Healthcare Delivery Practices Research Articles

Practice of balanced scorecard implementation and its contributing factors among public primary hospital professionals in Central Gondar zone, Northwest Ethiopia.

Globally, a Balanced Scorecard (BSC) is used to measure healthcare institutional performance. Thus, since 2010, Ethiopia has adopted and implemented BSC in all its civil service organizations. Ineffective implementation of this tool has a significant impact on the healthcare performance. The health sector's healthcare provision, customer satisfaction, customer retention, organizational profit, changes and improvements in the healthcare delivery practice are affected by the implementation of BSC tools. However, no evidence or study indicates the implementation of BSC practice in the Ethiopian context. Thus, this study aimed to assess the magnitude of BSC implementation practice and associated factors among healthcare providers at public primary hospitals in the Central Gondar zone, Northwest Ethiopia. A mixed methods study was carried out at public primary hospitals from May 25 to June 26, 2022, in Central Gondar zone with 404 study participants. Study participants were selected using a systematic random sampling technique for the quantitative part, and 12 study subjects were chosen purposively for the qualitative part. Bi-variable and multivariable logistic regression analyses were done. The strength of associations was measured using the adjusted odds ratio (AOR) at 95% CI and a p-value of less than 0.05 in the multivariable analysis to declare significant factors. Thematic analysis was applied for the qualitative data using open code 4.03 version software. The implementation practice of BSC was found at 48.5% (95% CI: 43.6, 53.4%) with a response rate of 95.28%. Teamwork (AOR: 2.68, 95% CI; 1.53, 4.69), organizational communication (AOR: 3.24, 95% CI: 1.79, 5.89), and availability of infrastructure (AOR: 2.03, 95% CI; 1.14, 3.64) were significantly associated to balanced scorecard implementation practice. The implementation practice of BSC was poor compared to the national standard and the findings of prior studies. Thus, concerned stakeholders need to focus on improving and working on organizational communication channels, teamwork, and infrastructure fulfilment to facilitate the implementation practice of a balanced scorecard.

A027: Does Participation in Sports Competitions Enhance Medical Students' Interprofessional Teamwork?

Background: Healthcare systems are complex linkages, and efficient interprofessional collaboration is essential to their efficiency, safety, and quality. The ability of medical students to collaborate across professions directly impacts future healthcare delivery practices. Physical education programmes provide a simple and easy way for medical students to develop interprofessional collaboration that can be translated into future team performance in clinical settings. To test the effectiveness of the physical education programme "competition instead of examination" in improving the teamwork ability of medical students. Method: Using a quasi-experimental intervention design, 188 students were recruited from five classes to complete a teamwork scale consisting of four sub-dimensions, namely, personal characteristics, teamwork, leadership, and conflict management. Before and after the course, we examined the effect of a 16-week cheerleading programme on the subjects' ability to improve their teamwork skills, and compared the non-winning students (n=102) with the winning students (n=86) in order to measure the effect of teamwork skills on team performance. Results: With 188 students participating in the course and 179 students effectively completing the scale posttest, overall teamwork scores (mean score of 4.81 on the pre-test and 5.05 on the posttest, p < 0.001) and scores on the four subdimensions were statistically significant from pre- to post-intervention. Of the 44 self-efficacy items on the scale, 22 significantly improved. Students who did not win the competition remained statistically significant compared to those who won (mean score of 4.86 for non-winners and 5.14 for winners, p < 0.01), with no differences for personal characteristics. Significance was observed for the 3 subdimensions of teamwork, leadership, and conflict management, and a significant increase in 13 out of 44 self-efficacy items on the scale. Conclusions: A "competition instead of examination" physical education programme improved medical students' teamwork skills. Teamwork skills are conducive to increased team performance, and team sports competitions provide a quantifiable method for improving medical students' interprofessional teamwork skills.

