Organization Of Health Services Research Articles

Sensemaking through crisis: critical care pharmacist (CCP) leadership during COVID-19

Purpose The purpose of this study is to understand how critical care pharmacists (CCPs) coped during the COVID-19 crisis by investigating what sense-making and leadership processes were evident during the crisis. Design/methodology/approach Data from ten semi-structured interviews of lead CCPs across different National Health Service organisations in the UK was analysed through a thematic process. Findings The findings identified that strong pre-existing relationships and high levels of trust play a significant role in successfully navigating a crisis. Four sense-making processes seem important to building and maintaining these relationships and trust, namely, identifying cues for change; authoring and labelling; interpretation and storytelling; negotiation and deliberation. Originality/value The research also highlights the need for organisations to acknowledge the leadership roles undertaken by CCP teams and leverage this role by investing in leadership training, thereby increasing resilience and preparedness for future storms or crises on the horizon.

Professionalising patient safety? Findings from a mixed-methods formative evaluation of the patient safety specialist role in the English National Health Service.

Objectives: While safety-dedicated professional roles are common in other high-risk industries, in health care they have tended to have a relatively narrow, technical focus. We present initial findings from a mixed-methods evaluation of a novel, senior role with responsibility for leadership of safety in English National Health Service organisations: the patient safety specialist. Methods: We conducted interviews with those responsible for designing, developing and overseeing the introduction of the role. We also carried out a national survey of current patient safety specialists. Data collection and analysis focused on the rationale for the role, its theory of change, and experiences of putting the theory into practice. Results: Interview participants articulated a clear theory of change for the role, highlighting ways in which the focus of the role, the seniority, responsibility and influence of role holders, and the expertise they brought might result in better safety management and speedier implementation of initiatives to manage risk and improve safety. Survey respondents had mixed experiences of the role to date, particularly in terms of material and symbolic support from their organisations. Together, findings from the two datasets indicated the need for a careful balance between strategic and operational activities to secure impact for patient safety specialists while ensuring they were embedded in the realities of clinical work as done-a balance that not all role holders found easy to achieve. Conclusions: The vision for the patient safety specialist role is clear, and supported by a plausible account of how the work of role holders might result in the intended objectives. The degree to which specialists are supported and resourced to deliver on these ambitions, however, varies markedly across organisations.

Bridging the divide: addressing discrepancies between clinical guidelines, policy guidelines, and biomarker utilization.

This paper aims to identify and address gaps in cancer treatment and diagnosis within European health services, focusing specifically on discrepancies between clinical guidelines and policy guidelines. It seeks to highlight how the underutilization of advanced diagnostic techniques recommended by medical societies contributes to missed opportunities for improving patient outcomes. A comprehensive analysis was conducted across multiple European countries to assess the compliance and integration of clinical guidelines with the availability of advanced diagnostic technologies. Secondary data related to clinical and policy guidelines in cancer care were collected and analyzed. Key indicators of adoption and utilization of next-generation sequencing and liquid biopsy were examined to evaluate their impact on health service efficiency and patient care. The analysis revealed significant discrepancies between the recommendations of medical societies regarding advanced diagnostic techniques and their adoption in health policy decisions across Europe. Country-specific assessments indicated varying levels of alignment between clinical guidelines and the availability of advanced diagnostics. These findings underscored missed opportunities for optimizing patient care and health service efficiency through better alignment and integration of clinical guidelines with policy decisions. This study concludes that there is a critical need for health policy decision-makers to prioritize the adoption of clinical guidelines in resource allocation and health service organization. Greater attention to the recommendations of medical societies regarding advanced diagnostic techniques could significantly enhance diagnostic accuracy, treatment efficacy, and overall patient outcomes in cancer care. The paper advocates for policy reforms that acknowledge and leverage the potential benefits of advanced diagnostics in improving health service performance and patient-centered care across Europe.

From Psoriasis to Psoriatic Arthritis: Decoding the Impact of Treatment Modalities on the Prevention of Psoriatic Arthritis.

