Quality Of Health Care Delivery Research Articles

Understanding the Relationship between Job Satisfaction and Psychological Well-being of Preventive Medicine Workers in Northern Vietnam

Objective: The study aims to access the relationship between job satisfaction and the psychological well-being of preventive medicine workers in Vietnam. Methods: A cross-sectional study was implemented in 12 preventive medicine centers in three provinces of northern Vietnam. A total of 400 preventive medicine staff participated, and a total of 383 questionnaires were analyzed. The questionnaire included validated questions related to general information, job satisfaction, and psychological well-being. Results: As expected, job satisfaction is correlated with psychological well-being. This association varied across dimensions. Satisfaction with supervision and community support had the lowest correlations with well-being (0.22 and 0.27, respectively), while co-worker satisfaction and overall job satisfaction had the strongest correlation (0.41 and 0.47, respectively) with psychological well-being. After controlling for personal factors, these correlations remained significant. Co-worker satisfaction and overall job satisfaction were the strongest predictors of psychological well-being (β = 0.38 and 0.45, respectively). Conclusion: Among preventive medicine workers, job satisfaction was positively correlated with psychological well-being. In turn, these findings should contribute to the development of sound policies for human resource management in the health system of Vietnam. A better understanding of the factors contributing to job satisfaction and psychological well-being among preventive medicine workers may help improve their working conditions, which may subsequently improve the quality of healthcare delivery.

Knowledge and Perception of Nurses about Occupational Hazard with Nurse Characteristics

Nurses' level of knowledge about hazards is essential in maintaining the safety of patients and nurses themselves. However, nurses' perceptions of threat are not all the same. Following the theory of planned behavior, a perception applied to a person's behavior is influenced by beliefs preceded by knowledge of something about hazards experienced while working in healthcare facilities such as hospitals. The vulnerability of health workers' jobs threatens the quality of health care delivery in developing countries, especially nurses. Meanwhile, this study analyzes the knowledge and perceptions of nurses about occupational hazards among health workers whose job descriptions require direct contact with patients almost every day in most health care facilities. Furthermore, this research aims to know the relationship between nurses' knowledge and perceptions about occupational hazards in RSUD Kanjuruhan Malang. This quantitative research method uses a cross-sectional number of respondents, as many as 52 nurses who work in RSUD Kanjuruhan Malang. This study shows a strong relationship between nurses' knowledge and perceptions about occupational hazards with a positive correlation with R = 0.836.

From anticipation to confidence: A descriptive qualitative study of new graduate nurse communication with physicians.

The aim of this study was to understand how new graduate nurses experience communication with physicians. Communication is necessary for high-quality health care delivery. With poor patient outcomes as a driving force, knowledge of the dialogue that occurs between new graduate nurses and physicians has been rarely explored. This qualitative descriptive study involved 13 new graduate nurses from an academic teaching hospital in the south-eastern United States. Data for this study were collected using face-to-face and virtual interviews with a focus on having nurses describe their experience communication with physicians in their current practice. Analysis led to four themes that describe new graduate nurses experience communicating with physicians. Those themes were gaps in preparation, developing confidence, learning to communicate, and interprofessional care. Effective communication with physicians is a stressor for new graduate nurses as they transition to practice. For these nurses, negative emotions in their anticipation of communicating with physicians were developed during their educational experience. The findings of this study emphasize the importance of enhanced interprofessional training in education and practice that facilitate effective communication between the two professions in the practice environment.

Medical students’ attitude towards cultural diversity: a cross-sectional study at a health sciences university in eastern Nepal

ObjectivesTo assess the attitude of medical students towards cultural diversity aiming to elucidate our current status in understanding cultural awareness and sensitivity.Design, setting and participantsA web-based cross-sectional study was carried...

Patient-Centered Care: A Panacea to Quality Health Care Delivery

Patient-Centered Care: A Panacea to Quality Health Care Delivery

Integrating Youth Voice in Health Plan Quality Improvement.

Incorporating youth and family voice to inform healthcare policies and practices has increasingly become recognized as essential to the delivery of quality health care.1 Underlying these efforts is the belief that involving youth and their families leads to more acceptable and accessible services and that consumers of health care have a rightful role and the requisite experience to offer important contributions in the design and delivery of services,1,2 despite limited evidence of its impact on outcomes.

