal Prince Alfred Hospital's Ketamine Treatment Clinic was the first public-sector ketamine treatment clinic for complex mood disorders in Australia. Based on 3 years' experience establishing, developing and running a public-sector ketamine treatment service, we review the progress, perils and pitfalls for clinicians and health services contemplating establishing a public-sector ketamine treatment service of their own. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patient satisfaction surveys are implemented as an essential quality improvement tool in healthcare markets. This study investigates patient satisfaction in public secondary and tertiary hospitals and identifies factors contributing to inpatient satisfaction, particularly trust-related factors, to eventually improve the quality of care in the healthcare system. Methods: A population-based cross-sectional survey was conducted between February and April 2021 in 31 Chinese provinces. Telephone interviews with computer assistance were used to gather data. Spearman Rank Correlation was used to analyze satisfaction with hospitalization services between secondary and tertiary hospitals. Multiple Linear Regression was used to determine the influencing factors of overall patient satisfaction. Results: Inpatients reported more satisfaction with inpatient care when doctors treated them respectfully (p < 0.01). Inpatients with higher self-identified social class reported higher satisfaction (p < 0.01). Inpatients who trust in most people in society (p < 0.01) and trust in the Chinese healthcare system (p < 0.01) reported higher satisfaction. Female inpatients reported higher overall satisfaction (p < 0.01). Conclusions: The study of Chinese inpatients in secondary and tertiary hospitals highlighted the importance of respect from doctors, their self-identified social class, and their trust in influencing satisfaction during their hospital stay and called for additional research into policy measures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the research was to identify tools used by management staff to manage loyalty in the professional group of nurses in public hospitals. Methodology: The research tool was an original survey questionnaire. It included a questions regarding the use of selected loyalty management tools and an indication of the managerial position at which they are used. Findings: The most important tools for loyalty management are: supporting the professional development of nurses, maintaining appropriate communication between the supervisor and nurses, and creating and maintaining appropriate relationships between the direct supervisor and nurses. Research limitations/implications: The author is aware of the limitations resulting from the conducted research. One of them is the research area limited only to three voivodships and public hospitals. Additionally, the responses of one professional group were analyzed - nurses, which may make it difficult to transfer the conclusions to other medical professions. Originality/value: The article presents original research on the tool for managing loyalty of public hospital employees. [ABSTRACT FROM AUTHOR]

Background: Over 50 million people are blind, and 135 million people suffer from severe visual impairments, with cataracts contributing to 51% of global blindness cases. Despite efforts to promote cataract surgery (CS), many patients remain hesitant, underscoring the importance of understanding their perspectives. Aim: This study aimed to explore and describe patients’ perceptions regarding reluctance to undergo CS to improve awareness and increase surgery uptake. Setting: The research was conducted in the Sedibeng District, Gauteng province, South Africa. Methods: A qualitative descriptive phenomenological design was employed to capture the lived experiences of patients through face-to-face, individual semi-structured interviews with 15 patients aged 38 – 72 years prior to their CS. Purposive sampling was used to select participants, and Colaizzi’s seven-step analysis was used for data analysis. Results: The findings highlight several barriers perceived by participants, including long waiting times; fear; lack of knowledge; limited financial, material and human resources; power outages; uncontrolled blood sugar levels; and coronavirus disease 2019 (COVID-19) pandemic restrictions. Nevertheless, some view it positively as a means to avert blindness and enhance vision. Conclusion: To address the challenges, the study recommends boosting the number of eye health care professionals, prioritising budget allocation, addressing electricity interruptions and conducting community outreach educational programmes to improve access to CS in the district. Contribution: The insights gained from this study can help health care providers and policymakers optimise care and support for CS patients through policy formulation and education. Addressing these knowledge gaps will likely increase surgery uptake and improve patients’ quality of life.

