Delivery Of Health Care Services Research Articles

Youth mental health care use during COVID-19: Evidence from administrative data in Alberta, Canada

Abstract Background The COVID-19 pandemic affected health care service delivery and accessibility. Our study examined how Canadian youth used mental health services before and during the COVID-19 pandemic, and whether youth access and use patterns differed for subgroups based on social determinants previously associated with health care access. Methods Cross-sectional population-based administrative health care data from the province of Alberta in Canada was used to examine youth (ages 15-24) mental health care use from 2018/19 to 2021/22. Data was analyzed using an interrupted time series design and segmented regression modeling on type of mental health care use. Outcome measures were mental health care use for: general physician visits, psychiatrist visits, emergency department, hospitalization, and different mental health diagnoses. We stratified by factors related to social determinants, including gender and socioeconomic status. Results The analysis indicates an overall increase in the proportion of youth that used mental health care from 2018/19 to 2021/22 (14.4% vs 17.5%, respectively). There was an immediate drop in use with the onset of the COVID-19 pandemic in Canada, followed by a steady rise during the pandemic years, which was largely due to an increase in general physician visits. This rise was seen for most mental health diagnoses of study (i.e., anxiety, adjustment, attention-deficit/hyperactivity disorder, schizophrenia, and self-harm disorders). Service use increased for young women/girls compared to young men/boys and for youth from wealthier neighborhoods. Conclusions This study provides evidence to support health services planning and delivery to respond to the mental health needs of youth and to prepare for future public health emergencies. Key messages • Our study findings indicate changes in health care use for mental health among Canadian youth (ages 15-24) during the COVID-19 pandemic, with use patterns differing for youth subgroups. • Administrative health data can provide evidence to support health services planning and delivery to respond to the mental health needs of youth and to prepare for future public health emergencies.

The global research landscape and future trends in healthcare Total Quality Management

Total Quality Management (TQM) is instrumental in augmenting the quality and efficacy of healthcare service delivery, but a comprehensive evaluation of present and evolving TQM research trends within healthcare research articles is notably absent. This study provides an insightful view into the prevailing international scenarios and upcoming research frontiers in healthcare TQM research field, utilizing bibliometric mapping through VOSviewer. Drawing data from 360 publications in the Web of Science core citation database, it delineates a steady growth in the field over the last 30 years. Research outputs span 51 countries and regions, with notable contributions from the United States, United Kingdom, Netherlands, and Italy. The top five research institutions and numerous authors predominantly hail from the United States. Key keywords in near years encompass healthcare safety, healthcare quality assurance, quality indicators, and the application of Six Sigma management principles. This exploration serves as a pivotal reference for understanding the global research landscape and future trends in healthcare TQM, particularly in guaranteeing quality and safety. Future scientific endeavors will build upon these focus areas, exploring and connecting research gaps in more specialized fields.

ANALYSIS OF PERIODIC SELF-ASSESSMENTS WITHIN THE SCOPE OF HEALTH QUALITY STANDARDS IN TERMS OF MATERIAL MANAGEMENT AS A PREVENTIVE ACTIVITY: A RETROSPECTIVE STUDY IN A UNIVERSITY HOSPITAL

This study aims to investigate the effects of periodic self-assessments on materials management within the framework of quality management in healthcare. The retrospective study, conducted in a university hospital, evaluates the effectiveness of quality improvement initiatives and compliance with health standards, while examining in detail the effects of these processes on materials management. It also investigates how self-assessment processes improve healthcare service delivery and contribute to materials management processes. Problems identified through Fishbone and Pareto analysis are examined, prioritised and solutions are developed. The findings obtained aim to improve material management processes and increase quality standards in health. The main purpose of the research is to examine the effects of periodic self-assessments on materials management in order to improve the quality of healthcare services. The findings emphasise the importance of maintaining quality standards in health services and systematic handling of periodic self-assessments. Problems identified by Fishbone and Pareto analysis are analysed by root cause analysis and solutions are developed. This approach aims to contribute to the development of materials management processes and to the improvement of quality standards in healthcare. The results of the research are an important guide for practitioners, managers and policy makers in the fields of quality management and materials management in health services.

Use and impact of clinical pathways across various healthcare settings: A protocol for an umbrella review of global evidence.

