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Background: Previous studies have demonstrated that high levels of physician empathy may be correlated with improved patient health outcomes and high physician job satisfaction. Knowledge about variation in empathy and related general practitioner (GP) characteristics may allow for a more informed approach to improve empathy among GPs. Objective: Our objective is to measure and analyze variation in physician empathy and its association with GP demographic, professional, and job satisfaction characteristics. Methods: 464 Danish GPs responded to a survey containing the Danish version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP) and questions related to their demographic, professional and job satisfaction characteristics. Descriptive statistics and a quantile plot of the ordered empathy scores were used to describe empathy variation. In addition, random-effect logistic regression analysis was performed to explore the association between empathy levels and the included GP characteristics. Results: Empathy scores were negatively skewed with a mean score of 117.9 and a standard deviation of 10.1 within a range from 99 (p5) to 135 (p95). GPs aged 45–54 years and GPs who are not employed outside of their practice were less likely to have high empathy scores (≥120). Neither gender, nor length of time since specialization, length of time in current practice, practice type, practice location, or job satisfaction was associated with odds of having high physician empathy. However, odds of having a high empathy score were higher for GPs who stated that the physician-patient relationship and interaction with colleagues has a high contribution to job satisfaction compared to the reference groups (low and medium contribution of these factors). This was also the trend for GPs who stated a high contribution to job satisfaction from intellectual stimulation. In contrast, high contribution of economic profit and prestige did not contribute to increased odds of having a high empathy score. Conclusions: Albeit generally high, we observed substantial variation in physician empathy levels among this population of Danish GPs. This variation is positively associated with values of interpersonal relationships and interaction with colleagues, and negatively associated with middle age (45–54 years) and lack of outside employment. There is room to increase GP physician empathy via educational and organizational interventions, and consequently, to improve healthcare quality and outcomes.

International audience; The organisation of production care is a task that requires three different levels of competence: operational, structural and learning skills. The organisational requirements (OR) of the Head Nurse (HN) are often centered on the operational level, to the detriment of the two other levels. This difficulty is due to the organisation which presents limited political, cognitive and pragmatic levels of rationality. The aim of this study is to identify the impact of a third party in regards to the organisation and its effect of the HN’s OR. An educational device puts HN students in the position of a third party to allow them to work on an organisational problem delegated by a HN. The research-intervention followed 17 projects over one year.This device has legitimised the problem by recognizing the difficulties in nursing and re-configuring relations between healthcare professionals in a political dimension. The methods employed by the third party reassured the HN and completed their knowledge, bringing particular focus on the importance of methodology and managerial posture. In practice, the third party relaunched the HN in his power to act and coordinate different actors of a team. The third party helps develop the HN’s OR and complete certain limits of his rationality. Nevertheless, difficulties still remain in the development of practices outside the medical team, limiting its reach to other services.A unit managerial support, a collective schedule and open spaces of discussion are recommended to bring structure and support to the OR.; L'organisation de la production de soins peut être considérée comme un travail d'organisation (TO) décomposé en trois niveaux, opérationnel, organisationnel et d'apprentissage. Le TO du cadre de santé (CdS) se concentre souvent au niveau opérationnel, au détriment des deux autres niveaux. Cette difficulté vient de l’organisation qui présente une rationalité politique, cognitive et pragmatique limitée. L'objectif de l’étude est d'identifier l'impact d'un tiers sur l'organisation et l'effet sur le TO du CdS. Un dispositif pédagogique met des étudiants cadres en position de tiers pour travailler un problème organisationnel délégué par un CdS. La recherche-intervention a suivi 17 projets sur une année.L’action de ces tiers a permis de légitimer le problème, reconnaitre les difficultés des soignants, reconfigurer les relations dans une dimension politique. Les méthodes employées par le tiers ont réassuré le CdS et complété ses connaissances. Pour les CdS, les apprentissages de la démarche concernaient la méthodologie et la posture managériale. En pratique le tiers a relancé le CdS dans son pouvoir d'agir et synchronisé les interrelations autour du TO. Le tiers aide pour développer le TO et combler certaines limites de la rationalité politique, cognitive et pragmatique. Les difficultés à faire évoluer les pratiques au-delà de l'équipe soignante limite toutefois la portée de l’action.Il est préconisé une unité de soutien managérial pour apporter la structure et l'accompagnement au TO, de mettre à l'agenda collectif le TO et de développer des espaces de discussion sur le TO.

