Health Management Staff Research Articles

Effect of the data-informed platform for health intervention on the culture of data use for decision-making among district health office staff in North Shewa Zone, Ethiopia: a cluster-randomised controlled trial

BackgroundSimilar to other low and middle-income countries, Ethiopia faces limitations in using local health data for decision-making.We aimed to assess the effect of an intervention, namely the data-informed platform for health, on the culture of data-based decision making as perceived by district health office staff in Ethiopia’s North Shewa Zone.MethodsBy designating district health offices as ‘clusters’, a cluster-randomised controlled trial was implemented. Out of a total of 24 districts in the zone, 12 districts were allocated to intervention arm and the other 12 in the control group arms. In the intervention arm district health office teams were supported in four-monthly cycles of data-driven decision-making over 20 months. This support included: (a) defining problems using a health system framework; (b) reviewing data; (c) considering possible solutions; (d) value-based prioritizing; and (e) a consultative process to develop, commit to, and follow up on action plans. To measure the culture of data use for decision-making in both intervention and control arms, we interviewed 120 health management staff (5 per district office). Using a Likert scale based standard Performance of Routine Information System Management tool, the information is categorized into six domains:- evidence-based decision making, emphasis on data quality, use of information, problem solving, responsibility and motivation. After converting the Likert scale responses into percentiles, difference-in-difference methods were applied to estimate the net effect of the intervention. In intervention districts, analysis of variance was used to summarize variation by staff designation.ResultsThe overall decision-making culture in health management staff showed a net improvement of 13% points (95% C.I:9, 18) in intervention districts. The net effect of each of the six domains in turn was an 11% point increase (95% C.I:7, 15) on culture of evidence based decision making, a 16% point increase (95% C.I:8, 24) on emphasis on data quality, a 20% point increase (95% C.I:12, 28) on use of information, a 21% point increase (95% C.I:13, 29) on problem solving, and a 10% point increase (95% C.I:4, 16) on responsibility and motivation. In terms of variation by staff designation within intervention districts, statistically significant differences were observed only for problem solving and responsibility.ConclusionThe data-informed platform for health strategy resulted in a measurable improvement in data use and structured decision-making culture by using existing systems, namely the Performance Monitoring Team meetings. The intervention supported district health offices in identifying and solving problems through a structured process. After further research, DIPH intervention could also be applied to other health administration and facility levels.Trial registrationClinicalTrials.gov ID: NCT05310682, Dated 25/03/ 2022.

Development of consensus quality indicators for cancer supportive care: a Delphi study and pilot testing

BackgroundHigh quality supportive care is fundamental to achieve optimal health outcomes for people affected by cancer. Use of quality indicators provides comparative information for monitoring, management, and improvement of care within and across healthcare systems. The aim of this Australian study was to develop and test a minimum viable set of cancer supportive care quality indicators that would be feasible to implement and generate usable data for policy and practice.MethodsA two-round, modified reactive Delphi process was employed firstto develop the proposed indicators. Participants with expertise in cancer control in Australia, the United Kingdom, and Canada rated their level of agreement on a 7-point Likert scale against criteria assessing the importance, feasibility, and usability of proposed indicators. Relative response frequencies were assessed against pre-specified consensus criteria and a ranking exercise, which delivered the list of proposed indicators. Draft indicators were then presented to a purposive sample of clinicial and health management staff via qualitative interviews at two acute care settings in Melbourne, Australia for feedback regarding feasibility. Desktop audits of online published health service policy and practice descriptions were also conducted at participating acute care settings to confirm health service data availability and feasibility of collection to report against proposed indicators.ResultsSixteen quality indicators associated with the delivery of quality cancer supportive care in Australian acute healthcare settings met pre-specified criteria for inclusion. Indicators deemed ‘necessary’ were mapped and ranked across five key categories: Screening, Referrals, Data Management, Communication and Training, and Culturally Safe and Accessible Care. Testing confirmed indicators were viewed as feasible by clinical and health management staff, and desktop audits could provide a fast and reasonably effective method to assess general adherence and performance.ConclusionsThe development of quality indicators specific to cancer supportive care provides a strong framework for measurement and monitoring, service improvement, and practice change with the potential to improve health outcomes for people affected by cancer. Evaluation of implementation feasibility of these expert consensus generated quality indicators is recommended.

Improving data use in decision-making and utilization of maternal healthcare services through a data-informed platform for health approaches in districts of the Gedeo Zone, southern Ethiopia, 2023: a cluster-randomized control trial.

