Administrative Workload Research Articles

How People with Parkinson's Disease and Health Care Professionals Wish to Partner in Care Using eHealth: Co-Design Study.

BackgroundWorldwide, the number of people with Parkinson’s disease (PD) is predicted to double between the years 2005 and 2030. Chronic care management requires active collaboration and knowledge exchange between patients and health care professionals (HCPs) for best possible health outcomes, which we describe as co-care. eHealth services have the potential to support the realization of co-care between people with PD (PwP) and HCPs.ObjectiveThis study aimed to explore how co-care could be operationalized in PD care, supported by eHealth. More specifically, this study explores PwP's and HCPs' expectations and desired eHealth functionalities to achieve co-care.MethodsPrinciples of participatory design were used to enable the identification of co-care needs and design ideas, in a series of 4 half-day co-design workshops. The sample included 7 (4 women) PwP and 9 (4 women) HCPs, including 4 neurologists, 3 nurses, and 2 physiotherapists. The co-design process resulted in a functional prototype that was evaluated by the co-design participants in the last workshop. Data were collected through note cards produced by the participants during the first 3 workshops and focus group discussions during the 3rd and 4th workshops. The data were analyzed using qualitative thematic analysis. After the workshop series, the prototype was demonstrated at a Mini Fair for ongoing PD research and evaluated using a self-developed questionnaire with 37 respondents: 31 PwP (14 women) and 6 informal caregivers (3 women). Descriptive statistics are reported.ResultsThe qualitative analysis of data resulted in 2 main themes. The first theme, core eHealth functionalities and their expected values, describes 6 desired eHealth functionalities for supporting PD co-care between PwP and HCPs: (1) self-tracking, (2) previsit forms, (3) graphical visualization, (4) clinical decision support, (5) self-care recommendations, and (6) asynchronous communication. The second theme, individual and organizational constraints, describes constraints that need to be addressed to succeed with an eHealth service for co-care. Individual constraints include eHealth literacy and acceptance; organizational constraints include teamwork and administrative workload. The majority of the questionnaire respondents (31/37, 84%) perceived that they would benefit from an eHealth service similar to the demonstrated prototype. All prototype functionalities were rated as very important or important by the majority of respondents (ranging from 86% to 97% per functionality).ConclusionsThis study adds to our knowledge on how PD co-care could be operationalized. Co-care implies a shift from episodic routine-driven care to more flexible care management that is driven by the mutual needs of patients and HCPs and supported by active information exchange between them, as well as automated information processing to generate patient-specific advice. More research is needed to further explore the concept of co-care in chronic care management and what it means for self-care and health care.International Registered Report Identifier (IRRID)RR2-10.2196/11278

Recruitment Strategy for Potential COVID-19 Convalescent Plasma Donors

Recruitment Strategy for Potential COVID-19 Convalescent Plasma Donors

Servitization of public service processes with a simulation modelling approach

Abstract This article aims to examine how the theory of co-production can be connected with servitization and digitalisation and used together for the public service development with the help of discrete-event simulation modelling to highlight time-related deficiencies of a complex public service process, which is most commonly used by patchwork families. Data was taken from the Guardianship Office in Győr (Hungary), based on which in-depth interviews were conducted. Based on the legal background and the interviews, the authors of the article created the process model of the contacting procedure. Based on the model, discrete-event simulation was used to identify the process elements for potential improvement through servitization. Discrete-event simulation showed the insufficiency of national regulation regarding the whole process and weaknesses of the contacting procedures in terms of quality and success. Basic reasons were found for the dissatisfaction expressed by participants of the procedures (administrators and customers). The increasing customer demand for high quality and efficient public services and failures in the New Public Management (NPM) in Eastern European countries require other approaches to advance. The paper connects the theory of co-production and servitization in a public service context and demonstrates how a complex public service can be examined with this approach to find possible improvements. The government must change the process regulation considering the number of the cases, the workload of administrators and family types (divorced or patchwork). The emphasis should be placed on the training and experience of administrators.

Using the Model for Improvement and Plan-Do-Study-Act to effect SMART change and advance quality.

Using the Model for Improvement and Plan-Do-Study-Act to effect SMART change and advance quality.

