Health System Quality Research Articles

Sustainability of GUINÉ-BISSAU-Application of the action of Standards ISO 9001, 14001, 26000 and 45001

Sustainability represents one of the greatest challenges of the millennium. Many countries have already implemented ISO standards on Management, Quality, Environment and Occupational Safety and Health systems. In Guinea-Bissau, the poor quality of management, forest deforestation, the extinction of several species of fauna and flora, the difficulties of collecting and treating waste, the non-compliance by companies with occupational safety and health standards, and the lack of business ethics in the process of operationalizing the activities of companies, aroused the interest in showing the relevance of the implementation of ISO standards - Quality Management (9001), Environment (14001), Safety and Health at Work (45001) and Social Responsibility (26000) in this country. The implementation of ISO standards in Guinea-Bissau will oblige organizations to comply with quality standards that will contribute to the improvement of the quality of life of Guineans and the sustainability of the planet.

Tourism during health disasters: Exploring the role of health system quality, transport infrastructure, and environmental expenditures in the revival of the global tourism industry.

Tourism is one of the most important promoters of sustainable development in many nations and regions around the globe. Tourism expansion has been a significant contributor to social and economic growth, particularly in developing economies. It is, however, vulnerable to all kinds of health crises and natural disasters, no matter how small they are. The primary purpose of this study is to acquire an empirical understanding of the effects of health crises and disasters on international tourism. The SYS-GMM was used to examine the impact of health calamities and crises, carbon footprints from transportation, and green finance on the tourism of 51 countries between 2007 and 2020. The results showed that health crises and natural disasters have a big effect on international tourism. Alternatively, the presence of eco-friendly and secure transportation at tourist destinations has a positive effect on the tourism industry. The results also showed that environmental expenditures have positive short- and long-term effects on international tourism. Furthermore, the sensitivity of travelers to health crises and natural disasters varies over the short and long term. The study also showed that compared to normal times, international tourism dropped by more than 67% during COVID-19. Consequently, this research assists us in comprehending, predicting, and preventing the potential adverse effects of COVID-19 and other similar economic, health disasters and crises that could occur in the future and harm the tourism industry.

Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future.

Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.

Navigating quality and safety in your health system: understanding the alphabet soup

Entering any new healthcare system today requires thorough knowledge about its quality and safety structure and culture. Learning that language is generally the first step in gaining a better understanding of how systems function. This overview of common mnemonics in the quality and safety world will provide the reader with better comprehension of their quality systems within their institutions. Healthcare providers should understand how patient safety organizations were established and the importance of our safety event classification system, along with the ability to recognize gaps in care that highlight opportunities for improvement. In addition, this review provides explanations of error prevention tools used every day to help new colleagues communicate better and share situational awareness to keep patients safe. Lastly, utilization of standard quality improvement tools can facilitate quality improvement projects and assist all healthcare systems to become highly reliable organizations.

Factors influencing social prescribing initiatives: a systematic review of qualitative evidence.

Social prescribing is a growing health policy agenda to improve the quality and effectiveness of health systems. However, systematically collected knowledge on factors influencing the effective implementation of SP is scarce. A systematic review was conducted to identify and categorize factors influencing social prescribing initiatives. A search of three electronic databases (PubMed, Scopus, and ISI Web of Knowledge) was carried out to retrieve studies from inception to May 2022, supplemented by grey literature searching and snowballing of the relevant references. The inclusion criteria were original empirical research, qualitative data collection, and a description of factors affecting social prescribing initiatives. Study quality was evaluated using the Critical Appraisal Skills Programme tool. We categorized the results of individual studies using a narrative approach. A total of 23 studies were included for analysis. Along with patient-related factors (patient-centeredness, clinical complexity, perception, knowledge), three main settings of social prescribing initiatives (including healthcare providers, link workers, and voluntary and community sectors) are affected by (1) individual characteristics (knowledge, perception, skill mix); (2) interpersonal relations (collaboration, trust, feedback, supportive climate, follow-up, sustained connection, peer support within and across sectors); (3) organizational contingencies (resource adequacy, staffing, training, role description, continuity of support, caseload management, monitoring, affordability, accessibility, referral criteria, and tailored support); and (4) political context (national policy and guidance, stewardship, planning, cocreation, bureaucracy, economic condition, and the number of support organizations). Many factors influencing social prescribing initiatives were identified. The results of this review can be applied by different stakeholders of social prescribing to guide development, implementation, description, and evaluation.