Abstract Aim This paper aims to investigate the humanistic care ability among surgical nurses in China and identify its statistically significant influencing factors. Design A cross‐sectional, descriptive and correlational design was used. Methods A total of 210 surgical nurses were recruited from a tertiary public hospital in Wuhu, Anhui Province. Four with incomplete responses were excluded, leaving 206 participants for data analysis. Variables were measured using the general questionnaire, caring ability inventory (CAI), and General Self‐Efficacy Scale (GSES). Multivariate linear regression analyses were performed to identify the statistically significant influencing factors of participants' humanistic caring ability. Results The overall average score of the CAI was 190.14 (SD = 19.24), and the average scores for the three dimensions of cognitive, courage, and patience were 70.46 (SD = 7.77), 62.12 (SD = 8.47) and 57.56 (SD = 6.02), respectively. The overall average score of the GSES was 26.05 (SD = 5.77). Professional attitude, perceived care from the department head nurse, perceived care from colleagues and self‐efficacy were the statistically significant factors influencing the humanistic care ability of surgical nurses (R2 = 0.45, adjusted R2 = 0.44, F = 40.64, p

BackgroundAbortion complications are the leading causes of maternal death in low and middle-income countries, including Ethiopia. Providing quality and comprehensive abortion care services is crucial for improving the health of women and increased their satisfaction. Evaluating a client's satisfaction with abortion care is clinically relevant since women's satisfaction with health services is one of the key indicators of high-quality healthcare services. Therefore, this study aimed to assess women's satisfaction with comprehensive abortion care services and associated factors.MethodsAn institution-based cross-sectional study was implemented among 333 women in Central Gondar Zone public primary hospitals from October 1, 2022, to April 30, 2023. Eligible participants were selected using a systematic random sampling technique. The data was collected using an interviewer-administered semi-structured, and pretested questionnaire. STATA version 17 and SPSS version 25 software were used for data entry and analysis respectively. Bivariable and multivariable logistic regression models were used to identify factors associated with clients’ satisfaction with comprehensive abortion care services. A P-value of ≤0.05 with a 95% confidence interval was the cutoff point for determining statistical significance.ResultsThis study revealed that the level of client satisfaction with comprehensive abortion care services was 60.4% (95% CI: 55.0%, 66.0%). The use of abortion medication (AOR = 4.41, 95% CI: 2.59, 7.48), women's age 20–24 years (AOR = 2.94, 95% CI: 1.02, 8.48), and being a student (AOR = 2.88, 95% CI: 1.10, 7.51) were significantly associated with women's satisfaction with comprehensive abortion care services.ConclusionsWomen's satisfaction with comprehensive abortion care services was relatively low, and it was strongly correlated with the method of abortion, age, and occupation. To improve women's satisfaction requires a comprehensive understanding of women's values and perspectives, providing sexual and reproductive health education, and quality abortion care services are recommended.

This research addresses the persistent problem of cost overruns in the construction of public hospitals in Vietnam, a challenge amplified by the increased demands and complexities brought on by the COVID-19 pandemic. Cost overruns not only increase financial strain but also miss opportunities to improve healthcare quality and accessibility. This paper delves into the specific issues contributing to these overruns, focusing exclusively on public hospitals which operate under distinct challenges compared to their private counterparts. Through a comprehensive and systematic methodology, the study incorporates both qualitative and quantitative analyses. It involves a broad literature review, expert consultations, a detailed survey, and rigorous statistical evaluations. The findings identify and rank 43 critical factors, revealing significant correlations across different stakeholder perspectives and confirming these factors in real-world hospital construction projects. The study also categorizes these factors into seven distinct groups using Principal Component Analysis (PCA), offering a nuanced understanding of the multifaceted nature of these challenges. Finally, this study suggests several recommendations that could be effective in addressing these issues. This research not only sheds light on the complexities of public hospital construction in Vietnam but also serves as a crucial guide for stakeholders in managing and mitigating cost overruns effectively.

