Organization Of Health Services Research Articles

Distance Health Services Organization in University Hospitals: The Case of a Public University Hospital

In today's globalized healthcare market, it has become a necessity for healthcare organizations to strive to provide the healthcare services needed by their target audience with modern medical technology and software, regardless of physical space, country and/or geography. In fact, although distance health services and tele-medicine applications are not new applications, they have been increasingly used by healthcare organizations due to the physical transmission feature of the New Coronavirus Disease (Covid-19) or corona pandemic. The aim of this study is to analyze the legal dimension of Distance Health Services (DHS) in a public university hospital, the path to be followed to obtain a “Distance Health Service Activity Permit Certificate”, the characteristics, quantity and qualifications of the human resources to provide health services, the physical structure of the areas to be served and the information technologies, information systems to be used, the ministry audit criteria related to the pricing, invoicing and refund methods of health service fees, and to contribute to the structuring stages of distance health services of similar health institutions.

Centering equity, diversity, and inclusion in youth digital mental health: findings from a research, policy, and practice knowledge exchange workshop.

Youth mental health service organizations continue to rapidly broaden their use of virtual care and digital mental health interventions as well as leverage artificial intelligence and other technologies to inform care decisions. However, many of these digital services have failed to alleviate persistent mental health disparities among equity-seeking populations and in some instances have exacerbated them. Transdisciplinary and intersectional knowledge exchange is greatly needed to address structural barriers to digital mental health engagement, develop and evaluate interventions with historically underserved communities, and ultimately promote more accessible, useful, and equitable care. To that end, the Digital, Inclusive, Virtual, and Equitable Research Training in Mental Health Platform (DIVERT), the Maritime Strategy for Patient Oriented Research (SPOR) SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit and IWK Mental Health Program invited researchers, policymakers, interprofessional mental health practitioners, trainees, computer scientists, health system administrators, community leaders and youth advocates to participate in a knowledge exchange workshop. The workshop aimed to (a) highlight local research and innovation in youth-focused digital mental health services; (b) learn more about current policy and practice issues in inclusive digital mental health for youth in Canada, (c) participate in generating action recommendations to address challenges to inclusive, diverse and equitable digital mental health services, and (d) to synthesize cross-sector feedback to inform future training curriculum, policy, strategic planning and to stimulate new lines of patient-oriented research. Eleven challenge themes emerged related to white-colonial normativity, lack of cultural humility, inaccessibility and affordability of participating in the digital world, lack of youth and community involvement, risks of too much digital time in youth's lives, and lack of scientific evidence derived from equity-deserving communities. Nine action recommendations focused on diversifying research and development funding, policy and standards, youth and community led promotion, long-term trust-building and collaboration, and needing to callout and advocate against unsafe digital services and processes. Key policy, training and practice implications are discussed.

Cardiovascular mortality rate between 2018 and 2022 in Kyrgyz Republic

Abstract Background Cardiovascular diseases (CVD) are the number one cause of death in low- and middle-income countries (LMICs), including Kyrgyz Republic. According to official statistics, CVD ranks first in the structure of overall mortality, accounting for more than half (52.1% according to 2022 data) of all deaths. Purpose to analyze the cardiovascular mortality rate in the Kyrgyz Republic, from 2018 to 2022. Methods Medical and statistical information on mortality from CVD in the population was obtained from the Centre for Electronic Health (CEH) of the Ministry of Health. To conduct a comparative analysis, relative indicators per 100 thousand population were calculated. A retrospective epidemiological study of mortality from CVD including different nosological forms over period for 2018–2022 was conducted, calculating the rate of increase (decrease). An analysis of the epidemiological situation of the disease in nine administrative-territorial units of the Kyrgyz Republic was also carried out with the calculation of the average 5-year mortality ratefor the period from 2018 to 2022. Results Despite the decrease in morbidity, a high proportion of mortality from CVD remains in all years, more than 50%. In terms of the percentage indicator for recent years, all this time it has maintained the highest position, in contrast to diseases of other organs and systems. In the last decade, from 2012 until 2020, there was a gradual decrease in the mortality rate. Since 2020, we have seen a sharp increase in the CVD mortality rate per 100 thousand population by 19.6% compared to 2018, by 19.4% since 2019, which is associated with the influence of Covid-19 pandemic, in 2021 this indicator amounted to 297.6 cases, in 2022 - 234.5. The main contribution to population death from CVD is made by coronary heart disease (65.90%), including acute myocardial infarction, cerebrovascular diseases (21.4%), arterial hypertension (5.9%). If we analyze the mortality rate from CVD by nine administrative-territorial units, the highest rates in 2022 are observed in the Chui and Talas regions, 291.9 and 266.3 per 100 thousand population respectively; the lowest in the Osh region (207.3), Osh city (196.1) and Bishkek (208.6), which is explained by the better organization of health services in these areas. Conclusion CVD remains the main cause of mortality in the population of the Kyrgyz Republic. Although over the past year there has been a good decline in this indicator, in almost all regions, particularly the greatest successes have been achieved in Naryn and Issyk-Kul regions. In connection with the above, there is requirement for a clear identification of priorities when determining the strategy of treatment and preventive interventions. It is necessary to create an effective National system of care for patients with CVD with a focus on emergency cardiac care and prevention issues.