In low-resource countries such as Ethiopia, the utilization of local data for planning and decision-making health systems was frequently constrained. In addition, despite several government initiatives, maternal health services were not completely utilized. On the other hand, efforts to effectively utilize the local data available to improve the utilization level of maternal healthcare services were insufficient, necessitating the need for a different approach. This implementation study aims to test and validate the effectiveness of a data-informed platform for health (DIPH) strategies on data use for decision-making and utilization of maternal health services in districts of the Gedeo Zone, southern Ethiopia. A two-arm parallel group, type II hybrid, cluster-randomized control trial design has been implemented to conduct the study between 1 September 2022 and 29 February 2024. Six woredas/districts have been assigned to the intervention arm and the other six to the control arm. Baseline and end-line data have been collected from 120 eligible health management staff (from both intervention arm and control arm). In the intervention arm, district health management staff have been given specialized training and continuous technical assistance as a package called the DIPH strategy by embedding it with the district's current decision-making platform such as Performance Review Team meetings. The DIPH strategy has mainly focused on five-step approaches such as situational assessment, stakeholder engagement, defining/setting priorities, planning, and follow-up. Health management staff in the control arm have performed their regular daily activities. The χ2 and t-tests have been used to check the effect of the intervention. In addition, difference-in-differences estimates have been calculated because the change may inherently occur over time. A P-value of <0.05 and a 95% confidence interval have been used to declare the significance of the intervention. The findings of this study were supposed to give insights into implementation strategies that improve data use in decision-making and utilization of maternal healthcare services at the woreda level and uncover contextual factors that boost the response of these strategies.

Establishment and application of the performance appraisal system for hierarchical diagnosis and treatment in China: A case study in Fujian province.

Hierarchical diagnosis and treatment, as an important measure and direction for China's medical reform, are conducive to improving the capacity of medical services and the national level of health. In this study, a hierarchical diagnosis and treatment performance evaluation index system is established to identify the effects of different influencing factors on developing hierarchical diagnosis and treatment. In this study, samples collected from 23 representative integrated medical institutions in nine Fujian cities from 2018 to 2020 are taken as subjects. A hierarchical diagnosis and treatment performance appraisal system is established based on the mechanism of research on the operation of hierarchical diagnosis and treatment. This is combined with the evaluation index system established by the Health Development Research Center, the National Health Commission of the People's Republic of China for the evaluation of hierarchical diagnosis and treatment and the construction of the medical treatment alliance, including studies carried out by related scholars. The weight of each evaluation index is determined with the CRITIC method, and the hierarchical diagnosis and treatment effects on 23 subjects are quantitatively evaluated by the Gray correlation method based on the weight of each index. The hierarchical diagnosis and treatment performance evaluation index system is established from three aspects, namely allocation of hierarchical diagnosis and treatment resources, establishment of the hierarchical diagnosis and treatment management system, and hierarchical diagnosis and treatment implementation effect; 27 tertiary indexes are formed in total. The Gray correlation of each year in Fujian exceeds 0.5, but <0.53. Gray correlation of each year in Fujian has gradually increased. But there is still room for improvement. The government departments must improve the investment in medical resources with measures adjusted according to local conditions, promote a balanced allocation of resources for hierarchical diagnosis and treatment, increase communication and interaction between upper and lower medical institutions, and optimize the allocation of resources for hierarchical diagnosis and treatment. Then determine the types of disease to be treated, expand the coverage of chronic disease management, establish standardized chronic disease health management, and strengthen training of health management staff.

COVID-19 in Jeddah Islamic Port (Ministry of Health, Kingdom of Saudi Arabia)

Health Surveillance Centers at Jeddah Islamic Port (HSCJIP) devised a plan consisting of preventive measures implemented alongside several agencies to contend with COVID-19. We aimed to explore the experience of the Ministry of Health in Jeddah in terms of dealing with COVID-19 in the Jeddah Islamic Port (JIP) in 2020. Methods: This is a cross-sectional study using secondary data from the HSCJIP, the primary data of which have been collected as a part of routine health surveillance. Results: HSCJIP identified 261 patients with 676 contacts and they performed 472 visits to thermal scans points and performed 106,633 thermal scans to the employee and visitors. Discussion and conclusion: HSCJIP conducted an epidemiological investigation of positive cases and follow-up of contacts with the quarantine of confirmed cases. Moreover, several infection control measures were applied such as thermal scans. Monitoring visits at government and private agencies at the port were required. In quarantine facilities, there was a need to assign doctors, nurses, pharmacists, infection control specialists, and health management staff and to define their tasks and coordinate their activities during work. There was also a need for HSCJIP to apply all environmental sanitation and infection control requirements to the quarantine facilities, with remarkable cooperation from the hotel administration, in order to meet all the needs of the medical team, including the provision of medical files, medicines, personal protective equipment, forms and patient files of referral and follow-up cases, and preparation for requirements for the safe disposal of medical waste in patient rooms.

