Implementation Of Health System Research Articles

Maturity Assessment of District Health Information System Version 2 Implementation in Ethiopia: Current Status and Improvement Pathways.

Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. The national DHIS2 implementation's maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed.

Timeliness and quality of peripartum care provision during a health system strengthening initiative in rural Guinea-Bissau: a qualitative situation analysis

Guinea-Bissau has among the world’s highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.

Relevance of learning health systems to physiatrists and its synergy with implementation science: A commentary.

As health care attempts to bridge the gap between evidence and practice, the concept of the learning health system (LHS) is becoming increasingly relevant. LHS integrates evidence with health systems data, driving health care quality and outcomes through updates in policy, practice, and care delivery. In addition, LHS research is becoming critically important as there are several initiatives underway to increase research capacity, expertise, and implementation, including attempts to stimulate increasing numbers of LHS researchers. Physical Medicine & Rehabilitation (PM&R) physicians (physiatrists), nurses, therapists (physical therapists, occupational therapists, speech therapists, clinical psychologists), and scientists are affiliated with LHSs. As LHS research expands in health care systems, better awareness and understanding of LHSs and LHS research competencies are key for rehabilitation professionals including physiatrists. To address this need, the Agency of Healthcare Research and Quality (AHRQ) identified 33 core competencies, grouped into eight domains, for training LHS researchers. The domains are: (1) Systems Science; (2) Research Questions and Standards of Scientific Evidence; (3) Research Methods; (4) Informatics; (5) Ethics of Research and Implementation in Health Systems; (6) Improvement and Implementation Science; (7) Engagement, Leadership, and Research Management; and the recently added (8) Health and Healthcare Equity and Justice. The purpose of this commentary is to define LHS and its relevance to physiatrists, present the role of implementation science (IS) in LHSs and application of IS principles to design LHSs, illustrate current LHS research in rehabilitation, and discuss potential solutions to improve awareness and to stimulate interest in LHS research and IS among physiatrists in LHSs.

A narrative review of e-health systems' evolution - evidence from a regional study.

The growing implementation of electronic health (e-health) systems has raised the importance of analyzing how these systems have been implemented in diverse regions. By employing a contextual sensitive approach and social mechanism theory, this study aims to better understand the reasons for the success and failure of e-health initiatives in the ex-Yugoslav region and derive useful insights for policymakers. We employ a narrative review process grounded in the social mechanism theory, extended with field experts' review, to acquire state-of-the-art information. Findings indicate that different e-health systems coexist and evolve in different contexts in different countries, with varying levels of success. The contextual differences shape the broader environment, affecting the level of preparedness and capability for e-health implementation. Top-down approaches dominate e-health implementation in most countries when it comes to design process features, and more developed countries do not rely on strong social mechanisms for implementing e-health due to the openness of their culture towards e-health innovations. Analyzing the milestones, challenges and functionalities of e-health systems in the region of interest can assist policymakers, academics and practitioners in making informed decisions and recommendations to enhance future e-health implementation. No known studies evaluated e-health initiatives in the former ex-Yugoslav countries holistically and evolutionarily in the form of a comprehensive regional study. Further, our research endeavor is contextually specific since the health systems of these countries in the past were tied together under the federative umbrella health system and then diverged in terms of e-health development.

#1377 Evaluation of state-wide health system implementation of renal supportive care shows substantial net benefits