4.P. Round table: Advancing genomic diagnostics for rare genetic diseases: a focus on non-clinical domains of HTA

Abstract Genetic rare diseases are a burning global public health issue requiring a thorough assessment of the related burden. Unfortunately, curative therapies are oftentimes unavailable for genetic rare diseases; nevertheless, a prompt diagnosis could allow clinicians to elaborate supportive care plans for patients and their caregivers, determine the best care setting, and potentially consider enrolling them in clinical trials, if suitable. Innovative, effective, and sustainable diagnostic techniques, such as Whole genome sequencing (WGS), are needed to address this growing health concern. At global level, there is a paucity of research that specifically investigates the implementation of WGS into clinical practice which is even more constrained at the European level. Furthermore, given the current challenges impacting pediatric patients suspected of having genetic diseases without a definitive diagnosis, there is an urgent need to improve the diagnostic workflow based on genomic techniques, such as WGS. Delving into this topic could contribute valuable insights that can inform policymakers, at macro-level, and health professionals, at micro-level, on how to develop suited genomic policies and clinical guidelines for the proper adoption of WGS within the daily clinical practice. From an international standpoint, it could be argued that these considerations resonate with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (i.e., “Good health and well-being”) and 10 (i.e., “Reduced inequalities”), as a priority for research and action. Notwithstanding, the broader implementation of WGS encounters hindrances owing to its complexity and the multifaceted social, economic, organizational, and ethical implications. In view of these challenges, Health Technology Assessment (HTA), as an integrated and multidisciplinary process, provides a comprehensive framework for the evaluation of these dimensions. This round table is intended to provide attendees with insights into nonclinical domains of HTA of WGS which, unlike clinical domains, demand a nuanced approach within the framework of the HTA. The intended objective is pursued through the initial presentation of a case study on the evaluation of WGS in paediatric genetic disorders from the Italian National Health Service perspectives followed by an open discussion with experts. The discussion will delve into issues related to economics, genomics, health services organization and ethics. Key messages • For pediatric patients suspected of having a genetic disease, WGS could shorten the so-called diagnostic odyssey. • Context-depending aspects of implementing WGS should be properly taken into account through HTA.

Evaluation of a public health workplace staff psychosocial risk assessment and wellbeing initiative

