Healthcare Managers Research Articles

Healthcare Leadership in Times of Crisis

Leadership is never more important than during a time of crisis, as healthcare organizations everywhere learned during the COVID-19 pandemic. This article defines crisis as it applies to healthcare leadership and suggests the various kinds of crises healthcare organizations may face in the future. It explores the psychology of crisis leadership—specifically, what it means for a leader to hold and contain during a crisis. It also explains the difference between crisis leadership and crisis management, and how the two work together. This article then offers healthcare administrators, leaders, and managers 25 practical strategies they can use to prepare for and lead through a crisis. Among these strategies are bounded optimism, circular vision, and leading by example. Finally, this article describes four key behaviors that will help leaders manage a crisis, and suggests what leaders need to do once a crisis is under control or over.

Patient Knowledge, Medication Adherence, and Influencing Factors: A Cross-Sectional Study among Hypertensive Patients in Greece

This study aimed to investigate the knowledge of patients with hypertension about their condition, adherence to antihypertensive medication, and the factors influencing it. A cross-sectional study was conducted in two cardiology outpatient clinics of two tertiary hospitals, in Greece. The study included 188 patients diagnosed with hypertension. The patients’ knowledge about their disease and adherence to medication were assessed by using the HK-LS and A-14 scales, respectively. Patients had sufficient knowledge levels about their disease, but significantly low levels of adherence to medication. Patients with higher knowledge levels were more adherent to medications [r(188) = 0.885, p < 0.001]. By using multivariate analysis, higher age (p = 0.018), residence in a more populous area (p = 0.041), more years with the disease (p = 0.012), and a lower number of medications (p = 0.03) were associated with higher levels of knowledge. Conversely, younger age (p = 0.036), lower educational levels (p = 0.048), fewer years with the disease (p = 0.001), and a higher number of medications (p = 0.003) were associated with lower adherence to medication. The Greek patients’ hypertension knowledge was sufficient; however, adherence to medication was significantly low. Healthcare managers could utilize our findings to design targeted interventions for improving adherence to medication for these patients.

The cost of protecting resources: a cross-sectional study on the interaction between LMX and role ambiguity on work addiction and burnout among Canadian first-level healthcare managers

IntroductionUsing the conservation of resources (COR) theory, our study explores the interaction between role ambiguity and leader-member exchange (LMX) quality on burnout using work addiction as a mediator among Canadian first-level healthcare managers.MethodsCross-sectional data was collected among 165 first-level managers working in healthcare with the support of interprofessional associations in Canada. Linear regression was used to test the presented hypotheses.ResultsWork addiction fully mediated the positive relationship between role ambiguity and burnout among first-level managers. In addition, high LMX exacerbated both the direct and indirect effects of role ambiguity.ConclusionOur study contributes by identifying role ambiguity as a context under which LMX can have adverse effects for first-level managers in healthcare. Moreover, work addiction acted as a mediator, theorized as a risky resource investment which depletes managers’ resources. Having a good relationship with their team further entices managers to develop a pathological relationship with their work to protect its members, which in turn is related to higher levels of burnout.

First-line managers' experience of guideline implementation during the COVID-19 pandemic.

