Healthcare Processes Research Articles

‘We listened and supported and depended on each other’: a qualitative study of how leadership influences implementation of QI interventions

BackgroundThere is growing recognition in the literature of the ‘Herculean’ efforts required to bring about change in healthcare processes and systems. Leadership is recognised as a critical lever for implementation...

Health experiences of pregnant and women with chagas disease in the Atacama, Tarapaca, and Metropolitan regions of Chile. Mistreatment as an indicator of healthcare barriers.

Congenital transmission is one of the most significant forms of Trypanosoma cruzi transmission worldwide. Migrant women, in particular, often face barriers to accessing the healthcare system; one such barrier being that their health rights are not recognised. The situation in Chile is a reality that can be extrapolated to historical territories affected by Chagas disease and that is characterized by migrant populations. This article explores the healthcare experiences of pregnant and women living with Chagas disease, both nationals and migrants, and residents of three regions of Chile. The qualitative research study analyzed the experiences and meanings around the problem of Chagas based on 54 in-depth interviews with women in pregnancy and women who were diagnosed with the disease. The information was processed following the Grounded Theory tenets through the constant encoding feedback procedure, which allowed us to describe and comprehensively understand the phenomenon. The findings indicate that managing information is a sensitive aspect in evaluating healthcare experiences, with the potential to either positively or negatively impact the acceptance of diagnosis and treatment planning. The negative impact is determined by the communicative dimension and how healthcare teams deliver information. Poor attention, poor treatment, and lack of empathy lead patients to reject or distance themseves from the healthcare system. The positive aspects are related to a sensitive, personalized, and highly empathetic treatment. In historically endemic areas, these factors are essential for ensuring continuity in healthcare processes. There is an evident need to understand and value the settings, means, and contents within Chagas´s healthcare contexts. Communication is crucial during diagnostic processes as it determines the assessment, credibility, and trust in the health system, thereby influencing the continuity of treatment, especially in highly sensitive moments such as pregnancy. Therefore, it is necessary to articulate strategies considering information magement with greater empathy and emotional support.

Exploring the Impact of Artificial Intelligence on Healthcare Management: A Combined Systematic Review and Machine-Learning Approach

The integration of artificial intelligence (AI) in healthcare management marks a significant advance in technological innovation, promising transformative effects on healthcare processes, patient care, and the efficacy of emergency responses. The scientific novelty of the study lies in its integrated approach, combining systematic review and predictive algorithms to provide a comprehensive understanding of AI’s role in improving healthcare management across different contexts. Covering the period between 2019 and 2023, which includes the global challenges posed by the COVID-19 pandemic, this research investigates the operational, strategic, and emergency response implications of AI adoption in the healthcare sector. It further examines how the impact of AI varies across temporal and geographical contexts. The study addresses two main research objectives: to explore how AI influences healthcare management in operational, strategic, and emergency response domains, and to identify variations in the impact of AI on healthcare management based on temporal and geographical contexts. Utilizing an integrated approach, we compared various prediction algorithms, including logistic regression, and interpreted the results through SHAP (SHapley Additive exPlanations) analysis. The findings reveal five key thematic areas: AI’s role in enhancing quality assurance, resource management, technological innovation, security, and the healthcare response to the COVID-19 pandemic. The study highlights AI’s positive influence on operational efficiency and strategic decision making, while also identifying challenges related to data privacy, ethical considerations, and the need for ongoing technological integration. These insights provide opportunities for targeted interventions to optimize AI’s impact in current and future healthcare landscapes. In conclusion, this work contributes to a deeper understanding of the role of AI in healthcare management and provides insights for policymakers, healthcare professionals, and researchers, offering a roadmap for addressing both the opportunities and challenges posed by AI integration in the healthcare sector.

Pandemic COVID-19 as a challenge for telemedicine in the Czech Republic.

