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Background: Electronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences?Methods: This single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol).Results: Through a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system.Conclusion: This study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others. [ABSTRACT FROM AUTHOR]

The health care system is a state institution that implements the constitutional right of citizens to health and medical care. It is part of the legal framework, and in case of unfavorable outcomes or the consequences of the medical process, law enforcement and judicial authorities may be involved. Sudden and rapid onset death is difficult categories to accurately establish and evaluate. Having sufficient clarity in medical terminology, these categories are not clearly represented in the legal system. Consequently, when the question regards responsibility of the doctor for one or another adverse outcome in case of quick, sudden death, there are a number of qualification difficulties. There is an inconsistency between medical and legal terminologies. Complex approach to the problem analysis contributes to the systematization of knowledge and experience in this field. The article provides an example of legal proceedings in such course of events. We emphasize the need for coordination of medical and legal terminologies.

Abstract Introduction This realist literature review, regarding active patient involvement in healthcare quality improvement (QI), seeks to identify possible mechanisms that contribute to success or failure. Furthermore, the paper outlines key considerations for organizing and supporting patient involvement in healthcare QI efforts. Methods Two literature searches were performed. Altogether, 1204 articles from a healthcare context were screened, focusing on improvement efforts that involve patients, healthcare professionals and/or managers and leaders. Among these, 107 articles fulfilled the chosen study selection criteria and were further analysed. Eighteen articles underwent a full realist review. In the realist synthesis, context‐mechanism‐outcome configurations were articulated as middle‐range theories and organized thematically to generate a program theory on how active patient involvement in QI efforts might work. Results The articles exhibited a diversity of patient involvement approaches at different levels of healthcare organizations. To be successful, organizations’ support of QI efforts that actively involved patients tailored the QI efforts to their context to achieve the desired outcomes, and involved the relevant microsystem members. Furthermore, it promoted interaction and partnership within the microsystem, and supported the behavioural change that follows. Conclusion This realist synthesis generates a program theory for active patient involvement in QI efforts; active patient involvement can be a tool (resource), if tailored for interaction and partnership (reasoning), that leads to behaviour change (outcome) within healthcare QI efforts. The theory explains essential resource and reasoning mechanisms, and outcomes that together form guidance for healthcare organizations when managing active patient involvement in QI efforts.

Abstract Background Public health policies tend to generalize the use of Hospital-At-Home (HAH) to answer the growing will of patients to be treated or to die at home. HAH is a model of care that provides acute-level services in the patient’s home with the interventions of variety of health care professionals. Relatives participate also in the interventions by helping for sick patients at home, but we lack data on the care of patients and caregivers in HAH. The aim of this study was to make an inventory of the experiences of patients and family caregivers in HAH. Methods The research was qualitative using nineteen semi-directed interviews from nine patients and ten caregivers of one care unit of Greater Paris University Hospitals’ HAH, and the grounded theory was used to analyze the transcripts. Caregivers were also asked, after the interview, to fill in the Zarit Burden Inventory. Results HAH remained mostly unknown for patients and caregivers before the admission proposition and the outlook of being admitted in HAH was perceived as positive, for both of them. Caregivers had a versatile role throughout HAH, leading to situations of suffering, but also had sources of support. The return home was considered satisfactory by both caregivers and patients, related to the quality of care and increased morale despite HAH’s organizational constraints. We noted an impact of HAH on the relationship between the patient and the caregiver(s), but caused by multiple factors: the fact that the care takes places at home, its consequences but also the disease itself. Conclusion HAH strongly involved the patient’s caregiver(s) all along the process. HAH’s development necessitates to associate both patients and caregivers and to take into account their needs at every step. This study highlights the need to better assess the ability of the caregiver to cope with his or her relative in HAH with acute and subacute care at home.

The goal of each company today is to improve business and increase profit through the reorganization and simplification of its processes, decrease of costs and resources utilization etc. Improving the business is usually implemented through different techniques and methodologies that have been developed. One of the ways to improve service processes, and health system processes also, is the implementation of the lean concept. This study shows benefits from using Lean tools value stream mapping (VSM) and simulations to simplify the laboratory work process. Using the VSM and simulation in department of clinical biochemistry authors showed significant improvement of the clinical processes such as eliminating non-value added times (NVAT) by minimum 30 working days/year, increasing number of laboratories analyses by approximately 80.000 analyses/year, eliminating unnecessary movement of 39,000 - 52,000 meters/year for samples and 78,000 - 104,000 meters/year for stuff and decreasing patient waiting times from average 70 to 20 min/patient.

Introduction Mental illness accounts for about one-third of the world’s disability, a burden that many health systems cannot adequately respond to. Up to 70% of mental health (MH) patients are followed-up in primary health care (PHC) settings. To bridge the treatment gap, the World Health Organization developed mhGAP, a guidance package for integrated management of priority MH disorders in lower-income countries. Other countries have developed their own evidence-based interventions. Objectives Overviewing countries’ strategies towards integrating MH services into PHC, their outcomes and challenges. Methods Review of literature using PubMed search terms “mental health primary care”, MeSH terms “Primary Health Care”, “Mental Health Care” and “organization and administration”, published in the last 5 years, in English. Results 25 of 602 articles were selected. The mhGAP programme has seen successful integration in pilot district-level programs, but wider implementation has stalled due to stigma and lack of clinical engagement, resources, MH specialists, and policy support. The Quebec MH reform promoted integrated service networks, improving accessibility and quality of care (QoC). A Norwegian-Russian long-standing collaboration initiative has significantly improved treatment for anxiety and depression (A&D), with 58% reliable recovery rate. A Danish collaborative care intervention provided high-quality treatment of moderate A&D. In Peru, a similar initiative allowed early detection, referral, and treatment of MH patients attending PHC services. Conclusions Comprehensive, integrated and responsive collaborative care models are a cost-efficient strategy to improve QoC for many MH conditions across diverse populations. MH-PHC integration initiatives have seen varying degrees of success. However, several barriers impact wider implementation and scale-up.