To explore first-line managers' experience of guideline implementation in orthopaedic care during the COVID-19 pandemic. A descriptive, qualitative study. Semi-structured interviews with 30 first-line nursing and rehabilitation managers in orthopaedic healthcare at university, regional and local hospitals. The interviews were analysed by thematic analysis. First-line managers described the implementation of guidelines related to the pandemic as different from everyday knowledge translation, with a swifter uptake and time freed from routine meetings in order to support staff in adoption and adherence. The urgent need to address the crisis facilitated guideline implementation, even though there were specific pandemic-related barriers such as staffing and communication issues. An overarching theme, Hanging on to guidelines for dear life, is substantiated by three themes: Adapting to facilitate change, Anchoring safety through guidelines and Embracing COVID guidelines. A health crisis such as the COVID-19 pandemic can generate enabling elements for guideline implementation in healthcare, despite prevailing or new hindering components. The experience of guideline implementation during the COVID-19 pandemic can improve understanding of context aspects that can benefit organizations in everyday translation of evidence into practice. Recognizing what enabled guideline implementation in a health crisis can help first-line managers to identify local enabling context elements and processes. This can facilitate future guideline implementation. During the COVID-19 pandemic, the healthcare context and staff's motivation for guideline recognition and adoption changed. Resources and ways to bridge barriers in guideline implementation emerged, although specific challenges arose. Nursing managers can draw on experiences from the COVID-19 pandemic to support implementation of new evidence-based practices in the future. This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR). No Patient or Public Contribution.

Health care managers' perspectives on workforce licensing practice in Ethiopia: A qualitative study.

Professional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure. The aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia. A cross-sectional study design with a phenomenological approach was employed between March 26 and April 30, 2021, to collect qualitative data. We conducted in-depth interviews with a total of 32 purposively selected health system managers. An interview guide was prepared in English, translated into Amharic, and then pretested. Audio recorded data was transcribed verbatim, translated, and analysed manually by themes and sub-themes. A member check was done to check the credibility of the result. The data revealed four major themes: awareness of licensing practices, enforcement of licensing practices, systems for assuring the quality of licensing practices, and challenges to licensing practices. Lack of awareness among managers about health workforce licensing was reported, especially at lower-level employers. Regulators were clear on the requirements to issue a licence to the health workforce if they are competent in the licensing exam, while human resource managers do not emphasise whether the employees have a licence or not during employment. As a result of this, non-licenced health workers were employed. Health care managers mentioned that they did not know any monitoring tools to solve the issue of working without a licence. Fraudulent academic credentials, shortage of resources (human resources, finance, equipment, and supplies), and weak follow-up and coordination systems were identified as main practice challenges. This study reported a suboptimal health professionals' licensing practice in Ethiopia, which is against the laws and proclamations of the country that state to employ all health workers only with professional licenses. Challenges for health professionals' licensing practice were identified as fraudulent academic credentials, a shortage of resources (HR, finance, equipment, and supplies), and a weak follow-up and coordination system. Further awareness of licensing practices should be created, especially for lower-level employers. Regulators shall establish a reliable digital system to consistently assure the quality of licensing practices. Health care managers must implement mechanisms to regularly monitor the licensing status of their employees and ensure that government requirements are met. Collaboration and regular communication between regulators and employers can improve quality practices.

A multiphase, multicentre development and validation of two maturity tools assessing the implementation of the FlaQuM co-creation roadmap.

As part of the new Flanders Quality Model (FlaQuM) towards sustainable quality management systems, a co-creation roadmap with 6 primary drivers and 19 building blocks that guides healthcare organizations has been developed. Currently, no assessment tool is available to monitor hospitals' quality management systems implementation according to this co-creation roadmap. Therefore, we aimed to measure the maturity of the implementation of the FlaQuM co-creation roadmap in hospitals. A three-phase approach in co-design with 19 hospitals started with defining the scope, followed by establishing content validity through a literature review, involvement of content experts (n = 47), 20 focus groups with content experts (n = 79), and a Delphi round with healthcare quality managers (n = 19) to test the content validity index. Construct validity was assessed by confirmatory factor analyses and convergent validity by Spearman's ρ correlation coefficients. Based on 17 included existing maturity instruments and subcomponents of content experts, two maturity tools were developed according to the implementation of the FlaQuM co-creation roadmap: (i) a maturity matrix with 52 subcomponents and (ii) a co-creation scan with 19 statements. The overall scale-content validity index varied between 93.3% and 90.0% in terms of relevance and clarity, respectively. In a sample of 119 healthcare professionals, factor analyses revealed a six-factor structure and 16 (84.2%) of the 19 hypothesis for testing convergent validity between both maturity tools were statistically significant. Measuring the implementation of the FlaQuM co-creation roadmap and monitoring its maturity over time should be feasible by using these comprehensive maturity tools in hospitals. Results of both tools should be able to describe the current state of hospitals' implementation of the co-creation roadmap as basis for strategic improvement plans and next steps.

