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Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). This research aims to provide a tool that engages health care workers (HCWs) in BSC implementation (BSC-HCW1). Additionally, it seeks to translate and validate it at Palestinian hospitals. In a cross-sectional study, 454 questionnaires were retrieved from 14 hospitals. The composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. In both EFA and CFA, the scale demonstrated a good level of model fit. All the items had loadings greater than 0.50. All factors passed the discriminant validity. Although certain factors’ convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine factors and 28 items in CFA. The BSC-HCW1 is the first self-administered questionnaire to engage HCWs in assessing the BSC dimensions following all applicable rules and regulations. The findings revealed that this instrument’s psychometric characteristics were adequate. Therefore, the BSC-HCW1 can be utilized to evaluate BSC perspectives and dimensions. It will help managers highlight which BSC dimension predicts HCW satisfaction and loyalty and examine differences depending on HCWs’ and hospital characteristics.

Background Lately, suggestions have been emphasizing the importance of engaging patients and family members in infection control (IC) through participation and education after showing that patients and family members can aid in preventing the transmission of health care-associated infections. However, assessing patient education on IC measures in hospitals is poorly investigated. Purpose To identify all available studies in the literature that assessed hospitalized patients’ education on IC measures. Methods PubMed, Embase, and CINAHL were searched from inception till May 6, 2020 without restrictions. We used Strengthening the Reporting of Observational Studies in Epidemiology tool for assessing the reporting quality of each eligible study. Main Findings Of the 6,740 identified papers, 25 were eligible for inclusion. Education on health care-associated infections was investigated in 8 studies, education on central line-associated bloodstream infections in 1, education on surgical site infections in 2, education on hand hygiene in 12, education on isolation rationale, precautions, usage of personal protective equipment in 3, and education on respiratory hygiene in 1. In general, a low percentage of patient education on IC was found in most of the included papers. Conclusions The low percentage of patient education on IC in hospitals highlights the need for additional emphasis on patient involvement in IC. Further studies are needed to assess patient education on several IC measures and to explore the education of family members as well.

BackgroundImproving health care in Palestinian territories is a challenging task. Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). In the BSC implementations, some health care organizations (HCOs) assessed the satisfaction of health care workers (HCWs), but none considered their loyalty. Furthermore, none of them explored the causal links between BSC dimensions and HCWs’ satisfaction based on HCWs’ observations. This research aims to provide a tool to assess the performance of BSC dimensions and their impact on HCWs’ satisfaction and loyalty (BSC-HCWSL). Additionally, it seeks to translate the BSC-HCWSL to Arabic and validate it at Palestinian hospitals.MethodsThis is a cross-sectional study. Two expert committees performed the BSC-HCWSL item development. We performed forward and reverse translations from English to Arabic and vice versa. Pretesting was performed on 13 HCWs at one hospital. Then, between January and October 2021, 540 questionnaires were retrieved in the other 14 hospitals. To detect redundant and poorly correlated items, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the construct validity.ResultsIn both EFA and CFA, the scales demonstrated a good level of model fit. All the items had loadings greater than 0.50. All constructs passed the discriminant validity. Although certain constructs’ convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine constructs and 28 items in CFA.ConclusionThe BSC-HCWSL is the first self-administered HCW questionnaire designed to assess BSC perspectives and dimensions and their impact on HCWs’ satisfaction and loyalty. The questionnaire scale was completed following all applicable rules and regulations. The findings revealed that this instrument’s psychometric characteristics were adequate. Therefore, BSC-HCWSL can be utilized in future BSC implementations. It can also be used to assess the influence of BSC factors on HCWs’ satisfaction and loyalty and examine differences depending on HCWs and hospital characteristics.

Objectives:The aim of this study was to assess the risks in confronting the coronavirus disease 2019 (COVID-19) pandemic and the ongoing lockdown effectiveness in each of Italy, Germany, Spain, France, and the United States using China’s lockdown model simulation, and cases forecast until the plateau phase.Methods:Quantitative and qualitative historical data analysis. Total Risk Assessment (TRA) evaluation tool was used to assess the pre-pandemic stage risks, pandemic threshold fast responsiveness, and the ongoing performance until plateau. The Infected Patient Ratio (IPR) tool was developed to measure the number of patients resulting from 1 infector during the incubation period. Both IPR and TRA were used together to forecast inflection points, plateau phases, intensive care units’ and ventilators’ breakpoints, and the Total Fatality Ratio.Results:In Italy, Spain, France, Germany, and the United States, an inflection point is predicted within the first 15 d of April, to arrive at a plateau after another 30 to 80 d. Variations in IPR drop are expected due to variations in lockdown timing by each country, the extent of adherence to it, and the number of performed tests in each.Conclusions:Both qualitative (TRA) and quantitative (IPR) tools can be used together for assessing and minimizing the pandemic risks and for more precise forecasting.