The COVID-19 Pandemic contributed to accelerating the process of using information and communication technologies and digital technologies in healthcare management and delivery within healthcare systems. At that time, the Czech healthcare system faced the same problems as other European systems and struggled with a temporary limitation of direct provision of healthcare services. It was solved by switching to telemedicine. The Czech healthcare system used telemedicine to a minimal extent until then. Despite adopting the law on healthcare digitisation, it is still one of the countries with a lower level of digitisation of healthcare processes. The article presents the results of an exploratory expert investigation focused on the implementation and development of telemedicine in the Czech Republic. The conducted research aimed to identify problems related to the implementation of telemedicine in practice, place them in the broader framework of the healthcare system and structure them, propose possible solutions, and identify the future challenges of telemedicine in the Czech Republic. We based our study on the results of a three-phase QUAL-QUAN-QUAL research. Data collection in the first phase took the form of individual semi-structured interviews with patients (25) with practical experience in the field of telemedicine, followed by the second quantitative phase of the questionnaire survey with patients (650). The third qualitative phase included semi-structured interviews with experts (17) with practical experience in telemedicine. The introduction and expansion of telemedicine require several fundamental changes. These include adjustments to the legislative environment and changes to the technological infrastructure, organisation of care and work. Several barriers have been identified at the healthcare system level, healthcare providers, healthcare professionals and patients.

Cost-effectiveness of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: the brazilian case with bayesian networks and markov influence diagrams

Abstract Background Heart failure (HF) is one of the leading causes of death worldwide, with a significant burden in middle-income countries, such as Brazil. Mineralocorticoid receptor antagonists (MRAs) have been established as a cornerstone in the treatment of HF with reduced ejection fraction (HFrEF), but their adoption has faced obstacles. Until recently, spironolactone was the only MRA available in Brazil, with restricted use due to associated side effects, such as gynecomastia and hyperkalemia. However, the introduction of new MRAs, such as finerenone and eplerenone, has the potential to change the therapeutic landscape. Understanding the cost-effectiveness of these agents in the Brazilian healthcare context is essential to optimize HF management. Methods A Bayesian Network approach complemented by Markov Influence Diagrams was employed to estimate incremental cost-effectiveness ratios (ICERs), presented in international dollars (Int$) gained per quality-adjusted life year (QALYs). Discontinuation rates for MRAs were incorporated into the model, reflecting real-world clinical practice, along with a 5% annual discount rate for both costs and effectiveness. To inform our model, a comprehensive systematic review was conducted, followed by a network meta-analysis (NMA) to assess the comparative effectiveness of ARMs. Data on incident cardiovascular outcomes were derived from a Brazilian real-world cohort of 1,098 patients with HFrEF. All cost assessments were made from the perspective of the Brazilian public health system, with values converted to Int$. Results The NMA highlighted that spironolactone [HR:0.75 (95%CI 0.67-0.84)], eplerenone [HR:0.84 (95%CI 0.77-0.93)] and finerenone [HR:0.90 (95%CI 0.82-0.98)] significantly reduced the relative risk of all-cause mortality compared to no MRA utilization. Notably, eplerenone significantly reduced hospitalizations due to HF [HR:0.60 (95%CI 0.41-0.90)] compared to no MRA therapy, with spironolactone and finerenone showing HRs of 0.68 (95%CI 0.40-1.17) and 0.83 (95%CI 0.59-1.15) . The analysis also revealed a notably higher risk of MRA discontinuation for finerenone (22%) and spironolactone (51%) compared to eplerenone. In cost-effectiveness comparisons, finerenone was dominated by alternatives, while eplerenone exhibited an ICER of Int$2,614 (95%CI 1,851-3,470)/QALY when compared to spironolactone. Both spironolactone and eplerenone emerged as cost-effective options when compared to no MRA therapy, with eplerenone being particularly favorable below the willingness-to-pay threshold of Int$8,900 per QALY. Conclusions In the Brazilian healthcare context, eplerenone will likely be the most cost-effective MRA compared to spironolactone, offering both a reduction in HF-related hospitalizations and a lower discontinuation rate. These findings underscore the value of integrating cost-effectiveness analyzes into healthcare decision-making processes.