Background: Global demand for standardized assessment of training needs and evaluation of professional continuing education programs across the healthcare workforce has led to various instrumentation efforts. The Hennessy-Hicks Training Needs Analysis (TNA) questionnaire is one of the most widely used validated tools. Endorsed by the World Health Organization, the tool informs the creation of tailored training to meet professional development needs. The purpose of this project was to describe TNA tool utilization across the globe and critically appraise the evidence of its impact in continuous professional development across disciplines and settings. Methods: A systematic integrative literature review of the state of the evidence across PubMed, Scopus, CINAHL, and Google Scholar databases was carried out. Full-text, peer reviewed articles and published dissertations/theses in English language that utilized the original, adapted or translated version of the TNA tool were included. Selected articles were appraised for type and level of evidence. Results: A total of 33 articles were synthesized using an inductive thematic approach, which revealed three overarching themes: individual, team/interprofessional, and organizational level training needs. Included articles represented 18 countries, with more than two thirds involving high-income countries, and one third middle-income countries. Four studies (12.1%) used the original English version instrument, 23 (69.7%) adapted the original version, and 6 (18.2%) translated and culturally adapted the tool. Twenty-three studies targeted needs at the individual level and utilized TNA to determine job roles and responsibilities. Thirteen articles represented the team/interprofessional theme, applying the TNA tool to compare training needs and perceptions among professional groups. Last, three articles used the tool to monitor the quality of care across an institution or healthcare system, demonstrating the organizational training needs theme. Conclusions: Overall evidence shows that the TNA survey is widely used as a clinical practice and educational quality improvement tool across continents. Translation, cultural adaptation, and psychometric testing within a variety of settings, populations, and countries consistently reveals training gaps and outcomes of targeted continuous professional development. Furthermore, it facilitates prioritization and allocation of limited educational resources based on the identified training needs. The TNA tool effectively addresses the "know-do" gap in global human resources for health by translating knowledge into action. [ABSTRACT FROM AUTHOR]

Background: A quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP.Methods: A focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts.Results: Four main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations.Conclusions: The accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers' and professionals' joint work. [ABSTRACT FROM AUTHOR]

BACKGROUND: The study aims to determine whether shifting to professional emergency department (ED) teams leads to a higher rate of radiologic workup. METHODS: We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1 (G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013 (all patients were examined by an internal medicine specialist); group 2 (G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019 (all patients were examined by an emergency physician). RESULTS: The chest X-ray (CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR (38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No difference in the rates of pathological CXR was found (47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specificity were obtained for the binary logistic regression model predicting pathological findings in G1. CONCLUSIONS: Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specific recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care. [ABSTRACT FROM AUTHOR]

Diversity is growing in work organizations and inclusive climates are gaining increasing significance. The Optimal Distinctiveness Theory (ODT) can be applied as an organizational framework that designates both belongingness and uniqueness as components of inclusion. The study sought to examine the experiences of healthcare workers who are members of a minority ethnic group in the context of a violent conflict. Fifty in-depth interviews were conducted with healthcare professionals – Jews and Arabs – employed at eleven public hospitals in Israel. The interviews reveal the diversity of staff members at Israeli public hospitals. Arab workers, specifically, experience both belongingness and uniqueness. The former is reinforced by values of humanism and professionalism, whereas the latter cannot be fully manifested: Their cultural and religious uniqueness is respected, but their opinions regarding the Israeli-Palestinian conflict are silenced. They experience tension and ambiguity and their inclusion in the organization is not effected in full. ODT implementation will improve our understanding of how to achieve inclusion of minority group workers in healthcare organizations, particularly in conflictual contexts. [ABSTRACT FROM AUTHOR]

Our primary aim was to provide a quantitative snapshot relying on a self-assessment tool developed for the local healthcare environment and formal tasks for top-level executive hospital managers of public healthcare organizations. We used a cross-sectional and descriptive mixed study design that targeted the nationwide population of 701 top-level managers in public hospitals in 2015 in Turkey. As the first step, position description content analysis was conducted based on document analysis to explore their legal tasks and statements, and the job requirements for an executive management position in public hospitals. Second, before designing the data-collection instrument, we conducted four meetings and group discussions with several hospital managers -- with and without medical backgrounds -- and five academics who were part of healthcare management and public administration departments. Lastly, we built upon past efforts and the literature, and constructed a questionnaire. The managers are fully responsible for the healthcare quality, medical, nursing, administrative issues and financial performance of the facility. The participants perceived that they were competent in most of the competencies. The participants' mean total competency score was 81%, and the competency gap between the required and current competency levels differed from 13% to 22%. This research provides deep insight into the competencies perceived by hospital executive managers in a developing country context. Our results have several practical implications for both healthcare policymakers and new executive hospital managers. There is an urgent need for follow-up self-assessment for competencies and ongoing management training programs. [ABSTRACT FROM AUTHOR]

