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BackgroundIn low- and middle-income countries, there is scarcity of validated and reliable measurement tools for health facility management, and many interventions to improve primary health care (PHC) facilities are designed without adequate evidence base on what management practices are critical.ObjectiveThis article developed and validated a scorecard to measure management practices at primary health care facilities under the performance-based financing (PBF) scheme in Nigeria.MethodsRelevant management practice domains and indicators for PHC facilities were determined based on literature review and a prior qualitative study conducted in Nigeria. The domains and indicators were tested for face validity via experts review and organized into an interviewer-administered scorecard. A stratified random sampling of PHC facilities in three States in Nigeria was conducted to assess the reliability and construct validity of the scorecard. Inter-rater reliability using inter-class correlation (ICC) (1, k) was assessed with one-way ANOVA. Exploratory factor analysis (EFA) was conducted to assess the construct validity, and an updated factor structure were developed.Results32 indicators and 6 management practice domains were initially described. Ordinal responses were derived for each indicator. Data on the scorecard were obtained from 111 PHC facilities. The ICC of mean ratings for each team of judges was 0.94. The EFA identified 6 domains (Stakeholder engagement and communication; Community-level activities; Update of plan and target; Performance management; Staff attention to planning, target, and performance; and Drugs and financial management) and reduced the number of indicators to 17. The average communality of selected items was 0.45, and item per factor ratio was 17:6.ConclusionsDespite a few areas for further refinement, this paper presents a reliable and valid scorecard for measuring management practices in PHC facilities. The scorecard can be applied for routine supervisory visits to PHC facilities, and can help accumulate knowledge on facility management, how it affects performance, and how it may be strengthened.

Purpose: We compared the impact of management of severe acute malnutrition (SAM) by lady health workers (LHWs) at a community level with the standard CMAM program provided at the health facility. Methods: A two-arm cluster randomised controlled trial was conducted in a rural district in sindh Pakistan. The primary outcome was recovery from SAM and secondary outcomes were relapse, defaulter and mortality rate. Results: A total of 829 children were recruited in the trial (430 in intervention and 399 in control groups). No significant difference was noted in recovery rate between the intervention and control groups (79.2% vs 85.6%, p = 0.276). Similarly, no significant differences were noted in relapse (p = 0.757), weight gain (p = 0.609), deaths (p = 0.775) and defaulter rate (p = 0.324) across the groups. Compliance of RUTF was significantly higher in the control group (93%) than in the intervention group (87%), p < 0.000. Conclusion: Our results showed no impact of SAM treatment on performance indicators of CMAM (recovery, relapse, death and default) between the standard CMAM programme performed at the health facility by the government and NGO staff and the programme performed at health house level by the LHWs in Pakistan. We recommend further robust trials in other settings to confirm our results. [ABSTRACT FROM AUTHOR]

Background: In the provision of medical facilities, intensive care units are very critical and it seems almost difficult to use the new therapeutic strategies without Intensive Care Unit (ICU). There are two types of ICU structure, known as the open or closed model. The aim of this study was to assess the variables driving the selection of the appropriate ICU management structure and modeling of the appropriate ICU management structure. Methods: This descriptive-exploratory study was performed among all resident doctors, consultants, therapists and neurosurgeons, ICU specialists, internal medicine specialists, respiratory diseases specialists, heads of associated units and head nurses, neurosurgery ICU workers and staff, and doctors of the Loghman Hakim Hospital in Tehran, Iran in 2018. The influence of independent variables on dependent variables and the effect of observed variables on latent variables were tested using the Structural Equation Technique (SEM technique) and the data collected in the LISREL program was analyzed. Results: This research included one hundred persons, including 91 men and 9 women. The factors affecting the performance and structure of the ICU were structural context (including open, semiclosed, and closed structure), organizational context, strategic context, treatment economics context, processes, and quality improvement. Conclusion: There is a good association between quality management and the application of the closed system of the ICU and each of the organizational, strategic, care economics, and processes factors. [ABSTRACT FROM AUTHOR]

Background: Nigeria has one of the largest Human Immunodeficiency Virus (HIV) epidemics in the world. Addressing the epidemic of HIV in such a high-burden country has necessitated responses of a multidimensional nature. Historically, community-based organizations (CBOs) have played an essential role in targeting key populations (eg. men who have sex with men, sex workers) that are particularly burdened by HIV. CBOs are an essential part of the provision of health services in sub-Saharan Africa, but very little is known about the management practices of CBOs that provide HIV prevention interventions.Methods: We interviewed 31 CBO staff members and other key stakeholders in January 2017 about management practices in CBOs. Management was conceptualized under the classical management process perspective; these four management phases-planning, organizing, leading, and evaluating-guided the interview process and code development. Data analysis was conducted thematically using Atlas.ti software. The protocol was approved by the ethics committees of the National Institute of Public Health of Mexico (INSP), the National Agency for the Control of AIDS in Nigeria (NACA), and the Nigerian Institute for Medical Research (NIMR).Results: We found that CBOs implement variable management practices that can either hinder or facilitate the efficient provision of HIV prevention services. Long-standing CBOs had relatively strong organizational infrastructure and capacity that positively influenced service planning. In contrast, fledgling CBOs were deficient of organizational infrastructure and lacked program planning capacity. The delivery of HIV services can become more efficient if management practices are taken into account.Conclusions: The delivery of HIV services by CBOs in Nigeria was largely influenced by inherent issues related to skills, organizational structure, talent retention, and sanction application. These, in turn, affected management practices such as planning, organizing, leading, and evaluating. This study shows that KP-led CBOs are evolving and have strong potentials and capacity for growth, and can become more efficient and effective if attention is paid to issues such as hierarchy, staff recruitment, and talent retention. [ABSTRACT FROM AUTHOR]