Improving the management of hypertension and diabetes: An implementation evaluation of an electronic medical record system in Nairobi County, Kenya

ObjectiveTo evaluate the implementation of a novel electronic medical record (EMR) system for management of non-communicable diseases (NCD) (hypertension (HTN) and diabetes mellitus (DM)) in health facilities in informal settlements in Nairobi. Questions of interest were on the use of, perception of the HCWs, and scalability and sustainability of the EMR system. MethodThe study utilised a descriptive and analytical implementation evaluation through a convergent parallel mixed-methods design in 33 health facilities in the informal settlements in Nairobi County, Kenya. We carried out semi-structured interviews with the county and sub-county health management staff (n = 9), facility in-charges (n = 8), healthcare workers (HCW) (n = 35), and project staff (n = 7). Additionally, quantitative analysis, trend analysis, critical evaluation and costing were done. Qualitative data were analysed thematically using NVIVO while quantitative data were analysed using Excel and Stata software. ResultsThe EMR system significantly improved data capture and management of HTN and DM patients. The system helped clinicians to adhere to treatment and management guidelines and in clinical decision making. Most HCWs had a positive attitude and perceptions about the EMR system, and it was a good initiative for improving the quality and standardisation of care. The data captured made it easier to generate health facility and clinics reports which were essential for planning and decision-making processes. A critical audit of the EMR system features showed adequate general design features (data elements, structure and organisation, ease of use, accessibility, interfaces, confidentiality, access limitation, accuracy and integrity). DiscussionUse of the EMR helped in improving patients care. The technology not only enhanced assurance of patients’ information safety and availability but also supported in clinical decision making and standardisation of care. Successful implementation of the technology is dependent on positive perception and attitude of the HCWs. While the initial cost of setting and managing the EMR is high, future maintenance cost could be lower, making it sustainable in the long run. However, it is vital for future implementors to source for adequate funds to run it to completion if it is to achieve its objective.

Analysis of occupational health activities through classifying reports from medical facilities in Japan

The objectives of this study were to analyze current trends in occupational health activities by classifying reports from medical facilities in Japan. Reports of current workplace-level occupational health activities from medical activities that were collected by the Japan Medical Association Occupational Health Committee were used for the study. Of 5,000 questionnaire forms sent to medical facilities, 1,920 responses were returned. The freely described reports on ongoing occupational health activities contained in these responses were classified according to each of the following aspects of reported activities: 1) details of occupational health activities including main actors in workplace-level actions; and 2) approaches taken for occupational safety and health. The classification of the reports was implemented by a working group comprising selected occupational health practitioners and researchers. Among 1,920 survey responses, 581 valid texts were analyzed. Altogether, 1,044 occupational health activities currently undertaken by the facilities were extracted. The reported activities that were classified according to details of occupational health activities mainly comprised "Measures for preventing overwork, labor management, and work-style reform" (35.7%), "Measures for improving mental health" (21.0%), and "Review of occupational safety and health management systems" (19.3%). Medical facilities implementing "Measures for mental health" alongside "Measures for preventing overwork, labor management, and work-style reform" were reported in 13.2% of the responding medical facilities. "Occupational health professionals or safety and health management staff" (71.7%) were the most frequent main actors of these activities, followed by "Members of the workplace" (18.4%) and "Outsourced experts" (2.4%). "Comprehensive safety and health management" (42.0%) was the most common approach taken for occupational safety and health, followed by "Management focusing on topics" (23.8%) and "Case management" (16.5%). Most of these activities focused on primary prevention aimed at labor management including prevention of overwork, work-style reform, and mental health promotion. Another key trend could be "Teamwork among occupational safety and health staff, workers, and employers at respective workplaces as well as outsourced experts." Several key trends were extracted from current occupational health activities at medical facilities. In most cases, these measures were implemented simultaneously. This suggests the importance of combining primary prevention measures for mental health with measures for labor management including prevention of overwork. These activities reflect emerging trends that incorporate teamwork between experts, workers, and employers, and provide new perspectives on workplace-level occupational safety and health activities.