This study aims to investigate the relationships between the planned behavior, burnout, overall job satisfaction, and organizational citizenship behavior of nurses in three public hospitals in Iraq. The methodology included descriptive statistics, PLS-based-SEM, and mediation analysis. An assessment of data collected from a survey based on an interview with 428 nurses participating showed that the attitude of the nurses toward their behavior significantly positively affected their burnout and overall job satisfaction, while their subjective norm and perceived behavioral control significantly positively influenced burnout. The burnout experienced by the nurses significantly negatively impacted their citizenship behavior, while overall; their job satisfaction significantly positively affected their citizenship behavior. Though the nurses' burnout partially mediated the relationships between their planned behavior and citizenship behavior, their overall job satisfaction partially mediated the association between their subjective norm/perceived behavioral control and citizenship behavior. [ABSTRACT FROM AUTHOR]

One-third of the global burden of disease is attributed to surgical conditions yet, 5 billion people globally, lack access to surgery. The Lancet Commission on Global Surgery, Obstetrics, and Anesthesia (LCOGS) published guidelines for improving access by reducing catastrophic health expenditures (CHEs) by 2030. This is especially important in sub-Saharan Africa (SSA) where 90% of the extreme poor reside. In this paper, we provide a narrative review of four studies on CHEs for surgical care in SSA published since 2015. We discuss healthcare financing in the countries and summarize the authors’ key findings of out-ofpocket payments (OOP) and CHEs. Briefly, the studies enrolled 130 to 300 patients and collected direct OOPs via chart review of health costs or patient interviews. Indirect costs were calculated from lost wages and transportation costs. CHEs were defined as health costs exceeding 10% of the GDP per capita or the household income. Despite healthcare being reported as free in all studies, 60%-90% of surgical patients had CHEs with all costs considered. OOPs persists for medicines and anesthesia that should be covered under any health insurance scheme. In some cases, indirect costs associated with transportation and wages were major drivers of CHEs for surgery. Without addressing these gaps in coverage, more people will risk impoverishment in seeking surgical care in SSA. [ABSTRACT FROM AUTHOR]

Background: How coronavirus disease 2019 (COVID-19) impacted non-ST-segment elevation acute coronary syndromes (NSTACS) is an object of controversial reports., Aim: To systematically review studies reporting NSTACS hospitalizations during the COVID-19 pandemic, and analyse whether differences in COVID-19 epidemiology, methodology of report, or public health-related factors could contribute to discrepant findings., Methods: Comprehensive search (Medline, Embase, Scopus, Web of Science, Cochrane Register), of studies reporting NSTACS hospitalizations during the COVID-19 pandemic compared with a reference period, following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Data were independently extracted by multiple investigators and pooled using a random-effects model. Health-related metrics were from publicly available sources, and analysed through multiple meta-regression modelling., Results: We retrieved 102 articles (553 038 NSTACS cases, 40 countries). During peak COVID-19 pandemic, overall incidence rate ratio (IRR) of NSTACS hospitalizations over reference period decreased (0.70, 95% confidence interval (CI) 0.66-0.75; P < 0.00001). Significant heterogeneity was detected among studies (I2 = 98%; P < 0.00001). Importantly, wide variations were observed among, and within, countries. No significant differences were observed by study quality, whereas comparing different periods within 2020 resulted in greater decrease (IRR: 0.61; CI: 0.53-0.71) than comparing 2020 vs. previous years (IRR: 0.74; CI 0.69-0.79). Among many variables, major predictors of heterogeneity were severe acute respiratory syndrome coronavirus 2 reproduction rate/country, number of hospitals queried, and reference period length; country stringency index and socio-economical indicators did not contribute significantly., Conclusions: During the COVID-19 pandemic, NSTACS hospitalizations decreased significantly worldwide. However, substantial heterogeneity emerged among countries, and within the same country. Factors linked to public health management, but also to methodologies to collect results may have contributed to this heterogeneity., Trial Registration: The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42022308159)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Introduction and Objectives: Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future., Methods: A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses., Results: Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses., Conclusion: This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal., (Copyright © 2023. Publicado por Elsevier España, S.L.U.)