Performance measurement of factors affecting consumer experience in healthcare services using fuzzy and grey techniques

PurposeThe importance of consumer experience in service industries, particularly healthcare, is widely acknowledged as it captures the intricacies of quality management. In tandem with the emerging research trends that evaluate service excellence through user experience, this study renders a performance analysis of the dimensions of consumer experience that individually or collectively shape healthcare consumers’ perceptions of service quality.Design/methodology/approachA cross-sectional study was conducted across 13 mid-tier corporate hospitals to collect data from 438 patients. The data was processed through factor analysis in SPSS to confirm sample adequacy and factor extractability. Further, two independent multi-criteria decision-making (MCDM) tools, Fuzzy Technique for Order Performance by Similarity to Ideal Solution (F-TOPSIS) and Grey Relational Analysis (GRA), were executed to render performance analysis of identified factors.FindingsUsing F-TOPSIS, factors such as “information” and “hospital environment” received higher performance ratings, while items related to “communication with doctors” and “humanistic care” received lower rankings. Minor yet anticipated deviations were observed while verifying performance scores using GRA. Nonetheless, both outcomes exhibited a strong correlation coefficient of 97.14%, confirming analytical consistency.Originality/valueHitherto, such usages of hybrid MCDM techniques have rarely been executed to convey a clear understanding of consumers’ experiences in healthcare services. Moreover, the findings provide a clear insight into consumers’ key response areas, which can further be translated to maximize consumer gratification, thus assisting healthcare managers in improving service performance and clinical decision-making.

Benchmarking Relevance for Hospital Design and Planning: An International Web-Based Survey.

The study aims to investigate what design practitioners and healthcare facility managers deem as important benchmarking metrics worldwide, investigating country differences in benchmarking usage and which metrics are prioritized. Benchmarking is a regular practice in the healthcare sector, both for clinical and managerial aspects to compare, measure, and improve standardized processes. However, limited knowledge is available about benchmarking procedures in hospital planning, design, and construction. A web-based survey was designed, revised, and pilot-tested in five countries; it was adjusted according to local experts' suggestions and submitted globally via SoSci multilingual platform to persons involved in hospital design, research, construction, and facility management. It was composed of closed questions on 5-point Likert-type scale ranking frequency or importance and open-ended questions divided into six sections. Two hundred and eighty full responses have been collected. Statistical analysis was performed via PowerBI and R-Studio, while qualitative analysis was performed via MAXQDA. The findings reported allow for both specific insights per each country or category as well as enabling general considerations of a practice that is becoming always more international with 30%-50% of respondents working in the international context. The evaluation of the survey highlights the most important benchmarks, among others. For example, for respondents from the top five countries (Sweden, Spain, Germany, Italy, and the United States), the most important metric for benchmark comparability is whether the project was new construction, new construction attached to an existing hospital, or interior renovation. Construction date, client type (public vs. private), and country of location were also generally rated as the most important metrics by respondents. Other metrics that were consistently rated as important globally included inpatient unit layout, walking distances, number of floors, and whether all patient rooms are private. Space-related metrics are considered very important elements in the design and planning of healthcare facilities worldwide. Regarding cost-related metrics, all countries consider the ratio construction cost per building gross area as the most important. Benchmarking emerges as a relevant tool for hospital design and planning as it can support efficiency, standardization, and confidence; currently, benchmarking is still underutilized due to the challenge of international comparison, access to data outside each specific company, and variation design metrics nationally. Benchmarking strategies should be further investigated to support knowledge exchange and to ensure reliable and comparable information globally.