Few studies have assessed the efficiency and quality of HIV services in low-resource settings or considered the factors that determine both performance dimensions. To provide insights on the performance of outpatient HIV prevention units, we used benchmarking methods to identify best-practices in terms of technical efficiency and process quality and uncover management practices with the potential to improve efficiency and quality. We used data collected in 338 facilities in Kenya, Nigeria, Rwanda, South Africa, and Zambia. Data envelopment analysis (DEA) was used to estimate technical efficiency. Process quality was estimated using data from medical vignettes. We mapped the relationship between efficiency and quality scores and studied the managerial determinants of best performance in terms of both efficiency and quality. We also explored the relationship between management factors and efficiency and quality independently. We found levels of both technical efficiency and process quality to be low, though there was substantial variation across countries. One third of facilities were mapped in the best-performing group with above-median efficiency and above-median quality. Several management practices were associated with best performance in terms of both efficiency and quality. When considering efficiency and quality independently, the patterns of associations between management practices and the two performance dimensions were not necessarily the same. One management characteristic was associated with best performance in terms of efficiency and quality and also positively associated with efficiency and quality independently: number of supervision visits to HIV units. [ABSTRACT FROM AUTHOR]

Tactical capacity planning is a key element of planning and control decisions in healthcare settings, focusing on the medium-term allocation of a clinic's resources to appointments of different types. One of the most scarce resources in healthcare is physician time. Due to uncertainty in demand for appointments, it is difficult to provide an exact match between the planned physician availability and appointment requests. Our study uses cardinality-constrained robust optimization to develop tactical capacity plans which are robust against uncertainty, providing a feasible allocation of capacity for all realizations of demand to the extent allowed by the budget of uncertainty. The outpatient setting we consider sees first-visit patients and re-visit patients, and both patient types have access time targets. We experimentally evaluate our robust model and its practical implications under different levels of conservatism. We show that we can guarantee 100% feasibility of the robust tactical capacity plan while not being fully conservative, which will lead to the clinic saving money while being able to meet demand despite uncertainty. We also show how the robust model helps us to identify the critical time periods leading to worst case physician peak load, which could be valuable to decision-makers. Throughout the experiments, we find that the step of translating available data into an uncertainty set can influence the true conservatism of a solution. [ABSTRACT FROM AUTHOR]

Background In low- and middle-income countries, there is scarcity of validated and reliable measurement tools for health facility management, and many interventions to improve primary health care (PHC) facilities are designed without adequate evidence base on what management practices are critical. Objective This article developed and validated a scorecard to measure management practices at primary health care facilities under the performance-based financing (PBF) scheme in Nigeria. Methods Relevant management practice domains and indicators for PHC facilities were determined based on literature review and a prior qualitative study conducted in Nigeria. The domains and indicators were tested for face validity via experts review and organized into an interviewer-administered scorecard. A stratified random sampling of PHC facilities in three States in Nigeria was conducted to assess the reliability and construct validity of the scorecard. Inter-rater reliability using inter-class correlation (ICC) (1, k) was assessed with one-way ANOVA. Exploratory factor analysis (EFA) was conducted to assess the construct validity, and an updated factor structure were developed. Results 32 indicators and 6 management practice domains were initially described. Ordinal responses were derived for each indicator. Data on the scorecard were obtained from 111 PHC facilities. The ICC of mean ratings for each team of judges was 0.94. The EFA identified 6 domains (Stakeholder engagement and communication; Community-level activities; Update of plan and target; Performance management; Staff attention to planning, target, and performance; and Drugs and financial management) and reduced the number of indicators to 17. The average communality of selected items was 0.45, and item per factor ratio was 17:6. Conclusions Despite a few areas for further refinement, this paper presents a reliable and valid scorecard for measuring management practices in PHC facilities. The scorecard can be applied for routine supervisory visits to PHC facilities, and can help accumulate knowledge on facility management, how it affects performance, and how it may be strengthened.

Healthcare systems have become increasingly complex and have faced difficulties in finding solutions to emerging population needs. New technologies have allowed users to obtain the information they need at speed never seen before in human history. This fact has promoted reflection, change, and restructuration in large healthcare corporations' traditional management style, which seeks to incorporate in their business model elements more flexible and interactive in connection with the recent challenges and the current healthcare trends. Promoting a creative and innovative culture in health organizations to allow the stakeholders to find solutions focused on healthcare systems' real needs is one of the most important elements to respond to emergent challenges. However, the development of mechanisms enhances a creative environment, and evaluative approaches that demonstrate the reliability and added value of innovations remain challenging. Therefore, this paper develops and recalls certain essential concepts that can help researchers, managers, and health workers interested in creating (or maintain) a favorable environment for innovation in healthcare organizations. The article also explores and clarifies some of the key critical elements of an innovation process from a strategic and organizational perspective, starting from contextual input elements favorable to its emergence until its evaluation stage. [ABSTRACT FROM AUTHOR]

The article presents the discussion on analyzing the behavioral factors related to the perinatal behavior of mothers having neonatal death. Topics include conducting antenatal care, planned births, assisted by health workers, ongoing intensive care in high-risk neonates and healthy neonates; and independent variables being knowledge, attitude, health facilities, family support, and the role of health workers.

