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It is necessary to deepen medical and health system reform by exploring and establishing the public hospital salary system which adapts to the characteristics of Chinese medical industry. The implementation of the annual salary system for the president is a significant component of the reform. By reviewing the related policy documents, this paper adopts literature review and comparative research to compare and analyze the primary practices and working characteristics of the annual salary system for presidents of Chinese public hospitals in terms of the target group, annual salary composition, funding source, annual salary level, verification mode, and annual salary payment. This paper also summarized the practical experience of the annual salary system for presidents in various regions, thus providing experience and reference for reforming the annual salary system of public hospital presidents in other regions. [ABSTRACT FROM AUTHOR]

This study aimed to measure the hospitalization costs for suspect or confirmation cases of COVID-19 and aggregate knowledge in the costing process for future research on related topics. A cost calculation model was applied using absorption costing technique. Cost was allocated into 2 main groups: hospitalization and personnel. The cost analysis considers the hospital perspective. This is a retrospective study whose data were collected between April and September 2020, equivalent to the first wave of the disease in Brazil. This research uses data from Hospital Information System, Brazilian Unified Health System (SUS) Cost Calculation and Management System, and SUS Hospital Information System. The average total cost per hospitalization was US$11 260 (R$63 504) for patients suspect or confirmed by COVID-19, and considering only detectable cases, the value was US$17 178 (R$96 886). The profile of hospitalized patients was male (51%), with a mean age of 59 years, white ethnicity (64%), and average length of stay of 9 days. The amount approved by SUS for remuneration of hospitalizations by COVID-19 proved to be insufficient to cover the calculated costs. The results of this study collaborate to measure the expenditure of hospital institutions with COVID-19 hospitalizations, contribute as a parameter for health managers to identify whether the values attributed to hospitalization by COVID-19 by the SUS are adequate to cover all costs involved, and provide lessons learned on costs to the public health system in the event of new pandemics. • Few studies presented information about the sufficiency (or not) of resources to pay for the hospitalization of the COVID-19 in Brazil. • This article applies an original method to estimate hospitalization costs for COVID-19 in a public hospital at Brazilian Unified Health System. • This research found that Brazilian Unified Health System–approved values of hospitalizations by COVID-19 are insufficient to cover the calculated costs at a Brazilian public teaching hospital analyzed. [ABSTRACT FROM AUTHOR]

ObjectiveWe aimed to evaluate the accessibility of anticancer medicines in public hospitals of Shaanxi, a representative province of Northwestern China.MethodsThirty-one anticancer medicines were investigated in 146 designated public hospitals in 10 cities of Shaanxi Province. We used medicine procurement data from the Shaanxi Drug Centralized Purchasing Platform during 2019–2021. Primary outcomes included the availability, drug utilization, and affordability of anticancer medicines.ResultsThe mean availability of 31 anticancer medicines increased significantly from 5.45% in 2019 to 14.72% in 2021. The mean availability of nationally negotiated medicines was significantly lower than that of Class B medicines (8.72% vs. 12.85%, p = 0.048), whilst the availability of injectable medicines was significantly greater than that of oral medicines (13.66% vs. 8.77%, p = 0.007). In 2019–2021, the annual mean amount purchased increased significantly from CNY 6.51 million to CNY 18.56 million (p = 0.007). The mean defined daily doses of 31 medicines significantly rose from 225.50 to 1019.50 (p = 0.008) whereas their defined daily drug cost significantly decreased from CNY 551.15 to CNY 404.50 (p

ObjectiveThe COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China’s hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing’s 2020–2021 pandemic relative to the 2017–2019 pre-COVID-19 benchmark period.MethodsHospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing’s HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included.ResultsIn the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017–2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5.ConclusionThe HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world.

AIM: This study aimed to explore occupational satisfaction experienced by nurses working in a public hospital. METHOD: Qualitative approach was used to explore experiences toward occupational satisfaction among 16 nurses working in different units of a selected public hospital in Tamil Nadu, South India. A semi-structured interview guide facilitated the individual in-depth face-to-face interviews, which were audio-recorded and transcribed verbatim. Thematic approach was used for data analysis and data management was performed using NVIVO-12 software. RESULTS: The two major themes that emerged as nurses' experiences on occupational satisfaction were "Quality patient care rendering and responses" and "Professional opportunities and responsibility." The sub-themes under quality patient care rendering and responses were patient care environment, team dynamics, leadership, and patient's health status. The sub-themes under professional opportunities and responsibility were pay and promotion, professional growth, and recognition. CONCLUSION: The findings help us understand the various facilitating and hindering challenges nurses face in occupational satisfaction. It also emphasizes the organization's focus on modifiable factors in the working environment, enhancing satisfaction, and helping the nurses work more effectively and efficiently to deliver quality nursing care. Nursing administration in every healthcare setting should focus on strategies to improve nurses' professional development. [ABSTRACT FROM AUTHOR]

Jordan's healthcare industry is marked by a fast-paced atmosphere and more competitive marketplaces. However, Jordan's healthcare system is vulnerable to several threats, including human factors, which can interrupt the supply of medical supplies and waste large expenditures. In Jordanian public hospitals, the current research includes surveys and analyses of empirical studies and models related to the high-performance work system (HPWS) and job performance (JP), with the mediating function of job stress (JS). The current study results were estimated based on Structural Equation Model (SEM). The results indicate that HPWS and its dimensions provide a critical role in determining the level of Nurses' JP in a public hospital in Jordan. In addition, they provide a direct effect on identifying the level of Nurses' JS in public hospitals in Jordan. Moreover, the results uncover that JS supports a positive relationship with Nurses' JP of the public hospital in Jordan. The findings also confirm that JS provides an essential mediation role between HPWS and JP of the public hospital in Jordan, which can enhance the performance workplace. Throughout this research, Discussion, recommendations, and conclusion have been fully expounded in their specific sections. [ABSTRACT FROM AUTHOR]

