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Public Health Consortiums (PHC) in Brazil represent a strategy to enhance regionalization in the Public Health Care System (SUS in Portuguese) and State/interstate/intermunicipal cooperation. The establishment of regional polyclinics aims to improve access to services with greater technological concentration and closer to users’ homes. This study specifically aims to analyze the process of creating PHC and regional polyclinics in Bahia State, based on documental analysis, identifying aspects related to entering the political agenda that facilitate and hinder, the role of state administration, specificities of the composition of these PHC and regional polyclinics. A documental analysis was carried out of the minutes of the Comissão Intergestores Bipartite (CIB-BA) [Bipartite Administrative Commission] from 2015 to 2018 and of constitutive documents of the consortiums established in this state. The Ceará State experience inspired the creation of consortiums in Bahia, especially the structuring of polyclinics. Municipal administrators demonstrated a favorable position regarding the potential of consortiums with cooperation among municipalities. The role of the state government proved to be a facilitating condition, whereas the maintenance of the municipal counterpart in finance constituted a hindering element. The consortiums contributed to the regionalization of health in the state as well as expansion of access to specialized care. [ABSTRACT FROM AUTHOR]

Matthew E Sprong,1,2 Heaven Hollender,3 Bob Blankenberger,2 Stuart Rumrill,4 Yu-Sheng Lee,5 Travis Bland,2 Jeremiah Bailey,6 Kenneth Weber,1 James Gilbert,1 Ken Kriz,2 Frank D Buono7 1Edward Hines Jr. VA Medical Center, Hines, IL, USA; 2University of Illinois Springfield, School of Public Management and Policy, Springfield, IL, USA; 3Indiana University - Indianapolis, School of Health & Human Services, Indianapolis, IN, USA; 4Univerity of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Champaign, IL, USA; 5University of Illinois Springfield, School of Integrated Sciences, Sustainability, and Public Health, Springfield, IL, USA; 6Florida Agricultural and Mechanical University, Department of Sociology and Criminal Justice, Tallahassee, FL, USA; 7Yale School of Medicine, New Haven, CT, USACorrespondence: Matthew E Sprong, Email mspro2@uis.eduIntroduction: Veterans diagnosed with mental health and/or substance use disorders (SUD) often face significant barriers to employment and reintegration into civilian society. In the current study, we investigated whether how the VA healthcare system for mental health and/or SUD treatment predicted program enrollment into vocational rehabilitation, simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation predicted employment at discharge, and mental health and/or SUD treatment continues and employment remain 60-days-post-vocational-rehabilitation discharge.Methods: An outcome-based, summative program evaluation design to measure quality assurance of vocational rehabilitation services provided to 402 veteran patients enrolled in a VA healthcare located within the Great Lakes Health Care System – Veterans Integrated Services Network.Results: Multivariable logistic regression analyses showed psychological empowerment (confidence in one’s ability to work or find work) is a significant factor determining whether a veteran is enrolled in the vocational rehabilitation program, prior mental health treatment (yes/no) and frequency of mental health treatment did not predict program enrollment, and frequency of SUD VA system treatment 60 days prior did not predict program enrollment. Other findings showed that simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation did not predict employment at discharge, and employment at discharge did not predict continued mental health and/or SUD treatment post-discharge from vocational rehabilitation. However, veterans with both SUD and mental health and continued mental health treatment were less likely to be employed.Conclusion: Utilization of real-world program evaluation data from an actual VHA vocational rehabilitation program enhances the study’s ecological validity, offering practical implications for policymakers and practitioners in the field. The findings support the importance of veterans enrolling in mental health and/or SUD treatment simultaneously while enrolled in vocational rehabilitation services, as integrating vocational rehabilitation with mental health and SUD treatment services can lead to improved vocational and health outcomes for veterans (eg, development of targeted interventions to support veterans’ successful reintegration into the workforce and society).Keywords: substance use disorders, mental health, veterans affairs, health administration, veterans, vocational rehabilitation, treatment access

It is important to fully comprehend the critical role of the healthcare and public health sector in safeguarding the economy from various threats, including terrorism, infectious diseases, and natural disasters. The private ownership of many healthcare assets underscores the need for enhanced collaboration and information sharing between the public and private sectors. The COVID-19 pandemic has accelerated the digitalization of this sector, leading to a heightened risk of cyber threats. The increasing reliance on emerging technologies such as blockchain, the metaverse, and virtual reality is further exacerbating the cybersecurity landscape, with the projected cost of cybercrime exceeding $10 trillion in 2023 and an anticipated surge to nearly $24 trillion in the next four years. Human error remains the primary cause of cybersecurity incidents, accounting for 95% of reported cases, with insider threats contributing significantly. Despite increased cyber training and risk mitigation efforts, vulnerabilities continue to be rapidly exploited. This paper provides an in-depth analysis of cybersecurity risks in the healthcare sector, drawing on existing literature and theoretical frameworks to highlight the complex challenges in this evolving landscape. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Investigación en Salud VIVE is the property of Revista de Investigacion en Salud VIVE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Telemedicine and telehealth have emerged as transformative forces in modern healthcare, reshaping the landscape of reproductive health for both women and men. These technologies have ushered in a new era of healthcare delivery, offering innovative solutions that enhance access, convenience, and quality of care in reproductive health. This article explores the profound impact of telehealth and telemedicine on reproductive healthcare and underscores the critical importance of cybersecurity in safeguarding the integrity of these services.