Background The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction. Aim This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations. Methods This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs). Results There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations. Conclusion This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.

Background Improving the healthcare sector in Palestinian territories is challenging. Organizations frequently use the balanced scorecard (BSC) for performance evaluation (PE) worldwide. BSC includes an evaluation of five perspectives: financial, customer, internal process, knowledge and innovation, and environmental. Most HealthCare Organizations (HCO) evaluated patient satisfaction in BSC, but none considered engaging patients in the evaluation process. This paper aims to develop an instrument to engage patients in assessing BSC perspectives (BSC-PATIENT) and customize it for Palestinian hospitals. Methods This is a cross-sectional study. Two panels of experts participated in the item generation of BSC-PATIENT. Forward and backward translation processes from English to Arabic and vice versa were performed. Pretesting was performed for 30 patients at one hospital. Then, 1000 patients were recruited at 14 hospitals between January and October 2021. Construct validity was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Additionally, the composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were assessed to find redundant and low correlated items. Results The scales had high adequate model fit in EFA and CFA. All items included had loadings higher than 0.50. Although the convergent validity was less than 0.50 for some constructs, their discriminant validity, CR, IIC, and CITC showed satisfactory results except the services experience (SERV EXR) construct, which had a CR of 0.50. The final best fit model in CFA comprised ten constructs with 34 items. Conclusion BSC-PATIENT is the first self-administered questionnaire specially developed to engage patients in evaluating their experiences and attitudes based on the BSC perspectives. The questionnaire scales were carried out following relevant guidelines and regulations. The results showed adequacy in the psychometric properties of this instrument. Three-point Likert scales are recommended to assess patient experiences and attitudes since they have higher response rates. Future research can be conducted using this instrument to evaluate the impact of patient experience on attitudes toward BSC perspectives and compare the differences based on patient and hospital characteristics.

The significance of patient engagement in infection prevention and control remains to be stressed as a means of improving patient safety. This study aimed to determine nurses' awareness on infection prevention and control, assess patient and family education on infection prevention and control, and examine the effect of nurses' infection prevention and control awareness on patient and family education. A multi-site, cross-sectional study was conducted among 566 nurses in Hungary. Nurses responded to a questionnaire of three parts including demographics, infection prevention and control awareness; healthcare-associated infections, hand hygiene, and standard precautions, and patient and family education. High scores were reached in overall awareness and standard precautions. Nurses educated patients and family members the most on hand hygiene and respiratory hygiene. Nurses with higher awareness educated patients more than those with lower awareness but, the differences were only significant for respiratory hygiene and the reason for isolation. Nursing leaders are encouraged to enhance the culture that is based on nurses-patients partnership and to develop reminders to emphasize the importance of engaging patients and family members in infection prevention and control. This article is protected by copyright. All rights reserved.

AimsThis systematic review aims to assess the impact of Balanced Scorecard (BSC) implementation at Health Care Organizations (HCOs) on Health Care Workers’ (HCWs’) satisfaction, patient satisfaction, and financial performance. Up to now, no previous systematic reviews have performed a comprehensive and rigorous methodological approach to figure out the impact of BSC implementation in HCOs.MethodsThis systematic review was prepared according to PRISMA guidelines. PubMed, Embase, Cochrane, and Google Scholar databases, as well as Google search engine, were inspected to find all BSC implementations at HCOs until 20 September 2020. Then the resulted articles were screened to find the implementations which measured the impact of BSC on HCWs’ satisfaction, patient satisfaction, and financial performance. Quality assessment was performed using the Standards for Reporting Implementation Studies: (StaRI) checklist.ResultsOut of 4031 records, 20 articles were finally included for measuring one or more of the three impact types. 17 measured the impact of BSC on patient satisfaction, 7 on HCWs’ satisfaction, and 12 on financial performance. Studies with higher quality had a higher positive impact.ConclusionThis paper offers evidence to HCOs and policymakers on the benefits of implementing BSC. BSC implementations showed a positive impact on patient satisfaction and financial performance in HCOs. However, less impact was found on HCWs’ satisfaction, which should be given better consideration in future BSC implementations. High and medium-quality BSC studies were associated with higher positive impacts than low ones. BSC can be utilized as an effective tool to improve HCOs’ performance during the COVID-19 pandemic.