Development of a competency framework for advanced practice nurses: A co-design process.

The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium. A co-design development process was conducted. This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants. A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter. The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come. This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging. What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses. The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions. No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.

Service provision for older adults living in prison with dementia/mild cognitive impairment in England and Wales: a national survey

ABSTRACT Older adults are the fastest growing age sub-group in prison. Prison, health and social work staff are required to provide support for complex health and social care issues including Dementia and Mild Cognitive Impairment (MCI). Dementia care for those living in the community is a national priority. There is, however, a lack of empirical evidence regarding service provision for those living in prison. This study was the first national survey of England and Wales to establish current service provision. Questionnaires were distributed to heads of healthcare and governors of all prisons in England and Wales. Our response rate was 85 (78%) for governors and 77 (71%) for healthcare managers. Reported prevalence of dementia/MCI from respondents was well below prevalence estimates from research. Furthermore, only 23 prisons (30%) had routine screening, and the majority reported that they did not have a defined care pathway (53; 69%) for dementia/MCI. Overall, the provision of services for those experiencing symptoms of dementia and MCI in prison is sub-optimal; however, many respondents reported aspirations to enhance services for this group. The forthcoming Ministry of Justice’s national strategy for ageing prisons should include recommended care pathways for dementia and MCI to strive towards equivalence of care to community settings.

PreventS-MD®: a New Digital Technology to Maintain Cardiovascular Prevention in Routine Clinical Practice

Stroke, myocardial infarction (MI), and other main non-communicable diseases (NCDs) remain major causes of mortality and disability globally. Up to 80% of cardiovascular events and up to 60% of NCDs are associated with potentially controlled risk factors (RFs). State-of-the-art digital technologies can help bridge the gap between evidence-based prevention methods and their critically low availability in routine clinical practice.
 An innovative digital platform named PreventS-MD® is a specially developed tool for healthcare professionals to be used under time constraints. With PreventS-MD®, clinicians can estimate patient's 10-year cardiovascular risk within several minutes. Then, they automatically get adapted results and recommendations to address identified RFs as well as graphical representation of specific RF contribution to overall stroke and MI risks. If some additional time is available, the clinician and the patient can collaboratively set customized achievable goals to correct modifiable RFs. An integrated analytical module provides healthcare managers with current digital risk profiles of the relevant population to evaluate prevention effectiveness and to forecast the load throughout the healthcare levels.
 PreventS-MD® has several unique advantages, including time-saving design, the function to activate motivated RF correction, individually tailored recommendations, and information on personally changed digital profiles of vascular risks. As cardiovascular diseases and main NCDs have a lot of common RFs, PreventS-MD® implemented into routine clinical practice will utilize a complex approach to the prevention of main NCDs, decreasing both stroke and MI burden and addressing complications of chronic pulmonary and kidney disease, tumors of any type, dementia, etc.

Effect of acupressure on the anxiety and pain of patients undergoing cardiac catheterization: A systematic review

The objective of this systematic review was to examine the influence of acupressure on the levels of anxiety and pain among individuals undergoing cardiac catheterization. An extensive search was carried out across global electronic databases, encompassing Scopus, PubMed, and Web of Science, along with Iranian databases like Iranmedex, spanning from the earliest available date to October 1, 2023. The search utilized keywords derived from Medical Subject Headings, encompassing terms like "acupressure", "anxiety", "pain", and "cardiac catheterization". The quality evaluation of randomized controlled trials and quasi-experimental studies was performed utilizing the critical assessment checklist from the Joanna Briggs Institute. A total of 781 patients participated in nine studies, with 59.60% being female, and 57.11% assigned to the intervention group. The participants had a mean age of 55.72 years (SD=9.13), and the average duration of the intervention was 12.78 minutes. The findings of this systematic review suggest that health professionals, including nurses, can effectively utilize acupressure to mitigate both pain and anxiety in patients undergoing cardiac catheterization. As a recommendation, it is advised that healthcare managers and policymakers create supportive environments within hospitals, enabling healthcare professionals to incorporate acupressure techniques. This proactive approach may contribute to the reduction of anxiety and pain experienced by patients undergoing cardiac catheterization.