Descriptive Epidemiology of Pediatric Inflammatory Bowel Disease in Oceania: A Systematic Review and Meta-Analysis.

Pediatric inflammatory bowel diseases (IBDs) are chronic, idiopathic illnesses of the digestive tract, which can impact adversely on children's quality of life and burden health systems. International studies have shown these diseases are increasing. The aim was to describe pediatric IBD epidemiology across Oceania by conducting a systematic review and meta-analysis of incidence and prevalence. Medline, EMBASE and Web of Science databases were searched in October 2022 for studies reporting rates of IBD, Crohn disease (CD), or ulcerative colitis (UC) in children (≤19 years). Several data collection methodologies were included and pooled estimates of incidence and prevalence were calculated using a random effects model with I2 measures of heterogeneity. Nineteen articles provided 15 incidence and 7 prevalence studies. Fourteen studies were from Australia, 8 studies from New Zealand, and no studies were found from the Pacific Islands. Study dates ranged from 1950 to 2020 with 11 studies using population-based designs. Pooled estimates for annual incidence were IBD 4.1 (3.4-4.8, I2 = 98.7), CD 2.3 (1.9-2.7, I2 = 98.6), and UC 0.9 (0.6-1.1, I2 = 96.8) per 100,000 person-years. Prevalence rates were IBD 36.0 (23.5-48.5, I2 = 98.4), CD 23.2 (6.6-39.8, I2 = 97.8), and UC 7.6 (2.7-12.5, I2 = 99.6) per 100,000 persons. Pediatric IBD is prevalent in Oceania with high incidence rates, particularly for CD. Low rates of IBD were observed in indigenous Australian, Māori, and New Zealand Pacific children and there were no studies from the Pacific Islands highlighting this as an area in need of further research.

Determinants of worldwide antibiotic resistance dynamics across drug-bacterium pairs: a multivariable spatial-temporal analysis using ATLAS

Antibiotic resistance (ABR) is a major concern for global health. However, factors driving its emergence and dissemination are not fully understood. Identification of such factors is crucial to explain heterogeneity in ABR rates observed across space, time, and species and antibiotics. We analysed count data of clinical isolates from 51 countries over 2006-19 for thirteen drug-bacterium pairs taken from the ATLAS database. We characterised ABR spatial and temporal patterns and used a mixed-effect negative binomial model, accounting for country-year dependences with random effects, to investigate associations with potential drivers, including antibiotic sales, economic and health indicators, meteorological data, population density, and tourism. ABR patterns were strongly country and drug-bacterium pair dependent. In 2019, median ABR rates ranged from 6·3% (IQR 19·7% [0·5-20·2]) for carbapenem-resistant Klebsiella pneumoniae to 80·7% (41·8% [50·4-92·2]) for fluoroquinolone-resistant Acinetobacter baumannii, with heterogeneity across countries. From 2006 to 2019, carbapenem resistance increased in more than 60% of investigated countries; no global trend was observed for other resistances. Multivariable analyses identified significant associations of ABR with country-level selecting antibiotic sales, but only in fluoroquinolone-resistant-Escherichia coli, fluoroquinolone-resistant-Pseudomonas aeruginosa, and carbapenem-resistant-A baumannii. We also found a correlation between temperature and resistance in Enterobacteriaceae and with the health system quality for all drug-bacterium pairs except Enterococci and Streptococcus pneumoniae pairs. Despite wide consideration of possible explanatory variables, drug-bacterium pair ABR rates still showed unexplained spatial random effects variance. Our findings reflect the diversity of mechanisms driving global antibiotic resistance across pathogens and stress the need for tailored interventions to tackle bacterial resistance. Independent research Pfizer Global Medical Grant and ANR Labex IBEID.

