Knowledge Of Health Systems Research Articles

Optimizing health system volume flexibility: key determinants and strategies during the COVID-19 crisis.

The need to match highly variable demand for healthcare services with existing capacity has been a significant health system challenge experienced by the COVID-19 pandemic. Despite mounting research on various COVID-19 responses in the recent literature, there has not been a structured review examining key determinants of health system volume flexibility. The focus of the present research is to review recent literature based on a conceptual framework developed based on the volume flexibility literature on COVID-19. The review also provides a meaningful way to guide practice and future research in the area. A literature review was performed guided by the theoretical frameworks developed in the previous volume of flexibility literature. Selected research papers were reviewed and analyzed to identify key determinants of health system volume flexibility. Seven determinants of health system volume flexibility under three domains (demand management, capacity management, and performance) included demand management strategies, integration, capacity management strategies, workforce management, technology, quality of disease outcomes, and health system knowledge. The research provides both health systems researchers as well as practitioners with a foundational conceptual framework and knowledge related to health system volume flexibility. In addition, this research identifies future research areas to expand knowledge relevant to health system volume flexibility.

Developing and validating a HEalthCare NAvigation Competency (HECNAC) Scale for refugees in the United States.

The complex healthcare system in the United States (US) poses significant challenges for people, particularly minorities such as refugees. Refugees often encounter additional layers of challenges to healthcare navigation due to unfamiliarity with the system, limited health literacy, and language barriers. Despite their challenges, it is difficult to identify the gaps as few tools exist to measure navigation competency among this population and many conventional tools assume English proficiency, making them inadequate for refugees and other immigrants. To address this gap, this study developed and validated a HEalthCare NAvigation Competency (HECNAC) Scale tailored to refugees' needs. The scale development process followed three phases: domain identification through a literature review and stakeholder interviews (n = 15), content validation through the Delphi method (2 rounds, n = 12), and face validity assessment via cognitive interviews (2 rounds, n = 4). Based on a literature review and stakeholder interviews, the initial version of the scale was developed, including ten domains and 47 items. An introductory email concerning the scale and the Delphi process was subsequently sent to 21 eligible experts, including staff from refugee resettlement agencies, health care providers serving refugee communities, and refugees. Twelve experts completed the two rounds of the Delphi, resulting in a consensus on 39 items. After conducting cognitive interviews with 4 Afghan refugees, the scale was finalized with ten domains and 35 items. The finalized scale captures multifaceted aspects of healthcare navigation crucial for refugees, organized into domains such as health system knowledge, insurance, making an appointment, transportation, preparing for a visit, in the clinic, interpretation, medicine, medical bills, and preventive care. Overall, the HECNAC Scale represents a significant step towards understanding and assessing refugees' competencies in navigating the US healthcare system. It has the potential to guide tailored interventions and standardized training curricula and ultimately mitigate persistent barriers faced by refugees in accessing healthcare services.

Barriers and enablers to secondary use of multi-regional linked administrative health data for three distinct user groups: academic researchers, health-system knowledge users, and private sector researchers

Objective and ApproachWe analyzed barriers and enablers to accessing pan-Canadian health sector data and data analytic services for three distinct user groups: 1) academic researchers, 2) health-system knowledge users (KUs), and 3) private sector researchers. Specifically, we a) conducted a legislative and policy scan regarding use of health administrative data for research, quality improvement, and health system management and b) systematically consulted with data centre directors and staff, privacy and legal experts, knowledge users (KUs), private sector entities, and university and government officials. ResultsKUs and private sector organizations face unique barriers because structures and regulations related to data access and use are set at multiple university and government institutions and are primarily designed for academic research. Additionally, data repositories often have specific policy/legislative barriers to working with KUs and/or private sector researchers. However, all groups face common issues including variations in regional regulations and policies making harmonized and streamlined processes challenging; lengthy data access and ethics review processes; and regional variations in data availability. Enablers included diverse expertise and initiatives across Canada such as: initiatives to streamline ethics reviews for multi-regional research, expand data holdings, increase standardization and harmonization, and implement systems for federated analyses. ConclusionsAccess to health system data and analytics in Canada varies by user group and across regions. Although each user group faces unique challenges, they also all have many barriers and enablers in common. ImplicationsImproving health system data access for one use group has the potential to benefit the others.