Background: Hypertrophic Cardiomyopathy (HCM) is characterized by unexplained left ventricle hypertrophy (LVH) ≥15 mm. The condition is often hereditary and family screening is recommended to reduce the risk of adverse disease complications and premature death among relatives. Correct diagnosis of index patients is important to ensure that only relatives at risk of disease development are invited for family screening., Purpose: To investigate if patients with ICD-10 codes for HCM (DI421) or hypertrophic obstructive cardiomyopathy (DI422) fulfilled recognised diagnostic criteria., Methods: All patients with ICD-10 codes for HCM or HOCM at a Department of Cardiology were identified and had their diagnosis validated by a cardiac investigation or a review of their medical records and previous investigations., Results: Two hundred and forty patients had ICD-10 codes for HCM/HOCM, of whom 202 (84%, 202/240) underwent re-examination, while 38 (16%, 38/240) had their hospital notes reviewed. Seventy-six patients (32%, n = 76/240) did not fulfil diagnostic criteria, of whom 39, (51%, n = 39/76) had normal (10 mm) or modest LV wall thickness (11-14 mm). The remaining 37 patients (49%, n = 37/76) had LVH ≥15 mm, which was well-explained by uncontrolled hypertension, (32%, n = 24/76), aortic valve stenosis (19%, n = 7/76) or wild-type amyloidosis (16%, 6/76)., Conclusion: One-third of patients with ICD-10 codes for HCM or HOCM did not fulfil recognised diagnostic criteria. Incorrect diagnosis of HCM may cause unnecessary family investigations which may be associated with anxiety, and a waste of health care resources. This highlights the need for specialised cardiomyopathy services to ensure correct diagnosis and management of HCM., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Introduction and Aims: The organization of healthcare pathways for neurodevelopmental disorders (NDD) relies on different levels of expertise depending on the complexity of these disorders. NDDs affect between 8% and 15% of children. Historically, national recommendations and healthcare planning measures were initially devoted to autism spectrum disorders and were gradually extended to Attention deficit hyperactivity disorder (ADHD) and specific learning and development disorders. Private doctors play an increasing role in these pathways at different levels of care due to difficulties in organization, particularly in the health and social sector. The aim of this work was to evaluate the contribution of second-line private doctors in the diagnosis and care of children affected by NDD., Methods: A first series of surveys in 2016 evaluated the level of commitment of primary care pediatricians; this online national survey was repeated in 2023 among 1,430 members of the French Association of Ambulatory Pediatrics (Association Française de Pédiatrie Ambulatoire: AFPA) to assess their training, current and future involvement, and activity in NDD care. Analysis was performed by the main author using Epi-Info software., Results: The study identified in 2023 214 second-line private doctors (14% of all pediatricians in activity), of which 185 agreed to appear in a directory published the same year by the AFPA to facilitate referrals from other professionals. Sex ratio of responders is usual for paediatricians: 79.5%/20.5% (F/M), with a distribution among ages showing a slight increase of the age range between age 51-60 (30.5%). Our data indicate that in France in 2022, second-line private doctors made 48%-53% of NDD diagnoses, 24%-26.4% of follow-up consultations and declare to be accountable for 21% of initial prescriptions for Methylphenidate. Among these second-line doctors, 40% had completed a post-university degree on NDD, 74.3% had completed professional development training (PDT) and 85.2% had completed either or both types of training. Most doctors participating in the survey wanted to improve their level of practice, suggesting that in five years, the number of second-line private doctors will increase by 20% to 244 despite 24 planned retirements within the same period. This data probably underestimates the role of private doctors in NDD diagnosis, follow-up, and initial Methylphenidate prescriptions given the unfavourable working conditions (no financial compensation for long appointments, difficulty accessing paramedical and psychological assessments)., Conclusions: Our data confirms that diagnosis and care coordination in the various presentations of NDD may rely on different types of practices and specializations: medical and social professionals, mental health professionals, but also a growing body of medical doctors involved in developmental and behavioural pediatrics. This data and reflection will be helpful for organizing healthcare in France or in other countries. Main study limitation relies in the self-declaration of MD's involvement in NDD and could not evaluate the activity of employed MD's from the social and medico social sector, nor be based on the national databases for prescription. It remains however the first attempt of characterization of medical activity at the national level in France for NDD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Willig, Blanc, Assathiany, Bilbault, Raffier and Werner.)

Résumé: Face à l'épidémie de COVID-19 et à la saturation du secteur hospitalier, les professionnels de santé de ville se sont mobilisés pour assurer une consultation pour tous les patients suspects, notamment en créant des centres de consultations ambulatoires dédiés COVID-19. Notre étude concerne le premier centre dédié COVID-19 dans un département en zone épidémique rouge créé dans le gymnase de la ville à l'initiative de praticiens de santé volontaires, centre de santé et libéraux, appartenant à une même Communauté Professionnelle Territoriale de Santé (CPTS). Cette étude permet de montrer la place importante de la médecine de ville dans la gestion de cette crise épidémique du COVID-19. Nos résultats vont permettre de faire la comparaison avec les autres centres dédiés qui ont vu le jour partout en France. Faced with the COVID-19 epidemic and the saturation of the hospital sector, city health professionals have mobilized to provide consultation for all suspected patients, in particular by creating dedicated COVID-19 outpatient consultation centers. Our study concerns the first dedicated COVID-19 center in a department in a red epidemic zone created in the city gymnasium on the initiative of voluntary health practitioners, health centers and freelancers, belonging to the same Territorial Professional Health Community (CPTS). This study shows the importance of community medicine in addressing the COVID-19 pandemic crisis. We will be able to compare these results with those of the other French COVID-19 ambulatory centers. [ABSTRACT FROM AUTHOR]

Abstract Introduction The capacity for teams and organizations to evolve and to thrive in ever‐shifting environments is attributed to their collective intelligence. Collectively, intelligent team could prevent repetition of past mistakes and can help organizations and people work more efficiently. Researchers aimed to find a framework or a tool that could help explain collective intelligence in primary healthcare organizations. Methods The framework was developed iteratively following a three‐step process based on the Pragmatic utility concept analysis, each step fetching data from both literature and the team's expertise: (i) finding an existing framework, (ii) developing an initial framework, (iii) testing and refining the framework. Results A broad literature search led researchers to focus more specifically on two interrelated frameworks, both concepts were created within the educational field. We first adapted these concepts to healthcare teams, then to the increasing interdisciplinarity of primary healthcare teams. We also subdivided the framework into clinical or organizational domain. Finally, we performed a secondary analysis from existing data of a larger project that aimed to evaluate seven primary care teams in Quebec. Conclusions This first attempt to conceptualize collective intelligence in a way that is specific to primary healthcare teams helps identify strengths and areas in which teams could potentially improve. From a theoretical perspective, the framework facilitates understanding of the concept of collective intelligence in primary healthcare teams. Our current results show a strong potential for this tool, but other tests and systematic validations are to be expected in order to better link collective intelligence and team performance.

