Private Hospital Group Research Articles

Exploring strategies promoting interprofessional collaborative practice in spinal cord injury rehabilitation at a private South African hospital group

Background. Implementing an interprofessional collaborative practice (IPCP) in hospitals improves health outcomes, enhances patient safety and reduces length of stay by optimising resource utilisation. Although this approach was desired at a private hospital group in South Africa (SA), the specific strategies for clinical guidelines and capacity management pertaining to spinal cord injury (SCI) patients and the implementation of IPCP were unknown. Objective. To explore strategies for implementing clinical guidelines and capacity management for SCI rehabilitation to promote IPCP in a private hospital group in SA. Method. This exploratory descriptive qualitative study included participants who were selected through purposive sampling. The participants comprised 11 staff from various disciplines and management of the private hospital group, one local and one international expert in IPCP. Three online focus groups (n=13) were conducted, involving three to five participants. The transcriptions were analysed thematically using Braun and Clarke’s framework. Results. Interprofessional communication and tools as well as capacity development were three emergent themes from the data. Strategies pertaining to communication methods, digitisation, visual displays, patient care information, educational information and education of healthcare workers were suggested to promote IPCP. Conclusion. These findings from the emergent themes could assist in implementing and integrating an IPCP approach into the rehabilitation service. Further research assessing the efficacy of implementing the IPCP strategies and digital platform would be beneficial.

Patient safety culture in private hospitals in China: a cross-sectional study using the revised Hospital Survey on Patient Safety Culture.

This study aimed to translate the revised Hospital Survey on Patient Safety Culture (HSOPSC 2.0) to Mandarin, evaluate its psychometric properties, and apply it to a group of private hospitals in China to identify the determinants associated with patient safety culture. A two-phase study was conducted to translate and evaluate the HSOPSC 2.0. A cross-cultural adaptation of the HSOPSC 2.0 was performed in Mandarin and applied in a cross-sectional study in China. This study was conducted among 3,062 respondents from nine private hospitals and 11 clinics across six cities in China. The HSOPSC 2.0 was used to assess patient safety culture. Primary outcomes were measured by the overall patient safety grade and patient safety events reported. Confirmatory factor analysis results and internal consistency reliability were acceptable for the translated HOSPSC 2.0. The dimension with the highest positive response was "Organizational learning - Continuous improvement" (89%), and the lowest was "Reporting patient safety event" (51%). Nurses and long working time in the hospital were associated with lower assessments of overall patient safety grades. Respondents who had direct contact with patients, had long working times in the hospital, and had long working hours per week reported more patient safety events. A higher level of patient safety culture implies an increased probability of a high overall patient safety grade and the number of patient safety events reported. The Chinese version of HSOPSC 2.0 is a reliable instrument for measuring patient safety culture in private hospitals in China. Organizational culture is the foundation of patient safety and can promote the development of a positive safety culture in private hospitals in China.

Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study.

The implementation of Enhanced Recovery After Surgery (ERAS) is a challenge for healthcare systems, especially in case of patients undergoing major surgery. Despite a proven significant reduction in postoperative complications and hospital lengths of stay, ERAS protocols are inconsistently used in real-world practice, and barriers have been poorly described in a cohort comprising medical and paramedical professionals. This study aims to assess the proportion of French healthcare providers who practiced ERAS and to identify barriers to its implementation amongst those surveyed. We conducted a prospective cross-sectional study to survey healthcare providers about their practice of ERAS using an online questionnaire. Healthcare providers were contacted through hospital requests, private hospital group requests, professional corporation requests, social networks, and personal contacts. The questionnaire was also designed to explore barriers to ERAS implementation. Identified barriers were allocated by two independent assessors to one of the fourteen domains of the Theoretical Domains Framework (TDF), which is an integrative framework based on behavior change theories that can be used to identify issues relating to evidence on the implementation of best practice in healthcare settings. One hundred and fifty-three French healthcare providers answered the online questionnaire (76% female, median age 35 years (IQR: 29 to 48)). Physiotherapists, nurses, and dieticians were the most represented professions (31.4%, 24.2%, and, 14.4%, respectively). Amongst those surveyed, thirty-one practiced ERAS (20.3%, 95%CI: 13.9 to 26.63). Major barriers to ERAS practice were related to the "Environmental context and resources" domain (57.6%, 95%CI: 49.5-65.4), e.g., lack of professionals, funding, and coordination, and the "Knowledge" domain (52.8%, 95%CI: 44.7-60.8), e.g., ERAS unawareness. ERAS in major surgery is seldom practiced in France due to the unfavorable environment (i.e., logistics issues, and lack of professionals and funding) and a low rate of procedure awareness. Future studies should focus on devising and assessing strategies (e.g., education and training, collaboration, institutional support, the development of healthcare networks, and leveraging telehealth and technology) to overcome these barriers, thereby promoting the wider implementation of ERAS.