Consequences of workplace bullying among nurses in Ghana: Does resilience matter?

PurposeThis study investigates the impact of workplace bullying on nurses' psychological distress and the quality of care as well as the impact of resilience in mitigating the negative effect of workplace bullying. DesignA cross-sectional survey design was employed to study the phenomenon among a purposive sample of 326 nurses in the Ghanaian healthcare sector with self-administered questionnaires for data collection. Data was analyzed using IBM’s Statistical Package for Social Sciences (SPSS) version 27.0 and Process Macro Version. ResultsThe study found evidence that bullied nurses in hospitals often suffer from psychological distress. Results also demonstrate a negative link between workplace bullying and the quality of care delivered by nurses. Furthermore, the study found that resilience moderated the workplace bullying and nurses' psychological distress relationship, however, resilience is not a significant moderator in the workplace bullying and quality of care relationship. OriginalityThe study advances our understanding of workplace bullying's consequences for nurses in the Ghanaian healthcare sector. It underscores the importance of addressing workplace bullying, offering practical recommendations for healthcare administrators and managers. Fostering personal resources like resilience is crucial to empower nurses in facing the challenges of their workplace environment effectively.

Learning motivation and self-assessment in health economics: a survey on overconfidence in healthcare providers

IntroductionLifelong learning is the foundation for professionals to maintain competence and proficiency in several aspects of economy and medicine. Until now, there is no evidence of overconfidence (the belief to...

Building Medical Device Supply Chain Resilience With the US Food and Drug Administration

Medical device supply chain shortages have the potential to negatively impact patient care when patients and caregivers are unable to obtain the medical devices they need. The US Food and Drug Administration (FDA), specifically the Center for Devices and Radiological Health, received expanded authorities requiring medical device manufacturers to notify the FDA of any interruption or discontinuance of medical devices during or in advance of a public health emergency. The clinical community, in particular, healthcare technology managers, can provide additional information and perspective to the FDA by voluntarily reporting any device availability concerns. This will provide the FDA with more data about the current supply chain landscape and drive communication about the issue. Ultimately, improved information sharing will help ensure devices are available when and where they are needed to protect the health of the nation's patients and healthcare workers into the future.

Impact of Structural Employee Empowerment on Hospital Ratings: Mediating Role of Social Climate and First-Line Managers' Resilience.

The purpose of this article is to investigate the relationship between the structural empowerment of first-line health managers and health facility performance, examining the mediating roles of resilience and social climate in shaping the ratings of Slovak hospitals. Additionally, we aim to investigate the deeper mechanisms of this relationship, particularly the impact of resilience and the social climate, which can positively influence it. The data collection was conducted through a questionnaire survey in February 2022. Respondents included 540 healthcare managers at the first level of management from 44 Slovak hospitals, all of which were part of the evaluation by the Institute for Economic and Social Reforms (INEKO). The analysis involved the use of the PLS-SEM method to examine the relationships between variables and assess direct and indirect effects, utilizing SmartPLS 3.3 software. The findings reveal a positive association between the structural empowerment of first-level managers and the ranking of health facilities. The hypotheses regarding the mediation of both variables - First-Level Managers' (FLMs) resilience and social climate - are supported, whether considered separately or jointly. In the case of joint mediation, a significant portion of the indirect effect is conveyed through FLMs' resilience, suggesting a potential avenue of support from hospital management to enhance health facility ratings. Structural empowerment of first-line managers establishes the conditions for improving the ratings of health facilities. The total effect is significantly more pronounced in promoting their resilience and fostering a supportive social climate.

