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Background/Aims: Asset sharing is becoming increasingly common in the healthcare sector. However, its specific applications to the healthcare sector and the potential unintended consequences have not received adequate research attention. This is the second study in a two-part research effort looking at the unintended consequences of asset sharing, particularly when the decision to share assets is made by the healthcare service provider, rather than the service user. This study aimed to assess the potential mediating role of patients' perceptions of contamination in shared healthcare assets on patient satisfaction with the physician and the treatment decision, intention to use the service again and willingness to recommend the service to others. Methods: This was an experimental study with 261 participants, recruited from the general population via an online crowdsourcing platform and randomly assigned to one of three conditions. All participants read a vignette scenario in which a physician recommends surgery for knee problems. In the non-sharing condition, the physician explains that the operating room is used by their practice only. In the two sharing conditions, the physician explains that the room is used by five or 10 other practices. After reading the scenarios, participants' perceived contamination was measured using a seven-item semantic scale tool. Participants' satisfaction with the physician and their treatment decision, intention to use the service again and willingness to recommend the service to others were measured using 7-point Likert scales. The SPSS macro PROCESS model 4 with Helmert coding was used to analyse the data. Results: There was a positive association between perceived contamination and sharing with both five other practices (b=0.40; P=0.01) and 10 other practices (b=0.42; P=0.02) among participants. There were negative associations between perceived contamination and predictions of satisfaction with the physician (b=-0.30; P=0.00), satisfaction with the physician's treatment decision (b=-0.30; P=0.00), intention to use the physician's service again (b=-0.34; P=0.00) and willingness to recommend the service to others (b=-0.36; P=0.00). Conclusions: This study indicates that perceived contamination is a key factor to consider when exploring and addressing the unintended effects of asset sharing in healthcare. Healthcare organisations should consider strategies to reassure patients and reduce the impact of perceived contamination on patients' perceptions of services that use shared assets. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Transitions to new care environments may have unexpected consequences that threaten patient safety. We undertook a quality improvement project using in situ simulation to learn the new patient care environment and expose latent safety threats before transitioning patients to a newly built adult ICU. DESIGN: Descriptive review of a patient safety initiative. SETTING: A newly built 24-bed neurocritical care unit at a tertiary care academic medical center. SUBJECTS: Care providers working in neurocritical care unit. INTERVENTIONS: We implemented a pragmatic three-stage in situ simulation program to learn a new patient care environment, transitioning patients from an open bay unit to a newly built private room-based ICU. The project tested the safety and efficiency of new workflows created by new patient- and family-centric features of the unit. We used standardized patients and high-fidelity mannequins to simulate patient scenarios, with "test" patients created through all electronic databases. Relevant personnel from clinical and nonclinical services participated in simulations and/or observed scenarios. We held a debriefing after each stage and scenario to identify safety threats and other concerns. Additional feedback was obtained via a written survey sent to all participants. We prospectively surveyed for missed latent safety threats for 2 years following the simulation and fixed issues as they arose. MEASUREMENTS AND MAIN RESULTS: We identified and addressed 70 latent safety threats, including issues concerning physical environment, infection prevention, patient workflow, and informatics before the move into the new unit. We also developed an orientation manual that highlighted new physical and functional features of the ICU and best practices gleaned from the simulations. All participants agreed or strongly agreed that simulations were beneficial. Two-year follow-up revealed only two missed latent safety threats. CONCLUSIONS: In situ simulation effectively identifies latent safety threats surrounding the transition to new ICUs and should be considered before moving into new units. [ABSTRACT FROM AUTHOR]

Background/Aims: The sharing economy comprises three main actors: sharing platforms, asset providers and end users (consumers). These actors arguably possess decision-making autonomy and make sharing-related decisions on their own behalf, but the growing prevalence of asset sharing in the healthcare sector implies the possibility of heteronomous, provider-driven decisions. This article reports the findings of the first part of a two-part study providing insights into the unintended effects of sharing healthcare assets when the sharing decision is made by the healthcare service provider, not the service user. Methods: Building on reactance theory, this study used an experimental scenario-based design. A total of 398 participants (all members of the general public) were randomly assigned to three groups and given a scenario involving a consultation with a physician. In one scenario, participants were told they would undergo an operation in a theatre used solely by the physician's practice, while in the other two scenarios the theatre was shared with either five or 10 other practices. Participants were asked about their perceptions of the physician and whether they would use their services again, ranking agreement to items on a 7-point Likert scale. Regression analyses were performed to assess the relationships between asset sharing conditions, participants' perception of the quality of the service and the intention to use the service again. Results: Healthcare asset sharing was significantly and negatively associated with perceived service quality (b=−0.54; P=0.000). While perceived service quality had a significant positive effect on intention to use the service again (b=0.91; P<0.001), none of the sharing or non-sharing conditions had a significant direct effect on intention to use the service again. This indicates that perceived service quality had a full mediating effect on the relationship between asset sharing and intention to use the service again. Conclusions: Sharing healthcare assets could negatively affect patients' intention to use the service again by reducing the perceived quality of the service. Healthcare organisations should work to reduce the impact of asset sharing on perceived quality in order to prevent a negative effect on patient-related outcomes, such as satisfaction and intention to use the service again. [ABSTRACT FROM AUTHOR]