‘Helper’ or ‘punisher’? A qualitative study exploring staff experiences of treating severe and complex eating disorder presentations in inpatient settings

BackgroundEating disorders have been described as challenging to treat, with the most severe cases requiring inpatient admission. Previous studies have explored staff’s perspectives on eating disorders and service provision. However, little is currently known about how staff experience working with severe and complex eating disorder presentations in inpatient settings and how they may be impacted by their work.AimsThis study aimed to explore the experiences of staff who contribute towards the treatment of severe and complex eating disorder presentations in inpatient settings.MethodsParticipants were recruited purposively via clinical contacts and a private hospital group in the UK. Semi-structured interviews were conducted, recorded, transcribed verbatim, and analysed guided by the principles of reflexive thematic analysis.ResultsInterviews were completed with twelve staff members, including frontline nursing staff and multidisciplinary team (MDT) staff, from both private and public specialist settings. Participants expressed uncertainty about the treatment approach for service-users with severe and complex presentations. As service-users often resisted treatment, participants felt positioned as a ‘punisher’ rather than a ‘helper’ in initial treatment stages. Many had experienced physically and emotionally impactful events at work, including violence and aggression, as well as serious incidents of self-harm and suicide attempts. Participants generally found support in their colleagues, however considered organisational support insufficient.ConclusionsThis research highlights an urgent need to consider the wellbeing of staff who works in eating disorder inpatient settings, as well as their support needs. Retention and recruitment strategies should be reviewed to reduce staff turnover and improve patient care. Further research should investigate whether specialist inpatient staff are impacted by symptoms of vicarious or direct trauma, moral injury and compassion fatigue.

Prevalence and comparison of psychological trauma and stressors in functional seizure patients from a public and private hospital

PurposeTo date not much is known about the differences, if any, between patients with functional seizures (FS) from different socioeconomic backgrounds. We sought to compare the psychological stress and trauma profiles of patients with FS from a private and public hospital in Cape Town, South Africa. MethodsOnly video-electroencephalography-confirmed patients with FS were eligible for the study. In this retrospective case-control study we collected data on self-reported demographic and psychological stressor/trauma variables using digital patient records starting with the earliest available digital patient record for each hospital. ResultsA total of 321 patients from a private hospital and 68 patients from a public hospital were included in the study. Most factors showed no significant differences. However, public hospital patients had higher odds of being older (p = 0.002), almost nine times the odds of reporting physical violence by an intimate partner (aOR = 8.65, 95% CI [1.70, 44.08]), more than eight times the odds of reporting psychological stress in the form of death and/or sickness in the family (aOR = 8.56, 95% CI [1.81, 40.41]) and almost three times the odds for other general psychosocial stressors (aOR = 2.82, 95% CI [1.08, 7.42]) compared to those attending the private hospital. They also had half the odds of being female compared to the private hospital patients (aOR = 0.47, 95% CI [0.23, 0.95]) and 93% fewer odds of reporting coming from an abusive home (aOR = 0.07, 95% CI [0.01, 0.52]). ConclusionHistory and psychological trauma and stressor profiles showed many similarities between the public and private hospital groups; however, some differences were noted and could benefit further exploration and consideration in therapeutic and diagnostic contexts.