Biologic therapies are licensed for both psoriasis (PsO) and psoriatic arthritis (PsA) with some electronic medical record data suggest that IL (Interleukin)-23 blockers might be more protective in PsA prevention than TNF blockers; however, the findings have been inconsistent. Higher Psoriasis Area and Severity Index (PASI) scores have also been linked to an increased PsA risk. To clarify these unresolved issues we investigated biologic agents, methotrexate, phototherapy, and topical therapy for PsA prevention in patients with psoriasis. This retrospective cohort study analyzed data from 58,671 patients with psoriasis from the Israeli Meuhedet Health Services Organization database was evaluated for incident PsA. Patients were categorized on the basis of treatment: group1, topical therapy; group2, phototherapy; group3, conventional disease-modifying antirheumatic drugs (cDMARDs; methotrexate); group4, biologic DMARDs which was also stratified according to biologic class. The PsA incidence rate was lower in the biologic agents' group versus the methotrexate group (HR 0.46 [95%CI 0.35-0.62]). The incidence rates per 100 person-years varied across biologic treatment groups, with the anti‑IL‑12/23 or anti‑IL‑23p19 group at 4.57, the anti-IL-17 group at 4.35, and the TNF inhibitor group at 2.55. No differences were found between various biological agents in terms of preventing PsA. The phototherapy group exhibited a higher PsA development rate than the topical therapy group (HR 1.85 [95%CI 1.65-2.07]). Biological agents are more effective than methotrexate in reducing incident PsA in patients with psoriasis. This lower rate of PsA on topical therapy compared to phototherapy supports the importance of psoriasis severity as a risk factor.

Factors associated with exclusive breastfeeding in " Near Miss " neonates in Brazil.

To assess the association between sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in near miss neonates in maternity hospitals. This is a prospective cohort of live births from the survey "To be born in Brazil" conducted between 2011 and 2012. The weighted number of newborns who met the neonatal near miss criteria was 832. Exclusive breastfeeding at hospital discharge and 45 days after delivery were dependent variables of the study. The sociodemographic and perinatal factors of the puerperal women and hospital practices to encourage breastfeeding were independent variables. The data were analyzed with Poisson regression and set with p value<0.05. Is exclusive breastfeeding in neonatal near misses associated with factors related to sociodemographic conditions, maternal characteristics and the organization of health services? Data from 498 women and their children were analyzed. Mothers with incomplete primary education were more likely (36%) to have exclusive breastfeeding (RR: 1.36; 95% CI: 1.06-1.74) at discharge. Women who did not offer the breast to the newborn in the joint accommodation (65%) were less likely to be breastfeeding exclusively (RR: 0.65; 95% CI: 0.56-0.75) at discharge. Variables that increased the probability of exclusive breastfeeding after 45 days of delivery were primiparity (RR: 1.36; 95% CI: 1.08-1.69) and having the newborn in the delivery room (RR: 1.90; 95% CI: 1.12-3.24). Exclusive breastfeeding in neonatal near misses was associated with maternal characteristics and important hospital practices, such as being breastfed in the joint accommodation and the newborn being in the mother's lap in the delivery room.

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

Recent analyses have shown that in health services research in Germany, healthcare organisations are often considered primarily as a study setting, without fully taking their complex organisational nature into account, neither theoretically nor methodologically. Therefore, an initiative was launched to analyse the state of Organisational Health Services Research (OHSR) in Germany and to develop a strategic framework and road map to guide future efforts in the field. This paper summarizes positions that have been jointly developed by consulting experts from the interdisciplinary and international scientific community. In July 2023, a scoping workshop over the course of three days was held with 32 (inter)national experts from different research fields centred around OHSR topics using interactive workshop methods. Participants discussed their perspectives on OHSR, analysed current challenges in OHSR in Germany and developed key positions for the field's development. The seven agreed-upon key positions addressed conceptual and strategic aspects. There was consensus that the field required the development of a research agenda that can guide future efforts. On a conceptual level, the need to address challenges in terms of interdisciplinarity, terminology, organisation(s) as research subjects, international comparative research and utilisation of organisational theory was recognized. On a strategic level, requirements with regard to teaching, promotion of interdisciplinary and international collaboration, suitable funding opportunities and participatory research were identified. This position paper seeks to serve as a framework to support further development of OHSR in Germany and as a guide for researchers and funding organisations on how to move OHSR forward. Some of the challenges discussed for German OHSR are equally present in other countries. Thus, this position paper can be used to initiate fruitful discussions in other countries.

