Healthcare Staff Research Articles

Prevalence of Sleepiness and Associated Factors Among Healthcare Staff: A Cross-Sectional Study in A University Hospital in Palestine

Prevalence of Sleepiness and Associated Factors Among Healthcare Staff: A Cross-Sectional Study in A University Hospital in Palestine

High blood pressure is correlated with anthropometric status in adults in Gribig district, Central Java, Indonesia

Background: More than 17 million deaths worldwide are caused by cardiovascular disease due to high blood pressure. According to the World Health Organization (WHO), around 1.3 billion adults will have high blood pressure in 2021. Obesity is a significant factor influencing blood pressure. Waist circumference measurements and body mass index (BMI) can be used to identify obesity issues. Objective: The aim was to analyze the correlation between BMI, waist circumference, and blood pressure among adults at Primary Health Care in Kudus, Central Java, Indonesia. Methods: This cross-sectional study evaluated BMI, waist circumference, blood pressure, and questionnaire. Men and women aged 18-59 (healthcare staff, patient caregivers, and patients) who agreed to become study subjects were included. Participants with a history of diseases, current conditions, medication intake that affects blood pressure, and pregnancy were excluded. Samples were taken using purposive sampling and the Pearson test as a statistical analysis. Results: The analysis showed a significant correlation between the BMI of patients with systolic blood pressure (p=0.000) and diastolic blood pressure (p=0.000). A moderate relationship was found between BMI and systolic blood pressure(r=0.473) and diastolic blood pressure (r=0.439). Moreover, waist circumference was significantly correlated with systolic blood pressure (p=0.000) and diastolic blood pressure (p=0.000). Conclusion: A significant correlation exists between BMI and waist circumference with blood pressure among adults at the Primary Health Care in Kudus, Central Java, Indonesia.

Can the Pioneering Impact of Artificial Intelligence in Anaesthetic Practice Uphold Good Medical Practice?

The potential applications of Artificial Intelligence (AI) in anaesthesia are expansive.~However, like any technological advancement, the integration of AI in anaesthetic practice comes with both benefits and potential risks. This article seeks to set out some of the advantages and disadvantages of the use of AI technologies within the field of anaesthesia. Benefits of the application of AI in anaesthesia include an improvement in perioperative risk stratification, personalisation of anaesthetic plans, improvement in efficiency and ultimately reduce healthcare costs. However, reliance on technology may reduce clinical acumen but furthermore there are issues surrounding data quality, privacy as well as legal and ethical concerns, which require further evaluation. Whilst AI within anaesthetic practice holds immense promise, there are substantial challenges which require careful consideration and ongoing evaluation. A collaborative approach will be required from healthcare staff, developers and regulators to promote the safe, responsible, and effective application of AI in anaesthesia practice.

LIFE AFTER STROKE AND THE KEY ROLE OF COORDINATED REHABILITATION FROM THE PERSPECTIVE OF THE STROKE SURVIVOR FAMILIES

Introduction. Stroke significantly affects the lives of survivors, requiring adaptation to lost capabilities while impacting physical, mental, and emotional well-being. Stroke is a leading cause of acquired disability in adults and a significant contributor to mortality, particularly among older individuals and in low-income countries. A stroke is described as a neurological deficit caused by acute damage to the central nervous system. Aim. The study's main aim was to explore the use of coordinated stroke rehabilitation before, during, and after hospital discharge. It examined components of coordinated rehabilitation, focusing on the needs of the client's family. This study was conducted as part of the GAJU 066/2022/S project and approved by the ethics committee under 6/2022. Materials and methods. This study used a qualitative research approach and semi-structured interviews with family members caring for stroke patients. The data collected was then analyzed using various coding strategies with the assistance of ATLAS.ti software. This rigorous methodology ensured the reliability and validity of the study's findings. Results. The effects of strokes are profound, not only on patients but also on their families and caregivers. Adapting to life after a stroke necessitates significant changes in family dynamics, values, and norms. The importance of effective communication and support from healthcare staff during patient hospitalization cannot be overstated. Respondents highlighted the role of quality care and communication in ensuring a positive hospital stay. However, they also pointed out certain deficiencies, such as delayed stroke diagnosis and inadequate information about post-discharge care and rehabilitation. The study underscored the importance of at-home rehabilitation in familiar environments for functional improvement. Conclusions. Life after a stroke presents a substantial challenge for patients and their families, requiring physical, psychosocial, and emotional adaptation. Coordinated rehabilitation facilitates post-stroke adjustments for patients and families and increases overall quality of life. Improved coordination and communication among healthcare providers, development of multidisciplinary rehabilitation teams, and effective post-discharge monitoring and support systems are essential for comprehensive care tailored to the needs of the patient and their families. Stroke patient family members advocate for enhanced support and services for better rehabilitation and for coping with post-stroke challenges.

