Dual Practice Research Articles

Making Populations for Deportation: Bureaucratic Knowledge Practices Inside a European Deportation Unit

AbstractThis article explores how people are made deportable through bureaucratic practices within European migration infrastructures. Drawing on months of ethnographic fieldwork in a deportation unit, the article focuses on the daily work of file practices. Bridging scholarship on street‐level bureaucrats and the materiality of paperwork, it traces how deportation files move along procedural trajectories, among case workers, databases, police, whiteboards, quota, subunits, embassies, and airlines. This shows how the relations gathered in file practices mobilize categories of populations, for example racialized or gendered. The research elaborates that the deportable subject is formed in a constellation of various populations, paradoxically given the legal call to individualize all deportees. Moreover, the populations themselves need to be made in file practices, too, unfolding a dual bureaucratic knowledge practice that shows the populations that are demarcated by state deportations to be intrinsically situated. [deportation, bureaucracy, file practices, population, Europe]

Role of emotional intelligence in job performance of healthcare providers working in public sector hospitals of Pakistan

Objective. To determine the association between emotional intelligence (EI) and job performance (JP) of health care providers (HCPs). Methods. Healthcare professionals from various hospitals were chosen for a crosssectional study. The survey was conducted using a three-part questionnaire including the demographic profile, Wong and Law Emotional Intelligence (EI) Scale, and an individual work performance (JP) questionnaire. The relationship of predictor variables on JP was sought by applying Chi-square test and multiple regression analysis. Results. About 43.3% of the 50.8% of participants who scored well on the EI scale also scored high on the JP scales. The remaining 7.5% had an unsatisfactory JP. From the 22.8% of respondents who also scored low on EI scales, about 20% scored low on the JP scale. Significant relationship between EI and JP was found at a p-level of 0.05 (2 tailed). Emotional intelligence (B=0.57, p-<0.05) positively predicted job performance whereas difficulties faced while performing job (B=-0.81, p= <.005), beds under supervision (B=0.09, p=<0.05), dual practice (B=-0.04, p=<0.05) and weekly off days (B=0.04, p<0.05) have no significant effect on job performance. Conclusions. Subjects with high EI on the WLEIS were good at their jobs and scored well on the IWPQ scale, implying that as an individual's EI rises, so will his or her JP.

Juridic Review Filling Membership of the Regional Representative Board of the Republic of Indonesia Post the Decision of the Constitutional Court Number 30/PUU-XIV/2018

Positions as functionaries of Political Parties with DPD membership are not common before the 2019 General Election as a political practice that is prohibited by Law Number 7 of 2017 concerning General Elections jo. KPU Regulation Number 21 of 2018. However, with the Constitutional Court Decision Number 30/PUU-XVI/2018 jo. KPU Regulation Number 26 of 2018 states that concurrent positions of political party functionaries in the DPD membership are a violation of the law, so all parties should obey it. In this study, analysis and discussion of the legal aspects of the dual position practice will be carried out after the Constitutional Court's Decision.

Stakeholders' Perspectives on the Unmet Needs and Health Priorities of the Urban Poor in South-East Nigeria.

Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders' perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the urban poor.

Implications of Dual Practice on Cataract Surgery Waiting Time and Rescheduling: The Case of Malaysia

Background: Dual practice was implemented in selected Ministry of Health Malaysia hospitals to reduce brain drain and provide an alternative for patients willing to pay higher user fees to seek prompt treatment from the specialist of their choice. This study aimed to assess the implications of dual practice on waiting time and rescheduling for cataract surgery. Methods: A retrospective study was conducted in a referral hospital. Inpatient medical records of patients who underwent cataract procedures were used to study the waiting times to surgery and rescheduling between private and public groups. Results: Private patients had a considerably shorter waiting time for cataract surgery, seven times shorter compared to public patients where all surgeries were conducted after hours on weekdays or weekends. Additionally, 14.9% of public patients experienced surgery rescheduling, while all private patients had their surgeries as planned. The main reason for surgery rescheduling was the medical factor, primarily due to uncontrolled blood pressure and upper respiratory tract infection. Conclusion: Private service provision utilizing out-of-office hours slots for cataract surgery optimizes public hospital resources, allowing shorter waiting times and providing an alternative to meet healthcare needs.

