Providing Quality Health Care Research Articles

Examining How the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model Improves Health Equity for Underserved Communities and Safety Net Hospitals in New York State.

Safety net hospitals (SNHs) are essential to our healthcare ecosystem, providing quality healthcare to underserved communities. These institutions offer specialized services and acute medical care to populations facing structural or systemic healthcare barriers. However, for decades, the NYS Medicaid program reimbursed hospitals less than the cost of care, resulting in several independent SNHs becoming financially distressed, with many facing closure. Recently, the Center for Medicaid and Medicare Service Innovation Center (CMSI) introduced the State All-Payer Health Equity Approaches and Development (AHEAD) Model, which aims to support the financial needs of providers while also addressing the complex medical and social circumstances of underserved communities. This article will explore how the AHEAD model can be utilized as an alternative payment method for SNHs in New York State (NYS) to improve healthcare for underserved communities.

Innovative performance-based remuneration model for oncologists: Balancing productivity with quality of care in a Brazilian healthcare setting.

e23089 Background: Traditional fee-for-service (FFS) models in oncology often lead to biased healthcare delivery, prioritizing quantity over quality of care. Our objective was to develop and implement a comprehensive remuneration model for oncologists in Brazil that emphasizes both productivity and quality in patient care. Methods: The '4E' model forms the basis of our remuneration strategy. 'Effectiveness' measures clinical productivity through patient consultations, treatments, and participation in multidisciplinary activities. 'Structure' evaluates academic credentials and scientific contributions, 'Efficiency' examines adherence to clinical and administrative protocols, and 'Excellence' assesses quality interactions with patients and healthcare systems. These elements provide nuanced bonus adjustments to the effectiveness score, facilitating a balanced and comprehensive compensation approach. Adapted to various healthcare settings, the model accommodates different budgeting methodologies. Results: Implemented in February 2020, the model has led to significant improvements in service delivery. Between May 2020 and August 2023, consultations in private services increased by 36.8%, and patient numbers grew by 42.2%. The financial impact was notable, with more than a doubling of revenue, reflecting the model's success in enhancing both the volume and quality of healthcare provision. Conclusions: This multi-level remuneration model offers a comprehensive, ethical approach, aligning physician compensation with a broad range of professional activities and responsibilities. It demonstrates potential for enhancing healthcare delivery quality while ensuring financial sustainability. However, a limitation of our study is the lack of longitudinal quality measurement, an aspect we aim to address in future research. This suggests the model's replicability in diverse global oncology settings and underscores its relevance in the current healthcare landscape.

ANALYSIS OF HEALTHCARE QUALITY: PUBLIC CLINICS AND PRIVATE REHABILITATION CENTERS FROM PATIENTS' PERSPECTIVE

Introduction: Continuous analysis of healthcare quality is crucial to ensure optimal health experiences for patients. In this study, we focus on comparing the quality of care provided between public clinics and private rehabilitation centers, considering the perspective of patients. Objective: To examine the attitudes of the general population towards satisfaction with care provided in private rehabilitation centers compared to public institutions of physical medicine. Materials and methods: In this cross-sectional study conducted in February 2023, 125 participants were surveyed via an online Google Form to gather sociodemographic data and explore perceptions of physical therapy. The subsequent statistical analysis, using Microsoft Excel 2007 and IBM SPSS 23.0, encompassed descriptive and inferential statistics, revealing significant insights into respondents' perspectives and forming the foundation for a comprehensive discussion. Results: Research results indicate higher satisfaction with care provided in private centers compared to public institutions, while simultaneously highlighting issues with the organization of the public sector system. The findings suggest that both types of institutions excel in specific areas, with other areas identified as potential areas for improvement. Conclusion: Based on the analysis of patient perspectives, we conclude that both public clinics and private rehabilitation centers play a pivotal role in providing quality healthcare. While public clinics emphasized their role inaccessibility and comprehensive care, private rehabilitation centers stood out for their personalized approach, prompt patient reception, and utilization of manual techniques. Keywords:healthcare quality analysis, public clinics, private rehabilitation centers, patients' perspective

Hexagonal Boron Nitride Quantum Dots Embedded on Layer-by-Layer Films for Peroxidase-Assisted Colorimetric Detection of β-Galactosidase Producing Pathogens.