Workload balancing for the nurse scheduling problem: A real-world case study from a French hospital

To improve the efficiency and viability of healthcare organizations, it is crucial to enhance both the quality of patient care and the well-being of healthcare staff, particularly nurses. They play a vital role as a key human resource in healthcare, and their well-being and job satisfaction are significantly influenced by effective scheduling. Improved scheduling practices not only enhance the quality of care provided but also contribute to better job satisfaction and overall well-being of the nursing staff. Despite the importance of this task, nurse scheduling is often conducted manually by head nurses, which is both challenging and time-consuming. This study proposes a mathematical model that addresses the nurse scheduling problem, with a specific application in a French hospital department. The objectives of the model are to accommodate a wide range of constraints flexibly, ensure balanced workloads and shifts, and align with the preferences of the nursing staff. A significant contribution of this research is the theoretical investigation and comparison of various workload balancing criteria tailored to the specific context of the problem. The study analyzes different workload balancing criteria to formulate an efficient scheduling solution. The effectiveness of the proposed approach is demonstrated through large experiments and practice feedback, confirming its potential to enhance both healthcare efficiency and nurses’ well-being.

What Women with HIV Know about Heart Health and Cardiovascular Risk and Intervention Preferences.

Cardiovascular disease (CVD) is a significant health concern influenced by various determinants. Stigma and resilience have emerged as factors in CVD development and management. Women with HIV (WWH) have higher CVD rates than women without HIV. To improve cardiovascular health for WWH, a comprehensive understanding of how these factors interact, the understanding about individual awareness and willingness to engage in risk-reduction interventions are needed. Methods: As part of a study examining CVD risk among WWH aged >35 years old, 90-min focus groups were conducted (May 2022) in the English language. Focus groups aimed to elicit participants' CVD risk knowledge and potential prevention strategies. Transcripts underwent a qualitative analysis. Results: Nineteen WWH participated in three focus groups. Participants experienced the following: (a) enacted stigma related to their HIV diagnosis (e.g., family, church member, healthcare staff); (b) a recent event (e.g., hospitalization of self/family, death in family, chest pain) triggered both heart health-promoting lifestyle changes and suboptimal health behaviors (e.g., COVID-19 pandemic: unhealthy snacking). Participants wanted to obtain more knowledge ("on a mission") about CVD risk. In total, 100% expressed willingness to take medication or embark on other lifestyle changes to prevent future CVD events. Although participants identified preventative heart health behaviors (e.g., eating healthy foods; exercising; limiting stress, substances, and smoking), misconceptions were also identified (e.g., "catching" heart disease). Conclusions: Understanding the interplay of the different factors related to heart health is needed both at the provider and the patient level to inform interventions that reduce CVD risk amongst racial/ethnic minoritized women with HIV, living in the Southern region of the US.

Patient Initiated Follow-Up (PIFU): how can rheumatology departments start to reap the benefits? A consensus document.