Аналого-цифровая тарификация в отрасли нефтепроводного транспорта: методы интеграции с системой профессиональных квалификаций

The author considers the new approaches to the rating system (labor complexity evaluation) of directors and specialists of the production and structural subdivisions of Transneft system entities, based on the results of independent expert and analytical evaluation of a universal set of production and technical values, representing the subdivisions’ activities. The author performed a number of practical studies and developments in the area of forming universal mathematical models, which allow economic analysis to be carried out and establishing a justified salary as per the positions of the directors of various subdivisions, regardless of activity type and level of position. The article introduces universal systems of point-based and factor-based ranking, based on the use of innovative mathematical analysis methods (multi-innovating normalizing, decision matrices, hierarchy analysis) for obtaining normalized assessment of production activity), administrative work load and professional labor complexity. The devised analytical approaches to the selection and assessment of the performance of subdivisions provide the possibility for objective and independent calculation for rating determination (salary) both for the Transneft system as a whole and for separate structural subdivisions (observing labor laws). The represented methods have significant applicability in modern conditions – on the stage of transition to the new system of professional standards and evaluation of qualifications, as well as the rejection of traditional models, based on strict attachment to the rating and qualification system, fixed salaries, etc.

Evaluation of a Tool that Enables Cancer Patients to Participate in the Decision-Making Process during Treatment Selection.

Patient participation in decisions related to their treatment is strongly recommended. This study was conducted to develop and evaluate a support tool that can help patients make decisions related to their own treatment. Twenty cancer patients who were hospitalized for first-line treatment were enrolled. Before hospitalization, a 'Check sheet on treatment selection', which contained 14 questions, was distributed to patients and/or their families. After hospitalization, the attending physician explained the treatment while referring to the written check sheet. At discharge, patients' responses to the 'Questionnaire on check sheet and treatment selection' were collected to evaluate the utility of the check sheet. Finally, the 'Questionnaire of the check sheet' was handed to the attending physician to evaluate. Of the fourteen patients who responded to the questionnaire, all indicated that the check sheets were helpful for decision-making and that using the sheets empowered them to ask their doctors questions. Only one person felt uncomfortable with compiling the check sheet. Physicians stated that the check sheet facilitated patient decision-making and improved communication with patients. However, some felt that this activity increased the administrative burden of medical professionals. Almost all patients stated that the present check sheet was useful as a decision support tool and facilitated communication between doctors and patients. Before incorporation into general clinical practice, this increased benefit should be weighed against the potential extra administrative workload imposed on clinicians.

Research on tax administration reforms in the Russian practice

Subject. The article deals with the scope of application of digital technologies to tax monitoring and administration. Digitalization plays an important part in activities performed by the Federal Tax Service and helps reduce the administrative workload on both taxpayers and tax authority. The use of digital communication channels saves our time, because it allows to submit tax returns and send letters online. Furthermore, it enhances the efficiency of in-office audits and helps identify eventual tax violations. Objectives. We review a set of digital services and technologies used by the Federal Tax Service, their effectiveness, and present our findings on taxpayers' attitude to ongoing digital reforms. Methods. The validity and argumentation are based on official statistics of the Federal Tax Service concerning the dynamics of tax revenues and inspections, quantitative research through questionnaires and analysis of the findings. Results. We examine a range of digital services and technologies, including the Automated Control System – Value Added Tax, a new type of cash registers – Automated Information System Marking, Federal Government Information System – Unified State Register of Civil Registry Office, and personal accounts of taxpayers. Moreover, the article presents results of a survey among owners and top managers of companies, identifying their opinion on the coming taxation reforms. Conclusions and Relevance. Digitalization helped the Federal Tax Service significantly increase the efficiency of tax audits, while reducing the frequency of tax audits and the number of fly-by-night companies and the likelihood of using informal tax administration schemes. However, authorities should find a balance between the enhancement of the taxation system and their relationship with businesses.

The End of the Academic Profession in Russia?