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Objective: To examine racial/ethnic differences in emergency department (ED) transfers to public hospitals and factors explaining these differences. Data Sources and Study Setting: ED and inpatient data from the Healthcare Cost and Utilization Project for Florida (2010–2019); American Hospital Association Annual Survey (2009–2018). Study Design: Logistic regression examined race/ethnicity and payer on the likelihood of transfer to a public hospital among transferred ED patients. The base model was controlled for patient and hospital characteristics and year fixed effects. Models II and III added urbanicity and hospital referral region (HRR), respectively. Model IV used hospital fixed effects, which compares patients within the same hospital. Models V and VI stratified Model IV by payer and condition, respectively. Conditions were classified as emergency care sensitive conditions (ECSCs), where transfer is protocolized, and non‐ECSCs. We reported marginal effects at the means. Data Collection/Extraction Methods: We examined 1,265,588 adult ED patients transferred from 187 hospitals. Principal Findings: Black patients were more likely to be transferred to public hospitals compared with White patients in all models except ECSC patients within the same initial hospital (except trauma). Black patients were 0.5–1.3 percentage points (pp) more likely to be transferred to public hospitals than White patients in the same hospital with the same payer. In the base model, Hispanic patients were more likely to be transferred to public hospitals compared with White patients, but this difference reversed after controlling for HRR. Hispanic patients were − 0.6 pp to −1.2 pp less likely to be transferred to public hospitals than White patients in the same hospital with the same payer. Conclusions: Large population‐level differences in whether ED patients of different races/ethnicities were transferred to public hospitals were largely explained by hospital market and the initial hospital, suggesting that they may play a larger role in explaining differences in transfer to public hospitals, compared with other external factors. [ABSTRACT FROM AUTHOR]

Background and Objectives: Health literacy and cyberchondria are effective for pregnant women to make the right health decisions for themselves and their babies. The purpose of this study is to investigate the correlation between e-health literacy, cyberchondria, and the factors influencing them in pregnant women. Materials and Methods: The cross-sectional study was conducted on a population of pregnant women who were admitted to two public hospitals located in Samsun. A questionnaire form consisting of 3 sections was used as a data collection tool in the study. Pregnancy information form, e-health literacy scale and cyberchondria scale. The study involved analysing 400 questionnaire forms. Data were analyzed by the frequency test, One Way ANOVA, correlation analysis and multiple regression. Results: The study participants had a mean age of 28.53 ± 6.53. Among them, 60.3% were aged 19-29, 37.3% had an associate degree, 45.3% were pregnant for the first time, and 38.3% were in their second trimester. The mean pregnancy was 1.81 ± 10.63. In the study group, the mean e-health literacy was 3.27 ± 0.99, and the mean cyberchondria was 30.29 ± 9.78. The study found a statistically significant difference in e-health literacy and cyberchondria based on age, educational status, gestational week, and number of pregnancies. Additionally, there was a statistically significant positive relationship between health literacy and cyberchondria severity. Conclusion: The results of the study showed that the level of e-health literacy and cyberchondria of pregnant women was moderate, and that e-health literacy, age and education level would affect cyberchondria. Therefore, this problem can be prevented by providing digital health practices, e-health literacy and safe internet use training to pregnant women in health institutions and the media. [ABSTRACT FROM AUTHOR]

ObjectiveEpidemics are sudden and rapidly spreading. Hospitals in underdeveloped areas are particularly vulnerable in case of an outbreak. This paper aims to assess the epidemic risk state and its change trend of hospitals in different epidemic stages, identify the key factors affecting hospital epidemic risk change, provide priority reference for hospital epidemic risk control, and enhance the hospital's ability to respond to sudden epidemics.MethodsBased on Grounded theory, the epidemic risk indicators that affect hospital safety are summarized. The concept of epidemic risk state and its random state space is proposed according to Markov chain theory. The impact of each indicator on the random risk state and its change is comprehensively assessed from two aspects: risk occurrence probability and risk loss. Finally, the assessment of the hospital epidemic risk state and its change at different stages is achieved.ResultsThe stable risk states of public hospitals in underdeveloped areas in non-epidemic stage t0, early epidemic stage t1, and outbreak stage t2 are P^t0(Sn)={0.142,0.546,0.220,0.093}, P^t1(Sn)={0.025,0.364,0.254,0.357}, and P^t2(Sn)={0.020,0.241,0.191,0.548}, respectively. In non-epidemic stage, the key factor in improving the hospital epidemic risk state is emergency funding. In early epidemic stage, the key factors in improving the hospital epidemic risk state are the training of medical staff in epidemic prevention skills and the management of public health. In outbreak state, the key factor in improving the hospital epidemic risk state is the training of medical staff in epidemic prevention skills and psychological awareness.ConclusionThis paper proposes the concept of epidemic risk state, providing an effective assessment method for the epidemic risk state and its change trend in public hospitals. According to the assessment, public hospitals in underdeveloped areas in different epidemic stages should adopt different risk control strategies to improve their current risk state. Blind risk control is inefficient and may even cause the epidemic risk to transition toward a more dangerous state.