Emergency Care Unit and Patient Satisfaction, During Covid-19 Pandemic: Durres Hospital Case

Abstract The outbreak of covid-19 is having a significant impact on both the physical and social environment. Over 108.2 million people still uncounted (1). Among the sectors of a hospital, the emergency service is one of the most challenging in relation to the promotion of care quality. Achieve good levels of satisfaction of patients of these services is a difficult task (2) due to weaknesses caused by overcrowding, lack of hospital beds, lack of human resources and inadequate physical infrastructure to meet all demand (3). The difficult situation created, during the pandemic outbreak, focused the entire influx of patients, in the emergency service, which encountered the initial difficulties, of facing a completely unknown and unimaginable crisis, deepening the above problems. Patient satisfaction, as a perception and an attitude that a consumer can have or view towards a total experience of health care, is a multidimensional aspect, which represents a vital key marker for the quality of health care delivery (4). The purpose of this study is to assess patient’s satisfaction with the emergency service in the regional hospital of Durres, during Covid-19 pandemic period, as well as to identify the main problems that led to patient’s dissatisfaction with the quality of service. In a for month period, 200 patients who received services at this hospital while affected by covid-19, were interviewed. A structured questionnaire was used to collect data from participants. The collected data were processed by SPSS statistical software. The main result of the analysis, showed that 62% of the respondents were satisfied with the service received, and that the degree of dissatisfactions on the rest of the patients was mainly related to the large number of patients hospitalized ate the same time, which created uncertainty among patients, about the service received and the fear to neglect. Preparing staff to deal with such critical situations is a must, as a good proportion of patients often perceived the insecurity of physicians and nurses in providing first aid. The overall opinions about the satisfaction level of patients for the availability and empathy of doctors in the hospital were good. As a conclusion we can say that there is a strong positive relationship between patients satisfaction and the promptness in the service as well as the necessary spaces for the treatment of patients.

Quality of care for children with acute respiratory infections in health facilities: a comparative analysis of assessment tools.

BackgroundSevere childhood pneumonia requires treatment in hospital by trained health care workers. It is therefore important to determine if health facilities provide quality health services for children with acute respiratory infections (ARI), including pneumonia. Using established indicators from WHO to measure quality of care (QoC) as a reference standard, this review aims to evaluate how well existing tools assess QoC for children presenting to health facilities with ARI.MethodsExisting assessment tools identified from a published systematic literature review that evaluated QoC assessment tools for children (<15 years) in health facilities for all health conditions were included in this ARI-specific review. 27 ARI-specific indicators or “quality measures” from the WHO “Standards for improving quality of care for children and young adolescents in health facilities” were selected for use as a reference standard to assess QoC for children presenting to health facilities with ARI symptoms. Each included assessment tool was evaluated independently by two paediatricians to determine how many of the WHO ARI quality measures were assessable by the tool. The assessment tools were then ranked in order of percentage of ARI quality measures assessable.ResultsNine assessment tools that assessed QoC for children attending health facilities were included. Two hospital care tools developed by WHO had the most consistency with ARI-specific indicators, assessing 22/27 (81.5%) and 20/27 (74.1%) of the quality measures. The remaining tools were less consistent with the ARI-specific indicators, including between zero to 16 of the 27 quality measures. The most common indicators absent from the tools were assessment of appropriate use of pulse oximetry and administration of oxygen, how often oxygen supply was unavailable, and mortality rates.ConclusionsThe existing WHO hospital-based QoC assessment tools are comprehensive but could be enhanced by improved data quality around oxygen availability and appropriate use of pulse oximetry and oxygen administration. Any tools, however, should be considered within broader assessments of QoC, rather than utilised in isolation. Further adaptation to local settings will improve feasibility and facilitate progress in the delivery of quality health care for children with ARI.RegistrationThe protocol of the original systematic review was registered in PROSPERO ID: CRD42020175652.