1.O. Scientific session: Trans & Gender-Diverse Individuals’ Mental & Behavioral Health Risks & Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

Rethinking electronic health records implementation in Germany: a value-based health system approach

Abstract Problem The Digital Act (Digital-Gesetz) in Germany stipulates that electronic health records (elektronische Patientenakte; ePA) will be set up for all persons under the statutory health insurance (SHI) in 2025; those who do not wish to use ePA can object. This opt-out approach aims to increase the coverage of ePA among the SHI population to 80%, which has been ca. 1.5% since its launch in 2021. According to law, ePA is managed solely by the patient and does not replace the conventional patient file stored in the medical practice management system. Without appropriate measures, it is likely that multiple parallel patient files are created, with the risk of ePA being side-lined over time. Description The Ministry of Health aims to make ePA the central platform for patients’ healthcare provision throughout their life. With ePA, patients should receive useful information about their healthcare as well as reminders and tailor-made medical advice. For healthcare providers, ePA should become an essential part of the healthcare process with containing reliable information and supporting the treatment. However, understanding ePA as more than a digital health solution, factors beyond technical interoperability must be considered for its successful implementation. Results The full potential of ePA and its positive impact on healthcare to tackle the fragmentation issue can only be realised when it is viewed as a helpful tool of collaboration for all involved parties. The existing regulatory frameworks in Germany create disincentives for greater integration, coordination, and interconnection, with each sector following its own reimbursement system and reinforcing the division between them. This contradicts with the idea of ePA fostering patient-centredness and inter-sectoral collaboration. Lessons How a health system functions and how health services are governed and remunerated have a substantial impact on the healthcare providers’ acceptance of digital services. Key messages • Changes in the governance of health systems may be necessary when implementing electronic health records to bring person-centred care and overcome the separation of in-patient and out-patient sectors. • Rather than a paternalistic approach, the relationship between the patient and healthcare provider should move towards a partnership model, based on the motivation of keeping individuals healthy.

Identifying Levers for Change in Healthcare Coordination Between the Emergency Youth Shelter and Health Systems in Toronto, Canada Through Stakeholder Engagement: A Qualitative Study

Background: Healthcare coordination involves supporting youth experiencing homelessness (YEH) with accessing appropriate healthcare; synchronizing delivery of their healthcare across multiple systems; sharing healthcare and discharge plans with youth and providers who fall under their ‘circle of care;’ and coordinating post-care follow-up as necessary. Challenges with coordinating healthcare within and between the emergency youth shelter (EYS) and health systems include poor accountability for healthcare coordination across systems; information-sharing and privacy policies inhibiting communication between sectoral staff; inconsistencies in system-based and organizational norms, operations, and funding; and each system’s historically fragmented structure. Methods: We used a system thinking framework to identify levers for change in healthcare coordination within and between the EYS and health systems in Toronto, Canada. Six stakeholders who work at various levels of each system participated in online breakout room discussions as part of a two-hour forum facilitated by our research team. A series of four questions were asked to identify levers for change in system parts and system patterns in healthcare coordination within and between the EYS and health systems. Breakout room discussions were recorded, transcribed, and co-analyzed by the research team using reflexive thematic analysis for each question. Results: Organizational and system-wide goals discussed to strengthen healthcare coordination include clarifying accountability in staff roles, revisiting discharge policies to improve continuity of care, prioritizing funding for programs evaluated to be effective, establishing more opportunities for system cross over, enhancing accessibility for YEH, integrating social medicine into healthcare approaches, and streamlining health communication across both systems. When asked about what is realistically possible, stakeholders were optimistic about enhancing information-sharing through digital health platforms, adapting organizational policies to consider the holistic needs of YEH, and dispersing funds more intentionally to support coordination initiatives. Furthermore, poor staff-youth relations, harmful discharge policies and the Toronto housing crisis were noted as patterns impeding meaningful change in coordinating healthcare. Finally, stakeholders identified systems integration and alignment of well-defined healthcare coordination processes across systems to harmonize efforts in achieving healthcare coordination goals. Conclusions: Stakeholder forum participants discussed promising levers for change that are recommended to strengthen parts of the EYS and health systems along with patterns that influence healthcare coordination between them.