SYSTEM OF STATE REGULATION OF PROFESSIONAL TRAINING OF MANAGING STAFF OF HIGHER MEDICAL EDUCATION IN UKRAINE

The article addresses the topical issue of public administration of professional training for higher medical education management personnel in Ukraine. It explores the current state and development prospects of the training system for managers of higher medical education institutions, and identifies priority areas for its improvement. The relevance of the research is determined by the need to provide the Ukrainian healthcare system with highly qualified managers capable of effectively managing higher medical education institutions in the context of dynamic changes and integration into the European and world educational and scientific space. The article defines the main approaches and mechanisms for implementing state policy in the field of healthcare and higher medical education. It identifies the directions for improving the organizational, legal, and economic mechanisms of state regulation of professional training for management personnel of higher medical institutions in Ukraine in terms of clarifying the content of the key research concepts "management personnel of higher medical education institutions" and "state administration of professional training for management personnel of higher medical education institutions". It is determined that the reforming and development of the healthcare and higher medical education sector of Ukraine in the context of integration into the European and world educational and scientific space requires the preparation of a new generation of managers - healthcare managers. It is determined that this category of managers includes vice-rectors and heads of relevant scientific, educational-methodological and educational commissions, deans and vice-deans of faculties, heads of departments and other structural units. The formation of a comprehensive mechanism of state administration of professional training for management personnel of higher medical education institutions should be carried out on the basis of such principles as scientific justification, legality, common interests and values, consistency, comprehensiveness, systematicity, subsidiarity, transparency, innovation, adequacy, efficiency, and responsibility. The article analyzes the features of the system of state administration of professional training for management personnel of higher medical education institutions in Ukraine and abroad. Based on a comparative analysis of management training systems in 6 developed countries of the world, it is proved that the system of professional training and advanced training of management personnel of higher medical education institutions should function in accordance with the current trends in the healthcare sector and the field of higher medical education, comply with the implementation of state policy principles, and be systematic. Statistical analysis of the dynamic changes in the indicators of provision with higher medical education institutions and medical institutions over the years of Ukraine's independence demonstrates the need for joint coordination and cooperation to coordinate the efficiency of the healthcare system. Thus, the article reveals the essence and features of state administration of professional training for management personnel of higher medical institutions, analyzes the regulatory framework governing this area, and identifies the main areas for improving the training system for managers of higher medical education institutions, namely: Updating the content and forms of training; Introduction of innovative teaching methods; Improvement of teachers' qualification; Strengthening the practical focus of training; Development of international cooperation.

THE RELATIONSHIP BETWEEN TOTAL QUALITY MANAGEMENT, PATIENT SATISFACTION, SERVICE QUALITY, AND TRUST IN THE HEALTHCARE SECTOR: THE CASE OF ETHIOPIAN PUBLIC HOSPITALS

The aim of this research is to investigate the direct effects of total quality management (TQM) on perceived service quality (SQ) and patient satisfaction (PSAT), the impact of SQ on PSAT and patient trust (TR), and the influence of PSAT on TR among in-patients in selected Public Hospitals in Northern Ethiopia. Employing a quantitative approach, a questionnaire was administered via convenience sampling. The study included a sample of 293 in-patients receiving treatment in selected public hospitals in Ethiopia, with data analysis conducted using Amoss26 and SPSS26. The findings revealed that total quality management positively influenced patient satisfaction and perceived service quality, while SQ also had a positive effect on PSAT and TR. Moreover, PSAT exhibited a positive impact on TR among in-patients in selected public hospitals in Northern Ethiopia. This research significantly contributes to the existing literature and warrants further investigation, as there is a dearth of studies on total quality management in the healthcare sector compared to manufacturing industries. Additionally, this study provides valuable insights for healthcare sector managers in strategic planning and decision- making processes.

A qualitative inquiry on drivers of COVID-19 vaccine hesitancy among adults in Kenya.