Abstract Adverse psychosocial work environments can have a detrimental effect on staff wellbeing causing chronic stress leading to burnout. Despite legislation mandating regular risk assessments, only one third of workplaces assess psychosocial risks. A 2020 European report identified one of the main barriers being a reluctance to talk openly about psychosocial issues. This paper describes an evaluation of a staff psychosocial risk assessment and wellbeing initiative in a Public Health Department in Ireland. The initiative commenced in October 2022 during a period of major health service organisational change. Informed by positive organisational psychology conceptual frameworks, guided by the European Psychosocial risk assessment framework (PRIMA-EF) and utilising the HSE Work Positive (CI) survey tool it was possible to constructively identify and categorise psychosocial risks across the Public Health team. In the evaluation, a mixed methods approach was used based on Donabedian’s structures, processes and outcomes overarching framework and Nielsen’s Model of Process Evaluation Framework. The first three iterative quality improvement cycles of the intervention were reviewed. The evaluation demonstrated that all of Nielson’s three indicators for a successful organisational level staff wellbeing intervention had been met: there was evidence of improvement in both working conditions and staff wellbeing; iterative quality improvement cycles including appreciative inquiry staff collaborative engagement ensured staff views and key learning was captured; new organisational structures within the Department enabled the sustainability of this process. The evaluation indicates that the staff psychosocial risk assessment process is beneficial for staff wellbeing and that the methods used are appropriate. The resources used in this process continue to be readily available within the health service organisation. The evaluation supports continuation of this process in its present form. Key messages • This evaluation supports staff psychosocial risk assessment and mitigation processes and provides a framework for healthcare managers to implement such processes and comply with legislation. • This evaluation indicates that effective and sustainable collaborative staff engagement can be achieved using a positive focus which builds on team strengths and harnesses collective wisdom.

Rethinking Change: Complexity Theory and Its Application to Human Service Nonprofits

The following article introduces complexity theory as an alternative for conceptualizing the dynamics of change in nonprofit health and human service organizations. We begin by reviewing theories most frequently used to frame change in nonprofits, identifying knowledge gaps that limit their explanatory capacity. The authors then introduce complexity theory as a lens for studying change as ongoing adaptation in dynamic systems; it emerges from the resolution of dualities and can appear unpredictable and nonlinear. Given the criticality of these organizations to public services, we consider new ways of analyzing nonprofit adaptation, and how understanding could lead to enhancing the sector’s capacity to respond to crises.

Reaching national Covid-19 vaccination targets whilst decreasing inequalities in vaccine uptake: Public health teams' challenges in supporting disadvantaged populations

BackgroundUK local authority public health teams (LAPHT) supported delivery of the Covid-19 vaccination programme, particularly to disadvantaged populations. We explored the challenges encountered and lessons learnt by LAPHTs in tackling low Covid-19 vaccine uptake. The aim of this study was to understand what works, and how, in addressing local inequalities in relation to uptake of the Covid-19 vaccination with a view to generalising insights to building back fairer after the pandemic and into the future. Study designQualitative. MethodWe conducted in-depth on-line interviews with Directors of Public Health or their representatives from 21 English local authorities covering a total population of over 8 million people. Data were analysed thematically. ResultsAccessing the requisite (and accurate) data, engaging with communities, and working with National Health Service (NHS) organisations presented challenges in delivering initiatives to improve vaccine uptake, particularly for disadvantaged groups. LAPHT’s assets beneficial to the programme - in-depth knowledge and experience of their communities and locality - were not considered in the national vaccination programme. Community engagement and relationships with local NHS featured heavily in the majority of LAPHTs responses to improving vaccine uptake rates. ConclusionsIncorporating local public health infrastructure, expertise and existing relationships into national vaccination planning during epidemics or pandemics is crucial. Community engagement and good relationships with NHS staff help to reach and serve disadvantaged populations. How these can be developed and maintained in the longer term without future investment was a concern. Future research should explore the design and implementation of PH and NHS joint service delivery models to tackle health inequalities, informed by experiences of the Covid-19 vaccination programme and with input from community partners.

Exploring the experience of participants in a pilot scheme to recognise teaching excellence in healthcare: A mixed methods approach.

