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Background: The success of an electronic health records (EHR) system is dependent on the effectiveness, satisfaction, and efficient use of these systems by health professionals. This paper explores the interdependency among effectiveness, satisfaction, and efficient use of Lightwave Health Information Management Systems (LHIMS) which is an EHR by health professionals., Methods: A non-interventional descriptive cross-sectional study design was employed for this research. The study used stratified random sampling for the selection of participants. The population for the study was all the health professionals in the Central Region of Ghana. The number of health professionals who responded to the questions was 1126., Results: The findings suggest that understanding the interdependency of efficiency, effectiveness and satisfaction is crucial for the successful implementation and adoption of LHIMS in healthcare organisations. The study investigated the interdependence among effectiveness, satisfaction, and efficient use of the LHIMS by health professionals, and found a positive but weak significant relationship between these factors., Conclusion: In conclusion, this study aimed to assess the interdependency among effectiveness, satisfaction, and efficient use of LHIMS by health professionals. The. results support a positive but weak significant relationship between satisfaction, effectiveness, and efficient use of the LHIMS. These findings have implications for policymakers and hospital management in their efforts to improve the use of LHIMS. Policymakers can focus on any one of the three usability areas to enhance LHIMS use, with visible effects across the other two domains., Competing Interests: Declarations Ethics approval and consent to participate The research adhered to the guidelines set forth by the Ghana Health Service Ethics Review Committee (GHS-ERC) (GHS-ERC:011/07/21) and the Cape Coast Teaching Hospital – IRB (CCTHERC/EC/2021/095). The research protocols were approved by the Ghana Health Service Ethics Review Committee (GHS-ERC). Before data collection, participants were provided with informed consent forms, assent forms, and a participant information sheet. The informed consent form covered the study objectives, assured participants of anonymity and confidentiality, and emphasised voluntary participation with the freedom to withdraw at any point without consequence. Informed consent was obtained from all the participants and/or legal guardians for the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The government has rapidly promoted the privatisation of healthcare to improve systemic performance, based on the theory that markets improve efficiency. This study aims to measure the efficiency of private hospitals following their expansion and venture into the medical tourism industry through extensive governmental support., Methods: Inpatient utilisation of 101 private, non-specialised hospitals in Malaysia in 2014 and 2018 from the Health Informatics Centre, Ministry of Health Malaysia database was studied using paired samples t-test, analysis of variance (ANOVA), and the Pabón-Lasso model., Results: Better quantitative performance was found among larger hospitals, those with hospital accreditation, and those participating in medical tourism activities. There is a scale effect of efficiency between smaller and larger hospitals. However, when compared within respective size categories, Category 1 (small hospitals with less than 100 beds) has the highest percentage of efficient hospitals (39.3 per cent in 2014 and 35.7 per cent in 2018 in Sector 3 of the Pabón Lasso graphs)., Conclusion: This study has found that a higher bed occupancy rate (BOR) and longer average length of stay (ALoS) are associated with larger private hospitals, hospital accreditation, and participation in medical tourism activities in Malaysia. There is a need to expedite strategic hospitals partnership for resource optimisation and capacity pooling towards producing better performance., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee, MOH, Malaysia (NMRR-19–2888-45815). This study did not include direct human involvement. The datasets on average length of stay, bed occupancy rates, and bed turnover rates provided by the Health Informatics Centre were deidentified and aggregated at hospital level. Therefore, informed consent could not be obtained, as this study involved aggregated hospital performance indicators instead of human subjects. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

BACKGROUND : The efficiency of medical services directly impacts the economic burden of healthcare, making it crucial to analyze the input-output efficiency of various types of medical institutions. However, while hospitals had been extensively analyzed for their efficiency, other types of medical institutions had received limited attention in this regard. METHODS : In this study, we employed data envelopment analysis (DEA) methods based on time series and internal benchmarks to autonomously assess the efficiency of 18 distinct categories of healthcare facilities in China over the past decade. The verification was conducted through the utilization of the critical incident technique (CIT). Additionally, we utilized the Delphi process (AHP) method to evaluate suppliers of medical consumables, implemented a multi-population genetic algorithm for managing these consumethod and analytic hierarchymables efficiently, and applied stakeholder theory to manage medical personnel efficiency.  RESULTS : Our findings indicated that medical institutions capable of providing clinical services exhibited higher levels of efficiency compared to those unable to do so. Multiple indicators suggested redundancy within these institutions. Notably, comprehensive benefit evaluation revealed that clinical laboratory had performed poorly over the past decade. We selected an inefficient medical institution for intervention in reagent management and the work efficiency of medical staff. After implementing the Delphi method and multi-population genetic algorithm for consumable replenishment, the reagent cost was reduced by 40%, 39% and 31% respectively in each of the three experimental groups, compared to the control group. By applying stakeholder theory and process reengineering methods, we were able to shorten quality control management time for medical staff in the experimental group by 41 min per day, reduce clinical service time by 25 min per day, and extend rest time by 70 min per day, while the quality indicators were all meeting the targets. CONCLUSION: By employing various mathematical models as described above, we were able to reduce costs associated with medical consumables and enhance medical personnel work efficiency without compromising quality objectives., Competing Interests: Declarations Ethics approval and consent to participate This study received ethical approval from the Research Ethics Committee (REC) of the Ping An Healthcare Diagnostics Center with the reference number ‘2021 Ethics approval (declaration) No. 67’. The study obtained voluntary and informed consent from all participants, who expressed their willingness to participate. Furthermore, each eligible participant was provided with detailed information about the study and their right to withdraw or decline participation at any point. Additionally, a unique identifier was assigned to ensure the confidentiality and privacy of respondents’ data. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Nurse staffing levels are increasingly challenged while pressures on healthcare systems are rising. There is a clear need to optimise efficiency in healthcare delivery in order to deliver safe, effective and quality health care., Aim: To understand how nurses working shifts spend their time and explore opportunities to improve efficiency in care delivery., Method: A time-motion study was conducted on three acute care wards in a district general hospital in West Wales; 13 nurses were observed over 14 shifts, each activity undertaken was recorded in real time., Findings: In all, 109 hours were observed. Approximately half of nurses' time is spent delivering direct patient care, with medications administration taking the majority of time., Conclusion: A number of recommendations are made involving processes and workforce modelling with the aim of improving efficiency and safety. Further research would be required to assess the impact of their introduction.