Background: The number of forced hospitalizations has increased across Europe. One way to reduce these is to set up mobile crisis teams. A reform of psychiatry in Belgium allowed the creation of these mobile teams. These offer an alternative to forced hospitalization. Subjects and methods: 196 situations were referred to the mobile crisis team located east of Brussels in 2017. We examined the orientation of these requests according to the applicants and the reasons for them. Results: It appears that the health sector has the best indications for using the mobile crisis team. Conclusion: Access to psychiatric care is of major importance in Western societies. The creation of mobile teams increases this accessibility and should reduce the need for forced hospitalizations. These observations must be confirmed.

Planned home births happen across Europe, but there are countries and formal limitations can be found by This article draws upon a short research project conducted in Denmark in March 2014, which aimed to explore the organization of home birth in Denmark and to compare it to the Portuguese case. Private home births, in Portugal, and publicly funded home births, in Denmark, show interesting similarities when looking at the individual experience of choosing and planning a birth at home. However, through this comparative analysis, I argue that the limitations imposed around the option of home birth in Portugal raise important inequalities between women and families planning to give birth at home and those planning a hospital birth. The success:fa models found in Denmark can potentially serve as grounds for a broader discussion and as a trigger for change in Portuguese policies, to promote ethical and evidence based practices among professionals, and the improvement in perinatal health outcomes for families who experience planned home births. info:eu-repo/semantics/acceptedVersion

Introduction: Flanders (Belgium) is searching for innovative solutions to tackle the challenges in elderly care. A care living labs program was launched in 2013 as a testing and experimentation space. The objective was to create new care concepts, services, processes and products together with the end users, and to test them in practice in 23 care innovation projects. These projects are very diverse, with topics including technology, housing, informal care networks, mobility, care management and care and cure integration. From a prior plan evaluation study it became apparent that direct references to the organization of care and the quality of working life of the care professionals could seldom be found in the project plans. These issues could however be crucially important for the projects to be successful. Moreover, we did not find any previous study of care living labs which specifically focused on these issues. The main research question here is: what is the impact of the 23 care innovation projects on the organization of care and the quality of working life? Theory: Drawing on Sociotechnical Systems theory, we used an organizational model (Van Hootegem, 2000) to conceptualize the possible impact on the organization of care. The impact on the quality of working life was conceptualized by using the Job Demand / Control model of Karasek (1979). Methods: A mixed method approach was applied. A document analysis was made of the initial project proposals. Subsequently, near the end of each care innovation project, an in-depth interview was conducted with the project coordinator, using a semi-structured questionnaire. Results: All 23 care innovation projects resulted in minor or major changes in the organization of care (such as changes in task division). Each project did impact the quality of working life of at least one type of care professionals (e.g. nurses), and in many cases multiple types of care professionals were affected. During the projects, many care professionals experienced an increase in job demands and steady or slightly increased job controls. According to the project coordinators the increase in job demands was expected to be temporary, with a decrease following once the innovation would be fully established. We also noticed a different impact on the quality of working life between various types of care professionals. Conclusions: Although the 23 care innovation projects in general did not explicitly aimed at changing the organization of care or affecting the quality of working life of the care professionals involved, our study shows a clear impact on both dimensions. Lessons learned: Implementing care innovations is likely to have implications for the organization of care and the quality of working of life. In order to avoid unintended implications, future care innovation projects are advised to take this explicitly into consideration. Limitations and future research directions: Further research is needed to differentiate between possible impacts, depending on the type of care innovation involved.

Background Patient satisfaction with the quality of primary health care (PHC) in Kosovo has not been previously reported. Our aim was to assess the level and socio-economic correlates of satisfaction of PHC users (also referred to as patients’ evaluation) in Kosovo, a transitional country in the Western Balkans. Methods A cross-sectional study was conducted in 2010 in Gjilan region, Kosovo, including a representative sample of 1039 PHC users (87% response). Patients’ evaluation of PHC services was assessed through EUROPEP, a 23-item instrument tapping different aspects of medical encounter. Results Mean age of survey participants (56% females) was 41+ 16 years. About 50% of the participants were satisfied with the overall quality of medical services, doctor–patient relationship and organization of care. Younger (below median age), urban and employed PHC users reported a significantly higher satisfaction level with the overall health encounter quality. Conversely, there were no sex or educational differences. Conclusions Considerably fewer PHC users in Kosovo were satisfied with the overall medical encounter compared with their European counterparts. This new and useful evidence may support health professionals and policy makers for improving the quality of PHC in Kosovo, a country struggling and mainstreaming all energies in order to get international recognition.