The COVID-19 outbreak is having a significant impact on both cardiac rehabilitation (CR) inpatient and outpatient healthcare organization. The variety of clinical and care scenarios we are observing in Italy depends on the region, the organization of local services and the hospital involved. Some hospital wards have been closed to make room to dedicated beds or to quarantine the exposed health personnel. In other cases, CR units have been converted or transformed into COVID-19 units. The present document aims at defining the state of the art of CR during COVID-19 pandemic, through the description of the clinical and management scenarios frequently observed during this period and the exploration of the future frontiers in the management of cardiac rehabilitation programs after the COVID-19 outbreak.

OBJECTIVES: Healthcare workers frequently deal with work stress. This is a risk factor for adverse mental and physical health effects. The objective of this study was to investigate the effectiveness of a digital platform-based implementation strategy – compared to a control group – on stress, work stress determinants (ie. psychosocial work factors) and the level of implementation among healthcare workers. METHODS: By way of matching, 30 teams from a healthcare organization were assigned to the experimental (15 teams; N=252) or wait-list control (15 teams; N=221) group. The experimental group received access to the strategy for 12 months. They were asked to complete the 5-step protocol within six months. The primary outcome was stress (DASS-21) and secondary outcomes were psychological demands, social support, autonomy, and the level of implementation. Questionnaire-based data were collected at baseline, and at 6- and 12-months follow-up. Linear mixed model analyses were used to test differences between the two groups. RESULTS: In total, 210 participants completed the baseline questionnaire and at least one follow-up questionnaire. There was a significant effect of the strategy on stress in favor of the experimental group [B=-0.95, 95% confidence interval (CI) -1.81 – -0.09]. No statistically significant differences were found for any secondary outcomes. CONCLUSIONS: The strategy showed potential for primary prevention of work stress, mainly explained by an increase in stress in the control group that was prevented in the experimental group. More research is necessary to assess the full potential of the strategy.

Six Sigma approach is based on decreasing defects and variations in the products and processes, and it provides important benefits to healthcare organizations. This study aims to identify managers’ opinions, who work in private healthcare organizations, about the reasons behind not using Six Sigma in their organizations. The research was performed between December 2016 and March 2018 in private healthcare organizations (private hospitals and medical centers) operating in Turkey and not using Six Sigma approach. Data were collected from managers, who have knowledge about Six Sigma, through using surveys. In this study, survey methodology was used to collect data. According to the results, the biggest barrier related to not using Six Sigma is based on the lack of knowledge about Six Sigma. The other important barrier about the diffusion of Six Sigma within this organizations is related to the lack of support from top management and leaders. Another finding about the reasons of not applying Six Sigma approach is that there is not a statistically significant difference among managers in terms of their managerial position. In order to overcome the lack of knowledge about Six Sigma, it is advised that managers should take steps in the direction of promoting Six Sigma within their current organization, and provide necessary support and leadership about the process.

Amaç: Bu çalışma, sağlık işletmelerinde örgüt ikliminin çalışanların örgütsel bağlılığına etkilerini araştırmak amacıyla yapılmıştır. Bunun için, örgüt iklimi unsurlarının örgütsel bağlılık üzerindeki etkileri incelenmiştir.Yöntem: Araştırma anket tekniği ile yapılmıştır. Araştırmanın evrenini Adıyaman, Gaziantep ve Kilis illerinde faaliyet gösteren özel ve kamu yataklı sağlık işletmeleri oluşturmaktadır. Araştırmanın örneklemini “Tabakalı Rasgele Örnekleme Yöntemi” ile seçilen 518 çalışan oluşturmuştur. TRC1 bölgesinde yapılan araştırmadaki sağlık kurumlarında görev alan katılımcıların örgüt iklimi ile örgütsel bağlılık arasında ilişki olup olmadığını saptamak üzere geliştirilen hipotezler Pearson-Korelasyon analizi aracılığıyla sınanmıştır.Bulgular: Analiz sonucunda %5 anlamlılık düzeyinde katılımcıların örgüt iklimi algılaması ile örgütsel bağlılık davranışları arasında orta düzeyde (r=0,394) bir ilişki bulunmaktadır.Sonuç: Örgüt ikliminin tüm boyutları ile örgütsel bağlılık arasında ilişki saptanmıştır.

Amaç: Bu çalışma ile hastane çalışanlarının çalışma yaşam kalitesi algı düzeyinin ve bu algı düzeyinin demografik özelliklere göre farklılaşıp farklılaşmadığının ortaya konulması amaçlanmıştır. Yöntem: Araştırma, Nisan 2018’de Yalova’da hizmet sunan özel bir hastanede ve bağlı kuruluşlarında gerçekleştirilmiştir. Araştırmada veri toplamak için anket yöntemi kullanılmıştır. Çalışma yaşam kalitesine ilişkin katılımcıların algı düzeyini belirlemek için, Chinomona ve Dhurup’un (2014), Donaldson vd.’nin (1999) çalışmasından uyarlamış oldukları ölçek kullanılmıştır. Araştırma kapsamında 229 adet anket formu toplanmıştır. Bulgular: Araştırma ile katılımcıların çalışma yaşam kalitesi algısının genel olarak olumlu olduğu belirlenmiştir. Yine araştırma ile çalışma yaşam kalitesi algı düzeyinin katılımcıların cinsiyetine, yaşına, eğitim durumuna, medeni durumuna ve hastanedeki çalışma süresine göre istatistiksel olarak farklılık göstermediği; ancak görevine göre farklılık gösterdiği belirlenmiştir. Sonuç: Çalışma yaşam kalitesinin çalışanlar, kurumlar, hastalar ve diğer paydaşlar açısından birçok konuya etki ettiği düşünüldüğünde, çalışma yaşam kalitesi algı düzeyinin olumlu çıkması hastaneler açısından istenilen bir durumdur. Bu durumun sürdürülebilir ve daha da iyi olabilmesi için, hastane yönetimlerinin çalışma yaşam kalitesine yönelik çalışmalar yapması ve gerekli hallerde iyileştirmeler yapması önerilmektedir.