Purpose: The new Italian National Recovery and Resilience Plan (NRRP) has prioritised a new healthcare model that will establish the additional community healthcare facilities (CHFs). The paper proposes a methodology for supporting decision-making on location of the future facilities according to new parameters that consider how proximity to healthcare benefits communities. Rethinking the spatial parameters for locating future CHFs, focusing on fragile areas, creates a novel decision support system. Design/methodology/approach: The methodology is based on multifactor analysis and on geographic information system (GIS) mapping to simulate the potential and risks associated with the proposed location of CHFs, focusing on territorial contexts of metropolitan cities, medium-sized cities, and Inner Areas, characterized by different fragilities. This method aims to innovate urban planning practices by updating the practice of per-capita urban planning standards and promoting implementation of the 15-minute city model. Findings: The method defines new spatial parameters useful to inform the appropriate location of CHFs in Italy's Inner Areas. This offers a new integrated approach to spatial design mixing urban planning and healthcare dimensions. Originality/value: The methodology will bring about an integrated urban planning approach, which guides both transformative urban choices and health services' implementation according to the needs of communities. [ABSTRACT FROM AUTHOR]

Objective: The issue of accessibility is more important in the selection of the location of health institutions where primary health care services are provided. In this study, it was aimed to obtain information about the experiences and experiences of family physicians during the establishment process of family health centers with zero population and no service building. Methods: The study is a qualitative research designed with a phenomenological approach. Data were collected through face-to-face interviews with 12 family physicians who settled in a total of 16 family medicine units in 5 family health centers with zero population and without a building within a 6-month period in Samsun province. Results: Family physicians thought that the 1-month period given to establish a family health center was too short. Family physicians stated that not every building in the desired region was suitable for a family health center. Financial expenditures were found to be one of the most challenging issues for family physicians. The interviewees mentioned the excitement of making a new start as the most important motivating factor. Other motivating factors included a new physical building, a new working environment, and getting to know new people. Conclusion: In terms of facilitating access to primary care services, it is important to establish FHCs without a population and service building. In the process of establishing a family health center, both the cost of building construction and the necessity of providing all the consumables required for the service by the family physician cause financial difficulties for family physicians. [ABSTRACT FROM AUTHOR]

Background: Many countries and communities in sub-Saharan Africa suffer from inadequate access to healthcare and healthy lifestyles as reflected in their high mortality and morbidity rates. Large-scale interventions like the medical city project presented in this article are necessary to address the significant health burdens faced by populations in this region. Objectives: This article shows how evidence-based approaches and multisectoral partnerships guided the development of the 327-acre Medical City master plan in Akwa Ibom, Nigeria. This is envisioned to be the first-of-its-kind medical city in this medically underserved "healthcare desert." Methods: The five-phased, seven-year (2013–2020) master planning process was guided by the overarching design framework of "sustainable one health" along with its 11 objectives and 64 performance measures. The data/evidence used to guide the planning decision-making process came from case studies, literature reviews, stakeholder interviews, and on-site investigations. Results: The outcome of this project is a comprehensive medical city master plan that includes a self-contained, mixed-use community anchored by a hospital and a primary healthcare village. This medical city provides access to the full range of healthcare services (e.g., curative-to-preventive, traditional-to-alternative) and is supported by multimodal transportation systems and extensive green infrastructure. Conclusions: This project offers theoretical and practical insights on "designing for health" in a frontier market while responding to the complex local contexts that present many unique challenges and opportunities. Those insights provide useful lessons for researchers and professionals interested in promoting health and healthcare services in healthcare deserts. [ABSTRACT FROM AUTHOR]