Development and Psychometric Testing of Task and Contextual Performance Scales for Clinical Nurses.

Background and Purpose: This study aims to develop a task performance scale and a contextual performance scale for clinical nurses and to test the scales psychometrically. Methods: This study was carried out in two phases in a private hospital group. During the first phase, the initial scales were developed, and then the validity and reliability of the scales were analyzed; 154 nurses participated in the second phase. Results: The task performance scale consisted of two factors (total variance explained: 75.87%); the contextual performance scale consisted of three factors (total variance explained: 74.05%). The content validity indexes of both scales were 0.99. The Cronbach's alpha coefficients of both scales were 0.98. The test-retest reliability and inter-rater agreement of the scales were also good. Conclusions: The scales can contribute to nursing literature and hospital managers in assessing the performance of clinical nurses.

Editorial introductions.

Editorial introductions.

#5292 BRAZILIAN SURVEY ON THE MANAGEMENT OF ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPIES

Abstract Background and Aims Acute kidney injury (AKI) diagnosis, management, the optimal prescription and delivery of renal replacement therapy (RRT) standards for best practice are lacking. The aim of this study was to explore the clinical approach to AKI and RRT in a broad population of Brazilian nephrologists. Method A cross-sectional survey was distributed to all nephrologists from multiple centres of a Brazilian private hospital group. The responses of the participants on several aspects of AKI management and renal replacement therapy were analysed and detailed. Results 97 (66%) nephrologists from 8 Brazilian states responded. 45% referred KDIGO 2 as the stage usually present at time of nephrologist consultation, and mean time for nephrology consultation after AKI diagnosis was 24-48h for 51% of answers. 85% reported creatinine as the only biomarker available for diagnosis, and only 24% reported any AKI alert system. Sepsis was reported as the most frequent etiology by 95%; kidney biopsy indication was considered in less than 10% of the evaluations by 94%. Fluid status assessment is described in Figure 1. The most common criteria for starting RRT was fluid overload (30%) followed by urine output reduction (26%), hyperkalemia (14%) and acidosis (17%). 62% of them usually use furosemide stress test before RRT indication. Seventy-seven percent of participants said that never use peritoneal dialysis in AKI patients, although its available for 44% of responders. Hypotension was the most frequent RRT complication for 91% responders, followed by coagulation of the system for 42% and catheter dysfunction for 33%. CRRT was available for 92% of participants and for 88% this is the RRT for patients using vasoactive drugs. 77% usually use regional anticoagulation with citrate. The most common starting dose is 26 to 30ml/Kg/h and the net ultrafiltration rate is 1,01-1,75 ml/Kg/h. There is no weaning protocol of RRT for 81%, but 90% use the urine output as a weaning tool. Thirty- nine percent said that RRT patients’ mortality stayed between 20 to 50%, and 36% had no information about mortality. Conclusion In our survey, Nephrology consultation occurred after 24h and at KDIGO 2 stage. Early recognition of AKI is impeded by the use of serum creatinine as the only biomarker and the unavailability of AKI alerts. Fluid overload is the main reason for indicating RRT and nephrologists have expanded the use of non-invasive fluid status assessment methods others than physical examination. CRRT is the method of choice for unstable patients in this sample from private medical facilities, where almost all responders have access to CRRT. Effluent doses and net ultrafiltration rate were in accordance with the established in literature. Optimal timing for discontinuing RRT is still defined according to the physician's discretion. Standardization of AKI management and continuing education seem to be a fundamental aspect to anticipate the diagnosis, improve the therapeutic approach and bring better results for AKI patients.