Patient Initiated Follow-Up (PIFU) is gaining momentum in the NHS, aiming to optimize outpatient care amidst rising service demands. PIFU is valuable in rheumatology, where the increasing demand for ongoing management exacerbates the patient backlog. Importantly, PIFU has demonstrated comparable safety and outcomes to traditional care in numerous studies. PIFU empowers patients, drives personalized care, increases efficiency, and has the potential to reduce waiting lists by allowing services to focus on new and acute cases. Effective PIFU implementation includes careful selection of patients, educating patients and healthcare staff, well defined operational guidelines, and robust remote monitoring. Digital solutions can enhance PIFU through patient education, active remote monitoring and streamlined escalation. Electronic Patient Reported Outcome Measures (ePROMs) provide a suitable and safe metric to monitor patients remotely. Given the potential benefits, outpatient departments should consider investing in PIFU as a solution to current healthcare delivery challenges and as a means for future proofing clinical systems against increasing service demands.

Everyone should have their own midwife: Women’s and staff experiences during the implementation of two midwifery continuity of care models in regional Australia

ProblemMidwifery Continuity of Care (MCoC) remains inaccessible for most Australian women; this is especially true in rural and regional areas. BackgroundStrong evidence demonstrates MCoC models improve experiences for women and their babies and are also shown to improve midwifery workforce wellbeing. However, implementation and upscale remains limited. AimTo explore the views and experiences of implementing MCoC for both staff and women, understanding their experiences, concerns and solutions in a regional context. MethodsQualitative data was collected via focus groups with women and healthcare staff, at six and twelve month post implementation. Data was thematically analysed using Braun and Clarke six step process. FindingsThe findings support that ‘women love it’ and midwives working in the new MCoC model ‘loved their job’. The major concern was that not all women could access the model and disconnected communication was problematic during implementation. ‘Sharing stories’ was a solution to overcoming these issues and promoting the positive impact of MCoC - in particular ways of working and adaption to an all-risk midwifery group practice. DiscussionThis study supports widespread evidence that MCoC is valued by both women and staff. In a regional context it is important to recognise challenges faced during implementation and identifying solutions that other maternity services could consider when implementing MCoC. ConclusionThe study offers strong recommendation for regional areas to consider MGP to maintain safe, quality local maternity services.

Enhancing Job Satisfaction for Oncology Staff: Research Versus Inquisitive Conversations.

The burden of cancer is increasing, and this is putting incredible strain on the healthcare system, specifically on frontline oncology health care providers. This is well documented in the published literature, and the situation has been exacerbated following the COVID-19 pandemic. There is ample evidence about the concerns of healthcare staff as to what changes are needed to improve their work lives and make them more efficient and effective at their jobs. There can always be more research done in this area, but, more importantly, there is an urgent need to start taking concrete steps and appropriate action to improve the situation so cancer patients can get the best available care possible.

Eliciting patient past experiences of healthcare discrimination as a potential pathway to reduce health disparities: A qualitative study of primary care staff.

To understand whether and how primary care providers and staff elicit patients' past experiences of healthcare discrimination when providing care. Twenty qualitative semi-structured interviews were conducted with healthcare staff in primary care roles to inform future interventions to integrate data about past experiences of healthcare discrimination into clinical care. Qualitative study. Data were collected via semi-structured qualitative interviews between December 2018 and January 2019, with health care staff in primary care roles at a hospital-based clinic within an urban safety-net health system that serves a patient population with significant racial, ethnic, and linguistic diversity. Providers did not routinely, or in a structured way, elicit information about past experiences of healthcare discrimination. Some providers believed that information about healthcare discrimination experiences could allow them to be more aware of and responsive to their patients' needs and to establish more trusting relationships. Others did not deem it appropriate or useful to elicit such information and were concerned about challenges in collecting and effectively using such data. While providers see value in eliciting past experiences of discrimination, directly and systematically discussing such experiences with patients during a primary care encounter is challenging for them. Collecting this information in primary care settings will likely require implementation of multilevel systematic data collection strategies. Findings presented here can help identify clinic-level opportunities to do so.

Leveraging Consistent Communication Tools and Organizational Values to Promote Accountability Among Health Care Providers.

Teamwork and effective communication between all health care staff members are essential to providing safe, high-quality patient care. High-reliability organizations align behavioral expectations with organizational values and prioritize safety over other performance metrics and pressures. Communication breakdowns, such as inadequate or incomplete information shared between caregivers, continues to be an issue that is linked to errors and staff member dissatisfaction. Initiatives to improve health care communication and improve patient outcomes are well documented, yet communication issues in the health care setting continue. An organization's credo defines its values and behavioral expectations. Educating team members on an organization's credo creates accountability among those teams to align their behavior with the organization's values, policies, and professional commitment. A Coworker Observation Reporting System offers a communication method for providing meaningful feedback on behaviors inconsistent with an organization's credo.