BackgroundWithin healthcare settings, practice-based healthcare professionals are expected to teach, supervise, assess and/or support learners in their respective disciplines. Ongoing development opportunities focusing specifically on teaching skills and support of students are varied and there are no mandatory requirements for practice-based healthcare professionals to develop formal teaching qualifications, despite their direct involvement with learners. ObjectiveTo explore the experience of participants in a pilot scheme to recognise teaching excellence in healthcare. DesignA mixed methods approach was used. Setting(s)One inner-city integrated health care system in the UK. ParticipantsThis study involved eleven participants in total: seven applicants who successfully completed the award and four mentors who supported them throughout the application process. Mentors were all Advance HE Fellowship holders employed within one National Health Service (NHS) organisation and one Higher Education Institution situated within the Northwest of England. MethodsData collection methods included an online anonymised survey followed by individual semi- structured interviews. Quantitative data were analysed descriptively, and qualitative data were analysed using framework analysis principles. ResultsThe findings indicated that participants (applicants and mentors) found the overall experience positive and rewarding. The main positive aspects of taking part were:I. Increased confidence and sharing of teaching experienceII. Increased reflection and use of pedagogyIII. Formation of a teaching community of practiceIV. Perceived teaching career progression opportunitiesThe application process appeared to act as a catalyst towards re-engagement with underpinning pedagogy when considering the suitability and utility of effective teaching approaches for learners in practice. It also helped to promote a teaching community of practice where mentors were able to ‘pay forward’ and support practice colleagues to be recognised for their teaching roles.The main challenges were the competing demands on applicants’ time and the self-directed approach required to complete the award application. ConclusionGaining recognition of teaching excellence through an award scheme such as Advance HE Fellowship can foster a sense of empowerment, recognition and reward for educators who work with learners undertaking Higher Education Programmes, irrespective of the setting where teaching and learning takes place. However, without wider organisation support and resources, the benefits of such schemes can be diminished. RegistrationN/A Tweetable abstractWith institutional support, Advance HE Fellowships offer accessible recognition for healthcare educator's commitment to teaching excellence @AdvanceHE @NHSE_WTE

TANTANGAN DAN PERAN PEMERINTAH DALAM MENINGKATKAN PELAYANAN KESEHATAN DI KABUPATEN TAKALAR

This study aims to determine the role of the village government in organizing health services in Sampulungan Village. In addition, this study also aims to determine the challenges faced by the village government and the community in the service process and accessibility to health facilities. Using a qualitative research approach with a case study strategy. The results of this study indicate that the role of the village government in health services is still very minimal, as seen from the unavailability of health centres and inadequate health facilities. The village government also lacks initiative in facilitating health services because it is hampered by the lack of participation in voicing the aspirations of the community in the village. In addition, the community's view of the role of government in the field of services, especially health, is greatly influenced by the low level of community knowledge about participation at the village apparatus level. This study also found several obstacles faced by the village government, especially in Sampulungan Village, in improving the quality of services, including social construction, power dominance, and the non-involvement of village officials in decision-making at the central and district levels. Therefore, it is important to provide education about bureaucracy in order to improve the understanding of the community and the village government of Sampulungan District regarding the quality of health services.

Online volunteering and subjective well-being in China

This study aims to examine the relationship between online volunteering and subjective well-being (SWB) and to explore the mediation effect of online bridging networks. The data used in this study came from the 2019 Chinese General Social Survey (CSS). In this study, individuals who responded to survey questions about their participation in online volunteering activities and their subjective well-being(SWB) were included for analysis (N = 5556). The results showed a positive relationship between online volunteering and online bridging networks and indicated that online volunteering affects subjective well-being through the mediating role of online bridging networks. The implications of this study are relevant to policy-makers in public health and social service organizations. Based on the findings, policy-makers and nonprofit organizations are called on to support this type of volunteering which is an important means of improving public health. Nonprofit organizations can establish online social networks for potential volunteers. In addition, nonprofit organizations need to invest more resources to enhance the digital literacy of employees and volunteers, in order to enhance the quality of online volunteering services.

Why Won't Anyone Talk? Challenges Naming and Addressing Tokenism Within Health and Human Service Agencies Serving the LGBTQ+ Community.

Workplace tokenism, the use of superficial efforts to appear equitable, which often leads to burnout of marginalized groups, is pervasive, even in health and human service organizations dedicated to improving their community's health and well-being. An original research project to identify interventions addressing tokenism within Lesbian, Gay, Bisexual, Transgender, Queer plus serving health and human service agencies in New York was unable to engage staff in focus groups. A follow-up survey with 41 potential participants reported burnout as the main reason for nonparticipation. Qualitative data revealed desired aftercare for the retraumatizing nature of sharing individual experiences. Utilizing a community-based participatory research approach with an antiracism lens may mitigate challenges addressing tokenism, thereby increasing workplace inclusion of our Lesbian, Gay, Bisexual, Transgender, Queer plus community.