Pathogen detection has become a major research area all over the world for water quality surveillance and microbial risk assessment. Therefore, designing simple and sensitive detection kits plays a key role in envisaging and evaluating the risk of disease outbreaks and providing quality healthcare settings. Herein, we have designed a facile and low-cost colorimetric sensing strategy for the selective and sensitive determination of β-galactosidase producing pathogens. The hexagonal boron nitride quantum dots (h-BN QDs) were established as a nanozyme that showed prominent peroxidase-like activity, which catalyzes 3,3',5,5'-tetramethylbenzidine (TMB) oxidation by H2O2. The h-BN QDs were embedded on a layer-by-layer assembled agarose biopolymer. The β-galactosidase enzyme partially degrades β-1,4 glycosidic bonds of agarose polymer, resulting in accessibility of h-BN QDs on the solid surface. This assay can be conveniently conducted and analyzed by monitoring the blue color formation due to TMB oxidation within 30 min. The nanocomposite was stable for more than 90 days and was showing TMB oxidation after incubating it with Escherichia coli (E. coli). The limit of detection was calculated to be 1.8 × 106 and 1.5 × 106 CFU/mL for E. coli and Klebsiella pneumonia (K. pneumonia), respectively. Furthermore, this novel sensing approach is an attractive platform that was successfully applied to detect E. coli in spiked water samples and other food products with good accuracy, indicating its practical applicability for the detection of pathogens in real samples.

Healthcare governance in prisons in England: prisoners’ experiences of changes over time

ABSTRACT According to international law, prisoners should have access to healthcare on an equivalent basis to the rest of the population, and the UK Government has stated its commitment to such equivalence. Healthcare provision in English prisons has seen several reorganisations, notably in 2006 and 2013, with the stated intentions of improving healthcare provision in prisons. This article focuses on prisoners’ reported experiences over the periods of changes in healthcare governance, with the aim of identifying whether there are improvements from their perspectives. Survey data from a sample of prisoners has been collected by HM Inspectorate of Prisons for over 20 years, and these data have been used for secondary analysis of prisoners’ health needs and experiences of healthcare in English prisons. Despite the reorganisations of healthcare governance, the trends from 2003 to 2019 are of increasing health needs of prisoners and decreasing initial access, ongoing access, and quality of healthcare provision. There is little indication of any improvements experienced by prisoners from the 2006 or 2013 reorganisations. Prisoners are widely recognised as having distinct healthcare needs, but the data analysis reveals demographic differences in health needs and health access within the prison population, and an overall decline in quality and accessibility of healthcare provision in English prisons.

Healing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Physicians in the Context of Black Maternal Health

ABSTRACT Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients’ beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants’ agreement with the importance of assessing patients’ perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed.

Interprofessional Education at the University Level: Evidence, Models, and Future Directions

Interprofessional education (IPE) continues to evolve as a critical component of providing quality health care. Emerging evidence suggests IPE is most effective if it exists across the continuum of academia to clinical practice. This article provides current evidence and models for IPE deliv­ery to students beginning in their academic programs.

Factors associated with the use of antibiotics for children presenting with illnesses with fever and cough obtained from prescription and non-prescription sources: a cross-sectional study of data for 37 sub-Saharan African countries