Traumatic Stress, Psychological Well-being, and Sociodemographic Correlates in High-stress Environments among Healthcare Professionals

Background Healthcare staff provide crucial services to their patients; hence, their well-being is essential to ensure they offer the best services with minimal harm to their health. Aim This study aimed to identify associations of traumatic stress, psychological well-being, and sociodemographic variables to provide insight into the experiences and feelings of healthcare personnel in high-stress settings. Furthermore, we will examine how sociodemographic factors and traumatic stress impact the psychological well-being of high-stress environment healthcare professionals. Objective This research investigated the relationship between traumatic stress, psychological well-being, and sociodemographic factors in high-stress environments among healthcare personnel in different medical units. It was hypothesized that sociodemographic variables and traumatic stress will predict psychological well-being among healthcare workers who work in high-stress environments. Furthermore, there will be differences in traumatic stress and psychological well-being based on sociodemographic variables among healthcare workers working in high-stress environments. will experience high l Methods To accomplish this goal, an online survey including sociodemographic information, standardized questionnaires of Secondary Traumatic Stress Scale, and a Brief Inventory of Thriving were administered to healthcare personnel (N=290) to collect data for sociodemographic characteristics, traumatic stress levels, and psychological well-being. The results were processed by using SPSS. The descriptive statistics measured participants' characteristics, traumatic stress levels, and psychological well-being. The pearson product-moment correlation, regression analysis, and ANOVA were used to measure the relationship and impact of sociodemographic factors, traumatic stress, and psychological well-being. Results A significant inverse relationship between traumatic stress and psychological well-being (r= -0.518, p < 0.05) was reported. Furthermore, multiple regression analysis provided the predictive association of traumatic stress and negative well-being (p<0.05). Additionally, ANOVA was conducted to measure the differences in socio- demographic variables of traumatic stress and the psychological well-being level of healthcare professionals. Conclusion The results of this research could help inform policy decisions and interventions that may improve the psychological well-being of healthcare personnel in high-stress environments. Ethical considerations such as participant privacy protection and addressing potential psychological distress are also discussed.

How much do hospital staff know, how much do they care, and what should they know about economic aspects of Diagnosis Related Groups? The case of an Italian children’s hospital

Background: Diagnosis Related Group (DRG) costing enables more efficient therapeutic choices. For this to occur, staff must be aware of the costs of the resources used in the process.Objective: The paper aims to identify potential information gaps of physicians, nurses, and administrative staff regarding economic aspects. It explores the intersection of financial awareness and the perceived importance of economic factors to evaluate the information deficiencies across these professional groups.Methods: The costs of DRG 546 different phases are estimated. Data on economic factors awareness (EFA) and economic factors importance (EFI) are gathered through a questionnaire. The survey involved 61 Italian employees of an Italian children’s hospital among physicians, nurses, and administrative staff.Results: A trade-off emerges between the scarce knowledge of the DRG economic aspects and their importance for physicians and nurses. Awareness of economic aspects does not depend on years of seniority.Conclusions: Economic factors awareness is low, although the staff considers this issue important. An information gap needs to be addressed. Clinical staff are partially aware of the costs of the activities in which they are directly involved, but they are unaware of other economic aspects of the therapeutic process. Nurses are the professional group with the lowest cost awareness. Different professional groups require different financial information. Physicians and nurses should be aware of relevant costs and the cost of activities with negligible impact on patient outcomes.Potential implications: Administrative offices often do not know what economic data could be helpful in the physicians’ or nurses’ decisions. In addition, medical and nursing staff do not know precisely what information to ask for. Workgroups composed of administrative and healthcare staff should define what relevant financial data should be provided and how.