Abstract Background Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care. Methods This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders. Discussion The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities. Trial registration This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404. Registered June 6, 2018.

The article suggests the reasons for the delayed help-seeking in patients with acute coronary syndrome in terms of individualization of work. For analysis, the approach of narrative medicine was used, that is, a way to conceptualize medical situations using the methods of the humanities, or rather, to understand the disease as an event in the patient’s life — his biographical narrative. These categories are important both from the standpoint of ethics and patient orientation, and from the standpoint of health improving through education of the population. A number of attitudes are shown that lead to delay in help-seeking: rigidity of thinking, unwillingness to cause discomfort, atypical manifestations, distrust of medicine and the unknown medical process. In general, the inclusion of a disease in the biographical process occurs through denial of the disease, distrust of medicine and/or healthcare, procrastination. As a solution of these problems, an assessment of the general informational background of patients as society participants and education depending on the social category, is proposed.

People with low health literacy experience difficulty understanding health information and using cancer services. Healthcare organizations are increasingly working to enhance patient understanding and their literacy of health information. However, no validated tools were available to measure a health literate cancer hospital until we developed and tested a self-assessment scale for this purpose. Two study phases were organized: Phase I aimed to identify the core components of a health literate cancer hospital scale using the three-round Delphi technique with 18 experts in the fields of health literacy, hospital accreditation and health education. Thematic content analysis and measure of central tendency and dispersion were performed for consensus, yielding 4 attributes with 42 items. Phase II tested the scale. A multicenter cross-sectional survey was conducted in six cancer hospitals in Thailand, and a total of 306 healthcare providers completed a questionnaire. Exploratory factor analysis with factor loading in excess of .63 reduced the items from 42 to 22, including leader's vision (8 items), healthcare provider's competency (8 items), health education materials (3 items) and patient-friendly environment (3 items). The scale demonstrated high internal consistency reliability (Cronbach's alpha coefficient .94) and acceptable discrimination (corrected item-total correlation ranged from 0.44 to 0.74). The final Health Literate Cancer Hospital Scale exhibited a reliable construct validity and internal consistency reliability. Nurses and other health professionals can use this scale as a guideline to provide care and improve their competencies. It can also be integrated in a hospital's quality assurance system so as to self-assess and improve the process of establishing a health literate cancer organization. However, the scale should be tested in other types of hospitals where cancer care is provided for broader generalization. [ABSTRACT FROM AUTHOR]

Introduction: The capacity for teams and organizations to evolve and to thrive in ever‐shifting environments is attributed to their collective intelligence. Collectively, intelligent team could prevent repetition of past mistakes and can help organizations and people work more efficiently. Researchers aimed to find a framework or a tool that could help explain collective intelligence in primary healthcare organizations. Methods: The framework was developed iteratively following a three‐step process based on the Pragmatic utility concept analysis, each step fetching data from both literature and the team's expertise: (i) finding an existing framework, (ii) developing an initial framework, (iii) testing and refining the framework. Results: A broad literature search led researchers to focus more specifically on two interrelated frameworks, both concepts were created within the educational field. We first adapted these concepts to healthcare teams, then to the increasing interdisciplinarity of primary healthcare teams. We also subdivided the framework into clinical or organizational domain. Finally, we performed a secondary analysis from existing data of a larger project that aimed to evaluate seven primary care teams in Quebec. Conclusions: This first attempt to conceptualize collective intelligence in a way that is specific to primary healthcare teams helps identify strengths and areas in which teams could potentially improve. From a theoretical perspective, the framework facilitates understanding of the concept of collective intelligence in primary healthcare teams. Our current results show a strong potential for this tool, but other tests and systematic validations are to be expected in order to better link collective intelligence and team performance. [ABSTRACT FROM AUTHOR]

BACKGROUND: TQM in health care institutions is a method for improving the effectiveness of work in general, and it is the view of the administration that tries to communicate with all stakeholders in the organization to achieve high-quality continuous improvement. OBJECTIVE: The objectives of the study are to analyses the feasibility of TQM in the public health organization in Ethiopia. This study deals with the implementation of the health organization by evaluating the performance of TQM. METHODS: The target sample was selected using the stratified random sampling method and also takes into account the quantitative methodological framework. The study is based on the Descriptive Approaches, focusing on the analysis of the sample and the main characteristics of its members. RESULTS: The study results show that there is significant awareness of TQM principles, benefits achieved by the TQM application, obstacles hampered by TQM application, and there are statistically significant differences in perception practitioners of the nursing profession to the importance of TQM application in the public healthcare organization in Ethiopia. CONCLUSIONS: Several conclusions were drawn on the subject of this study to propose appropriate recommendations for management. This study strongly recommended that hospital management should make efforts to create an advanced information system to effectively ensure TQM. [ABSTRACT FROM AUTHOR]