La administración eficiente del capital humano y la efectividad institucional de los centros hospitalarios es fundamental para la efectividad institucional. El objetivo del estudio fue correlacionar la influencia de la gestión eficaz de los recursos humanos y eficacia institucional en el Hospital Dos de Mayo en Lima metropolitana, durante el periodo de agosto de 2021 y agosto de 2022. Metodología: tipo correlacional, diseño no experimental, transversal. La muestra estuvo conformada por 100 trabajadores. Resultados: la efectividad institucional está correlacionada significativamente con administración eficiente (rho=,9022; p=0,0410) planeación eficiente del capital humano (rho=,9032; p=0,0308), organización eficiente del capital humano (rho=,9041; p=0,0397), dirección eficiente del capital humano (rho=,9031; p=0,0397), control eficiente del capital humano (rho=,9211; p=0,0455), responsabilidad social institucional (rho=,9233; p=0,0413). Conclusiones: la efectividad institucional de los hospitales está correlacionada con la administración eficiente del capital humano.

The COVID-19 pandemic has ushered in an unprecedented adoption and integration of telehealth and artificial intelligence (AI) driven by telemedicine technologies into healthcare systems worldwide. These innovations promise to revolutionize healthcare delivery by offering greater accessibility, efficiency, and responsiveness to patient needs. However, the rapid deployment of these technologies in response to the crisis has illuminated the imperative need for systematic evaluation processes that comprehensively assess their operations and outcomes. This article underscores the critical importance of developing rigorous evaluation frameworks tailored to the evolving landscape of telehealth and AI-driven telemedicine technologies. The absence of standardized evaluation processes presents multifaceted challenges including uncertainties regarding long-term efficacy, patient safety, data security, and ethical considerations. Ensuring the responsible and effective integration of telehealth and AI into healthcare systems requires adaptable, multidimensional evaluation mechanisms that align with clinical objectives and regulatory standards. Through an examination of documents, procedures, policies, and best practices by regional hospitals, this article advocates for developing evaluation processes that enable stakeholders to optimize the deployment of telehealth and AI technologies fostering patient-centered care while addressing emerging challenges. In an era marked by healthcare transformation, establishing robust evaluation frameworks emerges as a paramount endeavor essential for realizing the full potential of telehealth and AI-driven telemedicine in the post-COVID-19 healthcare ecosystem. [ABSTRACT FROM AUTHOR]

Abstract Background: There is a widespread commitment to implementing anti-Indigenous racism with health organizations in Canada by introducing cultural safety staff training. In partnership with a public health unit in Ontario, Canada, we developed an evaluation tool to assess the performance of staff who completed an online Indigenous cultural safety education course. Aims: To develop an accountability checklist that could be used for annual employee performance reviews to assess the use and level of knowledge received in professional cultural safety training. Intervention: We co-created a professional development accountability checklist. Five areas of interest were identified: terminology, knowledge, awareness, skills, and behaviours. The checklist comprises of 37 indicators linked to our community collaborators’ intended goals as defined in our partnership agreement. Outcomes: The Indigenous Cultural Safety Evaluation Checklist (ICSEC) was shared with public health managers to use during regularly scheduled staff performance evaluations. The public health managers provided feedback on the design, checklist items, and useability of the ICSEC. The pilot of the checklist is in the preliminary stage and data is unavailable about effectiveness. Implications: Accountability tools are important to sustain the long-term effects of cultural safety education and prioritize the wellbeing of Indigenous communities. Our experience can provide guidance to health professionals in creating and measuring the efficacy of Indigenous cultural safety education to foster an anti-racist work culture as well as improved health outcomes among Indigenous communities.