BACKGROUND: Health sciences libraries are being closed or are under threat of closure, but little is published that looks at context and causes or alternative library service delivery models such as affiliations or consolidations. There is also very little research about the effect of these changes on health care provider satisfaction, patient care, or hospital quality indicators. Preventing library closures is not always possible, but understanding some of the circumstances leading to the decision and implementation of a closure or consolidation could inform best practice management. CASE PRESENTATIONS: At a recent Medical Library Association joint chapter meeting, a panel of six librarians presented their cases of navigating a library closure or reorganization. Background information was given to highlight reasons that the decisions to reorganize or close were made. Following the case presentations, participants took part in discussion with audience members. Cases and discussion points were recorded for further research, publication, and advocacy. CONCLUSIONS: Several points from the cases are highlighted in the discussion section of the paper. An accurate reporting of US health sciences libraries and librarian staffing is needed. More needs to be written about new library service models and best practices for centralizing and maintaining library services. After a consolidation, remaining librarians will be expected to manage the effects of staff loss and site closures and so should be involved in planning and implementing these decisions. It remains to be determined how hospitals with librarians compare in patient care and other quality indicators against hospitals without librarians.

Two hours of travel time specified by the World Health Organization (WHO) to access quality health services is among the most important criteria for the Universal Health Coverage. However, locations of health facilities (HF) in many developing countries fail to realise this target due to a lack of appropriate models considering the local environment. This work used the central-place theory to explore locations of HF in Kishapu and their accessibility status based on two means of transport in the AccessMod tool: walking only and the combination of walking-and-motor devices. The results of the walking scenario indicated that the travel times to the health centres and hospitals exceeded 2 h, and a direct relationship existed between the facility level and the travel time spent to access it. The combined transport (walking and motorized) showed that dispensaries are easily accessible (14.5 min) compared to health centres (42.8 min) and hospitals (67.3 min). To address the challenge, we have developed a model revealing optimal sites with quick access for HF construction and improvement using Multi-Criteria-Evaluation and Analytical-Hierarchy Process methods weighting five criteria including distance from settlements (44% weight), roads (26% weight), existing health facilities (16% weight), rivers (9% weight) and railway (5% weight). A test of the model with both means of transport shows that at all places proposed to be optimal allow patitents to travel in less than 2 h, indicating that the proposed model can effectively and efficiently solve the challenge of allocating HF in society. • We argued that subjective approach of calculating travel time for the purpose of allocating limited resources, like healthcare facilities, has consistently resulted in disparities in quality healthcare access, particularly among disadvantaged populations. • Understanding the relationship between the facility level and the travel time required for access is fundamental to enhancing the delivery of quality health services. • Incorporating both walking and combined modes of transport when identifying health facility locations yields more valuable results. • In Kishapu district, Tanzania, dispensaries generally appear to be more easily accessible compared to higher facility levels, including health centres and hospitals, based on the WHO travel time criteria. [ABSTRACT FROM AUTHOR]

Abstract Background The recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a “care strategy” specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria. Results We designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria’s 2122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called “regional health care profiles for primary health care” (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area. Conclusions The RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health care structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria.

Overcrowding in Emergency Departments (EDs) is a phenomenon that is now widespread globally and causes a significant negative impact that goes on to affect the entire hospital. This contributes to a number of consequences that can affect both the number of resources available and the quality of care. Overcrowding is due to a number of factors that in most cases lead to an increase in the number of people within the ED, an increase in mortality and morbidity, and a decrease in the ability to provide critical services in a timely manner to patients suffering from medical emergencies. This phenomenon results in the Emergency Department reaching, and in some cases exceeding, its optimal capacity. In this review, the main causes and consequences involving this phenomenon were collected, including the effect caused by the SARS-CoV-2 virus in recent years. Finally, special attention was paid to the main operational strategies that have been developed over the years, strategies that can be applied both at the ED level (microlevel strategies) and at the hospital level (macrolevel strategies). [ABSTRACT FROM AUTHOR]

The burden of kidney disease in India is rising sharply. We estimated unmet needs of dialysis and found that Udupi district requires 57 additional dialysis machines. Feasibility studies were conducted for three business models: Standalone dialysis center, franchise-based model and mobile dialysis unit. Among these, a standalone dialysis center can provide upto 12% annual return on investment, while a franchise-based model is comparatively risk averse. Manpower cost comprises the major chunk of expenses incurred. A mobile dialysis center should be considered only by charitable institutions or if some costs can be met with NGO or governmental grants. [ABSTRACT FROM AUTHOR]