Health Insurance Exemptions for Older Ghanaians: Stakeholder Perspectives on Challenges Confronting an Ambitious Policy

ABSTRACT The health and wellbeing of older adults have taken center-stage in global policy agendas in recent times. In 2003, Ghana introduced an insurance exemption policy to eliminate financial barriers to healthcare for older adults and other vulnerable population groups. Embedded within the National Health Insurance Scheme (NHIS), this policy ostensibly guarantees free healthcare for older adults at publicly-funded facilities across the country. In this paper, we applied the implementation problem framework to identify gaps in the implementation of the exemptions policy and their impact on the healthcare experiences of older adults. Our data collection involved qualitative interviews with a purposive sample of community-residing older adults, health workers, community leaders, and policymakers. Our thematic data analysis identified resource, substantive, bureaucratic, political, and administrative constraints in the policy implementation process which, in turn, affected quality healthcare delivery. While most of these constraints are general challenges confronting the NHIS, they serve to undermine the intent of the scheme's exemptions policy. In particular, despite the exemptions, older adults continued to pay out-of-pocket for certain categories of treatments and medications, creating as yet financial barriers to healthcare. We present policy recommendations for addressing these implementation challenges, including suggestions to decentralize, depoliticize, and financially liberate the operations of the NHIS.

Has Strategic Purchasing Led to Improvements in Health Systems? A Narrative Review of Literature on Strategic Purchasing

ABSTRACT Strategic purchasing is noted in the literature as an approach that can improve the efficiency of health spending, increase equity in access to health care services, improve the quality of health care delivery, and advance progress toward universal health coverage. However, the evidence on how strategic purchasing can achieve these improvements is sparse. This narrative review sought to address this evidence gap and provide decision makers with lessons and policy recommendations. The authors conducted a systematic review based on two research questions: 1) What is the evidence on how purchasing functions affect purchasers’ leverage to improve: resource allocation, incentives, and accountability; intermediate results (allocative and technical efficiency); and health system outcomes (improvements in equity, access, quality, and financial protection)? and 2) What conditions are needed for a country to make progress on strategic purchasing and achieve health system outcomes? We used database searches to identify published literature relevant to these research questions, and we coded the themes that emerged, in line with the purchasing functions—benefits specification, contracting arrangements, provider payment, and performance monitoring—and the outcomes of interest. The extent to which strategic purchasing affects the outcomes of interest in different settings is partly influenced by how the purchasing functions are designed and implemented, the enabling environment (both economic and political), and the level of development of the country’s health system and infrastructure. For strategic purchasing to provide more value, sufficient public funding and pooling to reduce fragmentation of schemes is important.

Data Quality of Automated Comorbidity Lists in Patients With Mental Health and Substance Use Disorders.

EHRs provide an opportunity to conduct research on underrepresented oncology populations with mental health and substance use disorders. However, a lack of data quality may introduce unintended bias into EHR data. The objective of this article is describe our analysis of data quality within automated comorbidity lists commonly found in EHRs. Investigators conducted a retrospective chart review of 395 oncology patients from a safety-net integrated healthcare system. Statistical analysis included κ coefficients and a condition logistic regression. Subjects were racially and ethnically diverse and predominantly used Medicaid insurance. Weak κ coefficients ( κ = 0.2-0.39, P < .01) were noted for drug and alcohol use disorders indicating deficiencies in comorbidity documentation within the automated comorbidity list. Further, conditional logistic regression analyses revealed deficiencies in comorbidity documentation in patients with drug use disorders (odds ratio, 11.03; 95% confidence interval, 2.71-44.9; P = .01) and psychoses (odds ratio, 0.04; confidence interval, 0.02-0.10; P < .01). Findings suggest deficiencies in automatic comorbidity lists as compared with a review of provider narrative notes when identifying comorbidities. As healthcare systems increasingly use EHR data in clinical studies and decision making, the quality of healthcare delivery and clinical research may be affected by discrepancies in the documentation of comorbidities.

Ethics in healthcare: Knowledge, attitude and practices of nurses in the Cape Coast Metropolis of Ghana.