Learning effect of online versus onsite education in health and medical scholarship – protocol for a cluster randomized trial

BackgroundThe disruption of health and medical education by the COVID-19 pandemic made educators question the effect of online setting on students’ learning, motivation, self-efficacy and preference. In light of the health care staff shortage online scalable education seemed relevant. Reviews on the effect of online medical education called for high quality RCTs, which are increasingly relevant with rapid technological development and widespread adaption of online learning in universities. The objective of this trial is to compare standardized and feasible outcomes of an online and an onsite setting of a research course regarding the efficacy for PhD students within health and medical sciences: Primarily on learning of research methodology and secondly on preference, motivation, self-efficacy on short term and academic achievements on long term. Based on the authors experience with conducting courses during the pandemic, the hypothesis is that student preferred onsite setting is different to online setting.MethodsCluster randomized trial with two parallel groups. Two PhD research training courses at the University of Copenhagen are randomized to online (Zoom) or onsite (The Parker Institute, Denmark) setting. Enrolled students are invited to participate in the study. Primary outcome is short term learning. Secondary outcomes are short term preference, motivation, self-efficacy, and long-term academic achievements. Standardized, reproducible and feasible outcomes will be measured by tailor made multiple choice questionnaires, evaluation survey, frequently used Intrinsic Motivation Inventory, Single Item Self-Efficacy Question, and Google Scholar publication data. Sample size is calculated to 20 clusters and courses are randomized by a computer random number generator. Statistical analyses will be performed blinded by an external statistical expert.DiscussionPrimary outcome and secondary significant outcomes will be compared and contrasted with relevant literature. Limitations include geographical setting; bias include lack of blinding and strengths are robust assessment methods in a well-established conceptual framework. Generalizability to PhD education in other disciplines is high. Results of this study will both have implications for students and educators involved in research training courses in health and medical education and for the patients who ultimately benefits from this training.Trial registrationRetrospectively registered at ClinicalTrials.gov: NCT05736627. SPIRIT guidelines are followed.

Hospital-induced immobility – a backstage story of lack of chairs, time, and assistance

BackgroundInactivity and bedrest during hospitalisation have numerous adverse consequences, and it is especially important that older patients are mobile during hospitalisation. This study aimed to identify whether the introduction of formal education of clinical staff and a Mobilisation Initiative (MI) could increase mobilisation of patients in a geriatric and a medical ward. Furthermore, to explore patients’ and health care staffs’ view on facilitators and barriers for mobilisation during hospitalisation.MethodsThe study was a pragmatic clinical study. Both qualitative and quantitative methods were used. The patients’ level of mobilisation was obtained through short interview-based surveys and observations. Focus group interviews and formal education of clinical staff was initiated to increase awareness of mobilisation along with the implementation of a MI.Results596 patient surveys were included. Of all patients, 50% in the geriatric ward and 70% in the medical ward were able to independently mobilise. The highest percentage of patients sitting in a chair for breakfast and lunch in the geriatric ward was 57% and 65%, and in the medical ward 23% and 26%, respectively. A facilitator for mobilisation was interdisciplinary collaboration, and barriers were lack of chairs and time, and the patients’ lack of help transferring.ConclusionsThis study adds new knowledge regarding the lack of in-hospital mobilisation in geriatric and medical departments. Mealtimes are obvious mobilisation opportunities, but most patients consume their meals in bed. A potential for a MI is present, however, it must be interdisciplinarily and organisationally anchored for further investigation of effectiveness.Trial registrationRetrospectively registered at ClinicalTrials.gov with the trial number NCT05926908.

Working conditions, well-being, and retention of healthcare personnel: A comparative study between lean healthcare and nurse-to-patient ratio

ABSTRACT The issue of nurse retention due to stressful working conditions in several Western countries, including Canada, has been exacerbated in recent years by population aging, mass retirements, and the COVID-19 crisis. To address these challenges, healthcare organizations have drawn inspiration from service optimization models adopted by industry (Lean Healthcare) and staffing ratio projects. However, there is a lack of research exploring the working conditions of healthcare staff under these different systems. Drawing on conservation of resources theory and the job demands-resource model, we tested, using structural equation modeling and multigroup analysis, the effects of the workload intensification on job well-being and staff retention. We compared a sample of 145 nurses working under the Lean system with another sample of 155 nurses working under the ratio system. The results support our hypotheses and highlight that working conditions appear to be more challenging under the Lean system than under the ratio system.