The healthcare system in Pakistan faces several challenges, namely due to incompetence and a lack of provider responsiveness to the needs of consumers. Two parallel systems exist in the healthcare system of Pakistan. One consists of public hospitals that remained short, even, of basic healthcare facilities, and the other consists of private hospitals that are too costly for the people of Pakistan to afford. Solutions to the stumbling and compromised healthcare system of Pakistan are adequate financial support and infrastructure development. A dire need to invest in the healthcare system is required; otherwise, the healthcare system in Pakistan will continue fighting for its survival rather than improving and competing with the healthcare systems of other nations in the region. The overall data quoted here demonstrates that up-scaling of initiatives in the country would require lot of cautions to be taken by the government.

Objective: This study aimed to comparatively examine how public and private hospitals adhered to the COVID-19 safety protocols, and the factors associated with, and barriers to adherence in Ghana. Study design: A case study design drawing on quantitative and qualitative methods to determine adherence to, and barrier of adherence to the COVID-19 protocols. Method: A sample of 283 staff participated in the quantitative study, while in-depth interviews were conducted among management staff across the public and private hospitals. Data were analyzed using descriptive statistics, independent t-test to compare differences in adherence and logistic regression model to identify the factors associated with adherence to the COVID-19 protocols. Results: The regression results showed that adherence to the COVID-19 protocols in public and private hospitals were significantly associated with staff training on adherence in public (OR = 2.08; p p

Background: Given the preventable nature of most healthcare-associated infections (HAIs), it is crucial to understand their characteristics and temporal patterns to reduce their occurrence. Methods: A retrospective analysis of medical record cover pages from a Chinese hospital information system was conducted for surgery inpatients from 2010 to 2019. Association rules mining (ARM) was employed to explore the association between disease, procedure, and HAIs. Joinpoint models were used to estimate the annual HAI trend. The time series of each type of HAI was decomposed to analyze the temporal patterns of HAIs. Results: The study included data from 623,290 surgery inpatients over 10 years, and a significant decline in the HAI rate was observed. Compared with patients without HAIs, those with HAIs had a longer length of stay (29 days vs. 9 days), higher medical costs (96226.57 CNY vs. 22351.98 CNY), and an increased risk of death (6.42% vs. 0.18%). The most common diseases for each type of HAI differed, although bone marrow and spleen operations were the most frequent procedures for most HAI types. ARM detected that some uncommon diagnoses could strongly associate with HAIs. The time series pattern varied for each type of HAI, with the peak occurring in January for respiratory system infections, and in August and July for surgical site and bloodstream infections, respectively. Conclusions: Our findings demonstrate that HAIs impose a significant burden on surgery patients. The differing time series patterns for each type of HAI highlight the importance of tailored surveillance strategies for specific types of HAI.

Abstract Background Neurosurgical clinic assesses presence and extent of pathologies of central and peripheral nervous system or disorders affecting the spine, to identify most effective treatment and possible recourse to surgery. The aim of the study is to evaluate the appropriateness of request for a neurosurgical consult both in private and in public outpatient clinics. Materials and methods We collected and analyzed all the reports of outpatient visits of public and private clinic over a period between January and December 2018. Results There were 0.62% real urgent visits in the public sector and 1.19% in the private sector (p = 0.05). Peripheral pathologies represented 12.53% and 6.21% of pathologies evaluated in public and private sector respectively (p