Study protocol for a stepped-wedge implementation study investigating the intersectoral collaboration of implementering the TREAT INTERACT intervention for primary school teachers and the mhGAP for health care workers for child mental health promotion in Uganda

BackgroundMental and neuropsychological disorders make up approximately 14% of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs) of whom 90% cannot access mental health services. The main objective of the TREAT INTERACT study is to adapt, implement, and evaluate the impact of a novel, intersectoral approach to prevent, identify, refer, and treat mental health problems in children through a user centred task-sharing implementation of the TREAT INTERACT intervention, inspired by the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Uganda. Health care personell will be trained in the mhGAP-IG.MethodsThis is a pragmatic mixed-methods hybrid Type II implementation-effectiveness study utilizing a co-design approach. The main study utilize a stepped-wedged trial design with six starting sequences, randomizing three schools to the intervention at each interval, while the remaining act as “controls”. Other designs include a nested prospective cohort study, case control studies, cross-sectional studies, and qualitative research. Main participants’ outcomes include teachers’ mental health literacy, stigma, and violence towards the school children. Implementation outcomes include detection, reach, sustainability, and service delivery. Child and caregiver outcomes include mental health, mental health literacy, and help-seeking behaviour.DiscussionBased on the results, we will develop sustainable and scalable implementation advice on mental health promotion and draft implementation guidelines in line with current WHO guidelines. This project will generate new knowledge on the structure, organization, delivery, and costs of mental health services in a LMIC setting, as well as new knowledge on the implementation and delivery of new health services.Trial registrationClinicalTrials, NCT06275672, 28.12.2023, retrospectively registered.

Harnessing the power of empathy, visual art and patient narratives to improve health literacy: An exploratory study.

Health-related information can often be overwhelming for consumers, frequently infused with complex medical terminology that is difficult to understand and apply. Historically empathic connection, art and narratives have played key roles in communicating with diverse populations however collectively have received little recognition as a modality to improve health literacy. This study aimed to investigate the empathetic connection between art and patient narratives with a view to improve health literacy in the wider community. Nine recently discharged patients and one carer from a regional hospital were paired with 10 tertiary visual arts students for interview. Each narrative was transformed into visual art and exhibited at a community art gallery. The Empathy Quotient (EQ), Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and self-completed questionnaires assessed empathy and functional well-being. Health literacy was evaluated through community response surveys post-exhibition exposure. Student artist participants' EQ Cognitive Empathy (EQ-CE) scores were associated with 'Emotional Reactivity' (EQ-ER) (p = .038). SF-36 scores revealed that role limitations due to physical health and emotional problems had the greatest impact on patient/carer participant's life at the time. The SF-36 General Health domain was associated with the EQ-ER total score (p = .044). Exhibition surveys revealed that 96.9% of observers had learnt something new about illness or injury. SO WHAT?: Although a relatively small study, our findings suggest patient/carer narratives and visual art is a simple yet effective modality for health service organisations to facilitate affective learning and improve health literacy when engaging with consumers.