Objective: to determine the levels of empathy in professional nurses of a high-complexity hospital, to relate age to empathy (and each one of its dimensions), and to establish if there are differences between these levels according to the type of working schedules. Method: comparative, correlational and cross-sectional design. The sample used (n=271) constituted 40.9% of the total number of nursing professionals. Psychometric properties of the Jefferson Scale of Empathy for Health Professionals were studied. Descriptive statistics were calculated: mean and standard deviation. The association between empathy and age was estimated using regression equations and statistical significance of the regression coefficients, after evaluating the type of curve using variance analysis. Results: the underlying model of three dimensions of empathy was identified. The values of the descriptive statistics observed were relatively low in empathy and its dimensions. Empathy levels were not associated with the age range. No differences in empathy were found between the types of work schedules. Variability was found in the dimensions: "compassionate care" and "Walking on the patient's shoes". Conclusion: these results show that the levels of empathy observed may imply a deficient performance in empathetic care for patients. [ABSTRACT FROM AUTHOR]

Background: The current global nursing workforce is a combination of personnel from three different generation cohorts, which are the Baby Boomers, Generation X and Generation Y (Millennials). These generational cohorts work side by side to provide quality nursing care to the patients on a daily basis. Aim: This article aims to report the effects of generational diversity on the supervision of new professional nurses in selected public hospitals in North West Province. Setting: This study was conducted at seven public hospitals situated at three out of the four districts of North West Province, South Africa. These public hospitals classifications consist of six districts and one provincial hospitals. Methods: The study followed an exploratory, descriptive and contextual qualitative research design underpinning the constructivist paradigm was followed to pave a way for this study. Operational managers were purposively sampled and data were collected using the focus group discussion as well as individual interviews. Data analysis followed the guideline of the thematic analysis. Results: This article reports on three themes that emerged from data analysis, namely (1) generational differences, (2) insubordination and (3) impact on supervision. Conclusion: Understanding the generational diversity and its impact on the supervision of new professional nurses might assist in improving the leadership styles for operational managers and will promote collegiality among colleagues and positively influence the provision of quality care for patients. Contribution: These results provide a framework for future research and provide the basis for understanding the impacts generational diversity has on supervision of new professional nurses. [ABSTRACT FROM AUTHOR]

Background: Has the medical arms race (MAR) increased healthcare expenditures? Existing literature has yet to draw a consistent conclusion. Hence, this study aims to reexamine the relationship between the MAR and medical expenses by the data from public hospitals in Shenzhen, China, during the period of 2009 to 2013. Methods: This study's data were collected through panel datasets spanning 2009 to 2013 from the Shenzhen Statistical Yearbook, Shenzhen Health Statistical Yearbook, and annual reports from the Shenzhen Municipal Health Commission. The Herfindahl–Hirschman index and hierarchical linear modeling were combined for empirical analysis. Results: The MAR's impact on medical examination fees differed during the inpatient and outpatient stages. Further analysis verified that the MAR had the most significant impact on outpatient examination fees. Due to the characteristics of China's medical system, government regulations in the healthcare market may consequently accelerate the MAR among public hospitals. Strict government regulations on the medical system have also promoted increased medical examination costs to some extent. Once medical service prices are under strict administrative control, only drug and medical examination fees are the primary forms of extra income for hospitals. After the proportion of drug fees is further regulated, medical examinations will then become another staple method to generate extra revenue. These have distorted Chinese public hospitals' medical fees, which completely differ from those in other countries. Conclusion: The government should confirm that they have allocated sufficient financial investments for public hospitals; otherwise, the competition among hospitals will transfer the burden to patients, and especially to those who can afford to pay for care. A core task for public hospitals involves providing safer, less expensive, and more reliable medical services. [ABSTRACT FROM AUTHOR]

Background and Aim: With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran. Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital’s intelligent management system. The data were analyzed using R software’s interrupted time series analysis method. Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05). Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic’s beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic. [ABSTRACT FROM AUTHOR]

Abstract Background In the past decade, various breastfeeding policies were implemented in Hong Kong, including changes in perinatal guidelines in public hospitals, adoption of the Baby-Friendly Hospital Initiative (BFHI), provision of guidelines for the marketing of formula milk, penalisation of discrimination towards breastfeeding, and extension of the statutory maternity leave. Meanwhile, the COVID-19 pandemic brought new challenges and opportunities to breastfeeding practices. Infection control measures in public hospitals included the cancellation of antenatal classes, hospital tours, and postnatal classes; suspension of perinatal visiting periods; and compulsory separation of COVID-19 positive mothers from newborns. In addition, work-from-home policies were widely implemented. This study aimed to identify the associated factors of six-month predominant breastfeeding (PBF), and to evaluate the impact of COVID-19 on breastfeeding practice. Methods This study was conducted from 1 March 2021 to 7 April 2021 using a mixed-methods approach. An electronic questionnaire was distributed to members of breastfeeding or parenting groups who have had breastfeeding experience in the past 10 yrs. Logistic and linear regression analyses were conducted to identify factors associated with six-month PBF both in general and during the pandemic period. A qualitative content analysis was conducted using an inductive approach. Results The study included 793 participants. Giving birth in a public hospital (OR 2.21; 95% CI 1.46, 3.34) and breastfeeding support from family and friends (OR 1.28; 95% CI 1.05, 1.57) were significantly associated with six-month PBF, even during COVID-19. Factors associated with the self-rated impact of COVID-19 on breastfeeding include working from home, the perceived immunological benefits of breastfeeding, and the wish to avoid breastfeeding or expressing breast milk in public premises. Furthermore, breastfeeding practice in public hospitals was more likely to be affected by the busyness of staff, while private hospitals had worse rooming-in practices and staff who had inadequate breastfeeding knowledge. Conclusions Giving birth in a public hospital and having breastfeeding support from family and friends were associated with six-month PBF. Furthermore, COVID-19 in Hong Kong had an overall positive impact on six-month PBF. Further studies should investigate the impact of hospital practices and the COVID-19 pandemic on breastfeeding behaviours.

Background and Aim: With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran. Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method. Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05). Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.