A multi-phase approach for developing a conceptual model for human resources for health observatory (HRHO) toward integrating data and evidence: a case study of Iran

BackgroundEvidence-informed policymaking on human resources for health (HRH) has been directly linked with health system productivity, accessibility, equity, quality, and efficiency. The lack of reliable HRH data has made the task of planning the HRH more difficult in all settings.AimThis study aimed to develop a conceptual model to integrate HRH data and evidence.MethodsThe current study is a mixed-method study conducted in three phases: a rapid literature review, a qualitative phase, and an expert panel. Firstly, the electronic databases were searched up to 2018. Then, in the qualitative phase, semi-structured interviews with 50 experts were conducted. Data analysis was performed using the content analysis approach. After several expert panels, the draft of the model was validated with 15 key informants via two Delphi rounds.ResultsOur proposed model embraces all dominant elements on the demand and supply side of the HRH in Iran. The conceptual model consists of several components, including input (regulatory system, structure, functions), educational system (pre-service and in-service education), health labor market structure, process (technical infrastructure), and output (productions, policymaking process). We considered networking toward sustainable interaction among stakeholders, and also the existence of capacity to integrate HRH information and produce evidence for actions.ConclusionThe proposed model can be considered a platform for developing a harmonized system based on the HRH data flow to evidence-informed decision-making via networking. We proposed a step-by-step approach for the sustainability of establishing a national human resources for health observatory (HRHO). The proposed HRHO model can be replicable and flexible enough to be used in different context domains.

Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

ABSTRACT The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes (1) our screening and case identification process, (2) variation among adolescents versus young adults, and (3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12–24 years with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk indicators: 97% past-year suicidal ideation, 83% past suicidal behavior; and 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported more past-year suicide attempts (47% vs. 21%, p < .001) and NSSI (past 6 months, 64% vs. 39%, p < .001); less depression, anxiety, posttraumatic stress, and substance use; and greater social connectedness. Pandemic onset was associated with lower participation of racial-ethnic minority youths (18% vs. 33%, p < .015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.

The Question of Quality Ordering of Health Commodities in Tanga Region, IMPACT Approach Becomes Relevant Driver to the Answers

The effective delivery of integrated health services depends on the extent to which the six pillars of a health system as recommended by WHO are adhered to such as adequate human resources for health, service delivery, financing, health system governance, information, quality medicines and technologies. However, to improve supply chain management leading to uninterrupted supply of medicines and other health commodities, the use of data to inform all parts of the health supply chain logistics system, that include product selection, forecasting, quantification, procurement, storage and finally distribution of health commodities, is very important. Previously, Tanga Region had been facing a number of health supply chain issues such as delays in reportingfrom health facilities, a high number of orders for overstocked and no-demand health commodities, unnecessary higher expenditure on health commodities and a high rejection rate for the same R&R rejection reasons. Soon after the introduction of the IMPACT approach in the region, the IMPACT team at the regional level adopted some innovative data-driven strategies at its regular meetingssuch as regular data extraction and analysis to review indicators, monitoring timeliness of reporting as well as data quality, monitoring stock orders to avoid expiry dates, and sharing feedback with councils to take action to address identified gaps. These efforts resulted into decrease in the values of reordered overstocked and not in demand health commodities, massive improvement in terms of reporting timeliness from 76% in January 2022 to 99% in January 2023 and slight increase in the availability of essential health commodities. This study found that improving reporting timeliness and supply chain data quality is a cornerstone towards uninterrupted supply of health commodities and reduced health commodities wastages. Since IMPACT Team techniques has been vital in the identified supply chain improvements then it is an approach that can be applied to improve other supply chain indicators and reduce wastages. Despite the marginal improvement in the availability of health commodities, this study recommends the use of facility formulary-based approach in the calculation of health commodities availability to increase the validity of the results.

Health System Quality and Performance Indicators for Evaluating Home Care Programming: A Scoping Review

A systematic scoping review of health system Performance and Quality Indicators (PQI) related literature for evaluating publicly funded home care programming was conducted. Through the scoping review we identify PQIs, map these based on quadrants of the Institute for Healthcare Improvement’s (IHI) Quadruple Aim, classify these PQIs under general “areas of focus” categories, and present recommendations for use. We selected all articles that identified, referenced, proposed, and/or described at least 1 PQI to measure home care service programming. Minimum inclusion criteria were a description of 1 or more PQIs designed to evaluate and/or measure home care programming, outcomes of home care clients and/or caregivers, or overall system impacts of home care service provision. The review identified 3,475 citations. A review of the abstracts led to the retrieval of 510 full-text articles for assessment of which 105 articles were selected for detailed review and extraction of identified PQIs. Of the 105 identified articles a total of 829 unique PQIs were gathered. Based on the IHI Quadruple Aim, 661 unique measures were identified as Clinical Outcome, 35 as Healthcare Provider Satisfaction, 99 Patient Experience, and 34 in the Financial/Sustainability quadrants. Many patient outcome specific PQIs exist, followed by patient experience measures. Very few PQIs exist in the financial or healthcare provider experience quadrants. The lack of indicators across all the IHI Quadruple Aim quadrants is an opportunity for further development supporting home care quality oversight.