Abstract Background and Aims In 2016, the New South Wales (NSW) Health system implemented a service to make the principles and practice of palliative medicine comprehensively available to patients receiving chronic kidney disease (CKD) care across NSW. Summative evaluation of the economic value that this multi-disciplinary State-wide RSC service provided following implementation was prospectively planned in the domains of patient experience and economic value. This abstract reports the first cost-benefit analysis of a RSC service. Method De-identified patient-level data was extracted from the NSW Renal Supportive Care Register (a linked dataset comprising admitted patient, non-admitted patient, emergency department episodes and death registrations). Data was compared between 2015/16, prior to implementation of the State-wide RSC service; and 2018/19, following settled operation of the service. A cost-benefit analysis model was constructed to estimate the economic value of the RSC service between 2015/16 and 2018/19; and the projected value to 2029/30 under different scenarios. Multivariate Cox regressions were estimated to measure survival benefits, and a polynomial regression model was employed to estimate the impact of RSC on the share of patients receiving dialysis. Results Considering the actual impact of the NSW RSC service; in 2015/16, 5% (n = 443) of all ESKD patients, (defined as receiving dialysis >3 months, non-dialysis conservative care or in receipt of a functioning transplant) received any RSC service. By 2018/19, 16% (n = 1460) of all ESKD patients had received RSC within NSW. The proportion of patients receiving RSC from a non-dialysis conservative care or dialysis context remained stable between 2015/16 and 2018/19 at 41% and 29% respectively. Patients receiving RSC were estimated to have increased survival by 3-21 weeks, depending on patient characteristics, compared to the scenario of no RSC service. Considering the projected value of ongoing RSC services; scenarios with different assumptions were modelled. Assuming that the proportion of patients receiving different ESKD modalities and the costs of care remained stable, the RSC service would deliver a net financial benefit to the commissioning health system (avoided costs of service minus RSC costs) of ${\$}$109 million Australian Dollars (AUD), with a return on investment of 212%, compared to the scenario of no RSC service. When the economic value for the whole NSW community from increased survival benefit was included, the projected value was ${\$}$275 million AUD, with return on investment of 535%. The projected economic value of RSC was modelled under scenarios of increasing access to the service by ESKD patients (Figure). Increasing RSC access from the achieved 16% to 20% of ESKD patients was projected to deliver maximal economic value, with a 3% fall in ESKD patients receiving dialysis, increasing survival benefit (${\$}$221 million AUD) and economic value ${\$}$94 million AUD. As access to RSC expands further, modelling indicates that additional dialysis substitution becomes less likely but benefits still accrue from survival up to a maximum viable rollout of 50% of the ESKD population receiving RSC, when survival benefits plateau. Conclusion Economic evaluation of this implementation of the Statewide RSC service across NSW Health shows it has been associated with both a net economic benefit and survival benefits four years after implementation. It is projected to provide an economic value of ${\$}$275 million AUD over ten years, which would increase with greater participation of ESKD patients suitable for RSC.

Implementing the Serious Illness Care Program in Safety Net Health Systems: A Qualitative Study

ContextInterventions to improve the quality of care for people affected by serious illness commonly fail to reach patients from marginalized and underserved communities, which include those characterized by racialized or indigenous identity, sexual and gender minority status, and rural living. Interventions to improve care through serious illness conversations have demonstrated benefit, but little is known about their implementation in health systems that predominantly serve these patient groups. ObjectivesThe study aimed to understand factors influencing implementation of a serious illness communication-focused intervention—the Serious Illness Care Program in health systems who primarily provide care to marginalized and underserved communities. MethodsQualitative interviews (16) and focus groups (3) were conducted with 19 interdisciplinary team members from six geographically diverse U.S. healthcare systems. Using a template analysis approach, investigators coded data inductively and deductively to identify themes. ResultsThree themes emerged: patient factors, intervention elements, and health system contextual factors. Participants highlighted mission-driven efforts, creativity, interprofessional practice, and trainees as enablers of success. They identified weaknesses in the intervention's communication tool—the Serious Illness Conversation Guide as barriers to implementation of conversations. Resource constraints, socio-economic vulnerability, and mistrust in the health system were seen as additional barriers. ConclusionsHealth systems that provide care to underserved and marginalized communities face unique challenges implementing the Serious Illness Care Program. They also possess assets, some unique to these settings, that support program adoption. Findings suggest that implementation of similar programs in low-resource healthcare settings may help address unmet needs among marginalized populations.

Priority setting: Development of the South Australian Aboriginal Chronic Disease Consortium RoadMap for Action.