Citation: Denisova-Schmidt E. (2020) The End of the Academic Profession in Russia? Mir Rossii, vol. 29, no 3, pp. 86–95. DOI: 10.17323/1811-038X-2020-29-3-86-95
 This article discusses the attractiveness of the academic profession in Russia today. Unnecessary administrative workloads, “unteachable students”, restrictions on academic freedom, diminishing monetary incentives all contribute negatively to the intellectual, creative and teaching activities of faculty members, especially at mass universities. The article is a reflection on the open letter from Vera Afanasieva, a professor of philosophy at Saratov State University, to Olga Vasilyeva the then Russian Minister of Education and Science (2017). This letter, in which the author highlights several major problems of Russian higher education − “total poverty; paper paranoia and clerical schizophrenia; pathological lies − pseudology and mythomania; the devaluation of knowledge; mental illness” − led to a public discussion in the Russian academic community and a number of visits by law enforcement agencies. The paper argues that some of the symptoms might be common and even prevalent in other academic systems, but stresses the magnitude of these phenomena in Russia, including the possible personal responsibilities of faculty members for students’ “extracurricular activities” such as participating in protests.

The well-being of Swiss general internal medicine residents.

Physician well-being has an impact on productivity and quality of care. Residency training is a particularly stressful period. To assess the well-being of general internal medicine (GIM) residents and its association with personal and work-related factors. We conducted an anonymous electronic survey among GIM residents from 13 Swiss teaching hospitals. We explored the association between a reduced well-being (≥5 points based on the Physician Well-Being Index [PWBI]) and personal and work-related factors using multivariable mixed-effects logistic regression. The response rate was 54% (472/880). Overall, 19% of residents had a reduced well-being, 60% felt burned out (emotional exhaustion), 47% were worried that their work was hardening them emotionally (depersonalisation), and 21% had career choice regret. Age (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.05–1.34), working hours per week (OR 1.04 per hour, 95% CI 1.01–1.07) and <2.5 rewarding work hours per day (OR 3.73, 95% CI 2.01–6.92) were associated with reduced well-being. Administrative workload and satisfaction with the electronic medical record were not. We found significant correlations between PWBI score and job satisfaction (rs = -0.54, p<0.001), medical errors (rs = 0.18, p<0.001), suicidal ideation (rs = 0.12, p = 0.009) and the intention to leave clinical practice (rs = 0.38, p <0.001) CONCLUSIONS: Approximately 20% of Swiss GIM residents appear to have a reduced well-being and many show signs of distress or have career choice regret. Having few hours of rewarding work and a high number of working hours were the most important modifiable predictors of reduced well-being. Healthcare organisations have an ethical responsibility to implement interventions to improve physician well-being.

Burnout amongst members of the French-speaking Society of Pediatric and Adolescent Urology (SFUPA). Are there specific risk factors?

Burnout, which includes emotional fatigue, cynicism and low personal accomplishment is linked to poor job satisfaction, decreased empathy, job withdrawal, increased absenteeism and increased medical errors, and is present among pediatric urologists. We aimed to determine the incidence of burnout among the members of the French-speaking Society of Pediatric and Adolescent Urology (SFUPA) and determine which external factors, such as marital or familial status, gender, age, type of practice or religious belief, impacted burnout rates. We sent all members of the French-speaking Society for Pediatric and Adolescent Urology (SFUPA) an anonymous online questionnaire containing the validated French version of the 22-item Maslach Burnout Inventory - Human Services Survey (MBIHSS). The questionnaire comprised further questions on age, gender, marital status, presence of children at home, type of practice, professional status (trainee, consultant, or academic position), spirituality and whether responders believed they presented signs of burnout. 70 out of 94 members of the SFUPA answered the questionnaire (response rate 74%). The number of responders who presented high scores in one, two or the three domains of the questionnaire were respectively 48.6% (IC 95%: 36-61%), 21.4% (IC 95%: 12.5-33%) and 8.6% (IC 95%: 3-18%). 34.6% of responders who believed they presented no signs of burnout actually did have a high burnout score in at least one domain. There was no significant association between age, gender, having children or being a trainee and the presence of burnout. However, marital status and workplace were significantly associated with presence of signs of burnout. Burnout is a distinct type of work-related stress - a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity. In our study the most significant factor was working in Academic hospitals which can be associated with administrative workload, long hours and a lack of institutional resources. Being in a couple was also associated with less burnout, thus showing the importance of healthy relationships and sharing on burnout rate. Age, however was not associated significantly with burnout nor was gender, which is in coherence with previous findings. Amongst members of the French-speaking Society of Pediatric and Adolescent Urology, nearly half presented signs of burnout, especially those working in academic hospitals. Marital status also influenced burnout rates. Scientific societies should work on developing tools to identify and accompany affected individuals.

