Territorial health groups in Morocco: towards decentralized and equitable health system governance

Background The digitalization of healthcare systems is expected to lead to improvements in the quality and efficiency of healthcare services. Despite Germany’s leading economic and technological position, the implementation and utilization of digital health solutions is lagging far behind internationally. A look at other countries shows that the digital transformation in healthcare can be successful, and that financial resources and available technologies are not the only determining factors. Rather, it is a matter of political processes, the interests of different stakeholders and the acceptance of patients and HCPs. Methods While the impression often arises that the selection of countries in case studies is random, eight international case studies were identified using a scientific method. A systematic and multi-stage process was developed to select the case studies, taking into account various relevant criteria (e.g. degree of digitalization, geography, economy). The implementation and use of various digital health tools will be examined in selected countries and healthcare systems, in which the digitalization of the healthcare system is particularly advanced. Semi-structured interviews will be conducted with experts from the international healthcare systems between fall 2024 and summer 2025. The findings will inform the development of recommendations for actions for policymakers in Germany. Conclusions This study aims to provide new insights into the key success and failure factors for the digital transformation of healthcare systems. Recommendations for action, tailored specifically to the German healthcare system and aimed at policymakers, are intended to support decision-makers in setting the course for a successful further transformation towards digital health. Key messages • International case studies will be used to identify factors that contribute to the success or failure of digital transformation in healthcare systems. • Based on the findings of this research, recommendations for action will be developed for policymakers in Germany to set the course for the successful further digitalization of healthcare.

Purpose: Technology-Enhanced Learning (TEL) has become a central feature of contemporary education, offering digital platforms and tools to improve teaching and learning. In Ghanaian Senior High Schools (SHSs), TEL adoption has accelerated, particularly during the COVID-19 pandemic, yet questions remain about its impact on student engagement and motivation. This study therefore examined role of technology-enhanced learning on student engagement and motivation in selected Ghanaian Senior High Schools. Methods: Anchored in Self-Determination Theory, the study employed a positivist paradigm and a descriptive cross-sectional survey design. A deductive approach guided the analysis of theoretically grounded constructs. The sample comprised 73 students purposively selected from two public SHSs with established digital infrastructure. Data were collected using a structured questionnaire administered via Google Forms, adapted from validated instruments, and analysed using IBM SPSS (Version 27). Descriptive statistics summarised perceptions, while Pearson’s correlation tested associations among digital literacy, motivation, and engagement at a 95% confidence level. Findings: Findings revealed that students perceived digital literacy particularly confidence and positive attitudes toward digital tools as critical enablers of TEL use. Confidence in digital skills strongly influenced collaboration and motivation (Mean = 4.00; r = 0.93). Digital tool use was highly correlated with improved focus, enjoyment, and active participation in TEL classrooms (r = 0.91–0.94). These results highlight that competence and confidence are stronger predictors of motivation and engagement than peer influence or system usability. Conclusion: The study concludes that TEL can significantly enhance student motivation and engagement when supported by digital literacy. Implications: The implications highlight the need for targeted teacher training, equitable resource allocation, and digital literacy programmes to maximise TEL’s benefits in Ghanaian SHSs, thereby advancing SDG 4 (Quality Education). Originality: The originality of this research lies in its focus on the relationship between digital literacy and motivational outcomes in Ghanaian SHSs, moving beyond access and infrastructure debates to provide empirical evidence on how TEL shapes students’ learning experiences.

Introduction:The distinctive characteristics of the German health system are medical progress and financial pressure—and this is especially true of the hospitals. These challenges must be met by strategic management instruments for quality assurance, and by reducing costs.Purpose:This article presents the instrument “clinical pathway” (also known as “clinical treatment pathway”) and describes the possibilities it offers, both for quality assurance and risk management, and for cost reduction. The clinical pathway presented here will be that for “multimodal pain therapy”, as used in the context of acute inpatient care in Germany.Methods:A general presentation of the risks in hospital is followed by consideration of the risks associated with core processes. A comprehensive total cost analysis is performed for those patients who meet the pathway entry criteria and who fulfil the requirements for the structure of care provided within multimodal pain therapy.Discussion and Conclusion:Multimodal pain therapy places high demands on the structural, procedural and outcome quality of the medical, nursing and therapeutic services provided, and these demands are reflected in high costs for the provision of this care. The treatment process involves many different professional groups. These complex interfaces can potentially generate risks, which can lead to the possibility of legal liability. A clinical pathway must structure the core process and then combine elements of quality assurance in order to optimise patient care and minimise risk. The examination of costs reveals significant potential savings (patients with clinical pathway: EUR 3086±212; patients without clinical pathway: EUR 3774±460; Mann-Whitney U test; p<0.001). For the managers of a hospital, the clinical pathway represents a strategic management instrument that can serve for continual cost control and cost reduction, and can contribute in the form of quality assurance towards a transparent provision of services.

