Medical Staff Engagement Research Articles

Sự gắn kết của nhân viên y tế tại Bệnh viện Phụ Sản Nhi Bình Dương và một số yếu tố ảnh hưởng năm 2023

Describe the engagement of medical staff and analyze some influencing factors at Binh Duong Obstetrics anh Children Hospital in 2023. Research combining quantitative and qualiative at Binh Duong obstetrics and children hospital from October 2022 to October 2023Using the toolkit “Organizational Attachment Scale” and 12 in – depth interviews (170 health care staff). Results: 80% of medical staff are closely connected to the hospital, the average score is 4,23 ±0,56 points. Factors related to organizational cohesion include: age, seniority, marital status, department of work. Positive influencing factors: colleagues; training and development opportunities; leadership style, working environment; welfare policies, rewards &recognition of achievements. Barrier medical staff are: income, fairness. Hospitals need to increase remuneration for doctors sending patients from outside, reduce commitment time, commit to serving the hospital after training, increase the starting income for nurses, repairs, adjustments. Fair technical service training regime among clinical departments, organization of management skills exams for key staff. Keywords: Organizational cohesion, Influential factors, Binh Duong obstetrics and children hospital.

What’s the preferences of medical staff for providing health education service? – A discrete choice experiment in Beijing, China

ObjectiveTo quantify medical staff preferences for providing health education service in hospitals. MethodsThis study took medical staff in the department of internal medicine of hospitals in Beijing, China as the research subjects, and designed a discrete choice experiment (DCE) to investigate the health education service provision preferences of them. Through various methods, 8 attributes and corresponding levels were determined. An online survey was conducted among the medical staff of the sample hospitals from May to June 2023. Participants’ preferences were analyzed using conditional logit and mixed logit models. ResultsFinally, 831 respondents completed the questionnaire, among which 600 cases passed the consistency test. All the attributes included in this study had an impact on medical staff’ health education service preferences (P < 0.001). The most important one with the greatest impact on the health education service delivery behavior of the respondents was "department working atmosphere-encouraging health education" (β = 4.062, P < 0.001). ConclusionIn this study, the departmental work atmosphere and performance bonuses emerged as crucial factors influencing the engagement of medical staff in health education work. Practical implicationsHospitals should prioritize measures to improve the health education working atmosphere in departments to increase the enthusiasm of medical staff to provide services.

Connection with the organization of medical staff and factors affecting Nhan Ai - Binh Phuoc Hospital, the year 2021

This study aims to evaluate and some factors affecting the engagement of medical staff. Data was collected from 258 medical staff working at Nhan Ai Hospital. Overall engagement rate results in 78.7%. Engagement in terms of Loyalty 82.6%; Effort 86.4%; Pride in loving the organization 86.4%. The analysis results show that there are 5 factors positively correlated with engagement: Welfare policy, Hospital culture, Working environment, Training &amp; development opportunities, Income. The qualitative analysis shows: The factors that need to be improved are those belonging to the direct leadership (fairness, trust, information processing), the income factor. Factors to maintain: Hospital culture, Welfare policy, and working environment, Training &amp; development. From the research results, some recommendations are made to help hospital leaders improve resource management to improve employee engagement with the hospital.

Factors Associated With Medical Staff's Engagement and Perception of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Nationally Representative Mixed-Methods Study in China.