COVID-19 vaccination rates have been low among adults in Kenya (36.7% as of late March 2023) with vaccine hesitancy posing a threat to the COVID-19 vaccination program. This study sought to examine facilitators and barriers to COVID-19 vaccinations in Kenya. We conducted a qualitative cross-sectional study in two purposively selected counties in Kenya. We collected data through 8 focus group discussions with 80 community members and 8 in-depth interviews with health care managers and providers. The data was analyzed using a framework approach focusing on determinants of vaccine hesitancy and their influence on psychological constructs. Barriers to COVID-19 vaccine uptake were related to individual characteristics (males, younger age, perceived health status, belief in herbal medicine, and the lack of autonomy in decision making among women - especially in rural settings), contextual influences (lifting of bans, myths, medical mistrust, cultural and religious beliefs), and COVID-19 vaccine related factors (fear of unknown consequences, side-effects, lack of understanding on how vaccines work and rationale for boosters). However, community health volunteers, trusted leaders, mandates, financial and geographic access influenced COVID-19 vaccine uptake. These drivers of hesitancy mainly related to psychological constructs including confidence, complacency, and constraints. Vaccine hesitancy in Kenya is driven by multiple interconnected factors. These factors are likely to inform evidence-based targeted strategies that are built on trust to address vaccine hesitancy. These strategies could include gender responsive immunization programs, appropriate messaging and consistent communication that target fear, safety concerns, misconceptions and information gaps in line with community concerns. There is need to ensure that the strategies are tested in the local setting and incorporate a multisectoral approach including community health volunteers, religious leaders and community leaders.

Target Product Profile for a Machine Learning-Automated Retinal Imaging Analysis Software for Use in English Diabetic Eye Screening: Protocol for a Mixed Methods Study.

Diabetic eye screening (DES) represents a significant opportunity for the application of machine learning (ML) technologies, which may improve clinical and service outcomes. However, successful integration of ML into DES requires careful product development, evaluation, and implementation. Target product profiles (TPPs) summarize the requirements necessary for successful implementation so these can guide product development and evaluation. This study aims to produce a TPP for an ML-automated retinal imaging analysis software (ML-ARIAS) system for use in DES in England. This work will consist of 3 phases. Phase 1 will establish the characteristics to be addressed in the TPP. A list of candidate characteristics will be generated from the following sources: an overview of systematic reviews of diagnostic test TPPs; a systematic review of digital health TPPs; and the National Institute for Health and Care Excellence's Evidence Standards Framework for Digital Health Technologies. The list of characteristics will be refined and validated by a study advisory group (SAG) made up of representatives from key stakeholders in DES. This includes people with diabetes; health care professionals; health care managers and leaders; and regulators and policy makers. In phase 2, specifications for these characteristics will be drafted following a series of semistructured interviews with participants from these stakeholder groups. Data collected from these interviews will be analyzed using the shortlist of characteristics as a framework, after which specifications will be drafted to create a draft TPP. Following approval by the SAG, in phase 3, the draft will enter an internet-based Delphi consensus study with participants sought from the groups previously identified, as well as ML-ARIAS developers, to ensure feasibility. Participants will be invited to score characteristic and specification pairs on a scale from "definitely exclude" to "definitely include," and suggest edits. The document will be iterated between rounds based on participants' feedback. Feedback on the draft document will be sought from a group of ML-ARIAS developers before its final contents are agreed upon in an in-person consensus meeting. At this meeting, representatives from the stakeholder groups previously identified (minus ML-ARIAS developers, to avoid bias) will be presented with the Delphi results and feedback of the user group and asked to agree on the final contents by vote. Phase 1 was completed in November 2023. Phase 2 is underway and expected to finish in March 2024. Phase 3 is expected to be complete in July 2024. The multistakeholder development of a TPP for an ML-ARIAS for use in DES in England will help developers produce tools that serve the needs of patients, health care providers, and their staff. The TPP development process will also provide methods and a template to produce similar documents in other disease areas. DERR1-10.2196/50568.