Background Chronic illness health interventions aim to strengthen individuals' wellness resources, in addition to their ability to handle their condition. This presupposes a partnership between patients and professionals and flexibility in care organization. Aim This study aims to investigate possible changes in individuals' sense of coherence while living with long-term illness as they engage in a broadly applicable health promotion intervention developed in specialist care settings that was later implemented in the community care context. Method This study had a pre–postdesign. Sense of coherence was measured using the SOC-29 questionnaire at baseline and within 14 days of programme completion. The total baseline sample included 108 Norwegian adults (aged 21–89) with chronic illness. Data were analysed using paired samples t-tests. Results In both clinical sites, the total sample's mean SOC score changed positively from the baseline to the follow-up 4 months later. This change was larger for the participants in the community care context. Manageability increased significantly for women. Significant positive changes in SOC score and the manageability dimension were also identified among participants who had children. Similar findings were found for those who were living with a partner, as well as for public transfer payment recipients. Conclusion The intervention contributed to a positive change in participants' SOC while living with illness. The findings revealed that the intervention is a flexible health promotion tool across age, diagnostic categories and clinical sites. The community participants' SOC changed the most, which indicates that the intervention is especially relevant in the follow-up of persons living with long-term illness within the community. The intervention contributes to a shift of perspectives in health care towards strenght-based care and health within illness.

Background. The quality of recording of clinical data in diabetes care in general practices is very variable. It has been suggested that better recording leads to improved glycaemic control.Objectives. The purpose of this study was to assess the completeness of recording by GPs of data from type 2 diabetes patients; to compare recorded and missing data; and to investigate the association between completeness and glycaemic control.Methods. A cross-sectional survey was carried out in 52 general practices. Medical records were scrutinized for the presence of 11 variables. Examining patients through an active approach completed incomplete records. We compared recorded and unrecorded items. Completeness of recording was determined at both patient and practice levels.Results. Fifty-two general practices with 1641 type 2 diabetes patients cared for by the GP participated. The frequency of absence of any particular item ranged from 20 to 70%. Weight, systolic blood pressure and HbA(1c) were slightly lower in patients with those items missing on their files, and more such patients were non-smokers (P Conclusion. Records often were incomplete, which hampers a systematic approach to care of diabetic patients. However, the lack of association between completeness of data recording and control of glycaemia indicates that improved recording is not a valid indicator of good quality of care.

These leaders celebrate the ACA's successes, reflect on its shortcomings, and explain the politics that led to passage of the landmark act.

Background Patient safety can be increased by improving the organization of care. A tool that evaluates the actual organization of care, as perceived by multidisciplinary teams, is the Care Process Self-Evaluation Tool (CPSET). CPSET was developed in 2007 and includes 29 items in five subscales: (a) patient-focused organization, (b) coordination of the care process, (c) collaboration with primary care, (d) communication with patients and family, and (e) follow-up of the care process. The goal of the present study was to further evaluate the psychometric properties of the CPSET at the team and hospital levels and to compile a cutoff score table. Methods The psychometric properties of the CPSET were assessed in a multicenter study in Belgium and the Netherlands. In total, 3139 team members from 114 hospitals participated. Psychometric properties were evaluated by using confirmatory factor analysis (CFA), Cronbach’s alpha, interclass correlation coefficients (ICCs), Kruskall-Wallis test, and Mann–Whitney test. For the cutoff score table, percentiles were used. Demographic variables were also evaluated. Results CFA showed a good model fit: a normed fit index of 0.93, a comparative fit index of 0.94, an adjusted goodness-of-fit index of 0.87, and a root mean square error of approximation of 0.06. Cronbach’s alpha values were between 0.869 and 0.950. The team-level ICCs varied between 0.127 and 0.232 and were higher than those at the hospital level (0.071-0.151). Male team members scored significantly higher than females on 2 of the 5 subscales and on the overall CPSET. There were also significant differences among age groups. Medical doctors scored significantly higher on 4 of the 5 subscales and on the overall CPSET. Coordinators of care processes scored significantly lower on 2 of the 5 subscales and on the overall CPSET. Cutoff scores for all subscales and the overall CPSET were calculated. Conclusions The CPSET is a valid and reliable instrument for health care teams to measure the extent care processes are organized. The cutoff table permits teams to compare how they perceive the organization of their care process relative to other teams.