BackgroundMedical staff represent critical stakeholders in the process of implementing a quality improvement (QI) program. Few studies, however, have examined factors that influence medical staff engagement and perception regarding QI programs.Methods and ResultsWe conducted a nationally representative survey of a QI program in 6 cities in China. Quantitative data were analyzed using multilevel mixed‐effects linear regression models, and qualitative data were analyzed using the framework method. The engagement of medical staff was significantly related to knowledge scores regarding the specific content of chest pain center accreditation (β=0.42; 95% CI, 0.27–0.57). Higher scores for inner motivation (odds ratio [OR], 1.79; 95% CI, 1.18–2.72) and resource support (OR, 1.52; 95% CI, 1.02–2.24) and lower scores for implementation barriers (OR, 0.81; 95% CI, 0.67–0.98) were associated with improved treatment behaviors among medical staff. Resource support (OR, 4.52; 95% CI, 2.99–6.84) and lower complexity (OR, 0.81; 95% CI, 0.65–1.00) had positive effects on medical staff satisfaction, and respondents with improved treatment behaviors were more satisfied with the QI program. Similar findings were found for factors that influenced medical staff’s assessment of QI program sustainability. The qualitative analysis further confirmed and supplemented the findings of quantitative analysis.ConclusionsClarifying and addressing factors associated with medical staff’s engagement and perception of QI programs will allow further improvements in quality of care for patients with acute coronary syndrome. These findings may also be applicable to other QI programs in China and other low‐ and middle‐income countries.RegistrationURL: https://www.chictr.org.cn/; Unique identifier: Chi‐CTR2100043319.

Aotearoa New Zealand emergency medicine specialists on the provision of care at or near the end of life: A survey.

The ED is an increasingly important venue for the initiation of palliative care. We sought to characterise the opinions, experience, training and education of ED staff in Aotearoa/New Zealand (NZ) with regard to specific aspects of palliative care in the NZ ED setting. All NZ FACEMs were personally emailed a simple unstructured 16-part survey asking questions about initiating palliative care, goals of care, initiation and availability of advance care plans, frailty screening, availability of palliative expertise, training and education, cultural safety and pastoral care of staff. All EDs were contacted and a link provided for non-FACEM ED staff who wished to participate. Free-text comments were analysed for dominant themes. All NZ EDs had at least one participant. There was a high level of senior medical staff engagement with 60% of NZ FACEMs participating. More than 300 free-text comments from this group were available for theme analysis. A total of 93% of NZ FACEM respondents agree that palliative care should be able to be initiated in the ED. Only 25% of this group knew of training in serious illness conversations in the ED while only 34% felt culturally competent when providing end-of-life care for Māori and their whanau (family). Pastoral care for ED staff appears to be ad hoc. Time and privacy limitations were common themes. There is significant opportunity for quality improvement in the initiation and provision of palliative care from the ED. Attention to how departments provide pastoral care to their staff is needed.

Article Review: Present Perspectives of Hyperthyroidism During Pregnancy

Graves’ disease causes inflammatory hyperthyroidism in around 80% of hyperthyroidism cases inwomen of reproductive age. The hormonal changes in the maternal immune system after birth may belinked to the production and expression of diabetes other than gestational and early-onset diabetes. Asa result, in addition to hormonal influences, other anatomical modifications or abnormalities seen inthe body during pregnancy will affect the pregnancy test. Thyroid hormones are critical for a woman’shealth and the commencement of her pregnancy. These hormones are essential for early developmentand play a crucial role in the fetus’s continued growth after conception. Women with untreated orimproperly controlled hyperthyroidism are more likely to have complications during pregnancy. Futurediseases, particularly those that produce a large number of fetuses due to IUGRTH. The treatmentof hyperthyroid pregnant women is extremely difficult, and medical staff engagement is required toguarantee that it is properly monitored and treated. Anti-thyroid drugs are commonly administered topregnant women, and it is the medication of choice for the majority of them (ATDs). Despite the fact thatboth of these drugs are passed through the mother’s bloodstream to the fetus, they are highly effectivein the treatment of maternal hyperthyroidism. Nonetheless, they must exercise caution throughout thesecond half of pregnancy due to the risk of fetopathy. The most common side effect, except in thefirst trimesters from weeks 6 to 10, is fetal abnormalities; even with that proviso, the incidence ofbirth malformations is significant during the first trimester with the use of ATDs. The management ofhyperthyroidism during pregnancy is divided into four areas that obstetricians are currently concernedabout: Its aetiology, occurrence, correct identification, under treatment, complications, and actual ormissed diagnosis and intervention, and lastly, the technique of dealing with the problem are all factorsto consider.