Exploring barriers and facilitators to addressing hazardous alcohol use and AUD in mental health services: a qualitative study among Dutch professionals

BackgroundHazardous alcohol use and alcohol use disorder (AUD) are highly prevalent among clients in mental health services, yet significant gaps remain in the adequate assessment of alcohol use and provision of appropriate alcohol interventions. The aim of this study was to conduct an exploration of (i) alcohol intervention elements used in mental health services and (ii) professionals’ reported barriers and facilitators in identifying and intervening with hazardous alcohol use and AUD.MethodsQualitative data were obtained by conducting semi-structured interviews among a purposive sample of 18 professionals from 13 different Dutch mental health services organizations (i.e., five integrated mental health organizations with addiction services, five mental health organizations without addiction services, and three addiction services organizations without mental health services). Transcripts were qualitatively analyzed using inductive thematic analysis.ResultsIdentified alcohol intervention elements included conducting assessments, brief interventions, treatment, referrals of clients, collaborations with other parties, and providing information to professionals. Professionals mentioned nine barriers and facilitators in the identification and intervention with hazardous alcohol use and AUD, including three aspects of professionals’ behavior (i.e., professionals’ agenda setting, knowledge and skills, and attitudes), actions related to identification and intervening, client contact, collaboration with other parties, and three factors in a wider context (i.e., organizational characteristics, organizational resources, and governmental aspects).ConclusionsAlthough diverse alcohol intervention elements are available in Dutch mental health services, it remains unclear to what extent these are routinely implemented. To better address hazardous alcohol use and AUD in mental health services, efforts should focus on enhancing alcohol training, improving collaboration with addiction services, providing appropriate tools, and facilitating support through organizational and governmental measures.

The Role of Patient Organizations in Shaping Research, Health Policies, and Health Services for Rare Genetic Diseases: The Dutch Experience.

In 2023, the genetics scientific community celebrated two special anniversaries: the discovery of the double helix structure of DNA was published in 1953 and in 2003 the Human Genome Project was declared completed and made publicly available. To this day, genetics and genomics research is continuing to evolve at high pace and is identifying a steadily increasing number of genes as causal for distinct genetic diseases. The success story of genetics and genomics would not be complete without taking due account of the role of patient advocacy organizations in this process. This paper is based on the personal narrative (oral history) of a father whose daughter was born with a rare genetic disease (RGD) in the 1960s. The first-hand experience of living as a family with an RGD in those days made him a leading pioneer not only in the foundation of patient organizations at national, pan-European, and international levels but also in the development of multi-stakeholder co-operation and networking. Today, patient advocacy organizations play an active role in shaping health and research policies at national, EU, and international levels to ensure that their needs in regard to advancing RGD diagnostics, care, and treatment are addressed.

Co-creating a Shared Vision Post-Covid in a Health and Human Services Organisation

The global healthcare sector, deeply impacted by covid 19, faced unprecedented challenges in resilience and organisational complexity. Resilience in organisations where health and human services combined are served, especially in the disability sector, has often been less visible than that of healthcare professionals. This article explores the post-covid reconstruction of one such organisation, aiming to co-create an inspiring shared vision for a post-pandemic future.

S06-3: We Walk. Developing and pilot testing a dyadic intervention to promote outdoor walking in people after stroke: benefits, challenges and solutions