Exploring the Lived Experiences of Colorectal Cancer Patients With Diagnosis and Treatment in Egypt: A Qualitative Interview Study

PURPOSE Colorectal cancer (CRC) is a major health challenge in Egypt with an alarming 46.4% early-onset rate in people younger than 50 years and an overall 2 years of survival post-diagnosis. Understanding patient's experiences is necessary to enhance health outcomes. This study aims to explore patients' lived experiences of diagnoses, treatment, and perceptions of a healthy diet and physical activity. METHODS The Social Ecological Model (SEM), exploring variable-specific barriers and facilitators at individual, interpersonal, organizational, community, and policy levels, served as our theoretical framework. One-hour, face-to-face, semi-structured interviews were conducted with CRC patients in Alexandria, Egypt, between August and September 2023. Audio recorded interviews were transcribed and analyzed by thematic analysis. RESULTS Our study involved 19 participants;12 males and 7 females with a mean age of 53 years. All participants came from low-income backgrounds, 70% were urban residents, 80% were unemployed, and 52% were either illiterate or had not completed their primary education. Nearly half of the participants were in advanced cancer stage (stage 3 or higher). We identified facilitators and barriers to optimal care in patients experiences at several levels of the SEM. The main barriers were as follows: at the individual level, lack of CRC awareness and neglect of symptoms, fear of colonoscopy, loss of appetite, decreased physical activity, and being unemployed during treatment; at the health services organization level, misdiagnosis, negative colonoscopy experiences, and a lack of comprehensive treatment guidance. The main facilitators perceived by the participants were as follows: at the individual level, resilience in accepting diagnosis and treatment, and appreciation of the healthcare team; at the interpersonal level, social support from family, neighbors, and other patients; at the health services organization level, seamless and free access to oncology care, provider recommendations for a healthy diet and physical activity; and at the community level, religious faith in accepting one's destiny. CONCLUSION The findings of this study emphasize the need for early detection of CRC through screening programs and health campaigns for cancer symptoms awareness. It is also crucial to improve healthcare teams' communication with patients to ensure a higher likelihood of a positive experience.

Public–private partnerships, boundary spanners and the boundary wall in the English National Health Service

PurposeThe paper investigates English National Health Service (NHS) organisations partnering with private companies, a form commonly known as a Public-Private Partnership (PPP). Successive governments have promoted PPPs as a way of improving the delivery of health care, making the best of the different skills/experience which both sectors bring. However, the task of making these relationships work on the ground often falls to individual leaders/practitioners (“boundary spanners”) whose role has been under-researched in this type of partnership.Design/methodology/approachThe paper opted for a comparative three case study approach, including 13 semi-structured interviews and questionnaires with employees representing middle and senior management involved in managing the partnerships. The data were complemented by documentary analysis, including minutes, descriptions of internal processes and press releases.FindingsThe paper provides conceptual and empirical insights by creating a framework called the “boundary wall” that indicates the ways in which different elements of the boundaries between organisations influence the role and activities of boundary spanners (managers of the partnership).Research limitations/implicationsThis is an initial framework in an under-researched area, so will need further testing and application to other case study sites in future research.Practical implicationsThe paper includes implications for both practice and policy.Originality/valueWhile we know an increasing amount about the role of boundary spanners in public partnerships, the paper makes a unique contribution by exploring these concepts in the context of relationships between the public and private sectors.

We Rely on Relationships: Homeless Service Providers' Experiences in Coordinating Care Transitions During COVID-19.

Care coordination occurring across multiple sectors of care, such as when professionals in health or social service organizations collaborate to transition patients from hospitals to community-based settings like homeless shelters, happens regularly in practice. While health services research is full of studies on the experiences of case management and care coordination professionals within health care settings, few studies highlight the perspective of nonclinical homeless service providers (HSPs) in coordinating care transitions. This study explores the experience of nonclinical HSPs, employed in a large homeless service agency in New York, United States, responsible for coordinating care transitions of patients presenting to a homeless shelter after hospitalization, with attention to COVID-19 impact. Semi-structured interviews were conducted with providers at three hierarchical levels (frontline, managerial, and executive). The data were analyzed using qualitative content analysis. The implementation science framework Normalization Process Theory was used to structure semi-deductive coding categories. The findings included three major themes that highlight promoting and inhibiting factors in care coordination, including a reliance on informal relationships, the impact of strong hierarchical structures, and a lack of collaborative cross-sector information exchange pathways. Altogether, findings offer insights from an infrequently studied professional group engaging in cross-sector care coordination for a high-risk population. Operational insights can inform future research to ensure that the implementation of interventions to improve cross-sector care coordination is evidence-based. This study of nonclinical HSPs facilitating care transitions demonstrates the importance of understanding this critical provider population. Opportunities for acute care case managers and administrators include the importance of relationships, reciprocal education on the differences in work settings, and the need for administrative structure to ensure complex clinical information is effectively translated.

