Staffing Levels Research Articles

Military medicine of modern hybrid wars

During the hybrid armed conflict in which Russia became involved — the Special Military Operation — the medical service of the Armed Forces faced a number of challenges. This review analyzes foreign publications indexed in PubMed® concerning the conditions and factors affecting the activities of the medical services of armed forces, primarily those of NATO countries. It was revealed that a limiting factor for operational effectiveness is the staffing levels and qualitative composition of medical personnel, their preparedness to provide care for the specific pathologies of wartime, and maintaining these competencies in an up-to-date state. Important conditions for successful provision of medical care are preserving the integrity of medical facilities during targeted attacks on them, and the ability to use infrastructure in hostile or newly occupied territories. Prehospital care serves as a limiting factor in reducing lethality, with the main causes being fatal hemorrhages and head injuries from mine-blast trauma. Proper tourniquet application, rapid evacuation, and blood transfusions make the greatest contribution to reducing prehospital mortality. Among casualties, those with limb wounds are most significant, as they subsequently create the greatest social burden on the state, exceeding the “years lived with disability” parameter for all other disease classes, including oncological and cardiovascular diseases. In modern conflicts, the most dangerous in terms of lethality are mine-blast injuries (61.4–83.5%) and head injuries (20.9–59.0%), and in terms of subsequent disease burden, limb injuries (45.7%) constitute an absolute majority and are the point of focus for the main efforts of the medical services of the warring states’ armed forces. At the same time, there are no unified approaches regarding the place of application of qualified and specialized care among countries.

EHospitals and Parkinson’s disease care: audit insights from an EPIC-integrated Hospital

Abstract Introduction Parkinson’s disease (PD) is a neurodegenerative condition that affects approximately 145,000 individuals in the UK. PD symptoms are managed primarily through medications such as levodopa and dopamine agonists. Delays or omissions in administering these medications is the primary reason for increased length of stay in up to 73% of emergency admissions.1 This audit investigated the management of PD medications at Cambridge University Hospitals to identify areas for improvement in clinical practice. Aim This audit aimed to evaluate the pharmacological management of PD patients admitted to Cambridge University Hospitals NHS Trust. Specifically, it sought to assess the accuracy of drug histories, the quality of medication administration, and adherence to standards set by Parkinson’s UK ‘Get it on Time’ campaign and NICE.2,3 Methods A cross-sectional audit was conducted, reviewing the records of PD patients admitted over a three-month period. The sample included patients with a confirmed diagnosis of idiopathic PD who were prescribed at least one PD medication. Data were collected retrospectively from the electronic patient records, focusing on ten performance standards. Ethical approval was not required as the study involved a retrospective review of existing clinical records. Results The audit included 63 admissions, predominantly male (65%) with a mean age of 78.5 years. A significant portion of patients (81%) had their drug histories completed by a doctor after clerking, and 90% had orders for their regular treatment generated immediately post-clerking. Pharmacy staff completed drug histories within 24 hours for 81% of patients, though discrepancies between medical and pharmacy histories were noted in 70% of cases. Medication reconciliation within 24 hours was achieved for 83% of patients, yet only 29% received their PD medications on time for every dose. Additionally, 76% did not miss a dose or had a valid reason recorded for missed doses. 83% had PD listed in their electronic problem list after clerking. Alarmingly, just 5% were assessed for Self-Administration of Medicines (SAM), and 76% were assessed by a PD specialist during their stay. Discussion and conclusion The audit revealed substantial gaps in PD medication management, particularly regarding discrepancies between medical and pharmacy drug histories and delays in medication administration. The low rate of SAM assessments and inconsistent PD specialist consultations were also significant concerns. These findings highlight the need for improved documentation practices, such as standardized templates within the EPIC system, and increased pharmacy involvement during early stages of admission. Appropriate staffing levels and better interdisciplinary coordination are essential. The audit identified critical areas for improvement, emphasizing the need for better documentation, timely administration, and enhanced interdisciplinary coordination. Future audits should aim to randomize patient selection over a longer period to minimize bias and provide a more comprehensive assessment of medication management practices. The audit was limited by its retrospective design and the specific three-month timeframe, which may not fully represent broader trends. The exclusion of admissions shorter than 24 hours and the focus on a single hospital trust also limit the generalizability of the findings. Future studies should consider a larger, more randomized sample to validate and expand upon these results.