Yan Chen,1,2 Xinyu Cui,2 Jiahuan Zhuoma,2 Fang Zhu,2 Li Luo,3 Juan Xie,2 Yongzhong Cheng2 1Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 2The Commission for Discipline Inspection, West China Hospital of Sichuan University, Chengdu, People’s Republic of China; 3Industrial Engineering and Engineering Management Department, College of Business of Sichuan University, Chengdu, People’s Republic of ChinaCorrespondence: Li Luo; Juan Xie, Industrial Engineering and Engineering Management Department, Business School of Sichuan University, Chengdu, People’s Republic of China, Email luolicc@scu.edu.cn; 857538446@qq.comPurpose: To examine how employees perceive corruption risks in their hospital and to provide recommendations for good governance in that hospital.Methods: The “Questionnaire of Corruption Risk Perception Index in Public Hospitals” was designed and a questionnaire survey was conducted online from April 17 to 30, 2020 in West China Hospital of Sichuan University, to explore employees’ assessment of corruption risk. Employees were asked to evaluate the likelihood and impact of corruption risk to form a corruption risk perception index (CRPI). Related factors were examined in multifactor analysis.Results: A total of 5525 employees participated in the survey. Among all 15 kinds of risks, unreasonable personnel changes (CRPI=8.24), no collective discussion about important issues (CRPI=7.95), and violating the individual moral character (CRPI=7.85) were the top 3 ones that participants rated highest, while illegal procurement (CRPI=7.38), violating teaching ethics (CRPI=7.12) and medical ethics (CRPI=6.93) were rated lowest. Corruption risks were mainly concentrated in internal management, treatment regulation, professional conduct, and external cooperation. The OR value that the CRPI of leaders was 0.768 times that of ordinary employees (95% CI: 0.623– 0.945, χ 2=6.189, P=0.013). Fluke ideas were the most selected personal reason for corruption. Suggestions for strengthening the education of corruption risk were mentioned most.Conclusion: The results indicate the emphasis and direction of hospital management. First, WCH needs to pay attention to the construction and dynamic improvement of the hospital’s internal management regulations and external cooperation management regulations, and increase the transparency of decision-making and implementation. Second, it is necessary to restrict the discretion of leaders at all levels and strengthen supervision. In addition, WCH needs to carry out education from the perspectives of power awareness and corruption cost, and to strive to build a clean, honest culture.Keywords: corruption risk perception index, corruption risk, anti-corruption, public hospital

The options available for a specialist in India today can be broadly divided into joining a public teaching institution in the capacity of lecturer or higher, freelancing, and taking up a full-time corporate position. Whereas public teaching institutions have an abundance of academics, skill and mastery development potential, corporate positions and freelancing offer better monetary stability. From an ideal blend of both systems, stems the honorary system. This article elaborates on and exemplifies the same with several doyens who have been involved, and have been a product of the honorable “honorary system.”

Abstract Background The overcrowded patients, which cause the long waiting time in public hospitals, become significant problems that affect patient satisfaction toward the hospital. Particularly, the bottleneck usually happens at front-end departments (e.g., the triage and medical record department) as every patient is firstly required to visit these departments. The problem is mainly caused by ineffective resource management. In order to support decision making in the resource management at front-end departments, this paper proposes a framework using simulation and multi-objective optimization techniques considering both operating cost and patient satisfaction. Methods To develop the framework, first, the timestamp of patient arrival time at each station was collected at the triage and medical record department of Thammasat University Hospital in Thailand. A patient satisfaction assessment method was used to convert the time spend into a satisfaction score. Then, the simulation model was built from the current situation of the hospital and was applied scenario analyses for the model improvement. The models were verified and validated. The weighted max–min for fuzzy multi-objective optimization was done by minimizing the operating cost and maximizing the patient satisfaction score. The operating costs and patient satisfaction scores from various scenarios were statistically compared. Finally, a decision-making guideline was proposed to support suitable resource management at the front-end departments of the hospital. Result The three scenarios of the simulation model were built (i.e., a real situation, a one-stop service, and partially shared resources) and ensured to be verified and valid. The optimized results were compared and grouped into three situations which are (1) remain the same satisfaction score but decrease the cost (cost decreased by 2.8%) (2) remain the same satisfaction score but increase the cost (cost increased up to 80%) and (3) decrease the satisfaction score and decrease the cost (satisfaction decreased up to 82% and cost decreased up to 59%). According to the guideline, the situations 1 and 3 were recommended to use in the improvement and the situation 2 was rejected. Conclusion This research demonstrates the resource management framework for the front-end department of the hospital. The experimental results imply that the framework can be used to support the decision making in resource management and used to reduce the risk of applying a non-improvement model in a real situation.

Abstract Background Waiting time is defined as the total time that a patient spends in a facility from arrival at the registration desk until the time she/he leaves the facility or last service. In Ethiopia, the waiting time in the hospitals particularly in the outpatient department is lengthy. Studies at Jimma University specialized hospital indicated patients are forced to wait an average of 4.5 waiting hours to get service. Even there are many hospitals found in the zone, there is a paucity of information regarding waiting time and associated factors. Hence, this study is aimed to assess waiting time and associated factors at outpatient departments in Public Hospitals of Jimma zone, southwest Ethiopia. Methods An institution-based cross-sectional study design was used from March 22 to June 3, 2020. A total of 422 study subjects were included in the study and systematic random sampling methods were used. The data were collected by observing the whole service points of each patient. The exit interview was made at the last point of the service unit. Descriptive statistics, bi-variable and multi-variable logistic regressions were used. Results The whole waiting time patients spent in the hospitals before getting service was a minimum of 41 and a maximum of 185 min. Patients who came far from the hospitals were 1.93 times (AOR = 1.93; 95% CI, 1.16, 3.21) more likely to spend longer waiting time as compared to those who came from the hospital's area. Patients visited on Monday were 2.64 times (AOR = 2.64; 95% CI, 1.45, 4.79) more likely to spend longer waiting time than those who visited the hospital on Friday. Patients who arrived early in the morning were 3.22 times (AOR = 3.22; 95% CI, 1.32, 7.86) more likely to spend longer waiting time than those who arrived in the afternoon. Conclusions The mean waiting time was higher than the average recommended time by Business Process Reengineering (BPR) and more than five out of every ten clients spent long waiting time at outpatient departments Waiting time was affected by Educational status, residence, arrival time, and date of the visit.