Clocking your work.

Four months into my second faculty job, I was shocked to discover that I had to record the hours I'd worked. I'd heard that others at the university were required to do that—but surely not faculty members, I thought. I was wrong. At the end of each month, I was expected to sign and submit a sheet that listed my start and end times each day. At first, I was annoyed that I had to waste my time on such a mundane task. But the practice of writing down my work hours was surprisingly illuminating, ultimately sending me down a path to better work-life balance. > “The data have completely altered my view of work-life balance.” In my previous 16 years in academia, it had been up to me to judge whether I was working hard enough. Usually, I felt I needed to work harder. During my Ph.D., I always believed I could make my dissertation better with extra effort. My research never felt finished, and I had no idea how many hours I was supposed to work. That made it easy to go down rabbit holes and work more hours than necessary. After graduating, I continued to work long hours, even though my employment contracts spelled out shorter workweeks. During my postdoc years, I was supposed to work precisely 39.5 hours per week, according to the labor agreement for public servants in Germany. But nobody asked how long I actually spent in the office, and I probably exceeded that on a regular basis. When I started my first faculty position, my contract stated that I work anywhere from 36 to 48 hours per week. At first, I appreciated the flexibility, hoping for the occasional guilt-free 36-hour workweek. But my teaching and administrative workloads were so high that I regularly reached the 48-hour mark. I was conscious of my work hours. I kept track mentally and made a point of taking some time off when I felt as though I'd worked too hard. But there were stretches of time during my first faculty job when my children didn't see me enough, or when—between work and parental duties—I had no time to spend with my husband. In my second faculty position, I expected that my work hours would again be my business. So when I was told to track them, I was surprised. My contract stated that I work 40 hours per week, and couldn't I be trusted to do so? Grudgingly, I opened a spreadsheet and started to record my hours. It would have been easy to add standard start and end times for each day—for instance, 9 a.m. to 5 p.m.—and be done with it. But my scientific tendencies kicked in, and I decided to keep careful track of my hours, even noting breaks. I'm glad I did, because the data have completely altered my view of work-life balance. Recording my hours showed that I was racking up much longer workweeks than I realized. During the first month I started to track, for instance, I worked 15 hours more than was required of me—nearly two full workdays. That's far less than the insane hours that some academics work. But it was eye-opening for me. With my tracking, I've found that I generally accumulate 1 week of overtime every 2 to 3 months. So now, every time I reach that milestone, I take a few days or even a whole week off. I spend that time at home with my family. Or I use the days to take a longer vacation, or to spend more time with relatives who visit. The breaks have improved my overall happiness and job satisfaction. The data also help alleviate any guilt that I may have otherwise felt taking time off. I still have deadlines, tenure requirements, and the pressure to publish papers. And I still work a lot, sometimes even on weekends. But I now know how much I work—and that I deserve the time off. When I am tenured, I won't have to submit my hours to my university any longer. But I'm going to continue to track them to help keep my work in bounds. To some academics, it may seem like a waste of time. But for me, it's been anything but. I'd recommend opening a spreadsheet and tracking the hours that you spend at work. Even if you only do it for 1 or 2 weeks, you might be surprised what you'll discover.