Nursing is a profession that care for personal and private aspects of people's lives. Therefore, nurses need to know the basic ethical aspects of nursing which is integral in nursing practices. The purpose of the study was to describe the ethical knowledge, attitude and practice of nurses in the Cape Coast Metropolis of Ghana. A cross-section design was used to collect data from 264 nurses in three selected healthcare facilities in the Metropolis. A structured questionnaire was administered to all the categories of these nurses in the selected facilities. Frequency counts and multiple regression statistics were used to analyze the data. The results show 78% of nurses possess good ethical knowledge, 84% had a positive attitude, while 98% had good ethical practices. The results further show that nurses' professional rank [F (1, 259), 2.35, p = .02] and academic qualification [F (1, 259), 2.67, p = .008] were significant predictors of their ethical knowledge and attitude, respectively. Inadequate resources, poor set up of working areas and understaffing are the major barriers limiting the practice of good ethical standards among the nurses. The Regional Health Directorate, the Ministry of Health and the Managers in charge of the health facilities need to work together to eliminate these barriers as they have the potential to negatively impact quality healthcare delivery in the Metropolis.

SOCIO-DEMOGRAPHIC CORRELATES OF JOB SATISFACTION AMONG NURSES AND MIDWIVES IN HEALTH FACILITIES IN THE BOLE DISTRICT OF THE SAVANNAH REGION, GHANA.

In the Ghanaian health system, low job satisfaction has been shown to affect service delivery. It is indicated that poor remuneration, non-conducive working environments and poorly resourced healthcare facilities influence job satisfaction and affect quality healthcare delivery. In this study, the relationship between socio-demographic variables and job satisfaction were examined. An analytical cross-sectional design and a multistage sampling technique were employed and the Mueller/McCloskey Nurse Job Satisfaction Scale was adapted and used to carry out interviews among 156 nurses and midwives in the Bole District of the Savannah Region. Spearman’s correlational analysis was done at 95% confidence level (p 0.05); marital status (r=-0.120, p=0.137&gt; 0.05); level of education (r=0.055, p=0.576&gt;0.05); working experience (r=0.135, p=0.094) and job satisfaction. Job type by healthcare profession was the only socio-demographic variable that predicted job satisfaction. Whilst the midwives were more likely to be dissatisfied, the nurses were more likely to be satisfied. It is recommended that nursing leaders and policy makers should institute motivational packages in consonance with the job types of these health professionals and respecting their rights to be involved in decision making and creating fair promotion opportunities. &#x0D; Keywords: Nurse, Midwife, Job Satisfaction, Socio-demographic Factors, Bole District.&#x0D; &#x0D;

Healthcare professionals\u2019 experiences and perceptions regarding health care of indigenous pregnant women in Ecuador

BackgroundPregnancy is an important life experience that requires uniquely tailored approach to health care. The socio-cultural care practices of indigenous pregnant women (IPW) are passed along the maternal line with respect to identity, worldview and nature. The cultural differences between non-indigenous healthcare professionals (HPs) and IPW could present a great challenge in women’s health care. This article presents an analysis from a human rights and gender perspective of this potential cultural divide that could affect the health of the IPW in an Andean region of Ecuador with the objective of describing the health challenges of IPWs as rights holders through the experiences and perceptions of HP as guarantors of rights.MethodsWe conducted 15 in-depth interviews with HPs who care for IPW in Chimborazo, Pichincha provinces of Ecuador. We utilized a semi-structured interview guide including questions about the experiences and perceptions of HPs in delivering health care to IPW. The interviews were recorded, transcribed and subjected to thematic analysis in Spanish and translated for reporting.ResultsWe found disagreements and discrepancies in the Ecuadorian health service that led to the ignorance of indigenous cultural values. Common characteristics among the indigenous population such as illiteracy, low income and the age of pregnancy are important challenges for the health system. The gender approach highlights the enormous challenges: machismo, gender stereotypes and communication problems that IPWs face in accessing quality healthcare.ConclusionsUnderstanding the diverse perspectives of IPW, acknowledging their human rights particularly those related to gender, has the potential to lead to more comprehensive and respectful health care delivery in Ecuador. Further, recognizing there is a gender and power differential between the provider and the IPW can lead to improvements in the quality of health care delivery and reproductive, maternal and child health outcomes.

Risk Factors and Outcomes of Redo Craniotomy: A Tertiary Care Center Analysis.