SUSTAINABLE ORGANIZATIONAL PERFORMANCE IN HEALTHCARE: A LITERATURE REVIEW

Purpose: The purpose of this research is to explain the variables that influence Sustainable Organizational Performance (SOP) in health services. Theoretical framework: Performance assessment plays a key role in delivering high-quality healthcare services. Concept of Sustainability Organizational Performance (SOP) considers the natural environment, social and economic aspects of performance, which is also in line with the Triple Bottom Line (TBL) concept. The review aims to identify which factors are most important in the literature for Sustainability Organizational Performance in health services. Methods: The method used is PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Database searches were carried out via Google Scholar, Science Direct and PubMed. The keywords used in journal searches are Sustainable Organizational Performance" OR "Sustainability Performance" OR "Sustainability Organizational". Result and Conclusion: The results of the database search obtained 4,022,675 journals that matched the keywords, which were then screened based on inclusion criteria and exclusion criteria to obtain 36 journals. Of the 36 journals, there are 64 variables that influence SOP. Implications of research: This study enhances ten variables of which are the highest variables that influence the SOP the most, namely Outcome, Leadership, Culture, Innovation, Human Resource Management, Knowledge Management, Strategy, Organization, Evaluation and Competitiveness which influence each other. Originality/ Value: The value of this article can be used as material for conducting further research on health service organizations to get an idea of how organizations achieve sustainability outcomes.

A self-assessment guide for readiness to govern

PurposeThis viewpoint introduces a “Readiness Self-Assessment Guide” that can be used as a diagnostic tool to help health service governors and managers, particularly in Low-Middle Income Countries, or those in the early stages of developing their governance program.Design/methodology/approachThe approach uses the conceptual framework for governance developed by Barbazza and Tello (2014).FindingsThe Guide is based on five foundational elements or components of governance that frame the actual governance activities. The self-assessment process uses a sequence of real-world examples to help users of the Guide assess their organization’s “readiness” or current capacity to strengthen quality. A simple scoring process allows users to rate their organization’s progress through potential evolutionary steps. The resulting analysis is intended to be the starting point of a structured discussion among team members about priorities, enabling factors and constraints.Practical implicationsAssessment of the institutional context is a fundamental step that will enable quality teams to select the appropriate tools for their priority concerns. This Readiness Self-Assessment Guide can be used as part of that diagnostic assessment.Originality/valueThis paper is empirically derived from the author’s experience as a consultant helping health service organizations and governing authorities to develop health governance programs in several countries.

The value of health service-based research to health service organisations: a qualitative study with senior health service executives

BackgroundResearch evidence has demonstrably improved health care practices and patient outcomes. However, systemic translation of evidence into practice is far from optimal. The reasons are complex, but often because research is not well aligned with health service priorities. The aim of this study was to explore the experiences and perspectives of senior health service executives on two issues: (1) the alignment between local research activity and the needs and priorities of their health services, and (2) the extent to which research is or can be integrated as part of usual health care practice.MethodsIn this qualitative study, semi-structured interviews were conducted with senior health leaders from four large health service organisations that are members of Sydney Health Partners (SHP), one of Australia’s nationally accredited research translation centres committed to accelerating the translation of research findings into evidence-based health care. The interviews were conducted between November 2022 and January 2023, and were either audio-recorded and transcribed verbatim or recorded in the interviewer field notes. A thematic analysis of the interview data was conducted by two researchers, using the framework method to identify common themes.ResultsSeventeen health executives were interviewed, including chief executives, directors of medical services, nursing, allied health, research, and others in executive leadership roles. Responses to issue (1) included themes on re-balancing curiosity- and priority-driven research; providing more support for research activity within health organisations; and helping health professionals and researchers discuss researchable priorities. Responses to issue (2) included identification of elements considered essential for embedding research in health care; and the need to break down silos between research and health care, as well as within health organisations.ConclusionsHealth service leaders value research but want more research that aligns with their needs and priorities. Discussions with researchers about those priorities may need some facilitation. Making research a more integrated part of health care will require strong and broad executive leadership, resources and infrastructure, and investing in capacity- and capability-building across health clinicians, managers and executive staff.