A nationwide opinion survey was applied, in which each physician was able to express his or her feelings, understanding and personal opinion in the context of quality of life at work and bioethics. A structured questionnaire with relevant topics was used, sent by the Informatics Department of the Federal Council of Medicine to the 95,022 valid e-mails registered, and 426 complete responses were obtained. There were negative manifestations; on average, more than 50% of the specific responses, which evidenced that the lack of quality of life at work acts negatively on the understanding and opinion of physicians on bioethics and the doctor-patient relationship, and not necessarily that this manifestation is materialized through their actions. There were responsive physicians who, through their responses, were able to demonstrate that a lack of quality of life at work can alter and deconstruct this relationship in the context of bioethics. [ABSTRACT FROM AUTHOR]

Diabetes and heart disease are among the leading causes of death and disability in the United States, and these conditions are especially prevalent in the South. South Carolina's persistent racial and socioeconomic disparities in chronic disease outcomes are well-documented, yet little is known about how health care practices in medically underserved areas are addressing these challenges. Data were collected through a cross-sectional survey as part of two complementary 5-year cooperative agreements between the Centers for Disease Control and Prevention and the Division of Diabetes and Heart Disease Management (the Division) at the South Carolina Department of Health and Environmental Control. The Division fielded a survey to (a) assist in determining which Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were best poised to implement specific strategies as part of these cooperative agreements and (b) provide data to establish the baseline for performance measures. FQHCs and RHCs in the top 25% of counties with the highest diabetes and heart disease burden were surveyed about eight domains: staffing/services, electronic health records, team-based care policies, lifestyle change programs, medication therapy management, telehealth, quality improvement collaboratives, and patient demographics. Data representing 71 practices revealed contrasts between RHCs and FQHCs and opportunities for improvement. For example, while most practices reported they were not implementing evidence-based lifestyle change programs (e.g., the National Diabetes Prevention Program), most RHCs and FQHCs expressed interest in starting such programs. Findings are being used to guide efforts to improve diabetes and heart disease prevention and management in South Carolina. [ABSTRACT FROM AUTHOR]

Background: There is a widespread commitment to implementing anti-Indigenous racism with health organizations in Canada by introducing cultural safety staff training. In partnership with a public health unit in Ontario, Canada, we developed an evaluation tool to assess the performance of staff who completed an online Indigenous cultural safety education course. Aims: To develop an accountability checklist that could be used for annual employee performance reviews to assess the use and level of knowledge received in professional cultural safety training. Intervention: We co-created a professional development accountability checklist. Five areas of interest were identified: terminology, knowledge, awareness, skills, and behaviours. The checklist comprises of 37 indicators linked to our community collaborators' intended goals as defined in our partnership agreement. Outcomes: The Indigenous Cultural Safety Evaluation Checklist (ICSEC) was shared with public health managers to use during regularly scheduled staff performance evaluations. The public health managers provided feedback on the design, checklist items, and useability of the ICSEC. The pilot of the checklist is in the preliminary stage and data is unavailable about effectiveness. Implications: Accountability tools are important to sustain the long-term effects of cultural safety education and prioritize the wellbeing of Indigenous communities. Our experience can provide guidance to health professionals in creating and measuring the efficacy of Indigenous cultural safety education to foster an anti-racist work culture as well as improved health outcomes among Indigenous communities. [ABSTRACT FROM AUTHOR]

Background; Effective leadership is essential for the success of healthcare organizations, particularly in Saudi Arabia where the healthcare sector is undergoing rapid transformation. Leadership styles within health administration roles play a significant role in shaping employee satisfaction and organizational outcomes. Understanding prevalent leadership styles and their impact on employee satisfaction is crucial for enhancing the overall performance of healthcare organizations in Saudi Arabia. Purpose; The study aimed to evaluate prevalent healthcare leadership styles and their impact on employee satisfaction in health administration roles in Saudi Arabia's healthcare sector. Method; A cross-sectional descriptive research design was employed, and data were collected from healthcare employees in government hospitals in Taif, Saudi Arabia. A structured questionnaire was used to assess leadership styles and employee satisfaction, and data were analyzed using descriptive statistics, correlation coefficient analysis, independent t-tests, and multiple linear regressions. Results; The study identified three prevalent healthcare leadership styles; Autocratic, Democratic, and Laissez-Faire. Significant positive correlations were found between these leadership styles and employee satisfaction. Autocratic, Democratic, and Laissez-Faire leadership styles were all positively associated with employee satisfaction. Gender differences in leadership styles and job satisfaction were also explored, revealing variations across genders within healthcare administration roles. Conclusion; The study underscores the importance of effective leadership in healthcare administration for promoting employee satisfaction. Healthcare organizations in Saudi Arabia should prioritize leadership development programs tailored to enhance leadership skills and foster positive leadership practices. By understanding and implementing effective leadership strategies, healthcare administrators can create supportive work environments that contribute to overall employee satisfaction and organizational success. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Management & Health / Revista Gestão & Saúde is the property of Revista Gestao e Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose – The purpose of this paper is to investigate the consequential impact of COVID-19 on mental health organizations. Via the context organizational development (OD) action research of an organizational case analysis, this paper offers recommendations to mental health organizations on an approach to help recover from the financial losses caused by COVID-19 restrictions and to also help ensure that mental health specialists are provided with sufficient support so they may continue to provide meaningful service to clients in need of therapeutic care and assistance. Design/methodology/approach – The approach is an action research case study that uses an OD framework and a content analysis of the current literature. Findings – The real-world case study uses an action research OD intervention to provide tools and recommendations that other similar organizations might be able to use to respond to COVID-19. The findings implicate practices and approaches that organizations can use to adapt to business and marketplace disruption of COVID-19. Originality/value – COVID-19 is an emerging issue, as a result any research and development in this area is of significant value to researchers and professionals.