This article used a convenience sampling method to conduct a questionnaire survey of 810 medical staff in 30 tertiary public hospitals in Anhui Province on their awareness of the content of public health services in hospitals, participation in public health training, and their overall evaluation. The main aim of this article is to understand the current situation of medical staff’s awareness of public health services in public hospitals to improve their awareness of public health, and the level of public health management and services in public hospitals. Based on the analysis of the current situation of medical staff’s perception of public health services in public hospitals, the author proposed that it is vital to clarify the functional positioning of public hospitals and enhance public health awareness among staff. Secondly, scientific planning of public health functions and focusing on constructing a professional team are also crucial. We need to strengthen medical staff’s public health training to improve their public health literacy and service capacity. Lastly, it is essential to refine the performance assessment mechanism of public health services to enhance the motivation of medical staff. [ABSTRACT FROM AUTHOR]

Introduction: Existing evidence indicates that the best treatment model for obesity leading to successful weight loss consists of a so-called comprehensive lifestyle intervention program, but the offer, implementation, and coverage of these kinds of programs for the diagnosis, management, and follow-up of people living with obesity are limited. So, the aim of this study was an evaluation of the feasibility and effectiveness of a comprehensive care program for obesity in a public tertiary hospital in Mexico. Methods: An observational, longitudinal, and retrospective study evaluated a six-month long medium-intensity comprehensive care program (seven visits focused on medical, nutritional, psychological, and psychiatric diagnosis and treatment). A total of 1,017 people living with obesity were recruited for the program. Logistic regression models were used to predict the factors associated with attendance and weight loss. Results: Of the 1,017 participants, 661 completed the program (65% retention rate) and attended 4.9 ± 1.9 visits each, with 40.1% losing ≥5% of their starting weight (X = 4.3 ± 4.4%). From visit 1 to visit 7, the participants that completed the program had weight decreases of Δ = −4.8 kg and body mass index (BMI) −2.3 kg/m2; p < 0.01. Each additional visit increased the likelihood of a 5% weight loss [OR 1.90, 95% CI: 1.51–2.38, p < 0.001] and 10% [OR 2.45, 95% CI: 1.49–4.02, p < 0.001], becoming statistically significant after attending more than four visits. Each additional year of age increased the likelihood of losing ≥5% body weight [OR 1.01, 95% CI: 1.00–1.03, p < 0.05] and increased the likelihood of completing the program [OR 1.02, 95% CI: 1.00–1.03, p < 0.01] after controlling for sex, weight, BMI, and psychiatric and weight loss medications. Discussion/Conclusion: This study demonstrates the feasibility and effectiveness of a six-month comprehensive program for obesity in a public hospital in Mexico. [ABSTRACT FROM AUTHOR]

Aims: The objective of this audit was to analyze the radiotherapy (RT) practice in a newly established tertiary private hospital. With increasing radiation oncology (RO) facilities in private sector, this report is the first audit from a private health organization in India.Subjects and Methods: The audit of all consecutively registered patients in RO has focused to extract data from the time of RT simulation planning till the completion of RT course. The patient and disease characteristics,RT-related treatment factors and compliance were analyzed in-depth.Results: In this newly established RO department, the vendor-supplied equipment, e.g., RT planning system, treatment delivery (linear accelerator and brachytherapy), and RO information system (ROIS), are integrated with enterprise-wide hospital information system into unified paperless workflow management for the patient care records in a prospective manner. This analysis comprised consecutive 328 patients who consented for RT simulation and planning from April 20, 2018, to December 31, 2019. RT course compliance was 94.8% (311/328 patients), and treatment intent-wise: curative plus adjuvant in 60.2% and palliative RT in 36%. RT technique was conformal in all 100%, with volumetric arc radiotherapy (VMAT) delivered to 66.6% of patients. With overall median RT course duration of 29 days (range 1-81 days), the patients were delivered a median of 20 fractions.Conclusions: Compared to the previously published audit from an academic RO department in Delhi, this audit from a private hospital has shown (i) lesser waiting time, (ii) improved treatment compliance, (iii) utilization of higher techniques, and (iv) a lower duration of RT course. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has severely affected and changed medical activity worldwide. Public hospitals have been suffocated by the large number of Covid-19 patients, sometimes making it difficult for patients with other conditions to be admitted to hospital. This was also true for patients with cardiovascular disease. In the present article we describe the main variations in the activity of interventional cardiology laboratories in Romania between the pre-pandemic year 2019 and the pandemic year 2020 in private and public hospitals. [ABSTRACT FROM AUTHOR]

Background: Active participation of patients in managing their medical treatment is a major component of the patient empowerment process and may contribute to better clinical outcomes. Patient perceptions and preferences affect the patient–physician encounter in a variety of dimensions, such as patient autonomy, freedom of choice and trust in the healthcare system. The Israeli healthcare system is mostly publicly funded, with additional private healthcare services for surgery and other medical treatments. The aim of this study was to compare the perceptions and preferences of patients in the public and private hospitals in Israel. Methods: A cross‐sectional study among 545 individuals who had surgical procedures at two hospitals in Israel (one public and one private). A structured questionnaire comprising 23 items was used to collect perceptions via personal telephone interviews. The responses were categorized into five clusters and compared by type of health services provider (public vs. private) and sociodemographic characteristics (gender, age and education level). Results: A hierarchical cluster analysis methodology identified five conceptual groups: trust, concern towards medical errors, dialogue between medical staff and the patient/patient's family, confidentiality and staff bias towards more informed patients, or those with supportive families. Four main themes that highlight patients' preferences were found: physical conditions, personal empowerment and perceived autonomy, patient experience and patient–provider encounter communication. Significant differences between the private and the public healthcare systems were found in four clusters: trust and patient care, patient's concerns, the extent of explanation and medical staff's commitment. Differences secondary to sociodemographic parameters were noticed: patients treated at the private hospital scored significantly higher items of trust, medical staff caring and the importance of choosing their treating surgeon, while patients treated at the public hospital scored higher staff commitment to the patient than those treated at the private hospital. Conclusions: The study revealed the perceptions underlying the decisions of patients to undergo surgical procedures in public or private hospitals. Mutual learning could pave the way to better patient–physician encounters. Patient or Public Contribution: Patients from the two hospitals were involved in this study by responding to the questionnaire. The data presented is based on the patient's responses. [ABSTRACT FROM AUTHOR]