Program evaluation and healthcare process improvement focused on complex wheelchair procurement

ABSTRACT The operations of a specialty wheelchair (WC) seating center can influence the evaluation to delivery timeframe in days for a complex rehab technology (CRT) WC. Operations at one facility improved due to departmental process improvement (PI) project with evaluation of the delivery workflow and implementation of changes. A retrospective chart audit gathered baseline data on the evaluation to delivery timeframe in days of a CRT WC for 50 individuals prior to PI changes. Standard departmental workflow collected 745 individuals’ post-PI changes. The interventions took place from March 25, 2017, to April 5, 2018, and included defining and educating stakeholders on their roles and expectations, revisions of the electronic medical record, weekly and quarterly meetings with supplier leadership, paperwork completion goals, and follow-up paperwork centralization. Mean pre- and post-intervention evaluation to delivery timeframes in days was significantly different (162.2 versus 127.4 days, p < 0.0001). Overall, a reduction in the mean evaluation to delivery timeframe in days of CRT WC by 21.5% or 34.8 days occurred. Systematic change takes time as well as the commitment of all key players. PI changes resulted in evaluation to delivery timeframe reduction for patients to receive their CRT WCs.

Бережливые технологии как инструмент организации пациентоцентричного подхода к оказанию медицинской помощи пациентам центра амбулаторной онкологической помощи

It is crucial to implement and use patient-centered approach towards communication between doctors and patients and towards management of treatment and diagnostics. The instruments of lean production can be used in order to find problems of organizational processes and to solve and improve them. Purpose of the study is to evaluate the possibility of using lean production to improve patient-centered approach towards the work of Outpatient Cancer Center. Materials and methods. The scientific articles from databases pubmed, cyberleninka, elibrary were studied. The performance results of Outpatient Cancer Center were analyzed. Results. During research the performance of Outpatient Cancer Center and its change as a result of using lean production instruments was analyzed. The positive results including the improvement of availability of diagnostics and consultations were found out. The medical and patient ratings of organizations have also shown significant improvement. Findings. Thus, the use of lean production not only in outpatient clinic but also in Outpatient Cancer Center is relevant nowadays. The instruments of lean production can improve healthcare processes and make them more patient-centered.

Leveraging Blockchain Technology for Public Health

This study delves into the metamorphic potential pertaining to blockchain technology public health, concentrating on its aptness towards addressing the critical challenges related to data security, privacy, and it enroute for improving health service outcomes. By incorporating decentralized structures and smart contracts, blockchain intensify data integrity, ensuring consistency and protective access control, which is principally effective for sensitive medical information. The study enlightens on the advantages of blockchain in entrusting patients as well as healthcare providers with control over public health related information, ensuring privacy and reinforcing regulatory compliance. It delves into the process of how blockchain can streamline healthcare processes, upgrading interoperability among healthcare systems, and create more systematic and affordable models for healthcare service delivery. Based on the case studies from different healthcare stakeholders, the paper provides factual and feasible insights for real-world implementations of blockchain in healthcare, exhibiting its potential to transfigure supply chain management, different insurance claims processing and managing electronic health records. Moreover, the study also recognizes the challenges, including technical constraints, ethical reviews, and the complication of integrating blockchain with existing healthcare framework. The study widens it discussion towards the legal and regulatory aspect, emphasizing the need for a comprehensive approach to adoption. Looking forward, the paper covers the emerging trends and offers guidance for healthcare stakeholders considering blockchain implementation, summarizing that blockchain could be a catalyst for remarkable improvements in public healthcare data administration and patient care.