The present study is a secondary analysis of publicly available data pertaining to 44 health administration faculty salaries within the University System of Georgia. Data analysis indicates that overall, mean salaries of entry-level health administration faculty at the rank of Assistant Professor have not kept pace with inflation and are below the median industry salary in health administration. Salaries of health administration faculty at the ranks of Associate Professor and Professor are more in line with current industry salaries and have kept pace with inflation. The study also looks at the breakdown of mean salaries for health administration faculty housed in different schools at different colleges and universities, specifically the School of Business, School of Health, and School of Public Health, and discusses whether it is financially feasible to leave to leave the industry for academia in the present environment. [ABSTRACT FROM AUTHOR]

Copyright of Revista Habanera de Ciencias Médicas is the property of Universidad de Ciencias Medicas de La Habana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article intends to critique of the cultural authority of the medical sciences, opening up a discussion on its publicization from a political standpoint. At the same time, from a more technical standpoint, it proposes the implementation of an epidemiology of health systems and services. Based on Pierre Bourdieu's concept of interest in disinterestedness and Joseph Gusfield's notion of the cultural authority of public problems, it analyzes why epidemiological information is so rarely used in the evaluation and monitoring of clinical, population, institutional, and territorial practices. That is, why does the dominant culture of decision making eschew epidemiological information? Within this conceptual framework, a body of documental evidence is analyzed that sheds light on the weak scientific basis that upholds or that has underpinned certain practices in the health field at different historical moments. The discussion is organized around three major themes: assistentialist professional practice, medication, and biomedical technologies. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents are the eighth leading cause of mortality globally and the second in Saudi Arabia. Trauma patients need specialized care and access to health care facilities. Early intervention by a multidisciplinary team results in better outcomes in terms of mortality and morbidity. The aim of this study was to analyze the association between the different mechanisms of injury that resulted in trauma team activations (TTAs) and the time in the 24-hour day over a 3-year period in a tertiary trauma center. Methods: A single center retrospective study with trauma patients triggering the TTA was conducted. The study was conducted over a 3-year period, and the sample size was 587. Results: The highest volume of TTA's during the 3 years occurred from 20:00 and 23:00 and the busiest single hour was 21:00. Pedestrian trauma was more prevalent at the end of the day from 18:00 to 22:00. Our study showed the mechanism of injury for more than half of the sample was a motor vehicle accident, followed by pedestrian trauma. The highest proportion of the sample was admitted from the Emergency Department to an intensive care unit (46.6%) or operation room/angiography (37.5%). After 19:00, there were more severe injuries and unstable patients, who required an intensive care unit or operation room/angiography. The peak occurred after 17:00 for 1 hour. Age, systolic and diastolic blood pressure were not statically significant. The mortality rate was higher in TTA patients' groups with an initial mean heart rate of 118 per minute and a 91% oxygen pulse oximetry. Conclusion: The outcome of trauma patients was affected by the time of the 24-hour day. Severe injuries and unstable patients were more prevalent during nighttime. A higher initial heart rate for TTA patients was linked with increased mortality. [SJEMed 2022; 3(1.000): 010-016]

This article intends to critique of the cultural authority of the medical sciences, opening up a discussion on its publicization from a political standpoint. At the same time, from a more technical standpoint, it proposes the implementation of an epidemiology of health systems and services. Based on Pierre Bourdieu’s concept of interest in disinterestedness and Joseph Gusfield’s notion of the cultural authority of public problems, it analyzes why epidemiological information is so rarely used in the evaluation and monitoring of clinical, population, institutional, and territorial practices. That is, why does the dominant culture of decision making eschew epidemiological information? Within this conceptual framework, a body of documental evidence is analyzed that sheds light on the weak scientific basis that upholds or that has underpinned certain practices in the health field at different historical moments. The discussion is organized around three major themes: assistentialist professional practice, medication, and biomedical technologies.