Supplementing systematic review findings with healthcare system data: pilot projects from the Agency for Healthcare Research and Quality Evidence-based Practice Center program

ObjectivesThe US Agency for Healthcare Research and Quality, through the Evidence-based Practice Center (EPC) Program, aims to provide health system decision makers with the highest-quality evidence to inform clinical decisions. However, limitations in the literature may lead to inconclusive findings in EPC systematic reviews (SRs). The EPC Program conducted pilot projects to understand the feasibility, benefits, and challenges of utilizing health system data to augment SR findings to support confidence in healthcare decision-making based on real-world experiences. Study Design and SettingThree contractors (each an EPC located at a different health system) selected a recently completed SR conducted by their center and identified an evidence gap that electronic health record (EHR) data might address. All pilot project topics addressed clinical questions as opposed to care delivery, care organization, or care disparities topics that are common in EPC reports. Topic areas addressed by each EPC included infantile epilepsy, migraine, and hip fracture. EPCs also tracked additional resources needed to conduct supplemental analyses. The workgroup met monthly in 2022-2023 to discuss challenges and lessons learned from the pilot projects. ResultsTwo supplemental data analyses filled an evidence gap identified in the SRs (raised certainty of evidence, improved applicability) and the third filled a health system knowledge gap. Project challenges fell under three themes: regulatory and logistical issues, data collection and analysis, and interpretation and presentation of findings. Limited ability to capture key clinical variables given inconsistent or missing data within the EHR was a major limitation. The workgroup found that conducting supplemental data analysis alongside an SR was feasible but adds considerable time and resources to the review process (estimated total hours to complete pilot projects ranged from 283 to 595 across EPCs), and that the increased effort and resources added limited incremental value. ConclusionSupplementing existing SRs with analyses of EHR data is resource intensive and requires specialized skillsets throughout the process. While using EHR data for research has immense potential to generate real-world evidence and fill knowledge gaps, these data may not yet be ready for routine use alongside SRs.

Streamlining Communication: "Resident Huddle" on General Medicine Wards at a Veterans Affairs Hospital.

Background Orienting medical trainees to new practice environments is essential. Huddles have been shown to improve communication and safety outcomes. However, their use in orienting trainees to systems processes and changes on inpatient general medicine (GM) wards remains unexplored. Objective Implement a weekly inpatient huddle between residents and hospital leaders to improve dissemination of information around health system operations. Methods In 2019, we established "Resident Huddle," a weekly 20-minute huddle for senior internal medicine residents rotating on GM wards at a US Department of Veterans Affairs Hospital led by the site leads. Resident Huddle content included system updates, rotation updates, process reminders, performance feedback, and systems and patient safety concerns raised by trainees. Reactions to the huddle were assessed via survey. Behavioral change was assessed by rates of complete trainee admission medication reconciliation documentation before and after huddle implementation. Results Resident Huddle started in October 2019 and continues to this day. Between October 2019 and June 2022, 136 of 205 participants completed surveys (66% response rate). Respondents agreed or strongly agreed that the huddle provided useful information for care delivery (94%, 128 of 136), improved work engagement (73%, 99 of 136), provided feedback on practice patterns (90%, 121 of 135), and that issues they experienced were acknowledged and acted upon (86%, 114 of 133). Retrospective medical record analysis demonstrated improvement in admission medication reconciliation completion rate by trainees from pre-intervention (32%, 19 of 60) to post-intervention (73%, 44 of 60). Conclusions A weekly huddle between hospital leaders and residents strengthened communication and equipped trainees with operational health systems knowledge to enhance patient care outcomes while fostering a greater sense of engagement with their work environment.

System's Crisis Resilience as a Societal Crisis: Knowledge Structure and Gaze of the Finnish Health Care System.