Background and aimReoperation rate is defined as the percentage of patients returning to the operating room (OR) within 30 days of an initial craniotomy and undergoing a repeat (redo) craniotomy procedure. It is a key factor of quality-of-care assessments and has implications for outcomes, especially in oncological cases. Redo craniotomies are associated with improvement in neurological status and decreased mortality rate compared to non-surgical interventions but are associated with higher costs and risk of complications. It is important to gauge the indications and frequency of redo craniotomies as an index of quality of healthcare to improve patient outcomes. This study aimed to identify the indications, frequency, and outcomes of reoperation following an initial craniotomy in neurosurgical patients at a tertiary care hospital.MethodsThis retrospective cohort study was conducted at a tertiary care center in Pakistan and included all patients who underwent unplanned reoperation within 30 days of initial craniotomy from January 1, 2010, to December 31, 2017. Demographics, indications for index surgery as well as reoperation, and outcomes in the form of complications, neurological status, and mortality were collected from medical charts and analyzed.ResultsThe study comprised 111 patients who underwent reoperations. Median age of the patients was 36 years (interquartile range {IQR}: 33 years). From a total of more than 1900 annual cases, the frequency of unplanned reoperations was 3.5%. The most common indication of unplanned reoperation based on MRI/CT was hemorrhage (40%, subdural hemorrhage was most common), followed by hydrocephalus (22%), cerebral edema (13%), and residual tumor (13%). The most common clinical reason for unplanned reoperation was a drop in Glasgow Coma Scale (GCS) (59%), whereas anisocoria was seen in 10.8% of patients. The highest mortality rate was observed in patients who were reoperated from post-operative day two to post-operative day seven (56%). Hypertension (p=0.014) and thrombocytopenia (p<0.001) showed significant associations with developing intracranial hemorrhage. Seventy-eight percent of patients showed significant improvement in their Karnofsky Performance Score (KPS) whereas 22% showed deterioration in their KPS.ConclusionThe delivery of consistent quality healthcare relies on early detection and intervention in at-risk patients. Our center’s reoperation rate is consistent with the average range among other centers globally. Hypertension, anticoagulation, and antiplatelet therapy were common risk factors for redo craniotomies within 30 days. Patients with these conditions need special care to prevent returns to the operating room. Patients also need to be monitored for hemorrhage in the short term (one to two days) and hydrocephalus in the long term (two to 30 days) to intervene early if needed.

Overcoming the language barrier: a novel curriculum for training medical students as volunteer medical interpreters

BackgroundOver 41 million people in the United States speak Spanish as their primary language, of which 16 million have limited English proficiency (LEP). It is well-established that language barriers contribute to health disparities and that the use of ad-hoc interpretation by untrained family members results in substandard care. We developed a novel interpreter training program for medical students to serve as in-person interpreters at a charitable, resident continuity clinic so as to overcome the language barrier in the delivery of healthcare to LEP patients.MethodsThe Medical Student Interpreter Training Program (MSITP) consists of three steps. First, fluent Spanish-speaking students shadowed a licensed interpreter. Second, students took a standardized phone exam to demonstrate language proficiency. Finally, students completed a three-hour training on the methodology and ethics of interpreting conducted by the Department of Interpreter Services.ResultsPre- and post-tests were administered to assess students’ familiarity with the Interpreter Code of Ethics and interpreter skills. Familiarity with the Interpreter Code of Ethics increased significantly with all students reporting feeling comfortable (47%) or very comfortable (53%) after training. The pre- and post-tests included free response questions, which were administered to assess competence in the methodology and ethics of interpreting. The cohort’s aggregate score increased by 35% after the training (Wilcoxon signed rank z-score = 2.53; p = .01).ConclusionsImplementing the MSITP resulted in an increased number of trained, Spanish-speaking interpreters available to provide their services to LEP patients at an affiliated charitable clinic and throughout the university hospital. Unlike other program models which are time and resource-intensive, this program is replicable and easily managed by volunteers. The MSITP is an effective model for training students as medical interpreters to ensure the delivery of quality healthcare for LEP patients.