Background: The recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a "care strategy" specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria. Results: We designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria's 2122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called "regional health care profiles for primary health care" (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area. Conclusions: The RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health care structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria. [ABSTRACT FROM AUTHOR]

Involving people living with dementia in service design and planning has become more common in high-income countries. It remains rare in low- and middle-income countries where two-thirds of the world's people with dementia live. In this commentary article, we explore the barriers to inclusion of people living with dementia in planning in low- and middle-income countries and make a case for the inclusion of people living with dementia in care and service planning. We suggest how this can be done at individual, community or national and state level using the following principles: 1) respecting the rights of people living with dementia to self-determination; 2) valuing people living with dementia's unique understanding of dementia; 3) creating a culture of active inclusion which creates a space for people living with dementia to participate and 4) ensuring appropriate accommodations are in place to maximise participation. [ABSTRACT FROM AUTHOR]

Objectives: The Society of Critical Care Medicine convened its Academic Leaders in Critical Care Medicine taskforce on February 22, 2016, during the 45th Critical Care Congress to develop a series of consensus papers with toolkits for advancing critical care organizations in North America. The goal of this article is to propose a framework based on the expert opinions of critical care organization leaders and their responses to a survey, for current and future critical care organizations, and their leadership in the health system to design and implement successful regionalization for critical care in their regions.Data Sources and Study Selection: Members of the workgroup convened monthly via teleconference with the following objectives: to 1) develop and analyze a regionalization survey tool for 23 identified critical care organizations in the United States, 2) assemble relevant medical literature accessed using Medline search, 3) use a consensus of expert opinions to propose the framework, and 4) create groups to write the subsections and assemble the final product.Data Extraction and Synthesis: The most prevalent challenges for regionalization in critical care organizations remain a lack of a strong central authority to regulate and manage the system as well as a lack of necessary infrastructure, as described more than a decade ago. We provide a framework and outline a nontechnical approach that the health system and their critical care medicine leadership can adopt after considering their own structure, complexity, business operations, culture, and the relationships among their individual hospitals. Transforming the current state of regionalization into a coordinated, accountable system requires a critical assessment of administrative and clinical challenges and barriers. Systems thinking, business planning and control, and essential infrastructure development are critical for assisting critical care organizations.Conclusions: Under the value-based paradigm, the goals are operational efficiency and patient outcomes. Health systems that can align strategy and operations to assist the referral hospitals with implementing regionalization will be better positioned to regionalize critical care effectively. [ABSTRACT FROM AUTHOR]

Projects and construction management in healthcare facilities are usually assigned to architectural firms and engineering companies with previous experience. However, there is no evaluation system to ensure their level of competence in the healthcare sector. In the past, this was also the case for clinicians when they were self-appointed specialists without any supervision. Currently, the Specialised Health Training (SHT) programme in Spain is the only official specialisation pathway and consists of a period that combines training and paid healthcare practice. Similarly, but from Argentina, hospital residencies in architecture have been carried out for specialised postgraduate training. The aim of this article was to show the experience in Argentina and to propose the extension of the SHT in Spain. Our proposal consists of a programme of residencies in architecture and engineering to be developed in healthcare centres. We believe that this initiative has great potential to address health from its multiple disciplines and to reinforce the maturity of a National Health System in constant change., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Hurricane Katrina destroyed much of the health care infrastructure in and around New Orleans in 2005. We describe a natural experiment that occurred afterward, amid efforts to rebuild the city's health care system, in which diverse safety-net clinics were transformed into medical homes. Using surveys of clinic leaders and administrative data, we found that clinics made substantial progress in implementing new clinical processes to improve access, quality and safety, and care coordination and integration. But there was wide variation, with some clinics making only minimal progress. Because the transformation was closely tied to the receipt of federal grants and bonus payments, we observed declines in performance toward the end of the study, when clinics faced diminished federal funding and refocused their priorities on survival. Now that federal funds have dried up, moreover, clinics may be losing ground in sustaining their practice changes. The experience shows that payment to support medical home transformation must be robust and stable, and clinics need to be fully integrated into the broader health care system to improve overall coordination of care.

