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O propósito do estudo é levantar a produção de conhecimentos e práticas, nos níveis nacional e internacional, para auxiliar na proposição de medidas de proteção da maternidade e do trabalho em setores hospitalares de assistência direta à saúde.

Wen-Yi Chen Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung City, TaiwanCorrespondence: Wen-Yi ChenDepartment of Senior Citizen Service Management, National Taichung University of Science and Technology, 193 Sec 1, San-Min Road, Taichung City, 40343, TaiwanTel +886 4 22196932Fax +886 4 22196811Email chenwen@nutc.edu.twPurpose: The purpose of this study is to investigate the effect of interdependences of healthcare providers’ referral behaviors on the quality of ambulatory care. The significance of this study is to address the concern regarding the low quality of ambulatory care due to the lack of a compulsory referral system under Taiwan’s National Health Insurance system.Methods: We applied the dynamic connectedness network analysis to estimate the total connectedness index of the referral behavior network, which was separated into the horizontal and vertical referral behavior components in order to measure the interdependences of horizontal and vertical referral behaviors across hospitals and local clinics, respectively.Results: Our results suggest that the interdependences of referral behaviors increase the quality of ambulatory care. The harmful effect on the quality of ambulatory care from the interdependences of horizontal referral behaviors within the local clinics sector is more significant than that from the interdependences of horizontal referral behaviors within the hospital sector, and the negative effect on the overall and chronic composite measures of avoidable hospital admissions from the interdependences of vertical behaviors associated with local clinics is more substantial than that from the interdependences of vertical behaviors within the hospital sector.Conclusion: These results not only highlight the significance of care collaboration between local clinics and hospitals to restrain avoidable hospital admissions of chronic diseases for a better overall quality of ambulatory care, but they also suggest that the surveillance system established for the quality of ambulatory care under the global budget payment scheme for the local clinics sector should target ambulatory care for patients with acute conditions.Keywords: connectedness network analysis, connectedness index, referral behavior, referral policy, National Health Insurance

Background: The Laboratory Incident Notification Canada surveillance system monitors laboratory incidents reported under the Human Pathogens and Toxins Act and the Human Pathogens and Toxins Regulations. The objective of this report is to describe laboratory exposures that were reported in Canada in 2020 and the individuals who were affected. Methods: Laboratory incident exposures occurring in licensed Canadian laboratories in 2020 were analyzed. The exposure incident rate was calculated and the descriptive statistics were performed. Exposure incidents were analyzed by sector, activity type, occurrence type, root cause and pathogen/toxin. Affected persons were analyzed by education, route of exposure sector, role and laboratory experience. The time between the incident and the reporting date was also analyzed. Results: Forty-two incidents involving 57 individuals were reported to Laboratory Incident Notification Canada in 2020. There were no suspected or confirmed laboratory acquired infections. The annual incident exposure rate was 4.2 incidents per 100 active licenses. Most exposure incidents occurred during microbiology activities (n=22, 52.4%) and/or were reported by the hospital sector (n=19, 45.2%). Procedural issues (n=16, 27.1%) and sharps-related incidents (n=13, 22.0%) were the most common occurrences. Most affected individuals were exposed via inhalation (n=28, 49.1%) and worked as technicians or technologists (n=36, 63.2%). Issues with standard operating procedures was the most common root cause (n=24, 27.0%), followed by human interactions (n=21, 23.6%). The median number of days between the incident and the reporting date was six days. Conclusion: The rate of laboratory incidents were lower in 2020 than 2019, although the ongoing pandemic may have contributed to this decrease because of the closure of non-essential workplaces, including laboratories, for a portion of the year. The most common occurrence type was procedural while issues with not complying to standard operating procedures and human interactions as the most cited root causes.

Many factors affect the caregiver burden. However, there is no clear information about whether older patients’ self-efficacy levels affect the caregiver burden. This study was carried out to determine the relationship between the self-efficacy of older patients and the caregiver burden in Turkey. This cross-sectional and correlational study was conducted at a university hospital with a sample of patients and their family caregivers. The population of the study consisted of 163 older patients and their caregivers. Data were collected using the demographic data form, Self-Efficacy Scale, and Burden Interview. The self-efficacy of older patients was found to be the strongest predictor of the caregiver burden. Other significant predictors of the caregiver burden were the caregiver’s degree of kinship with the patient, marital status of the caregiver, and the patient’s duration of illness. This study determined that the predictor variables explained 28% of the total variance. The addition of applications that increase patient self-efficacy to the scope of the programs aimed at reducing the caregiver burden will increase the effectiveness of the programs. © 2022 Taylor & Francis Group, LLC.