Abstract Introduction Hospitals, as complex organizations with clinical, financial, and social functions, face different barriers to providing high-quality and safe services at reasonable costs. Various initiatives have been carried out in hospital governance to improve quality, safety, and accountability. This research aims to identify the structures and dimensions that make hospital governance accountable. Methods The research used Arksey and O'Malley's scoping review framework to examine the research literature on hospital governance structure and accountability. The literature review included PubMed, Web of Science, Embase, Scopus ProQuest, Google search engine, and Google Scholar databases from 2010 to 2023. Data were analyzed using the content analysis method. Results Excluding unrelated and duplicate sources, 40 articles and reports were included in the study. The studies were reviewed and analyzed based on organizational type, type of source, year of publication, objectives, and key findings. Accountable governance features were extracted from the selected articles and reports. The four main themes include inclusive governance, commitment to accountability, planning for accountability, and autonomous governance. Thirteen subthemes were extracted from the study literature. Conclusion Various initiatives have been implemented regarding the reform of the governance structure of public hospitals in different countries. Many of these reforms aim to improve financial and clinical accountability. The study results could be used to identify the structures and dimensions that make hospital governance accountable.

Sait Revda Dinibutun College of Business Administration, HRM Department, American University of the Middle East, Kuwait City, KuwaitCorrespondence: Sait Revda Dinibutun, College of Business Administration, HRM Department, American University of the Middle East, Block 6, Building 1, Egaila, Kuwait City, Kuwait, Tel +965 2225 1400, Fax +965 2654 8484, Email sait.revda@aum.edu.kwPurpose: The purpose of this study is to investigate and analyze the impact of physicians’ burnout levels on their job satisfaction, the factors related with burnout and job satisfaction, and to see whether there is a difference between public and private hospital physicians.Methods: A cross-sectional survey design was adopted and conducted on 160 physicians in Aydin/Turkey. Personal Information Form, Maslach Burnout Inventory, and Minnesota Job Satisfaction Scale were used. Independent samples t-test, one-way analysis of variance (ANOVA), and correlation analysis were conducted.Results: A negative relationship between burnout and job satisfaction among physicians was determined. Female private hospital physicians have significantly higher levels of burnout compared to male physicians. Married public hospital physicians’ job satisfaction is significantly higher than single physicians. Public hospital physicians have significantly higher levels of burnout compared to private hospital physicians, as well as a significant lower level of job satisfaction.Conclusion: The physicians have high burnout and low satisfaction levels. For this reason, burnout levels of the physicians should be determined and measures should be taken to reduce it. A possible reason of female physicians having higher levels of burnout in private hospital could be the result of the unique, demanding organizational factors, culture, climate and expectations, including work-life balance issues on working women. An important finding of the study showed that public hospital physicians have higher burnout levels and lower job satisfaction levels than private hospital physicians, largely attributed to the demanding workload and the burdensome bureaucratic processes they must navigate.Keywords: healthcare professionals, burnout, job satisfaction, public hospital, private hospital, comparative analysis

The objective of this study was to investigate the satisfaction of cancer patients with the service quality of a Brazilian public hospital located in the city of Rio de Janeiro. The study is quantitative, based on application of a questionnaire to a sample composed of 245 outpatients of the hospital. The data were treated with structural equation modeling supported by partial least squares (PLS-SEM). The results indicated the patients place value on the quality of the service rendered by physicians, quality of the administrative service, quality of the hospital facilities and quality of the nursing service, in that order. The main theoretical contribution is the identification, in contrast to previous findings in the literature, that the cancer patients in our sample attributed little importance to the nursing service, even though nurses are the healthcare professionals who interact the most with patients. [ABSTRACT FROM AUTHOR]

This study examined the magnitude and predictors of hand hygiene compliance among 325 healthcare workers in three public hospitals of Northeastern Ethiopia using standardized observational tool. A multivariable logistic regression analysis was computed to identify factors associated with non-compliance. The overall proportion of observed hand hygiene non-compliance was 41.8% (95%CI: 36.6–48.1). Having <5 years of work experience (AOR = 1.5; 95%CI: 1.2–2.5), absence of hand washing soap (AOR = 3.1; 95%CI: 2.3–5.4), work overload (AOR = 2.5; 95%CI: 1.9–4.1), pipe water supply interruption (AOR = 2.8; 95%CI: 2.1–4.9), lack of hand hygiene training (AOR = 3.1; 95%CI: 2.2–4.4), and absence of infection prevention committee (AOR = 2.1; 95%CI: 1.5–4.9) were determinant factors for hand hygiene non-compliance. Therefore, regional health bureau and hospitals' managers should work towards the provision of regular hand hygiene trainings, uninterrupted piped water supply, hand washing soap, and establishment of functional infection prevention committee. Moreover, healthcare workers should be also committed to comply with hand hygiene. [ABSTRACT FROM AUTHOR]