The proposed umbrella review aims to assess the use and impact of clinical pathways on professional practice, patient outcomes, length of hospital stay, hospital costs, patient satisfaction, and hospital staff satisfaction through a synthesis of existing systematic reviews and meta-analyses. Following PRIOR guidelines, a systematic search will be conducted in MEDLINE, Epistemonikos, and the Cochrane Library to identify relevant systematic reviews and meta-analyses, from inception till March 2024. Two reviewers will independently screen titles and abstracts, with a third resolving any disagreements. Full-text articles considered potentially relevant will be assessed for eligibility by the same process. The data extraction form will cover information about the review methods, characteristics of the included primary studies, the types of interventions evaluated, and the reported outcomes. This standardized data extraction form will be piloted by the review team on five to ten articles to ensure all relevant information is recorded. The quality of included systematic reviews and meta-analyses will be evaluated using AMSTAR 2. PROSPERO registration number is CRD42024529371. The study will present a narrative synthesis of the findings, addressing the clinical and methodological heterogeneity and assessing the impact of clinical pathways on various healthcare outcomes. This umbrella review will provide evidence-based insights into the effectiveness, challenges, and best practices of clinical pathways, guiding healthcare decision-making and identifying areas for future research. Results will be disseminated widely to inform policy and improve healthcare service delivery. No patient or public contribution, as this paper is a protocol of an umbrella review.

Integrated Online-to-Offline Model of Care for HIV Prevention and Treatment Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and a Multiphase Trial.

HIV continues to have a disproportionate impact on specific populations in Malaysia, particularly men who have sex with men (MSM). HIV self-testing (HIVST) is a strategy that has been shown to scale up HIV testing rates. However, it faces shortcomings because of concerns about self-efficacy, result interpretation, and lack of counseling and linkage to care. This underscores the need for an innovative approach that integrates HIVST with timely counseling, expert guidance, and referrals to enhance engagement in relevant HIV prevention or treatment. This study aims to describe the protocol used in developing and testing a web-based platform (ie, CINTAI) providing an HIVST kit and real-time e-counseling to support online-to-offline linkage to HIV care services for MSM in Malaysia. The methods are reported according to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 guidelines. In phase I, we will adapt existing HIVST web-based platforms to create a new online-to-offline HIVST and counseling platform called "CINTAI" for Malaysian MSM. In phase II, we will use a type 1 hybrid implementation trial design to determine the feasibility, acceptability, and preliminary efficacy of "CINTAI" compared with treatment as usual among Malaysian MSM, with assessments conducted over 6 months. Multilevel implementation factors will also be collected to guide future adoption and scale-up. We will enroll 78 MSM in the pilot randomized controlled trial. Baseline characteristics will be tested for homogeneity between groups using appropriate statistical tests. A generalized linear mixed model with random subject effects will account for within-subject correlation. Treatment assignment, time, interaction, and confounders will be included. The proportion of MSM tested for HIV over 6 months and other outcomes (pre-exposure prophylaxis for HIV or antiretroviral therapy linkage, HIV risk behaviors, and chemsex harm reduction) will be compared using linear contrasts. We completed phase I of the proposed study in April 2024 and started phase II in May 2024, with 15 participants recruited (7 in the CINTAI and 8 in the treatment-as-usual groups). On the basis of a series of formative works completed during phase I, we developed a fully functional, web-based platform that provides a digital platform for MSM in Malaysia to order HIVST kits for free and to receive HIV counseling, followed by offline linkage to HIV prevention services (if HIV negative) or HIV treatment services (if HIV positive). Despite being at high risk for HIV transmission, MSM in Malaysia have alarmingly low testing and linkage to HIV care services, prompting the need for innovative approaches to support HIV prevention efforts. If found to be feasible and acceptable, CINTAI can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries. DERR1-10.2196/60962.

Community-Based Health Information Systems in Africa: A Scoping Review of Data Generation, Utilization, and Community Empowerment