Hospitals, as essential healthcare institutions, play a critical role in ensuring the quality and efficiency of healthcare services. The increasing demand for accountability, cost-efficiency, and improved service quality has led to the implementation of key efficiency indicators such as Average Length of Stay (AvLOS), Bed Occupancy Rate (BOR), Bed Turnover (BTO), and Turnover Interval (TOI) to optimize hospital operations. In response, the Indonesian Ministry of Health has introduced Regulation No. 30 of 2022 concerning the National Hospital Quality Indicators (INM-RS), which includes cardiovascular services as a national priority. The use of Clinical Pathways (CP) in disease management, including cardiovascular conditions, aims to reduce variation in services, improve efficiency, and enhance care quality. This study aims to evaluate the relationship between efficiency indicators, INM, and the implementation of CP in managing cardiovascular diseases at Mokopido Tolitoli Regional General Hospital. The results highlight the hospital's achievements in various quality indicators, efficiency metrics, and CP implementation, shedding light on the gaps in the integration of policies and their practical application.

In an increasingly complex and competitive landscape, higher education institutions must leverage data-driven governance to enhance decision-making processes. This paper presents a conceptual framework aimed at integrating data analytics into the governance structures of higher education, facilitating informed decision-making, and improving institutional effectiveness. The framework emphasizes the importance of collecting, analyzing, and utilizing data across various dimensions, including academic performance, student engagement, financial management, and operational efficiency. By adopting a data-driven approach, institutions can identify trends, forecast outcomes, and make strategic decisions that align with their mission and goals. The study outlines key components of the framework, including data governance, analytics capabilities, stakeholder engagement, and institutional culture. Data governance ensures that data quality, integrity, and security are maintained, while analytics capabilities empower decision-makers with actionable insights. Engaging stakeholders—faculty, administrators, students, and external partners—fosters a collaborative environment where data-driven decisions are embraced and supported. Furthermore, the framework addresses the challenges institutions face when implementing data-driven governance, such as resistance to change, data silos, and inadequate technological infrastructure. Strategies for overcoming these challenges include investing in professional development, enhancing data literacy, and promoting a culture of continuous improvement. The framework also highlights the significance of ethical considerations and transparency in data usage, ensuring that decision-making processes are equitable and accountable. The findings indicate that by embracing data-driven governance, higher education institutions can enhance their responsiveness to changing demands, optimize resource allocation, and improve overall institutional performance. Ultimately, the conceptual framework serves as a guide for higher education leaders seeking to harness the power of data in their decision-making processes, fostering a proactive and adaptive institutional environment.

Decision-making for sustainable land use transformations is a key driver of society's future development, particularly in addressing complex threats posed by climate change and biodiversity loss. Digital tools represent promising technologies that can support decision-makers in facing these challenges. However, existing literature reveals a gap in studies exploring digital tools within the land-use decision framework. The present study uses the PRISMA methodology to systematically review digital tools in Europe. As a result, 48 digital tools were identified and analysed regarding their functionalities, limitations, and adoption factors. The findings highlight the prevalence of spatially explicit outputs and key functions such as interaction and visualization, scenario modelling, and stakeholder engagement. Despite their potential, challenges remain, including barriers to accessibility, the need to enhance trust in tool outputs, and an overall lack of digital literacy that could further promote the adoption of these tools. This study thus provides co-development recommendations gathered from interviews with five tool developers and systematic review analysis. By addressing the identified barriers and fostering digital literacy, digital tools can provide valuable contributions in supporting sustainable land use decisions, bridging the gap between data-driven insights and real-world complexity.