A study on the correlation between medical staff engagement, perceived organizational support and turnover intention

Objective: To explore the relationship between medical staff's engagement, perceived organizational support and turnover intention. Methods: In May 2019, 600 medical and nursing staff from a tertiary hospital in Tianjin were selected by random sampling method. The questionnaire survey was conducted by using Gallup Q12 questionnaire, perceived organizational support scale and turnover intention scale. The correlation between engagement, organizational support and turnover intention was analyzed by person correlation analysis and regression analysis, and multivariate stepwise linear analysis was used for multiple factor analysis Return. Results: the total average scores of engagement, sense of organizational support and turnover intention were (2.18±0.56) , (3.48±0.72) and (2.71±0.67) respectively. There was a positive correlation between engagement and perceived organizational support (r=0.674, P<0.01) , and negatively correlated with turnover intention (R=-0.416, -0.487, P<0.05) . The factors of turnover intention were engagement and organizational support (F=54.673, 81.558, P<0.01) . Perceived organizational support partially mediated the relationship between engagement and turnover intention (P<0.01) . Conclusion: The engagement and organizational support of medical staff are related to turnover intention.

A Quality Improvement Project to Standardize Surfactant Delivery in the Era of Noninvasive Ventilation

Introduction:Continuous positive airway pressure (CPAP) and surfactant both improve outcomes for premature infants with respiratory distress syndrome. However, prolonged trials of CPAP, as well as observation periods after intubation, may delay the administration of surfactant. Late surfactant treatment likely increases the incidence of bronchopulmonary dysplasia, which leads to significant morbidity and healthcare utilization.Methods:We aimed to decrease time from meeting standard criteria (start of a continuous run of FiO2 > 40% or PaCO2 > 65 for >90 min) to intubation, and from intubation to surfactant administration, for infants <1,500 g or younger than 32 weeks gestation. Retrospective data collection from the electronic medical record assessed those process measures as the primary endpoints. Balancing measures were the adverse outcomes of asymmetric lung disease, the inappropriate position of the endotracheal tube, or pneumothorax on the first x-ray (within 24 h) after surfactant.Results:Mean time to intubation for infants 28–32 weeks gestation decreased from 321 to 81 minutes in response to a literature review for physicians and free-text orders for notification. Time to intubation for infants younger than 28 weeks gestation did not change. Administration of surfactant within 1 hour of intubation improved from 78% to 100% after a program for trainees and coordination with radiology. There were no adverse occurrences.Conclusions:Educational interventions and targeted process change can successfully implement standard criteria for intubation and surfactant administration for premature infants. Determination of an acceptable range of evidence-based practice is essential for the engagement of medical staff. Timely intubation and surfactant may decrease bronchopulmonary dysplasia.

Principal characteristics of patients acutely poisoned by ethanol in the region of Belgrade (Serbia)