Assessment of Level of Knowledge in Medical Waste Management in Selected Hospitals in Kenya

Background: Medical waste is waste generated during diagnosis, treatment or immunization of human beings or animals. Approximately 10-25% of the medical waste is hazardous, injurious to humans, animals, and environment and has high potential for diseases transmission when not properly managed. Objective: The aim of the study was to determine the level of knowledge among health professionals and individuals involved in medical waste management in Kenyan hospitals. Design: A descriptive cross sectional study was used in the study. This was done within the period of April to August 2015. Settings: The study was done in Nairobi, Kenya at Kenyatta National Hospital (KNH) a public hospital and Kiambu County at Kikuyu Mission Hospital (KMH) a private hospital. Participants: All Health management staff and waste workers who met the inclusion criteria and consented. A total of 246 respondents from each hospital were used to collect the data. Results: It was observed that the overall knowledge towards medical waste (MW) management was high amongst all the healthcare professionals in both hospitals (above 50%). Doctors were the most knowledge among other professionals in both hospitals among other health workers In KNH staffs with1-5 years of experience (84.62%) had the most knowledge towards medical waste management issues as compared to KMH with 5-10 years (83.72%). On the knowledge of management of medical waste handling rule policy of 1998, doctors had (94.1%, KNH and 88.2% KMH while public health officers in each hospital had 100%. About source of segregation of medical waste nurses had 93.3%, KNH, 94.1% KMH and doctors had 88.2% (KNH) and 88.1% (KMH) respectively. On knowledge towards recognition of a biohazard symbol, nurses had the highest scores with KNH scoring 87.2% while at KMH they had 77.2%. Conclusion: The level of knowledge on medical waste aspects was high. Doctors and public health officers had the highest level of education in the hospitals and had most knowledge in theoretical rules and regulations questions, while nurses and clinical officers had the most knowledge on technical issues such as segregation and recognition of biohazard. In the present study, it was concluded that there was the least experienced but committed and the long serving and dedicated to serve. KNH had better knowledge towards medical waste aspects than KMH. There is therefore need to have a joint collaboration on medical waste aspects in public and private hospitals.

Violence against rural women: gender and health actions

Objective: To analyze from an analytical category of gender, the dimensions of violence against rural women according to health management staff, professiona...

Assessing the Role of Transport in the Achievement of Maternal Mortality Reduction in Ghana

Purpose: this study seeks to find the role and impact of transport’s intervention in the achievement of the maternal mortality reduction in Ghana. The study used a number of approaches including case study, descriptive and exploratory approaches, and all these were adopted to gain a better understanding on the role of transport in the achievement of maternal death reduction. The study revealed that good vehicles and road infrastructure are perceived as a key link between potential accessibility and actual utilization of maternal health services. Again finding out the possibility of achieving zero maternal death in the municipality by the year 2015, health management staff perceived that it is likely to be achieved in Ghana; a little deviation from the report by African countries’ MDG Africa Steering Group.

Women's health in violent situations: municipal administrative roles and decision-making in the Brazilian public health system

The aim of this study was to investigate the role of health management staff concerning the health of women facing violent situations and the impact these roles have on decisions concerning health measures targeting these women. The study employed a qualitative, descriptive methodology including 18 health management staff members from three municipalities classified as having fully autonomous municipal management systems under the Unified National Health System (SUS) in Greater Metropolitan Recife, Pernambuco State, Brazil. Staff members were divided into three distinct groups according to their opinions on women in violent situations and women's health interventions. However, the three groups were convergent with respect to their roles in determining decisions on health actions for these women. The health management staff's commitment to the feminist movement proved to be the most relevant factor. Common issues among staff members, such as the problem of public health and quality of living, or more technically, the cost-benefit issue, did appear as key arguments.

Integrating Reproductive Health Services in a Reforming Health Sector: The Case of Tanzania

Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000–2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.

Creative strategies for promotion of worksite health services: the employee ambassador program.

Boston’s Beth Israel Hospital is a major clinical, teaching, and research affiliate of Harvard Medical School. The 415-bed nonprofit institution employs a culturally diverse workforce of more than 5000 people located at multiple sites in addition to the main hospital campus. The Beth Israel system includes a growing network of communitybased health centers and group practices in eastern Massachusetts. Beth Israel Hospital’s Health Management Department has offered its workforce health and fitness services since 1985, when it established an 1800 square foot on-site fitness and wellness center. The department’s staff of health educators, fitness instructors, and nurse specialists provides comprehensive health assessments and screenings, behavior change programs, self-care sessions, and fitness and exercise classes. Systems Review and Redesign Health management staff decided to design a promotional strategy that would involve employees in dissemination of program information. In the fall of 1993 a systematic review of facility floor plans was initiated, identifying distinct departments and the location of their bulletin boards in high-traffic areas. A list was compiled of all areas that health management staff wished to target for promotion. Managers of these areas were asked to identify an employee interested in serving as an ambassador. The ambassador would act as a liaison between health management staff and the department. On a quarterly basis, health and fitness newsletters would be mailed to the ambassador for posting and distribution. In return, ambassadors would earn points that could be used to purchase incentive items, and their names would be entered into a quarterly raffle for a special prize.