Purpose: Smoking represents a primary risk factor for the development of urothelial carcinoma (UC) and a relevant factor impacting UC-specific prognosis. Data on the accordant knowledge of UC-patients in this regard and the significance of physicians in the education of UC-patients is limited. Materials and Methods: Eighty-eight UC-patients were enrolled in a 23-items-survey-study aimed to analyse patient knowledge and awareness of their tumor disease with smoking along with physician smoking cessation counselling. Results: The median age of the study patients was 69 years; 26.1% (n=23), 46.6% (n=41), and 27.3% (n=24), respectively, were non-smokers, previous, and active smokers. Exactly 50% of active smokers reported a previous communication with a physician about the association of smoking and their tumor disease; however, only 25.0% were aware of smoking as main risk factor for UC development. Merely 33% of the active smokers had been prompted directly by their physicians to quit smoking. About 42% of active smokers had received the information that maintaining smoking could result in a tumor-specific impairment of their prognosis. Closely 29% of active and about 5% of previous smokers (during the time-period of active smoking) had been offered support from physicians for smoking cessation. No association was found between smoking anamnesis (p=0.574) and pack-years (p=0.912), respectively, and tumor stage of UC. Conclusions: The results of this study suggest that the medical conversation of physicians with UC-patients about the adverse significance of smoking is limited. Implementation of structured educational programs for smoking cessation may be an opportunity to further enhance comprehensive cancer care.

Coronavirus disease 2019 (COVID‐19) is now an epidemic of global proportion, with major adverse impacts on older adults, persons with chronic diseases, and especially residents of long‐term care facilities. This health catastrophe has challenged healthcare facilitiesʼ capacity to deliver care to not only COVID‐19 patients but all patients who need hospital care. We report on a novel approach of utilizing long‐term care beds at a Department of Veterans Affairs healthcare facility for managing recovering COVID‐19 patients. J Am Geriatr Soc 68:2163–2166, 2020. [ABSTRACT FROM AUTHOR]

Staff members in the intensive care unit expect to deal with medical emergencies and are typically well-educated and trained to manage these. However, when faced with unusual threats such as an active shooter in the environment, they may be less well-prepared to take prompt and definitive actions. This brief article outlines the active shooter scenario and suggests strategies to ensure the safety of patients, staff members, and visitors who are in the unit. Hospital shootings are rarely anticipated on the basis of a known threat, and there is limited time to prepare for this terrorizing event. This article describes mass shooting scenarios in hospitals and offers some definitive ways to ensure survival of those involved. [ABSTRACT FROM AUTHOR]

Health facility planning is a key global health engagement capability that assesses the health needs of a population and identifies the combination of services, equipment, facilities, and infrastructure necessary to support them. Collaboration with local health care and building professionals is essential to achieving local buy-in and sustainable solutions., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The clubhouse model is a community psychiatric rehabilitation program aiming to provide a restorative environment for people with severe mental health problems. These clubhouses provide their members with opportunities for friendship, employment, and education, which help them on their paths towards mental health recovery. Towards that end, the model features clubhouse members and staff working side by side to execute clubhouse activities. That is, unlike most of the community mental health programs where staff provide services to their clients, clubhouse staff are required to partner with members in their work. The aim of this qualitative study was to understand how the clubhouse staff elicited member participation and facilitate recovery. The research was conducted between Year 2013 and Year 2014 at the world's first clubhouse: Fountain House in New York City. The first author conducted 262 hr of active participant observation in 41 visits to Fountain House, and in‐depth interviews with 38 staff members who had worked at Fountain House for at least 1 month during the study period. The dimensional analysis procedure was used to analyse the observation notes and interview transcripts. Results showed that participation was a key to rebuilding members' self‐confidence, which further encouraged members to seek more opportunities for self‐enhancement and personal growth. Specific organisational policies, programming, practical considerations, and other strategies shaped a positive environment for members to exercise autonomy, experience self‐efficacy, and model behaviours after others who have succeeded. Findings of this research support the egalitarian staff–member relationships and the maintenance of an open and transparent atmosphere of the clubhouse, as observational learning enables members to move forward with their journeys to recovery. Findings also may inform efforts to shift traditional psychiatric services towards recovery‐oriented care. [ABSTRACT FROM AUTHOR]

Summarize and synthesize published literature regarding whether the physical design of healthcare facilities affect patient and family engagement in care. Systematic literature review. EBSCOhost Health Business FullTEXT, InformeDesign, Journal of Interior Design, Journal of Health Environments Research and Design and hand search. Thesaurus, MeSH and truncated terms were used where appropriate. A modified PICO framework was used to develop literature search strategies. Articles that met the inclusion criteria were reviewed. A total of 18 articles met the inclusion/exclusion criteria. There is a modest amount of evidence indicating that the physical environment may affect patient and family engaged care. Designs that are comfortable and foster control of one's physical and social environment, access to social support and positive distractions may enhance the patient and family experience and promote engagement in care delivery. • There is modest evidence that design may influence patient and family engaged care. • Designers play a role in helping achieve the quadruple aim in healthcare. • Environmental affordances potentially moderate engagement. [ABSTRACT FROM AUTHOR]