Aboriginal and Torres Strait Islander (Aboriginal) people in South Australia are overburdened by cardiovascular disease, diabetes and cancer. The South Australian Aboriginal Chronic Disease Consortium (Consortium) was established in June 2017 as a collaborative partnership to lead the implementation of three state-wide chronic disease plans using a strategic approach to identifying key priority areas for action. In 2017-2018, the Consortium Coordinating Centre facilitated a priority setting process, which involved extensive consultation, including a prioritisation survey and stakeholder workshops. The Consortium's Aboriginal Community Reference Group was instrumental in leading the identification of priorities for action. The Consortium RoadMap for Action identified seven across-plan priorities and six condition-specific priorities. It acknowledged that: strengthening social and emotional well-being is central to improving health outcomes; prevention and early detection, acute management and ongoing management are all components of the continuum of care; and improving access to services, strengthening the workforce, and monitoring and evaluation are required across the continuum of care. Widespread implementation failure in the past across the health system and health services implementation and research translation highlights the value of the Consortium approach and its commitment to implementing the state-wide chronic disease plans in a collaborative manner. The Consortium relies on and fosters cross-sectoral alignment, with all key players including all public, private and Aboriginal Community Controlled health services, to progress its priorities and aspirations to improve health outcomes for Aboriginal people using evidence-based strategies. SO WHAT?: Rigorous and transparent priority setting processes that bring together research, clinical practice, health services operations, policy and community perspectives can foster intersectoral collaboration and partnership and support the implementation of shared priorities.

Health system implementation of the PROMIS Cognitive Function Screener in the Medicare Annual Wellness Visit: framing as abilities versus concerns

BackgroundCognitive assessment is a required component of the Medicare Annual Wellness Visit (AWV). In this prospective study, we evaluated acceptability and usefulness of a patient-reported outcome measure (the PROMIS® Cognitive Function Screener, or PRO-CS) to screen for cognitive impairment during the AWV. We compared two versions of the PRO-CS: Abilities and Concerns.MethodsWe developed PRO-CS Abilities and PRO-CS Concerns using items from the PROMIS Cognitive Function item banks. We partnered with a large health system in Pennsylvania to implement an electronic health record (EHR)-integrated version of the 4-item PRO-CS into their AWV workflow. PRO-CS Abilities was implemented in June 2022 and then replaced with PRO-CS Concerns in October 2022. We used EHR data to evaluate scores on Abilities versus Concerns and their association with patient characteristics. We gathered feedback from providers on experiences with the PRO-CS and conducted cognitive interviews with patients to evaluate their preferences for Abilities versus Concerns.ResultsBetween June 2022 and January 2023, 3,088 patients completed PRO-CS Abilities and 2,614 patients completed PRO-CS Concerns. Mean T-scores for Abilities (54.8) were slightly higher (indicating better cognition) than for Concerns (52.6). 10% of scores on Abilities and 13% of scores on Concerns indicated concern for cognitive impairment (T-score < 45). Both Abilities and Concerns were associated with clinical characteristics as hypothesized, with lower scores for patients with cognitive impairment diagnoses and those requiring assistance with instrumental activities of daily living. Abilities and Concerns had similar negative correlations with depression (r= -0.31 versus r= -0.33) and anxiety (r= -0.28 for both), while Abilities had a slightly stronger positive correlation with self-rated health (r = 0.34 versus r = 0.28). In interviews, providers commented that the PRO-CS could be useful to facilitate conversations about cognition, though several providers noted potential limitations of patient self-report. Feedback from patients indicated a preference for PRO-CS Concerns.ConclusionsOur findings suggest potential utility of the PRO-CS for cognitive screening in the Medicare AWV. PRO-CS Abilities and Concerns had similar associations with patient clinical characteristics, but the Concerns version was more acceptable to patients.