Treatment Outcomes of Acute Coronary Syndrome Patients in Bangkok Dusit Medical Services (TOACS-BDMS)

OBJECTIVES: The research team analyzed an acute coronary syndrome (ACS) registry from a private hospital group in Thailand. We aimed to analyze patients’ characteristics, treatment outcomes in ACS patients and compare the outcomes between ST segment elevation acute coronary syndrome (STE-ACS) and non-ST segment elevation acute coronary syndrome (NSTE-ACS). MATERIALS AND METHODS: This is a multi-centered, retrospective review of an ACS registry with seven participating hospitals carried out between January 2017 to December 2020. Web-based data entry was used, and the data were centrally managed and analyzed. RESULTS: A total of 2,024 ACS patients were included. Of these, patients were predominantly male (81.07%), NSTE-ACS 52.17% and the mean age was 62.27 ± 13.08 years. Diabetes mellitus (DM), hypertension (HT), dyslipidemia, and current smokers were observed in 25.24%,54.89%,46.64% and 30.38%, respectively. Reperfusion rate in STE-ACS was 93.20 % and 73.80% was primary percutaneous coronary intervention (PCI). STE-ACS patients were significantly younger (59.03 ± 12.27 vs. 65.24 ± 13.09 years),more current smokers (39.77% vs. 21.78%), more cardiogenic shock (15.28%vs. 3.03%) and more cardiac arrest before reperfusion therapy (9.71% vs.1.79%). Meanwhile, NSTE-ACS patients presented significantly more DM(30.58% vs. 19.42%), HT (62.40% vs.46.69%), and dyslipidemia (53.78%vs.38.84%). In-hospital mortality rate was 2.91% and significantly higher in STE-ACS (STE-ACS 4.95% vs. NSTE-ACS 1.04%). CONCLUSION: Treatment outcomes of ACS patients in Bangkok Dusit Medical Services revealed high reperfusion rate and resulted in low inhospital mortality rate. STE-ACS patients were more severe and with a higher mortality rate compared to NSTE-ACS patients.

Strategies for the Facilitation of Self-Leadership Among Ward Nurses in a Nurse-Led Critical Care Outreach Service.

Nurses are responsible for monitoring and providing nursing care to patients. The early detection of a patient who is starting to deteriorate - and the activation of critical care outreach services (CCOS) - can improve patient outcomes. However, the literature indicates that CCOS are underutilised. Self-leadership is a process whereby persons influence their own behaviour. The purpose of this study was to develop strategies for the facilitation of self-leadership in ward nurses that will enable them to act proactively and promptly in utilising CCOS at a private hospital group in South Africa. A sequential exploratory mixed-method research approach was followed to develop strategies for the facilitation of self-leadership in nurses that will enable them to utilise CCOS proactively when a patient starts to deteriorate. An adapted version of Neck and Milliman's self-leadership strategic framework was used as the methodological steps of the study. The quantitative analysis extracted eight factors, which were used as the departure point to develop strategies for the facilitation of self-leadership among nurses in a CCOS. Five strategies were developed that related to self-motivation, role models, patient outcome, assistance and guidance from CCOS, and the power of self-confirmation; these strategies aligned with the themes and categories extracted from the qualitative data analysis. There is a need for self-leadership among nurses in a CCOS.

Hemşirelerin Mesleki İmaj Algılarının Belirlenmesi: Tanımlayıcı-Kesitsel Bir Araştırma