We use an established model of organizational identification to try to understand the voluntary cooperative behavior of professionals in organizations. We examined the relationships among physicians' assessments of the attractiveness of a health care system's perceived identity and construed external image, strength of system identification, and cooperative behaviors. We surveyed 1,504 physicians affiliated with three health care systems and collected follow-up data from 285 physicians a year later. Attractiveness of perceived identity and construed external image were positively related to physicians' identification with the system, which in turn was positively related to cooperative behavior. Extensions to the model of organizational identification are suggested. [ABSTRACT FROM AUTHOR]

Total quality management (TQM) is directed at quality consciousness throughout all organisational processes. A successful TQM practice requires a culture that can adapt to changes and promote innovation. Development culture focuses especially on improvement, flexibility and external environment, concerning with growth, innovation and adaptation. From this perspective, the present study aims to examine the link between development culture and TQM in Turkish healthcare organisations and to explore the mediating roles of top management leadership and employee empowerment. Data were collected by using survey method and analysed by using structural equation modelling while being controlled for common method bias. The findings revealed that while development culture has a positive influence TQM, it is the top management leadership which mediates this relationship, not the employee empowerment. The results are discussed considering the difference in these mediating effects and organisational implications of the findings are provided. [ABSTRACT FROM AUTHOR]

There is no doubt that the organization of healthcare is currently shifting, partly in response to changing macrolevel policies. Studies of healthcare policies often do not consider healthcare workers' experiences of policy change, thus limiting our understanding of when and how policies work. This article uses longitudinal qualitative data, including participant observation and semistructured interviews with workers within hospice care as their organizations shifted in response to a Medicare policy change. Prior to the policy change, I find that the main innovation of hospice-the interdisciplinary team-is able to resist logics from the larger medical institution. However, when organizational pressures increase, managers and workers adjust in ways that reinforce medical logics and undermine the interdisciplinary team. These practices illustrate processes by which rationalization of healthcare affects workers' experiences and the type of care available to patients. [ABSTRACT FROM AUTHOR]

Objectives: To describe a staff management and quality improvement system implemented in an assisted‐living facility (ALF) that provides dementia care. Design: Prospective quality improvement project over 13 consecutive months. Setting: One ALF that provides dementia care services. Participants: ALF residents with dementia (N=57). Intervention: A staff management and quality improvement system was implemented for 3 aspects of daily care: morning and evening activity of daily living (ADL) care, nutritional care, and activity engagement. Measurements: Supervisory staff monitored the quality of daily care processes of all residents and direct care staff using standardized observations. Observational data were summarized into quality measures for each of the 3 daily care areas and ranged from 0% to 100%, with a higher score indicative of better quality. These quality measures were shared with direct care staff in weekly huddles at which feedback was provided about areas in need of improvement. The management team also reviewed the data weekly to discuss strategies for improvement. Results: The quality measures in each of the 3 areas improved or remained consistently high over the 13 study months: morning and evening ADL care (83–96%), quality nutritional of care during meals (74–95%), activity engagement (69–97%). Conclusion: A staff management and quality improvement system that relies on standardized observations of quality of care, weekly review by managers, and feedback to direct care staff informs areas in need of improvement and supports consistent implementation of quality of care over time for ALF residents receiving dementia care. [ABSTRACT FROM AUTHOR]

Purpose The history of the development of non-clinical services in infection control (IC) dates back to the pre-modern era. There is evidence of health-care facility management (HFM) services in Roman military hospitals. With the fall of the Roman Empire, Christian beliefs and teaching shaped the development of HFM in monastic hospitals. It was not until the late Victorian era that the link between HFM services and diseases caused by “miasma”, or bad air, became established. The discovery of bacteria in the modern scientific era reduced the level of importance previously attached to non-clinical causes of infections. Today, in the NHS, HFM services continue to be treated as though they had no real role to play in IC. This paper aims to collate historical and epidemiological evidence to show the link between HFM and IC.Design/methodology/approach The evidence gathered in this research paper is primarily based on an in-depth review of research from a wide range of sources. A “within-study literature analysis” was conducted to synthesise the research materials. This involved the application of “between-source triangulation” to verify the quality of the information contained in the studies, and “between-source complementarity” to provide an in-depth elaboration of the historical facts.Findings Historical and epidemiological evidence shows that HFM services such as cleaning, waste management, catering, laundry and maintenance continue to play a crucial role in IC. This is corroborated by evidence gathered from the work of renowned pioneers in the field of IC. However, reforms in the NHS have failed to consider this, as HFM services have been largely fragmented through different partnership arrangements.Practical implications Among many other things, this research raises the profile of HFM staff in relation to the issue of IC in hospitals. It presents convincing evidence to show that the relationship between the clinical and non-clinical domains in controlling infections in hospitals has a long history. The findings of this research give HFM staff invaluable information about the significant role of their profession in the control of infections in hospitals.Originality/value This is one of the few studies examining the historical development of HFM services, as well as their contribution to IC. Other work in this area has mainly been framed from a clinical health-care perspective. [ABSTRACT FROM AUTHOR]