Trauma-informed care (TIC) initiatives in state child welfare agencies are receiving more attention, but little empirical evidence exists as to their efficacy. The purpose of this study was to assess changes in self-reported practices and perceptions of child welfare staff involved in a multifaceted, statewide TIC intervention. Ten child welfare offices were matched and randomized to an early or delayed cohort. Staff were surveyed at Time 1 prior to any intervention, Time 2 postintervention for Cohort 1, and Time 3 postintervention for Cohort 2. The survey covered six domains: trauma screening, case planning, mental health and family involvement, progress monitoring, collaboration, and perceptions of the state's overall system performance. Linear mixed modeling assessed the effect of the intervention. Cohort by time interaction was significant for three intervention targets. We demonstrate, using a rigorous study design, the mixed results of a multimodal intervention to improve trauma-informed attitudes, practices, and system performance. TIC initiatives must account for complex, dynamic contextual factors. [ABSTRACT FROM AUTHOR]

The authors comment on the report "Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing," which offers strategies and recommendations to improve maternity care in the U.S. Topics include the inequalities in maternal and infant health face by the African American, rural and low-income families, the anticipated outcomes of high-value maternity care on childbearing women and newborns and the principles in transforming the maternity care system.

Despite recognition that person-centered care is a critical component to providing high quality family planning services, there lacks consensus on how to operationalize and measure it. This paper describes the development and validation of a person-centered family planning (PCFP) scale in India and Kenya. Cross-sectional data were collected from 522 women in Kenya and 225 women in India who visited a health facility providing family planning services. Psychometric analyses, including exploratory factor analysis, were employed to assess the validity and reliability of the PCFP scale. Separate scales were developed for India and Kenya due to context-specific items. We assessed criterion validity by examining the association between PCFP and global measures of quality and satisfaction with family planning care. The analysis resulted in a multidimensional PCFP scale, including 20 items in Kenya and 22 items in India. Through iterative factor analysis, two subscales were identified for both countries: "autonomy, respectful care, and communication" and "health facility environment." This scale may be used to evaluate quality improvement interventions and experiences of women globally to support women in achieving their reproductive health goals. [ABSTRACT FROM AUTHOR]

Context.--The Department of Anatomic Pathology is a division of the Pathology & Laboratory Medicine Institute at Cleveland Clinic Abu Dhabi. The hospital offers the same model of care as its US-based counterpart the Cleveland Clinic, established in 1921 in Cleveland, Ohio. Pathology services at Cleveland Clinic are internationally acclaimed: the endeavor for Cleveland Clinic Abu Dhabi was to create a parallel facility, with the same standards in a greenfield start-up environment. Objective.--To narrate how we addressed challenges customary in any laboratory start-up and issues distinctive to our setting with the aim to provide a model for others involved in a similar undertaking. Data Sources.--All information in this article is based on published literature obtained by search on internet-based search engines, Clinical and Laboratory Standards Institute, and the authors' firsthand experience. Conclusions.--Key considerations in establishing an anatomic pathology laboratory are careful planning and design, adherence to local and international regulatory standards, selection of equipment and supplies, appropriate staffing, development of a laboratory information system, and sound test validation. In addition to meeting our clinical needs, alliance with the US Cleveland Clinic had an integral role in establishing our laboratory and regional reputation. [ABSTRACT FROM AUTHOR]

In recent years children's emergency admissions have risen by 18%. In 2011 a team at a city district general hospital in England recognised that children were being admitted to the general children's ward and often only staying for short periods of time. After a review of the service a plan was put forward for the development of a paediatric short-stay observation and assessment unit. The unit has led to a reduction in ward admissions and offered opportunities for children's nurses to extend their roles in assessment and treatment. This article explores the planning, delivery and audit of this unit and offers an exemplar for other trusts considering a similar change to service delivery. [ABSTRACT FROM AUTHOR]