Research on tax administration reforms in the Russian practice

Subject. The article deals with the scope of application of digital technologies to tax monitoring and administration. Digitalization plays an important part in activities performed by the Federal Tax Service and helps reduce the administrative workload on both taxpayers and tax authority. The use of digital communication channels saves our time, because it allows to submit tax returns and send letters online. Besides, it enhances the efficiency of in-office audits and helps identify eventual tax violations. Objectives. We review a set of digital services and technologies used by the Federal Tax Service, their effectiveness, and present our findings on taxpayers’ attitude to ongoing digital reforms. Methods. The validity and argumentation are based on official statistics of the Federal Tax Service concerning the dynamics of tax revenues and inspections, quantitative research through questionnaires and analysis of the findings. Results. We examine a range of digital services and technologies, including the Automated Control System – Value Added Tax, a new type of cash registers – Automated Information System Marking, Federal Government Information System – Unified State Register Civil Registry Office, and personal accounts of taxpayers. Moreover, the articles presents the results of a survey among owners and top managers of companies, identifying their opinion on the coming taxation reforms. Conclusions and Relevance. Digitalization helped the Federal Tax Service to significantly increase the efficiency of tax audits, while reducing the frequency of tax audits and the number of fly-by-night companies and the likelihood of using informal tax administration schemes. However, authorities should find a balance between the enhancement of the taxation system and their relationship with businesses.

Work Satisfaction and Nursing Management: A Quantitative Study

Abstract Nursing professionals, especially the hospital staff, develop their assistance activities in a demanding and stressing environment turning them into a collective with high levels of burn-out. The management of these teams has a direct effect on the work environment and the work satisfaction of the staff. This study uses the bibliography available related to work satisfaction and the management of teams, as well as a quantitative study to study both object groups; managers and nursing assistance professionals. The results obtained show that the work satisfaction is widely studied specifically in the industrial world, and it is not until recently that studies emerge on the health area. The study with the nursing staff has described that managers wish to develop their wards/areas, but their administrative workload does not allow them, and they are not being trained for these activities. The assistance nursing staff refers to the absence of their manager for being engaged in other compromises. Both collectives agree on the importance of team management as well as the influence it has over the work satisfaction of the staff. The study showed that nursing managers at directors or high management positions have a higher work satisfaction than assistance staff. There are initiatives to define the functions of the nursing manager and are taking the steps for them to being developed and implemented, recognizing the value and influence of nursing managers in the work satisfaction.

WRITING AND GETTING PUBLISHED: DEVELOPING THIS IMPORTANT SKILL SET FOR GERIATRIC MENTAL HEALTH PROFESSIONALS

Programs that train professionals in geriatric mental health expect the trainees to engage in scholarly activities including writing scientific manuscripts and getting them published either in books or journals. However, the training provided to achieve and or maintain academic and scholarly productivity is limited. Additionally, there is no standard format or curriculum to teach the trainees on how to acquire their own skill set to develop and implement their own academic portfolio. Furthermore, these deficiencies in developing scholarly productivity continue to hinder the career growth of the professional caring for older adults with mental health disorders. The clinical and administrative work load for these professionals often presents additional challenges that prevent them from acquiring the skill set to develop a writing and publishing career. In this symposium, we will discuss ideas and methods on how a geriatric mental health professional can develop and implement their own scientific writing and publishing career. We will provide step by step instructions on how scientific manuscripts can be developed and published. Additionally, the faculty presenting at this symposium will provide case examples from their academic portfolio to illustrate how specific manuscripts were developed and published.

General

When I set out to read the new complete English translation of Cassiodorus’ letters (the quotation is from the preface to Book 1, paragraphs 4–5), I certainly did not expect to be transported to the picket lines of the currently ongoing industrial action of the British University and College Union, and yet the overwhelming administrative workload and the avalanche of tasks that Cassiodorus describes have much in common with the academic pressures many are facing today. Nevertheless, Cassiodorus persevered and published many works, including a collection of no fewer than twelve books of letters, the latter in the middle of the eighteen-year Gothic War (536–54). He did not have to worry about his pension, though, as he was a scion of long line of wealthy and prominent property owners and aristocrats from Calabria and was himself a highly placed magistrate at the court of the Ostrogothic Kingdom of Italy. Cassiodorus was responsible for official state correspondence, and his letters are either written in the name of the Amal kings Theoderic, Amalasuntha, and Athalaric, or are appointments to public office, honorary titles, and legal and administrative decisions. They span thirty years of his career in administration and are a prime source for the political and social history of Italy in the sixth century ad.