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Physician burnout is now a public health crisis and dentist is a stressful professional health occupation. The purpose of this cross-sectional study was to determine the level of burnout and related factors among 423 Thai dentists working in public hospitals, southern Thailand. A self-administered questionnaire was collected through an online platform and included 5 parts: general information, work information, 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS), 23-item Thai Effort-Reward Imbalance Questionnaire (Thai ERIQ), and the Utrecht Work Engagement Scale-9 (UWES-9). The data were analyzed for descriptive statistics – frequency, percentage, mean, standard deviation – and inferential statistics using binary logistic regression. The prevalence of medium to high level of burnout were 45.8%, 44.3%, 4.0% for emotional exhaustion, depersonalization, and low personal accomplishment, respectively. Regarding to the multivariate analysis, the statistically significant factors associated with emotional exhaustion were age, work engagement, workplace relationship, work effort, work reward, grade point average, and workplace consultant. The factors associated with depersonalization were age, work engagement, workplace relationship, work effort, and job reselection. The factors associated with personal accomplishment were age, work engagement, work reward, and level of workplace. In this study, we identified several factors that can be modified to reduce the risk of burnout among dentists in Thailand. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is common and adversely impacts quality‐of‐life and healthcare cost. In Australia, less than 10% of bariatric surgeries are performed in the public sector. This study reports our 10‐year experience from a high volume public bariatric service which delivers multi‐disciplinary care for primary and revisional procedures with mid‐ to long‐term follow‐up. Methods: A prospectively maintained database of all patients who underwent bariatric surgery from January 2010 to January 2020 at a tertiary metropolitan hospital was analysed. We analysed patient demographics, comorbidities, perioperative outcomes, 2‐ and 5‐year weight loss as well as comorbidities reduction. Results: A total of 995 patients underwent 1086 (674 primary and 412 revisional) bariatric procedures with mean age of 46.9 years, mean BMI of 49.6 ± 9.1 kg/m2 and 92% patients with ≥1 obesity‐related co‐morbidity. Length‐of‐stay was longer for revisional than primary surgery (5.6 vs. 3.5 days). Major complication rate was 4.2%. Overall, % Total body weight loss (%TBWL) for primary surgeries at 2 years was 26.2%, and for revision surgery was 17.4%. At 2 years follow‐up, treatment was ceased or reduced in 65% of diabetics, 29% of hypertensive patients and 69% of sleep apnoea patients. Conclusion: This study confirms that bariatric surgery in Australia can be delivered effectively in resource constrained public health system with outcomes similar to private sector. [ABSTRACT FROM AUTHOR]

Bu araştırmanın amacı, örgüt kültürünün algılanan kurumsal itibar üzerindeki etkisinin incelenmesidir. Araştırmada veri toplama aracı olarak, yüz yüze anket tekniği kullanılmıştır. Araştırmanın evrenini Adana ilinde faaliyet gösteren bir kamu hastanesi yönetici ve çalışanları oluşturmaktadır. Araştırmanın örneklemi ise basit tesadüfi örnekleme yöntemiyle seçilmiş 322 hastane çalışanından oluşmaktadır. Ölçeklerden elde edilen veriler kodlanarak SPSS 22.0 paket programıyla analiz edilmiştir. Verilerin çözümlenmesinde tanımlayıcı istatistiklerden, t testi, ANOVA testi ve korelasyon testlerinden faydalanılmıştır. Araştırmada elde edilen bulgulara göre, örgüt kültürünün alt boyutları ile algılanan kurumsal itibarın alt boyutları arasında anlamlı ve pozitif ilişkiler olduğu tespit edilmiştir. Diğer bir ifade ile çalışanların örgüt kültürünü benimseme düzeyleri arttıkça, algılanan kurumsal itibarın da arttığı sonucuna ulaşılmıştır.

Abstract Background Demand for eye care has increased in recent decades in China due to rapid socioeconomic development and demographic shift. Knowledge of output and productivity of ophthalmic services would allow policymakers to optimize resource allocation, and is therefore essential. This study sought to map the landscape of ophthalmic services available in Shanghai, China. Methods In 2018, a government-led survey was conducted of all 86 tertiary/secondary hospitals and five major private hospitals providing eye care in Shanghai in the form of electronic questionnaire, which encompassed ophthalmic services (outpatient and emergency room [ER] visit, inpatient admissions, and surgical volume) and service productivity in terms of annual outpatient and ER visits per doctor, inpatient admissions per bed, and surgical volume per doctor. Comparisons were made among different levels of hospitals with categorical variables tested by Chi-square analysis. Results The response rate was 85.7%. The Eye and Ear, Nose, and Throat (EENT) Hospital was the largest tertiary specialty hospital, and alone contributed to the highest 21.0% of annual ophthalmic outpatient and ER visits (visits per doctor: 5460), compared with other 26 tertiary hospitals, 46 secondary hospitals and five private hospitals (visits per doctor: 3683, 4651 and 1876). The annual inpatient admission was 20,103, 56,992, 14,090, and 52,047 for the EENT Hospital, all the other tertiary hospitals, secondary hospitals and five private hospitals, respectively. Turnover rates were highest for the EENT Hospital and private hospitals. The average surgical volume at the EENT Hospital was 72,666, exceeding that of private (15,874.8) and other tertiary hospitals (3366.7). The EENT Hospital and private hospitals performed 16,982 (14.2%) and 55,538 (46.6%) of all cataract surgeries. Proportions of both complicated cataractous cases and complicated cataract surgeries at the EENT Hospital was the highest, followed by other tertiary and secondary/private hospitals (P

OBJECTIVE: Burnout among physicians in public hospital has become a major public health issue in most Western countries. Qualitative literature has underlined the importance of interpersonal and group aspects in this context. Yet, no qualitative study has ever explicitly explored workplace direct environment’s association with physicians’ burnout. This study aimed to fill this gap. METHODS: This qualitative study used the five-stage inductive process to analyse the structure of lived experience (IPSE) approach and was conducted in French hospitals. We interviewed 45 participants – 16 with a lived experience of burnout and 29 of their colleagues – 19 women/26 men, (13 radiologists, 12 gastroenterologists, 10 gastrointestinal surgeons and 10 residents) from February 2018 to April 2019. Data analysis followed the IPSE analytic procedure and was conducted in two stages: three individual researchers carried out independent work and the group collectively pooled data. RESULTS: Three axes of experience were identified: (i) the loss of meaning, that is being a doctor, no longer has any meaning in the actual context of public hospitals; (ii) “the tower of Babel”, the impossibility of dialogue with both management and colleagues; and (iii) physicians’ daily interactions: too many conflicts, too much pressure and not enough recognition. CONCLUSION: Physicians in this study described being exposed to a deleterious atmosphere, experiencing both emotional abuse and structural violence within the workplace. They considered that such an environment could contribute to the development of burnout. Further research is necessary to assess this hypothesis.