Background: Neurosurgical clinic assesses presence and extent of pathologies of central and peripheral nervous system or disorders affecting the spine, to identify most effective treatment and possible recourse to surgery. The aim of the study is to evaluate the appropriateness of request for a neurosurgical consult both in private and in public outpatient clinics. Materials and methods: We collected and analyzed all the reports of outpatient visits of public and private clinic over a period between January and December 2018. Results: There were 0.62% real urgent visits in the public sector and 1.19% in the private sector (p = 0.05). Peripheral pathologies represented 12.53% and 6.21% of pathologies evaluated in public and private sector respectively (p < 0.00001). In addition, 15.76% of visits in public lead to surgery, while they represented 11.45% in private (p = 0.0003). Conclusions: No study is available comparing accesses of patients in neurosurgical outpatient clinics. In public clinic, visits are booked as urgent on the prescription of the general practitioner: in reality, only 5% of these visits were really confirmed as urgent by the specialist. Peripheral pathologies are more frequent in public clinic, while cranial pathologies are more frequent in private one. Patients with cranial pathologies prefer to choose their surgeon by accessing private clinic. [ABSTRACT FROM AUTHOR]

Introduction: Hospitals, as complex organizations with clinical, financial, and social functions, face different barriers to providing high-quality and safe services at reasonable costs. Various initiatives have been carried out in hospital governance to improve quality, safety, and accountability. This research aims to identify the structures and dimensions that make hospital governance accountable. Methods: The research used Arksey and O'Malley's scoping review framework to examine the research literature on hospital governance structure and accountability. The literature review included PubMed, Web of Science, Embase, Scopus ProQuest, Google search engine, and Google Scholar databases from 2010 to 2023. Data were analyzed using the content analysis method. Results: Excluding unrelated and duplicate sources, 40 articles and reports were included in the study. The studies were reviewed and analyzed based on organizational type, type of source, year of publication, objectives, and key findings. Accountable governance features were extracted from the selected articles and reports. The four main themes include inclusive governance, commitment to accountability, planning for accountability, and autonomous governance. Thirteen subthemes were extracted from the study literature. Conclusion: Various initiatives have been implemented regarding the reform of the governance structure of public hospitals in different countries. Many of these reforms aim to improve financial and clinical accountability. The study results could be used to identify the structures and dimensions that make hospital governance accountable. [ABSTRACT FROM AUTHOR]

The present document has the objective of justifying the incorporation of a dietician/nutritionist to the multidisciplinary teams of specialized care that provide education, food anamnesis, nutritional recommendations, treatment and follow up of those patients in risk of malnutrition in Madrid. The appropriate nutritional status of hospitalized patients bears a close relationship with the existence of dieticians at hospitals. Dieticians use nutrition therapy as a cost-effective means to achieve significant health benefits by preventing or altering the course of diabetes, obesity, hypertension, lipid metabolism disorders, heart failure, osteoporosis, celiac disease, and chronic kidney disease, among other diseases. [ABSTRACT FROM AUTHOR]