Promoting sleep and rest in hospitalized children: a best practice implementation project.

The objective of this project was to implement scientific evidence to promote sleep and rest in pediatric patients during hospitalization. Hospitals are not conducive to quality sleep, as external factors such as light, noise, and interruptions from health care staff can disturb patients. Being hospitalized has a detrimental impact on children's sleep because it reduces how much sleep they get and the quality of that sleep. It has been reported that up to 20% to 30% of hospitalized children experience sleep problems. This project was conducted at the Marqués de Valdecilla University Hospital in Cantabria, northern Spain. The project used the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process, together with a structured approach to identifying and managing barriers to change. The study subjects were 100 children aged 2 to 16 years, who were admitted to the hospital's pediatric unit from November to December 2021, and 27 multi-disciplinary health care staff. Implementing the evidence-based strategies improved our care practices, with the follow-up audit results showing a marked improvement in compliance. Thus, training health care staff on pediatric sleep increased from 4% to 80%; using a multi-faceted approach to sleep promotion increased from 21% to 87%; and promoting relaxation techniques to promote sleep increased from 0% to 80%. The project met its objectives. Areas for improving children's sleep and rest during hospitalization were identified. To avoid resistance to change, it was necessary to involve the entire team and maintain training. We recommend follow-up audits once a year, to ensure the sustainability of the project. http://links.lww.com/IJEBH/A252.

Toward Laboratory Notification in Pediatric Emergency Departments.

This study explores how patient's laboratory result are accessed in pediatric emergency departments. The rapid turnaround of laboratory results and their timely access by the medical team are crucial for effective patient management and care decision-making. This study revealed a systematic access prioritization to the Electronic Health Record, led by physicians, followed by nurses, and then other healthcare staff Despite efforts to streamline access through computerized laboratory results, optimized laboratory turnaround time and integration of final results into the electronic health record remain key challenges. Delays in accessing analysis results issued by the central hospital laboratory are consistently experienced across various laboratory types, indicating broader systemic workflow issues rather than inefficiencies specific to individual laboratories.

Patterns of health workforce turnover and retention in Aboriginal Community Controlled Health Services in remote communities of the Northern Territory and Western Australia, 2017–2019

BackgroundAboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs’ geographical and demographic characteristics.MethodsThe study used 2017–2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels.ResultsThere was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and ‘other health workers’ combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01).ConclusionsParticipating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs’ resources and may also support quality of service delivery due to improved cultural safety and continuity of care.

Longitudinal Care Management for Diabetes and Hypertension

Addressing common sources of chronic disease leads to improved patient health, as well as presenting a scalable target for the improvement of value-based care outcomes. Improving patients’ self-management skills and quality of life is the key goal of chronic disease management. Mitigating high-costs and slowing disease progression create mutual success for both patients and health care systems. By training nurses to deliver a refined model of longitudinal care management, Corewell Health West was able to achieve improved chronic disease control and create additional capacity among primary care providers. The initial focus of the longitudinal care program was diabetes and hypertension management. Corewell Health created a Multidisciplinary Approach to Disease Over Time (MADOT) framework to guide care management for patients with multiple chronic conditions or who are facing long recovery journeys. The framework emphasizes timely and actionable patient identification, regular contact between patients and health care staff that prioritizes patient goals and assesses their “readiness to change,” and specialized skills development for health care staff. The framework has shown success among patients with uncontrolled diabetes (A1c ≥8.0). Of the targeted interventions carried out for more than 1,000 patients since January 2022, 608 patients fully completed the program; these patients demonstrated an average 2.24-percentage point reduction in hemoglobin A1c. Of those 608 patients, 364 had a pre-intervention hemoglobin A1c level ≥9.0 and achieved an average 3.02-percentage point reduction in hemoglobin A1c. Similarly, patients who graduated from the program saw greater improvement in systolic blood pressure than patients who disenrolled or declined interventions.