A case study on COVID-19 infected patient’s experience - challenging journey at Colombo East Base Hospital- Mulleriyawa

This study investigates the patient experience within the COVID-19 treatment centre at Colombo East Base Hospital, Mulleriyawa, amidst the global pandemic. A cross-sectional descriptive study was conducted over one month, involving 30 participants recruited through convenience sampling. Participants completed self-administered questionnaires assessing various aspects of care, including staff interaction, cleanliness, health education, counselling, and attention to health-related matters. Results indicate high levels of satisfaction among participants across multiple care domains, with the majority expressing satisfaction with staff interaction, cleanliness, health education, counselling, and attention to health-related matters. These findings underscore the healthcare delivery system's effectiveness in meeting patients' diverse needs and expectations during the pandemic. The study highlights the importance of patient-centred care in promoting positive patient experiences and outcomes, particularly in the context of public health emergencies. Recommendations include sustaining and enhancing best practices in healthcare delivery, prioritizing infection prevention and control measures, and promoting effective communication and patient education. By prioritizing patient-centred care and continuous quality improvement initiatives, healthcare providers can ensure the safety, satisfaction, and well-being of patients amidst crises such as the COVID-19 pandemic.

Shifting paradigms in endoscopic sinus surgery: a comprehensive analysis from Japan’s national database

Background In 2013, Japan established a standardized classification system for categorizing endoscopic sinus surgery (ESS) into types I–V, yet no evaluation has been conducted thereof. Objective We assessed the ESS trends and status in Japan, focusing on outpatient and inpatient surgeries. Material and Methods This descriptive retrospective cohort study used Japan’s National Database of Health Insurance Claims and Specific Health Checkups between 2014 and 2021. The distribution of ESS types I–V and outpatient and inpatient surgeries was analysed, along with age groups and regional differences, focusing on ESS type III. Results Overall, 427,813 ESS procedures were performed, with types III and IV being most common. Outpatient ESS type III increased substantially compared to inpatient surgeries. Younger individuals favoured outpatient ESS type III over inpatient surgeries, with substantial regional variations across prefectures. Conclusions and Significance The adoption of a standardized ESS classification in Japan has facilitated a detailed understanding of surgical trends. The shift toward outpatient surgeries, especially for type III ESS, aligns with global trends toward minimally invasive procedures and reflects changing patient preferences and healthcare delivery practices. Consequently, continuous monitoring and research are crucial for adapting surgical practices to the evolving healthcare needs and patient expectations.

Choosing Wisely in Physical Medicine and Rehabilitation: Developing Canadian Recommendations for Resource Stewardship

ABSTRACT Choosing Wisely Canada (CWC) aims to reduce potentially harmful or unnecessary diagnostic investigations and practices in health care delivery. A committee of the Canadian Association of Physical Medicine & Rehabilitation (PM&R) surveyed the general membership seeking suggestions on new or revised PM&R CWC recommendations. Draft recommendations were revised and refined with an emphasis on resource stewardship and alignment with the CWC mission. The updated 2023 CWC recommendations for PM&R are to avoid: (1) investigating and treating asymptomatic bacteriuria in patients with neurogenic bladder; (2) recommending more than a brief period of physical and cognitive rest after mild traumatic brain injury; (3) starting opioid treatment for chronic noncancer pain without exhausting other approaches; (4) ordering diagnostic imaging for low back pain in the absence of red flags; (5) repeating injections without evaluating patients’ responses to them; and, (6) recommending carpal tunnel release without first confirming nerve entrapment with electrodiagnostic studies or ultrasonography. We present unique implementation tools to equip practitioners with quality improvement strategies to adopt these recommendations into their practices. Future work will include developing recommendations that consider planetary health co-benefits, creating knowledge translation tools, and assessing the impact of recommendation adoption into clinical practice.