Purpose: Network configurations have been proposed as an efficient form of organisation and a promising area of research; however, a lack of conceptual clarity can be noted. The purpose of this review is to allow for a broad appreciation of network configurations and provide guidance for future studies of the concept., Design/methodology/approach: A systematic literature review was conducted based on the PRISMA method; Scopus, Web of Science, PubMed and the Cochrane Library were searched for conference proceedings and journal articles describing organisational networks to integrate resources aimed at care delivery. Around 80 articles were included in the final review and analysed thematically and by use of bibliographic coupling., Findings: The last decades have seen an increase in the frequency of articles describing networks for healthcare delivery. The most common contexts are care for multiple and/or long-term conditions. Three clusters of articles were found, corresponding to different conceptualisations of networks in healthcare: efficiency-enhancing cooperation, efficiency-enhancing integration and involvement for cocreation., Research Limitations/implications: To increase conceptual clarity and allow the research on network configurations in healthcare to produce meta-learnings and guidance to practice, scholars are advised to provide ample descriptions of studied networks and relate them to established network classifications., Originality/value: The current review has only included articles including networks as a key concept, which provides a focused overview of the use of network configurations but limits the insights into similar approaches not described explicitly as networks., (© Emerald Publishing Limited.)

Background: With rising healthcare costs over the last decades, the concept of efficiency has gained popularity in healthcare provision research. As efficiency can be understood and measured in many different ways, it is often unclear what is meant by "efficient health systems" or "efficient healthcare providers"., Objectives: This study aims to analyze and categorize the different definitions and understandings of "efficiency" used in healthcare provision research over time., Methods: We searched five databases (Medline, Embase, CINAHL, Business Source Premier, and EconLit) to conduct a scoping review. Sources were screened independently by two researchers, using the online software Rayyan. Results are reported using PRISMA-ScR., Results: Of 1,441 individual sources identified, 389 were included in the review. Most papers (77.3%) using the term "efficiency" do not include explicit definitions or explanations of their understanding of it. Almost all papers (99.0%) are interested in productive efficiency (vs. allocative efficiency) and more specifically technical efficiency, therefore comparing the number of inputs used and outputs produced. While many papers (70.4%) include some elements of quality of care or health outcomes in their discussion, few (30.3%) include aspects of quality in their measurement of efficiency. Over the last decades, Data Envelopment Analysis has become the main method to measure efficiency. We propose a broad categorization of efficiency definitions that could be used by researchers to improve the comprehensibility and comparability of their research. Key features are the general type of efficiency, inclusion of quality or outcome information, and inclusion of cost information., Discussion: To allow for better comparability and comprehensibility, researchers in healthcare provision should state explicitly which type of efficiency they are studying. To do this, we propose to use combinations of the terms productive efficiency , allocative efficiency , quality-inclusive efficiency , and cost efficiency ., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lötscher-Stamm and Lenzin.)

Introduction: Efficient emergency medical care is becoming more important with continually increasing emergency department volumes. Decreasing door to discharge (D2D) times has been shown to improve patient satisfaction and decrease wait times and health care costs. We hypothesize that standardized onboarding for new faculty physicians in microhospital emergency departments will reduce D2D times., Methods: In this retrospective observational study, D2D times were tracked for newly hired physicians at 2 microhospital emergency departments within an academic health system during 2021-2022. Physicians hired after July 2022 received an onboarding process that emphasized reducing D2D times. D2D times for these physicians were compared with those of physicians hired earlier who did not receive any onboarding. D2D means and standard deviations (SD) of each group were compared with 2-sample t tests., Results: There were 25 newly hired emergency department physicians across both study locations over 2 years; 15 received no onboarding, while 10 received onboarding. At one of the emergency departments, physicians who received onboarding had a significantly reduced mean D2D time compared with those who received no onboarding (119 minutes [SD = 29] vs 146 minutes [SD = 34], P  = 0.049). At the other emergency department, there was no significant difference in D2D times between physicians who did or did not receive onboarding (97 minutes [SD = 35] vs 102 minutes [SD = 30], P  = 0.760). Across both locations, physicians who received onboarding had a nonsignificant reduction in D2D times compared with those who received no onboarding (110 minutes [SD = 32] vs 126 minutes [SD = 39], P  = 0.160)., Conclusions: After implementing an onboarding process for new physician hires, there was a statistically significant decrease in D2D times at one of the microhospital emergency departments. Thus, an onboarding process may represent a simple, cost-effective technique that emergency departments can use to reduce D2D times and prevent overcrowding. Future work may evaluate the efficacy of such processes in non-microhospital emergency department settings., (Copyright© Board of Regents of the University of Wisconsin System and The Medical College of Wisconsin, Inc.)