Copyright of Revista del CLAD Reforma y Democracia is the property of Centro Latinoamericano de Administracion para el Desarrollo (CLAD) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Ongoing developments in the medical field have improved survival rates and long-term management of children with complex chronic health conditions. While the number of children with medical complexity is small, they use a significant amount of health resources across various health settings and sectors. Research to date exploring this pediatric population has relied primarily on quantitative or qualitative data alone, leaving significant gaps in our understanding of this population. Objective: The objective of this research is to use health administrative and family-reported data to gain an in-depth understanding of patterns of health resource use and health care needs of children with medical complexity and their families in the Canadian Maritimes. Methods: An explanatory sequential mixed methods design will be used to achieve our research objective. Phase 1 of this research will leverage the use of health administrative data to examine the prevalence and health service use of children with medical complexity. Phase 2 will use case study methods to collect multiple sources of family-reported data to generate a greater understanding of their experiences, health resource use, and health care needs. Two cases will be developed in each of the 3 provinces. Cases will be developed through semistructured interviews with families and their health care providers and health resource journaling. Findings will be triangulated from phase 1 and 2 using a joint display table to visually depict the convergence and divergence between the quantitative and qualitative findings. This triangulation will result in a comprehensive and in-depth understanding into the population of children with medical complexity. Results: This study will be completed in May 2022. Findings from each phase of the research and integration of the two will be reported in full in 2022. Conclusions: There is a current disconnect between the Canadian health care system and the needs of children with medical complexity and their families. By combining health administrative and family-reported data, this study will unveil critical information about children with medical complexity and their families to more efficiently and effectively meet their health care needs. Results from this research will be the first step in designing patient-oriented health policies and programs to improve the health care experiences, health system use, and health outcomes of children with medical complexity and their families. International Registered Report Identifier (IRRID): DERR1-10.2196/33426 [ABSTRACT FROM AUTHOR]

This inquiry concerns managerial adaptability and strategic planning of a mental health organization attempting to adapt to the marketplace and business disruption of COVID-19. The medical group has seen a noteworthy decreased in revenue of more than three-quarters (80 percent). It is for this reason, that it is imperative for the MHMG to carefully examine the presented issue and immediately strategize ways to address such issue. This analysis intends to review the literature and engage in action organizational development research to provide an understanding of the issue, its severity and spread as well as propose appropriate recommendations that could alleviate the business complexities that have been created by the pandemic.

Abstract Background COVID-19 has presented challenges to healthcare systems and healthcare professionals internationally. After one year of the pandemic, the initial evidence on health system responses begins to consolidate, and there is a need to identify and synthesise experiences of responding to COVID-19 among healthcare professionals and other health system stakeholders. This systematic review of primary qualitative studies depicts the experiences and perceptions of organisations and actors at multiple levels of health systems internationally in responding to COVID-19. Methods Six main databases of biomedical information, public health and health administration research were searched over the period October 1, 2019, to October 21, 2020. Information extracted from included studies was analysed thematically. Results Thirty-four studies were eligible for data extraction. Nine of those studies, of lower methodological quality, were removed from the thematic analysis of study results. Considering the professional level experiences, predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, recognition of ´unseen´ healthcare workers, and positive changes and emergent solutions amid the crisis. Organisational level findings of the studies included provision of psychological support, COVID-19 as "catalyst" for change, and exercise of more "open" leadership by managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were roles identified at the local health system level. Conclusions The experiences of frontline healthcare workers have been the focus of attention of the majority of primary qualitative studies as of October 2020. However, organisational and wider system level studies indicate that some responses to COVID-19 have been characterised by increased emphasis on coordination activities by local health system actors, making service adaptations at pace, and reliance on expanded roles of front-line workers. The need for theory-informed qualitative studies was identified at the organisational level. Trial registration CRD42020202875

Copyright of Revista del CLAD Reforma y Democracia is the property of Centro Latinoamericano de Administracion para el Desarrollo (CLAD) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Health administrators are constantly challenged by their role in the management of organizational processes in complex social contexts. This essay presents a reflection on the ethical challenges that face health administrators, originated in the socioeconomic contexts of the contemporary era, as well as those related to the exercise of health administration in its functional areas: administrative processes, human talent management, financial management, management of care processes and health research. The ethical reflection, from different perspectives, is a necessary path to find answers to moral contradictions and to discern the complex arbitrations of being (ontology) and, of duty (deontology), without losing focus on the purpose of health administration which is to improve health and quality of life of populations. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: While there are core competencies required in health administration programs, little is known about how they are taught in health administration programs to support/change practises. This discussion paper describes an educational innovation to design a contemporary Master of Health Administration program to meet the current needs of health managers in Australia based on evidence-based practise.Method: A detailed gap analysis of health managers educational needs was undertaken with various stakeholders to design a contemporary health managers' program. Stakeholders surveyed in the course design included prospective students, international students' agencies, prospective employers, Alumni evaluation, mapping of health managers courses in Australia and faculty feedback. An integrative pedagogical approach was used to implement the program into action.Results: Various themes were emerged from the stakeholder consultations including the importance of basic knowledge of key subjects and the significance of learning new skills such as strategic planning and emotional intelligence in the workplace. The integrative pedagogical approach used is based on adult teaching principles, which were identified by Knowles. The subjects in the new course incorporate several knowledge-based presentations along with interactive activities, including use of general ability-based outcomes to define learning opportunities, case-based and problem-based learning, experiential learning, and comprehensive assessments.Conclusion: The results of this intensive consultation led to the design of a contemporary Master of Health Administration Course that included eight core subjects and multiple options of specialisations for students to choose from. Examples of specialisations include aged care and ageing, health promotion, data for decision making, public health, international development and Health Strategy and decision making.