Medication review, the systematic examination of an individual patient's medicines in order to improve medication therapy, has been advocated as an important patient safety measure. Despite widespread use, little is known about how medication review is conducted when implemented in routine health care. Drawing from an ethnographic case study in a Swedish emergency department and using a practice-based approach, we examine how medication review is practically accomplished and how knowledge is mobilized in everyday practice. We show how physicians construct and negotiate medication safety through situated practices and thereby generate knowledge through mundane activities. We illustrate the centrality of practitioners' collective reflexive work when co-constructing meaning and argue here that practitioners' local adaptations can serve as important prerequisites to make "standardized" practice function in everyday work. Organizations need to build a practical capacity to support practitioners' work-based learning in messy and timepressured health care settings. [ABSTRACT FROM AUTHOR]

In this study, we analysed stakeholders' organizational role expectations for nurses. We defined organizational role expectations as a set of informal expectations in behavioural patterns and formal expectations in work tasks related to a certain position in the organization. A qualitative study was conducted, and content analysis was applied to 150 articles published in a Finnish nursing trade journal. We identified five general organizational role expectations of patients and their relatives, physicians and other healthcare professionals, the work community, the nursing association, and legislators in our analysis: "the alongside stroller," "the patients' advocate," "the reliable colleague and team member," "the expert and skills developer," and "the organizational underdog." This study explores these nursing roles and links stakeholder perspective to the organizational role expectations in professional services. [ABSTRACT FROM AUTHOR]

This article examines how social workers and managers perceive meaningful work and expertise in six care and treatment facilities in Denmark. Based on 29 interviews with social workers (n=22) and managers (n=7), the article shows how New Public Management-inspired tools such as scoring schemas align with social work values such as "client-centeredness" and working with the individual welfare recipient face-to-face. The article finds that fitting social work into organizational schemas changes the work practices of social workers and also the way members of this profession define meaningful work and expertise. In addition, the article also finds that scoring schemas cause conflicts among social workers regarding the character of expertise when values of social work (to meet a welfare recipient's need) must be aligned with NPM-inspired values of organizations (to meet managers' demand for documentation). [ABSTRACT FROM AUTHOR]

Wilensky's seminal article on professionals mentions three identifying characteristics besides the familiar specialized knowledge, autonomy and professional ideology. These are the referral principle, which states that professionals should refer clients to a colleague with a different specialty if necessary, the principle of sloughing off, which dictates that professionals allocate less rewarding parts of their job to lesser paid assistants, and the principle of impersonal service delivery, which admonishes professionals to treat clients equally. A changing clientele in health care and social care warrants a reappraisal of these three principles. Population ageing necessitates a reappraisal in health care. The deinstitutionalization of people with psychiatric or mental disabilities necessitates a reappraisal in social care. Referral, sloughing off and impersonal service delivery are professional characteristics that concur with managerial or political objectives. Managers and politicians are partly responsible for their widespread application. Hence, professionals need their help to fight this "enemy within professionalism." [ABSTRACT FROM AUTHOR]

Safe environmental conditions and the availability of standard precaution items are important to prevent and treat infection in health care facilities (HCFs) and to achieve Sustainable Development Goal (SDG) targets for health and water, sanitation, and hygiene. Baseline coverage estimates for HCFs have yet to be formed for the SDGs; and there is little evidence describing inequalities in coverage. To address this, we produced the first coverage estimates of environmental conditions and standard precaution items in HCFs in low- and middle-income countries (LMICs); and explored factors associated with low coverage. Data from monitoring reports and peer-reviewed literature were systematically compiled; and information on conditions, service levels, and inequalities tabulated. We used logistic regression to identify factors associated with low coverage. Data for 21 indicators of environmental conditions and standard precaution items were compiled from 78 LMICs which were representative of 129,557 HCFs. 50% of HCFs lack piped water, 33% lack improved sanitation, 39% lack handwashing soap, 39% lack adequate infectious waste disposal, 73% lack sterilization equipment, and 59% lack reliable energy services. Using nationally representative data from six countries, 2% of HCFs provide all four of water, sanitation, hygiene, and waste management services. Statistically significant inequalities in coverage exist between HCFs by: urban-rural setting, managing authority, facility type, and sub-national administrative unit. We identified important, previously undocumented inequalities and environmental health challenges faced by HCFs in LMICs. The information and analyses provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources. [ABSTRACT FROM AUTHOR]

To increase efficiency and quality, process development has been implemented in many Swedish hospitals. These hospitals are usually organized as professional bureaucracies in which health care managers have limited decision control. The new governance principles has been implemented without removing bureaucratic elements. This study analyzes how managers implement planned change in these professional bureaucracies, considering if managers coaching style, organizational preconditions, implementation strategy, appraisal of change and clinic autonomy, is associated with health care process quality (HPQ). The study is based on interviews with health care managers and longitudinal assessments of HPQ. The results revealed significant differences between coaching style, organizational preconditions, and HPQ over time. The conclusion is that leadership and preconditions is of importance for the health care manager's ability to work with planned change, as that the health care managers understand how management methods, governance principles, and professional bureaucracies work in practice. [ABSTRACT FROM AUTHOR]