Por medio de este estudio se analiza el papel de las mujeres y de las familias en la producción de los cuidados en salud desde los discursos que producen los equipos de salud y el análisis de las fichas familiares en un CESFAM de una localidad urbano-rural de la Región Metropolitana. Se concluye que a pesar de las reformas modernizadoras impulsadas por el Estado en el sector salud, se perpetúa el lugar tradicional de las mujeres y su condición de género, así como un ideario de familia sustentado en la clásica división sexual del trabajo. Asimismo se aprecia que a pesar de la centralidad del papel de las mujeres en la producción de la salud familiar, este permanece invisibilizado y sólo se transparenta con relación a la responsabilidad de estas en las problemáticas familiares. We have analyzed the role of women and their families regarding the health group speeches and the analysis of the family records from CESFAM in an urban rural place in the Metropolitan region. It is concluded that in spite of the modern reforms boosted by the state health department the traditional role of women and their genre condition remains the same as well as their way of living supported by the classical sex division in their jobs. At the same time it is observed that in spite of the central role of women in maintaining the family health, this remains unseen and it is only observed in their responsibilities in the family circumstances.

Background Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care’s complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service. Methods Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data. Results Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries. Conclusion This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations. Improving the organization of palliative care: identification of barriers and facilitators in five European countries This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Introduction: Miscarriage is common, occurring in nearly 20% of pregnancies. Most women experiencing symptoms such as bleeding or abdominal pain in early pregnancy consult emergency services, the front line of care. While research has shown the psychological and physical effects of miscarriage on women, less is known about how emergency services are organized to manage their care. Objective: To describe and analyze the organization of emergency services for women experiencing miscarriage. Methods: A multiple case study was conducted in four emergency rooms in Quebec, Canada, between 2014 and 2015. A reference framework setting out an organized system of action in care adapted to emergency services was used to analyze 198 medical records of women who experienced miscarriage and were treated in these emergency rooms. Results: From the analysis, observations were made regarding the accessibility, responsiveness, and productivity of emergency services, as well as deficiencies in care continuity. While medical treatments generally corresponded to standards, system responsiveness was poor, with long waits that may have added to women’s psychological distress. Gaps were observed in care continuity, effectiveness, and quality, including missing notes in charts, high readmission rates, and lack of referrals to relevant psychosocial and other support services. Discussion and conclusion: Recommendations include developing clinical guidelines, care trajectories, and checklists for nurses’ clinical assessments. As well, early pregnancy assessment clinics are an innovative care delivery model that has proven effective in reducing admissions, shortening hospitalizations, and providing comprehensive support services., Introduction : Environ 20 % des grossesses se terminent par une fausse couche. La majorité des femmes qui présentent des symptômes de fausse couche tels les saignements ou les douleurs pelviennes ou abdominales consultent les services d’urgence. Les effets psychologiques et physiques de cet événement sur les femmes sont bien connus, or on sait moins comment les services d’urgence s’organisent pour les prendre en charge. Objectif : L’étude visait à décrire et analyser l’organisation des services d’urgence. Méthodes : Une étude de cas multiples a été réalisée dans 4 urgences du Québec (Canada) entre 2014 et 2015. Le cadre de référence décrivant un système organisé d’action a permis d’analyser 198 dossiers médicaux de femmes vivant une fausse couche et prises en charge dans ces urgences. Résultats : L’analyse permet de faire des constats sur l’accessibilité, la réactivité et la productivité des services d’urgence, de même que sur le manque dans la continuité des soins. La réactivité du système est pauvre, avec des attentes prolongées qui pourraient contribuer à la détresse des femmes. Des lacunes existent dans la continuité des soins, l’efficience et la qualité, incluant des données absentes dans les dossiers, un taux élevé de réadmission et l’absence de références à des ressources psychologiques. Discussion et conclusion : Des recommandations incluent le développement de lignes directrices et de trajectoires de soins. Les cliniques d’évaluation précoce de la grossesse sont des modèles innovants ayant démontré leur efficacité pour réduire les admissions, raccourcir les hospitalisations, et offrir des services de soutien plus complets.