Los costos ocultos se presentan a consecuencia de la aparición de disfuncionamientos, o desviaciones, presentes en la operatividad de la organización y que resultan de la interacción entre lógicas de comportamiento y aspectos de estructura. Su importancia se ejemplifica a través de análisis realizados en la Unión Europea; en donde se refiere, que equivalen entre 7.5 a 12% del costo estándar de producción o 20-30% de la nómina organizacional. En México, se reportan hallazgos de investigaciones, sobre costos ocultos, en los sectores metalmecánico, de la ropa, del trasporte... pero no en el de la salud. Objetivo.- Este análisis, corresponde a una investigación de tipo cualitativo para la identificación de los disfuncionamientos presentes en un hospital mexicano y de los costos ocultos que se generan en consecuencia; específicamente, en lo que corresponde a un tópico de interés en el Sector Salud como lo son los Eventos Adversos Hospitalarios asociados al uso de medicamentos y que para fines de esta investigación se denominan Eventos Adversos a Medicamentos y Errores Asociados al Uso de Medicamentos. Resultados.- El costo oculto tangible por fármacos corresponde al 6.53% del presupuesto hospitalario asignado en el 2013 o el 25.62% de los gastos de operación erogados para el mismo año y el intangible se asocia a la falta de creación potencial y deterioro del clima organizacional. Conclusiones.- Se sugiere la implementación de la metodología para la identificación de disfuncionamientos y costos ocultos asociados, en la unidades del Sector Salud como un área de oportunidad para la mejora organizacional.

Purpose This paper aims to study the relationship between servant leadership (SL), employee turnover intention (TI) and organizational identification (OI) in hospitals. Design/methodology/approach The study uses a quantitative approach to investigate the relationships between SL, OI and TI, using data collected from a sample of 266 front-facing employees in a private Indian hospital setup. Structural equation modeling is used to analyze the data and test the hypotheses. Findings The findings reveal that servant leadership has a positive relationship with organizational identification and negatively impacts turnover intentions of the front-facing employee. Further, the study also reveals, contrary to expectations, organizational identification has no significant mediating effect between servant leadership and turnover intentions. Research limitations/implications This research is limited to front-facing employees in hospitals and the study may be extended to other industries in the service sector. Future studies may consider other mediating and moderating variables to fully understand the mechanism of impact of servant leadership on turnover intention. Multi-level studies can also be carried out. Practical implications With the ever-increasing expectations for better patient care, robust leadership models have required that address front-facing employee’s well-being, enabling their attention toward patients. This paper provides the impetus for the development and adoption of servant leadership specifically within hospitals and the service sector. Originality/value This study is one of the few studies that empirically examines servant leadership in the health-care domain. The study also contributes to the extant literature on servant leadership by empirically examining the mediation effect of organizational identification between SL and TI. To the authors’ best of knowledge, this study may be the first of its kind, providing evidence of servant leadership’s impact on turnover intention and organizational identification in hospitals using data from the Indian context.