US health care spending is growing at an unsustainable rate. Since physicians control or influence the majority of spending, it is our responsibility to try and control costs. As surgeons we need to learn and consider the cost of implants and supplies and factor them into our treatment decisions to ensure we are providing value for our patients. Although the burden is on us to become more cost conscious, we should never do it at the expense of quality of patient care., Competing Interests: Disclosure Author has no relevant financial relationships or conflicts of interest with any ineligible companies., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Customarily, academic chairs have embodied the triple role of excellence in clinical work,education and research. With the rapid changes in healthcare, it has become clear that surgical expertise and academic achievements do not necessarily translate into leadership greatness. Currently to successfully run an academic department the chairperson must also be an experienced manager, with an understanding of business administration, financial restrictions, productivity goals, and medical ethics. A successful chair needs to be able to balance variable tasks and diverse people, and be proficient in managing uncertainty and change. In this review we summarize the clinical, academic and administrative challenges associated with running an academic department., Competing Interests: Disclosure None of the authors has a financial interest in any of the drugs, products, or devices mentioned in this discussion or the article being discussed., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Call-center-based telephone triage is an example of a complex sociotechnical system relying on successful interactions between patients, callers, and the integration of many digital technologies. Digital technologies such as computer decision support systems are used to standardize triage outcomes with little consideration of how these unique healthcare systems adapt to maintain functionality in response to real-world operating challenges. Using structured observations of call handlers in two call centers and guided by usability heuristics and the concept of 'workarounds', this paper aims to investigate the effects of technology design on workflow and system adaptations. Opportunities for improvement are highlighted, particularly, assessment prompts, and updating software to reflect dynamic real-world situations. Interactions between system components, especially technological and organizational processes affected workflow, making adaptations at the individual and organizational levels necessary to ensure callers could be triaged safely. System designers could consider these findings to improve systems and procedures during challenging periods., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: IC24 provided funding for travel costs to undertake this research. The third author is directly employed by the organization in which this research was undertaken., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Parametric regression models have been the main statistical method for identifying average treatment effects. Causal machine learning models showed promising results in estimating heterogeneous treatment effects in causal inference. Here we aimed to compare the application of causal random forest (CRF) and linear regression modelling (LRM) to estimate the effects of organisational factors on ICU efficiency., Methods: A retrospective analysis of 277,459 patients admitted to 128 Brazilian and Uruguayan ICUs over three years. ICU efficiency was assessed using the average standardised efficiency ratio (ASER), measured as the average of the standardised mortality ratio (SMR) and the standardised resource use (SRU) according to the SAPS-3 score. Using a causal inference framework, we estimated and compared the conditional average treatment effect (CATE) of seven common structural and organisational factors on ICU efficiency using LRM with interaction terms and CRF., Results: The hospital mortality was 14 %; median ICU and hospital lengths of stay were 2 and 7 days, respectively. Overall median SMR was 0.97 [IQR: 0.76,1.21], median SRU was 1.06 [IQR: 0.79,1.30] and median ASER was 0.99 [IQR: 0.82,1.21]. Both CRF and LRM showed that the average number of nurses per ten beds was independently associated with ICU efficiency (CATE [95 %CI]: -0.13 [-0.24, -0.01] and -0.09 [-0.17,-0.01], respectively). Finally, CRF identified some specific ICUs with a significant CATE in exposures that did not present a significant average effect., Conclusion: In general, both methods were comparable to identify organisational factors significantly associated with CATE on ICU efficiency. CRF however identified specific ICUs with significant effects, even when the average effect was nonsignificant. This can assist healthcare managers in further in-dept evaluation of process interventions to improve ICU efficiency., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The efficient and fluid organization of surgical interventions in an operating room (OR) and operating suite (OS) is important as these are among the most expensive units to run in medical-surgical facilities. The complexity of OS organization requires careful coordination, defined here as the directing of individuals' efforts toward achieving common and explicitly recognized goals. There is currently sparse literature on OS coordination, especially in the French context. This study aimed to respond to this gap by reporting on the coordination mechanisms associated with the perceived performance of OS across 4 facilities in an urban setting in France., Methods: We used a qualitative comparative case study based on ethnographic methodology to explore 4 facilities (2 teaching, 1 general, and 1 private). Several investigation techniques were used for data collection (semistructured interviews, participant and nonparticipant observations, and informal interviews) in the OR, the OS, the regulation council (dedicated to adapting the necessary resources to specific procedures and patients' health status), and the OS council (dedicated to strategic and operational OS transformations and adaptations, and responsible for finding solutions to organizational problems). Analysis was guided by Okhuysen and Bachky's theoretical framework on coordination and multi-team systems theory. Data were compared across the 4 facilities and triangulated using the different techniques to ensure coherence and accuracy., Results: Overall, 48 interviews with health care providers and hospital managers and 200 hours of direct observations were performed. The OR exhibited a high degree of coordination, whereas improved perception of performance in the OS depended on managerial competency, trust, and authority. Perceived performance in the regulation council and OS council, on the other hand, depended on the identification of formal objectives by all stakeholders and the development of common understanding (developing agreement, direct information sharing, creating common perspective, substitution, bringing groups together, and storing of knowledge)., Conclusions: Based on existing literature on multi-team systems (as represented in the OS organization), this study identifies success factors influencing OS coordination. These include the OS manager's leadership skills; the identification of formal system objectives; and professional differentiation between stakeholders (absence/decrease of a sense of belonging to a multi-team system). This differentiation was related to the high degree of specialization within OS teams, each bringing different norms, cultures, and contingencies that induce dissonance in organization and task performance. Interventions targeting these success factors might improve coordination, and thus performance, in the OS., Competing Interests: Conflicts of Interest, Funding : Please see DISCLOSURES at the end of this article., (Copyright © 2024 International Anesthesia Research Society.)

Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: A routine preoperative assessment is considered both ineffective and inefficient. Despite the widespread application of lean thinking in healthcare, there is little evidence of successful experiences in preoperative admissions in order to reduce "No value added" activities. A conceptual framework reporting the drivers (clinic, tools, innovation, organization, and governance) and impacts (patient, efficiency, sustainability, time, learning and growth) was developed. Methodology: Drawing on the experience of an Italian high complexity hospital, this paper analyzes the case study by reporting evidence on how to implement lean in preoperative assessment and how to evaluate the positive results obtained. Results: Applying lean principles, the identification of value improved the appropriateness of care by creating 40 personalized pathways; the value stream resulted in a reduction of "No Value Added Time" from 37% to 28%, chest X-rays from 41% to 14% and cardiac visits from 49% to 37%; the pursuit of continuous flow through innovation contributed to increase the use of digitalization; the new pull organization helped to reduce the average time spent per year by 1.5 h; the continuous improvement was ensured through the governance of results. Conclusion: The proposed framework should be used to improve the quality of care in preoperative admissions by adopting the lean drivers for successful implementation and reporting the impacts., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Analysing and evaluating how efficiently health resources are allocated to county-level Traditional Chinese Medicine (TCM) hospitals in Zhejiang Province, this study aims to provide empirical evidence for improving operational efficiency and optimising resource allocation in these hospitals., Design and Setting: The study employed a three-stage Data Envelopment Analysis (DEA) model to assess efficiency, using data from 68 county-level TCM hospitals. Four input and five output variables related to TCM services were selected for the analysis., Results: The first-stage DEA results indicated that in 2022, the technical efficiency (TE) of TCM hospitals in Zhejiang Province was 0.788, the pure technical efficiency (PTE) was 0.876 and the scale efficiency (SE) was 0.903. The classification of hospitals into four groups based on the bed size showed statistically significant differences in returns to scale (p<0.001). The Stochastic Frontier Analysis regression results were significant at the 1% level across four regressions, showing that environmental variables such as per capita GDP, population density and the number of hospitals impacted efficiency. In the third stage DEA, after adjusting the input variables, the TE, PTE and SE improved to 0.809, 0.833 and 0.917, respectively. The adjusted mean TE rankings by region were West (0.860) > East (0.844) > South (0.805) > North (0.796) > Central (0.731)., Conclusion: There is an imbalance between the inputs and outputs of county-level TCM hospitals. Each region must consider factors such as the local economy, population and medical service levels, along with the specific development characteristics of hospitals, to reasonably determine the scale of county-level TCM hospital construction. Emphasis should be placed on improving hospital management and technical capabilities, coordinating regional development, promoting the rational allocation and efficient use of TCM resources and enhancing the efficiency of resource allocation in county-level TCM hospitals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The appropriate physical layout of hospital services can help resolve management problems by streamlining the work of medical teams, improving the flow of patients between specific areas and the medical support environment. Nevertheless, the academic literature lacks structured research into how the physical layout of hospitals might be improved. Our study aims to fill this research gap, providing information for researchers and professionals who intend to guide the hospital facility layout planning (HFLP) from the steps and prescribed approaches found in the literature., Design/methodology/approach: This study analyzes the current literature status and concerning approaches that support HFLP and identifies their strengths and weaknesses. The literature was classified using the following criteria: approaches for layout generation, approaches for layout evaluation and healthcare facility layout outcomes., Findings: The hospital facility layout outcomes achieved for each phase served as a basis for identifying a list of strengths and weaknesses for the hospital layout facility generation and evaluation approaches. Readers can refer to this paper to identify the approach that best fits the desired goal and the HFLP step., Practical Implications: This is a contribution to current studies into HFLP, and it provides guidelines for selecting the approach to be utilized based on the desired outcome., Originality/value: The paper describes how to conduct an HFLP and lists the strengths and weaknesses of each approach. The research may be used as a strategy for determining which tool is most suited based on the practitioner's target purpose., (© Emerald Publishing Limited.)