Knowledge, attitudes and practices of the healthcare staff and students about disposal of unwanted medications: a systematic review

Abstract Introduction Improper disposal of medications poses a significant environmental risk on the ecosystems and human beings1. When medicines are discarded by flushing them down the toilet or throwing them in the household trash, their active components may leak into the water supply2. Aim This systematic review seeks to compile studies that examine healthcare professionals' and students' knowledge, attitudes, and practices (KAP) regarding medication disposal. It also aims to explore recommendations and barriers related to appropriate medication disposal. Methods A systematic review was conducted by adhering to guidelines outlined in Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and the Joanna Briggs Institute. The primary outcome is to measure the levels of the healthcare staff and students' knowledge, as well as their attitudes, and practices about disposal of unwanted medications. Authors included qualitative, quantitative, and mixed-method primary research studies. Participants included pharmacists, doctors, nurses, and both undergraduate and postgraduate medical, pharmacy, and nursing students due to their significant involvement with medication and its disposal in healthcare settings. Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains i.e., knowledge, attitude, and practice using the KAP model. Other relevant information was also extracted, thematically, such as challenges and recommendations. Ethical approval was not required as this systematic review used previously published data. Results 37 studies from 18 countries (21 from Asia, 7 from the US, 5 from Africa, and 2 each from the EU and South America) met the inclusion criteria. 86.5% (n=32) investigated participants' knowledge of medication disposal. Although there is a good level of awareness about the environmental impacts, there are significant gaps in knowledge regarding correct disposal methods, available services, guidelines, and training. 30 studies explored participants' attitudes toward medication disposal. The results indicate a generally positive attitude towards the need for environmentally safe disposal practices. 35 studies evaluated participants' practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, majority of the participants do not follow the practice guidelines, especially outside healthcare settings. This inconsistency may be due to numerous factors such as inadequate practical training, limited resources, or unclear guidelines. Discussion/ Conclusion Overall, it was found that while healthcare staff and students have fair knowledge and positive attitudes toward medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines in many regions. Even in cases where take-back programs are available, they often face issues with accessibility. To tackle these challenges, it is suggested by the studies that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among healthcare professionals and students about appropriate disposal methods. Furthermore, improving access to take-back programs is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards.

Triage nurse staffing: a study on the need for model improvements

This study addresses the challenge of determining appropriate nurse staffing levels for triage in Emergency Departments (EDs). It evaluates whether existing nurse staffing models, typically designed for other hospital settings, can be effectively applied to triage. The research was conducted at Merano Hospital’s ED from January 1, 2021, to November 30, 2022, and involved an analysis of data from patient triage assessments. The findings indicate that standard ward staffing models are not easily adaptable to the triage environment, underscoring the need for a more systematic approach to calculating triage nurse staffing. The current Italian ministerial guidelines do not account for the unique demands and complexities of the triage setting.

The reality of nursing time: how nurses spend their shifts.

Nurse staffing levels are increasingly challenged while pressures on healthcare systems are rising. There is a clear need to optimise efficiency in healthcare delivery in order to deliver safe, effective and quality health care. To understand how nurses working shifts spend their time and explore opportunities to improve efficiency in care delivery. A time-motion study was conducted on three acute care wards in a district general hospital in West Wales; 13 nurses were observed over 14 shifts, each activity undertaken was recorded in real time. In all, 109 hours were observed. Approximately half of nurses' time is spent delivering direct patient care, with medications administration taking the majority of time. A number of recommendations are made involving processes and workforce modelling with the aim of improving efficiency and safety. Further research would be required to assess the impact of their introduction.

Unveiling Efficiency: A Research Inquiry into Technical Staff Utilization in South Indian Clinical Laboratory using Workload Indicators Staffing Need (WSN) Analysis.