Core values of employed general practitioners in Germany – a qualitative study

Background“Core values” help to guide practice of health care delivery. The core values of general practice are described in the European definition of general practice by WONCA, e.g. a holistic, comprehensive and continuous care. They may be associated with the idea that the general practitioner is the owner of the practice rather than an employee.ObjectivesThe objective was to examine the core values of employed GPs in their professional setting and their practical manifestation.MethodsFrom April to May 2021, we conducted 17 semi-structured telephone-interviews with employed GPs in two districts in Baden-Wuerttemberg, Germany. The data were analysed using qualitative content analysis.ResultsWe identified twelve core values, including values relevant to patient care and values relevant to the lives of employed GPs. Values with high relevance were job satisfaction, the professional distance from patients, collaboration and collegial exchange, comprehensive care, adequate consultation time and availability to patients. Values with heterogeneous relevance were continuity of care, waiting times and medical autonomy. The value “availability” of employed GPs to patients was associated with both patient care and personal life. The limited availability of employed GPs was accompanied by tensions between these two trends and other values.ConclusionThe values of employed GPs are partly consistent with the current WONCA definition of general practice. There were also indications of new values. The increase in the proportion of employed GPs implies a need to reflect on the core values of general practice, taking into account factors on the part of employed GPs, patients, and practice organisation.

Improving Health Training Institutions Status to Function As Tertiary: Challenges and the Way Forward in Ghana

The objective of this opinion article is to explain how to improve Health Training Institutions Status to Function as Tertiary. Health Training Institution (HTI) is a unit under Ministry of Health of Ghana which has as its principal object the conducting of courses of training in the theory and practice of health care delivery, including nursing, midwifery and allied health subjects. These and many other measures like being abreast with accreditation procedures, improving facilities such as library, ICT and skill laboratories, general infrastructure and proper and efficient governance system coupled with good leadership style to reflect on the contemporary tertiary education system.

Surgical waitlist management: Perspectives from surgeons on surgical prioritization at a paediatric hospital.

Globally exacerbated surgical waitlists have provided the opportunity to reflect on prioritization and resource allocation decisions. The unique circumstances of paediatric surgery and consequences of surgical delay prompted the study reported in this paper. As part of a larger project to attend to prioritization in our surgical waitlists, we conducted a Quality Improvement study, the purpose of which is to understand surgeon's perspectives regarding the ethical and practical realities of surgical prioritization at our institution. The study comprises semi-structured interviews with nine full-time paediatric surgeons from a variety of subspecialties conducted at our institution, which is a tertiary paediatric hospital with ten surgical subspecialties in a publicly funded healthcare system. Participants articulated how they prioritize their waitlists, and how they understand ethical prioritization. These findings resonate with the growing public concern for ethical practice in healthcare delivery and transparency in prioritization and resource allocation practices. Specifically, more transparency, consistency, and support is required in prioritization practices. This work highlights the importance of institutional dialogue regarding surgical case prioritization. Because quality improvement work is necessarily site-specific, concrete generalizations cannot be offered. However, the insights gleaned from these interviews and the process by which they were gleaned are a valuable knowledge-sharing resource for any institution that is interested in ongoing quality improvement work. The objectives here were to clarify the goals of prioritization within the institution, improve prioritization practices, and make them more ethical and transparent.

Impact of HPV testing in opportunistic cervical screening: Support for primary HPV screening in the United States.

Human papillomavirus (HPV) testing for cervical screening increases diagnosis of precancer and reduces the incidence of cervical cancer more than cytology alone. However, real-world evidence from diverse practice settings is lacking for the United States (U.S.) to support clinician adoption of primary HPV screening. Using a population-based registry, which captures all cervical cytology (with or without HPV testing) and all cervical biopsies, we conducted a real-world evidence study of screening in women aged 30 to 64 years across the entire state of New Mexico. Negative cytology was used to distinguish cotests from reflex HPV tests. A total of 264 198 cervical screening tests (with exclusions based on clinical history) were recorded as the first screening test between 2014 and 2017. Diagnoses of cervical intraepithelial neoplasia grades 2 or 3 or greater (CIN2+, CIN3+) from 2014 to 2019 were the main outcomes. Of cytology-negative screens, 165 595 (67.1%) were cotests and 4.8% of these led to biopsy within 2 years vs 3.2% in the cytology-only group. Among cytology-negative, HPV tested women, 347 of 398 (87.2%) CIN2+ cases were diagnosed in HPV-positive women, as were 147 of 164 (89.6%) CIN3+ cases. Only 29/921 (3.2%) CIN3+ and 67/1964 (3.4%) CIN2+ cases were diagnosed in HPV-negative, cytology-positive women with biopsies. Under U.S. opportunistic screening, across a diversity of health care delivery practices, and in a population suffering multiple disparities, we show adding HPV testing to cytology substantially increased the yield of CIN2+ and CIN3+. CIN3+ was rarely diagnosed in HPV-negative women with abnormal cytology, supporting U.S. primary HPV-only screening.

Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study

Background & objective: Corona pandemic has had profound effects on the practice of healthcare delivery across the globe. The institutional practices and protocols had to be rewritten to cope up with the surge of corona patients and to save the staff and the non-corona patients. We evaluated the emergency surgery cases during the first wave of COVID-19 after the decision to stop elective surgeries, in regard to differences in terms of case distribution, patient profile, anesthesia methods used and the management, and compared with an equivalent period before the pandemic.
 Methodology: Patient files related to emergency surgery from October-November 2019 and April-May 2020, were retrospectively evaluated. Assessment parameters included age, gender, surgical discipline, ASA score, type of anesthesia, time to discharge, reoperation, laparoscopic or open surgery.
 Results: The most common surgical cases in both periods belonged to general surgery. While the number of patients in ASA-I decreased during the COVID period, those in ASA-II increased. We found that while general anesthesia was preferred in majority of the surgeries during the non-COVID period, spinal anesthesia gained popularity in the COVID period (p < 0.05).
 Conclusion: The decrease in the number of patients with ASA-I indicates a change in the surgeons’ priorities in emergency surgery cases. Although there is a worldwide approach to the use of laparoscopic surgery, the use of open surgical techniques increased in our hospital.
 Key words: Covid-19; Pandemic, Emergency surgery
 Citation: Akcaalan Y, Erkilic E, Gulec H, Gumus T, Ozturk L, Kayan G, Kanbak O, Celik N. Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study. Anaesth. pain intensive care 2022;26(3):469-473; DOI: 10.35975/apic.v26i4.1949
 Received: Sep 29, 2021; Reviewed: Jan 10, 2022; Accepted: Mar 26, 2022

Status of Compassionate, Respectful, and Caring Health Service Delivery: Scoping Review.

BackgroundA compassionate, respectful, and caring (CRC) health professional is very important for human-centered care, serving clients ethically and with respect, adhering to the professional oath, and serving as a model for young professionals. As countries try to achieve universal health coverage (UHC), quality delivery of health services is crucial. CRC health care is an initiative around the need to provide quality care services to clients and patients. However, there is an evidence gap on the status of CRC health care service delivery.ObjectiveThis scoping review aimed to map global evidence on the status of CRC health service delivery practice.MethodsAn exhaustive literature review and Delphi technique were used to answer the 2 research questions: “What is the current status of CRC health care practices among health workers?” and “Is it possible for health professionals, health managers, administrators, and policy makers to incorporate it into their activity while designing strategies that could improve the humanistic and holistic approach to health care provision?” The studies were searched from the year 2014 to September 2020 using electronic databases such as MEDLINE (PubMed), Cochrane Library, Web of Science, Hinari, and the World Health Organization (WHO) library. Additionally, grey literature such as Google, Google Scholar, and WorldWideScience were scrutinized. Studies that applied any study design and data collection and analysis methods related to CRC care were included. Two authors extracted the data and compared the results. Discrepancies were resolved by discussion, or the third reviewer made the decision. Findings from the existing literature were presented using thematic analysis.ResultsA total of 1193 potentially relevant studies were generated from the initial search, and 20 studies were included in the final review. From this review, we identified 5 thematic areas: the status of CRC implementation, facilitators for CRC health care service delivery, barriers to CRC health care delivery, disrespectful and abusive care encountered by patients, and perspectives on CRC. The findings of this review indicated that improving the mechanisms for monitoring health facilities, improving accountability, and becoming aware of the consequences of maltreatment within facilities are critical steps to improving health care delivery practices.ConclusionsThis scoping review identified that there is limited CRC service provision. Lack of training, patient flow volume, and bed shortages were found to be the main contributors of CRC health care delivery. Therefore, the health care system should consider the components of CRC in health care delivery during in-service training, pre-service training, monitoring and evaluation, community engagement, workload division, and performance appraisal.