The Emergence of Teacher Leadership in TESOL: An Exploratory Study of English Language Teachers as Teacher Leaders in the Saudi EFL Context

As part of a larger qualitative case study, this article explores the notion of teacher leadership in English as a Foreign Language (EFL) context and a higher educational institution in Saudi Arabia. Twelve EFL teacher leaders were interviewed to understand their perceptions of teacher leadership practices in the EFL context. Qualitative data were collected through semi-structured interviews and opened-ended questionnaires, and analysed using NVivo10. Data analysis led to 18 main categories and four overarching themes; however, four major categories and one key theme are part of this article that represent the EFL teacher-leaders’ perceptions of their leadership practices and roles at the English Language Institute (ELI). The findings reveal that teacher leadership is a novel concept at the ELI and teacher leaders operate in hierarchical leadership structures. However, their wide range of leadership roles, both instructional and operational match with the three historical waves of teacher leadership (Silva, Gimbert & Nolan, 2000) in the US context. The impact of hierarchical structures on teacher leadership practices is evidently found as EFL teacher leaders encounter various difficulties, such as heavy administrative workload and lack of autonomy. Nevertheless, their shared leadership practices within the groups help them deal with these challenges.

Job satisfaction of public and private primary care physicians in Malaysia: analysis of findings from QUALICO-PC

BackgroundJob satisfaction of doctors is an important factor determining quality and performance of a health system. The aim of this study was to assess job satisfaction among doctors of the public and private primary care clinics in Malaysia and evaluate factors that could influence the job satisfaction rating.MethodsThis study was part of the Quality and Costs of Primary Care (QUALICOPC) Malaysia, a cross-sectional survey conducted between August 2015 and June 2016 in Malaysia. Data was collected from doctors recruited from public and private primary care clinics using a standardised questionnaire. Comparisons were made between doctors working in public and private clinics, and logistic regression analysis was used to determine factors influencing the likelihood of job satisfaction outcomes.ResultsA total of 221 doctors from the public and 239 doctors from the private sector completed the questionnaire. Compared to private doctors, a higher proportion of public doctors felt they were being overloaded with the administrative task (59.7% vs 36.0%) and part of the work does not make sense (33.9% vs 18.4%). Only 62.9% of public doctors felt that there was a good balance between effort and reward while a significantly higher proportion (85.8%) of private doctors reported the same. Over 80% of doctors in both sectors indicated continued interest in their job and agreed that being a doctor is a well-respected job. Logistic regression analysis showed public-private sector and practice location (urban-rural) to be significantly associated with work satisfaction outcomes.ConclusionA higher proportion of public doctors experienced pressure from administrative tasks and felt that part of their work does not make sense than their colleague in the private sector. At the same time, the majority of private doctors reported positive outcome on effort-and-reward balance compared to only one third of public doctors. The finding suggests that decreasing administrative workload and enhancing work-based supports might be the most effective ways to improve job satisfaction of primary care doctors because these are some of the main aspects of the job that doctors, especially in public clinics, are most unhappy with.

A first assessment of the electronic health insurance card for asylum seekers in Berlin

Abstract Background Healthcare provision for asylum seekers differs across Germany. Most states use treatment vouchers as proof of eligibility; i.e., asylum seekers must first obtain a voucher from the welfare office to access healthcare. Since 2016 several states have introduced an electronic health insurance card (EHIC) for asylum seekers that enables access to care akin to statutory insurance. The EHIC has reanimated an old debate about asylum seekers’ health benefits. Opponents claim that medical costs will rise if control over healthcare access is eased. Proponents argue that the EHIC reduces costs through the cutback of administrative workloads and improves access to care. Evidence for either position is scarce. Goal The study goal was to assess the 2016 EHIC introduction in Berlin to enable evidence-informed decision-making. Methods We analyzed claims data that were retrieved from the Berlin Senate Administration and ten semi-structured in-depth interviews with key informants. Interviews were recorded, transcribed and subjected to thematic analysis using ATLAS.ti software. Ethical clearance was obtained. Results Our study found an overall positive evaluation of the EHIC. Although the introduction implied extra efforts and total administrative workloads remained unaltered, the EHIC was said to have the following advantages as compared to treatment vouchers: 1) It simplifies certain work processes and 2) allows for unprecedented financial transparency and control. 3) It eases access to care with 4) no increase in medical costs. Finally 5) the EHIC signifies equality and integration for asylum seekers. Conclusions In light of our study results the common economic arguments against greater inclusion of asylum seekers into public healthcare systems appear unfounded. On the contrary, the example of the EHIC shows that inclusion can create win-win-situations by improving healthcare access, whilst keeping medical costs constant and advancing financial transparency. Key messages In Germany there is a long-standing debate whether easing access to care for asylum seekers will increase health costs. Our case study shows that, on the contrary, the introduction of an electronic health insurance card for asylum seekers can both improve access and have organizational and economic benefits.