Exploration of Hospital Management and Organization Strategies: A Literature Review of Health Services

Background - Healthcare management strategy and organization encompasses the principles and practices used to operate healthcare facilities efficiently and effectively. It involves the planning, implementation, and coordination of various activities to ensure the delivery of high-quality patient care while optimising resource utilisation. The literature review in healthcare provides valuable insights into various aspects of hospital management strategy and organization. Objective - This article aims to find out the importance of management and organizational strategies in service businesses (hospitals) and related factors, so as to create improved human resource performance related to achieving effective and efficient organizational goals to face business competition and can be an organizational strategy in creating job satisfaction, can perform well and can create a competitive advantage for organizations in health services. Research Methode - The method used is the identification of previous articles with a total of 29 articles in the time span of 2000-2023. Search data for literature review was conducted in international journals to support the theory and take the topic of Management and Organizational articles, found 234,347 articles, scope Innovation, 2000-2023, Business, management and accounting, article, organization and management, English found 1,239 articles, Qualitative - 363 articles, Strategic - 134 articles, Performance - 95 articles, Effectiveness - 52 articles, Leadership, Health - 35 articles. Furthermore, articles that do not fit the topic will be ignored. Researchers only use data bases from Scopus and Web of Science because researchers only look for quality articles and the results are more accurate and very credible sources, because the results can be used as references and policies. Results - The importance of the role of management and organization in hospitals and can have a major impact on healthcare organizations. As explained in previous research that Management has a big role to improve hospital performance in an organization. The importance of management and organizational performance as they relate to each other. Human resources (HR) provide special attention in personal development and impact on performance in creating a health service. Conclusion - Management and organization are important in the hospital business because human resources are the driving force of the service business. Good management and organization can create professional and talented human resources results that can improve performance and will have an impact on organizational goals, and services to patients can run well which has an impact on the main objectives of the hospital. Management can be seen from several things including training and development, management practices, organizational climate, and other things that have a relationship in creating effective and efficient management so as to provide optimal results for the organization. Managerial Implications - The healthcare management needs to pay more attention to the evaluation of healthcare operational activities and feedback provided by patient families, the hospital management needs to increase the frequency of its discussions with employees to maintain excellent service quality for patient families, and the hospital management leaders need to set an example and encourage their employees to maintain a good organizational culture in order to maintain their service image.

‘It’s a delicate topic’: Stigma, capabilities and young people’s mental health in post-conflict Colombia

ABSTRACT Young people in Colombia present high rates of mental health problems, to which the country’s history of armed internal conflict contributes in complex ways. Mental health services in Colombia are fragmented, inadequate, and difficult to access for many. Young people’s help-seeking is often hindered by mental health stigma and/or poor experiences with services. This paper presents a thematic analysis of qualitative data from a mixed-methods study aimed at developing and testing a mental health intervention for Colombian youths. We draw upon theoretical lenses from scholarly work on stigma and Sen’s ‘capabilities approach’ to inform our analysis of interviews and group discussions with staff and young people involved in the state-funded human capital building programme ‘Jovenes en Acción’ (JeA). By illustrating how study participants talked about stigma, vulnerability, mental health services organisation, and the challenges of discussing mental health topics in a learning environment, we illuminate aspects of mental health support and anti-stigma interventions that might need enhancing. In particular, we suggest that more emphasis on ‘community competencies’ as complementary to and interrelated with individual competencies would strengthen young people’s individual and collective resources for mental wellbeing while being in line with the sociocritical principles of existing human capital-enhancing programmes.