Zusammenfassung Hintergrund Mit der zunehmenden Verbreitung der Lu-177-PSMA-RLT zur Behandlung des fortgeschrittenen Prostatakarzinoms ist von Interesse, wie sich die Versorgungssituation mit Blick auf die hierfür nötigen nuklearmedizinischen Therapiebetten angesichts hoher Fallzahlen beim fortgeschrittenen PCa hypothetisch darstellen würde, und ob es hier potenziell zu einem infrastrukturbedingten Engpass für die Patientenversorgung kommen könnte. Methodik Das in deutschen Krankenhäusern verfügbare Angebot an nuklearmedizinischen Therapiebetten wurde dem bei etwaiger Zulassung eines Therapeutikums zur Lu-177-PSMA-RLT als Letztlinientherapie für mCRPC-Patienten perspektivisch insgesamt zu rechnenden nuklearmedizinischen Nachfragepotenzial an Therapiebetten in einer Basiskalkulation gegenübergestellt. Eine mögliche Ausweitung des Lu-PSMA-Indikationsspektrums wurde dabei nicht berücksichtigt. Ergebnisse Nach der Basiskalkulation ergäbe sich bei einer bundesweit aktuellen nuklearmedizinischen Bettenkapazität von ca. 234 000 Behandlungstagen eine rechnerisch geringe Reserve von bundesweit ca. 19 000 nuklearmedizinischen Bettentagen, was umgerechnet einer Reserve von 63 Betten für die interessierende Fragestellung entspricht. Dabei zeigen sich regionale Unterschiede bei der Bettenkapazität: Während sich für einige Bundesländer eine rechnerische Unterkapazität an nuklearmedizinischen Therapiebetten bei Zulassung der Lu-177-PSMA-RLT andeutet, gilt dies für andere Bundesländer weniger. Diskussion Diese Basiskalkulation zeigt, dass die Kapazität nuklearmedizinischer Therapiebetten bei einer etwaig zugelassenen Lu-177-PSMA-RLT für mCRPC sehr gut ausgelastet sein dürfte, in einigen Bundesländern sogar an ihre Grenzen stoßen könnte. Bei einer perspektivischen Ausweitung des Indikationsspektrums oder absehbar klinischen Etablierung weiterer therapeutischer Radiopharmaka könnte die Bettenzahl mittelfristig einen Engpassfaktor für das flächendeckende Behandlungsangebot darstellen.

O diagnostico dos medicos envolve a requisicao de exames, onde sao coletadas amostras biologicas dos pacientes para realizar analises laboratoriais. Ao ajudar no desenvolvimento dos procedimentos, alguns profissionais da saude podem estar sujeitos a contaminacao ocasionada por exposicoes a materiais coletados dos pacientes. O artigo tem como objetivo desenvolver um projeto conceitual de um equipamento para o transporte de material biologico, que proporcione conforto e seguranca aos profissionais da area da saude. Foi adaptada uma metodologia sobre o Processo de Desenvolvimento de Produto (PDP) para o setor hospitalar. Em complemento, foi realizada uma pesquisa de campo em instituicoes hospitalares com profissionais que sao responsaveis pelos procedimentos de coletas. A concepcao do equipamento apresenta beneficios para as condicoes de trabalho dos profissionais da area da saude. Com o uso do equipamento, e possivel reduzir as possibilidades de contaminacao com materiais potencialmente infectantes, distribuir os materiais de forma mais organizada e auxiliar as coletas nos ambientes em que forem requeridas. A pesquisa contribuiu tambem para o entendimento, ensino e aprendizagem no processo de integracao entre o gerenciamento de projeto e desenvolvimento de produto. Palavras-chave: Hospital. Coleta. Transporte. PDP. ABSTRACT The diagnosis of doctors involves the ordering of exams, where biological samples are collected from patients to perform laboratory tests. When assisting in the development of procedures, some health professionals may be subject to contamination caused by exposures to materials collected from patients. The article aims to develop a conceptual design of an equipment for the transport of biological material, which provides comfort and safety to health professionals. A methodology on the Product Development Process (PDP) was adapted for the hospital sector. In addition, a field research was carried out in hospital institutions with professionals who are responsible for the collection procedures. The design of the equipment has benefits for the working conditions of health professionals. With the use of the equipment, it is possible to reduce the chances of contamination with potentially infectious materials, distribute the materials in a more organized way and assist collections in the environments that are required. The research also contributed to the understanding, teaching and learning in the process of integration between project management and product development. Keywords: Hospital. Collect. Transport. PDP.