The crisis resilience of vital social systems is currently the target of constant development efforts in Finland, as their drifting into crisis would weaken societies' functional abilities, safety, and security. This is also the case regarding the Finnish health care system. In an attempt to move beyond existing frameworks of crisis imagination, this article takes an unconventional stance by elucidating endogenous crisis dynamics present in the Finnish health care system. Delphi process was conducted for top experts in Finnish health care and crisis management. With a dissensus-seeking orientation, our aim was to fertilize disagreements among panelists to reveal key vulnerabilities in the health system. Despite our efforts to evoke dissensus, the panelists ended up generating a consensus that aims to protect the underlying assumptions of the health system's knowledge structure. Through inductive analysis of expert discourses, the data was analyzed through our research question "what constitutes a crisis-proof health system and a crisis-prone health system". What is framed as a strength of the system by our panelists, namely the ability to maintain legitimacy, improve efficiency, and guarantee continuity, can still have questionable implications that are left ungrasped. A system's theory approach illustrates how such effects can develop and escalate beyond the reach of social interventions, and thus be predisposed to cause objectionable yet concealed social crises. The discussion illustrates how these endogenous crisis dynamics could be seen to materialize in real-life cases.

Health research prioritization in Somalia: setting the agenda for context specific knowledge to advance universal health coverage.

Despite recognition that health research is an imperative to progress toward universal health coverage, resources for health research are limited. Yet, especially in sub-Saharan Africa, more than 85% of the resources available for health research are spent on answering less relevant research questions. This misalignment is partially due to absence of locally determined health research priorities. In this study, we identified health research priorities which, if implemented, can inform local interventions required to accelerate progress toward universal health coverage in Somalia. We adapted the child health and nutrition research initiative method for research priority setting and applied it in 4 major phases: (1) establishment of an exercise management team, (2) a web-based survey among 84 respondents to identify health research questions; (3) categorization of identified health research questions; and (4) a workshop with 42 participants to score and rank the identified health research questions. Ethical approval was received from ethics review committee of the London School of Hygiene and Tropical Medicine (Ref:26524) and the Somali Research and Development Institute (Ref: EA0143). Two hundred and thirty-one unique health research questions were identified and categorized under health systems, services and social determinants (77), communicable diseases (54), non-communicable diseases (41) and reproductive, maternal, new-born, child, adolescent health and nutrition (59). A priority score ranging from 1 to 9 was assigned to each of the questions. For each category, a list of 10 questions with the highest priority scores was developed. Across the four categories, an overall list of 10 questions with the highest priority scores was also developed. These related to bottlenecks to accessing essential health services, use of evidence in decision making, antimicrobial resistance, distribution and risk factors for non-communicable diseases, post-traumatic stress disorder and factors associated with low antenatal care attendance among others. The developed priority research questions can be used to focus health research and to inform appropriation of health research resources to questions that contribute to generation of local health system knowledge which is required to accelerate progress toward universal health coverage in Somalia. The Somalia national institute of health should set up a consortium for provision of technical and financial support for research addressing the identified priority research questions, establish a mechanism to continuously monitor the extent to which new health interventions in Somalia are informed by knowledge generated through conducting prioritized health research and prioritize interventions aimed at strengthening the broader national health research system for Somalia.

Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia

BackgroundPatients from culturally and linguistically diverse (CALD) backgrounds often face difficulties in accessing health and social care services. This study explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in general practice setting, to help patients from CALD backgrounds access health and social care services in Australia.MethodsThis research was conducted in two general practices in Sydney where most patients are from specific CALD backgrounds (Chinese in one practice and Samoan in other). Three CHWs trained as BCNs were placed in these practices to help patients access health and social care service. A mixed-method design was followed to explore the feasibility and acceptability of this intervention including analysis of a record of services provided by BCNs and post-intervention qualitative interviews with patients, practice staff and BCNs exploring the feasibility and acceptability of the BCNs’ role. The record was analyzed using descriptive statistics and interviews were audio-recorded, transcribed, and thematically analyzed.ResultsBCNs served a total of 95 patients, providing help with referral to other services (52.6%), information about appointments (46.3%), local resources (12.6%) or available social benefits (23.2%). Most patients received one service from BCNs with the average duration of appointments being half an hour. Overall, BCNs fitted in well within the practices and patients as well as staff of participating practices accepted them well. Their role was facilitated by patients’ felt need for and acceptance of BCNs’ services, recruitment of BCNs from the patient community, as well as BCNs’ training and motivation for their role. Major barriers for patients to access BCNs’ services included lack of awareness of the BCNs’ roles among some patients and practice staff, unavailability of information about local culture specific services, and inadequate time and health system knowledge by BCNs. Limited funding support and the short timeframe of the project were major limitations of the project.ConclusionBCNs’ placement in general practice was feasible and acceptable to patients and staff in these practices. This first step needs to be followed by accredited training, development of the workforce and establishing systems for supervision in order to sustain the program. Future research is needed on the extension of the intrevention to other practices and culture groups.

The Clinical Microsystems Clerkship at University of California, San Francisco: Integrating Clinical Skills and Health Systems Improvement for Early Medical Students.

Medical educators recognize that partnering actively with health system leaders closes significant health care experience, quality, and outcomes gaps. Medical schools have explored innovations training physicians to care for both individual patients and populations while improving systems of care. Yet, early medical student education fails to include systems improvement as foundational skills. When health systems science is taught, it is often separated from core clinical skills. The Clinical Microsystems Clerkship at the University of California, San Francisco School of Medicine, launched in 2016, integrates clinical skills training with health systems improvement from the start of medical school. Guided by communities of practice and workplace learning principles, it embeds first-year and second-year students in longitudinal clinical microsystems with physician coaches and interprofessional clinicians one day per week. Students learn medical history, physical examination, patient communication, interprofessional teamwork, and health systems improvement. Assessments include standardized patient examinations and improvement project reports. Program outcome measures include student satisfaction and attitudes, clinical skills performance, and evidence of systems improvement learning, including dissemination and scholarship. Students reported high satisfaction (first-year, 4.10; second-year, 4.29, on a scale of 1-5) and value (4.14) in their development as physicians. Clinical skills assessment accuracy was high (70%-96%). Guided by interprofessional clinicians across 15 departments, students completed 258 improvement projects in 3 health systems (academic, safety net, Veterans Affairs). Sample projects reduced disparities in hypertension, improved opiate safety, and decreased readmissions. Graduating students reported both clinical skills and health systems knowledge as important to physician success, patient experience, and clinical outcomes (4.73). Most graduates discussed their projects in residency applications (85%) and disseminated related papers and presentations (54%). Integrating systems improvement, interprofessional teamwork, and clinical skills training can redefine early medical student education. Health system perspectives, long-term outcomes, and sustainability merit further exploration.

“The world is so white”: improving cultural safety in healthcare systems for Australian Indigenous people with rheumatic heart disease

ObjectiveTo examine the views of senior health system knowledge holders, including Aboriginal experts, regarding the spaces where elimination strategies for rheumatic heart disease take place: Aboriginal and Torres Strait Islander ways of knowing, being and doing; and biomedical healthcare models. We aimed to support the implementation of the RHD Endgame Strategy by providing some of the ‘how’. MethodsIn‐depth interviews were undertaken with 23 participants. The design of the interview questions and analysis of the data used strengths‐based approaches as directed by Aboriginal researchers. ResultsGiven the dominance of the biomedical worldview, and the complex trajectory of RHD, there is significant tension in the intersection of worldviews. Tensions that limit productive dialogue are juxtaposed with suggestions on how to reduce tension through reflexivity, power shifting and endorsing Aboriginal leadership and governance. Evidence supported cultural safety for RHD care, prevention and elimination as the key action. ConclusionsRecommendations include addressing power imbalances between dominant and minority populations throughout the health system; reform that both supports and is supported by Non‐Indigenous and Aboriginal and Torres Strait Islander leadership. Implications for public healthIncreased understanding of and support for Indigenous leadership and cultural safety will enable implementation of the new RHD strategy.