Background Effective clinical laboratories are the need of the hour, they play a significant role in healthcare, providing tests for diagnosis, treatment monitoring. Having skilled and adequate staffing is crucial for clinical laboratories to operate efficiently, manage their workload effectively, and deliver test results in a timely manner. Despite being critical for healthcare delivery, ensuring adequate staffing levels in clinical laboratories remains a complex challenge for healthcare providers worldwide due to resource constraints and workforce shortages. Methods This study evaluates the effectiveness of clinical laboratory staff utilization by considering workload, work pressure, and staffing requirements. We utilized the Workload Indicators of Staffing Need (WISN) method to assess the staffing in the clinical laboratory of a tertiary care hospital. Annual hospital statistics were collected for two years from June 2021 to May 2023 to calculate the average number of days (234) worked annually, percentage of workload, distribution of activity time measurement units, and the ratio of needed, surplus, and existing staff. The findings aim to provide valuable insights for optimizing staffing levels and ensuring an efficient laboratory environment. Result The analysis found a significant workforce gap in the laboratory between the current staff numbers and the calculated staffing needs. The WISN ratios ranged from 0.2 to 0.7, indicating the existing 33 staff members face a high workload burden. The calculated ideal staffing level was 46.33 personnel. These results demonstrate staff shortage and excess workload pressure on the current laboratory employees. Conclusion The results highlight the importance of optimizing staffing levels in clinical laboratories to ensure quality service delivery. The WISN methodology can be a useful tool in healthcare facilities for making evidence -based decisions for staff allocation, maximizing the utilization of employee skill sets, and establishing standard staffing benchmarks tailored to the needs of clinical laboratories.

Enhancing Infection Control Protocols Across Medical Teams: A Comprehensive Approach for Safer Healthcare

Healthcare-associated infections (HAIs) pose significant risks to patient safety and healthcare quality, impacting all levels of medical staff. This article examines the development and implementation of enhanced infection control protocols aimed at reducing infection rates through a unified, multidisciplinary approach. By engaging healthcare providers across roles—including physicians, nurses, support staff, and administrators—we identify key factors affecting protocol adherence and infection control effectiveness. Through a mixed-methods study, we assess quantitative reductions in infection rates alongside qualitative feedback on protocol practicality and ease of use. Results indicate that comprehensive, role-specific infection control measures, paired with continuous training and feedback mechanisms, significantly improve adherence and reduce HAIs. This study underscores the value of adaptable, universally applied protocols to establish safer healthcare environments, advocating for further research and sustained implementation efforts in diverse clinical settings.

Cautionary lessons from the COVID-19 pandemic: Healthcare systems grappled with the dual responsibility of delivering COVID-19 and non-COVID-19 care.

During the COVID-19 pandemic, hospitals were challenged to provide both COVID-19 and non-COVID treatment. A survey questionnaire was designed and distributed via email to hospitals empanelled under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana(AB-PMJAY), the world's largest National Health Insurance Scheme. Telephonic follow-ups were used to ensure participation in places with inadequate internet. We applied support vector regression to quantify the hospital variables that affected the use vs. non-use of hospital services (Model-1), and factors impacting COVID-19 revenue and staffing levels (Model-2).We quantified the statistical significance of important input variables using Fisher's exact test. The survey, conducted early in the pandemic, included 461 hospitals across 20 states and union territories. Only 55.5% of hospitals were delivering emergency care, 26.7% were doing elective surgery and 36.7% providing obstetric services. Hospitals with adequate supplies of PPE, including N95 masks, and separate facilities designated for COVID-19 patients were more likely to continue providing emergency surgeries and services effectively. Data analysis revealed that large hospitals (> 250 beds) with adequate PPE and dedicated COVID-19 facilities continued both emergency and elective surgeries. Public hospitals were key in pandemic management, large private hospital systems were more likely to conduct non-COVID-19 surgeries, with not-for-profit hospitals performing slightly better. Public and large private not-for-profit hospitals faced fewer staff shortages and revenue declines. In contrast, smaller hospitals (< 50 beds) experienced significant staff attrition due to anxiety, stress and revenue losses. They requested government support for PPE supplies, staff training, testing kits, and special allowances for healthcare workers. The inclusion of COVID-19 coverage under AB-PMJAY improved access to healthcare for critical cases. Maintaining non-COVID-19 care during the pandemic indicates healthcare system resiliency. A state-wide data-driven system for ventilators, beds, and funding support for smaller hospitals, would improve patient care access and collaboration.

