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Item does not contain fulltext, BACKGROUND: Many countries are looking for ways to increase nurse practitioner (NP) and physician assistant/associate (PA) deployment. Countries are seeking to tackle the pressing issues of increasing healthcare demand, healthcare costs, and medical doctor shortages. This article provides insights into the potential impact of various policy measures on NP/PA workforce development in the Netherlands. METHODS: We applied a multimethod approach study using three methods: 1) a review of government policies, 2) surveys on NP/PA workforce characteristics, and 3) surveys on intake in NP/PA training programs. RESULTS: Until 2012, the annual intake into NP and PA training programs was comparable to the number of subsidized training places. In 2012, a 131% increase in intake coincided with extending the legal scope of practice of NPs and PAs and substantially increasing subsidized NP/PA training places. However, in 2013, the intake of NP and PA trainees decreased by 23% and 24%, respectively. The intake decreased in hospitals, (nursing) home care, and mental healthcare, coinciding with fiscal austerity in these sectors. We found that other policies, such as legal acknowledgment, reimbursement, and funding platforms and research, do not consistently coincide with NP/PA training and employment trends. The ratios of NPs and PAs to medical doctors increased substantially in all healthcare sectors from 3.5 and 1.0 per 100 full-time equivalents in medical doctors in 2012 to 11.0 and 3.9 in 2022, respectively. For NPs, the ratios vary between 2.5 per 100 full-time equivalents in medical doctors in primary care and 41.9 in mental healthcare. PA-medical doctor ratios range from 1.6 per 100 full-time equivalents in medical doctors in primary care to 5.8 in hospital care. CONCLUSIONS: This study reveals that specific policies coincided with NP and PA workforce growth. Sudden and severe fiscal austerity coincided with declining NP/PA training intake. Furthermore, governmental training su

The importance of a sustainable health workforce is increasingly recognised. However, the building of a future health workforce that is responsive to diverse population needs and demographic and economic change remains insufficiently understood. There is a compelling argument to be made for a comprehensive research agenda to address the questions. With a focus on Europe and taking a health systems approach, we introduce an agenda linked to the 'Health Workforce Research' section of the European Public Health Association. Six major objectives for health workforce policy were identified: (1) to develop frameworks that align health systems/governance and health workforce policy/planning, (2) to explore the effects of changing skill mixes and competencies across sectors and occupational groups, (3) to map how education and health workforce governance can be better integrated, (4) to analyse the impact of health workforce mobility on health systems, (5) to optimise the use of international/EU, national and regional health workforce data and monitoring and (6) to build capacity for policy implementation. This article highlights critical knowledge gaps that currently hamper the opportunities of effectively responding to these challenges and advising policy-makers in different health systems. Closing these knowledge gaps is therefore an important step towards future health workforce governance and policy implementation. There is an urgent need for building health workforce research as an independent, interdisciplinary and multi-professional field. This requires dedicated research funding, new academic education programmes, comparative methodology and knowledge transfer and leadership that can help countries to build a people-centred health workforce.

Background: The need for organisational development in primary care has increased as it is accepted as a means of curbing rising costs and responding to demographic transitions. It is only within such inter-organisational networks that small-scale practices can offer treatment to complex patients and continuity of care. The aim of this paper is to explore, through the experience of professionals and patients, whether, and how, project management and network governance can improve the outcomes of projects which promote inter-organisational collaboration in primary care. Methods: This paper describes a study of projects aimed at improving inter-organisational collaboration in Dutch primary care. The projects' success in project management and network governance was monitored by interviewing project leaders and board members on the one hand, and improvement in the collaboration by surveying professionals and patients on the other. Both qualitative and quantitative methods were applied to assess the projects. These were analysed, finally, using multi-level models in order to account for the variation in the projects, professionals and patients. Results: Successful network governance was associated positively with the professionals’ satisfaction with the collaboration; but not with improvements in the quality of care as experienced by patients. Neither patients nor professionals perceived successful project management as associated with the outcomes of the collaboration projects. Conclusions: This study shows that network governance in particular makes a difference to the outcomes of inter-organisational collaboration in primary care. However, project management is not a predictor for successful inter-organisational collaboration in primary care.

Currently, many organizations employ business logic, and therefore business rules, as part of their products and/or services to deliver added value to their customers. However, as the amount of business rules utilized increases, the cohesion between those business rules is not taken into account. This makes it practically impossible to perform proper impact analysis before changes need to be implemented. Furthermore, the configuration of the business logic in products and/or services containing business rules are generally not designed to cope with modifiability. This seems very counterintuitive as previous research already proved that business logic is characterized by the highest change frequency in combination with the highest amount of effort required to perform the changes when compared to other aspects of IS development and maintenance. First, a literature review is conducted to provide an overview of the context of business logic, business rules, the curent state-of-the-art on business rule architectures, neighbouring fields, and modifiability as a measurable quality attribute of a architecture. The literature review was followed by the exploration of three rule-oriented architectures for application in the BRM domain. The three rule-oriented architectures are utilized to construct logical architectures for the cases Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Mellitus (DM) of the NHS, which concern the remuneration of healtcare services. Both the exploration and constuction of logical architectures regarding the three selected architectural candidates is performed according to the design science research approach, including a multitude of validation cycles with subject-matter experts. This was followed by selecting an architecture evaluation method from the body of knowledge to evaluate the architectural candidates on effort required to apply modifications, and therefore a means to analyse modifiability. Based on four criteria the ALMA-method f

As cyber security becomes more important at hospitals, the components of cyber security should be improved as well. Cyber security risk assessment (CSRA) is one of these important components of cyber security. This research develops a Hospital Cybersecurity Risk Assessment Maturity Model (HCRAMM) to enable hospitals to measure the maturity of their CSRA process. The research starts with a systematic literature research and a comparison analysis of CSRA related methods to identify important concepts and requirements for the HCRAMM. The HCRAMM is then further iteratively improved by 17 expert interviews, of which four were used to validate final results, among security officers of hospitals and other cyber security experts in the health-care sector. The developed HCRAMM is translated into a survey, which in turn is distributed among hospitals in the Netherlands. From this thesis research it is concluded that the HCRAMM is a useful tool to measure the maturity of CSRA. Also hospitals have large opportunities to improve their CSRA by increasing the awareness and skills of human capital related to the risk assessment as well as the improvement of process structures, which then could enable the use of more tools and quantification as to improve the maturity. Finally a more sophisticated form of iterative improvement could be obtained from the use of centralized information storage and retrieval considering the data needed and processed during the CSRA process.