Traditionally health statistics are derived from civil and/or vital registration. Civil registration in low- to middleincome countries varies from partial coverage to essentially nothing at all. Consequently the state of the art for public health information in low- to middle-income countries is efforts to combine or triangulate data from different sources to produce a more complete picture across both time and space - data amalgamation. Data sources amenable to this approach include sample surveys, sample registration systems, health and demographic surveillance systems, administrative records, census records, health facility records and others. We propose a new statistical framework for gathering health and population data - HYAK - that leverages the benefits of sampling and longitudinal, prospective surveillance to create a cheap, accurate, sustainable monitoring platform. HYAK has three fundamental components: • Data amalgamation: A sampling and surveillance component that organizes two or more data collection systems to work together: (1) data from HDSS with frequent, intense, linked, prospective follow-up and (2) data from sample surveys conducted in large areas surrounding the Health and Demographic Surveillance System (HDSS) sites using informed sampling so as to capture as many events as possible; • Cause of death: Verbal autopsy to characterize the distribution of deaths by cause at the population level; and • Socioeconomic status (SES): Measurement of SES in order to characterize poverty and wealth. We conduct a simulation study of the informed sampling component of HYAK based on the Agincourt HDSS site in South Africa. Compared with traditional cluster sampling, HYAK's informed sampling captures more deaths, and when combined with an estimation model that includes spatial smoothing, produces estimates of both mortality counts and mortality rates that have lower variance and small bias. [ABSTRACT FROM AUTHOR]

BJECTIVE; To investigate the application of antibiotics in grade DI class A hospitals in Henan, so as to provide references for rational application of antibiotics and scientific management. METHODS: Data ol usage rates of antibiotics in outpatient and emergency departments, usage rate ol antibiotics in inpatients, use intensity and the inspection rates ol bacteriological examination samples ol inpatients that receiving antibiotics treatment in 7 grade HI (dass A hospitals in Henan during 2014-2016 were collected and analyzed. RESULTS: During 2014-2016, die usage rate ol antibiotics in outpatients in 7 grade HI class A hospitals in Henan Had been decreased from 15. 51% in 2014 to 13.00% in 2016; the usage rate ol antibiotics in emergency department had been decreased from 31.58% in 2014 to 25. 78% in 2016; the usage rates ol antibiotics in inpatients were respectively 55. 85% , 53. 49% and 54. 28% ; the use intensities of antibiotics in inpatients were respectively 34. 87, 34. 84 and 35. 85 DDDs/(100 people. d) ; the total inspection rates ol bacteriological examination samples ol inpatients that receiving antibiotics treatment were respectively 37. 99% , 39.29%, 38.67%. CONCLUSIONS: The application of antibiotics in grade III class A hospitals in Henan has basically met the criteria ol National Health and Family Planning Community, ellective measures needed to be adopted to continuously consolidate the results ol specialized renovation, long-term management on the clinical application ol antibiotics should be steadily built and completed to promote the rational application ol antibiotics and improve the management ol medical institutions. [ABSTRACT FROM AUTHOR]

The article explores ways for improving a cancer center operations in the U.S. Topics discussed include managing chemotherapy treatment, admissions and emergency department visit rates; listening patients' complaints and concerns; and focusing on quality of care, patient management, and value improvement.

Disasters are the constant companions of mankind. Mostly, any talk on disasters centres around only natural disasters, with anthropogenically caused disasters not being given adequate credence. Utilising an exploratory approach and the World Health Organisation's Hospital preparedness checklist, this paper examines the preparedness of Chandigarh health facilities to combat incidents of Biological Disasters. The findings have been discussed under nine major heads - viz. Command and Control; Communication; Safety and Security; Triage; Surge Capacity; Continuity of Essential Services; Human Resource Development; Logistics and Supply Management and Post Disaster Recovery. [ABSTRACT FROM AUTHOR]

After a brief introduction (I.) the article first outlines how cloud services are an important element of the transformation of healthcare (II.) and then sets out policy recommendations for regulators and policymakers (III.) to establish appropriate data security and protection while streamlining regulator processes, requirements and reviews. [ABSTRACT FROM AUTHOR]