Abstract Purpose After stroke, physical activity (PA) levels are low, risking secondary stroke, cardiovascular disease, falls and poor mobility. Regular PA reduces these risks. Walking is a preferred PA option for stroke survivors, and social support influences uptake and maintenance of behaviours. We therefore developed WeWalk, a person-centred, dyadic peer-support behavioural intervention supported by walking buddies, to promote regular walking after stroke. This study evaluated participants’ experiences of WeWalk to refine it ready for effectiveness testing and implementation. Methods Intervention: WeWalk involved facilitated face-to-face and telephone sessions with a researcher with behaviour change training, supported by intervention handbooks and diaries. Dyads agreed walking goals and plans, monitored progress, and developed strategies for maintaining walking. Evaluation Data were collected through semi-structured interviews and facilitator fieldnotes during intervention delivery, and were analysed using thematic analysis, guided by a theoretical framework of acceptability. Results We recruited 21 dyads comprising community-dwelling PWS and their walking buddies. Eighteen dyads completed exit interviews, one dyad was lost to follow-up and two withdrew with ill-health. We identified three themes: acceptability evolves with experience, mutuality, and person-centredness with personally relevant tailoring. As dyads recognised how WeWalk components supported walking, perceptions of acceptability grew. Effort receded as goals and enjoyment of walking together were realised. The dyadic structure provided accountability, and participants’ confidence developed as they experienced physical and psychological benefits of walking. WeWalk required careful facilitation. It worked best when dyads exhibited relational connectivity and mutuality in setting and achieving goals however in a few dyads agreeing and enacting mutual goals was more challenging. Tailoring intervention components to individual circumstances and values supported dyads in achieving meaningful goals. Conclusions WeWalk is feasible and acceptable, illustrating the potential of dyadic interventions after stroke. However, its complexity requires considered implementation strategies. Data highlight the need for careful matching of dyads, facilitation of dyadic working by practitioners who can support development of dyadic relationships; and community structures linked to healthcare pathways that support implementation. We have worked with charities health services organisations to plan and develop these implementation strategies and report the challenges and potential solutions to delivering this complex intervention.

The use of locum doctors in the NHS: understanding and improving the quality and safety of care.

The use of locum doctors in the National Health Service is widely believed to have increased, and there have been widespread and sustained concerns among policy-makers, healthcare providers, professional associations and professional regulators about the quality/safety, cost and effective use of locum doctors. To provide evidence on the extent, quality and safety of medical locum practice and the implications of medical locum working for health service organisation and delivery in primary and secondary care in the English National Health Service, to support policy and practice. Four interlinked work packages involving surveys of National Health Service trusts and of general practices in England; semistructured interviews and focus groups across 11 healthcare organisations in England; analysis of existing routine data sets on the medical workforce in primary care and in National Health Service trusts in England from National Health Service Digital and National Health Service Improvement; and analysis of data from the Clinical Practice Research Datalink in primary care and of electronic patient record data from two National Health Service hospitals in secondary care. In primary care, about 6% of general practice medical consultations were undertaken by locums in 2010 and this had risen slightly to about 7.1% in 2021. In National Health Service trusts (mostly secondary care and mental health), about 4.4% of medical staff full-time equivalent was provided by locum doctors. But those overall national rates of locum use hide a great deal of variation. In primary care, we found the National Health Service Digital workforce returns showed the rate of locum use by Clinical Commissioning Group varied from 1% to almost 31%. Among National Health Service trusts, the reported rate of locum use varied from < 1% to almost 16%. We found that there was poor awareness of and adherence to national guidance on locum working arrangements produced by National Health Service England. Our research showed that locum working can have adverse consequences for the quality and safety of care, but that such consequences were probably more likely to result from the organisational setting and the working arrangements than they were from the locum doctors themselves and their competence, clinical practice or behaviours. Our research was hampered in some respects by the COVID pandemic which both resulted in some delays and other challenges. Our efforts to use electronic patient record data in secondary care to explore locum doctor working were stymied by the problems of data access and quality. Locum doctors are a key component of the medical workforce in the National Health Service, and provide necessary flexibility and additional capacity for healthcare organisations and services. We found that the extent of reliance on locum doctors varied considerably, but that an over-reliance on locums for service provision was undesirable. Some differences in practice and performance between locum and permanent doctors were found, but these seemed often to arise from organisational characteristics. We found that patients were more concerned with the clinical expertise and skills of the doctor they saw than whether they were a locum or not. Organisational arrangements for locum working could be improved in many respects. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128349) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 37. See the NIHR Funding and Awards website for further award information.