Summary: In Denmark, osteoporosis treatment is either handled by general practitioners or at more resource demanding specialist clinics. We evaluated the treatment adherence and persistence in the two settings, which were overall similar. The type of medical support did, however, differ and was provided to two very different patient populations. Purpose: The study aimed to investigate the effect of patient care by general practitioners (GPs) or specialists on treatment adherence among osteoporosis patients initiating treatment with oral bisphosphonates (OB). Methods: Dual-energy X-ray absorption (DXA)-scanning data from 2005 to 2013 were extracted. Treatment naïve patients with a T-score ≤ − 2.5 (spine or hip) were included. Information on medical treatment, comorbidities, and socio-economic status was extracted from Danish registries. Scanning results were evaluated by a specialist. Subsequent treatment initiation and follow-up was either handled by GPs or specialists: GP population (GPP) vs. specialist population (SP). Primary adherence was defined as treatment initiating within 12 months from diagnosis and secondary adherence as days with medicine possession rates (MPR) > 80%. Results: Of 11,201 DXA-scanned patients, 3685 met the inclusion criteria (GPP = 2177, SP = 1508). The GPP consisted of relatively more men, was older, had shorter education, lower income, and more comorbidities. There was no difference in baseline T-score or prior incidence of major osteoporotic fractures (MOFs). The GPP was primarily treated with OB and had better primary adherence (adjusted ORGPP/SP = 1.52 [1.31–1.75], p < 0.0001) than the SP that to a higher degree received another treatment. Secondary adherence was similar (adjusted ORGPP/SP: OR12 months = 1.02 [0.83–1.26]; OR24 months = 0.90 [0.73–1.10]; OR4 years = 0.88 [0.71–1.07]; OR5 years = 0.91 [0.74–1.13]. Conclusion: Patients in care of specialists were most likely to receive a treatment other than OB. Primary adherence was highest in the GPP, whereas short- and long-term persistence was similar for up to 5 years whether treated by a specialist or a GP. [ABSTRACT FROM AUTHOR]

This study seeks to create an integrated multitheoretical model of public healthcare services delivery organizations. A literature review of selected organization theories and their relevance to healthcare was conducted. By illuminating the aspects of control over resources, isomorphism, adaptation to the changing environment and contracts between parties based on the key elements of the resource-dependence theory, institutional theory, population ecology and transaction-cost economics theory, an integrated multitheoretical model of a public healthcare services delivery organization has been presented. There is a need for empirically testing the model proposed by this study. [ABSTRACT FROM AUTHOR]

Objectives To gain insight into SSc patients' perspective on quality of care and to survey their preferred quality indicators. Methods An online questionnaire about healthcare setting, perceived quality of care (CQ index) and quality indicators, was sent to 2093 patients from 13 Dutch hospitals. Results Six hundred and fifty patients (mean age 59 years, 75% women, 32% limited cutaneous SSc, 20% diffuse cutaneous SSc) completed the questionnaire. Mean time to diagnosis was 4.3 years (s. d. 6.9) and was longer in women compared with men (4.8 (s. d. 7.3) vs 2.5 (s. d. 5.0) years). Treatment took place in a SSc expert centre for 58%, regional centre for 29% or in both for 39% of patients. Thirteen percent of patients was not aware of whether their hospital was specialized in SSc. The perceived quality of care was rated with a mean score of 3.2 (s. d. 0.5) (range 1.0–4.0). There were no relevant differences between expert and regional centres. The three prioritized process indicators were: good patient-physician interaction (80%), structural multidisciplinary collaboration (46%) and receiving treatment according to SSc guidelines (44%). Absence of disease progression (66%), organ involvement (33%) and digital ulcers (27%) were the three highest rated outcome indicators. Conclusion The perceived quality of care evaluated in our study was fair to good. No differences between expert and regional centres were observed. Our prioritized process and outcome indicators can be added to indicators suggested by SSc experts in earlier studies and can be used to evaluate the quality of care in SSc. [ABSTRACT FROM AUTHOR]