Required Capabilities for Employee-Driven Innovation Emerges in Healthcare Organizations; Comment on "Employee-Driven Innovation in Health Organizations: Insights From a Scoping Review"

Employee-driven innovation (EDI) is still under-researched in health policy and system research, particularly in low and middle-income countries. EDI is recognized as a lever to improve the commitment of health workers, promote quality of care, and contribute to creating value and transforming healthcare practices, services, structures, and processes. The mechanisms underlying the emergence of EDI processes and outcomes include core capabilities to cope with complexity, building spaces for learning, fostering sense-making and sense-giving, and collective problem-solving. The development of such capabilities depends on organizational and individual conditions. Organizational capabilities include complex leadership, trust management practices, task complexity, and the availability of slack resources. Individual capabilities comprise capabilities to cope with complexity, such as sense-making, autonomy, system thinking, and adaptive learning. The sustainability of EDI depends on local ownership and frontline employees' involvement during problem definition, innovation design, and implementation.

Experiences of Indonesian nurses as Hajj health personnel in caring for Hajj pilgrims: A qualitative study.

Investigating the experiences and roles of nurses during Hajj is vital due to the unique public health challenges posed by the mass gathering of diverse pilgrims. Nurses play a crucial role in disease surveillance, infection control, and managing emergencies like heat stroke and injuries. Their insights can improve emergency preparedness and public health management. This study aimed to explore the experiences of Indonesian nurses as Hajj health personnel caring for Hajj pilgrims during the 2023 Hajj season. This study employed a qualitative descriptive design and selected participants through purposive sampling from hospitals, public healthcare centers, and clinics in Yogyakarta, Indonesia. Nine nurses participated in the research, and data were collected through a focus group discussion in December 2023. Thematic analysis was used to analyze the data. Six themes emerged, including practicing ethical principles in providing health care during the hajj process, competency qualifications as a health worker, the health care process during Hajj, legal Requirements for Hajj, the importance of therapeutic communication skills to establish cooperation with various parties, and recognizing the role of duties and responsibilities during the hajj process. The study emphasizes the importance of competencies, ethics, communication, and strategic planning in Hajj healthcare. Effective online communication, especially via WhatsApp, was crucial for coordination. The findings emphasize the need for strategic workforce planning, resource allocation, and continuous training to enhance care quality for pilgrims, informing better planning and policy development for future Hajj seasons.

Adapting Group Model Building for Mental Healthcare: A Participatory Co-Design Approach.

Countries around the world are experiencing both a growing need for mental health services and major gaps in the delivery of mental healthcare. The World Health Organisation's 2022 report on mental health emphasised co-designed and systems-level innovations responsive to the voice of those with lived experience. However, evidence for implementing such methodologies is sparse. Group model building (GMB), a participatory systems-based approach, has been used in various fields, but its application is limited within mental healthcare settings. It is recognised as a valuable tool for engaging stakeholders, including those with lived experience, in understanding and redesigning health systems and services. The participatory approach aligns with the mental health sector's shift towards co-design and person-centred care. This study assessed the acceptability of GMB as a method for co-design within mental healthcare, aiming to explore its potential for meaningful collaborative improvement and systems-level insights. Participants from a regional Mental Health and Drug and Alcohol Service (MHDAS) engaged in GMB workshops and focus groups. Eighteen individuals, including lived experience workers and healthcare professionals, provided feedback that informed adjustments to the workshops' design, language, timing and facilitation techniques, enhancing GMB's relevance for mental health co-design. The findings demonstrate the value and acceptability of the adapted GMB process in acute mental healthcare, marking a significant step towards evidence-based, person-centred service improvement. This study highlights the potential effectiveness of participatory methods in identifying and addressing systemic challenges, paving the way for future mental health reforms. Future work will focus on implementing and evaluating co-designed interventions, aiming for more inclusive and effective mental healthcare and advancing innovation and reform in the field.