Background/Aim. Acute intoxication by ethanol constitutes a significant part of the acute pathology caused by toxic chemicals, which require medical care in specialized health care institutions. The aim of the study was to determine some principal characteristics of the patients treated after acute ethanol poisoning, such as: participation in the total number of patients treated after acute poisoning by all chemical agents, age, sex, severity of poisoning and capacities for ambulatory or hospital treatment. Methods. A five-year retrospective case study was conducted on 20,891 acute poisoned patients, of which 10,731 were treated after acute ethanol poisoning during the period 2011?2015. All the subjects satisfied the diagnostic criteria of poisoning according to the World Health Organization International Classification of Diseases-10 and standardized Poison Severity Score scale. Results. Monitored parameters were analyzed in 10,731 patients acutely poisoned by ethanol, and their average number during one study year was 2146.2 ? 437.95. The average number of treated patients due to poisoning by ethanol (51.47 ? 2.86%) was statistically significantly higher than that of other causes of acute poisoning (p &lt; 0.001). The majority of poisoned patients were men, aged 19 to 65 years, with mild to moderate symptoms of acute ethanol intoxication. The highest number of patients poisoned by ethanol had Poison Severity Score 1 (70.25 ? 5.04%, p &lt; 0.001). Very few acute poisoned with ethanol required hospital treatment (1.05%). Anticipated number of patients acutely poisoned by ethanol had high percentage of increase for the period 2016?2020 (slightly more than 20%), which is worrying, primarily due to their high absolute number. Conclusion. Acute alcohol poisoning represents a significant part of the pathology in the total number of patients treated due to acute poisoning with various chemical substances. The results of this analysis showed that certain populations are particularly vulnerable to abuse of alcohol to the level requiring health care (male population, age 19?65 years). Only a small number of patients (1% of all patients treated for acute alcohol poisoning) required clinical treatment. The obtained data provided the basis for a more targeted preventive action in certain population groups, as well as the adequate planning of professional medical staff engagement, material, spatial and other capacities. These data, also, provided the basis for additional detailed social, economic, health and other researches in this area as well as a more detailed registration of this type of poisoning and establishing a monitoring system and database.

International Uptake of a Proven Intervention to Reduce Death and Dependency in Acute Stroke: A Cross-Sectional Survey Following the QASC Trial.

Uptake of proven interventions requires dedicated resources that may only result in local implementation, thus precluding international practice change. We explored international uptake through online dissemination of the fever, sugar, and swallow (FeSS) protocols from the Quality in Acute Stroke Care (QASC) trial, which showed decreased death and dependency by 15.7% 90-day poststroke. To identify: (a) the clinical discipline of healthcare professionals who downloaded the QASC resources; (b) the purpose for downloading; (c) successful implementation of any or all the FeSS protocols; (d) barriers to implementation; and (e) associations with self-reported successful implementation. A cross-sectional, online survey of those who downloaded the QASC resources between October 2011 and August 2013. Associations between implementation and participant characteristics were determined. One-hundred and fifty-nine people from 21 countries participated. Nurses were the largest group to download the resources (n = 54, 38%), with the primary purpose to inform clinical practice (n = 97, 64%). Less than half (n = 77, 48%) downloaded, and less than a quarter (n = 38, 24%) attempted to implement all three protocols. Of those personally involved in implementation (n = 50) half reported doing so successfully for one or more protocols (n = 27, 54%) with 10 (20%) reporting successful implementation of all three protocols. Only about half (n = 13, 48%) used the proven implementation strategy with about one-third (n = 10, 29%) confirming successful uptake via audit. Implementation barriers were potential increase in nursing workload (n = 28, 56%) and lack of medical staff engagement (n = 27, 53%). Higher autonomy was associated with greater likelihood of implementation of all three protocols (p = .038). The QASC intervention required use of all three protocols. However, less than half downloaded them all and implementation was not guided by the proven implementation strategy. While encouraging that these resources were being used to drive practice change, piecemeal implementation of a proven intervention is unlikely to improve patient outcomes.

Quality improvement in hospitals: barriers and facilitators

PurposeThe purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety.Design/methodology/approachAn extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives.FindingsThe response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses’ active involvement and medical staff engagement in QI with improved patient care and physicians’ active involvement and medical staff engagement with greater patient safety.Practical implicationsThere is the need to study how best to support and encourage physicians and nurses to become more engaged in QI.Originality/valueQI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.

The impact of an integrated medical leadership programme.