Impact of the Ebola Virus disease in Nigeria

The study, impact of Ebola Virus Disease in Nigeria, is intended to assess the prevention and control program implemented by the Nigerian government towards a successful containment of the outbreak of Ebola Virus Disease; determine the effectiveness of the program implemented in terms of public awareness, healthcare delivery practices and provision of resources; also determine the impact of the Ebola Virus Disease in terms of economic, social and psychological. The study utilized the descriptive research design and a self-structured questionnaire. A pre-test of the questionnaires was conducted to test their reliability. Data were analyzed using weighted and composite means, ranking, and Pearson Correlation. Findings showed that the Ebola Virus Disease prevention and Control Programs initiated by the government were highly implemented and effective with respect to public awareness, healthcare delivery practices, and provision of the resource. Finally, Ebola Virus Disease had a great negative impact on the economic, social, and psychological health status of Nigerians .

Quality and Safety Challenges in Inpatient Pediatric Care during the COVID‐19 Pandemic: A National Qualitative Study

Research ObjectiveThe COVID‐19 pandemic has necessitated rapid changes in healthcare delivery, including surge planning and modifying healthcare delivery environments and practices. Our objective was to identify the major resulting challenges for quality and safety of pediatric inpatient care.Study DesignWe conducted semi‐structured video interviews. Using constant comparative methods, we iteratively coded data to identify themes related to pediatric inpatient quality and safety challenges during the pandemic.Population StudiedWe purposefully sampled from community and children's hospitals serving pediatric patients in the 6 U.S. states with the highest COVID‐19 hospitalization rates at the onset of the pandemic (NY, NJ, DC, MA, CT, LA). We recruited 2 front‐line clinicians per site (mix of administrators, nurses, physicians).Principal FindingsTwenty‐four participants from 12 hospitals were interviewed. The most commonly encountered themes are detailed in Table 1. Changes in healthcare delivery practices potentially impacting quality and safety of inpatient pediatric care included: 1) limits on family and caregiver visitation, which may have hindered gathering important details for diagnosis and engaging in shared‐decision making about management; 2) personal protective equipment and isolation practices, which may have compromised effective communication with caregivers and interpreters; 3) changes in quality improvement (QI) infrastructure and activities, with potential decreases in monitoring and safety efforts; 4) difficulties defining and providing high‐quality care for children with COVID‐19 and multi‐system inflammatory syndrome in children, both novel diagnoses; and 5) potential increases in safety events due to decreased direct contact with patients and monitoring (e.g., wound infections, central line‐associated bloodstream infections and catheter‐associated urinary tract infections).TABLE 1 ThemeExemplary QuoteLimiting family or caregiver visitation“In challenging diagnoses, even if it wasn't COVID‐related, you couldn't have both parents there at the same time.”Experiencing personal protective equipment or isolation status as a barrier to communication“With non‐English speaking parents, we were trying to use an interpreter phone with an N9, an extra mask, the negative pressure circulator running in the background. Trying to get a good history and to provide quality care was really brutal.”Difficulty maintaining high‐quality care“These people would not have any care. They would be sitting in the ED in the hallway, one ED doc taking care of 50 patients. No, you were not qualified to take care of this patient, but this is a pandemic.”Changes in QI operations (staffing, data monitoring, QI activities)“Everything non‐essential stopped. Meetings canceled, research on hold, IRB halted, labs shut down. We have mandatory reporting on things like sepsis. There was too much else going on, we stopped measuring certain things.”Increasing healthcare‐associated safety events or harms“We had an uptake in our CLABSI, in every healthcare‐associated condition we were capable of tracking. After the fact, because that was not the priority.”ConclusionsThis national qualitative study of early COVID‐19 epicenters described changes in several domains of healthcare delivery affecting quality and safety of pediatric inpatient care.Implications for Policy or PracticeThe several potential areas of focus identified can help clinicians and hospital leaders plan for safe and high‐quality care for hospitalized children, during this ongoing crisis and for future pandemics.Primary Funding SourceAgency for Healthcare Research and Quality.