Multigrade education, characterized by the instruction of students from different grade levels in the same classroom, has garnered significant attention in educational research due to its prevalence in diverse global contexts. This comprehensive literature review offers a nuanced exploration of multigrade education, synthesizing empirical research, theoretical frameworks, and practical insights to provide a holistic understanding of its complexities and implications. The review begins by delineating the global landscape of multigrade classrooms, examining their prevalence, significance, and diverse manifestations across various regions and socio-economic contexts. It delves into the positive aspects of multigrade education, such as fostering collaborative learning environments, maximizing resource utilization, and addressing educational inequalities, while also addressing the negative effects of inadequate support, including teacher burnout and limited access to resources. Central to the literature review is the examination of stakeholder engagement in multigrade education, with a focus on the roles of educators, policymakers, parents, and communities in supporting effective teaching and learning practices. Through an interdisciplinary lens, the review analyzes strategies to maximize stakeholder support, including investments in professional development for teachers, equitable allocation of resources, community involvement, and policy advocacy. Furthermore, it explores culturally-appropriate interventions and collaborative teaching practices to address the unique challenges faced by multigrade educators and students across diverse cultural landscapes and socio-economic environments. By offering actionable recommendations grounded in empirical evidence and best practices, the literature review aims to inform policy, practice, and future research directions in multigrade education, ultimately advocating for inclusive learning environments where every student can thrive and succeed, irrespective of their grade level or school size.

BackgroundThe maturity of practices and infrastructure in the health care domain directly impacts the quality and efficiency of health care services. Therefore, various health care administrations (e.g. from hospital management to the nationwide health authority) need to assess and improve their operational maturity.ObjectiveThis study aimed to review and classify studies that propose/use maturity assessment or maturity models (MMs) as a vehicle to achieve operational excellence in the health care domain.MethodTo achieve this objective, we performed a multivocal literature review (MLR) – a form of systematic review that includes data from the grey literature (e.g. white papers and online documents) in addition to formal, peer-reviewed literature.ResultsBased on 101 sources, 80 from peer-reviewed literature and 21 from the grey literature, we identified 68 different MMs on, for example, telemedicine, care pathways and digital imaging. We reviewed them with respect to various aspects, including types of research and contribution, list of MMs proposed/used with their subject areas, elements of maturity/capability and application scope or scale. In the synthesis of empirical benefits of using MMs, two were found to be significant: (a) identifying issues and providing guidance for improvement in health care contexts, and (b) improving efficiency, effectiveness, performance and productivity.ConclusionThis MLR provides an overview of the landscape and serves as an index to the vast body of knowledge in this area. Our review creates an opportunity to cope with the challenges in obtaining an overview of the state-of-the-art and practice, choosing the most suitable models or developing new models with further specialties.

Emerging health systems in low- and middle-income countries (LMICs) face persistent challenges in extending equitable, consistent, and culturally responsive care across diverse geographies. Centralized health infrastructure often fails to meet the complex demands of remote or marginalized populations, leading to gaps in continuity of care, delayed access, and diminished health outcomes. This paper explores a holistic approach to strengthening decentralized healthcare access through the strategic integration of supply chain resilience, stakeholder engagement, and patient-centered support systems. We begin with a systemic overview of decentralization as a policy instrument and operational model in global health, focusing on its implementation in LMICs through primary healthcare networks, task-shifting, and regional service hubs. Particular emphasis is placed on how logistics systems especially last-mile distribution, cold chain management, and data synchronization enable or constrain service availability in under-resourced settings. Next, the paper examines stakeholder engagement as a critical enabler of decentralized care, highlighting the role of local governance structures, community health workers, and civil society actors in co-designing solutions, ensuring cultural alignment, and sustaining trust. In parallel, patient support structures such as digital follow-up tools, mobile health reminders, and decentralized chronic disease management are assessed for their ability to improve adherence, reduce attrition, and promote health literacy. The paper synthesizes these three domains into a unified operational framework, illustrated through comparative case studies from East Africa and Southeast Asia. Ultimately, we propose that successful decentralization requires not just physical redistribution of services, but a re-engineering of operational flows, incentive systems, and trust-building mechanisms tailored to local realities.

How societal expectations, new digital tools, andthe COVID crisis are driving a step-change in human centric remediation.

Corpora are being increasingly used as a digital medium for language work in practical environments and, consequently, as a digital learning tool in foreign language learning. This has given rise to the relatively new area of corpus didactics within media pedagogy for German as a Foreign Language.This article explores the possibilities of the corpus-based approach to learning languages for specific purposes and its potential advantages in comparison to other digital tools, with a particular focus on legal language. The corpus GeLeCo (German Legal Corpus) is used to illustrate corpus-based methods in LSP didactics.By using the example of intertextual markers in court decision, the study investigates whether and in what ways corpora might offer advantages over machine translation tools and AI chatbots when translating legal texts. The analysis of linguistic means in the corpus GeLeCo shows that the linguistic means used in court decisions to reference other legal texts differ in frequency from those produced by translation engines.These findings provide the foundation for didactic considerations and the development of teaching scenarios and tasks designed to raise awareness of learners in law-related GFL learning of the limitations of automated translation tools and chatbots. While such tools might roughly reproduce the general content of a legal text, they often fail to capture the nuanced legal formulations that are critical for professional legal communication.