Organizational Conflict and Productivity Level of Academic Staff in Selected Universities in Nigeria

The study specifically examined the effect of organizational conflict on quality assurance, students’ academic performances, and the reduced rate of plagiarism among academic staff of the University of Calabar and the Micheal Okpara University of Agriculture, Umudike, Abia State, Nigeria. The survey research design was used while data were collected from 282 academic staff of the selected universities. The simple regression and independent t-tests were used for the hypotheses test. It was discovered that organizational conflict significantly affects the quality assurance of academic activities of the universities [tcal = 42.730 &gt; t 0.05 = 1.96] and organizational conflicts lead to a reduced rate of plagiarism among academic staff of the universities. Discovered also was that the performance of the academic staff members during the pre-conflict era was low (M=1.3298, SD=.47266) compared to the performance of the staff in the post-conflict (M= 3.5765, SD=.56267). It was concluded that tertiary institutions should occasionally stimulate conflict by encouraging divergent views and rewarding staff and units/departments for outstanding performance.

Examining the association between professional language interpreter services and intensive care unit utilization among patients with non-English language preference: Evidence from a large U.S. hospital

ObjectiveTo examine the healthcare utilization of patients with non-English language preference (NELP) who utilized a professional language interpreter (PLI) in the intensive care unit (ICU) compared to similar patients with NELP who did not utilize a PLI in the ICU. MethodsSingle center cohort study of patients with NELP with at least one ICU admission a large academic medical center in the U.S. Midwest (1/1/2008-12/31/2022). The first model examined ICU length-of-stay (LOS) using a negative binomial and the second model examined whether a patient was readmitted to the ICU using a logistic regression with each model controlling for PLI utilization and covariates. ResultsPatients with NELP who utilized a PLI in the ICU had 0.87-days longer in the ICU (p<0.01) and had a 46% decreased odds of being readmitted to the ICU (p<0.01) than a comparable patient with NELP who did not utilize a PLI in the ICU. ConclusionProviding patients with NELP with access to a PLI in the ICU can improve patient outcomes and reduce language barriers. Practice implicationsThese results can provide the justification to potentially increase PLI staffing levels or increase the access to existing PLIs for more patients with NELP in ICUs.

Free Speech, DEI, and Deplatforming: A Critical Analysis

Abstract Introduction: In recent years, the number of deplatforming attempts has increased at universities. Deplatforming is an attempt to block a person from speaking when certain groups find their content to be objectionable. An institution’s culture of free speech may affect the number of deplatforming incidents. Methods: This study utilized data from a new database of deplatforming incidents on campus. The data were tested for correlations in relation to an institution’s free speech ranking and its level of DEI (Diversity, Equity, and Inclusion) staffing. Results: These initial results show a negative relationship between free speech ranking and deplatforming incidents, and a positive relationship between DEI staffing and deplatforming incidents. Discussion: Institutions face the challenge of balancing an inclusive and equitable environment with the preservation of robust intellectual diversity and academic freedom. Finding this balance requires a thoughtful and deliberate approach that considers the nuances of promoting diversity, equity, and inclusion while safeguarding the principles of free expression and open dialogue. Limitations: These results were only for Power 5 universities in the United States. A more diverse sample may show different results. Conclusions: The culture of an institution is related to the number of deplatforming incidents that take place. This culture can be examined via its commitment to free speech and to its DEI staffing levels. Initial results show that these two factors have a relationship with the number of deplatforming incidents.

Service center in electricity distribution sector with variable peak electricity time: A two-stage queuing model approach with nested simulation

Customer service is essential for any business, significantly impacting customer satisfaction, brand reputation, and reducing associated costs. In the electricity industry, this importance is heightened due to the critical nature of electricity in daily life and growing usage rate of new technologies. Effective customer service in electric distribution companies involves handling a wide range of inquiries, from billing issues to technical support, requiring both remote and on-site assistance. The variability in customer calls, influenced by factors such as peak electricity hours, and different service and customer types, presents unique challenges in designing efficient service centers. This research develops a tailored model for the service center operations of a power distribution company, focusing on optimal staffing levels within budget constraints. A two-stage queuing model is proposed to address the needs of residential and non-residential customers. The study employs nested simulation techniques to account for variability in customer arrival times and peak hours. Key performance indicators (KPIs) are used to evaluate the effectiveness of staffing policies, considering both quantitative and qualitative costs. The study integrates stochastic optimization and ranking and selection methods to identify the best staffing configurations. The findings offer actionable insights for improving customer service efficiency and operational effectiveness in electricity customer service centers.