Introduction The community-based health information system (CBHIS) is a vital component of the community health system, as it assesses community-level healthcare service delivery and generates data for community health programme planning, monitoring, and evaluation. CBHIS promotes data-driven decision-making, by identifying priority interventions and programs, guiding resource allocation, and contributing to evidence-based policy development. Objective This scoping review aims to comprehensively examine the use of CBHIS in African countries, focusing on data generation, pathways, utilisation of CBHIS data, community accessibility to the data and use of the data to empower communities. Methods We utilised Arksey and O'Malley's scoping review methodology. We searched eight databases: PubMed, EMBASE, HINARI, Cochrane Library, Web of Science, Scopus, Google Scholar, and grey literature databases (Open Grey and OAIster). We synthesised findings using a thematic approach. Results Our review included 55 articles from 27 African countries, primarily in Eastern and Southern Africa, followed by West Africa. Most of the studies were either quantitative (42%) or qualitative (33%). Paper-based systems are primarily used for data collection in most countries, but some have adopted electronic/mobile-based systems or both. The data flow for CBHIS varies by country and the tools used for data collection. CBHIS data informs policies, resource allocation, staffing, community health dialogues, and commodity supplies for community health programmes. Community dialogue is the most common approach for community engagement, empowerment, and sharing of CBHIS data with communities. Community empowerment tends towards health promotion activities and health provider-led approaches. Conclusion CBHIS utilises both paper-based and electronic-based systems to collect and process data. Nevertheless, most countries rely on paper-based systems. Most of the CBHIS investments have focused on digitisation and enhancing data collection, process, and quality. However, there is a need to shift the emphasis towards enabling data utilisation at the community level and community empowerment.

Leveraging Blockchain Technology for Public Health

This study delves into the metamorphic potential pertaining to blockchain technology public health, concentrating on its aptness towards addressing the critical challenges related to data security, privacy, and it enroute for improving health service outcomes. By incorporating decentralized structures and smart contracts, blockchain intensify data integrity, ensuring consistency and protective access control, which is principally effective for sensitive medical information. The study enlightens on the advantages of blockchain in entrusting patients as well as healthcare providers with control over public health related information, ensuring privacy and reinforcing regulatory compliance. It delves into the process of how blockchain can streamline healthcare processes, upgrading interoperability among healthcare systems, and create more systematic and affordable models for healthcare service delivery. Based on the case studies from different healthcare stakeholders, the paper provides factual and feasible insights for real-world implementations of blockchain in healthcare, exhibiting its potential to transfigure supply chain management, different insurance claims processing and managing electronic health records. Moreover, the study also recognizes the challenges, including technical constraints, ethical reviews, and the complication of integrating blockchain with existing healthcare framework. The study widens it discussion towards the legal and regulatory aspect, emphasizing the need for a comprehensive approach to adoption. Looking forward, the paper covers the emerging trends and offers guidance for healthcare stakeholders considering blockchain implementation, summarizing that blockchain could be a catalyst for remarkable improvements in public healthcare data administration and patient care.

Healthcare leadership practice and associated factors among primary healthcare managers in East Gojam Zone, Northwest Ethiopia: a mixed method study

BackgroundLeadership plays a critical role in the delivery of person centered, safe, efficient, and effective healthcare services globally. Poor healthcare leadership contributes to low staff motivation, patient dissatisfaction, and reduced healthcare-seeking behavior. However, there is limited evidence on healthcare leadership practice and associated factors among primary healthcare managers in the study area and at large in Ethiopia. Therefore, the findings of this study will contribute to improved healthcare leadership practices among primary healthcare managers.MethodFacility-based cross-sectional study supplemented with qualitative inquiry was conducted in the East Gojam zone among 532 primary healthcare managers selected by a two-stage stratified random sampling technique. A pre-tested and structured self-administered questionnaire was used to collect the quantitative data. Data were entered into Epi-Data version 4.6 and exported into Stata version 14.0 for analysis. Multiple linear regression analysis was used to identify factors associated with healthcare leadership practice, and statistical significance was declared at a p-value < 0.05 with a 95% CI. Six key informant interviews were conducted, and thematic analysis was used for the qualitative study.ResultThe magnitude of healthcare leadership practice among primary healthcare managers in the East Gojam zone was 45.7% (95% CI: (41.4, 50.0)). Factors associated with healthcare leadership practice were age [β = 0.44, 95% CI: (0.16, 0.71)], training in healthcare leadership practice [β = 1.19, 95% CI: (0.19, 2.20)], experience sharing [β = 1.68, 95% CI: (0.59, 2.76)], organizational communication [β = 0.19, 95% CI: (0.05, 0.33)], managerial working experience [β = 0.94, 95% CI: (0.18, 1.69)] and emotional intelligence [β = 0.35, 95% CI: (0.31, 0.38)].Conclusion and recommendationThe magnitude of healthcare leadership practice among primary healthcare managers in the East Gojam zone was low as compared with a previous study in Ethiopia. It was significantly associated with age, training in leadership, experience sharing, organizational communication, managerial working experience, and emotional intelligence. Thus, human resource managers at primary healthcare level should consider older and more experienced candidates during assigning managers, organize training on healthcare leadership and experience sharing with model managers to improve the leadership practice of primary healthcare managers in the East Gojam zone.