Objective: The nursing image is built on a tripod of the public, nursing students, and nurses. Determining how each leg of this tripod perceives the nursing is crucial to improving the professional image. This study aimed to determine the nursing image perceptions among nurses at a private hospital group in Istanbul.Material-Method: This descriptive-cross-sectional study was carried out with 428 nurses at four private hospitals affiliated with a foundation university in Istanbul. Data were collected through a random sampling method using a self-administered questionnaire, including a personal information form, and The Image Scale for Nursing Profession. Data analysis was performed using descriptive statistics, Mann-Whitney U test, and Kruskal Wallis-H variance analysis. Results: Nurses generally perceived the nursing image as positive with a median score of 169 (160-177) out of 210. Nursing image for gender and professional status subscales was perceived more negatively than others, with median scores of 23 (19-28) and 19 (17-22), respectively. Nurses who were female (p=0.007), younger than 22 years (p=0.001), unwilling to re-choose nursing as a career (p=0.001), had professional experience less than a year (p=0.002), and worked more than 55 hours a week (p=0.000) perceived nursing image more negatively.Conclusion: The results of this study showed that nurses working at a private hospital group had positive perceptions of the nursing image at a high level, except in terms of gender and professional status. Reflecting a gender equality perspective on nursing management, employing only undergraduate nurses for nursing, and planning an effective work schedule are recommended.

Solving Problems Due to Hurricane Maria and COVID-19: CT Trends in Puerto Rico Before, During, and Beyond Public Health Crises

Our objective was to evaluate the impact of recent public health crises on radiology CT services in Puerto Rico. We gathered and analyzed CT statistics from 2 of Puerto Rico's major private hospital groups and obtained monthly data from January 2016 to March 2021. We quantified short- and long-term impacts of Hurricane Maria (September 2016-August 2017, September 2017-August 2018, September 2018-August 2019) and COVID-19 (April 2019-March 2020, April 2020-March 2021) by calculating month-to-month and year-to-year percentage differences for each hospital and all hospitals combined for the dates leading up to, in the immediate aftermath, and following these major events. Despite short-term effects throughout September from Hurricane Maria, there were no noticeable year-to-year differences in the total number of CT studies performed. Both March and April 2020 highlighted the instantaneous impact caused by COVID-19; these months contributed less than 6% of the total yearly scans performed between April 2019 and March 2020 and April 2020-March 2021 for all the hospitals individually. Hurricane Maria exerted a short-term impact on CT studies performed throughout September 2017. COVID-19 also demonstrated immediate yet prolonged effects on the number of CT studies performed with all 3 hospitals reporting decreases between a full pandemic year and the year prior. Our results support fortifying medical and societal infrastructure to better prepare for future natural and public health disasters, particularly in Puerto Rico and similarly resourced areas, to maintain steady, if somewhat diminished, radiology services such as CT for regular and emergency purposes.

The penetration of financial capital and the growth of private hospital groups in Europe: the case of Spain (1975–2022)

AbstractFrom the last decades of the twentieth century, above all, in the more service-oriented post-industrial economies, and in a context of debilitation of public health systems, health care became exponentially profitable, thereby attracting new types of investors. In fact, this new stage entails moving from the commercialisation of health care to its financialisation; that is, medical care becomes just one more financial asset and its price and quality are quoted on the stock exchange. This study intends to participate in the debate initiated by historians of medicine and economic historians with the aim of tracing capitalist traits and market participation in the evolution of health coverage, a process initially promoted by professional doctors who converted their consulting rooms into small clinics and larger hospital companies and which, over time, saw the incorporation of financial capital. In particular, this paper has two specific objectives for the case of Spain. First, to analyse the relationship of collaboration and/or competition between public and private hospitals under democracy and the factors that have conditioned this relationship. Second, to make an initial contribution towards understanding how, in this context, the large private hospital groups have been created in Spain during this period, especially in recent decades with concentration in the hands of financial capital, originating from both the traditional banking sector and investment funds.

Editorial introductions.

Editorial introductions.

Factors associated with anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein antibody titer and neutralizing activity among healthcare workers following vaccination with the BNT162b2 vaccine.