Changing Welding to Digital and Green - Actions and Communication

The implementation of Industry 4.0 is based, among other things, on the digitization and greening of manufacturing systems. Most traditional manufacturing systems are known for low productivity and efficiency. They are also known for the impact they have on the environment, with relatively high carbon footprints. The paper transfers a series of knowledge on the steps to be taken to transition a traditional manufacturing system to a digitized and green one. Customization of this discussion is done for manufacturing systems that have joining processes (welding and soldering). Each set of measures, whether aimed at the transition to digital or aimed at the transition to green, has two components: a technical component, directly related to the transformation of the hardware system (equipment, devices, measuring instruments) and a component auxiliary which is related to the transformation of the human resource, the modification of the working conditions and the continuous optimization of the newly created system. As no change is possible without removing employee misunderstandings and suspicions, the communication to be implemented must be clear, prompt, cover all levels of staff and continuously provide confidence by presenting successful cases and related beneficial figures.

Making medical education great again: analysing trainee feedback to identify key drivers of trainee satisfaction and improve experience

ObjectivesThe London School of Paediatrics (LSP) surveys trainees annually regarding their training placements. There is a wide variation in satisfaction. We explored the last 5 years of data to identify trends and determine predictors of overall trainee satisfaction.MethodsThe survey is distributed annually to all London paediatric trainees with response rates of 86–90%. It explores overall placement satisfaction, followed by key questions covering staffing, supervision, teaching, facilities and other facets. The survey blends both quantitative and qualitative feedback.Satisfaction levels were analysed using time series trend analysis. Overall levels were compared using t-tests. Associations between satisfaction and components of the survey were identified using a convergence of multiple regression and other multivariate analyses.ResultsOverall trainee satisfaction increased steadily until 2020. There was a considerable variation across sites, some having consistently higher or lower scores than the median, while others showed an upward or downward trend, or very variable pattern.By training levels, ST3 trainees consistently rated their placement below average and ST7 trainees above average. There was also a considerable variation in responses by training level with regard to perceived staffing levels and teaching.To understand the influences on overall satisfaction, regression coefficients were derived between specific metrics and overall satisfaction using multiple regression and then normalised to 100%. The explanatory power of this list to explain satisfaction overall is high at 82% R2.Trainee satisfaction was most strongly correlated with workplace atmosphere and consultant support. Staffing, educational supervision, facilities and wider MDT (Multidisciplinary Team) support are associated with overall satisfaction, but to a lesser degree.ConclusionsTrainee satisfaction is crucial, affecting patient safety, retention and trainee mental health. Our analysis identified significant associations with satisfaction including modifiable elements such as consultant engagement and team morale. Staffing levels were less related to satisfaction than expected.Experimental data exploring the components of clinical training in real-world situations are lacking. These data use the natural experiment of placing trainees in different training locations to explore the factors that relate to their overall experience.

Alleviating Worker Shortages Through Targeted Subsidies: Evidence from Incentive Payments in Healthcare

Abstract Worker shortages are common in many industries. This paper examines the effect of government subsidies to address these shortages in the context of a reform that tied Medicaid payments to nursing home staffing levels. We find that the reform substantially increased staffing, especially for facilities serving many Medicaid patients. Facilities responded primarily by hiring workers in lower-wage roles rather than increasing hours of incumbent or high-wage staff. This contrasts with null effects we estimate for a non-incentivized rate increase, suggesting that the incentive structure of government payments—rather than just the level—is key to boosting employment in sectors facing worker shortages.