Background: Physician self-referral occurs where a full-time paid doctor diverts patients from one hospital to another in which he or she has financial interest. Aim: This study is aimed at investigating the views of service users, physicians and policymakers on physician self-referral practice in public hospitals in Nigeria. Setting: The study was carried out in Enugu urban area of South East Nigeria. Methods: A mix of qualitative and quantitative methods was used to collect information from different categories of stakeholders. Service user views were explored through analysis of four focus group discussions involving 26 participants and 407 questionnaires completed with household members who had recently visited a public hospital and then gone to private hospitals. In-depth interviews were completed with 15 public sector doctors not involved in dual practice and eight key policymakers. Results: Thirty-four of 407 respondents (8.4%) visiting a public hospital were diverted to a private facility associated with the attending public hospital doctor. The research examined age, gender and socio-economic status (SES) as factors that might influence the likelihood of patient diversion. Advice to transfer to a private clinic usually came directly from the doctor involved but might also come from nurses. Conclusion: Physician self-referral in Nigeria could take different forms. It was found that both direct and indirect forms of diversion exist, suggesting that this is an organised practice in which dual-practice doctors and supporting hospital staff members cooperate. The study recommends, among other things, that service users should be adequately protected from any form of diversion to private practice by the public system employee doctors. Contribution: This study contributes to understanding the extent and pattern of patient diversion in public hospitals in Nigeria. The findings reveal coordinated tactics for diverting public hospital patients and provide a direction for future research in negative behaviour among healthcare professionals in Nigeria.

The government performance appraisal of public hospitals serves as an effective management tool to promote high-quality development. It is also an important means of realizing the “Healthy China” initiative. Since the founding of the People's Republic of China, changes in performance appraisal have been divided into the following four periods: the early stage of performance appraisal (1949–1977), the exploration period (1978–2008), the development period (2009–2018), and the integration period (2019–present). This clarifies the regional practice of public hospital performance and identifies the institutional factors of the evolution. It also demonstrates that administrative forces, market-driving forces, and mission-driving forces combine to bring about change in the public hospital performance appraisal system. However, problems such as insufficient application of performance appraisal and coordination between health administrative departments and medical insurance departments still loom large.

ObjectivesWork-related fatigue is a serious safety risk to nurses and their patients. This study aimed to assess self-reported work-related accumulative fatigue of nurses and its associated factors.MethodsA questionnaire survey of 2,918 clinical nurses conveniently sampled from 48 public hospitals across six provinces in China was conducted. The “Self-diagnosis Checklist for Assessment of Workers' Accumulated Fatigue” was adopted to assess the level of work-related accumulative fatigue of the study participants. Chi-square tests and ordinal regression analyses were performed to determine the sociodemographic characteristics associated with work-related accumulative fatigue.ResultsAbout one third of respondents reported low work-related accumulative fatigue, compared with 23.1% reporting high and 24.6% reporting very high levels of work-related accumulative fatigue. Higher levels of work-related accumulative fatigue were associated with female gender (AOR = 0.614 for male relative to female, p = 0.005), age between 30 and 40 years (AOR = 1.346 relative to >40 years, p = 0.034), 5–10 years of work experience (AOR = 1.277 relative to >10 years, p = 0.034), and bachelor or above degree qualifications (AOR = 0.806 for associate degree relative to bachelor or above degree, p = 0.007). Those who worked in rural county hospitals (AOR = 0.816 for metropolitan relative to rural county hospitals, p = 0.006) and resided in central China (AOR = 1.276 relative to western China, p = 0.004) had higher odds of reporting higher levels of work-related accumulative fatigue.ConclusionHigh levels of work-related accumulative fatigue are evident in nurses of public hospitals in China. The problem is more serious in the female nurses in their mid-career and those who worked in the central region and rural setting.

BackgroundBeijing is a city with high concentration and congestion of quality medical resources in China. While moderate slack seems to be beneficial to the improvement of medical quality. The actual relationship between hospital slack resources and their performance deserves further exploration. The study aims to analyze the slack resources of public hospitals in Beijing and investigate the relationship between slack and hospital financial performance. Finding a reasonable range of slack to optimize resource allocation.MethodsThe panel data of 22 public hospitals in Beijing from 2005 to 2011 were selected as the sample, and the DEA model was applied to measure the main variable using DEAP 2.1. Descriptive statistical analysis was performed using Excel and STATA 15. Pearson correlation coefficient analysis and variance inflation factor test were performed for each variable to avoid multicollinearity. The HAUSMAN test was used to determine the appropriate panel regression model, and then to analyze the influence relationship between the variables.ResultsFrom 2005 to 2011, hospital slack resource transitioned from high to low. The slack measured by the DEA model has an inverted U-shaped relationship with financial performance, with ROA increasing from 4.088 to 8.083 when slack increases from 0 to about 0.378, and then showing a decreasing trend; slack measured by financial indicators has a transposed S-shaped relationship with financial performance, with ROA increasing when slack increase from 3.772 to 5.933.ConclusionsThe slack resources of Beijing public hospitals decreased year by year from 2005 to 2011. Moderate slack resources are conducive to the improvement of healthcare quality, but when slack resources increase to a certain level, it will have a negative impact on healthcare quality. Therefore, hospital managers should control the slack within a moderate range according to the hospital operation policy and development plan to obtain the best performance.

Objective: To describe the context of low back pain (LBP) presentations to emergency departments (EDs) by remoteness areas, hospital delineation level and staffing portfolios. Design: A retrospective observational study using routinely captured ED and admission data over a 5‐year period (July 2014–June 2019). Settings: Thirty seven EDs across a large health district in NSW, Australia, covering major cities, inner regional areas and outer regional areas. Participants: Emergency department (ED) presentations with a principal or secondary diagnosis of LBP based on ICD‐10 code (M54.5). Main outcome measures: ED presentation and associated admission measures, including presentation rate, referral source, time in ED, re‐presentation rate, admission details and cost to the health system. Results: There were 26 509 ED presentations for LBP across the 5 years. Time spent in ED was 206 min for EDs in major cities, 146 min for inner regional EDs and 89 min for outer regional EDs. Re‐presentation rates were 6% in major cities, 8.8% in inner regional EDs and 11.8% in outer regional EDs. Admission rates were 20.4%, 15.8% and 18.8%, respectively. Conclusions: This study describes LBP presentations across 37 EDs, highlighting the potential burden these presentations place on hospitals. LBP presentations appear to follow different pathways depending on the ED remoteness area, delineation level and staff portfolio. [ABSTRACT FROM AUTHOR]