Aims: This study aimed to assess the operational efficiency of Sub-District or Tambon Health Promoting Hospitals (THPHs) in Thailand's Eastern Economic Corridor (EEC) and to propose management guidelines for future improvements., Background: The current state of Thailand's public health demonstrates that government policy has prioritized equal access to public health services in all areas. This increases the need for primary public health services, yet resources are limited and cannot be increased to meet the growing demand. The only effective way to address this issue is to develop the efficiency of public health operations., Methods: The sample consisted of 104 THPHs in Chachoengsao, a province in Thailand's EEC. Data for five input and seven output variables were collected between September 18 and November 15, 2023. An online survey was conducted to gather the required data for fiscal year 2022. Data envelopment analysis was used to measure the efficiency of THPHs., Findings: The average efficiency index of the 104 THPHs was 0.9066, with about 60% having an efficiency index of 1.00. When classified by size, it was found that the efficiency levels of the THPHs grew with size, considering that the average efficiency index of the small, medium, and large THPHs was 0.8642, 0.9140, and 0.9417, respectively. The proportion of efficient THPHs also increased with size, at 58.14%, 60.00%, and 66.67%, respectively. Regarding efficiency improvement targets, small THPHs had the highest output targets (28.40%), followed by medium THPHs (15.31%) and large THPHs (9.91%). For the inefficient THPHs, some management guidelines were made to improve their future performances.

Objectives: The purpose of this study is to analyze how the dynamic capacity for innovation mediates the relationship between the managerial skills and organizational performance of micro, small and medium-sized enterprises (MSMEs) located in the department of Caquetá., Methods: The hypotheses are statistically tested via structural equation modeling (SEM), where the dynamic capacity for innovation mediates the relationship between the managerial skills and organizational performance of MSMEs located in the department of Caquetá, with a cross-sectional sample of 496 MSMEs., Results: The results indicate that the relationship between managerial skills and organizational performance is mediated by the dynamic capacity for innovation of the MSMEs of the department of Caquetá, Colombia. In addition, the robust adjustment values obtained for this model are an RMSEA of 0.044 and a CFI of 0.862. Both values meet the requirements to conclude that the model has a good fit and is therefore reliable., Conclusions: This study shows that managers, administrators or legal representatives use the constructs presented in this publication. In addition, it is shown that the dynamic capacity for innovation mediates the relationship between managerial skills and the organizational performance of MSMEs located in the department of Caquetá, Colombia., Competing Interests: No author has a competing interest., (Copyright: © 2024 Penagos Guzman, Solarte. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Lean methodology, originally developed in the manufacturing sector, is a process management philosophy focused on maximizing value by eliminating waste. Its application in laboratory settings, particularly concerning laboratory turnaround times (TAT), involves a systematic approach to identifying inefficiencies and optimizing processes to enhance value for end customers., Methods: This systematic review was registered in PROSPERO with identification number (CRD42024552350) and reported based on the 2020 PRISMA checklist. An extensive search strategy was performed using PubMed, Scopus, and Embase databases and gray literatures. Advanced searching was used using Boolean operators (AND & OR). After articles were exported to endnote x8, duplications were removed and articles were selected based on titles, abstracts, and full texts. The illegibility of the articles was independently assessed by the three authors (NC, DMB, and BBT), and the disagreements were settled through scientific consensus. Methodological quality was assessed using JBI critical appraisal checklist., Discussion: In this review, electronic databases search yielded 1261 articles, of which 7 met the inclusion criteria. The review demonstrated, implementation of lean principle into the routine laboratory testing had an overall impact 76.1% on reducing laboratory TAT. Transportation, manual data processing, inefficient workflow, and the heavy workload were identified as the main wasteful procedures. To eliminate these non-value-added steps, several intervention techniques were implemented, including the use of a barcoding system, process redesign, workflow optimization, hiring additional staff, and relocating the sample collection room closer to the result distribution center. Lean implementation is crucial in the medical laboratory industry for optimizing processes, reducing TAT, and ultimately enhancing customer satisfaction. As a result, all clinical laboratories should adopt and implement lean principles in their routine testing processes. The medical laboratory industry should also proactively look for and apply lean tools, provide ongoing training, and foster awareness among laboratory staffs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Cherie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Burkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)-which correspond to district hospitals-in Burkina Faso over the 2017-2020 period and identify the factors that promote-or, on the contrary, limit-the efficiency of these health structures., Method: We first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC's efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs' internal and environmental factors were both considered., Results: We found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs' efficiency., Conclusion: Our results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system., (© 2024. The Author(s).)

Objective: Overcrowding and extended waiting times in emergency departments are a pervasive issue, leading to patient dissatisfaction. This study aims to compare the efficacy of two process mining and simulation models in identifying bottlenecks and optimizing patient flow in the emergency department of Al-Zahra Hospital in Isfahan. The ultimate goal is to reduce patient waiting times and alleviate population density, ultimately enhancing the overall patient experience., Methods: This study employed a descriptive, applied, cross-sectional, and retrospective design. The study population consisted of 39,264 individuals referred to Al-Zahra Hospital, with a sample size of at least 1,275 participants, selected using systematic random sampling at a confidence level of 99%. Data were collected through a questionnaire and the Hospital Information System (HIS). Statistical analysis was conducted using Excel software, with a focus on time-averaged data. Two methods of simulation and process mining were utilized to analyze the data. First, the model was run 1000 times using ARENA software, with simulation techniques. In the second step, the emergency process model was discovered using process mining techniques through Access software, and statistical analysis was performed on the event log. The relationships between the data were identified, and the discovered model was analyzed using the Fuzzy Miner algorithm and Disco tool. Finally, the results of the two models were compared, and proposed scenarios to reduce patient waiting times were examined using simulation techniques., Results: The analysis of the current emergency process at Al-Zahra Hospital revealed that the major bottlenecks in the process are related to waiting times, inefficient implementation of doctor's orders, delays in recording patient test results, and congestion at the discharge station. Notably, the process mining exercise corroborated the findings from the simulation, providing a comprehensive understanding of the inefficiencies in the emergency process. Next, 34 potential solutions were proposed to reduce waiting times and alleviate these bottlenecks. These solutions were simulated using Arena software, allowing for a comprehensive evaluation of their effectiveness. The results were then compared to identify the most promising strategies for improving the emergency process., Conclusion: In conclusion, the results of this research demonstrate the effectiveness of using simulation techniques and process mining in making informed, data-driven decisions that align with available resources and conditions. By leveraging these tools, unnecessary waste and additional expenses can be significantly reduced. The comparative analysis of the 34 proposed scenarios revealed that two solutions stood out as the most effective in improving the emergency process. Scenario 19, which involves dedicating two personnel to jointly referring patients to the ward, and scenario 34, which creates a dedicated discharge hall, have the potential to create a more favorable situation., (© 2024. The Author(s).)