Combining Frameworks to Improve Military Health System Quality and Cybersecurity

Existing conceptual frameworks and commercially available technology could be considered to rapidly operationalize the use of Quality Measures (QM) within military health systems (Costantino et al. 2020). Purchased healthcare as well as digital healthcare services have paved the way for data collection from multiple information systems thus offering stakeholders actionable intelligence to both guide and measure healthcare outcomes. However, the collection of data secondary to Smart Devices, disparate information systems, cloud services, and the Internet of Medical Things (IOMT) is a complication for security experts that also affect clients, stakeholders, organizations, and businesses delivering patient care. We have combined three conceptual frameworks: (1) Donabedian’s Quality Attributes Framework (DQA), (2) The National Academy of Medicine (NAM) framework, and the (3) Healthcare and Public Health (HPH) Cybersecurity Framework (HCF). Each of these frameworks is well-tested, widely accepted, and referenced as the gold standard in delivering quality care (DQA and NAM) and cybersecurity (HCF) for healthcare. Separately, each framework provides long-used analysis, guidance, and application of quality reliable measures of healthcare services. The combined frameworksmay enhance data integrity (collection and standardized safety of data in regard to regulatory compliance). The combined frameworks also support identifying gaps in quality of care, support the prioritization of cost-effective methodologies that predictably improve patient outcomes, and support DHA’s quality measures. Finally, we offer the importance of understanding the components of quality measures in a more precise manner while maintaining information technology (IT) governance compliance.

Measuring Health System Responsiveness in a national community health worker primary care program in rural Liberia.

As many low- and middle-income countries scale up community health worker (CHW) programs to achieve universal health coverage, ensuring quality as well as access is critical. Health system responsiveness (HSR) is a core domain of quality patient-centred care, but has not been widely measured in CHW-delivered care. We report results from a household survey measuring HSR and health systems quality of CHW-delivered care in two Liberian counties where the national CHW program of Community Health Assistants (CHAs) for communities five kilometres or more from a health center has been implemented. We conducted a cross-sectional population-based household survey in 2019 in Rivercess (RC) and Grand Gedeh (GG) counties, using a two-stage cross-sectional cluster sampling approach. We included validated HSR questions on six responsiveness domains and patient-reported health system outcomes, such as satisfaction and trust in the CHA's skills and abilities. The HSR questions were administered to women aged 18-49 who reported seeking care from a CHA in the three months prior to the survey. A composite responsiveness score was calculated and divided into tertiles. Multivariable analysis using Poisson regression with log link and adjusting for respondent characteristics was used to determine the association between responsiveness and patient-reported health system outcomes. The proportion of individuals rating responsiveness as very good or excellent were similar across all domains within a district, with ratings were lower in RC (23-29%) than GG (52-59%). High ratings in both counties were seen for high trust in the CHA's skills and abilities (GG 84%, RC 75) and high confidence in CHA (GG 58%, RC 60%). Compared with women in the lowest responsiveness tertile (score ≤3), women in the highest tertile (score 4.25) were significantly more likely to report high quality of CHA-delivered care (prevalence ratio, PR=14.1), very good/excellent at meeting health needs (PR=8.0), high confidence in the CHA to provide future care (PR=2.4), and high level of trust in CHA's skills and abilities (PR=1.4). Controlling for respondent characteristics, the composite responsiveness score was significantly associated with all patient-reported health system outcomes (P<0.001). We found that HSR was associated with important patient-reported health system quality outcomes, including satisfaction, trust, and confidence in the CHA. Measuring patients' experience and outcomes of care is important to complement more common measures of technical quality for CHW-delivered care to ensure that this domain of quality is central to community health program design and delivery.

The social value of health: A frontier analysis of life expectancy gaps across 33 European countries

We estimate the life expectancy gaps that can be bridged by improving the quality of public health and health care policies at the country level. Our model calculates the net effect of amenable deaths on life expectancy after controlling for time effects and factors affecting amenable deaths related to education, health policies (health expenditure to GDP and waiting lists), and per capita income in a two equation system. We further estimate the life expectancy gap that countries with lower quality health systems can bridge by catching up and reaching the existing health quality frontier and compute the social value of that upside potential.