Background: In the Democratic Republic of Congo, the penal code prohibits the provision of abortion. In practice, however, it is widely accepted that the procedure can be performed to save the life of a pregnant woman. Although abortion is highly restricted, anecdotal evidence indicates that women often resort to clandestine abortions, many of which are unsafe. However, to date, there are no official statistics or reliable data to support this assertion. Objectives: Our study provides the first estimates of the incidence of abortion and unintended pregnancy in Kinshasa. Methods: We applied the Abortion Incidence Complications Method (AICM) to estimate the incidence of abortion and unintended pregnancy. We used data from a Health Facilities Survey and a Prospective Morbidity Survey to determine the annual number of women treated for abortion complications at health facilities. We also employed data from a Health Professionals Survey to calculate a multiplier representing the number of abortions for every induced abortion complication treated in a health facility. Results: In 2016, an estimated 37,865 women obtained treatment for induced abortion complications in health facilities in Kinshasa. For every woman treated in a facility, almost four times as many abortions occurred. In total, an estimated 146,713 abortions were performed, yielding an abortion rate of 56 per 1,000 women aged 15–49. Furthermore, more than 343,000 unintended pregnancies occurred, resulting in an unintended pregnancy rate of 147 per 1,000 women aged 15–49. Conclusions: Increasing contraceptive uptake can reduce the number of women who experience unintended pregnancies, and as a consequence, result in fewer women obtaining unsafe abortions, suffering abortion complications, and dying needlessly from unsafe abortion. Increasing access to safe abortion and improving post-abortion care are other measures that can be implemented to reduce unsafe abortion and/or its negative consequences, including maternal mortality. [ABSTRACT FROM AUTHOR]

While several studies have documented the various barriers that caretakers of children under five routinely confront when seeking healthcare in Uganda, few have sought to capture the ways in which caretakers themselves prioritize their own barriers to seeking services. To that end, we asked focus groups of caretakers to list their five greatest challenges to seeking care on behalf of children under five. Using qualitative content analysis, we grouped responses according to four categories: (1) geographical access barriers; (2) facility supplies, staffing, and infrastructural barriers; (3) facility management and administration barriers (e.g. health worker professionalism, absenteeism and customer care); and (4) household barriers related to financial circumstances, domestic conflicts with male partners and a stated lack of knowledge about health-related issues. Among all focus groups, caretakers mentioned supplies, staffing and infrastructure barriers most often and facility management and administration barriers the least. Caretakers living furthest from public facilities (8-10 km) more commonly mentioned geographical barriers to care and barriers related to financial and other personal circumstances. Caretakers who lived closest to health facilities mentioned facility management and administration barriers twice as often as those who lived further away. While targeting managerial barriers is vitally important-and increasingly popular among national planners and donors-it should be done while recognizing that alleviating such barriers may have a more muted effect on caretakers who are geographically harder to reach - and by extension, those whose children have an increased risk of mortality. In light of calls for greater equity in child survival programming - and given the limited resource envelopes that policymakers often have at their disposal - attention to the barriers considered most vital among caretakers in different settings should be weighed. [ABSTRACT FROM AUTHOR]

Background: Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators.Methods: Forty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors.Results: Women and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers.Conclusion: Prior to introducing companion of choice at birth, understanding providers' attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women's privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of companion of choice at birth on care-seeking behavior for subsequent births. [ABSTRACT FROM AUTHOR]

Introduction: In Turkey, there is a lack of data on the frequency of cardiovascular diseases, risk factors, co-morbid diseases, and drug usage among the elderly population. We aimed to compile a data of frequency of cardiovascular diseases, cardiovascular risk factors, concomitant diseases, and drug usage among elderly patients visiting cardiology clinics in Turkey. Materials and Method: This non-interventional, multicenter study evaluated 5694 patients aged 65 years or older and who were followed up at cardiology clinics. Cardiovascular diseases, risk factors, co-morbidities, and medication use were surveyed. Results: Mean age of patients was 73.5±6.3 years (males: 49.8%). The frequency rates were 73% for hypertension, 28.8% for diabetes mellitus, 35% for hyperlipidemia, 50% for previous myocardial infarction, 27.3% for atrial fibrillation, and 11.5% for chronic renal failure. The body mass index of participants was 27.7±4.4 kg/m², systolic blood pressure was 130±18 mmHg, diastolic blood pressure was 77.1+11 mmHg, and resting heart rate was 76±14 bpm, 66.3% of the study population used beta blockers, 71.7% angiotensin system inhibitors, 59.6% diuretics, 7.9% digoxin, 30.5% calcium channel blockers, 34% lipid-lowering agents, 71.5% acetylsalicylic acid, and 25.9% oral anticoagulants. The most common non-cardiovascular medications were vitamins (12.3%) and nonsteroidal anti-inflammatory drugs (11.2%). Conclusion: Valuable data of Turkey's elderly population at cardiology clinics, pertaining to cardiovascular and co-morbid diseases was collected. The identification of risk factors for cardiovascular diseases as well as concomitant diseases, and medication use in elderly patients may lead to interventions that could improve the health of elderly in the general population. [ABSTRACT FROM AUTHOR]

The Low Vision Service Wales (LVSW) was founded in 2004 with the aim of providing a better quality of care that was available closer to people's homes and facilitating rapid service access. The service has been found to be as effective as traditional hospital-based services and effective over the longer term (Court et al. 2011; Ryan et al. 2013). In 2015, 11 years after the establishment of the service, the LVSW had completely replaced all secondary care-based low-vision services in Wales. During 2016 over 8000 patients were seen within the service, which is provided by practitioners who have undergone further postgraduate training and a process of service accreditation. Access to the service is open, with referrals being accepted from any source, including the patients themselves. As a Welsh Government-funded service, the low-vision assessment is free at point of contact, with any low-vision aids issued being supplied on a loan basis. Eligibility is based on clinical need, thus, despite the majority of the patient base being over the age of 80, children and younger adults are also seen within the service. Multidisciplinary working is core to the success of the LVSW, as is ensuring good access for patients in a country which presents geographic challenges. The LVSW is regularly audited, with the aim of using audit results to develop the service further and inform the training needs of the workforce. Recent service developments include the addition of the Peli lens to the catalogue of low-vision aids available to prescribe, and the assessment of falls risk of patients. Future developments include the identification of patients with symptoms of depression. [ABSTRACT FROM AUTHOR]

Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law. To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington. We convened a conference of 112 stakeholders in December 2015, and herein present their recommendations. Themes of recommendations regarding implementation include (1) institutions should develop and revise physician-assisted death policies; (2) legal physician-assisted death will have implications for California's culturally and socio-economically diverse population, and for patients from vulnerable groups; (3) conscientious objection and moral distress for health care providers must be considered; and (4) palliative care is essential to the response to the law. The expert conference participants' insights are a valuable guide, both for providers and health care facilities in California planning or revising their response, and for other jurisdictions where physician-assisted death laws are being considered or implemented. [ABSTRACT FROM AUTHOR]

The aim of the article is to identify the criteria and methods for the evaluation of medical institutions. The article uses economic analysis, comparative analysis, and methods of descriptive statistics. The analysis of existing regulations, source materials, and the specific business character of health care entities indicates the need to evaluate these units with particular regard to the criteria such as costs, quality of assets (level of consumption, i.e., wear and tear and modernness), employment, financial liquidity or the level of debt. The results of the study are the basis for the evaluation of the healthcare sector. The value of the article is in showing the direction taken by the evaluation of the financial standing of entities. The ability to use specific criteria and methods of evaluation for health care entities in business practice. [ABSTRACT FROM AUTHOR]

The purpose of this article is to evaluate the use of tools of strategic management in hospitals in Lublin region. The study was conducted among 14 medical entities from the area of Lublin Voivodeship. The survey was addressed to economic directors or chief accountants of health care facilities and sent by post. The questionnaire was also helpful in conducting an in-depth interview as it provided a required structure. As part of the interviews with managers of health care facilities, information beyond the questionnaire was acquired, e.g. about the mission. According to studies, most health care facilities develop strategic plans (71.4%). For 21.4% of the studied facilities, the strategic plan is known mainly to management. In contrast, 28.6% of entities do not have a strategic plan. The presented results of the research can increase the effectiveness of activities in each area of the health care facility, continuous process improvement and rapid response to changes in the environment. [ABSTRACT FROM AUTHOR]

Private healthcare services in Vietnam are seen as a major part of the solution to the rapid increase in need and demand for healthcare services. Formally recognized over 20 years ago, the private health services coexist with public services and are available all over the country. However, the scale and size of private sector is still small compared to the public sector and public acceptance and reputation still limited. There are substantial concerns with the quality of services and the adequacy of regulation. Human resource for health is currently inadequate to support growth in both public and private sectors. The role of the private sector in achieving Vietnam's population health objectives is not clear. In this emerging economy, there is significant potential for increased dependency on private healthcare to increase health access inequities. This paper discusses how private healthcare could better contribute to healthcare coverage in Vietnam. [ABSTRACT FROM AUTHOR]

Background Disinfectant use among healthcare workers has been associated with respiratory disorders, especially asthma. We aimed to describe disinfectants used by U.S. nurses, and to investigate qualitative and quantitative differences according to workplace characteristics and region. Methods Disinfectant use was assessed by questionnaire in 8,851 nurses. Hospital characteristics were obtained from the American Hospital Association database. Results Working in a hospital was associated with higher disinfectant use (OR: 2.06 [95%CI: 1.89-2.24]), but lower spray use (0.74 [0.66-0.82]). Nurses working in smaller hospitals (<50 beds vs. ≥200 beds) were more likely to use disinfectants (1.69 [1.23-2.32]) and sprays (1.69 [1.20-2.38]). Spray use was lower in the West than in the Northeast (0.75 [0.58-0.97]). Conclusion Disinfectant use was more common among nurses working in smaller hospitals, possibly because they perform more diverse tasks. Variations in spray use by hospital size and region suggest additional targets for future efforts to prevent occupational asthma. Am. J. Ind. Med. 60:131-140, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Purpose This paper aims to enquire into how building information modelling (BIM) and gaming can be integrated to support professionals in their learning about the spatial layout of a new building. This knowledge is important to prepare building operation and facilities management (FM).Design/methodology/approach Ingrained in task–technology fit theory, this paper reports from a case study of a serious game staged in the graphical environment of a building information model. A series of interviews with the client, subject-matter experts and software developers involved in developing the game were conducted. The industrial setting for the study is a major hospital construction project in Norway. The project has been awarded BuildingSMART’s 2015 award for “outstanding open BIM practice”, making it Norway’s role model for BIM practice.Findings Importing and exporting geometry from BIM into a game engine remain challenging. The transfer of data between the two requires workarounds using intermediary software. Apart from issues related to technical interoperability, several sociotechnical challenges influential for the integration of BIM and gaming have been identified, related to: the collaboration among construction, operational and gaming experts; clear communication of information needs; and better contractual agreements.Research limitations/implications BIM’s geometric and semantic data enabled the creation of a sophisticated game for preparing building operation. Test-users perceived the game to be superior to classroom teaching for learning about the spatial layout of the building. However, quantifying the business value of the game for operation after occupancy of the new facilities was beyond the scope of this study.Originality/value The work presented exemplifies a novel application area of BIM and gaming technology in FM. The findings presented in this article are relevant for professionals and scholars seeking to expand the utility of BIM for starting up the operation of new facilities. [ABSTRACT FROM AUTHOR]