Alzheimer's dementia in people with Down syndrome : Results of guideline-assisted expert interviews on healthcare deficits in the diagnostics and treatment as well as solution approaches

People with Down syndrome have agenetically increased risk of developing early onset Alzheimer's dementia. An interview study with healthcare providers, patient representatives and employees in residential and work facilities was conducted to identify deficits in the healthcare process and approaches to overcoming them. In this study 14 semi-structured interviews were conducted and analyzed using qualitative content analysis. Alack of knowledge and experience on the part of medical service providers in dealing with and providing medical care for people with Down syndrome was identified as akey challenge. In addition, the diagnosis of dementia in people with Down syndrome is difficult for various reasons (including lack of appropriate diagnostic tools in standard care and lack of time or financial resources). Doubts were expressed about the efficacy of antidementia medications and the reasons for the increased use of sedatives were discussed. Attentive observation of behavior and involvement of caregivers, regular review and reduction of polypharmacy and the use of alternative behavior modification techniques were mentioned as possible solutions. The identified deficits in the medical care of the target population and the approaches to solving them will be incorporated into the development of health policy recommendations in order to optimize the care situation of those affected in the long term.

Block Medcare: Advancing Healthcare Through Blockchain Integration

In an era driven by information exchange, transparency and security hold crucial importance, particularly within the healthcare industry, where data integrity and confidentiality are paramount. This paper investigates the integration of blockchain technology in healthcare, focusing on its potential to revolutionize Electronic Health Records (EHR) management and data sharing. By leveraging Ethereum-based blockchain implementations and smart contracts, we propose a novel system that empowers patients to securely store and manage their medical data. Our research addresses critical challenges in implementing blockchain in healthcare, including scalability, user privacy, and regulatory compliance. We propose a solution that combines digital signatures, Role-Based Access Control, and a multi-layered architecture to enhance security and ensure controlled access. The system's key functions, including user registration, data append, and data retrieval, are facilitated through smart contracts, providing a secure and efficient mechanism for managing health information. To validate our approach, we developed a decentralized application (dApp) that demonstrates the practical implementation of our blockchain-based healthcare solution. The dApp incorporates user-friendly interfaces for patients, doctors, and administrators, showcasing the system's potential to streamline healthcare processes while maintaining data security and integrity. Additionally, we conducted a survey to gain insights into the perceived benefits and challenges of blockchain adoption in healthcare. The results indicate strong interest among healthcare professionals and IT experts, while also highlighting concerns about integration costs and technological complexity. Our findings underscore the transformative potential of blockchain technology in healthcare, pointing towards a new era of patient-centric and secure healthcare services. By addressing current limitations and exploring future enhancements, such as integration with IoT devices and AI-driven analytics, this research contributes to the ongoing evolution of secure, efficient, and interoperable healthcare systems.

Comparisons of some new and existing EWMA schemes for binomial count processes with applications to monitoring hospital No-Shows

ABSTRACT Applications of several exponentially weighted moving average (EWMA) schemes for monitoring binomial count data have been widely used in the manufacturing and healthcare industries. However, practitioners may be confused about selecting the appropriate scheme for their needs. In this paper, we compare the performance of some existing EWMA schemes and a new EWMA scheme utilizing the weighted likelihood ratio test (WLRT), referred to as the EWLRT scheme. Firstly, some properties of the EWLRT scheme for binomial proportion are outlined. Next, a method for choosing the optimal smoothing parameter based on the relative mean index (RMI) is described, and various competing schemes are compared at the optimal level, which was not done in most previous studies. Additionally, current comparisons consider the zero-state (ZS) run-length performance and the conditional expected delay (CED) for a delayed shift. The results based on the Monte Carlo method indicate that the EWLRT scheme’s efficacy is somewhat more encouraging than that of its competitors in detecting small to moderate changes in terms of CED. Finally, a real example of monitoring hospital No-Shows, a necessary healthcare management process, describes the implementation.