Does staffing impact health and work conditions of staff in long-term care homes?: a scoping review

Abstract Background Long-Term Care (LTC) homes are highly regulated and task oriented, with demanding work and insufficient resources. Chronic underfunding of the sector, coupled with increased complexity of care, has deteriorated working conditions, resulting in precarious employment, intensified and stressful work, and decreased job satisfaction. These work conditions have contributed to severe staffing shortages of healthcare workers globally. To meet increased labour demands, OECD countries on average will need to increase the proportion of overall employment dedicated to LTC by 32% over the next decade. While reviews of literature have examined the association between staffing and care outcomes for residents in LTC, they have not examined how staffing structures affect the healthcare staff themselves. This scoping review asks: How does staffing impact the health of staff and working conditions in LTC? Methods A scoping review of empirical peer reviewed and grey literature was conducted to examine the association between LTC staffing practices and how they impact working conditions and the health and well-being of staff. PubMed, CINHAL, and Scopus databases were searched for relevant articles published within the past 10 years. Results Searches yielded 3994 unique articles, which were independently screened by pairs of reviewers. Preliminary results highlight that staffing levels are not optimized for healthy, sustainable work conditions. The level of staff, their skill mix, and ratios all impact the ability to provide care. In circumstances where there is inadequate staffing, care workers are more likely to experience stress, burnout, job dissatisfaction, and increased injury and illness. Conclusions Staffing practices shape working conditions which impact healthcare workers own health outcomes. To facilitate a strong LTC workforce, working conditions and occupational health need to be a priority in improvement initiatives. Key messages • With extreme staffing shortages challenging the healthcare sector, this review highlights the need for heightened attention to the impact of staffing practices on the healthcare workforce. • Improving working conditions and attuning to the needs of the workforce, ultimately improves quality of care.

Insights from an international clinic survey on CIED patient management practices and perceptions

Abstract Background Remote monitoring (RM) is recommended as standard of care to manage patients with cardiac implantable electronic devices (CIEDs). However, implementation within overall follow-up (FU) practice is challenging with many organizational aspects to consider. While the 2023 HRS/EHRA/APHRS/LAHRS consensus on management of remote device clinics provided guidance, data on current patient management practice is lacking to understand existing gaps. Purpose This survey of device clinic staff characterized the state and perceptions of CIED patient management. Methods A Delphi panel of US and EU clinical experts guided the research objectives, structure, and content of the survey. Once consensus was reached, the online survey (Qualtrics) was deployed in partnership with HRS. An available case analysis was performed to handle missing data. Results A total of 471 responses were received between September 2023-January 2024 (66% US, 19% Europe, 15% other). Overall, performing a combination of in-office visits and RM was the most frequent FU practice for all devices. Remote-only management was only commonly reported for insertable cardiac monitors (ICM). Adoption of RM was lower in EU compared to US for therapeutic devices, especially pacemakers for which in-person only FU remained high (Figure 1). Frequency of routine visits and transmissions is reported in Figure 2. While the majority of respondents (48-67%, depending on device type) expressed that less than 20% routine visits are actionable, adopting a practice of FU visits scheduled every 2 years as suggested in the 2023 consensus was rarely reported for therapeutic devices. However, alert-based RM seems to emerge for ICM without routine FU. In the US, frequency of scheduled transmissions appeared aligned with reimbursement rules (monthly for ICMs; quarterly for therapeutic devices), whereas there was more variability in EU where RM often lacks clear funding. Divided opinion was observed regarding staff sufficiency as 43% found staffing levels somewhat/very sufficient, while 42% rated it as somewhat/very insufficient. Managing disconnected patients, initial transmission review, and patient phone calls were identified as most burdensome tasks and were the ones for which there was most willingness to outsource. Although 60% respondents rated their practice as somewhat/very efficient, the majority (45%) did not report monitoring performance. The minority (29%) assessing patient management performance primarily tracked workload volume rather than quality-related metrics. Conclusion This large international survey characterized contemporary CIED patient management practices. While the 2023 HRS/EHRA/APHRS/LAHRS consensus highlighted the potential for alert-based RM, reducing in-person visits, and third-party resources to streamline patient FU, these practices have yet to be fully implemented. As such, there is opportunity to standardize and optimize workflows to drive efficiency and quality of care.Follow-up paradigm by regionFrequency of routine follow-up

An exploration of factors leading to readiness for organizational health literacy change in community-based health organizations.