Occupational safety & health risk analysis in formwork in high-rise building projects

The implementation of Occupational Health and Safety Management systems remains a significant concern, particularly in the context of multi-storey building construction projects. Within the realm of these complex endeavors, the management of work-related accidents during formwork operations is of paramount importance. This research employs a rigorous methodology involving questionnaire distribution and interviews, complemented by advanced analytical tools such as the Frequency Adjusted Importance Index (FAII) and Bow Tie Analysis. The study focuses on the Indonesian Development University’s high-rise building project, systematically assessing potential hazards associated with formwork activities. Furthermore, this research evaluates the inherent risk levels and proposes comprehensive control measures to mitigate these hazards effectively. By shedding light on the intricate interplay between safety management and high-rise construction, this study contributes to the enhancement of occupational safety and health practices in the construction industry, ultimately promoting safer and more efficient work environments.

A Comparative Study of Hospitals in Yasuj, Iran, in Terms of the Implementation of the Health System Planning and the Quality of Medical Services

Background: Today, the implementation of the health system plan has led to the reduction of people's payments and to equitable access to health services and the improvement of the quality of services. Objectives: The current research was conducted with the aim of a comparative study of hospitals in Yasuj, Iran, in terms of the implementation of the health system plan and the quality of medical service. Methods: The statistical population of the present descriptive study was 380 patients at Shahid Beheshti Hospital, Yasuj, 150 patients in Shahid Rajaei Hospital and 300 patients in Imam Sajjad Hospital, all located at Yasuj, Iran. According to Morgan's table, 181 patients at Shahid Beheshti Hospital, 108 patients at Shahid Rajaei Hospital and 169 patients at Imam Sajjad Hospital were included as the statistical sample. All the participants completed the questionnaire and the implementation status of the health system plan and the quality of medical services. One-way ANOVA was used to analyze the statistical findings. All statistical operations were performed using SPSS v.18 software Results: The results of the the present study indicated that the health system implementation status of Shahid Beheshti Hospital, Imam Sajjad Hospital and Shahid Rajaei Hospital in Yasuj was favorable. These findings indicated that the health system plan in Yasuj were properly and correctly implemented. Moreover, the quality of medical services at Shahid Beheshti Hospital, Imam Sajjad Hospital, and Shahid Rajaei Hospital in Yasuj were satisfactory. Also, the results showed that there is was no significant difference in the quality of medical services in Yasuj hospitals (P = 0.44 &amp; F = 0.81 &amp; 455 &amp; 2 F). Correspondingly, the results disclosed that there was no significant difference in the implementation status of the health system plan of hospitals in Yasuj city (P = 0.39 &amp; F = 0.93 &amp; 455 &amp; 2). Conclusions: Medical centers should continuously evaluate the quality of their services, since improving the quality of medical services encourages patients to follow their treatment instructions correctly and on time, and also accelerate the progress of treatments and achieves the main therapeutic goal of treating patients.

Partnership-building considerations for implementation science in learning health systems: a case study of the Implementation Science Collaborative in Alberta, Canada.

Implementation of health innovations is inherently collaborative, requiring trans-sectoral partnerships between implementation researchers, innovation teams, and implementation practitioners. Implementation science has been shown to improve implementation successes; however, challenges that hinder partnerships to advance implementation science continue to persist. Using a whole-system approach to assess and respond to implementation science partnership barriers may shed light on effective responses. We conducted a case study of Alberta's learning health system, using semi-structured group and individual interviews to create a nuanced understanding of the considerations required for implementation research collaborations. We interviewed 53 participants representing 21 offices in the health system, academia, professional associations, and government who regularly plan, evaluate, and/or study health system implementation initiatives in Alberta. Using the Partnership Model for Research Capacity Building, we identified current facilitators and challenges for partnerships for conducting and using implementation science, at different levels of Alberta's health-research ecosystem. Alberta's healthcare system is well set up to readily embed intervention effectiveness and efficacy research. Infrastructure was also in place to strengthen implementation practice. However, weaknesses around exchanging knowledge and skills, providing feedback and mentoring, and accommodating diversity affected the ability of both individuals and teams to build implementation science capacity. Without this capacity, teams could not participate in embedded implementation research collaborations. We report the response of the Alberta Strategy for Patient-Oriented Research SUPPORT Unit to these barriers to provide practical guidance on various program options to strengthen individual- and organization-level implementation science capacity. This study applied a whole-system approach to assess factors across Alberta's health-research ecosystem, which affect partnerships to advance implementation science. Our findings illustrated that partnership considerations go beyond interpersonal factors and include system-wide considerations. With the results, health organization leaders have (1) a method for assessing organizational capability to readily embed implementation research and (2) a catalog of potential responses to create conditions to readily engage with implementation science in their day-to-day implementation processes.

Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial

BackgroundIntimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women’s needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context.MethodsA parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6–7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics.ResultsOf 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain.ConclusioniHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions.Trial registrationClinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018).

From Today to Tomorrow: Leveraging Digital Health to Move toward Health for All.

This series of papers explores the concept of essential digital health for the underserved. Several cross-cutting themes are highlighted in this paper, for example: (1) harmonizing journeys of different patient groups to understand diverse perspectives; (2) engaging health professionals in interoperability, change management and health human resource capacity building; (3) ensuring harmonization of micro, meso and macro levels of health services delivery; and (4) integrating evaluation iteratively to enable continuous improvement and learning. Adopting a learning health system (LHS) approach facilitates iterative growth and evolution, incorporating concepts from the software industry, as well as participatory processes such as failing forward, developing ecosystems for collaboration and engagement of stakeholders. The example of HealthLink BC's 811 as a digital front door is used to demonstrate how an LHS approach can enable meaningful system change. We welcome further dialogues and discussion on existing and emerging examples of health system implementation approaches that can help our Canadian health systems move continuously and progressively closer toward the ultimate goal of Health for All (WHO 2023).

Analysis of occupational health and safety management system internal audit implementation based on SMK3 PP No. 50, 2012 (Study at Pasuruan Concrete Industry, Indonesia)

Technological updates impact the risk of new hazards that can cause accidents and occupational diseases. The risk of hazards in the workplace is controlled through control efforts and the commitment of industries and workers to implementing the Occupational Health and Safety Management System. Indonesian manufacturing industries in implementing Occupational Health and Safety Management System are guided by SMK3 PP No. 50, 2012. Internal audit includes the fourth principle of occupational health and safety management system, namely monitoring and evaluating Occupational Health and Safety (OHS) performance. This research is descriptive research that aims to describe and analyze the application of occupational health and safety management system based on SMK3 PP No. 50, 2012 at Pasuruan Concrete Industry, Indonesia. Information sources are obtained from in-depth interviews, filling out document study checklist sheets, and field observations. The method to obtain in-depth interview informants through purposive sampling, with research informants is the party who has the authority and knowledge regarding the implementation of Occupational Health and Safety Management System in the Pasuruan Concrete Industry, Indonesia. Of the total 166 elements required by SMK3 PP No. 50, 2012, the company managed to fulfill as many as 160 elements, or 96%, with the category 'Satisfactory'. Overall, the company implements occupational health and safety management system progressively and sustainably, as evidenced by the increase in achieving the conformity of occupational health and safety management system audit internal elements and the guarantee of worker safety and health starting from management support, OHS programs, and the availability of adequate facilities and infrastructure.

Perceived Factors Affecting the Implementation of Occupational Health and Safety Management Systems in the South African Construction Industry