Role of servicescape in patients' clinic care waiting experience: Evidence from developing countries.

The aim of this research is to investigate the role of servicescape on re-patronage and recommended intention through pleasure feeling and satisfaction in healthcare settings that put substantial contribution in the process of healthcare service delivery. Data were collected through cross-sectional convenience sampling via a self-administered survey questionnaire from 431 clinical outpatients who revisit the same hospital of metropolitan areas of Punjab, Pakistan. Structural Equation Modeling (SEM) was carried out for path analysis through AMOS (24.0 V), while statistical measures were analyzed using SPSS (25.0 V). The present study results revealed that patients' intention optimistically triggered through partial mediation and affirm the direct and indirect association with servicescape. It also revealed that patient-recommended and re-patronage intentions to visit the clinic were statistically substantial and positively influenced by intervening constructs of pleasure feeling and satisfaction. Additionally, it is found that servicescape and pleasure feeling contributed to 30% change in satisfaction. Moreover, pleasure feeling, and satisfaction contributed to 50% change in re-patronage and 31% change in recommendation intention of the patients. The current study findings contribute significantly to servicescape literature from a theatrical perspective and reevaluate the patterns and operations in healthcare. It also helps managers and administrators of private hospitals to make strategies to increase patient satisfaction.

Visualizing Scholarly Trends in Electronic Health (eHealth) Business Models: A Bibliometric Analysis.

The integration of digital health technologies with innovative business models became a crucial driver in the transformation of healthcare service delivery and management worldwide. As the adoption of electronic health (eHealth) solutions grows, there is increasing scholarly interest in understanding and optimizing these models. This paper reviewed the literature on eHealth business models from 1991 to 2024 through a bibliometric analysis of 1,118 documents published across 711 sources. The analysis primarily focused on journal articles and conference papers, utilizing VOSviewer (Centre for Science and Technology Studies, Leiden University, NLD) and Biblioshiny (Bibliometrix, Naples, ITA) to explore emerging trends, influential authors, and prominent sources. The results revealed a significant rise in research output, especially post-2007, with a peak during the COVID-19 pandemic. Key emerging themes included telemedicine, digital health, and information management, with a strong emphasis on international collaborations, particularly among countries in Europe, North America, and Asia. This study provided valuable insights into the evolution of eHealth business models, highlighting the importance of international and multidisciplinary approaches in this rapidly evolving field.

Waiting times spillovers in a National Health Service hospital network: a little organizational diversity can go a long way

BackgroundThe objective of this study is to assess if waiting times for elective surgeries within the Portuguese National Health Service (NHS) are influenced by the waiting times at neighboring hospitals. Recognizing these interdependencies, and their extent, is crucial for understanding how hospital network dynamics affect healthcare delivery efficiency and patient access.MethodsWe utilized patient-level data from all elective surgeries conducted in Portuguese NHS hospitals to estimate a hospital-specific index for waiting times. This index served as the dependent variable in our analysis. We applied a spatial lag model to examine the potential strategic interactions between hospitals concerning their waiting times.ResultsOur analysis revealed a significant positive endogenous spatial dependence, indicating that waiting times in NHS hospitals are strategic complements. Furthermore, we found that NHS contracts with private not-for-profit hospitals not only reduce waiting times within these hospitals but also exert positive spillover effects on other NHS hospitals.ConclusionsThe findings suggest that diversifying the organization of the NHS hospital network, particularly through contracts with private entities for marginal patients, can significantly enhance competitive dynamics and reduce waiting times. This effect persists even when patient choice is confined to a small fraction of the patient population, highlighting a strategic avenue for policy optimization in healthcare service delivery.

Debate: Bridging the gap - role of nonspecialists in child and adolescent mental health care.

The first point of contact for patients and families seeking professional help for health problems is often in nonspecialist community healthcare settings that vary widely across the countries in funding sources, resources and support from specialist services. They typically involve general practitioners, family physicians, general and community paediatricians, and nonphysician health workers such as nurses, social workers and public health professionals. This article discusses the role of nonspecialists in addressing the challenges of limited resources in Child and Adolescent Mental Health (CAMH) care services as healthcare systems struggle to meet the high demand. Stakeholders and decision-makers need to reconsider traditional healthcare models and service delivery. Integrating nonspecialist community care can be a potential solution but is beset with ethical, geopolitical, practical and economic challenges. The urgency and complexity of the issue are highlighted, emphasising the need for global discussion around CAMH care.