Challenges and threats of investigator-initiated multicenter randomized controlled trials: the BACE trial experience

<p class="abstract"><strong>Background:</strong> Investigator-initiated clinical research has become a complex environment. Increasing administrative tasks and costs, imposed by stringent regulatory demands, risk to reduce this creative, independent and indispensable research field. The objective of the present study was to illustrate the burden of non-scientific challenges associated with an investigator-initiated multicentre randomized controlled trial, based on the Belgian trial with azithromycin for Chronic obstructive pulmonary disease (COPD) Exacerbations requiring hospitalization (BACE) trial experience.</p><p class="abstract"><strong>Methods:</strong> The trial enrolled 301 patients with COPD, hospitalized for an acute exacerbation between 2014-2017, and assessed the potential of azithromycin, an off-patent antibiotic. Key experienced challenges were complemented with registry data from the Clinical Trial Centre of the University Hospital Leuven to outline the local clinical respiratory research field, quotations for the trial protocol obtained from 3 pharmaceutical companies to provide insight into the budget restraints and a participation survey to capture the consortium’s perspective.</p><p class="abstract"><strong>Results:</strong> 60% of the required sample size was enrolled. Key challenges included trial implementation, study drug and database management. Industry-initiated trials dominated the local research field (61%), whereas investigator-initiated prospective interventional and multicenter trials accounted for 19% and 13%, respectively. The triple quotation revealed the BACE trial to require 1.6 to 2.1-fold the amount when executed by the pharmaceutical industry. The survey identified the lack of a local study team as an important obstacle for participation, along with inadequate financial compensation and excessive administrative workload.</p><p class="abstract"><strong>Conclusions: </strong>Without an adaptation of current regulatory and funding policies to overcome non-scientific challenges, investigator-initiated clinical research is risking to further decline.</p>

Legitimacy of work tasks, psychosocial work environment, and time utilization among primary care staff in Sweden

Objective: Primary care staff faces a complex work environment including a heavy administrative work load and perceive some work tasks as illegitimate. This study aimed to elucidate associations between the perceived legitimacy of work tasks, the psychosocial work environment, and the utilization of work time among Swedish primary care staff.Design and setting: The study was designed as a multicenter study involving all staff categories, i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals, at eleven primary care centers in Sweden.Subjects: Participants completed the Bern Illegitimate Tasks Scale and the Copenhagen Psychosocial Questionnaire. They also recorded time spent on all work tasks, day by day during two separate weeks.Main outcome measures and results: More than a quarter (27%) of primary care physicians perceived a high proportion of unnecessary work tasks. After adjusting for profession, age and gender, the perception of having to perform unreasonable work tasks was positively associated with experiencing role conflicts and with the proportion of organization-related administration and service work tasks.Conclusion: Across all staff groups, the perception of unreasonable work tasks was more pronounced among staff with a high proportion of non-patient related administration. Also, the perception of having to perform a large amount of illegitimate work tasks affected the psychosocial work environment negatively, which might influence staffs perception of their professional roles. These results illuminate the importance of decision makers to thoroughly consider the distribution and allocation of non-patient related work tasks among staff in primary care.Key pointsWe observed an interaction between perception of having a large proportion of illegitimate work tasks and impaired psychosocial work environment. • More than a quarter of the primary care physicians perceived a high proportion of unnecessary work tasks.• Across all staff groups, performing unreasonable work tasks was associated with an experience of having role conflicts.• Across all staff groups, a perception of performing unreasonable work tasks was associated with the proportion of non-patient related administrative work tasks.