Decentralization and immunization program in a single-party state: the case of the Lao People’s Democratic Republic

BackgroundThe Lao People’s Democratic Republic (Lao PDR), a lower-middle-income country, lags behind other Southeast Asian countries in immunization coverage for children under two years of age. The organization of health services is a key determinant of the functionality of immunization programs. However, this aspect, and in particular its decentralization component of the healthcare system, has never been studied.MethodsA case study in the Lao National Immunization Program was performed using a neo-institutional theory-based conceptual framework, highlighting the structure (rules, laws, resources, etc.) and interpretative schemes (dominant beliefs and ideas) that underlie the state of decentralization of the healthcare system that support the conduct of the immunization program. Twenty-two semi-structured interviews were conducted with representative actors from various government levels, external donors, and civil society, in four provinces. Data were complemented with information retrieved from relevant documents.ResultsThe Lao healthcare system has a deconcentrated form of decentralization. It has a largely centralized structure, albeit with certain measures promoting the decentralization of its immunization programs. The structure underlying the state of centralization of immunization services provided is coherent with a shared dominant interpretive scheme. However, the rapid economic, technical, and educational changes affecting the country suggest that the coherence between structure and interpretative schemes is bound to change.ConclusionUnprecedented opportunities to access quality higher education and the use of social networks are factors in Lao PDR that could affect the distribution of responsibilities of the different levels of government for public health programs such as the National Immunization Program.

Investigating Electronic Incident Reporting Systems and Its Role Within Healthcare to Improve Patient Safety: An Integrative Literature Review

Incident reporting is a welcomed practice in industries such as aviation for improving safety. This practice is now welcomed in healthcare in many countries (Vincent, 2010). For instance, In the UK, incident reporting is a component of individual hospital risk governance processes and a key requirement for National Health Service (NHS) Organizations (Rooksby et al., 2007). In spite of this, widespread implementation of incident reporting is still not clear even though reporting has resulted in improvements to safety. Vincent et al. (2008) cited that recent studies of incident reporting suggest that its role in managing safety has been over emphasized and there should be less emphasis on counting incidents and more emphasis on analyzing the effectiveness of incidents and institutional learning (Braithwaite et al., 2011). Most studies of incident reporting have focused on factors, such as staff willingness to report incidents, barriers to incident reporting, and the culture surrounding reporting. However, few studies have examined the effectiveness of electronic incident reporting systems in improving safety, and there is little evidence regarding how the technology contributes to safety (Anderson et al., 2013). For this reason, the purpose of this study was to investigate electronic incident reporting systems and its role within healthcare to improve patient safety. By focusing on this, the researcher was successful in highlighting a series of behaviors and perceptions around electronic incident reporting. Equally important, the researcher provided several themes that has been known to both inhibit and promote confidence within this technology offering. Thereafter, the researcher then suggested strategies for healthcare leaders to consider when adopting as a means to help bridge the gap between healthcare workers and electronic incident reporting systems.

Risk mitigations to prevent methotrexate dispensing errors in English hospitals: a mixed-methods exploratory study