Senior manager leadership competencies for quality residential aged care: an Australian industry perspective

BackgroundDocumented poor quality and standards of care in Australia’s residential aged care (RAC) sector have highlighted a need to better understand the role of and skills required by, RAC senior management personnel to address these concerns. This study examined which senior management leadership skills and personal qualities are necessary to deliver and strengthen the quality of RAC, with the aim of improving understanding of the professional development needs of leaders in the sector.MethodsWe conducted 12 in-depth interviews with Australian aged care industry experts, including academics, and representatives from the primary health network, consumer, and provider advocate groups. Abductive, thematic analysis incorporated coding derived from existing leadership skills frameworks as well as inductively identified themes.ResultsIdentified leadership skills were grouped into five domains including i) workforce development and retention, ii) governance and business acumen; iii) health systems knowledge; iv) stewardship and v) responding to regulatory and political contexts. Skills particularly emphasised by participants were those required to recruit and retain a skilled workforce, manage relationships, and promote a positive organisational culture and employee wellbeing.ConclusionsRAC senior managers require a complex mix of business, human resource management, and clinical skills to deliver quality care in Australia’s complex RAC setting. The lack of any professional development framework to guide the acquisition or updating of those skills is a concern.

Development of the Oral Health Literacy Profile (OHLP)-Psychometric properties of the oral health and dental health system knowledge scales.

Current oral health literacy (OHL) instruments vary in focus, methodology, administration time and burden. The widely used word recognition tests fail to encompass important OHL domains, while others exceed time frames for use in practical settings, require an interviewer or mainly measure self-assessments. This paper describes the development of the Oral Health Literacy Profile (OHLP), introduces its components and evaluates the psychometric properties of its two core modules, the knowledge tests. A preliminary version of the questionnaire was developed and assessed for content validity, relevance and redundancy by an expert panel. It was tested in a convenience sample (n=95) leading to the creation of a 28-item questionnaire, which was afterwards tested in a second convenience sample (n=193). Item difficulty, discrimination, internal reliability and construct validity were assessed for the oral health knowledge (OHK) and dental health system knowledge (DHSK) modules. The items showed acceptable range of difficulty (ideal: 7 items; easy: 5 items; and difficult: 3 items) and good to very good discriminatory power (the point-biserial index (PBI) > 0.30: all items). Construct validity was considered to be fulfilled when 75% of the hypotheses of expected group differences were met. Satisfactory internal reliability was observed. With all its components, the OHLP is a suitable short instrument to assess the most relevant dimensions of the multifaceted construct of OHL. The OHLP can be widely used in research, especially suitable in practical settings, and thereby identify patients who may benefit from oral health education.

Improving Collaboration Between Public Health and Medicine: A Timely Survey of Clinician Public Health Knowledge, Training, and Engagement

ObjectiveTo assess the core knowledge of health indicators, federal health programs, and public health functions in practicing clinicians along with perceptions of their education and engagement with public health. Patients and MethodsA paper survey in booklet form was administered to attendees at 2 general medical conferences in May 2019. The survey was divided into 5 sections: knowledge of health systems and policy, knowledge of public health concepts and function, public health engagement, public health education, and demographics. ResultsOne hundred two surveys were received from 402 attendees (response rate, 24.3%). Most were male (56%), older than 50 years (51%), and physicians (86%). Respondents had a fairly good knowledge of federal health programs (77%) and public health functions (84%), but less than half had a personal interaction with public health in the past 2 years (45%) or were aware of how to work with public health organizations in their community (46%). Only a few respondents rated their public health training as good or excellent during their primary degree (7%) or graduate medical education (15%), and most (75%) were interested in learning more about public health and health policy. ConclusionRespondents had generally good foundational knowledge of federal health programs and public health functions, although some gaps were identified. Inclusion of health policy and public health topics in continuing medical education would be well received by clinicians. To improve collaboration between public health and medicine, public health should personally engage clinicians more and explain how they can work together to improve population health.