Telemedicine employs the use of technology to increase access to health care. This is especially relevant in developing countries where accessibility is an important issue. In developed countries, studies have shown that despite greater availability and accessibility, there are still disparities in telemedicine use. In the Philippines, however, it is unknown what factors are related to telemedicine use since its underutilization precludes proper characterization of telemedicine patients. We sought to compare the characteristics of telemedicine patients and patients consulting in-person in the internal medicine outpatient department of a Philippine public hospital. This is a retrospective descriptive study. Chart reviews were done for patients who consulted from May 2021 to July 2021. They were classified as either having telemedicine consults only or having in-person consults only. Each group was characterized and compared according to demographics, socioeconomic characteristics, health behaviors, and reasons for consultation. Unadjusted analyses showed that younger, single, or employed individuals were more likely to use telemedicine. However, in adjusted analyses, no demographic factors were associated with telemedicine use. Only the patient type and medical concern were significantly different between patient groups in this public hospital setting. New patients and those consulting for clearance/referral purposes or endocrine-related symptoms were more likely to seek teleconsults. The findings showed which patients are more likely to use telemedicine in the Philippines. Continued telemedicine use for these patients should be explored to complement in-person medical care. [ABSTRACT FROM AUTHOR]

Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Commuting accidents account for 48% of work-related accidents in Malaysia. However, commuting accidents among health care workers are understudied and formally reported commuting accident numbers among nurses are likely to be an underestimate of actual numbers. This is the first study in Malaysia to attempt to establish the true incidence and associated factors for commuting accidents among nurses in Malaysia. A cross-sectional study was conducted to determine the true incidence of commuting accidents and its associated factors among public hospital nurses in Selangor, Malaysia. A validated and pilot-tested self-reported questionnaires were distributed to all nurses via an online-based platform. This study found a significant difference between the incidence of formally reported and self-reported commuting accidents from 2018 to 2022, with incidence rates ranging between 0.3 and 8.6 per 1000 nurses. Multivariable logistic regression showed that nurses working in district hospitals had lower odds to be involved in commuting accidents, while nurses working in clinical departments and traveling longer distances between home and workplaces had increased odds of commuting accidents. [ABSTRACT FROM AUTHOR]

The aim of the study to solve problems related to revenue collection at Public Hospitals in Malaysia. Using the action research approach, two phases were adapted to review the state of metastasizing outstanding medical fees at one of the public hospitals located at west coast of Sabah and its contributing factors. The secondary data from monthly or annual financial reports, focus group discussions (N = 20), and review of government documented regulations and manuals were gathered in this study. It was revealed that the significant proportion of outstanding medical fees in the public hospital is attributed to non-citizens. The main problems faced include noncompliance with policies and procedures in the revenue collection process; lack of IT-based revenue cycle management; and poor engagement of hospital staff in revenue cycle management. Implementation of an IT-based billing system has improved communication between frontline and backend staff and hence improved revenue collection efficiency. Further collaboration with higher authorities in the implementation of a comprehensive online payment system and to increase insurance coverage for non-citizens via medical and social services are explored. [ABSTRACT FROM AUTHOR]

Public hospitals are important agencies in the provision of public services. Upon considering the diversity of the people and the ability to provide appropriate services, human security can be realized. This research aims to study the development model of services among public hospitals attributed to Muslim practices. It is developed as qualitative research relatively collecting data through the optimization of in-depth interviews, document revision, and observation. The data is analyzed by applying the method of thematic analysis and content analysis. As for the result, it depicts that the model hospital has performed the service development of public hospitals attributed to Muslim practices, covering four key aspects. In terms of religious practices, the hospital offers relevant services to newborns, Muslim youth, prayer venue establishment, the provision during the fasting month, and terminal patients. When it comes to the provision of Halal food, a specific department is set up together with the preparation of responsible personnel. In parallel, the environment and venue for Halal food preparation are in control. The control also implies Halal process in raw material selection, logistics, production, and delivery process in addition to canteen service. In terms of patient gowns, the hospital prepares patients with the hospital gowns and grants permission to wear the hijab during a hospital stay. In relation to patient contacts, some guidelines are put in place to guide physicians when treating patients of the opposite gender. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Vie et Sciences de l'Entreprise is the property of ANDESE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Clinical supervision is pivotal in supporting nurses in rendering quality, safe patient care. Therefore, it is essential to understand clinical supervision from operational nursing managers’ context to define existing challenges and propose suitable recommendations. Objectives: This study aimed to explore and describe operational nursing managers’ experiences of clinical supervision within the context of an academic hospital in Gauteng province and propose evidence-based practice recommendations to improve patient safety and the quality of clinical supervision. Method: An exploratory, sequential, mixed-method design was used and implemented over two phases to take advantage of the strengths of both the qualitative and quantitative research designs. Unstructured individual interviews were conducted to collect data in phase one, and an adapted Manchester Clinical Supervision Scale (MCSS) questionnaire was used to collect data in phase two. Results: Operational nursing managers work in stressful conditions and environments with a gross shortage of staff and tools of the trade while being expected to deliver high-quality and safe nursing care. Of the sampled respondents, 36% (n = 17) were dissatisfied with the supervision they received, while 64% (n = 30) were indifferent in the sense that they did not think it was adequate or inadequate. Conclusion: Clinical supervisors should be trained and supported in clinical supervision, with regular workshops on interpersonal relations. Contribution: A clearer understanding of clinical supervision within the hospital context and evidence-based practice recommendations to improve patient safety and the quality of clinical supervision.