Background and Objectives: The primary objective of this study was to evaluate the influence of operating room nurse (ORN) characteristics on the duration of elective neurosurgical procedures in adults. In addition, we conducted a cost-benefit analysis of various strategies for organizing the workflow of ORNs., Methods: We collected and analyzed operating times for adult elective neurosurgical procedures, categorizing them by surgeon, procedure complexity (dichotomized as technologically complex and simple), and ORN characteristics (dichotomized as ORN dedicated to neurosurgery [dORN] and ORN not dedicated to neurosurgery [ndORN]). The monetary valuation of operating times is based on the unitary cost per minute of the operating room, including opportunity costs of ORN, as well as their training costs and salaries. Cost-benefit analysis adopted the hospital perspective., Results: Analysis of operating times reveals an approximately 20-minute difference for complex procedures when performed with ndORN. However, there is no significant difference in operating times for simple procedures, whether they are conducted by dORN or ndORN. The additional annual cost incurred by complex procedures performed with ndORN is estimated at CHF 68 144.4 for the Geneva University Hospitals., Conclusion: Complex neurosurgical procedures exhibit shorter durations when performed by dORNs. We explore several hypotheses to explain this difference. By adapting available human resources and optimizing workflow organization, hospitals can potentially achieve a net benefit., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Centralized scheduling of nursing professionals is regarded as an effective strategy for optimizing workforce allocation and mitigating critical staffing shortages. The aim of this review is to (1) determine the effect of centralized scheduling on unit productivity (ie, overtime, contract labor, and floating), time savings for managers, and staff perceptions and retention and (2) discuss current approaches in the implementation of centralized scheduling in inpatient hospital settings., Methods: This rapid review of the evidence follows methodological guidance from the Cochrane Rapid Reviews Methods Group. Four electronic bibliographic databases were searched for research published from 2013 to 2023. A total of 446 articles were identified and screened, with a total of 12 articles included. Studies and reports were included if they addressed the operational question and were conducted in an inpatient hospital within the United States., Results: Case study reports describe improved labor productivity (ie. less overtime and less contracted labor), more consistently balanced staffing of frontline nursing professionals, less staff reassignment (ie, floating), and increased satisfaction and time savings for managers after transitioning to a centralized scheduling model. These findings were consistent with a computational, experimental study that found centralized scheduling resulted in less labor costs and fewer undesirable shifts from the frontline nurse's point of view compared to decentralized scheduling., Competing Interests: The author declares no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Physicians are experiencing an increasing burden of messaging within the electronic health record (EHR) inbox. Studies have called for the implementation of tools and resources to mitigate this burden, but few studies have evaluated how these interventions impact time spent on inbox activities., Objective: Explore the association between existing EHR efficiency tools and clinical resources on primary care physician (PCP) inbox time., Design: Retrospective, cross-sectional study of inbox time among PCPs in network clinics affiliated with an academic health system., Participants: One hundred fifteen community-based PCPs., Main Measures: Inbox time, in hours, normalized to eight physician scheduled hours (IB-Time 8 )., Key Results: Following adjustment for physician sex as well as panel size, age, and morbidity, we observed no significant differences in inbox time for physicians with and without message triage, custom inbox QuickActions, encounter specialists, and message pools. Moreover, IB-Time 8 increased by 0.01 inbox hours per eight scheduled hours for each additional staff member resource in a physician's practice (p = 0.03)., Conclusions: Physician inbox time was not associated with existing EHR efficiency tools evaluated in this study. Yet, there may be a slight increase in inbox time among physicians in practices with larger teams., (© 2024. The Author(s).)

Purpose: A comprehensive return on investment (ROI) calculator was developed to evaluate the monetary and nonmonetary benefits of an artificial intelligence (AI)-powered radiology diagnostic imaging platform to inform decision makers interested in adopting AI., Methods: A calculator was constructed to calculate comparative costs, estimated revenues, and quantify the clinical value of using an AI platform compared with no use of AI in radiology workflows of a US hospital over a 5-year time horizon. Parameters were determined on the basis of expert interviews and a literature review. Scenario and deterministic sensitivity analyses were conducted to evaluate calculator drivers., Results: In the calculator, the introduction of an AI platform into the hospital radiology workflow resulted in labor time reductions and delivery of an ROI of 451% over a 5-year period. The ROI was increased to 791% when radiologist time savings were considered. Time savings for radiologists included more than 15 8-hour working days of waiting time, 78 days in triage time, 10 days in reading time, and 41 days in reporting time. Using the platform also provided revenue benefits for the hospital in bringing in patients for clinically beneficial follow-up scans, hospitalizations, and treatment procedures. Results were sensitive to the time horizon, health center setting, and number of scans performed. Among those, the most influential outcome was the number of additional necessary treatments performed because of AI identification of patients., Conclusions: The authors demonstrate a substantial 5-year ROI of implementing an AI platform in a stroke management-accredited hospital. The ROI calculator may be useful for decision makers evaluating AI-powered radiology platforms., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objective: One minute of operating room (OR) time costs $36 to 37. However, ORs are notoriously inefficient. There is growing literature on improving OR efficiency, but no formal review of this topic within otolaryngology has been performed. This study reviews and synthesizes the current literature on improving OR efficiency within otolaryngology., Data Sources: MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, preprints.org, and medRxiv were searched on November 4, 2022., Review Methods: Published English studies were included if they reported on metrics for improving OR efficiency within otolaryngology. There were no publication date restrictions. Articles were screened by 2 reviewers. Preferred Reporting Items for Systematic Reviews and Meta-analysis reporting for scoping reviews was followed., Results: The search yielded 9316 no-duplicate articles; 129 articles were included. Most of the studies reported on head and neck procedures (n = 52/129). The main tactics included surgical considerations: hemostatic devices, techniques, and team/simultaneous approaches; anesthetic considerations: local anesthetic and laryngeal mask airways; procedure location considerations: procedures outside of the OR and remote technologies; standardization: equipment, checklists, and personnel; scheduling considerations: use of machine learning for booking, considering patient/surgeon factors, and utilizing dedicated OR time/multidisciplinary teams for on-call cases., Conclusion: The current literature brings to attention numerous strategies for improving OR efficiency within otolaryngology. Applying these strategies and implementing novel techniques to manage surgical cases may assist in offloading overloaded health care systems and improving access to care while facilitating patient safety and outcomes. Anticipated barriers to implementation include resistance to change, funding, and the current strain on health care systems and providers., (© 2024 The Authors. Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