Training mental health peer support training facilitators: a qualitative, participatory evaluation.

The facilitator's training for peer support workers in mental health course was a recovery-based initiative addressed to professionalize peer support in Catalonia, Spain. Our aim was to elicit participants' motivations, significant learnings, and opinions regarding the training programme. A qualitative approach was used through content and thematic analyses of the course contents and participation narratives. The motivations to attend the course were helping others, learning, and supporting the implementation of the peer support profession. Participants learnt concepts on pedagogy, peer support, and recovery. The key resulting themes were organization and moderation; peer support's role, skills, functions, and values; language; health system knowledge; and types of support. The course programme seems appropriate in preparing people who have lived experience of mental health problems as facilitators of future peer support training courses. The present analysis identifies the participants' vision regarding their learning needs. It aims to serve as a guide for similar train-the-trainers courses.

Menstrual health and period poverty among young people who menstruate in the Barcelona metropolitan area (Spain): protocol of a mixed-methods study

IntroductionThe importance of menstrual health has been historically neglected, mostly due to taboos and misconceptions around menstruation and androcentrism within health knowledge and health systems around the world. There has...

A Required, Combined Neurology-Physical Medicine and Rehabilitation Clerkship Addresses Clinical and Health Systems Knowledge Gaps for Fourth-Year Medical Students.

This study evaluated the impact of a 4-wk mandatory neurology-physical medicine and rehabilitation advanced-core clerkship for fourth-year medical students. The combined clerkship encouraged an interdisciplinary and function-based approach to the management of common neurologic, musculoskeletal, and pain complaints. Seventy-three fourth-year medical students participated in the rotation over 1 yr. A survey assessing knowledge and skill set topics was conducted before and after the clerkship. Qualitative feedback regarding the rotation was provided by the students and analyzed. Significant gaps in knowledge and skill sets were identified before the clerkship and successfully addressed by combined teaching modalities. These data demonstrate that an integrated neurology-physical medicine and rehabilitation clerkship can improve students' confidence in multiple domains. Integrating physical medicine and rehabilitation into core clerkships at other medical schools may provide an avenue to address curriculum gaps.

Transnational Networks' Contribution to Health Policy Diffusion: A Mixed Method Study of the PerformanceBased Financing Community of Practice in Africa.

Background: Transnational networks such as Communities of Practice (CoPs) are flourishing, yet their role in diffusing health systems reforms has been seldom investigated. Over the past decade, performance-based financing (PBF) has rapidly spread in Africa. This study explores how, through the PBF Community of Practice’s attributes, structure, and strategies, PBF diffusion was fostered in sub-Saharan Africa (SSA). Methods: Informed by the diffusion entrepreneurs’ (DEs) framework dimensions, we used a mixed methods convergent design to investigate how the attributes, structure, and strategies of this community fostered the diffusion of PBF. The quantitative strand of work included firstly a semantic discourse analysis of textual data extracted from CoP’s online discussion forum (n=1346 posts). Secondly, the relational data extracted from these 1346 forum posts was examined using social network analysis (SNA). We confronted these quantitative results with a thematic analysis of qualitative interviews (n=40) and data extracted from the CoP’s key documentation (n=17). Results: CoP members’ attributes included: representation systems anchored in clinical and economic sciences, strong expectations that the CoP would boost professional visibility and career, and significant health systems knowledge and social resources. The CoP’s core group, dominated by high-income country (HIC) members, critically matched PBF principles to major health systems issues in Africa. The broad consensus in online PBF thematic discussions created a strong sense of community, a breeding ground for emulation among CoP members. The CoP also sought to produce and promote experiential knowledge exchanges about PBF amongst African practitioners. Findings from network analyses showed that the promoted Africa-driven community was led by HIC members, although their prominence tended to decrease with time. Conclusion: This empirical research highlighted some of the constituting features, structure, and strategies of policy networks in influencing health policy diffusion. Despite good intentions to disrupt the established governance landscape, influential actors coming from HICs continued to drive the framing, and shaped health systems policy experimentation, emulation, and learning in African countries. Beyond mere knowledge exchange platforms, CoP can act as meaningful transnational policy networks pursuing the diffusion of health systems reforms, such as PBF.