Background & Aim: The challenges of mothers residing at hospital while their ill babies are admitted to a neonatal care unit are understudied and poorly documented. Unfavorable living arrangements and tension between mothers and staff can disrupt their well-being and create feelings of helplessness. This study explored how mothers experienced having to stay at a lodging residence of a public hospital while their newborns were admitted to a neonatal care unit. Methods & Materials: This qualitative content analysis study was conducted through face-to-face, in-depth interviews between March 2021 – April 2021. Data were gathered from 13 mothers who lodged at a public hospital for at least two weeks, were able to speak Sesotho, English, and/or Afrikaans, and were above 18 years of age. Data were analyzed using Tesch's eight steps in the coding process. Results: Data analysis resulted in five categories, each with subcategories. The main categories are "Lodging environment", "Emotional experiences", "Nursing care of babies", "Interaction with staff", and "Participant perspectives". Participants' ages ranged between 23 and 37 years. Three participants had a spouse while the other ten were unmarried and were single parents. Conclusion: The mothers were not optimistic about their lodging experiences, the nursing care of their newborns, and their interaction with healthcare professionals. Hence, they require intervention to alleviate conditions that cause unnecessary stress and anxiety. Health professionals and hospital managers must accommodate the needs of mothers who have no choice but to reside at the hospital when their newborns are admitted for extended periods.

Background: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout. Aim: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic. Setting: Three public sector hospitals in Gqeberha, South Africa. Methods: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout. Results: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71–26.40), being in the lowest income band (AOR = 10.78, 2.55–45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12–8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92–13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98–10.18). Low support at work (AOR = 9.99, 3.66–27.23), medium job satisfaction (AOR = 5.38, 2.65–10.93) and medium support at work (AOR = 3.39, 1.71–6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10–0.80) and high levels of resilience (AOR = 0.08, 0.03–0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout. Conclusion: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors. Contribution: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.

Following the marketization of China’s health system in the 1980’s, the government allowed public hospitals to markup the price of certain medications by 15% to compensate for reduced revenue from government subsidies. This incentivized clinicians to induce patient demand for drugs which resulted in higher patient out-of-pocket payments, higher overall medical expenditure, and poor health outcomes. In 2009, China introduced the Zero Markup Drug Policy (ZMDP) which eliminated the 15% markup. Using Shanghai as a case study, this paper analyzes emerging and existing evidence about the impact of ZMDP on hospital expenditure and revenue across secondary and tertiary public hospitals. We use data from 150 public hospitals across Shanghai to examine changes in hospital expenditure and revenue for various health services following the implementation of ZMDP. Our analysis suggests that, across both secondary and tertiary hospitals, the implementation of ZMDP reduced expenditure on drugs but increased expenditure on medical services, exams, and tests thereby increasing hospital revenue and keeping inpatient and outpatient costs unchanged. Moreover, our analysis suggests that tertiary facilities increased their revenue at a faster rate than secondary facilities, likely due to their ability to prescribe more advanced and, therefore, more costly procedures. While rigorous experimental designs are needed to confirm these findings, it appears that ZMDP has not reduced instances of medical expenditure provoked by provider-induced demand (PID) but rather shifted the effect of PID from one revenue source to another with differential effects in secondary vs. tertiary hospitals. Supplemental policies are likely needed to address PID and reduce patient costs.