The purpose of this study was to identify factors associated with the increase in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S1) protein and neutralizing antibody titer following SARS-CoV-2 vaccination. This observational study was conducted among healthcare workers working for a private hospital group in Fukushima Prefecture, Japan. Two blood samples were obtained from each participant. The first sample was obtained before the first dose of BNT162b2 (Pfizer-BioNTech) vaccine, and a second sample was obtained approximately 6 weeks later. Immunoglobulin G (IgG) antibody against the SARS-CoV-2 spike (S1) protein, immunoglobulin M (IgM) antibody against SARS-CoV-2 N-protein, and neutralizing activity were measured using the chemiluminescent immunoassay with iFlash 3000. A total of 231 healthcare workers who agreed to participate, and were negative for anti-SARS-CoV-2 IgM antibodies at enrollment, were included in the analysis. All participants had elevated IgG antibodies and neutralizing activity above the cutoff values. A total of 174 (75.3%) and 208 (90.0%) participants experienced adverse reactions after the first and second vaccine doses, respectively. Younger age, female sex, not taking immunosuppressive or antipyretic analgesic medication regularly, a lack of local adverse reactions after the first dose, and the presence of adverse reactions (fever, muscle, and joint pain) after the second dose were associated with higher IgG antibody titers and neutralizing activity. Intake of analgesic antipyretic for adverse reactions to vaccines was not significantly associated with antibody and neutralizing activity titer production. Immune responses after vaccination may differ among individuals, and continued countermeasures to prevent SARS-CoV-2 infection are vital.

Perceived Risk of COVID-19 and Employee Decision-Making: How Psychological Distress during the Pandemic Increases Negative Performance Outcomes among Healthcare Workers.

In this research, we examined how COVID-19 impacts employee decision-making and performance, knowing that this virus has negatively affected public health, crippled economies, and transformed social and business environments across the globe. To quantitatively test our specific hypotheses regarding the effects of employees’ perceived risk of COVID-19 and psychological distress on negative performance outcomes, we surveyed 443 healthcare workers who were employed by a group of private hospitals in Zimbabwe. These essential workers were delivering day-to-day frontline services with high exposure to COVID-19 during the pandemic. We find that employees’ perceived risk of COVID-19 increases their disengagement, turnover intention, burnout, and low morale at a p < 0.05 significance level. These latter relationships are mediated by employees’ psychological distress at a p < 0.05 significance level. Our findings shed light on how the COVID-19 pandemic is affecting the cognitions and behaviors of the frontline workers who are vulnerable to this contagious disease. Turnover intentions are amplified among healthcare employees, due to their perceived risk of COVID-19 and the resulting psychological distress. Similarly, burnout becomes predominant as these workers worry about contracting the coronavirus due to the poor working conditions they face. As such, our research confirms that the pandemic has intensified the precariousness of work and challenge of managing employee performance, especially for frontline healthcare workers.

Patient anxiety levels in orthopedic outpatient clinics at hospitals with different patient population densities

Background/Aim: Prolonged wait times for examination and delayed hospital appointment times can negatively affect patients, and increased anxiety in orthopedic outpatient clinic patients can disrupt diagnosis and treatment and increase psychological tension in both patients and healthcare professionals. The aim of our study is to compare the anxiety levels of patients at institutions with different patient population densities. Methods: This cross-sectional survey study included 189 patients who voluntarily completed the Beck Anxiety Scale while registering for treatment of non-traumatic conditions at the orthopedics and traumatology outpatient clinics of two tertiary health care hospitals. Patients were grouped by hospital attended. The study assessed patients’ age, education level, estimated monthly income levels, and anxiety levels. Results: 99 patients from the public hospitals and 90 from the private hospitals participated in the survey. A significant positive correlation existed between educational status and income level (P<0.001). No significant difference in income level existed between the two groups (P=0.063), but the education level of patients in the private hospital group was significantly higher than in the public hospital group (P<0.001). The anxiety levels of the patients in the private hospital group was significantly higher (P=0.043); this difference was correlated to education level rather than income level. Patients with higher education levels demonstrated significantly higher anxiety levels (P<0.001). Conclusion: The study concluded that the anxiety levels of patients who applied to the orthopedic outpatient clinics were independent of facility patient density and related primarily to patient attributes. Prospective studies are needed examining the relationship between patient anxiety levels and waiting time and patient anxiety levels and orthopedic disease.