Although notable efforts have been made in the past to improve Occupational Health and Safety (OHS), the overall performance has not significantly improved as high-level injuries, risks, and fatalities continue to occur. Earlier studies have shown that implementing an Occupational Health and Safety Management System (OHSMS) ensures a reduction in accidents on site, which is, however, not easy due to the many challenges arising during its implementation. The research objectives were to identify, in order of importance, factors that affect the implementation of an OHSMS on construction sites and to analyse how an OHSMS can be implemented in the construction industry of the Western Cape, South Africa, using the Plan Do Check Act (PDCA) method. The research questionnaire obtained online opinions from construction professionals. The data were analysed using the Statistical Package for Social Sciences (SPSS) software version 27.0. The data were interpreted through Cronbach’s alpha coefficient, frequencies, descriptive statistics, and a multi-regression analysis. A multi-regression test was conducted to determine the relationship between internal and external factors and the implementation of an OHSMS, including the use of the PDCA method. The findings reveal that both internal and external factors affected the implementation of the OHSMS. The most important internal factors were risk control strategies, senior management commitment, and support and communication channels. The most common external factors were pressure from clients on project delivery, company reputation, OHS enforcement, and government legislation. A framework was developed to outline how an OHSMS can be implemented using the PDCA approach based on the findings from this study. The framework can be adopted by the construction industry to improve effectiveness when implementing their OHSMS.

Evaluation of Occupational Health Safety Management System in Hospitals in Banda Aceh City

The most dominant hospital activity actors at risk of occupational safety accidents (SMK3) are hospital employees such as nurses, cleaning services, patients and visitors. The purpose of this study was to evaluate the application and factors affecting the implementation of occupational health and environmental safety management systems at dr. Zainal Abidin Regional General Hospital, Meuraxa Hospital and Banda Aceh Mother and Child Hospital. The data collection technique uses a mix method that combines quantitative and qualitative data with sequential explanatory strategies. The legal basis is Permenkes No. 66 of 2016, and the data was analyzed using the Likert scale method points 1-5 through SPSS version 26. The results of research at RSUDZA, RSIA, and RSUDM Banda Aceh show that the application of SMK3 is good to very good. However, there are several inhibiting factors that need to be considered by the hospital in order to improve the implementation of the Occupational Safety and Health Management System (SMK3) at RSUDZA, RSIA, and RSUDM Banda Aceh, some improvements can be recommended. First, RSUDZA needs to ensure the stability of K3 field officers and improve the marking of K3 signs. In addition, the unification of the drug room with pharmacy employees must be separated to be more effective. RSIA needs to obtain budget for ceiling repairs so as to block various small dirt falling from roof gaps, avoid splashing rainwater falling through the roof insulators or regulators of heat and cold coming from the roof, roof frame covers to make the space neater and cleaner, sound dampers, both generated by rainwater and other sounds and rearrange the right material placement. RSUDM needs to overcome solid waste piles, improve the marking of K3 rooms, and improve the arrangement of parking areas. In addition, it is important to hire additional security personnel in the ER. All these improvements are expected to improve occupational safety and health conditions in hospitals.

Electronic health record impact on data quality: An integrated review

Few studies have assessed the impact of Electronic Health Record (EHR) on data quality and how it has impacted timeliness, accuracy, availability, integrity, consistency and uniqueness of health data. Assessing the current gaps between electronic health record utilisation in relation to enhancing data quality can help to identify and recommend key measures to improve healthcare delivery. This review examines the impact of electronic health record on data quality, and proposes recommendations desirable to improving healthcare delivery. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Integrative Review Frameworks (IRF) were adapted as a sign post for the study. These frameworks guided literature search, data analysis and presentation of findings. Boolean AND/OR operators were combined with search terms to increase relevant search results. Six (6) electronic databases that were used for literature search are Scopus, Web of Science, Science Direct, PubMed, ProQuest and Google Scholar. Searched articles were between 2012 to 2022, with the exception of two articles on the Technology Acceptance Model (TAM) published in 1986 and 1975. EHR implementation impact key health outcomes and contribute to timely and complete data submission. Implementation of Electronic Health Systems (EHS) embellish consistency, completeness, accuracy and integrity of clinical data significantly through embedded interoperability solutions. By reducing the scope of manual reviews, integrating a technology that automates data integrity and quality checks into EHR may potentially lessen the strain of maintaining data quality. Our findings depict that interoperability of clinical data sources will ensure consistent, timely and available health data when using EHR. The automated data integrity and consistency checks in the EHR improve data quality. The study contributes to advancing the theory of Technology Acceptance Model (TAM) in electronic health records and its impact on data quality in healthcare delivery.