Institutionalization of Minimum Service Standards (MSS) for Health Facilities in Nepal:

Access to health facilities alone, without quality services, does more harm than the benefit to the people’s health. Nepal has invested more than two decades in expansion of number of health facilities and the journey is still on to balance level of health facilities based on the federal structure. Institutionalization of Minimum Service Standards (MSS) for health facilities in Nepal implemented by Ministry of Health and Population is an exemplary Plan-Do-Study-Act (PDSA) cycle for health facilities readiness and service availability for quality improvement. From its design, development, stakeholders’ engagement, implementation to development of action plan makes MSS lively and outcome oriented tool. MSS for health facilities in Nepal is an effort of government to prepare foundation of readiness and service availability to move ahead with effective quality service utilization. Digitalization of the all sets of MSS, development of MSS to cover the existing type of the health facilities currently present in the country and access of data set for researchers is the way forward. Developing standards for national accreditation system and international collaboration is the next step to embrace. Furthermore, MSS gradually reported through self assessment of the health facilities with occasional monitoring by the local, provincial and federal government and gap fulfillment through routine annual work plan and budgeting is the future direction. It is high time MoHP moves ahead with service specific quality improvement tools integrated with MSS assessment prepare them for high quality health systems that can adapt to changing health needs and health shocks.

SMART BIOACTIVE PERSONALIZED AND IMPLANTABLE 3D-PRINTED SCAFFOLD FOR TENDON REGENERATION: PRELIMINARY RESULTS OF TRITONE PROJECT

Traumatic acute or chronic tendon injuries are a wide clinical problem in modern society, resulting in important economic burden to the health system and poor quality of life in patients. Due to the low cellularity and vascularity of tendon tissue the repair process is slow and inefficient, resulting in mechanically, structurally, and functionally inferior tissue.Tissue engineering and regenerative medicine are promising alternatives to the natural healing process for tendon repair, especially in the reconstruction of large damaged tissues. The aim of TRITONE project is to develop a smart, bioactive implantable 3D printed scaffold, able to reproduce the structural and functional properties of human tendon, using FDA approved materials and starting from MSC and their precursor, MPC cell mixtures from human donors.Total cohort selected in the last 12 months was divided in group 1 (N=20) of subjects with tendon injury and group 2 (N=20) of healthy subject. Groups were profiled and age and gender matched. Inclusion criteria were age&gt;18 years and presence of informed consent. Ongoing pregnancy, antihypertensive treatment, cardiovascular diseases, ongoing treatment with anti-aggregants, acetylsalicylic-acid or lithium and age&lt;18 years were exclusion criteria.Firstly, we defined clinical, biological, nutritional life style and genetic profile of the cohort. The deficiency of certain nutrients and sex hormonal differences were correlated with tendon-injured patients. It was established the optimal amount of MPC/MSC human cell (collected from different patients during femoral neck osteotomy). Finally, most suitable biomaterials for tendon regeneration and polymer tendon-like structure were identified. Hyaluronic acid, chemical surface and soft-molecular imprinting (SOFT-MI) was used to functionalize the scaffold.These preliminary results are promising. It will be necessary to enroll many more patients to identify genetic status connected with the onset of tendinopathy. The functional and structural characterization of smart bioactive tendon in dynamic environment will represent the next project step.

Editor's Spotlight/Take 5: The Price-Quality Mismatch: Are Negotiated Prices for Total Joint Arthroplasty Associated With Hospital Quality in a Large California Health System?

Editor's Spotlight/Take 5: The Price-Quality Mismatch: Are Negotiated Prices for Total Joint Arthroplasty Associated With Hospital Quality in a Large California Health System?