This study comprehensively explores the factors that lead to low performers in an organization. A thorough literature review was conducted to construct an interview guide and obtain classification criteria for the factors that lead to low performers. Managers and low performers at multiple firms were interviewed individually to understand the various phenomena related to low performers in organizations. Based on the content of these interviews, 12 factors, classified into individual, leader, work, and organizational dimensions, were identified after three rounds of revisions by business administration experts. Next, a case study of Korea's S Life Insurance Company was conducted to examine the practical implications of the factors that contribute to creating low performers. In this case study, the analytic hierarchy process (AHP), involving eight departmental heads S Life Insurance Company's HR division, was utilized to identify the main factors that must be considered when evaluating low performers. While previous studies have examined low performers either at the individual, organizational, or institutional levels, this study presents a comprehensive and integrated evaluation framework of the factors that cause low performers. The proposed framework facilitates the identification and evaluation of low performers in various organizations and industries, and thus has practical implications in terms of establishing strategies to manage low performers more efficiently and improve organizational performance., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Nearly 400 million Indians (30 % of the total population) lack any financial protection for health which leads to very high out of pocket expenditure. In India more than 90 million people spend 10-25 % of household expenses on healthcare. This is a serious threat to Sustainable Development Goal 3, which aims at providing universal health coverage along with protection from catastrophic spending on health., Aim: The aim of this paper is to estimate the efficiency and determinants of public health in India at subnational level., Methods: To estimate the efficiency of public healthcare, input oriented bias corrected DEA model has been used. In this model life expectancy at birth and infant survival rate have been treated as outputs. Public health spending and per capita income are treated as inputs. In the second stage Tobit regression is used to analyse the determinants of efficiency., Results: The mean bias corrected efficiency score across Indian states is 0.60, implying that on average there is a 40 % inefficiency in public healthcare in India. Maharashtra and Mizoram are the most and least efficient states with efficiency score of 0.921 and 0.218, respectively. Fourteen states have efficiency scores less than 0.60, two states have efficiency score of 0.60 and 15 states have the efficiency score greater than 0.60. Socio economic factors outweigh the medical factors in determining the public healthcare efficiency in India., Conclusion: There are 40 % inefficiencies in public health in India implying significant wastages in public health. By improving public health efficiency, there would be savings of 48 % in terms of government expenditure on health per capita. It will also improve infant survival rate by 27.19 % and life expectancy by 20.65 %., Competing Interests: Declaration of Competing Interest The authors have no conflicting interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Advanced rooming is a workflow that enables non-clinician staff to take on additional responsibilities to improve quality and productivity. However, the impact is not well understood, particularly in Federally Qualified Health Centers (FQHCs). In this observational study at two FQHC sites, we found that in advanced rooming more questions were asked by patients and staff and more problems were identified and addressed. Advanced rooming medical assistants spent more time with patients and huddled longer with clinicians without significant differences in the clinical portion of the visit or total visit length. Advanced rooming may be a way to enhance care, ease clinician burden, and increase efficiency., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Industrywide, primary care nurses' work is increasing in complexity and team orientation. Mobile health information technologies (HITs) designed to aid nurses with indirect care tasks, including charting, have had mixed success. Failed introductions of HIT may be explained by insufficient integration into nurses' work processes, owing to an incomplete or incorrect understanding of the underlying work systems. Despite this need for context, published evidence has focused more on inpatient settings than on primary care., Objective: This study aims to characterize nurses' and health technicians' perceptions of process inefficiencies in the primary care setting and identify related work system factors., Methods: Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, we conducted an exploratory work system analysis with a convenience sample of primary care nurses and health technicians. Semistructured contextual interviews were conducted in 2 sets of primary care clinics in the Midwestern United States, one in an urban tertiary care center and the other in a rural community-based outpatient facility. Using directed qualitative content analysis of transcripts, we identified tasks participants perceived as frequent, redundant, or difficult, related processes, and recommendations for improvement. In addition, we conducted configuration analyses to identify associations between process inefficiencies and work system factors., Results: We interviewed a convenience sample of 20 primary care nurses and 2 health technicians, averaging approximately 12 years of experience in their current role. Across sites, participants perceived 2 processes, managing patient calls and clinic walk-in visits, as inefficient. Among work system factors, participants described organizational and technological factors associated with inefficiencies. For example, new organization policies to decrease patient waiting invoked frequent, repetitive, and difficult tasks, including chart review and check-in using tablet computers. Participants reported that issues with policy implementation and technology usability contributed to process inefficiencies. Organizational and technological factors were also perceived among participants as the most adaptable. Suggested technology changes included new tools for walk-in triage and patient self-reporting of symptoms., Conclusions: In response to changes to organizational policy and technology, without compensative changes elsewhere in their primary care work system, participants reported process adaptations. These adaptations indicate inefficient work processes. Understanding how the implementation of organizational policies affects other factors in the primary care work system may improve the quality of such implementations and, in turn, increase the effectiveness and efficiency of primary care nurse processes. Furthermore, the design and implementation of HIT interventions should consider influential work system factors and their effects on work processes., (©Willi L Tarver, April Savoy, Himalaya Patel, Michael Weiner, Richard J Holden. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 30.09.2024.)

Background: Outpatient Clinics (OCs) are under pressure because of increasing patient volumes and provider shortages. At the same time, many patients with chronic diseases receive routine follow-up consultations that are not always necessary. These patients block access to care for patients that are in actual need for care. Pre-assessing patient charts has shown to reduce unnecessary outpatient visits. However, the resulting late cancellations due to the pre-assessment, challenge efficient alignment of capacity with actual patient demand, leading to either empty slots or overtime. This study aims to develop a method to analyse the effect of pre-assessing patients before inviting them to the OC. This involves 1) to select who should come and 2) to optimize the impact of pre-assessment on the schedule and efficient use of OC staff., Methods: This prospective mixed-methods evaluation study consists of 1) an expert meeting to determine a pre-assessment strategy; 2) a retrospective cohort study to review the impact of this strategy (12 months of a Dutch nephrology OC); 3) mathematical optimization to develop an optimal criteria-based scheduling strategy; and 4) a computer simulation to evaluate the developed strategy. Primary outcomes are the staff idle time and staff overtime. Secondary outcomes evaluate the number of weekly offered appointments., Results: The expert group reached consensus about the pre-assessment criteria. 875 (18%) of the realized appointments in 2022 did not meet the OC visit pre-assessment criteria. In the best performing scheduling strategy, 94 slots (87% of the available capacity) should be scheduled on a weekly basis. For this schedule, 26.8% of the OC weeks will experience idle time ( μ =2.51, σ =1.44 appointment slots), and 21% of the OC weeks will experience overtime ( μ =2.26, σ =1.65 appointment slots) due to the variation in patient appointment requests. Using the pre-assessment strategy combined with the best performing scheduling strategy under full capacity (108 slots), up to 20% increase in patient demand can be handled with equal operational performance., Conclusions: This evaluation study allows OC managers to virtually test operational impact of pre-assessment strategies on the capacity of their OC, and shows the potential of increasing efficient use of scarce healthcare capacity., Trial Registration: Not applicable., (© 2024. The Author(s).)