Abstract Introduction Oral methotrexate is indicated for paediatric cancer indications and autoimmune diseases. Unfortunately, cases of inadvertent overdose due to confusion between 2.5mg and 10mg tablet strengths are widely documented. National guidance is available to prevent such errors; indeed, the overdose of methotrexate for non-cancer treatment is a Never Event.[1] At our organisation, the main mitigations to reduce the risk of dispensing errors were to segregate tablet strengths and restrict 10mg tablets to cancer indications.[2] Adherence had not been evaluated, and alternative risk mitigations had not been explored. Aim We aimed to 1) determine whether methotrexate 10mg tablets were restricted to cancer indications; and 2) explore strategies to prevent errors associated with methotrexate tablet strength at a sample of hospitals. Methods First, an audit approach was used to determine use of 10mg tablets; standards were derived from local policy.[2] The setting was a large teaching hospital providing acute, specialist, paediatric and cancer care. Dispensing transactions of 10mg tablets on the electronic pharmacy dispensing system between April 2022 and March 2023 were included. Details of prescription, dispensed quantity, dose instructions and speciality were recorded onto the data collection tool. Data were analysed descriptively. Second, a survey was conducted with a sample of twenty English hospitals (including the study site). These comprised ten large teaching hospitals and specialist paediatric cancer centres. A relevant pharmacist was contacted by email at each trust and asked a series of open questions about local risk strategies associated with methotrexate 10mg tablets. Notes were taken and data summarised descriptively. Results There were 79 dispensing issues for methotrexate 10mg tablets. Of those, 65 issues were for 13 cancer patients; the other 14 were erroneous issues where 10mg were dispensed instead of 2.5mg for non-cancer indications. Whilst most errors were rectified (n=13), one patient received a weekly dose of 40mg instead of 10mg, a four-times overdose. Nineteen (95%) trusts responded to our survey. There were three broad strategies reported: to only use 2.5mg tablets (n=9); isolate dispensing of 10mg tablets to dedicated cancer or paediatric dispensaries (n=5); or reliance on local protocol and physical segregation of 2.5mg and 10mg tablets within multi-service dispensaries (n=5). Conclusion It was encouraging that 10mg tablets were solely intended for cancer indications. However, the incidental discovery of errors highlighted the need for improvement. Findings suggest that eliminating 10mg tablets from practice was a feasible strategy, even for organisations providing cancer services. Findings have limited generalisability due to the small sample sizes, and detail provided in survey responses was variable. Nevertheless, the audit was effective in identifying a previously unknown Never Event. National Health Service organisations should acknowledge the risk associated with keeping 2.5mg and 10mg methotrexate tablets, particularly within dispensaries servicing multiple specialties. Dedicated cancer dispensaries are not commonplace, therefore eliminating 10mg tablets altogether should be considered. Indeed, the principle of limiting strengths is a well-established and effective medication risk management strategy. Further research should explore the potential negative implications for patients, such as increased tablet burden, if 2.5mg tablets are used exclusively for all indications. This may further inform national strategy to prevent Never Events.

The Online Support System for Mental Health Problems After the Earthquake: A Prompt Response from The Psychiatric Association of Turkey

IntroductionPrevious research demonstrated that disasters have adverse mental health outcomes. Preventive mental health interventions in the golden hours/days after a disaster may reduce psychological harm by getting in the way of emerging mental disorders or alleviating existing ones. The widespread use of smartphones and broad internet access enabled remote mental health interventions during disasters. After the 2023 Turkey earthquake, observing the mental health burden of the earthquake, The Psychiatric Association of Turkey conducted an online platform for psychological first aid. The aim was to unite volunteer psychiatrists and disaster survivors.ObjectivesThis study presents the organization of an online mental health service during a disaster while reporting the characteristics of the service users.MethodsThe Psychiatric Association of Turkey called its members to volunteer for an Online Support System for Mental Problems After the Earthquake. The group regularly united to set standards of care. An action plan and algorithm were set up for applicants with acute suicidal, homicidal risk, or active psychotic symptoms in collaboration with local institutions and field volunteers. Volunteer psychiatrists were asked to collect information on the applicant’s sociodemographic characteristics, disaster experience, and mental health status.ResultsVolunteer psychiatrists collected data on 180 applications. Most cases applied for themselves (%95.5), and some asked for advice to care for their relatives (%4.5). Earthquake survivors have the highest psychopathology rate (%64.9), followed by healthcare workers and search and rescue personnel (%61.1). Figure 1 summarizes the subgroups of the service users. The earthquake survivors group had a mean age of 34.45, % and 76.1 of them were female. Only %15.7 of them had lower educational levels than high school. %75 cases reached safe places on the 5th day of the disaster. Applicants reported discrimination and aggression after the catastrophe, related to experiencing mental health problems, owning a pet, looting, and being seen as less traumatized since their relatives are alive.Image:ConclusionsThe present experience of the Psychiatric Association of Turkey is an example of a fast and collaborative response to a disaster regarding mental health. Our results also represent the characteristics of online mental health service users during a disaster.Disclosure of InterestNone Declared