IntroductionFever and cough in under-five children are common and predominately self-limiting illnesses. Inappropriate prescribing of antibiotics in sub-Saharan Africa is a significant public health concern. However, prescription sources and use among children with fever or cough have not been explored. Therefore, we explored the factors associated with the use of antibiotics obtained from prescription and non-prescription sources for children with illnesses associated with fever and cough.MethodsA secondary data analysis was conducted based on the Demographic and Health Survey (DHS) data from 37 sub-Saharan African countries. A total weighted sample of 18,866 under-five children who had a fever/cough and took antibiotics were considered for this study. Given the hierarchical nature of DHS data and the use of antibiotics prescribed from the formal healthcare setting (> 10%), a multilevel modified poisson regression model was fitted. Deviance was used for model comparison and the model with the lowest deviance value was chosen as the best-fitted model. Variables with p ≤ 0.2 in the bivariable analysis were considered for the multivariable modified poisson regression model. In the multivariable multilevel modified poisson regression model, the Adjusted Prevalence Odds Ratio (APOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were reported to declare a significant association with taking antibiotics for fever/cough prescribed from formal healthcare setting.ResultsIn sub-Saharan Africa, the proportion of use of antibiotics from informal healthcare setting for fever and cough among under-five children was 67.19% (95% CI: 66.51%, 67.85%). In the multilevel modified poisson regression analysis; residing in a rural area (APOR = 1.08, 95% CI: 1.04, 1.12), a child aged 36–47 months (APOR = 0.94, 95% CI: 0.90, 0.98), a child aged 48–59 months (APOR = 0.89, 95% CI: 0.84, 0.94), maternal primary education (APOR = 0.96, 95% CI: 0.93, 0.99), maternal secondary education (APOR = 0.95, 95% CI: 0.92, 0.99), belonged the middle household wealth status (APOR = 1.07, 95% CI: 1.02, 1.11), maternal exposure to news/electronic media (APR = 1.06, 95% CI: 1.02, 1.10), being from a household with 2 under-five children (APR = 0.94, 95% CI: 0.91, 0.97), being from a household with 3 under-five children (APR = 0.89, 95% CI: 0.85, 0.93), being from a household with 4 under-five children (APR = 0.90, 95% CI: 0.83, 0.98), and children of caregivers who were not involved in decision-making for their child health issues were significantly associated with taking antibiotics prescribed from formal healthcare setting for fever/cough among under-five children.ConclusionOnly two-thirds of the antibiotics used for children under five who had fever and cough were prescribed from formal healthcare setting. Our findings underscore the significance of addressing healthcare disparities, improving access to qualified healthcare providers, promoting maternal education, and empowering mothers in healthcare decision-making to ensure appropriate antibiotic use in this vulnerable population. Further research and interventions targeted at these factors are warranted to optimize antibiotic prescribing practices and promote responsible antibiotic use in the management of fever and cough in under-five children.

A machine learning‐based approach for wait‐time estimation in healthcare facilities with multi‐stage queues

AbstractDigital technologies have been contributing to providing quality health care to patients. One aspect of this is providing accurate wait times for patients waiting to be serviced at healthcare facilities. This is naturally a complex problem as there is a multitude of factors that can impact the wait time. However, the problem becomes even more complex if the patient's journey requires visiting multiple stations in the hospital; such as having vital signs taken, doing an ultrasound, and seeing a specialist. The authors aim to provide an accurate method for estimating the wait time by utilising a real dataset of transactions collected from a major hospital over a year. The work employs feature engineering and compares several machine learning‐based algorithms to predict patients' waiting times for single‐stage and multi‐stage services. The Random Forest algorithm achieved the lowest root mean squared error (RMSE) value of 6.69 min among all machine learning algorithms. The results were also compared against a formula‐based system used in the industry, and the proposed model outperformed the existing model, showing improvements of 25.1% in RMSE and 18.9% in MAE metrics. These findings indicate a significant improvement in the accuracy of predicting waiting times compared to existing techniques.

Antibiotic prescription sources and use among under-5 children with fever/cough in sub-Saharan Africa.