Objectives: Emergency medical services have been established in many countries all over the world. Good first care improves the outcome of patients in terms of hospital stay duration, chances of full recovery and of treatment costs. In this paper, we present an integrated approach combining spatial information and integer optimization for emergency medical service location planning. The research is motivated by a recent call for bids to restructure the location of emergency medical services in the Austrian federal state of Lower Austria by the local state government.Methods: Our framework allows for constraints on the places where an emergency care physician is stationed, accounting for the fact that - for economical reasons - it might not be feasible to arbitrarily place emergency care physicians. We use maximum coverage linear programs to get accurate solutions for the problem instances (depending on the maximum allowed number of emergency care physicians and the constraints of their placement). We optimize for the maximum number of covered residents given certain parameters. The travelling distances are calculated by means of a digital road graph. Moreover we analyze the coverage of the day population as there are significant shifts in the number of persons present at daytime. For every problem instance we have calculated the ten best solutions and examined the variance among them. For the demand point aggregation we have used a cell grid.Results: Using our method we can show that with less emergency care physicians more residents can be covered. This is highly applicable to low populated areas where the coverage becomes better. There is little variance from the best to the second best solution: There are only small changes (usually only one cell is shifted) between the best and the second best solution. The coverage of the day population - except for a few problem instances - is always better than the coverage of the residents (reflecting the fact that many residents commute to more densely populated areas).Conclusions: In our study, we show that our solutions provide better coverage of residents with fewer emergency care physicians than the current status quo. [ABSTRACT FROM AUTHOR]

Purpose: Smoking represents a primary risk factor for the development of urothelial carcinoma (UC) and a relevant factor impacting UC-specific prognosis. Data on the accordant knowledge of UC-patients in this regard and the significance of physicians in the education of UC-patients is limited. Materials and Methods: Eighty-eight UC-patients were enrolled in a 23-items-survey-study aimed to analyse patient knowledge and awareness of their tumor disease with smoking along with physician smoking cessation counselling. Results: The median age of the study patients was 69 years; 26.1% (n=23), 46.6% (n=41), and 27.3% (n=24), respectively, were non-smokers, previous, and active smokers. Exactly 50% of active smokers reported a previous communication with a physician about the association of smoking and their tumor disease; however, only 25.0% were aware of smoking as main risk factor for UC development. Merely 33% of the active smokers had been prompted directly by their physicians to quit smoking. About 42% of active smokers had received the information that maintaining smoking could result in a tumor-specific impairment of their prognosis. Closely 29% of active and about 5% of previous smokers (during the time-period of active smoking) had been offered support from physicians for smoking cessation. No association was found between smoking anamnesis (p=0.574) and pack-years (p=0.912), respectively, and tumor stage of UC. Conclusions: The results of this study suggest that the medical conversation of physicians with UC-patients about the adverse significance of smoking is limited. Implementation of structured educational programs for smoking cessation may be an opportunity to further enhance comprehensive cancer care. [ABSTRACT FROM AUTHOR]

Vaginal bleeding is a rare presenting complaint in pre-pubertal girls which can cause a lot of anxiety in parents and carers. The differential diagnoses range from relatively simple conditions such as vulvovaginitis to more sinister conditions including malignant vulval tumours or child sex abuse. A detailed clinical review is required in making a diagnosis and planning treatment. This review article will provide an overview of the most likely differential diagnosis and suggests an approach to assessment and management for the general paediatrician. [ABSTRACT FROM AUTHOR]

There is a substantial literature assessing the impact of entry restrictions created by state certificate-of-need (CON) programs on hospital and nursing home markets, but comparatively little research has focused on CON for home health agencies (HHAs). We assessed the impact of state CON programs for HHAs, and for potential substitute service providers, on quality ratings for HHAs. HHA quality ratings were obtained from the Home Health Compare database developed by the Centers for Medicare and Medicaid Services (CMS) for the last quarter of 2010 through the last quarter of 2013. The HHA-level data were augmented with county-level area characteristics for each HHA in the CMS database. An ordered logit model was used to estimate the association between state CON restrictions and Low, Medium, and High quality categories, adjusted for HHA and area characteristics. The results indicated that HHAs in states with CON for HHAs were less likely to have High quality ratings, and more likely to have Medium quality ratings, compared to agencies in states without CON for home health. Additional research is needed to assess whether the apparent adverse impact of CON on HHA quality is related to diminished competition among HHAs in states with CON. [ABSTRACT FROM AUTHOR]