Construction of Mental Health Education System for College Counselors Based on Web Technology

The basic task of a college counselor to stand up to people is to contact more college students, and it is also an irreplaceable middle force for mental health education in colleges. Looking at the mental health education of college students in our country, college counselors lack the necessary psychological knowledge and attach little importance to mental health education, which leads to a great reduction in the role of mental health education practice. The purpose of this article is to build a web-based psychological health education system for college counselors, to provide psychological health education services to college counselors, and to improve the mental health education of counselors. This article will build a web-based mental health education system for college counselors based on a systematic approach so that computer networks and web technologies can be used to improve the level of mental health education services for college counselors. The system is composed of two subsystems, an online expert-type mental health knowledge system and an online psychological counseling system. The experimental results show that the college counselors’ learning on this system has strengthened the psychological common sense of college counselors, improved the counselors’ ability of self-cognition, self-evaluation, and self-balance, and also improved the counselors’ Ability for mental health education.

Impacts of case-based health knowledge system in hospital management: The mediating role of group effectiveness

With the rise of artificial intelligence, case-based health knowledge management systems (CBHKS) have been widely adopted in hospitals. CBHKS are data-driven intelligent platforms that integrate latest technologies, such as artificial intelligence and cloud computing. As an integral part of smart hospitals, CBHKS can support decision processes at different levels in hospitals. However, researchers have not yet clearly addressed how CBHBKS improves hospital management outcomes. Based on group effectiveness and leadership performance-maintenance theories, we develop a conceptual model to explain the role of CBHKS in hospital management. To test the research hypotheses in the conceptual model, we collected survey data from 214 doctors, and performed data analysis using partial least squares (PLS)-based structural equation modeling. The empirical testing results show that the CBHKS implementation significantly and positively influences group performance, group members’ satisfaction, group learning, and external satisfaction; and group members’ satisfaction and external satisfaction significantly and positively affect management performance and maintenance.

Surgery at Sea: Exploring the Training Gap for Isolated Military Surgeons

Newly-graduated military general surgeons often find themselves isolated at sea, solely responsible for all surgical care of several thousand sailors, regardless of the surgical specialty training required for any individual procedure. This educational need assessment explored trends in afloat surgical care over the last 25 years, and assessed trainees' preparedness for their expected role as an isolated surgeon. A sample of deidentified US Navy Ship's Surgeon case logs were reviewed to determine afloat case load trends in 5 common afloat case categories (urologic/gynecologic, anorectal, hernia, appendectomy, and hand/orthopedic/trauma) from 1990s to 2017. Individual procedures were mapped to American College of Surgeons/Military Health System Knowledge, Skills, and Attitudes line items to ensure afloat-relevant skills were identified. Recent military resident case logs were then compared with afloat cases to evaluate relevant trainee experience. US Navy ships at sea from 1995 to 2017. US Navy afloat-deployed surgeons, totaling 1340 cases within the study period. Case log analysis of 1340 surgeries, comprising >200 months at sea, reflected 46 named procedures; 34 of 46 (74%) correlated to an intraoperative knowledge, skills, and attitudes item. The most common surgeries were vasectomy, (304 of 1340, 23%). No difference in case mix was apparent comparing pre- and post-2000 deployments (representing afloat laparoscopic integration) in 4 of 5 categories, while hernias proportionally declined. Case volume per deployment markedly declined overall (p < 0.001) and in each category. Resident case log analysis from 2012 to 2016 showed experience was limited in urologic/gynecologic, orthopedic, and open appendectomy categories. No formal case repository exists for afloat surgery, making detailed analysis problematic. Current training provides excellent surgical education but minimal exposure to rare-but-real cases expected on deployments, which may not translate to competency for the isolated, afloat surgeon. Military surgical leadership should embrace training for these cases and assertively invest in the development of the military's newest surgeons.