Online Healthcare Practices and Associated Stakeholders: Review of Literature for Future Research Agenda

The rise of online platforms for health information exchange is changing the traditional healthcare delivery practices. With Internet technologies, online healthcare practices are continuously growing through their diversified delivery functionalities with better and faster reachability. Participants use such forums for various purposes, for instance, to gather information, seek medical assistance, connect with other users, and purchase healthcare products or services. The need for a consolidated study, considering all key aspects of virtual healthcare, is crucial. We aim to examine the existing literature to study stakeholders of online healthcare and their behaviour dynamics, available functionalities and service delivery approaches during different phases. We have identified five key stakeholders who are vital for online healthcare deliveries and explored their contributions across life-cycle stages of online healthcare community (OHC) in India. The PRISMA reporting approach was used to select suitable literature for this study. About 78 articles were identified, which were shortlisted to 67 articles, keeping in mind the objectives of this study. Key findings from all these articles are segregated according to identified themes and systematically presented to enlarge the visibilities of associated functionalities. This study is one of the initial studies on India’s OHC that has defined associated stakeholders, functionalities and association dynamics during different life-cycle phases. People are proactively emerging towards OHC to acquire knowledge, share experience and decide their healthcare drives. Being operated virtually, information technology (IT) is the driving factor of OHC, and we have addressed the diversified IT aspects applicable in an OHC set-up. We also have accumulated all key attributes of OHC and produced a theoretical framework through this study, which academic researchers can use to understand the present approaches better and derive futuristic studies. Similarly, service providers can use the findings to evaluate their services, identify the present loopholes in the operational approaches and effectively manage the deliverables to meet end-user needs.

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care.

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care.

Intersectional invisibility experiences of low-income African-American women in healthcare encounters

ABSTRACT Background The disparities that Black/African-American women experience in health care are persistent and staggering. Findings from health outcomes research continue to demonstrate poorer outcomes for African-American women compared to women of other race/ethnicity in several conditions. These racial/ethnic and gender health disparities observed are complex, heavily nuanced and multi-factorial. To understand these, there is a need to apply an ‘intersectionality’ lens. Intersectionality refers to the experience of persons with multiple intersecting statuses. The objective of this exploratory study was to gain insight into the healthcare experiences of low-income African-American women. Methods In-depth one-on-one interviews were conducted with 22 women and 2 focus group discussions with community leaders and advocates. Investigators conducted a thematic analysis of the transcripts. Results The thematic analysis revealed four major themes, which tell the story of the intersectional invisibility experienced by low-income AA women in the healthcare system. These included (1) the perception of ‘not feeling heard’; (2) patient as ‘expert of her own body’; (3) disregard of patient preferences; and (4) the need for self-advocacy. Conclusions Black/African-American women, and particularly those with socioeconomic disadvantage, experience intersectional invisibility resulting from provider implicit bias, stereotypical assumptions, and systemic structures that enable discriminatory practices in healthcare delivery. Healthcare provider education that more explicitly addresses these biases and stereotypes should be complemented with system-level interventions that aim to dismantle the structural racism inherent in healthcare policies and practices.

“Seconds save lives – clean your hands”: the 5 May 2021 World Health Organization SAVE LIVES: Clean Your Hands campaign

To highlight the urgent need to save lives by implementing best practices in health care delivery, the slogan for 5 May 2021, world hand hygiene day, is “Seconds save lives – clean your hands”. The WHO campaign calls to action key stakeholders: health care workers, IPC practitioners, patients and families, facility managers, policy-makers, vaccinators, and the general public who can play critical roles in achieving optimal hand hygiene at the point of care, helping to strengthen society involvement.

Impact of geography and travel distance on outcomes in epithelial ovarian cancer: a national cancer database analysis

BackgroundAs ovarian cancer treatment shifts to provide more complex aspects of care at high-volume centers, almost a quarter of patients, many of whom reside in rural counties, will not have...