Résumé: Contexte : l'évolution démographique entraîne une adaptation de l'offre de soins gériatrique, orientée volontiers vers la communauté, avec notamment le déploiement d'unités mobiles extrahospitalières de gériatrie et psychiatrie de la personne âgée. Bien que les troubles psychiques du sujet âgé nécessitent une approche globale, intégrative et pluridisciplinaire, les unités mobiles extrahospitalières de gériatrie et psychiatrie de la personne âgée fonctionnent souvent en parallèle sans concertation et rencontrent régulièrement des difficultés dans la prise en charge des pathologies complexes. L'objectif de ce travail est de faire un retour d'expérience du fonctionnement du dispositif du CHRU de Tours, comprenant un gériatre et un psychiatre de la personne âgée (PPA) dans la même équipe. Méthode : recueil de données mettant en lumière la dyade médicale gériatre – PPA durant la première année de fonctionnement de l'Équipe mobile de gériatrie extra-hospitalière (EMGEH) du CHRU de Tours (2018). Les modes d'adressage, motifs d'intervention, caractéristiques cliniques des patients et préconisations ont été enregistrées à l'issue de l'évaluation gériatrique initiale, puis après évaluation PPA complémentaire lorsqu'elle était indiquée. Résultats : 151 patients dont 53 % (n = 80) en rupture de suivi médical ou en difficulté d'accès aux soins ont été évalués ; 40 % (n = 60) pour des troubles du comportement, 30 % (n = 45) des chutes, 15 % (n = 23) une problématique sociale, 10 % (n = 15) une altération de l'état général et 5 % (n = 7) une conciliation médicamenteuse. Après l'évaluation gériatrique initiale, 40 % (n = 60) ont bénéficié d'une évaluation PPA ; 100 % (n = 60) étaient en rupture/difficulté de suivi, 83 % (n = 50) présentaient des troubles psychocomportementaux bruyants sur troubles neurocognitifs, 17 % (n = 10) des troubles psychocomportementaux sur maladie psychiatrique, 10 % (n = 6) un mésusage de psychotropes à l'origine de décompensation de comorbidités gériatriques ; 32 % (n = 19) ont bénéficié ensuite de consultations gériatrique, gérontopsychiatrique ou mémoire et 33 % (n = 20) présentaient un refus de soins persistant ; 23 % (n = 14) ont été réévalués pour troubles psychocomportementaux bruyants. Discussion : la collaboration originale gériatre – PPA au sein de la même EMGEH permet une prise en charge médicale globale des patients, intégrant les comorbidités organiques, psychiatriques et cognitives intriquées et une réflexion collaborative sur l'iatrogénie qui en découle. Le lien privilégié avec les médecins traitants est une réponse possible pour ces patients fragiles, en rupture de soins, permettant une réinsertion dans la filière gériatrique. Background : Demographic changes require an adaptation of the geriatric care offer, which is readily oriented towards the community and including the development of out-of-hospital mobile geriatric team (MGT). Although psychiatric disorders of older persons require a comprehensive, integrative and multidisciplinary approach, geriatrics and old age psychiatry mobile units often work in parallel without concertation for the management of complex pathologies. The aim of this paper is to present the organisation and the results of a out-of-hospital MGT with a geriatrician and old age psychiatrists (OAP) in a same unit. Method : Data were collected during the first-year (2018) of the out-of-hospital MGT of Tours University hospital. After initial geriatric assessment and when old age psychiatry (OAP) intervention was needed, referral mode and justification, patient's characteristics and recommendations made by the team were collected. Results : During the study period, 151 patients were assessed, 53% (n=80) had out-of-medical follow-up or difficulties to access to healthcare; 40% (n=60) had behavioural and psychological symptoms of dementia (BPSD), 30% (n=45) falls, 15% (n=23) social problems, 10% (n=15) alteration of overall health status and 5% (n=7) drug conciliation; 40% (n=60) benefited from an OAP evaluation; 100% (n=60) had out of medical follow-up, 83% (n=50) had severe BPSD, 17% (n=10) psychological symptom with psychiatric condition, 10% (n=6) misused psychotropic medications in charge of general comorbidities decompensation; 32% (n=19) had geriatric, OAP consultations and 33% (n=20) were in denial of care; 23% (n=14) with severe BPSD had a second OAP consultation. Discussion : Relationship between geriatrician and OAP in the same MGT enables to deliver comprehensive care, including organic, psychiatric and cognitive comorbidities and collaborative assessment of iatrogenicity. A strengthened relationship with general practitioners is a possible option for these frail older patients, out-of-medical follow-up allowing their reintegration in the geriatric healthcare system. [ABSTRACT FROM AUTHOR]

Purpose: A marketing strategy is a set of actions by which the company intends to achieve its goals. This also applies to healthcare organizations in which specific medical purposes overlap with market purposes. Building a marketing strategy boils down to the selection of elements that create it, so that the composition is as coherent as possible and creates a system that allows achieving goals. In this process, it is necessary to include all employees of the healthcare organization in its implementation. Employees of healthcare institutions are characterized by specific features and therefore, during the implementation of the marketing strategy, resistance may be encountered. However, a well-organized process of creating and implementing strategies can be successful. Methodology: Literature study and secondary data study. Findings: Marketing strategy implementation for a healthcare organization is a long and demanding process. In medical institutions it is determined by both medical goals, characteristic only for these institutions, and economic goals - market-specific characteristics for all entities operating on the market. The most important element of introducing strategies is proper training of personnel so that they understand their role in the strategies implementation. Practical implications: This paper can help managers of healthcare organizations to understand the role of employees in the marketing strategies. Value: New look at the important subject. It can help manage the healthcare organization. [ABSTRACT FROM AUTHOR]

Rising healthcare costs are major concerns in most high-income countries. Yet, political measures to reduce costs have so far remained futile and have damaged the best interests of patients and citizen. We therefore explored the possibilities to analyze healthcare systems as a socially constructed complex adaptive system (CAS) and found that by their very nature such CAS tend not to respond as expected to top-down interventions. As CAS have emergent behaviors, the focus on their drivers – purpose, economy and behavioral norms – requires particular attention. First, the importance of understanding the purpose of health care as improvement of health and its experience has been emphasized by two recent complementary re-definitions of health and disease. The economic models underpinning today’s healthcare – profit maximization – have shifted the focus away from its main purpose. Second, although economic considerations are important, they must serve and not dominate the provision of healthcare delivery. Third, expected health professionals’ behavioral norms – to first consider the health and wellbeing of patients – have been codified in the universally accepted Declaration of Geneva 2017. Considering these three aspects it becomes clear that complex adaptive healthcare systems need mindful top-down/bottom-up leadership that supports the nature of innovation for health care driven by local needs. The systemic focus on improving people’s health will then result in significant cost reductions.