Background Despite its popularity, the effectiveness of audit and feedback in support quality improvement efforts is mixed. While audit and feedback-related research efforts have investigated issues relating to feedback design and delivery, little attention has been directed towards factors which motivate interest and engagement with feedback interventions. This study explored the motivating factors that drove primary care teams to participate in a voluntary audit and feedback initiative. Methods Interviews were conducted with leaders of primary care teams who had participated in at least one iteration of the audit and feedback program. This intervention was developed by an organization which advocates for high-quality, team-based primary care in Ontario, Canada. Interview transcripts were coded using the Consolidated Framework for Implementation Research and the resulting framework was analyzed inductively to generate key themes. Results Interviews were completed with 25 individuals from 18 primary care teams across Ontario. The majority were Executive Directors (14), Physician leaders (3) and support staff for Quality Improvement (4). A range of motivations for participating in the audit and feedback program beyond quality improvement were emphasized. Primarily, informants believed that the program would eventually become a best-in-class audit and feedback initiative. This reflected concerns regarding existing initiatives in terms of the intervention components and intentions as well as the perception that an initiative by primary care, for primary care would better reflect their own goals and better support desired patient outcomes. Key enablers included perceived obligations to engage and provision of support for the work involved. No teams cited an evidence base for A&F as a motivating factor for participation. Conclusions A range of motivating factors, beyond quality improvement, contributed to participation in the audit and feedback program. Findings from this study highlight that efforts to understand how and when the intervention works best cannot be limited to factors within developers’ control. Clinical teams may more readily engage with initiatives with the potential to address their own long-term system goals. Aligning motivations for participation with the goals of the audit and feedback initiative may facilitate both engagement and impact.

RESUMO - Num contexto em que a prestação de cuidados de Fisioterapia e Reabilitação é identificada como apresentando uma desigualdade e desajustamento da oferta regional superior à dos restantes cuidados de saúde, assim como uma falta de adequação dos preços praticados, perante as condições de oferta e procura actualmente existentes, o presente trabalho tem por objectivo investigar, no domínio do Desempenho, a influência do Financiamento na definição da prestação destes cuidados, tendo como pressuposto genérico que as decisões estratégicas e a reestruturação produtiva das organizações de saúde são condicionadas pelo sistema de preços. Considera-se que o actual sistema de Financiamento/Pagamento provoca um constrangimento na qualidade da resposta destes cuidados a dois níveis: um primeiro nível, ao colocar o pagamento no âmbito dos Meios Complementares de Diagnóstico e Terapêutica (MCDTs) a contratar pelo Serviço Nacional de Saúde, com isso determinando a configuração organizativa do sistema; um segundo nível de constrangimento que incide sobre as estruturas das organizações prestadoras, pela modelação que induz, nomeadamente a nível da sua produção. Na impossibilidade de tratar as duas dimensões do problema, pela falta de indicadores de desempenho deste sector, analisou-se, relativamente ao segundo nível de constrangimento, a produção de fisioterapia de três organizações que, potencialmente, teriam o mesmo o mesmo perfil de oferta por se enquadrarem num mesmo perfil de procura. Os resultados reflectem o pressuposto genérico do trabalho e abrem espaço para colocar como futura hipótese de investigação a razão da(s) causa(s) que poderão estar subjacentes à discrepância encontrada na média de tratamentos por sessão (duas vezes e meia) na produção das duas organizações que foi possível comparar.------------------- ABSTRACT - In a context where the provision of Physical Therapy and Rehabilitation care is identified as having a regional mismatch of supply and inequality above all the others health cares, and a lack of adequacy of prices in the current conditions of supply and demand, the present work has, as main purpose, to investigate, in the field of Performance, the Payment’s influence in shaping the provision of such health care. The general assumption tracking this analysis is that the strategic decisions on productive structure of health care organizations are influenced by the price systems. It is considered that the current Finance / Payment system causes two levels of constraints on the quality of such health care: a first constraint, as it putts its payment under the Supplementary Means of Diagnosis and Therapy (MCDTs), witch ends up establishing the organizational setup of the system; a second level of constraint by modelling the internal structure of these organizations. The lack of indicators characterizing the performance of this sector, addressed the present study to the second dimension, in witch was analysed the physical therapy production in three organizations that, potentially, would have the same profile of supply responding to similar characteristics of demand. The results reflect the above mentioned general assumption that supported the work, and leave an open space for future research, about the reason (s) that lay behind the discrepancy found between the average of treatments per session (two and a half times) in