Pilot implementation study of a web-based men’s health screening app in primary care during COVID-19: a mixed-methods approach

BackgroundThe traditional delivery of healthcare services, including crucial preventive measures such as health screenings, faced significant disruption due to the COVID-19 pandemic. In response, eHealth technology emerged as a practical alternative for conducting screening services. This pilot study introduces ScreenMen, a web-based app for men’s health screening, implemented in a primary care setting. The study aims to assess patient uptake and healthcare provider’s acceptability and feasibility of implementing ScreenMen, emphasizing the importance of implementation science research in healthcare innovation.MethodsThis study employed a mixed-method explanatory sequential design, using a tailored implementation intervention to implement ScreenMen in an urban health clinic. Quantitative phase focused on patient uptake of ScreenMen and healthcare provider involvement, utilizing Google Analytics and provider questionnaires. Qualitative phase, using in-depth interviews with providers, explored factors influencing uptake and implementation. Data analysis employed means and percentages for quantitative data and framework analysis for qualitative data.ResultsWe invited 47 healthcare providers to attend the ScreenMen implementation workshop, with 26 participating, resulting in a 55.3% participation rate. Throughout the five-month study, there were 75 recorded accesses, with a completion rate of 20%. The primary way users accessed the app was through QR codes on buntings (38.7%), followed by postcards (12%). In qualitative interviews with three healthcare providers, it was found that the Identify and prepare champions strategy was helpful, as these champions led the implementation and encouraged other providers to promote ScreenMen. The use of QR codes on buntings, part of the Provide education and training strategy, was effective due to their visibility in patient waiting areas. However, the Mandate change strategy was considered ineffective, as providers felt obligated rather than motivated to implement ScreenMen.ConclusionThis study highlighted the uptake of ScreenMen and found barriers and facilitators during the pilot implementation. Two useful strategies were Identify and prepare champions and QR codes while Mandate change was not helpful. Further studies are needed to study the effectiveness of these implementation strategies to implement web-based apps.Trial registrationClinical Trial Number: NCT06388473 (Retrospectively registered 05/04/2024).

The Impact of Rural Electrification on Healthcare Service Delivery: A Case Study of Nyasa District, Tanzania

The Impact of Rural Electrification on Healthcare Service Delivery: A Case Study of Nyasa District, Tanzania

Determinants of e-Health Routinization in Public Healthcare Facilities in Kenya

The integration of e-Health into health has the potential to transform healthcare service delivery by increasing quality. Quality service delivery has the following components: safety, timeliness, effectiveness, efficiency, patient-centeredness, and equity. However, the uptake and routinization of these systems remain a challenge, particularly in developing countries. The paper adopted a narrative literature review approach to explore determinants that influence e-Health routinization in public healthcare facilities. The search was conducted across multiple academic databases, including PubMed, Google Scholar, and JSTOR, using the key terms “e-Health,” “routinization,” “Kenya,” “health facilities,” “health information systems,” and “digital health adoption.” The study peer-reviewed articles, reports, and relevant policy documents published between 2014 and 2023. The findings show that organizational support, user training, technological infrastructure, and the involvement of stakeholders in design as critical to the successful implementation of e-Health and its routinization. Challenges such as inadequate infrastructure, user involvement during implementation, and resistance to change hinder uptake and widespread use of routinization. If these challenges are adequately addressed, uptake of e-Health routinization will easily be achieved.

Determinants of e-Health Routinization in Public Healthcare Facilities in Kenya

The integration of e-Health into health has the potential to transform healthcare service delivery by increasing quality. Quality service delivery has the following components: safety, timeliness, effectiveness, efficiency, patient-centeredness, and equity. However, the uptake and routinization of these systems remain a challenge, particularly in developing countries. The paper adopted a narrative literature review approach to explore determinants that influence e-Health routinization in public healthcare facilities. The search was conducted across multiple academic databases, including PubMed, Google Scholar, and JSTOR, using the key terms “e-Health,” “routinization,” “Kenya,” “health facilities,” “health information systems,” and “digital health adoption.” The study peer-reviewed articles, reports, and relevant policy documents published between 2014 and 2023. The findings show that organizational support, user training, technological infrastructure, and the involvement of stakeholders in design as critical to the successful implementation of e-Health and its routinization. Challenges such as inadequate infrastructure, user involvement during implementation, and resistance to change hinder uptake and widespread use of routinization. If these challenges are adequately addressed, uptake of e-Health routinization will easily be achieved.