Introduction: The coronavirus pandemic poses a massive challenge for the healthcare system and overburdens the Healthcare Workers (HCWs) in a developing country like India. The coronavirus may survive on various surfaces and/ or aerosols for hours to days, making it a necessity to use Personal Protective Equipment (PPE) while treating infected patients. Wearing the PPE is often uncomfortable while working, more so in the summer season, when the temperatures in a tropical country like India are soaring. Aim: To identify, quantify and highlight the difficulties faced by the HCWs while wearing PPEs. Materials and Methods: This descriptive cross-sectional study was conducted in June 2020, by a team of researchers working in a government owned designated Coronavirus Disease 2019 (COVID-19) hospital in metropolitan city, west India. The questionnaire was prepared for a multi-centre survey for 230 HCWs who had used PPE kits during their COVID-19 duties. The online questionnaire responses were recorded in an excel sheet and the results were analysed using Statistical Package for the Social Sciences (SPSS) software version 19.0. Results: Total 230 responses were received out of which 74% were doctors, 21.7% nurses and 4.3% paramedical staff. The mean duration of work was 6.24 hours and per duty one, PPE was used by almost all of the respondents. The most common difficulty faced by the responders while on duty was excessive sweating (96%/n-230), itching of the nose (56%/n-129) and face (51%/n-117). While after the duty 62% of respondents reported being dehydrated and 67% complained of de novo headache. In a subset with a history of migraine, almost all reported worsening of migraine with increased frequency and severity of attacks. Many (40%) reported occasionally lowering the masks or face shield due to unbearable heat, risking self-contamination. Conclusion: The PPEs in current use in the hot and humid conditions in the summer months in tropical countries poses a unique challenge for the HCWs. Customisation of PPEs and working conditions is essential in the mitigation of the problems faced by the HCWs. [ABSTRACT FROM AUTHOR]

The historiography of western medicine in colonial India has predominantly been analysed from the perspectives of the elite services – the Indian Medical Service (IMS) and their recruits. Unfortunately, perceiving colonial medical practices through the lens of the IMS has remained inadequate to provide a nuanced understanding of the role played by Indians in the semi-urban and rural areas of colonial India. This article examines the contributions of local administration and the role played by the recruits of the Subordinate Medical Service. This article uses the Madras Presidency as its case study and focusses on the medical subordinates who were pivotal in establishing a western medical tradition in the region. This will shift the urban-centric focus and examine mostly the rural parts of the presidency, in particular, the district hospitals and dispensaries located in the districts, taluks and villages. The article analyses the transformation in the Madras medical administration from the late nineteenth century until 1935 to argue how subordinates were the ones controlling the local medical services, and thus pulling the strings of health administration in the presidency. This will also demonstrate the uniqueness of Madras and how it disseminated western medical care with an active participation and involvement of the local residents. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus pandemic poses a massive challenge for the healthcare system and overburdens the Healthcare Workers (HCWs) in a developing country like India. The coronavirus may survive on various surfaces and/ or aerosols for hours to days, making it a necessity to use Personal Protective Equipment (PPE) while treating infected patients. Wearing the PPE is often uncomfortable while working, more so in the summer season, when the temperatures in a tropical country like India are soaring. Aim: To identify, quantify and highlight the difficulties faced by the HCWs while wearing PPEs. Materials and Methods: This descriptive cross-sectional study was conducted in June 2020, by a team of researchers working in a government owned designated Coronavirus Disease-2019 (COVID-19) hospital in metropolitan city, West India. The questionnaire was prepared for a multicentre survey for 230 HCWs who had used PPE kits during their COVID-19 duties. The online questionnaire responses were recorded in an Microsoft Excel sheet and the results were analysed using Statistical Package for the Social Sciences (SPSS) software version 19.0. Results: Total 230 responses were received out of which 74% were doctors, 21.7% nurses and 4.3% paramedical staff. The mean duration of work was 6.24 hours and per duty one, PPE was used by almost all of the respondents. The most common difficulty faced by the responders while on duty was excessive sweating (96%/n-221), itching of the nose (56%/n-129) and face (50.9%/n-117). While after the duty 61.7% of respondents reported being dehydrated and 68.2% complained of de novo headache. In a subset with a history of migraine, almost all reported worsening of migraine with increased frequency and severity of attacks. Many (40%) reported occasionally lowering the masks or face shield due to unbearable heat, risking self-contamination. Conclusion: The PPEs in current use and in the hot and humid conditions of summer months in tropical countries poses a unique challenge for the HCWs. Customisation of PPEs and working conditions is essential in the mitigation of the problems faced by the HCWs.