Transitioning to a new facility can be challenging for employees and detrimental to operations. A key aspect of the transition is employee understanding of, and involvement in, the design of the new facility. The literature lacks a comprehensive study of the impact of change engagement throughout the design, construction, and activation of a project as well as how that can affect perceptions, expectations, and, eventually, satisfaction of employees. The purpose of this research was to examine employee perceptions and satisfaction throughout a hospital design, construction, and activation process. Three pulse-point surveys were administered throughout the transition of achildren's hospital emergency department and neonatal intensive care unit to a new facility. We also administered a postoccupancy survey 3 months after the move into the new facility. We received 544 responses and analyzed themto assess the relationship between involvement in design or change engagement initiatives and overall perceptions. The results revealed a strong relationship between employee engagement and their level of preparedness to move, readiness to adapt, and satisfaction. Early involvement in the design of a facility or new processes can significantly affect staff preparedness and readiness to adapt as well as employees' overall satisfaction with the building after occupancy. In addition, our findings suggest that keeping a finger on the pulse of employee perceptions and expectations throughout the design, construction, and activation phase is critical to employee preparedness and satisfaction in transitioning to a new facility. [ABSTRACT FROM AUTHOR]

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Background and context: Resource planning is performed ahead of time within outpatient clinics (OPC). Due to local control of operations (department-centric decision-making) and limited resources, OPCs cannot handle high variability and uncertainty in demand. There is always a difference between planning and reality, and this leads to operational problems such as excessive waiting times. The OPCs often react to the situation when problems are encountered and reaction times play an important role in determining patient waiting times. Objectives: To propose a predictive resource planning that incorporates variability in the short term with the OPC-wide perspective, not department-centric. Methodology: The process and patient data were collected from the OPC under study by observation, interviews and from the records of the hospital management information system. A resource planning model (RPM) was developed that matched resources according to demand in short term. A mathematical model with outputs resource plan for a day was formulated utilizing Takt time (the average time a patient needs to move out of the OPC system) management that is used in Toyota Production System (TPS), to allocate resources to all the departments. Using a Discrete Event Simulation Model, the effects of predictive resource planning with different reaction times on waiting times and cycle times were analyzed. The resource plans were implemented in the OPC of Aravind Eye Hospital, Madurai, Tamil Nadu, India, that has high patient volumes and random patient arrivals. Results and discussion: The simulation and implementation results indicate that predictive resource planning is robust and improves waiting times, and cycle times in OPCs. Study findings confirm that the predictive planning model reduces the average waiting time by 43.4 per cent during simulation and by 41.1 per cent during its implementation. The reduction in standard deviations in waiting times indicate reduction of unregulated waiting times. The OPC scheduled 28 resources throughout the day, whereas with predictive resource planning, the number of resources varied between a minimum of 12 to a maximum around 30–34 resources. Conclusions: The OPCs currently match demands to their supply, while matching resources to varying demand in short term; throughout the OPC (all departments) improves patient flow, and minimizes waiting time and cycle time. Previously, Takt time management (TTM) has applied to systems with even and stable demand; in this study, it has been applied to stochastic demand. Implications: This planning model helps the management to identify resource requirements: types of resources and number of resources, for the future demand growth and expansion. It can probably be extended to general hospitals by considering their demand forecast, precedence constraints and workflow complexities. [ABSTRACT FROM AUTHOR]

Background: Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure.Methods: We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms.Results: A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner.Conclusions: Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector. [ABSTRACT FROM AUTHOR]

Background: Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. Methods: An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Results: Central governance shaped what information and knowledge was valued -- and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. Conclusions: Strengthening local level managers' ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices. [ABSTRACT FROM AUTHOR]

Health status and academic achievement have been found to be linked: When students have poor health status, they are at increased risk for poor academic outcomes. The school-based health center is a delivery model that supports improved access to health care, as well as healthy behaviors and outcomes, for students. Interact for Health is a private foundation that has provided funding to open school-based health centers in the Greater Cincinnati, Ohio, area since 1999. This article outlines grant-making strategies and effective policies that the foundation has identified as most conducive to creating sustainable school-based health centers. These include identification of the right partners, development of a business plan, and guidelines and policies that support long-term financial sustainability. [ABSTRACT FROM AUTHOR]

The master planning of new radiotherapy facilities requires the input and engagement of a range of highly specialised professionals, both in the construction and health sector. Although radiation protection and safety aspects of radiotherapy services are universal, low and middle income countries are often presented with unique challenges that also need to be considered, e.g. competing needs within the health sector, lack of financial and human resources, environmental factors like poor provision of transport or electrical power, inadequate regulatory infrastructure, etc. Efforts to establish, upgrade or expand radiotherapy services should therefore not only focus on the technology that is appropriate and sustainable, but also be mindful of the need for quality, safety and optimal utilisation of technology. The workflow in a radiotherapy department can be facilitated by strategic placement of the main functional areas into the concept design. [ABSTRACT FROM AUTHOR]