Background: Little attention has been paid to quality improvement (QI) capacity within smaller primary care practices which comprise nearly half of all primary care settings. Strategies for external support to build such capacity include practice facilitation (PF), shared learning opportunities, and educational outreach. Although PF has proven effectiveness, little is known about the comparative effectiveness of combining these strategies. Here, we describe the protocol of the "Healthy Hearts Northwest" (H2N) study, a randomized trial designed to address these questions while improving risk factors for cardiovascular disease. Methods/design: The targeted enrollment is 250 smaller primary care practices across Washington, Oregon, and Idaho. The study is utilizing a two-by-two factorial design to assess four different combinations of practice support: PF alone, PF with educational outreach, PF with shared learning opportunities, or PF with both. A mixed methods approach is being used for evaluation and will include data from (1) baseline and follow-up practice and staff surveys; (2) baseline and quarterly clinical performance measurement from each practice on four cardiovascular risk factors: appropriate aspirin use, blood pressure control, lipid management and smoking cessation support; and (3) a quality improvement capacity assessment (QICA) survey used by external practice facilitators to guide improvement efforts. Discussion: Results from this study will inform future large-scale practice improvement initiatives by providing comparisons of promising external practice support strategies and advance our understanding of how to build QI capacity in primary care. [ABSTRACT FROM AUTHOR]

Concerning the premium «dermatologist from the Heart» awarded by the Fondation La Roche Posay in 2014, we put into practice the winning project "Corvo Island Dermatology". The project's main objective was to perform a screening of the skin in an area of the country with difficult geographical accessibility to specialized health care. The island has a single doctor, a general practitioner - Dr. José Pinto Faustino. The screening was performed for 5 days, between 13 and 18 July 2015 in the Health Unit of Corvo. There were attended 120 people living on the island that were observed by 2 participant dermatologists. No skin diseases with statistical significance were detected. [ABSTRACT FROM AUTHOR]

Background: Maternity care in South Asia is available in both public and private sectors. Using data from demographic surveillance sites in Bangladesh, Nepal and rural and urban India, we aimed to compare institutional delivery rates and public-private share.Methods: We used records of maternity care collected in socio-economically disadvantaged communities between 2005 and 2011. Institutional delivery was summarized by four potential determinants: household asset index, maternal schooling, maternal age, and parity. We developed logistic regression models for private sector institutional delivery with these as independent covariates.Results: The data described 52 750 deliveries. Institutional delivery proportion varied and there were differences in public-private split. In Bangladesh and urban India, the proportion of deliveries in the private sector increased with wealth, maternal education, and age. The opposite was observed in rural India and Nepal.Conclusions: The proportion of institutional delivery increased with economic status and education. The choice of sector is more complex and provision and perceived quality of public sector services is likely to play a role. Choices for safe maternity are influenced by accessibility, quantity and perceived quality of care. Along with data linkage between private and public sectors, increased regulation should be part of the development of the pluralistic healthcare systems that characterize south Asia. [ABSTRACT FROM AUTHOR]

A combination of quantitative and qualitative approaches was used to evaluate the effectiveness of LEED-certified healthcare settings from the perspectives of both staff and facility managers. This study surveyed 164 staff members in two healthcare settings in a case study to compare LEED and non-LEED-certified healthcare facilities and surveyed 146 staff in six LEED-certified healthcare settings for the main study. Telephone interviews with six facility managers were used to verify the survey results and further examine the facilities' performance and the effectiveness of the LEED strategies. An independent t-test was used to examine the difference between a LEED hospital and a non-LEED hospital in one healthcare system. Building performance was rated higher by staff in the LEED-certified hospital than in the non-LEED hospital. Multivariate analysis of variance (MANOVA) was conducted to compare staff ratings between the silver and gold LEED certification levels and between males and females, as well as to explore the possibility of interaction effects. Compared with the staff in silver-certified facilities, staff members in the gold-certified hospitals gave the buildings significantly higher ratings in most performance variables, including building overall, overall comfort and controllability. Males felt more comfortable than females with temperatures in healthcare facilities. [ABSTRACT FROM AUTHOR]

Healthcare emergency management continues to suffer from not being part of daily organisational operations. Tire aim of this paper is to shed light on a new paradigm for healthcare emergency management by viewing it in a distilled way: incidents that negatively affect the environment of care are simply deviations from normal. Doing so simplifies the approach and enables such work to meld more easily into the already complex healthcare clinical, operational and financial environs. Readers will take away knowledge on healthcare emergency management as deviations from normal operations, the goal being to aid in improving understanding and integrating such work into daily operations. The scope o f this paper is a descriptive one o f healthcare facilities, be they inpatient or outpatient, urban or rural and any combination o f each. [ABSTRACT FROM AUTHOR]