Background: COVID-19 has presented challenges to healthcare systems and healthcare professionals internationally. After one year of the pandemic, the initial evidence on health system responses begins to consolidate, and there is a need to identify and synthesise experiences of responding to COVID-19 among healthcare professionals and other health system stakeholders. This systematic review of primary qualitative studies depicts the experiences and perceptions of organisations and actors at multiple levels of health systems internationally in responding to COVID-19.Methods: Six main databases of biomedical information, public health and health administration research were searched over the period October 1, 2019, to October 21, 2020. Information extracted from included studies was analysed thematically.Results: Thirty-four studies were eligible for data extraction. Nine of those studies, of lower methodological quality, were removed from the thematic analysis of study results. Considering the professional level experiences, predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, recognition of ´unseen´ healthcare workers, and positive changes and emergent solutions amid the crisis. Organisational level findings of the studies included provision of psychological support, COVID-19 as "catalyst" for change, and exercise of more "open" leadership by managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were roles identified  at the local health system level.Conclusions: The experiences of frontline healthcare workers have been the focus of attention of the majority of primary qualitative studies as of October 2020. However, organisational and wider system level studies indicate that some responses to COVID-19 have been characterised by increased emphasis on coordination activities by local health system actors, making service adaptations at pace, and reliance on expanded roles of front-line workers. The need for theory-informed qualitative studies was identified at the organisational level.Trial Registration: CRD42020202875. [ABSTRACT FROM AUTHOR]

Introduction: The American College of Emergency Physicians (ACEP) Task Force on Boarding described high-impact initiatives to decrease crowding. Furthermore, some emergency departments (EDs) have implemented a novel initiative we term “vertical patient flow,” i.e. segmenting patients who can be safely evaluated, managed, admitted or discharged without occupying a traditional ED room. We sought to determine the degree that ACEP-identified high-impact initiatives for ED crowding and vertical patient flow have been implemented in academic EDs in the United States (U.S.).Methods: We surveyed the physician leadership of all U.S. academic EDs from March to May 2010 using a 2-minute online survey. Academic ED was defined by the primary site of an emergency residency program.Results: We had a response rate of 73% (106/145) and a completion rate of 71% (103/145). The most prevalent hospital-based initiative was inpatient discharge coordination (46% [47/103] of respondents) while the least fully initiated was surgical schedule smoothing (11% [11/103]). The most prevalent ED-based initiative was fast track (79% [81/103]) while the least initiated was physician triage (12% [12/103]). Vertical patient flow had been implemented in 29% (30/103) of responding EDs while an additional 41% (42/103) reported partial/in progress implementation.Conclusion: We found great variability in the extent academic EDs have implemented ACEP’s established high-impact ED crowding initiatives, yet most (70%) have adopted to some extent the novel initiative vertical patient flow. Future studies should examine barriers to implementing these crowding initiatives and how they affect outcomes such as patient safety, ED throughput and patient/provider satisfaction. [West J Emerg Med 2013;14(2):85-89.]

Objective: Time-driven activity-based costing (TDABC) is a method used in cost accounting that has gained traction in health economics to identify value optimization initiatives. It measures time, assigns value to time increments spent on a patient, and integrates the cost of material and human resources utilized in each episode of care. In this study, the authors report the first use of TDABC to evaluate costs in a pediatric neurosurgical practice., Methods: A clinical pathway was developed with a multifunction team. A time survey among each care team member, including surgeons, medical assistants (MAs), and patient service representatives (PSRs), was carried out prospectively over a 10-week period at a pediatric neurosurgery clinic. Consecutive patient encounters for Chiari malformation (CM), hydrocephalus, or tethered cord syndrome (TCS) were included. Encounters were categorized as new or established. Relative annual personnel costs, using the salary of a PSR as a reference (i.e., 1.0-unit cost), were calculated for all members using departmental financial data after adjustments. The relative capacity cost rates (minute-1) for each personnel, a representation of per capita cost per minute, were then derived, and the relative costs per visit were calculated., Results: A total of 110 visits (24 new, 86 established) were captured, including 40% CM, 41% hydrocephalus, and 19% TCS encounters. Surgeons had the highest relative capacity cost rate (118.4 × 10-6), more than 10-fold higher than that of an MA or PSR (10.65 × 10-6 and 9.259 × 10-6, respectively). Surgeons also logged more time with patients compared with the rest of the care team in nearly all visits (p ≤ 0.002); consequently, the total visit costs were primarily driven by the surgeon cost (p < 0.0001). Overall, surgeon cost constituted the vast majority of the total visit cost (92%-93%), regardless of whether the visits were new or established. Visit costs did not differ by diagnosis. On average, new visits took longer than established visits (p < 0.001). This difference was largely driven by new CM visits (44.3 ± 13.7 minutes), which were significantly longer than established CM visits (29.8 ± 9.2 minutes; p = 0.001)., Conclusions: TDABC may reveal opportunities to maximize value by highlighting instances of variability and high cost in each module of care delivery. Physician leaders in pediatric neurosurgery may be able to use this information to allocate costs and streamline value care pathways.