Digital Interventions for Managing Medication and Health Care Service Delivery in West Africa: Systematic Review.

As a result of the recent advancements in technology, the incorporation of digital interventions into the health care system has gained a lot of attention and adoption globally. However, these interventions have not been fully adopted, thereby limiting their impact on health care delivery in West Africa. This review primarily aims at evaluating the current digital interventions for medication and health care delivery in West Africa. Its secondary aim is to assess the impacts of digital interventions in managing medication and health care service delivery with the intent of providing vital recommendations that would contribute to an excellent adoption of digital intervention tools in the health care space in West Africa. In line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a comprehensive search through various databases yielded 529 results. After a rigorous screening, 29 articles that provided information on 3 broad digital health intervention tools were found eligible for this review. Out of 29 studies, 16 (55%) studies examined phone-based interventions, 9 (31%) studies focused on tele- and e-based interventions, and 4 (14%) studies evaluated digital interventions. These interventions were used for diverse purposes, some of which are monitoring adverse drug reactions, general health, sexual and reproductive health, and training of health care practitioners. The phone-based intervention appears to be the most known and impactful of all the interventions, followed by tele- and e-based, while digital interventions were scarcely used. Digital interventions have had a considerable level of impact on medication and health care delivery across West Africa. However, the overall impact is limited. Therefore, strategies must be developed to address the challenges limiting the use of digital intervention tools so that these tools can be fully incorporated into the health care space in West Africa.

Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment.

Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that "there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level," seconded by the Botswana National eLearning strategy (2020), which states that "there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating." The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. DERR1-10.2196/52411.

Ideal Clinic Realisation and Maintenance programme implementation in rural KwaZulu-Natal.

The delivery of quality primary healthcare (PHC) services is vital for enhancing the health status of rural communities, yet persistent barriers exist in resource-constrained rural settings. The study explored perspectives on the barriers to and facilitators of implementing the Ideal Clinic Realisation and Maintenance (ICRM) programme as a quality assurance initiative in a rural KwaZulu-Natal subdistrict. Professional nurses and healthcare managers from seven PHC clinics in a rural subdistrict of KwaZulu-Natal and supervising managers from a district hospital participated in this study. Telephonic semi-structured interviews were conducted using a qualitative case study approach with the purposively selected sample. Data were inductively and thematically analysed. Themes included ICRM programme organisation, barriers and facilitators for implementing the ICRM programme. Barriers in rural PHC settings included overburdened clinics, suboptimal infrastructure, staff burnout, poor communication and non-adherence to clinical guidelines. Despite obstacles, programme implementation was facilitated through stakeholder support and teamwork. Participants emphasised the need for infrastructure upgrades, more human and physical resources, and maintenance of stakeholder support. If challenges are mitigated and supportive factors are leveraged, the potential for successful programme implementation and improved healthcare delivery can benefit both healthcare providers and recipients.Contribution:Through providing insight into the perspectives of both implementers and supervisors, the study informs stakeholders and policymakers about difficulties encountered and potential improvements to be made in the implementation of the ICRM programme in rural PHC.

Defining, measuring and managing healthcare quality using unstructured physician review comments

PurposePhysician review websites (PRW) and Medicare requirements are pressing administrators to measure, monitor and improve healthcare service delivery. Healthcare service attributes linked to patient satisfaction have received increased attention. Text analysis provides an alternative methodology to capture contemporaneous data on service delivery attributes. A Kano analysis based on these service attributes can help administrators prioritize service delivery and ultimately improve patient satisfaction.Design/methodology/approachHealthcare service attributes were defined from 4,000+ comments on a PRW using latent content text analysis. The resulting 15 attributes were validated by medical professionals using a q-sort methodology and analyzed using a Kano methodology.FindingsThe 15 attributes cover three domains of healthcare service – clinic operations, competency and care. The Kano analysis yields a hierarchy, or pyramid, of healthcare service attributes: (1) must-be’s: establish service operational capabilities and benchmark peer performance; (2) satisfiers: establish and increase trust through: (a) clinical competence, (b) careful management of young patients and (c) delivery of appropriate care and treatment (3) delighters: use service-dominant logic to provide patient-centered care.Originality/valueThis research bridges the gap between the “what” and “how” that is frequently missing in text analysis of online reviews. We provide a methodology coupled with a Kano analysis, a widely used quality improvement tool, which results in a hierarchy of service attributes that can guide administrators and researchers.