Study the Types of Medical Crimes and Medical Infractions in the Penal Code of Afghanistan

Doctors are regarded as lifesavers in the world. Earlier, people who practiced medicine used to be precise in their treatment and more concerned with curing patients, it was considered as a service to humanity. However, currently, the profession has evolved into a money-making enterprise rather than a noble work. This has devolved into misuse of a noble deed. One of the ways to make money is medical crimes and medical infractions. So one of the most important issues discussed in today's law is the Medical Crimes and Medical Infractions. All countries have complete laws on prosecuting delinquent doctors. Afghanistan's legal system has incomplete laws regarding medical crimes and infractions. Unfortunately, no research has been done in this field in Afghan law. This is the first research that discusses medical crimes and medical infractions in the Afghan penal code. The penal code of Afghanistan is incompletely criminalized medical crimes and has not criminalized medical infractions. Therefore, it is necessary that the Afghan penal code should criminalize and recognize the medical infractions. This research wants to provide a legal solution to compensate the physical damage and mental damage of the patient, explaining the difference between medical infractions and medical crimes, study the challenges of the Afghan penal code regarding the criminalization of medical infractions cases and providing a suitable solution to prevent medical infractions and crimes in the Afghan society. Overall, there is a need for a fair and effective method to monitor and punish physician misconduct that will be conductive to the honest delivery of quality health care.

Theory-Practice Gap: The Knowledge and Perception of Nigerian Nurses.

Background:The theory-practice gap can be described as a lack of ability to relate the knowledge acquired in academics and research work with practice. This study aims to assess the knowledge and the perception of Nigerian nurses on the theory-practice gap in Nursing.Materials and Methods:This cross-sectional correlational study was carried out with a sample of 196 nurses who were working in the Federal Medical Centre Keffi and Aminu Kano Teaching hospital in Kano, all from the northern part of Nigeria, from April to June 2019. The participants were selected using a convenient sampling technique, where a self-administered questionnaire was utilized to collect the data and analysis was undertaken using SPSS.Results:The results of this study showed that 83.80% of respondents had good knowledge and 89.10% of the respondents had good perceptions. The levels of knowledge were significantly different in correlation with the educational level of respondents (χ2 = 13.88, df = 6, p = 0.022), which was determined using a Fischer exact test. Also, the level of perception was significantly different when considering the nature of work participants undertook (X2 = 7.65, df = 2, p = 0.022).Conclusions:Given the participants' awareness and perceptions in this study, it is clear that they are well informed of the theory-practice gap. This is a call for all professionals at an individual and organizational level to work, as it will translate into gap minimization, thereby increasing the quality of health care delivery as nurses constitute the largest part of the health care team in Nigeria.

Studying the Experience of Care Through Latent Class Analysis: An Application to Italian Neonatal Intensive Care Units.

Though many data on the experience of care of patients and caregivers are collected, they are rarely used to improve the quality of health care delivery. One of the main causes is the widespread struggle in interpreting and enhancing these data, requiring the introduction of new techniques to extract intelligible, meaningful, and actionable information. This research explores the potentiality of the latent class analysis (LCA) statistical model in studying experience data. A cross-sectional survey was administered to 482 parents of infants hospitalized in several Italian neonatal intensive care units. Through a 3-step LCA, four subgroups of parents with specific experience profiles, sociodemographic characteristics, and levels of satisfaction were identified. These were composed of parents who reported (1) a positive experience (36%), (2) problematic communication with unit staff (30%), (3) limited access to the unit and poor participation in their baby's care (26%), and (4) a negative experience (8%). Through its explorative segmentation, LCA can provide valuable information to design quality improvement interventions tailored to the specific needs and concerns of each subgroup.

Healthcare in the hand: Patients' use of handheld technology in video consultations with their general practitioner.

ObjectiveTo analyse how the patient's use of handheld technology in video consultations with their general practitioner affects communication and the possibilities for the delivery of quality healthcare. Focusing on the visually communicated aspects of the video consultation, we present three episodes from our recordings of eight video consultations between Danish general practitioners and patients.MethodsUsing a multimodal social semiotic framework to conduct a micro-level analysis, we present episodes from our data in which the hardware's affordance of mobility gave rise to salient events in the interactions of patients who used handheld devices to carry out their video consultations.ResultsPatients’ use of technology plays a significant role in the interactions between general practitioner and patient and is thus an important factor to consider in how practice is shaped when using handheld video consultation technology.ConclusionsOur findings demonstrate that the mobility of handheld devices (smartphone, tablet) can be used to augment sensing and embodiment and enhance the delivery of healthcare in video consultations. However, mobility may also disrupt the interaction. As a result, possibilities for the delivery of quality healthcare lie quite literally in the patients’ hands.