Evaluation of success factors of utilizing AI in digital transformation of health and safety management systems in modern construction projects

In the construction industry, managing health and safety concerns is paramount to preventing accidents, injuries, and project delays. The integration of Artificial Intelligence (AI) into existing health and safety management systems holds the potential for significantly improving risk detection, mitigation, and overall management [1,2,3]. However, despite the evident benefits of AI in this domain, there remains a notable gap in the literature concerning the essential factors for successful implementation [4,5]. This study aims to address this gap by meticulously analyzing the key elements that contribute to the success of AI integration into the digital transformation of health and safety management systems within cutting-edge construction projects. Our methodology involved the identification of 25 factors, drawn from prior research and industry consensus. These factors were subjected to rigorous analysis, including Exploratory Factor Analysis (EFA) following a pilot survey with field experts and Structural Equation Modeling (SEM) using data obtained from a comprehensive questionnaire distributed among a representative sample of construction industry experts. The study's findings underscore the paramount importance of six critical constructs in determining the success of AI implementation in construction health and safety management systems: Adaptability, Operation, Management, Reliability, Integration, and Knowledge. These findings provide valuable insights for enhancing safety measures in the construction industry through AI-driven solutions.

Analisis Penerapan Sistem Manajemen Keselamatan dan Kesehatan Kerja (SMK3) di PT. Air Liquide Indonesia – Plant Cilegon Tahun 2023

Occupational health and safety are things that cannot be separated from carrying out work, occupational health and safety are very important factors to pay attention because someone who is working is not in good health or has an accident which will have an impact on themselves, their family, and the company where they work. To handle and overcome the dangers that exist in the workplace, it is necessary to implement an occupational health and safety management system in accordance with Republic of Indonesia Government Regulation No. 50 of 2012 concerning the Implementation of Occupational Health and Safety Management Systems. This research aims to determine the implementation of OH&amp;S Management System at PT Air Liquide Indonesia – Plant Cilegon. This research is a type of qualitative research that uses the case study method. The method for collecting data is by using measuring instruments in the form of interview guides and observation sheets. There is 5 informants for this research. Data processing and analysis through transcription, sorting, classification, and content analysis processes. The research results show that PT Air Liquide Indonesia – Plant Cilegon has an OH&amp;S policy in the form of 12 life saving rules. K3 planning is prepared based on identifying potential hazards using Job Safety Environment Analysis (JSEA). The implementation of the K3 plan is carried out by all parties under the responsibility of the HSE department. K3 monitoring and evaluation is carried out by Safety Flash and internal audits once a year. The review is carried out with related parties once a year and improving SMK3 performance focuses on what is lacking.

An Expert System to Evaluate the Impacts of Health, Safety, and Environment System Implementation on Firms’ Financial Performance Using Analytic Network Process and Promethee Techniques

Sustainability involves balancing the environment, equity, and economy, with a focus on the green or low-carbon economy. Four strategic targets for a green economy encompass green management, green production, green lifestyle, and green technologies. Adopting a green economy poses challenges for companies, necessitating innovative systems like green supply chain management, smart homes, and health-safety-environment systems. Companies' concern about financial effectiveness drives the need for investments in these systems, as financial performance is critical for survival and growth. This study investigates the influence of health-safety-environment practices on a firm's financial performance. By determining key health-safety-environment indicators and financial metrics, the research gathered insights through 97 questionnaires, which were completed by experts from four Iranian companies. The collected data was analyzed employing the analytic network process and Promethee techniques, enabling a robust evaluation of the relationship between HSE practices and financial performance. Finally, an expert system was designed based on decision matrices to provide suitable financial indicators derived from HSE data. Linking HSE practices to financial performance enhances overall effectiveness and sustainability, guiding businesses in making informed decisions while respecting growth, success, environmental issues, and finally low carbon economy.