Reconstructing the Bicultural Worker within Health and Human Service Organisations

ABSTRACT Limited literature considers the role and contribution of bicultural workers in Australia. This article explores how bicultural workers are constructed by social workers within health and human service organisations, through the lens of Whiteness. Eight White social workers participated in this multimethod qualitative study. Data were analysed using a critical approach to narrative analysis. The findings suggest that bicultural workers can be constructed as inferior and of less value than other employees, and as a “resource” to be “used” within organisations. These findings are consistent with previous literature, which highlighted how bicultural workers, or similar, are treated and how they experience workplaces differently to other employees within mainstream White Western organisations. It is concluded that we need to reconstruct the bicultural worker role in a way that meaningfully privileges their expertise, skillset, and diversity. IMPLICATIONS Social workers’ constructions of bicultural workers appear to relate to what expertise is privileged within the West. Cultural othering of bicultural workers may contribute to diminishing their role and the credibility and capabilities of organisations. Ensuring bicultural workers receive career pathway progression and professional development could help facilitate their repositioning within organisations.

Has cross-level clinical coordination changed in the context of the pandemic? The case of the Catalan health system

BackgroundThe COVID-19 pandemic triggered numerous changes in health services organisation, whose effects on clinical coordination are unknown. The aim is to analyse changes in the experience and perception of cross-level clinical coordination and related factors of primary (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022.MethodsComparison of two cross-sectional studies based on online surveys by means of the self-administration of the COORDENA-CAT (2017) and COORDENA-TICs (2022) questionnaires to PC and SC doctors. Final sample n = 3308 in 2017 and n = 2277 in 2022. Outcome variables: experience of cross-level information and clinical management coordination and perception of cross-level clinical coordination in the healthcare area and related factors. Stratification variables: level of care and year. Adjusting variables: sex, years of experience, type of specialty, type of hospital, type of management of PC/SC. Descriptive bivariate and multivariate analysis using Poisson regressions models to detect changes between years in total and by levels of care.ResultsCompared with 2017, while cross-level clinical information coordination remained relatively high, with a slight improvement, doctors of both care levels reported a worse experience of cross-level clinical management coordination, particularly of care consistency (repetition of test) and accessibility to PC and, of general perception, which was worse in SC doctors. There was also a worsening in organisational (institutional support, set objectives, time available for coordination), attitudinal (job satisfaction) and interactional factors (knowledge between doctors). The use of ICT-based coordination mechanisms such as shared electronic medical records and electronic consultations between PC and SC increased, while the participation in virtual joint clinical conferences was limited.ConclusionsResults show a slight improvement in clinical information but also less expected setbacks in some dimensions of clinical management coordination and in the perception of clinical coordination, suggesting that the increased use of some ICT-based coordination mechanisms did not counteract the effect of the worsened organisational, interactional, and attitudinal factors during the pandemic. Strategies are needed to facilitate direct communication, to improve conditions for the effective use of mechanisms and policies to protect healthcare professionals and services in order to better cope with new crises.

The effect of organizational justice and job involvement on organizational citizenship behavior (OCB) with organizational commitment as mediation variable

A hospital is a non- profit health service organization profit oriented, and own various specifications, specifically related with human resources. In this context, hospitals are often mentioned as an organization that is intensive in human resources, this is because it is in a hospital there are various professions and types of work that have specifications and tasks different principal. Apart from that, hospitals are also known as solid organizations regulations and intensive technology and science. Technology and science intensive knowledge because there is technology and sophisticated medical equipment as well the rapid development of science as a result of education and study in in House Sick. Congested regulations because in House Sick there is Lots regulation and terms service Which must obeyed by all over element Which There is At home Sick. This research aims to investigate influencing factors OCB to nurses at Samarinda Medika Citra Hospital. This research uses OCB as a dependent variable which influences Organizational Justice, Job involvement and Organizational Commitment as mediating variables. This research is categorized as explanatory research. The respondents in this study were nurses at Samarinda Medika Citra Hospital who had worked for more than 2 years and determining the sample size in this study used a saturated sample technique with a total sample of 172 respondents. The data collection method uses a questionnaire, and the data is analyzed using SEM-PLS. The findings from this research show that organizational justice, job involvement and organizational commitment have significant effects on OCB. Organizational Commitment also plays a role in mediating the relationship between organizational justice and work engagement hope OCB.

Correction: Navigating the Future of Organisational Health Services Research in Germany and beyond: a Position Paper.

Correction: Navigating the Future of Organisational Health Services Research in Germany and beyond: a Position Paper.