This study seeks to analyze health administration in the hajj pilgrimage in Indonesia. Taking a quite different landscape, this study combines health administration in the context of the interests and obligations of the state to provide protection and safety for pilgrims. This protection is related to aspects of regulations and laws as the basic norms for policymaking at the operational level in the administration of Hajj, especially in the context of the health of the pilgrims. Meanwhile, the safety aspect is related to the fulfillment of managerial aspects to improve service functions and improve quality. By taking an interlinked dialogue from various theoretical outlooks, this study provides a perspective on the relationship between legal and management aspects through good corporate governance and total quality management in the administration of hajj and its basis for pilgrimage health administration. [ABSTRACT FROM AUTHOR]

The establishment of a modern health system in China can be divided into three stages. Stage One covers the periods between late nineteenth century and 1927, during which the Qing government and the Beiyang government established a rudimentary health system in a couple of Chinese cities. Stage Two, covering the period from 1928 to 1949, witnessed the efforts of the Nationalist government in managing nationwide public health by relying on medical professionals with modern Western training. In Stage Three, which spans the period between 1949 and 1966, a modern heath system was established in China. Not only was a national network of health institutions put into place, but also the state-imposed direct management of the newly-established healthcare system. Health institutions at different levels were reorganized as public institutions and pharmaceutical companies were nationalized. Overall, the evolution of China's modern healthcare system experienced a shift from administration of public health and private medical care providers to a set of nationwide public institutions to serve the people. [ABSTRACT FROM AUTHOR]

The goal of this study was to examine the degree to which youths and caregivers attend to different factors in evaluating their experiences with mental health programs. Youth (n = 251) receiving mental health services at community agencies and their caregivers (n = 275) were asked open-ended questions regarding the positive and negative aspects of the services. Qualitative analyses revealed some agreement but also divergence between youth and caregivers regarding the criteria by which services were evaluated and aspects of services that were valued most highly. Youths’ positive comments primarily focused on treatment outcomes while caregivers focused more on characteristics of the program and provider. Youths’ negative comments reflected dissatisfaction with the program, provider, and types of services offered while caregivers expressed dissatisfaction mainly with program characteristics. Results support the importance of assessing both youth and caregivers in attempts to understand the factors used by consumers to evaluate youth mental health services.

In this pilot study we examined the determinants of recovery orientation among employees and influential stakeholders in a sample of 12 county departments of mental health in California. A two-level hierarchical linear model with random intercepts was estimated. Analyses show that recovery orientation has a U-shaped relationship with the age of staff/influential stakeholders and is negatively related to the difference between the desired level of adhocracy and the current level of adhocracy. Recovery orientation is positively related to the education level of staff/influential stakeholders, satisfying transformational leadership outcomes, and larger mental health budgets per capita. Policy implications are discussed.

The objective of this study is to examine the characteristics of outpatient mental health services delivered in community-based outpatient clinics, comparing information obtained from two different sources, therapists serving children and families, and observational coders viewing tapes of the same treatment sessions. Videotaped therapy sessions were rated by therapists and independent coders regarding goals and strategies pursued during each session. Sixty-three sessions were taped of outpatient care provided to 18 children and their caregivers by 11 therapists. Children were 4–13 years old and families were receiving services at least in part due to reported child behavior problems, confirmed by ratings from the Child Behavior Checklist and Conners Parent Rating Scale—Revised. Analyses assessed the frequency, type, and intensity of goals and strategies pursued in therapy sessions from both therapist and observational coders’ perspectives. Reliability of observer ratings and correspondence between therapist and observer reports were also examined. The reliability of observational coding of goals and strategies was moderate to good, with 76% of 39 codes having ICCs of .5 or greater. Therapists reported pursuing 2.5 times more goals and strategies per session, on average, than identified by observational coders. Correspondence between therapists and coders about the occurrence of specific goals and strategies in treatment sessions was low, with 20.5% of codes having a Kappa of .4 or higher. Substantial differences exist in what therapists and independent coders report as occurring in outpatient treatment sessions. Both perspectives suggest major differences between the content of services provided in community-based outpatient clinics and the structure of evidence-based programs, which emphasize intense pursuit of a small number of goals and strategies in each treatment session. Implications of the findings for quality improvement efforts in community-based mental health care settings are discussed.