The purpose of this paper is to determine the impact of an integrated Medical Leadership Programme (MLP) on a cohort of participating specialty doctors and the NHS services with which they were engaged. This was a qualitative study designed to obtain rich textual data on a novel training intervention. Semi-structured interviews were conducted with participating MLP trainees at fixed points throughout the programme in order to capture their experiences. Resulting data were triangulated with data from extant documentation, including trainees' progress reports and summaries of achievements. Recurring discourses and themes were identified using a framework thematic analysis. Evidence of the positive impact upon trainees and NHS services was identified, along with challenges. Evidence of impact across all the domains within the national Medical Leadership Competency Framework was also identified, including demonstrating personal qualities, working with others, managing services, improving services and setting direction. Data were drawn from interviews with a small population of trainees undertaking a pilot MLP in a single deanery, so there are inevitable limitations for generalisability in the quantitative sense. Whilst the pilot trainees were a self-selected group, it was a group of mixed origin and ability. The study has provided valuable lessons for the design of future leadership programmes aimed at doctors in training. Identifying the effectiveness of an innovative model of delivery with regard to the Medical Leadership Curriculum may assist with medical staff engagement and support health service improvements to benefit patient care.

Barriers and enablers to implementing clinical treatment protocols for fever, hyperglycaemia, and swallowing dysfunction in the Quality in Acute Stroke Care (QASC) Project--a mixed methods study.

The Quality in Acute Stroke Care (QASC) trial evaluated systematic implementation of clinical treatment protocols to manage fever, sugar, and swallow (FeSS protocols) in acute stroke care. This cluster-randomised controlled trial was conducted in 19 stroke units in Australia. To describe perceived barriers and enablers preimplementation to the introduction of the FeSS protocols and, postimplementation, to determine which of these barriers eventuated as actual barriers. Preimplementation: Workshops were held at the intervention stroke units (n = 10). The first workshop involved senior clinicians who identified perceived barriers and enablers to implementation of the protocols, the second workshop involved bedside clinicians. Postimplementation, an online survey with stroke champions from intervention sites was conducted. A total of 111 clinicians attended the preimplementation workshops, identifying 22 barriers covering four main themes: (a) need for new policies, (b) limited workforce (capacity), (c) lack of equipment, and (d) education and logistics of training staff. Preimplementation enablers identified were: support by clinical champions, medical staff, nursing management and allied health staff; easy adaptation of current protocols, care-plans, and local policies; and presence of specialist stroke unit staff. Postimplementation, only five of the 22 barriers identified preimplementation were reported as actual barriers to adoption of the FeSS protocols, namely, no previous use of insulin infusions; hyperglycaemic protocols could not be commenced without written orders; medical staff reluctance to use the ASSIST swallowing screening tool; poor level of engagement of medical staff; and doctors' unawareness of the trial. The process of identifying barriers and enablers preimplementation allowed staff to take ownership and to address barriers and plan for change. As only five of the 22 barriers identified preimplementation were reported to be actual barriers at completion of the trial, this suggests that barriers are often overcome whilst some are only ever perceived rather than actual barriers.

A Longitudinal Study of Clinical Peer Reviewʼs Impact on Quality and Safety in U.S. Hospitals

Clinical peer review is the dominant method of event analysis in U.S. hospitals. It is pivotal to medical staff efforts to improve quality and safety, yet the quality assurance process model that has prevailed for the past 30 years evokes fear and is fundamentally antithetical to a culture of safety. Two prior national studies characterized a quality improvement model that corrects this dysfunction but failed to demonstrate progress toward its adoption despite a high rate of program change between 2007 and 2009. This study's online survey of 470 organizations participating in either of the prior studies further assessed relationships between clinical peer review program factors, including the degree of conformance to the quality improvement model (the QI model score), and subjectively measured program impact variables. Among the 300 hospitals (64%) that responded, the median QI model score was only 60 on a 100-point scale. Scores increased somewhat for the 2007 cohort (mean pair-wise difference of 5.9 [2-10]), but not for the 2009 cohort. The QI model is expanded as the result of the finding that self-reporting of adverse events, near misses, and hazardous conditions--an essential practice in high-reliability organizations--is no longer rare in hospitals. Self-reporting and the quality of case review are additional multivariate predictors of the perceived ongoing impact of clinical peer review on quality and safety, medical staff perceptions of the program, and medical staff engagement in quality and safety initiatives. Hospital leaders and trustees who seek to improve patient outcomes should facilitate the adoption of this best practice model for clinical peer review.

Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government's intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers' viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers' attitude toward CG and ultimately affected the success of quality improvement activities.

Engaging medical staff in clinical governance: introducing new technologies and clinical practice into public hospitals

To enhance patient care, medical staff at major tertiary teaching hospitals are encouraged to innovate through introducing new technologies and clinical practices. However, such introduction must be safe, efficient, effective and appropriate for patients and the organisation, and actively lead by engage medical staff. This study outlines the development, implementation and evaluation of a framework for introducing new technologies and clinical practice to a major tertiary health service. Evaluation includes survey of medical Heads of Units (HOUs) for framework's effectiveness, and comparison of level of medical staff engagement against a best-practice model. Over 2-year period: 19 applications, 7 approved. Successful external funding of $1.993 million achieved. Survey of HOUs in June 2009: response rate 59% (25 of 42 HOUs), with 11 of 25 respondents utilised the committee. Of those 14 of 25 who had not utilised the committee, low awareness of the committee's existence (2 respondents). Most elements of the best-practice model for engaging medical staff were achieved. Recommendations include improvements to committee process and raising profile with medical staff. This study demonstrates an effective and successful clinical governance process for introducing new technologies and clinical practice into a major tertiary teaching hospital, supported by moderate levels of medical staff engagement.

1339 Engagement of medical staff to acute coronary syndromes patients education-Can we do something more?

1339 Engagement of medical staff to acute coronary syndromes patients education-Can we do something more?

Improving organisational systems for diabetes care in Australian Indigenous communities

BackgroundIndigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from diabetes. There is an urgent need to understand how Indigenous primary care systems are organised to deliver diabetes services to those most in need, to monitor the quality of diabetes care received by Indigenous people, and to improve systems for better diabetes care.MethodsThe intervention featured two annual cycles of assessment, feedback workshops, action planning, and implementation of system changes in 12 Indigenous community health centres. Assessment included a structured review of health service systems and audit of clinical records. Main process of care measures included adherence to guideline-scheduled services and medication adjustment. Main patient outcome measures were HbA1c, blood pressure and total cholesterol levels.ResultsThere was good engagement of health centre staff, with significant improvements in system development over the study period. Adherence to guideline-scheduled processes improved, including increases in 6 monthly testing of HbA1c from 41% to 74% (Risk ratio 1.93, 95% CI 1.71–2.10), 3 monthly checking of blood pressure from 63% to 76% (1.27, 1.13–1.37), annual testing of total cholesterol from 56% to 74% (1.36, 1.20–1.49), biennial eye checking by a ophthalmologist from 34% to 54% (1.68, 1.39–1.95), and 3 monthly feet checking from 20% to 58% (3.01, 2.52–3.47). Medication adjustment rates following identification of elevated HbA1c and blood pressure were low, increasing from 10% to 24%, and from 13% to 21% respectively at year 1 audit. However, improvements in medication adjustment were not maintained at the year 2 follow-up. Mean HbA1c value improved from 9.3 to 8.9% (mean difference -0.4%, 95% CI -0.7;-0.1), but there was no improvement in blood pressure or cholesterol control.ConclusionThis quality improvement (QI) intervention has proved to be highly acceptable in the Indigenous Australian primary care setting and has been associated with significant improvements in systems and processes of care and some intermediate outcomes. However, improvements appear to be limited by inadequate attention to abnormal clinical findings and medication management. Greater improvement in intermediate outcomes may be achieved by specifically addressing system barriers to therapy intensification through more effective engagement of medical staff in QI activities and/or greater use of nurse-practitioners.