Considering the gap observed in studies on health costs, this article aims to propose a cost calculation model for surgical hospitalization. A systematic literature review using PRISMA was conducted to map cost drivers adopted in similar studies and provide theoretical background. Based on the review, an integrated model considering real patient flow was developed using CHEERS guidelines. The micro-costing top-down method was adopted to develop the cost model allowing a balance between the accuracy of the information and the feasibility of the cost estimate. The proposed model fills two gaps in the literature: the standardization of a cost model and the ability to assess a vast number of different surgery costs in the same hospital. Flexibility stands out as an important advantage of the proposed model, as its application enables evaluation of elective and urgent surgeries of medium and high complexity performed in public and private hospitals. As a limitation, the hospital should have hospital information and cost systems implemented. The proposed cost model can provide important information that can result in better decision making. This becomes more relevant in public health, especially in low- and middle-income countries, which faces a lack of resources and whose positive effects can improve healthcare. [ABSTRACT FROM AUTHOR]

通过文献梳理结合相关方访谈, 对公立医院医疗电子票据的多部门用票数据汇聚共享、异地应用下的统筹化管理、公立医院数字服务能力等现状进行定性及定量分析。通过对样本医院“一体化电子会计档案平台”的应用研究, 提出驱动业、财、数、治融合, 建立以数据为主体、以连接和协同为核心的财务数字化转型应用模型及公立医院数字服务体系, 为进一步推动医疗电子票据场景下的社会数字化转型提供借鉴经验及政策建议。 [ABSTRACT FROM AUTHOR]

This study introduces a hybrid method to analyze the abnormal information in big data to precisely monitor, distinguish and exclude anomaly. First, statistical data anomalies are defined and strictly analyzed based on probability distribution events for the purpose of determination of anomaly analysis theory. Then, deep learning is used to monitor and distinguish abnormal data and link the statistical anomaly with practical risk management problems in the public healthcare. Last, three performance indicators from some public hospital are chosen for experiment to check the effectiveness of the proposed method in data anomaly monitoring, distinguishing and exclusion. The experiment result shows the availability of this method in data anomaly identification, processing and control. [ABSTRACT FROM AUTHOR]

Background:The development level of public hospitals has a direct impact on people's health. The reform of the medical industry in China has been gradually underway in recent years, while hospitals face a complex and uncertain environment. This study aims to explore the mechanism of resources slack in buffering environmental uncertainty and promoting innovation in public hospitals.MethodsBased on previous literature related to environmental adaptability, resources slack, and innovation performance, this study has conducted a literature review and has established a study framework. A questionnaire survey has been conducted among clinicians in representative tertiary public hospitals in Beijing. A total of 318 valid data have been eventually obtained, while regression models have been used to analyze the data.ResultsInnovation performance has played a mediating role in the impact of both resources slack and its three dimensions on environmental adaptability of public hospitals. Among them, there has been a complete mediating effect for time slack, while there has been a partial mediating effect for staff and space dimensions.ConclusionThis study found that resources slack in public hospitals can improve environmental adaptability by affecting innovation performance. It is necessary for public hospitals to reserve resources slack to ensure that there is sufficient condition for innovation in the face of uncertain changes.

ObjectiveIt is essential to focus on the rehabilitation of COVID-19 patients after discharge to prevent their long-term sequelae, but there is less research on healthcare organizations enhancing rehabilitation services for patients discharged from COVID-19. Therefore, this study aimed to describe how a public hospital provides better rehabilitation services for patients after being identified as a designated rehabilitation hospital for patients with COVID-19 and attempted to combine the theory of organizational change to analyze how the hospital finally successfully transformed.MethodsA tertiary public hospital located in the center of Xi'an was selected for the study. It was identified as a designated hospital for the rehabilitation of patients discharged from the hospital with COVID-19. Nine hospital leaders and group leaders closely related to the rehabilitation management work were invited to participate in interviews to explore the fact about the hospital's rehabilitation work. The semi-structured interview with the hospital director and the focus group interview with group leaders were used for data collection. Two researchers independently conducted a thematic analysis of these responses.ResultsOne hundred and seventy-eight primary codes, 22 subcategories, six main categories, and one core theme were obtained from data analysis. The main categories include organization and coordination (overall deployment, transfer patient, and external coordination), hospital infection prevention and control (process transformation, ward disinfection, hospital infection training, inspection, and supervision), staff management (staff classification, closed-loop management, and staff health screening), individual services for patients (create an individual scheme, humanistic care, organize special activities, and strengthen communication and guidance), comprehensive supporting (basic medical guarantee, daily necessities guarantee, health and nutrition guarantee, and assistance fund guarantee) and positive transformation (strategic thinking, benchmarking, strengthen cohesion, and expand influence).ConclusionThe hospital had to transform its operations in the face of a complex environment during the pandemic. After deciding to transform, the hospital effectively prevented nosocomial infections and provided rehabilitation services to 583 patients through systematic management measures such as organizational coordination, staff classification, and personalized services. In the end, it has been successfully transformed and has grown rapidly. To ensure that it can continue to grow sustainably, the hospital enhanced the new ways that have emerged from this transformation.

Abstract Background Patient experience is recognised as a quality of care indicator and increasingly health services are working on achieving set targets and improving their performance. Interventions at the point of care targeting communication with patients, patient engagement in care processes and discharge planning are associated with better patient experience. However, their efficacy and application to different contexts are still unclear. The aims were to describe the interventions implemented by health services to improve patient experience, their impact on overall patient experiences and specific experiences in areas of communication, discharge planning, patient education on treatment/tests, the physical environment and access to care. Methods Secondary data analysis of the Victorian Healthcare Experience inpatient surveys reported in September 2016 and 2018 and content analysis of interventions published in the Victorian Quality Account for 2017 from 59 public health services in Victoria, Australia. The interventions were categorised using an adapted taxonomy of professional interventions by the Cochrane EPOC Review Group. Univariate tests and confirmatory factor analysis were conducted to test measure invariance across the 2016 and 2018 groups and examine the association between each of the intervention categories on overall patient experience measure and specific outcome measures. Results This study found that the overall patient experience was consistent (93%) between 2016 and 2018 samples. In comparing impact, a single intervention rather than none or multiple interventions in communication, respect and dignity and treatment and disease education areas were associated with a higher level of the overall patient experience. Interventions in waiting time, access to service, care continuity and emotional support categories were associated with a decrease in overall patient experience. Conclusion This study found that to improve the overall patient experience, more focus is needed on evidence-based interventions in dignity and respect and emotional support. Furthermore, the choice of interventions should be guided by evidence of their efficacy and prioritising implementing one intervention well, provides more gains.