Physicians' Dual Practice: A Theoretical Approach

The present study seeks to evaluate the theoretical approach towards physicians’ dual practice. This is done by investigating the various theoretical grounds that form the basis of physicians’ dual practice. The study presents theoretical findings by comparing them with practical primary data from experienced experts. An in-depth search of the top keywords related to dual practice was done in various databases. The study first identified all articles related to dual practice in various databases. In total, 59,838 articles identified after duplicates were removed were narrowed down to four hundred and thirty-eight (438) studies and considered relevant for review. The filtration process was carried out based on the recentness of the articles. A review of the articles was done to eliminate duplicates, a linguistic check was conducted, and a final sorting was carried out to arrive at fully accessible reviewed articles in the journal databases. Filtration was done to select fully accessible publications under the following keywords: Herzberg’s two-factor theory, contract theory, and supply of labour theory. Forty-one (41) fully accessible and peer-reviewed articles were used for analysis. The study underscores that dual practice can be theoretically modelled as a function of three theories (Herzberg’s two-factor theory, contract theory, and supply of labour theory). It is paramount, therefore, for studies to appreciate the theories in understanding the motivation behind the dual practice. Thus, the present study has proposed a hybrid integrated theory, the Integrated Theory of Labour, Supply and Motivation, in order to offset the weaknesses of the theories and build on their strengths.Implications for Central European audience: This study proposes the Integrated Theory of Labour, Supply and Motivation in order to help researchers and government institutions better address the concept of moonlighting in public institutions. The study concludes that future scholars and researchers in related fields could extrapolate the Integrated Theory of Labour, Supply and Motivation by conducting a factor analysis in order to validate the theory since it offers a platform to cover the drivers behind the dual practice in a comprehensive manner and also builds on the strengths of other theories explaining the dual practice. Theoretically, the study also validates the theories it uses and the extent of their applicability to this and similar studies. This is not through ruling out theories explaining dual practice but reinforcing them. The findings of this study may be useful in shaping policy in the area of managing contracts for physicians in dual practice and supply of labour economics in general.

Negotiating figurative language from literary texts: second-language instruction as a dual literacy practice

The aim of this article is to contribute knowledge about how figurative language from literary texts is negotiated through oral interaction in second-language instruction. The material consists of transcriptions of recordings from a classroom study of basic adult second-language instruction involving two teachers and their two student groups. Theories of semantic waves and discursive mobility are used to explore and visualize discursive shifts between concrete and condensed abstract meanings. The results show a varied use of linguistic resources, where students’ contributions often serve as a bridge between the teachers’ concrete examples and abstract paraphrases in which lexical metaphors interplayed with grammatical metaphors. In some exchanges, characters and events in the literary texts were significantly expanded upon in the interaction as they were used as contextual resources. The study sheds light on second-language instruction as a dual disciplinary literacy practice, involving both language learning and the study of literary texts.

Public-private differentials in health care delivery: the case of cesarean deliveries in Algeria.

Akin to other developing countries, Algeria has witnessed an increasing role of the private health sector in the past twodecades. Our study sheds light on the public-private overlap and the phenomenon of physician dual practice in the provision of health care services using the particular case of cesarean deliveries in Algeria. Existing studies have reported that, compared to the public sector, delivering in a private health facility increases the risk of enduring a cesarean section. While confirming this result for the case of Algeria, our study also reveals the existence of public-private differentials in the effect of medical variables on the probability of cesarean delivery. After controlling for selection in both sectors, we show that cesarean deliveries in the private sector tend to be less medically justified compared with those taking place in the public sector, thus, potentially leading to maternal and neonatal health problems. As elsewhere, the contribution of the private health sector to the unmet need for health care in Algeria hinges on an appropriate legal framework that better coordinates the activities of the two sectors and reinforces their complementarity.