BackgroundDespite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation. Theories that explain how CPWs work in hospitals are lacking, making it difficult to identify important factors for sustaining changes arising from CPWs implemented in hospitals. The objective of this realist review is to develop a program theory for CPWs in hospitals.MethodsThis is a protocol for a realist review. The review will use a six-step iterative process to develop a program theory for CPWs in hospitals: (1) development of a preliminary program theory; (2) search strategy and literature search; (3) study selection and appraisal; (4) data extraction; (5) data analysis and synthesis; and (6) stakeholder engagement. In addition to searching the gray literature and contacting authors, we will search electronic databases such as MEDLINE, NHSEED, CINAHL EBSCO, HMIC, and PsycINFO. Studies will be included based on their ability to provide data that test some aspect of the program theory. Two independent reviewers will select, screen, and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome heuristics that explains how CPWs implemented in hospitals translates to better health system outcomes.DiscussionOverall, the review aims to develop a program theory for CPWs in hospitals and to explore how, why, to what extent, and in what contexts does the implementation of CPWs in hospitals contribute to better health system outcomes. As a result, the review will provide a theoretical framework of how CPWs work in hospitals.Systematic review registrationPROSPERO CRD42018103220

Health care professionals most relevant phrases used in a digital medical translation tool in 24-7 communication with minority speaking heart surgery patients during hospitalization

In response to the global urgency for education systems to adapt to the demands of the 21st century, this study examines strategic efforts to enhance education quality through digitalization at Universitas Pendidikan Indonesia (UPI) Bumi Siliwangi’s partner schools. As nations strive to develop competitive and future-ready human capital, integrating digital technologies into school systems has become a critical pathway toward achieving World Class Education. This research investigates how digital tools—such as Learning Management Systems, multimedia platforms, and online communication applications—are utilized to transform learning processes, administrative operations, and stakeholder engagement. Key enablers identified include visionary leadership, ongoing professional development, infrastructure readiness, and collaborative support from UPI. However, challenges such as digital inequality, varying levels of digital literacy, and resistance to change highlight the need for systemic and sustainable strategies. The findings emphasize that advancing digitalization is not merely a technical upgrade but a cultural shift, requiring long-term commitment and policy alignment to ensure inclusive, high-quality education for all learners.

The increased spread of digital technology has significantly transformed the character, the extent, and the course of contemporary social movements. During the past twenty years, digital media in the form of social media networks, mobile communication technologies, online forums and digital advocacy tools become the key modes in which collective action is coordinated, maintained, and amplified. In this paper, I explore the complex nature of the digital technology in the formation of contemporary social movements, with attention to its impact on the process of mobilization, organizational forms, identity development, political action, and outcome of the movements. In comparison to the old social movements where gathering physically, use of print press and top-down leadership hierarchy were the main pillars of operation, modern movements are slowly shifting to digitally networked setting that is fast, decentralized, and transnational. It takes a qualitative and exploratory research method based on a thorough review of the literature available and a comparison of case studies. The paper presents a case study of the Arab Spring, the BlackLivesMatter movement, as well as similar youth-led movements focused on climate change and shows how digital tools can be used to spread information quickly, reduce entry barriers, and allow marginalized voices to be heard. Through the digital technology, individuals have become active contributors of information rather than passive receivers of life and have democratized communication in politics, thus questioning established power bases. Nevertheless, the paper critically questions the constraints and dangers of digital activism, as well. The problem of misinformation, the biases of algorithms, online surveillance, harassment in the Internet, and the ongoing digital differences are all significant questions of the sustainability and inclusivity of digitally mediated movements. Digital platforms increase visibility and short-term mobilization, but they do not necessarily have a long-term structural change and policy reform. The trend of slacktivism and susceptibility of movements to state oppression and takeover by corporate platforms are discussed as the most critical issues. This paper results indicate that digital technology is an enabling infrastructure and not a solution to social change. The best social movements are the ones which cleverly combine digital with offline organizing, institutional mobilization, and collective action which is sustained. This study provides a balanced and critical analysis that can be used to further discussions on the topic of digital activism, and the emergent technologies can further influence how social movements develop in the future in the ever-interconnected world.