Purpose - The purpose of this study is to find out the implementation of green accounting in Public Hospitals in Malang and to determine the preferences of Public Hospitals in running their business. Method - This research is a descriptive quantitative study conducted by survey method. The total of population are 40 Public Hospitals in Malang Raya and the sample obtained as respondents are 37 Public Hospitals spread across Malang District, Malang City and Batu City. The sample selection used probability sampling by sending a questionnaire to the entire population. Result - The results showed that the green accounting practices in Public Hospitals in Malang Raya based on financial activities, social activities and environmental activities had been implemented properly and consistently. Public Hospitals with higher types tended to be better and more consistent in applying green accounting than Public Hospitals with lower types (classes). Implication - With the awareness of Public Hospitals in Malang Raya to implement green accounting in the accountability of their business activities, it can have an impact, especially on environmental sustainability and the welfare of the community around the Public Hospital from the impact of the resulting waste. Originality - The concept of green accounting can also be implemented to Public Hospitals as a public entity. On this basis, of course, it is necessary to conduct research on the implementation of green accounting in Public Hospitals as a public entity so that in its operational activities it does not only consider the financial aspects to generate profits, but also considers environmental and social aspects. As a result, its business can have an impact especially on environmental sustainability and the welfare of the community around Public Hospitals from the impact of the waste produced.

Background: In the past decade, various breastfeeding policies were implemented in Hong Kong, including changes in perinatal guidelines in public hospitals, adoption of the Baby-Friendly Hospital Initiative (BFHI), provision of guidelines for the marketing of formula milk, penalisation of discrimination towards breastfeeding, and extension of the statutory maternity leave. Meanwhile, the COVID-19 pandemic brought new challenges and opportunities to breastfeeding practices. Infection control measures in public hospitals included the cancellation of antenatal classes, hospital tours, and postnatal classes; suspension of perinatal visiting periods; and compulsory separation of COVID-19 positive mothers from newborns. In addition, work-from-home policies were widely implemented. This study aimed to identify the associated factors of six-month predominant breastfeeding (PBF), and to evaluate the impact of COVID-19 on breastfeeding practice. Methods: This study was conducted from 1 March 2021 to 7 April 2021 using a mixed-methods approach. An electronic questionnaire was distributed to members of breastfeeding or parenting groups who have had breastfeeding experience in the past 10 yrs. Logistic and linear regression analyses were conducted to identify factors associated with six-month PBF both in general and during the pandemic period. A qualitative content analysis was conducted using an inductive approach. Results: The study included 793 participants. Giving birth in a public hospital (OR 2.21; 95% CI 1.46, 3.34) and breastfeeding support from family and friends (OR 1.28; 95% CI 1.05, 1.57) were significantly associated with six-month PBF, even during COVID-19. Factors associated with the self-rated impact of COVID-19 on breastfeeding include working from home, the perceived immunological benefits of breastfeeding, and the wish to avoid breastfeeding or expressing breast milk in public premises. Furthermore, breastfeeding practice in public hospitals was more likely to be affected by the busyness of staff, while private hospitals had worse rooming-in practices and staff who had inadequate breastfeeding knowledge. Conclusions: Giving birth in a public hospital and having breastfeeding support from family and friends were associated with six-month PBF. Furthermore, COVID-19 in Hong Kong had an overall positive impact on six-month PBF. Further studies should investigate the impact of hospital practices and the COVID-19 pandemic on breastfeeding behaviours. [ABSTRACT FROM AUTHOR]

Occupational health and safety (OHS) risk assessment studies have gained importance recently as a result of increasing occupational accidents and occupational diseases. The health sector has a greater risk than many sectors for occupational accidents and occupational diseases. Although the health sector is one of the priority sectors in Turkey, OHS practices have not been fully implemented in this field. For this reason, this study adopts a two-stage approach to assess the OHS risks in the health sector by combining the Fine-Kinney and multi-criteria hesitant fuzzy linguistic term set (HFLTS) methods. The proposed method was applied to the OHS risks in the operating room of a public hospital in Turkey. As a solution to the problem, first, the potential hazards and related risks in the operating room were determined by the experts. In this first stage, 44 hazards were determined from the opinions of experts and records of past incidents. Parameter weights were then determined using the multi-criteria HFLTS method. The multi-criteria HFLTS method was used to evaluate seven hazards to be categorized as substantial-risk or higher according to the Fine-Kinney method, taking into account parameter weights. Sensitivity analysis was then carried out. Finally, actions were taken to mitigate the risks. [ABSTRACT FROM AUTHOR]

This paper was aimed to evaluate comprehensively the level of high ⁃ quality development of public hospitals in 16 cities in Anhui Province in 2020 by using the variation coefficient method, the rank sum ratio method, and the coupling coordination degree model to calculate the coupling coordination development level. The results showed that the high ⁃ quality development level of public hospitals in Hefei, Wuhu and Anqing ranked the top three； while Suzhou, Chizhou and Huangshan ranked bottom. From a regional perspective, the development level of public hospitals in central Anhui was highest, followed by northern Anhui and southern Anhui. The development of public hospitals in 14 cities in Anhui Province had reached the coordinated level, accounting for 87.50%，while the imbalance existed in 2 cities, accounting for 12.50% . From a regional perspective, southern Anhui was on the verge of maladjustment, central Anhui was faced with moderate maladjustment, and northern Anhui was barely coordinated. To improve the high⁃quality development level of public hospitals in Anhui Province, we need to improve the medical and health service system and promote the coordinated development of public hospitals; strengthen the refined management and improve the operation level of public hospitals; improve the service capacity of public hospitals by focusing on discipline construction; and improve the service mode of public hospitals and patients’ satisfaction with medical treatment. [ABSTRACT FROM AUTHOR]