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DELINEATINGACCESS TO SPECIALTY HEALTHCARE IN ZIMBABWE A CROSS-SECTIONAL STUDY TO INFORMEVIDENCE-BASED PUBLIC HEALTH POLICY AND PRACTICE

The study investigated the determinants of access and utilization of specialty healthcare services in the case of public referral hospitals in Zimbabwe using the period post-independence in 1980s to 2018. This becomes an exciting period for the study as it presents the rise and fall of Zimbabwe’s healthcare system. Although there are many specialists offering specialty healthcare, the study limited its focus on specialty care physicians operating at public health facilities. The study objectives were to identify the socio-economic and health behavioural determinants that could influence access to and utilization of specialty healthcare amongst different groupings in Zimbabwe. The study specifically examined the influence of household income, insurance, health information/ education, distance to the nearest health centre, waiting time and dual practice as a variable of interest on access to specialty care. The study utilized cross-sectional household data collected through a survey from April to October 2019. Out of the 40 selected districts from a cluster of 63 existing administrative health districts, 1000 households were randomly selected using one stage cluster sampling (probability sampling design). The study used the Logistic regression model to identify the determinants of access to and utilisation of specialty healthcare based on 653 households that had reported sickness of a member within the last twelve months before the survey. The study tested the hypotheses that dual practice does not affect the supply capacity at public hospitals hence does not reduce access and utilisation of specialty healthcare household income does not increase the demand for specialized healthcare services and that the distance to the nearest health facility does not reduce the probability of seeking of specialty healthcare services. The Logistic regression results revealed that distance to the nearest health care facility, household income, health insurance coverage, presence of dual practice and waiting time all had a significant statistical relationship with access and utilization (demand) for specialty healthcare at public health institutions. However, the study found out that health information had negative effect though an insignificant variable. Distance to the nearest health facility and waiting time was found to negatively affect access (demand) to specialty healthcare whereas household income, dual practice and insurance coverage were found to positively influence access and utilization of specialty healthcare at public health institutions. The study established that, as there is an increase in income and insurance coverage, access and utilization of specialty care also increased. More households in Zimbabwe (71%) are not medically insured. The study found that the provision of specialty healthcare services is too centralized thereby patients are compelled to travel long distancesto metropolitan facilities where specialty health services are more concentrated. The study further established that dual practice affects the supply capacity in public hospitals. The constraining arrangement of management and teaching services at main teaching hospitals affects the supply of specialty services. Households tend to wait longer to consult specialists at public hospitals due to poorly regulated dual practice that induces long waiting times. Given the study findings, the study recommends health policy planners to adopt a balanced centralized and decentralized modelon access to specialty care, differentiating higher and lower tier specialty care facilities to address the geographic accessibility and availability dimensions and revisiting management of training and structuring of specialty teaching services. Other major recommendations of the study include the review of supply-side policies used to enhance access to specialty healthcare services. The policies may target at implementing a public sector ‘National Health Insurance Fund’, driven by the government of Zimbabwe offering realistic, acceptable and affordable premiums for vulnerable groups and expanding the scope of participation in developing the policy regulating dual practice. The study also recommends the creation of Special Economic Zones (SEZ) for Specialty health riding on the existing Government framework on SEZs. The adoption of Strategic Specialty care Partnerships (SSCPs) can enhance access and institutional capacities in dealing with the expensive response to Non Communicable Diseases, which are the main drivers for households to seek specialty care. Zimbabwe through its national health authority needs to ‘Reframe the Health Agenda’ on specialty care thus initiate a national health action plan that will continue to drive to evidence-based health policy and practice.

Dual attending surgeon strategy learning curve in single-staged posterior spinal fusion (PSF) surgery for 415 idiopathic scoliosis (IS) cases