The Experiences of the Operating Department Assistants in the Perioperative Environment

BackgroundThe Operating Department Assistant is employed in the perioperative environment to assist with anaesthetics, scrubbing and circulating duties. Research indicates a lack of this phenomenon experienced by Operating Department Assistant in the perioperative environment. AimTo explore and describe the Operating Department Assistants' experiences in the perioperative environment. Methodological designA qualitative, exploratory, descriptive and contextual design was followed using a phenomenological research method. A purposeful sampling method was utilised to select eight female participants from one private hospital group in Gauteng. In-depth, individual, unstructured interviews were conducted using Giorgi's method of data analysis to reveal the construct of the phenomenon. FindingsThe results revealed that Operating Department Assistants experienced happiness, pride, joy, understanding of their duties and fostered teamwork with in the perioperative environment. Furthermore the Operating Department Assistants experienced unhappiness, revealing role confusion, distrust, emotional suppression, limited professional and exploitation in the perioperative environment. ConclusionThe experiences of the Operating Department Assistants in the perioperative environment was explored and described. The sensitive nature of this phenomenon highlighted the happiness and unhappiness experienced by the Operating Department Assistants in the perioperative environment. Recommendation practices include effective orientation. mentorship, transitioning and partnership to caringly support, clarify the Operating Department Assistant role, affirmation and display their expertise, providing valuabe assistance in the perioperative environment.

The private health sector's capitalist dynamic in Brazil from 2009 to 2015

Hospitals have shown changes in their role in health systems. In Brazil, private hospitals have always stood out, with charitable hospitals gaining increasing importance in the 21st century. Especially in the United States, there has been a trend towards consolidation of hospitals, concentrating great market power, in keeping with the capitalist phenomenon of financialization. This study aims to describe the current evolution in the Brazilian context in private hospitals and hospital groups, identifying the principal characteristics and trends according to the current capital dynamics. A descriptive exploratory study was performed, focused on dimensions of net worth, accounting-finance, and policy. The study covered the period from 2009 to 2015, analyzing 10 hospitals and 3 hospital groups selected intentionally. Datasets were created from different sources, used to calculate indicators and to analyze information on each of these dimensions. The private hospital sector in Brazil, including charitable hospitals, already displayed strategies that are characteristic of financialization, such as the formation of oligopolies through mergers and acquisitions and diversification to other areas such as teaching and management of public units, a focus on high profit, and internationalization, backed by the sector's own policy agenda. The trend is intrinsically exclusionary, concentrating wealth, inconsistent with the constitutional principles of universal care and the right to health, and it requires the adoption of public policies, regulation, and social control to contain it.

The impact of paternalistic leadership behaviour on organizational trust among healthcare professionals

Aim: The aim of the current study was to investigate the impact of paternalistic leadership on organizational trust among healthcare professionals in Turkey. As a starting point, it acknowledges that the impact of paternalistic leadership may vary depending on the cultural values of a given society. The study then offers the regression model between the variables among with implications of this relationship for healthcare management in Turkey. Methods: A questionnaire-based cross-sectional study and face-to-face interviews were conducted at a private hospital group in Turkey. The study sample encompassed 329 employees. In data analysis and evaluations, frequency tables, central and prevalence criteria, Pearson's correlation test and simple linear regression analysis were employed and analysed in the SPSS 20 statistical package program. Results: A statistically significant and positive correlation was found between paternalistic leadership behaviour and organizational trust (r = 0.669, p = 0.000; R2 = 0.448). The analysis indicated that paternalistic leadership behaviour explained about 45% of the variance in organizational trust. Conclusion: In our study, it was found that paternalistic leadership behaviours are strongly related to organizational trust among healthcare professionals in Turkey. Paternalistic leadership, particularly in collectivist cultures with high power-distance structures, may yield to positive organizational outcomes.