Knowledge creation practices at organizational boundaries: the role of ICT in sickle-cell care for tribal communities

PurposeThis paper aims to examine the role of information and communication technology (ICT) in the knowledge creation practices adopted by a health care organization. The organization is delivering care to patients of a genetic disorder, called the sickle cell, in tribal communities. The paper identifies how ICT intermediates knowledge creation practices across the organizational boundaries wherein tribal patients, front-line counselors and expert physicians interact, which then produces context-specific, evidence-based medicine (EBM).Design/methodology/approachThe knowledge-in-practice approach is adopted to conduct an ethnographic study of sickle cell care practices in a non-profit health care organization in Western India. The analysis focuses on ICT-mediated interactional practices among the physicians, front-line counselors, tribal patients and their families, for more than a year-long observation. These are supplemented with informal and formal interviews, archival records and vignettes based on several episodes to explicate the key knowledge creation practices.FindingsTechnology-mediated informative interactions at organizational boundaries can bridge socio-linguistic and interpretive barriers between actors, while also providing a generative structure that leads to the creation of longitudinal clinical evidence about a rare genetic disorder. Three specific ICT-entwined knowledge creation practices emerge, namely, knowing the community, increasing interactional engagement and constructing gradients of socio-clinical history. These practices generate organization-wide knowledge about the social and clinical dimensions of the genetic disorder. The findings are presented through vignettes and a novel conceptual framework.Research limitations/implicationsThis study identifies various useful knowledge creation practices in health care delivery for resource-constrained emerging economy contexts. Further, the study suggests that the involvement of local front-line actors and ICT can become important resources in the delivery of health care in these settings.Originality/valueA novel framework is developed which demonstrates knowledge creation at organizational boundaries wherein the actors use ICT-based practices for effective delivery of health care. The proposed framework may be used by health care organizations in similar contexts providing care to marginalized communities.

Perceived Challenges of Working Environment Among Emergency Department Nurses in Saudi Arabia

Background: Emergency room nurses are faced with many challenges related to the nature of complex practices and the environment. Research has approved a number of characteristics of emergency department nurses in order to fulfill the required role. Objectives: To determine the perception of nurses of the Emergency Department to the challenges associated with their working environment. Methods: A cross-sectional design was used in four selected governmental hospitals in Hail. Among one hundred and seventy-five of Emergency registered nurses; One Hundred and Fifty-Eight emergency registered nurses were recruited conveniently based on the inclusion criteria. A closed ended questionnaire sheet was marked out by all the selected nurses to determine their perception towards challenges associated with their working environment. Results: In this study among the total population of Emergency Room staffs, 90 % of staffs were included; ages ranged between 23-29 yrs were 77.8%. Majority of female nurses were 88.6% most of the sample 83.5% hold bachelor’s degree in nursing. Moreover, 48.7% practicing as a nurse about 1-4 yrs. The ER nurses ranged from 1- 4 yrs of experience were 75.9%. Majority of 79.7% were working as a staff Nurse. More than half of the Non-Saudi were working in ER was 54.4%. The variables under the quality of environment for professionals, most of them shows bad perception in working environment so far in comfort zone were 27.8%, nursing assistance and technician, hours of work shift have higher in bad perception overall level of 22.7%. In regards the Cleaning were 29.7%, Quality of materials were 37.9%, Physician were 36.7%, Number of calls per shift were 39.2%. In determining the perception of Emergency Department nurse towards challenges associated with their working environment shows higher perception level with the mean value of 32.03 and standard deviation was 5.6. Conclusion: From this study we concluded that, the healthcare policy makers may have concern about health care providers. The working condition of the Emergency Room nurses Perceived that they have somewhat discouragement in their working environment. Some changes in reimbursement and the practice of health care delivery required hospital to change the way they operate. These results will also propagate the managers to re-define a development plan for the Emergency Department working Environment of the selected Hospitals, in hail. Keywords : Nurse, Perception, Emergency Department, Challenges, Working Environment. DOI: 10.7176/JBAH/10-10-05 Publication date: May 31 st 2020