BACKGROUND CONTEXTThe implementation of a dual attending surgeon strategy had improved perioperative outcomes of idiopathic scoliosis (IS) patients. Nevertheless, the learning curve of a dual attending surgeon practice in single-staged posterior spinal fusion (PSF) surgery has not been established. OBJECTIVETo evaluate the surgical learning curve of a dual attending surgeon strategy in IS patients. STUDY DESIGNRetrospective study. PATIENT SAMPLE415 IS patients (Cobb angle <90°) who underwent PSF using a dual attending surgeon strategy OUTCOME MEASURESPrimary outcomes included operative time, total blood loss, allogenic blood transfusion requirement, length of hospital stay and perioperative complication rate. METHODSRegression analysis using Locally Weighted Scatterplot Smoothing (LOWESS) method was applied to create the best-fit-curve between case number versus operative time and total blood loss in identifying cut-off points for the learning curve. RESULTSThe mean Cobb angle was 60.8±10.8°. Mean operative time was 134.4±32.1 minutes and mean total blood loss was 886.0±450.6 mL. The mean length of hospital stay was 3.0±1.6 days. The learning curves of a dual attending surgeon strategy in this study were established at the 115th case (operative time) and 196th case (total blood loss) respectively (p<.001). In comparison of cases before and after the cut-off points, mean operative time reduced significantly from 147.2±36.5 minutes to 129.5±28.9 minutes and mean total blood loss reduced significantly from 1015.1±506.6 mL to 770.4±357.3 mL (p<.001). No allogenic blood transfusion was required and there were 7 perioperative complications (n=7/415, 1.7%) recorded. CONCLUSIONThe learning curve of a dual surgeon strategy in single-staged PSF surgery based on operative time and total blood loss were established at 115th case and 196th case respectively (p<.001).

The author’s pedagogical model of health’s formation among russian judokas of preschool age

This article examines the scientific problem of health’s formation among Russian (non-oriented) judokas of preschool age through their early immersion in judo practice. The solution to this scientific problem is extremely important in the context of the necessity to form a special creative kids’ ability to “adapt as quickly as possible to a partner / changing situation, anticipating the result, with minimal costs and maximum achievement of the chosen goal”, which determines the effectiveness of mastering and practicing judo. Complex analysis of the judo’s phenomenon in the context of main types and components of health allows us to consider it in four dimensions: social (level of communication), spiritual (level of consciousness), soulful (level of subconscious and unconscious) and physical (level of corporeality). The application of the method of theoretical modeling made it possible to propose the author’s pedagogical model of judokas’ health formation through the dual practice of judo: judo as a life principle (the judo’s practice number one) and judo as the eastern system of formation of a person’s physical culture (the judo’s practice number two). The author’s pedagogical model of health’s formation among Russian judokas of preschool age is based on the implementation of the judo’s practice number two. The effectiveness of this author’s pedagogical model has been confirmed experimentally.

Podwójna praktyka pielęgniarek w Polsce na tle aktualnych zasobów kadrowych

BACKGROUND Employment of health care workers simultaneously in 2 workplaces (the so called dual practice) is a common phenomenon in almost every country. In Poland, a possibility of employment in 2 or more workplaces arose with the socio-political changes and the reform of the health care system. In Poland, the scale of the phenomenon, as well as its motifs and potential effects influencing both employees and the whole health care system, are still not known despite numerous studies being conducted to that end. MATERIAL AND METHODS The study group consisted of 1023 nurses (males and females) employed in public and non-public health care facilities in the territory of the Lesser Poland Voivodeship. The research tool was the authors' poll questionnaire. In the statistical elaboration, the non-parametric Mann-Whitney U test and the χ2 independence test were used. For all the analyses, the maximum permissible error of type I, α = 0.05, was accepted, and p ≤ 0.05 was recognized as statistically significant. RESULTS Work experience of the nurses studied ranged 1-43 years, on average it was 23.1 years (SD = 11.1). Persons aged >40 years accounted for 77.5% (N = 793), out of whom 38.2% (N = 391) were aged 41-years and 39.3% (N = 402) >50 years. In the study group, 450 (44%) people were employed in 2 workplaces, out of whom 93.5% in the nurse position, working >160 h/month (39%). A decisive reason to take up an additional job (93.3% of the study group) were financial matters. CONCLUSIONS Financial matters are the main reason for which almost half of the studied nurses undertake additional employment, in the scope twice as high as the work load. Research suggests the need to verify the Central Registry of Nurses and Midwives in order to precisely estimate the number of dual practice positions and the number of persons employed as nurses not only in the south of Poland but also in whole country. The results point to the necessity of further research concerning both the reasons for and consequences of dual practice for nurses, and the impact of this phenomenon on the quality of care and patient safety. Med Pr. 2021;72(2):113-21.