The authors wish to make the following corrections to this paper [...]

BackgroundThe balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction.AimThis systematic review aims to identify key performance indicators (KPIs) and dimensions that are vital and most frequently used by health care managers in BSC implementations. Additionally, it attempts to analyze the resulting dimensions during the COVID-19 era.MethodsThis systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi- experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs).ResultsThere were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 46 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers (HCW) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations.ConclusionThis review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Lastly, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.

Aims To explore the relationships of family, co‐worker and manager support with paediatric nurses' satisfaction and their perception of adverse events. Furthermore, this study aimed to assess the job satisfaction, social support and the perceived patient adverse events. Design This study used a cross‐sectional correlational design. Methods A convenient sample of 225 paediatric nurses was selected from nine hospitals in Jordan. Both the Pearson correlations and multiple regression tests were used in the analysis. The study was prepared and is reported according to the STROBE checklist. Results Significant and positive correlations were found between paediatric nurses' job satisfaction and the social support they receive. Significant negative correlations were also found between adverse events and both family and manager support. The multiple regression results showed that manager support is a significant negative predictor of both pressure ulcers and patient falls, and family support significantly predicted paediatric nurses' job satisfaction.

Background Several tools measuring fear of childbirth (FOC) have been developed in the last three decades, however concerns about their readability have been raised. Aim To explore the fear of childbirth in a sample of women of reproductive age by evaluating the readability of Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ-A). Methods The Flesch Reading Ease Formula, the Flesch-Kincaid Grade Level, the FOG Scale, the SMOG Index, the Coleman-Liau Index, the Automated Readability Index, and the Linsear Write Formula were used to evaluate the readability of the W-DEQ-A. Also, focus group discussions were held to validate the findings of the readability scales mentioned above. Findings The SMOG Index (score = 7.6), Coleman-Liau Index (score = 7.6), and the Linsear Write Formula (score = 9.4) were easily readable by women of reproductive age who had at least secondary school education (grade 12). Concerns were raised over some terms used such as desolate and deserted, which were rarely used in day to day English language conversations. Conclusions In this study, participants observed that W-DEQ- A was readable if administered to expectant women with a basic secondary school certificate; but there is a need to simplify some words. It was emphasized that societal dynamics play an important role in the fear of childbirth and therefore the questionnaire should address all aspects contributing to fear of childbirth and not merely the feelings and thoughts women may have at the prospect of labor and delivery.

Background: Healthcare Associated Infections are serious problems in healthcare sector that threatened patient safety since decades till present. The proper adherence to infection control measures is a major factor in reducing these infections. Objectives: The objectives of this study were, to assess the level of nurses’ awareness with infection control measures in Lebanon and to determine its role in implementing patient and family education. Methodology and Results: A quantitative study was done. Questionnaires were distributed over 260 nurses, and 260 patients and family members at four well known hospitals in Lebanon. The study showed a high level of infection control awareness (81.57 %) among Lebanese nurses, and showed that Lebanese hospitals are training their nurses on IC topics (99.1 % of nurses were trained). As for patients and family members’ education, the JCI accredited hospital showed the highest level of education on infection control measures (58.3 %). Conclusion and Recommendations: The study showed that nurses who had a high awareness in infection control educated more their patients and family members on these measures than nurses with low awareness. (64.1 % and 42.1 % when educating on respiratory hygiene, p=0.013, 86.2 % and 57.9 % when educating on usage of PPE, p=0.000, 89.2 % and 68.4 % when educating on the reason for isolation, p=0.001). The major recommendations were to enhance the culture that believes in the partnership between patients, their families and healthcare providers at the hospitals level, and to include a new standard in the Lebanese Accreditation Standards that requires educating patients and family members on infection control measures at the Ministry of Public Health level.