FACTORS RELATED TO HOSPITAL ACCREDITATION OF COMMUNITY HOSPITAL DURING COVID-19 OUTBRAKE

Background: The health system is responsible for providing services as well as providing services for everyone to access that are safe and good quality. Currently, health problems are changeable and complex, especially the COVID-19 pandemic, which is also related to health legislation. Therefore, a good quality health system is critical.Methods: This Cross-sectional survey study was conducted from July 2021 - March 2023 using a sample of 384 of 11 community hospitals. Spearman’s rank correlation coefficient was used to analyze. Results: The results showed that the samples had an average age of 39 years (S.D.=10.15), an average time of work 13 years (S.D.=10.19), with a bachelor's degree of 73.18%, while 38.80% were a nurse. In addition, samples had knowledge and attitude on the hospital accreditation (HA) at a high level of 68.49%, and 47.92% (=.85 S.D.=.11; = 4.05, S.D.= .40 respectively). But organization, process, and outcomes are at a moderate level of 54.17%,55.47%, and 58.85% (=3.93, S.D.=.55, 3.96 S.D.=.54, =3.85 S.D.=.57 respectively). Most hospitals had HA at level 3 (81.82%). Furthermore, the knowledge factors related to HA level (significance at .01 level; rs= .161). The factors affecting HA development results were attitude, organization, and process factors (p&lt; 0.01). Conclusions: The majority of hospital had moderate levels of HA. Knowledge, attitude, organization, and method with health legislation being the key elements. These elements can be used to get HA information during COVID-19 outbrake.

Expectations of industrial enterprises towards suppliers related to management of quality, environment and occupational health and safety systems

The aim of the article is to present the expectations of industrial enterprises towards suppliers related to quality, envi-ronment, occupational health and safety management systems (QEOH &amp;SMS). The article presents the results of empiri-cal research conducted in 151 companies operating on the Polish B2B market. The study was commissioned to a spe-cialised research agency that conducted a targeted selection of companies registered in the Bisnode database, which is a business directory search platform. The expectations of production companies towards their suppliers regarding the implementation of QEOH&amp;SMS were assigned a rank on a scale from one (the least important criterion) to five (the most significant). The methodological apparatus in this study was set so that it was possible to fulfil the research goal based on empirical data. A questionnaire was used to verify the characteristics of the operational process after the implementation of particular managerial systems. This article examines the relationship between the requirements for suppliers and the implementation of management systems by manufacturing companies. The results of the conducted research indicate that expectations of industrial enterprises towards suppliers related to QEOH&amp;SMS are strongly focused on their development. Research shows that companies that adhere to the requirements of standardised man-agement systems have a greater requirement for suppliers than companies that do not implement QEOH &amp; SM require-ments. In particular, the implementation of quality and environmental management systems by the surveyed organisa-tions translates into increased requirements for suppliers. The article contributes to the existing scientific literature by analysing the impact of the implementation of individual management systems on the expectations towards suppliers. This study shows which of the 18 examined aspects are particularly important for manufacturing companies. Addition-ally, the expectations towards suppliers were classified into four groups (Corrective, Preventive, Improvement, Innova-tion).

Access to advanced cancer care services in the West Bank-occupied Palestinian territory.

Universal Health Coverage (UHC) identifies the provision of palliative care for people with advanced disease as an essential health service. Palliative care is also stipulated as a human right under existing covenants. Oncology services provided by the Palestinian Authority under Israeli military occupation are limited to surgery and chemotherapy treatment. Our study aimed to describe the experiences of patients with advanced-stage cancer in the West Bank in accessing oncology services and meeting their health care needs. We conducted a qualitative study among adult patients diagnosed with advanced lung, colon, or breast cancer in three Palestinian governmental hospitals, and with oncologists. Thematic analysis was conducted on the verbatim interview transcripts. The sample consisted of 22 Palestinian patients (10 men and 12 women) and 3 practicing oncologists. The findings reveal that cancer care is fragmented, with limited access to the services needed. Patients face referral delays in accessing treatment which worsen their health condition in some cases. Some patients reported difficulties in getting Israeli permits to access radiotherapy treatment in East-Jerusalem, and others experienced interruptions of their chemotherapy treatment sessions due to the unavailability of chemotherapy medications caused by Israeli-side delays. Other reported problems were related to the Palestinian health system and service delivery and quality, including fragmentation of services, infrastructure issues, and unavailability of medications. Advanced diagnostic services and palliative care are almost absent at Palestinian governmental hospitals, and patients need to seek these services in the private sector. The data demonstrate specific access restrictions to cancer care in the West Bank due to Israeli military occupation of Palestinian land. This affects all stages of the care pathway, from restricted diagnosis services, to limited treatment and then poor availability of palliative care. Cancer patients will continue to suffer if the root causes of these structural constraints are not addressed.