Growth and welfare in mixed health system financing with physician dual practice in a developing economy: a case of Indonesia

Based on Indonesia’s hybrid BPJS Kesehatan health system, we analyze for welfare-optimal government financing strategy in an economy with a mixed health system using an endogenous growth framework with physician dual practice. We find the model solution to produce two vastly different regimes in terms of policy implications: a “high” public-sector congestion regime as in the benchmark case of Indonesia, and a “low” public-sector congestion, high capacity regime. In the former, welfare-optimal health financing strategy appears to be promoting private health service. In contrast, in the low-congestion, high capacity regime, a welfare-optimal strategy is to do the opposite of increasing government physician wage at the expense of private health subsidy. These results highlight the importance of developing a benchmarking system that measures the actual degree of congestion faced by the public health service in a developing economy, as it ultimately would influence the optimal health financing strategy to be pursued.

Influence of social-cultural factors and gender on health workforce absenteeism: a qualitative study from Nigeria

Abstract Background Absenteeism is widespread across the Nigerian health sector among all cadres of providers. Little is known about the health worker incentives and drivers of absenteeism among staff working in primary health care settings in rural areas in Enugu State. Methods We focused on six primary care centers in rural and urban regions in Enugu State, south-east Nigeria. We conducted in-depth interviews and focus group discussions with 70 respondents living nearby: comprising 12 frontline health workers, 12 healthcare managers, 6 Health Facility Committee leaders and 40 service users. We used thematic data analysis, drawing on conceptualisations of culture and gender. Results Socio-cultural causes of absenteeism included gender roles (caregiving responsibilities, home keeping, child bearing issues, etc.), marital status, attending to social events and cultural ceremonies. Consequently, women were more likely to be absent than men, given traditional roles (e.g. home keeping, caregiving, farming) and child bearing. Male absenteeism reflected a need to generate additional income through dual practice and other jobs. Sanctions against those absent was similar for men and women. Individual health workers who were connected to politically powerful individuals “godmothers” or “godfathers” were able to use these connections to improve their placements and protect themselves from potential sanction. Conclusions Effective strategies to tackle absenteeism will require socio-economic and these factors to be taken into account when addressing health systems and structural factors. Long-term change also requires addressing the power imbalances that give rise to these conditions, something that is likely to be especially challenging.

Preferences of physicians for public and private sector work

BackgroundThe public-private mix of healthcare remains controversial. This paper examines physicians’ preferences for public sector work in the context of dual practice, whilst accounting for other differences in the characteristics of jobs.MethodsA discrete choice experiment is conducted with data from 3422 non-GP specialists from the Medicine in Australia: Balancing Employment and Life (MABEL) panel survey of physicians.ResultsPhysicians prefer to work in the public sector, though the value of working in the public sector is very small at 0.14% of their annual earnings to work an additional hour per week. These preferences are heterogeneous. Contrary to other studies that show risk averse individuals prefer public sector work, for physicians, we find that those averse to taking career or clinical risks prefer to work in the private sector. Those with relatively low earnings prefer public sector work and those with high earnings prefer private sector work, though these effects are small.ConclusionsOther job characteristics are more important than the sector of work, suggesting that these should be the focus of policy to influence specialist’s allocation of time between sectors.

The Role of HRM Practices in the Workforce Racial Diversity and Firm Performance

Embracing racial diversity in the workplace is an important strategic decision for many firms to achieve a competitive advantage. While previous studies report conflicting consequences of workforce racial diversity, this study examined its effects on firm performance in a less researched large corporate law firm context. Furthermore, the study investigated the moderating role of human resource management practices (i.e., lateral hiring, temporary employment, and dual career ladder practice) related to employment and career management aspects. Our hypotheses were tested based on the longitudinal datasets of 232 large U.S.-based corporate law firms for the period 2000-2008. Initially, no significant relationship was found between workforce racial diversity and firm performance. However, further analyses indicated that human resource management practices determined the performance effect of workforce racial diversity. Specifically, workforce racial diversity had a negative impact on performance for firms that relied more on temporary employment and actively utilized dual career ladders.