Adhering to Patient Safety Standards: A Healthcare Imperative for the 21st Century

The ethics of healthcare processes aim to protect patient safety by emphasizing the importance of adhering to rules and avoiding harmful practices. They also suggest practical solutions to prevent such failures. Non-compliance, whether due to human error or technical failure, can result in operational failures and pose severe hazards to patients, healthcare workers, and hospital facilities. This paper discusses intentional non-compliance with healthcare standards and guidelines, referred to as deviation, and demonstrates how adhering to these rules can reduce the risk of harm. Noncompliance can have severe consequences, as it may reveal an organization's fail-safe mechanisms, defenses, or safety nets, potentially resulting in catastrophic events and causing significant harm. These errors typically occur when active errors combine with latent errors, such as flaws or vulnerabilities in a system's defenses. This habit allows the latter to overcome the defenses, gain patient access, and cause harm. There is no such thing as a completely safe environment, even the most advanced ones. Additionally, all humans, regardless of their intelligence, have weaknesses. In healthcare processes, every signal has the potential to cause harm, leading to tragic outcomes or even death. The factors contributing to non-compliance fall under individual, collective, organizational, or sociocultural categories. Reducing non-compliance in healthcare processes and ensuring patient safety requires all stakeholders to commit to patient safety ethics.

Using Patient-Generated Health Data more efficient and effectively to facilitate the implementation of Value-Based Healthcare in the EU – Innovation Report

Healthcare services and products are rapidly changing due to the development of new technologies, offering relevant solutions to improve patient outcomes. Patient-Generated Health Data and knowledge-sharing across the European Union (EU) has a great potential of making healthcare provision more effective and efficient by putting the patient at the centre of the healthcare process. While such initiatives have been taken before, a uniting and overarching approach is still missing. The EU-funded IMPROVE project will develop an evidence-based and actual framework to effectively leverage the added value of people-centred integrated healthcare solutions, using predominantly PROMs, PPI, PREMs, and other Patient-Generated Health Data (PGHD). As a result, the project facilitates the effective and efficient implementation of Value-Based Healthcare across the EU by putting the patient central in the healthcare process.

Optimizing the green synthesis of antibacterial TiO2 - anatase phase nanoparticles derived from spinach leaf extract

Titanium dioxide nanoparticles, renowned for their abundance, non-toxicity, and stability, have emerged as indispensable components in various fields such as air purification, healthcare, and industrial processes. Their applications as photocatalysts and antibacterial agents are particularly prominent. The synthesis methods significantly influence the properties and subsequent applications of these nanoparticles. While several techniques exist, the biological approach using plant extracts offers advantages such as simplicity, biocompatibility, and cost-effectiveness. This study focused on the green synthesis of titanium dioxide nanoparticles utilizing spinach leaf extract. Within the scope of this investigation, the green synthesis of titanium dioxide nanoparticles through spinach leaf extract were synthesized and optimized, followed by a comprehensive examination of their morphological, structural, and chemical attributes with UV-visible spectroscopy, FTIR spectroscopy, XRD, FESEM, and EDX. The minimum inhibitory concentration (MIC) against E. coli and S. aureus was determined to evaluate their antibacterial potential. Optimal synthesis conditions were identified at 50 °C, using a 1/30 concentration and 20 ml of spinach leaf extract. Spherical anatase nanoparticles, ranging from 10 to 40 nm, were produced under these conditions. The change in the color of the extract, absorption at 247 nm, change and increase of the peak at 800 − 400 wavelengths, and the maximum intensity of X-ray diffraction at the angle of 25.367 with the crystal plane 101 were indications of the synthesis of these nanoparticles. Notably, the synthesized nanoparticles exhibited antibacterial activity with MIC values of 0.5 mg/ml against E. coli and 2 mg/ml against S. aureus. This research presents a novel, eco-friendly approach to synthesizing titanium dioxide nanoparticles with promising antibacterial properties.