Healthcare systems have a responsibility to improve organizational health literacy (OHL) to increase health equity. This study explored two organizational cultural factors, leadership support and staff buy-in, for organizations planning OHL change. Ten community-based health organizations participated in an OHL program. The study design was mixed methods. The qualitative inquiry was interviews with senior leaders to explore awareness of OHL and: impetus to transform, leadership commitment, staff engagement, alignment to organizational goals, and integration of health literacy change with current practices. The quantitative assessment was the Organizational Readiness for Implementing Change (ORIC) questionnaire to assess staff's perceptions about OHL change readiness. Senior leaders articulated the effects of low health literacy in their patient and client population. Support for OHL change was seen at both leadership and staff levels. Impetus for change was primarily a response to a community need or for quality improvement. Most of the non-clinical organizations had higher ORIC scores than the clinical organizations, indicating a perceived higher level of readiness for OHL change. Leadership commitment and staff buy-in are important factors of readiness for OHL change. A novel finding is that community-based health organizations are able and willing to engage in OHL change.

The Communication Performance Analysis of the In Room Dining Division at Hotel “A” as the Basis for the Formation of Organizational Culture

Communication performance and organizational culture are closely related, in the process an individual's communication performance reflects their organization's culture. Every company has its organizational culture, including Hotel “A," which is one of the 5-star international hotels in Jakarta, also experiencing issues with its organizational culture. This study employs descriptive research with a qualitative approach. The method used in this research is interview with employees from the in-room dining division at Hotel “A”, that is a 2 active members of the organization. The research findings reveal problems in the communication performance at Hotel “A”. For instance, in terms of ritual performance, there is a company culture of working overtime. Additionally, in terms of passion performance, the abundance of job tasks in the in-room dining division diminishes the manager's focus, especially for unexperienced leader in a similar divisions. Social performance shows the existence of factions within the organization but with no significant impact on operations. Political performance manifests as a sense of superiority over certain groups (seniority). Lastly, enculturation performance indicates differences in training between staff levels and daily workers, creating clearer disparities. All of these issues stem from the inadequate communication performance in the in-room dining division at Hotel “A”. If left unaddressed, they may lead to demotivation, a decline in work ethic, and feelings of saturation among employees, ultimately impacting the formation of the company's culture. The researcher suggests that management and Human Resources collaborate to address these issues, fostering open communication and welcoming input to establish positive organizational culture.

Caring in crisis: addressing patient safety, burnout, and long hours in healthcare

Madam, The World Health Organization defines patient safety as preventing errors and adverse effects to patients associated with health care and “to do no harm to patients”. Specifically, in low and middle-income countries (LMICs), about 134 million adverse events occur each year due to unsafe care in hospitals, resulting in 2.6 million deaths annually. [1] Along with other determining factors, professional well-being, long hours, and burnout syndromes also influence patient care. [2] Burnout is a condition directly linked to workplace environment, stemming from occupational stress and extended working hours. Garcia, C.L. et al., through meta-analysis, found a relationship between the development of burnout and patient safety actions, with a probability of superiority of 66.4%. High levels of burnout and worsening patient safety are related to external factors such as high workload, long working hours, lack of a secure environment, and interpersonal relationships. [3] These findings raise concerns, particularly in a country like Pakistan, where the extent of understaffing and high workload can be inferred from the following statistics: The doctor-to-population ratio in Pakistan was 1:1000 in 2018 [4]. In contrast, the doctor-to-population ratio in Malaysia was 2.2:1000 in 2018 [5]. As a result of this shortage, the current workforce in Pakistan is negatively affected. In a study by Kasi PM et al. on postgraduate trainees in Pakistan, individuals under stress were more likely to report longer working hours. This increased workload made them prone to medical errors, which ultimately undermines the patient safety culture. A study conducted at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC) compared the benchmarks from hospitals in the USA and discovered that high staff workload is a significant concern among staff [6] In Pakistan, where healthcare resources are limited, fostering a culture of effective work-hour management and breaks is essential for creating a healthier and safer environment for health professionals and patients. Ensuring adequate staffing levels to distribute the workload and prevent overburdening is essential. Providing designated areas for relaxation, offering mental health resources and mindfulness programmes like yoga or meditation can help doctors to cope with stress. Furthermore, promoting a culture of multidisciplinary teamwork, a mentorship program, and effective handover protocols during shift changes can ensure continuity of care. Medical institutes should invest in technology that can streamline administrative tasks and reduce paperwork burden. ---Continue