Effect of public hospital managers\u2019 risk and gain perception on their attitude towards physician dual practice: a cross-national study in 31 provinces of China

BackgroundThis study aims to explore the effect of public hospital managers’ risk and gain perception on their attitude towards physician dual practice (PDP).MethodsA cross-sectional study enrolling 1513 managers from public hospitals in the East, Middle and West of China was conducted. Generalized linear mixed models (GLMM) were used to identify the determinants of managers’ support for PDP.ResultsThe rate of managers’ support for allowing PDP or implementing PDP with restriction, was 94.3% (95% CI: 0.93, 0.95). The mean score of managers’ risk perception was 67.7 ± 14.46, and the mean score of managers’ gain perception was 24.0 ± 5.56. After controlling for individual and institutional characteristics, the GLMM presented the score for risk perception increased 1 score and the rate of managers’ support for PDP decreased by 5% (OR = 0.95, 95% CI: 0.93, 0.97); while the score for gain perception increased 1 score and the rate of managers’ support increased by 18% (OR = 1.18, 95% CI: 1.12, 1.24).ConclusionsOur data demonstrate that the majority of Chinese public hospital managers are in favor of allowing or implementing PDP with restrictions. Although gain perception is comparatively weaker than risk perception, a stronger influence in determining public hospital managers’ support for PDP is demonstrated.

Burnout Syndrome and its Risk Factors among Gynecology Consultants

Objective: To assess the frequency of burnout among gynecologists and to determine the factors leading to burnout.Methodology: This was a cross-sectional study done at the Gynecology and Obstetrics department of King Edward Medical University; Lahore from January to June 2017. Fifty-five consultant gynecologists, working in public sector teaching hospitals of Lahore filled Maslach Burnout Inventory (MBI) proforma for assessment of burnout. The data analysis was performed by SPSS version 20.Results: Burnout was found in 13 of 55 (23.6%) consultants. Twenty-four participants (43.6%) were having high emotional exhaustion (EE), 41.8% had high depersonalization (DP) and 16.4% had low personal and professional achievement (PPA). Single doctors were found to be more burnout as compared to those who were married (p = 0.037). Additionally, having private practice was associated with high EE and high PPA. Those having higher monthly income were more burnout in EE domain.Conclusion: Burnout Syndrome is common among the consultant gynecologists of public sector healthcare. Risk factors for having burnout syndrome include dual practice as well as low monthly salary.

Emergency physicians in critical care: where are we now?

ObjectivePrior to 2011, emergency physicians who completed critical care (CC) fellowship were unable to obtain board certification in the United States. Three pathways for CC board certification have since been established. This study explores the training, practice, and perceived challenges of emergency medicine/critical care fellows and emergency medicine/critical care physicians in the United States.MethodsAnonymous institutional review board‐approved survey distributed via email through an online survey engine from April to December 2016. Participants were recruited through national organizations and independent interest groups. Emergency physicians who were in CC fellowship or had completed a CC fellowship and were in practice in the United States participated voluntarily.ResultsOf the 162 respondents, 152 were included (92 physicians, 60 fellows). Eighty‐nine percent ranged from 31–50 years old. Among fellows, 90% desired a dual discipline practice. Among physicians, 63% split their time between the emergency department and ICU. Seventy‐one percent of physicians reported working in academic institutions. Among physicians engaged in a dual practice, mean full‐time equivalent (±SD) devoted to the ED was 0.37 (±0.22), mean full‐time equivalent for ICU was 0.47 (±0.22), and mean full‐time equivalent for protected academic time was 0.28 (±0.19). Emergency medicine/critical care fellows and emergency medicine/critical care physicians identified numerous challenges associated with duality.ConclusionsSince the advent of critical care board certification for emergency physicians in the United States, there has been an increasing number of emergency physicians pursuing CC fellowships and achieving CC board certification. Emergency medicine/critical care physicians are venturing into a variety of practice models, demonstrating that the employment landscape remains plastic. Not unexpectedly, emergency medicine/critical care fellows and emergency medicine/critical care physicians are encountering challenges intrinsic to their duality.