Enterprise architecture (EA) is a systematic way of designing, planning, and implementing process and technology changes to address the complexity of information system (IS) landscapes. EA is operationalized when architecture visions move towards realization through concrete projects. We report a case study on the dynamics of operationalizing EA in the Norwegian hospital sector by exploring different EA project trajectories. Our empirical context is an institutionally pluralistic setting where multiple logics coexist. We show that the distinct logic of EA is added to the institutional context and we find that tensions among existing medical, technical, and managerial logics and EA principles and assumptions emerge. We contribute to the under‐researched topic of EA operationalization by suggesting a model that demonstrates how the meeting of multiple institutional logics can lead to varying degrees of differentiation or even disassociation from EA visions during decision‐taking in projects. Furthermore, we advance extant research on IS projects' implementation in institutionally pluralistic settings by providing an empirical account of actors' interactions and project leadership arrangements that contribute to the persistence of coexisting logics in a dynamic equilibrium.

We examined the status and necessity of a cultural change regarding the internal health promotion perspective in the Austrian hospital sector to check how the implementation of workplace health promotion proceeded compared to the last survey. This was done by analyzing the current situation of working conditions, replicating a quantitative study by Schaffenrath-Resi et al. (Schaffenrath-Resi et al. Pflege Gesellschaft 15:145–162, 2010). A link to an online survey was sent to all hospitals in Austria. The topics covered were the internal evaluation and current status, reasons and pitfalls of workplace health promotion. While approximately 40% of the respondents state using health circles, only 18.5% report a holistic workplace health promotion (WHP) approach, though certain elements are offered by the majority (+70%). Program failure beliefs are rather focused on the employees. Evaluations of the current programs are required to clarify not only how WHP was designed but also reasons for WHP failure. In addition, future research would profit from a broader database.

The objective of this research is to analyze the supply chain of the health sector in the territory of the province of Matanzas. A hospital was used as the basis for the study in order to identify the operation of the chain through the development of logistics activities. This to determine if there is a relationship between the different elements that compose it. The tools were used: checklist, flow chart and performance of teamwork techniques. In addition to conducting individual interviews and reviewing the literature. A methodology that characterizes the chain and its actors is applied, together with its diagnosis and proposing measures for its improvement. This allowed determining that the main problem refers to the lack of integration between the different elements of the chain, which negatively affects the development of activities aimed at satisfying the customer at the lowest possible cost. Resumen El objetivo de esta investigación es analizar la cadena de suministro del sector salud en el territorio de la provincia de Matanzas. Se utilizó un hospital como base para el estudio con el fin de identificar la operación de la cadena a través del desarrollo de actividades logísticas. Esto para determinar si existe una relación entre los diferentes elementos que la componen. Se utilizaron las herramientas: lista de verificación, diagrama de flujo y desempeño de técnicas de trabajo en equipo. Además de realizar entrevistas individuales y revisar la literatura. Se aplica una metodología que caracteriza a la cadena y sus actores, junto con su diagnóstico y proponiendo medidas para su mejora. Esto permitió determinar que el problema principal se refiere a la falta de integración entre los diferentes elementos de la cadena, lo que afecta negativamente el desarrollo de actividades destinadas a satisfacer al cliente al menor costo posible.

Different forms of partnership in the hospital sector exist depending on the degree of integration between the individual participants, the types of partners, their goals and motives for cooperation. The theory describes many conceptual frameworks of the strategic alliance formation process. The purpose of the publication is to analyze some of the existing models and as a result to present a model of creating hospital strategic alliances. This framework integrates the strategic process of cooperation with the particular features of healthcare management. Some of the elements in the model are specific and derive from the characteristics of the Bulgarian healthcare system. The emphasis in its application is the creation of a successful strategic alliance.

The rapidly growing number of private hospitals in a short period of time has led to intense competition. Thanks to the rapid development of technology and the rapid imitation of institutions, private hospitals are similar to each other and resort to many different strategies to get rid of the same pressure. Private hospitals offer preventative medical services, outpatient or inpatient services, and rehabilitation services for individuals. However, private hospitals do not pay enough attention to healthcare development. It is assumed that private hospitals that provide services that others do not provide, establish fitness and sports centers in their structures, avoid competition and open up to the Blue Ocean, expand medical services by creating a new client segment and contribute to the image of the hospital.

Clemence, Laura and Mathilde are graduates of the nursing training institute of Neuilly-sur-Marne (93) since July 2020. Approximately six months after taking up their position in the hospital sector, they share their thoughts and relate their first steps in the practice of this nursing profession which they have all three fully chosen.

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