Hospital bed occupancy serves as an important indicator of healthcare system efficiency, directly impacting patient care quality and staff workload. This study delves into the efficacy of midnight census, a conventional method for assessing bed occupancy, in supporting hospital operational planning. Historically, the midnight census has been utilised to gauge bed occupancy; however, its reliability is debated due to fluctuations throughout the day. This paper presents an analysis of 5.5 years of patient flow data from one of the hospitals in Queensland, Australia, scrutinising the statistical associations between different occupancy levels, e.g., midnight, peak, average, and minimum. The findings shed light on the efficacy of the midnight census and suggest the adoption of an hourly-based occupancy rate for more accurate capacity planning and management.

Purpose: Despite national recommendations to standardize infusion concentrations, there is minimal guidance on institution-specific strategies and outcomes related to epidural infusion concentration standardization and optimization. The purpose of this project is to identify the optimal compounded preparation for use in select adult epidural infusions and assess the impact on drug and fluid utilization and cost savings if the designated preparation is adopted., Methods: A previously validated tool, the VERB (vial, exchange, rate, and bag) analysis, was applied to epidural infusion pump administration data to identify preparations optimized for efficient supply and resource utilization at a large academic medical center., Results: Weighing all components of the VERB analysis, the preferred preparation of hydromorphone and bupivacaine for the hospital site was hydromorphone (10 µg/mL) and bupivacaine (0.125%) in 50 mL of 0.9% sodium chloride injection (2,500 µg of hydromorphone per epidural). The preferred preparation of fentanyl and bupivacaine was fentanyl (2 µg/mL) and bupivacaine (0.0625%) in 50 mL of 0.9% sodium chloride injection (100 µg of fentanyl per epidural). Both recommendations are different from the currently utilized preparations at the study site., Conclusion: Analyzing historic drug administration data using the novel 4-step VERB analysis identified optimized drug preparations and fluid bag sizes for the most-prescribed epidural drug combinations at the hospital study site., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: The purpose of this paper is to improve the understanding of the social contexts of sustainable Lean culture in healthcare by examining self-efficacy (SE) as a fundamental construct related to the value of perceived readiness, prior education of Lean and the importance of leadership's system-level support., Design/methodology/approach: A descriptive correlational study was conducted to identify the relationships between SE and Lean readiness factors, SE and prior Lean training, SE and clinical vs administrative roles and SE and perceived system-level support in a large health system., Findings: There was a statistically significant difference in self-reported readiness to use Lean tools between individuals who had received Lean training during their academic education and those who had not; however, their level of education did not impact SE. Lastly, and perhaps most important, the learner who embodies SE also has system-level support., Research Limitations/implications: Future directions of this research, in addition to assessing team readiness as other studies suggest, would be to evaluate individual team member readiness by gauging SE and addressing deficits prior to the deployment of process improvement (PI) projects to promote success and sustainability., Practical Implications: This contributes to the ongoing scholarship of Lean management systems, providing clinical and non-clinical leaders with a contextual understanding of their supportive role in the SE of teams., Originality/value: This study demonstrates the value of understanding SE of individual team members and how it can contribute to overall improved team outcomes, directly impacting the sustainability of Lean change culture and its promotion of improved patient safety, cost efficiencies and access to care., (© Emerald Publishing Limited.)

Background: The benefits of lean adoption in healthcare include improved process efficiency and quality of patient care. However, research indicates that lean implementation in healthcare, and specifically hospitals, is often not sustained. Furthermore, there is a need for maturity models that guide lean implementation, specifically in hospitals. This study develops a prescriptive maturity model named the Sustaining of Lean Adoption in Hospitals Roadmap (SOLAR) that acts as a practical guideline for the sustainable adoption of lean in hospitals., Methods: The SOLAR has three theoretical foundations, namely lean implementation success factors in hospitals, implementation science, and change management theory. A systematic literature review was conducted to determine the lean implementation success factors in hospitals as the first building block. Secondly, practices from implementation science were used to create the action items in the SOLAR. Ten change steps were elicited from change management theory as the third theoretical building block of the roadmap. We refined the roadmap through three Delphi rounds that verified its useability in hospitals., Results: The final SOLAR consists of four maturity phases (prepare, plan, experiment and learn, and sustain) and includes action items for each phase related to the hospital's strategy, resources, engaging of people, and culture. The action items and change management steps shown in the SOLAR are not intended as an exhaustive list but provide guidelines on aspects hospitals must consider when they aim to adopt lean sustainably., Conclusions: The strong theoretical base of the SOLAR enables hospitals to safely experiment and learn which implementation methods are best suited to their unique environment. The SOLAR is, therefore, an actionable guideline that informs both academics and practitioners involved in lean adoption in hospitals. This roadmap can guide future retrospective longitudinal or action research., (© 2024. The Author(s).)

Introduction: As the Chinese government places an increasing emphasis on public fitness services, there has been a concomitant growth in public demand for greater fiscal expenditure in this area. However, in light of the constrained growth in government financial resources, it is of paramount importance to allocate these resources in a rational manner in order to effectively address the public's fitness and health needs. This study aims to evaluate the efficiency of public expenditure on national fitness services across China, thereby providing valuable insights for policymakers to optimize resource allocation and improve service efficiency., Methods: The study employs a super-efficiency Data Envelopment Analysis (DEA) model, in conjunction with the Malmquist Index and Tobit regression model, to assess the efficiency of fiscal spending on fitness services in 31 Chinese provinces from 2017 to 2020. The analysis employs both static and dynamic approaches to present an objective view of the development of public fitness service levels across different regions and to empirically identify the key factors influencing fiscal spending efficiency., Results: The findings indicate substantial regional variations in the efficiency of fiscal expenditure on public fitness services. While some provinces demonstrate high efficiency in the use of public funds, others exhibit notable inefficiencies, particularly in areas with lower levels of economic development and population density. The findings underscore the existence of redundant expenditure and the varying effectiveness of resource utilization across provinces., Discussion: The study recommends that future strategies prioritize the scientific planning of fiscal inputs into public fitness services, the precise optimization of expenditure structures, the exploration of collaborative supply mechanisms, the expansion of demand-driven feedback channels, the integration of technological innovations, and the acceleration of digitalization in public fitness services., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gao, Cao and Gu.)

Objective: The Brazilian remote rurality has been classified more reliably only recently, according to demographic density, proportion of urban population, and accessibility to urban centers. It comprises 5.8% of the municipalities, in nearly half of the states, with a population of 3,524,597 (1.85%). Remote rural localities (RRL) have reduced political/economic power, facing greater distances and barriers. Most health strategies are developed with the urban space in mind. We aim to understand how RRL are positioned concerning efficiency/effectiveness in health, compared to other urban-rural typologies of Brazilian localities, focusing on Primary Health Care (PHC), and its organizational models., Methods: We evaluated the efficiency and effectiveness of the organizational models using the health production model, from 2010-2019, gradually deepening the immersion into the RRL reality. We analyzed the human and financial resources dimensions, emphasizing teams, the results of PHC actions, and health levels. We used the fixed effects model and data envelopment analysis, cross-sectioned by intersectional inequities. We compared the Brazilian states with and without RRL, Brazilian municipalities according to rural-urban typologies, and RRL clusters., Results: Brazilian RRL states show superior resource/health efficiency through services utilization according to health needs. The remote rural typology demonstrated greater efficiency and effectiveness in health than the other typologies in the RRL states. The organizational models with the Family Health Strategy (FHS) teams and the Community Health Worker (CHW) visits played a key role, together with local per capita health expenditures and intergovernmental transfers. Thus, financial resources and health professionals are essential to achieve efficient/effective results in health services. Among the RRL, the Amazon region clusters stand out, denoting the importance of riverine and fluvial health teams, the proportion of diagnostic/treatment units in addition to the proportion of illiteracy and adolescent mothers along with the inequity of reaching high levels of schooling between gender/ethnicity., Conclusion: Hopefully, these elements might contribute to gains in efficiency and effectiveness, prioritizing the allocation of financial/human resources, mobile FHS teams, availability of local diagnosis/treatment, and basic sanitation. Finally, one should aim for equity of gender/ethnicity in income and education and, above all, of place, perceived in its entirety., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Schenkman and Bousquat.)

Objective: Because admitted emergency department (ED) patients waiting for an inpatient bed contribute to dangerous ED crowding, we conducted a patient flow investigation to discover and solve outflow delays. After solution implementation, we measured whether the time admitted ED patients waited to leave the ED was reduced., Methods: In June 2022, a team using Lean Healthcare methodologies identified flow delays and underlying barriers in a Midwest, mid-sized hospital. We calculated barriers' magnitudes of burden by the frequency of involvement in delays. During October-December 2022, solutions targeting barriers were implemented. In October 2023, we tested whether waiting time, defined as daily median time in minutes from admission disposition to departure (ADtoD), declined by conducting independent sample, single-tailed t -test comparing pre- to post-intervention time periods, January 1-September 30, 2022 (273 days) to January 1-September 30, 2023 (273 days). Additionally, we regressed ADtoD onto pre-/post period while controlling for ED volume (total daily admissions and ED daily encounters) and hospital occupancy. A run chart analysis of monthly median ADtoD assessed improvement sustainability., Results: Process mapping revealed that three departments (ED, environmental services [EVS], and transport services) co-produced the outflow of admitted ED patients wherein 18 delays were identified. The EVS-clinical care collaboration failures explained 61% (11/18) of delays. Technology contributed to 78% (14/18) of delays primarily because staff's technology did not display needed information, a condition we coined "digital blindness." Comparing pre- and post-intervention days (3,144 patients admitted pre-intervention and 3,256 patients post), the median minutes a patient waited (ADtoD) significantly decreased (96.4 to 87.1 minutes, P  = 0.04), even while daily ED encounter volume significantly increased (110.7 to 117.3 encounters per day, P  < 0.001). After controlling in regression for other factors associated with waiting, the intervention reduced ADtoD by 12.7 minutes per patient (standard error 5.10, P  = 0.01; 95% confidence interval -22.7, -2.7). We estimate that the intervention translated to ED staff avoiding 689 hours of admitted patient boarding over nine months (ADtoD coefficient [-12.7 minutes] multiplied by post-intervention ED admissions [3,256] and divided by 60). Run chart analysis substantiated the intervention's sustainability over nine months., Conclusion: After systemwide patient flow investigation, solutions resolving digital blindness and environmental services-clinical care collaboration failures significantly reduced ED admitted patient boarding., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Introduction: Effective medical education must balance clinical service demands for institutions and learning needs of trainees. The question of whether these are competing demands or can serve complementary roles has profound impacts on graduate medical education, ranging from funding decisions to the willingness of community-based hospitals and physicians to include learners at their clinical sites. Our objective in this article was to systematically review the evidence on the impact of medical trainees on productivity and efficiency in the emergency department (ED)., Methods: We queried PubMed, Embase, Scopus, and Web of Science from earliest available dates to March 2023. We identified all studies evaluating the impact of medical students and/or residents in the ED on commonly used productivity and efficiency metrics. Only studies in EDs in the United States were included. No additional filters were used. We assessed the risk of bias of included studies using the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. Certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Study findings were combined in a narrative synthesis and reported according to PRISMA guidelines., Results: The literature search yielded 3,390 unique articles for abstract screening. Eighty-one abstracts were identified as relevant to our PICO question (population, intervention, control, and outcomes), 76 of which had retrievable full-text articles and the themes of which were discussed in a narrative synthesis. We selected 13 of the full-text articles for final inclusion in a systematic review. Studies were roughly split between observational (6) and quasi-experimental (7) designs. The majority of studies (11) were single-site studies. Only two studies could be graded as low risk of bias per the ROBINS-I tool., Conclusion: Low-GRADE evidence suggests that students and residents decrease ED efficiency by a statistically small effect size of debatable clinical importance. Residents provide a moderate boost to ED productivity. Students do not produce a statistically or clinically significant impact on ED productivity. Residents increase emergency department relative value units revenue by $26.30 an hour, while students have no impact. Both types of learners decrease efficiency., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare-affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities. There are no other conflicts of interest or sources of funding to declare.

Competing Interests: The author declares no conflicts of interest.

Background: International oral health policy directions led by the World Health Organisation call for the inclusion of oral health within universal health coverage. The aim of this study is to perform a budget impact analysis of a policy option for a more cost-efficient oral health workforce skill-mix (dentists and oral health therapists) to provide public oral healthcare in Victoria, Australia., Methods: Two hypothetical standard care pathways were developed. A dynamic population Markov model in TreeAge software, with a time horizon of 6 years. Two scenarios were modelled to determine: (1) base-case scenario: the threshold the dentist workforce could reduce per year, while achieving the same service delivery outputs, and (2) alternative scenario: the potential cost-savings for utilising an optimally cost-efficient oral health workforce skill-mix., Results: The threshold analysis showed a minimum reduction of 13% of the dentist workforce being replaced with oral health therapists can occur without having any impact on the same service delivery outputs. Under the alternative scenario, the potential cost-savings would be AUD$1,425,037 (standard deviation 58,954)., Conclusions: Governments and policy-decision makers should consider strategies in training, attracting, and retaining oral health therapists to achieve an optimally cost-efficient oral health workforce skill-mix when delivering public oral healthcare., (© 2024 The Author(s). The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)