Childhood febrile illness is among the leading causes of hospital admission for children <5y of age in sub-Saharan Africa (SSA). Antibiotics have played a pivotal role in enhancing health outcomes, especially for children <5y of age. Antibiotics prescription pattern evidence exists for SSA, however, prescription sources (either from qualified or unqualified sources) and use among children with fever or cough have not been explored. Thus the present study assessed antibiotic prescription sources and use among children <5y of age with fever and cough in SSA. We used Demographic and Health Survey data from 37 countries with a total of 18866 children <5y of age who had fever/cough. The surveys span from 2006 to 2021. The dependent variable was antibiotics taken for fever/cough based on prescriptions from qualified sources. The data were weighted using sampling weight, primary sampling unit and strata. A mixed-effects logistic regression model (both fixed and random effects) was fitted since the outcome variable was binary. Model comparison was made based on deviance (-2 log likelihood) and likelihood ratio tests were used for model comparison. Variables with p≤0.2 in the bivariable analysis were considered for the multivariable mixed-effects binary logistic regression model. In the final model, the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p<0.05 in the multivariable model were used to declare a significant association with taking antibiotics for fever/cough prescribed from qualified sources. The percentage of unqualified antibiotic prescriptions among children <5y of age who had a fever/cough and took antibiotics was 67.19% (95% CI 66.51 to 67.85), ranging from 40.34% in Chad to 92.67% in Sao Tome. The odds of taking antibiotics prescribed from unqualified sources for fever/cough among children <5y of age living in rural areas were 1.23 times higher (AOR 1.23 [95% CI 1.13 to 1.33]) compared with urban children. The odds of taking antibiotics prescribed from qualified sources for fever/cough among children <5y of age whose mothers had primary, secondary and higher education decreased by 14% (AOR=0.86 [95% CI 0.79 to 0.93]), 21% (AOR 0.79 [95% CI 0.72 to 0.86]) and 21% (AOR 0.79 [95% CI 0.65 to 0.95]) compared with those whose mother had no formal education, respectively. The study showed that the majority of the children who received antibiotics obtained them from unqualified sources in the 37 SSA countries. Our findings underscore the significance of addressing healthcare disparities, improving access to qualified healthcare providers, promoting maternal education and empowering mothers in healthcare decision-making to ensure appropriate antibiotic use in this vulnerable population. Further research and interventions targeted at these factors are warranted to optimize antibiotic prescribing practices and promote responsible antibiotic use in the management of fever and cough in children <5y of age.

(Un)disciplined Patients, (Un)controlled Medical Authority?

Abstract Starting at the end of the 1940s, the so-called “democratic transformation of healthcare” was not limited to the expansion of beneficiaries and making care provided in the system free of charge. It also sought to define the new roles of those who run (physicians) and use (patients) the system. To enforce the implementation of new norms, medical ethics committees were set up, and in many respects, these new structures were integrated into the system of social courts and were tasked mainly with the protection patients’ rights during investigations into complaints against doctors. This article aims to address the following question: What role did the functioning of these medical ethics committees play in healthcare operations organized along socialist principles, considering their involvement in both politics and healthcare? Additionally, what forms of governmentality can be inferred from the ways these committees functioned within the framework of socialist healthcare? To answer these questions, I examine patients’ complaints received by the medical ethics committees, as the core objective of socialist healthcare was to provide quality healthcare and educate individuals about utilizing the socialist healthcare system. My hypothesis is that while the committees exhibited organizational and operational characteristics aligned with the basic institutions of socialist democracy, their ultimate goal was to educate individuals in accordance with the principles of the socialist system. However, the committees’ decisions were influenced by the degrees of autonomy granted to them and existing practices for supervising medical activity prior to the establishment of the state-socialist system. Consequently, they functioned not as guardians of the socialist state’s biopolitics but rather as autonomous bodies of medical advocacy. Although patients used various strategies of argumentation to justify the incompatibility of their grievances with socialist healthcare, doctors did not primarily assess the seriousness of the problems based on patient complaints. Institutional constraints and specific professional practices, which also played a role in medical activities, had a more significant impact on the decision-making process.

Healthcare Public Relations – A Pilot Study in Romania

Communication is a critical component in the process of providing quality healthcare services and products. The role of public relations (PR), as a strategic, proactive, and responsible type of communication, is to establish and maintain a positive reputation and relationships with the public, based on trust and mutual understanding. Given the complex approach and process of this activity, when properly applied, PR can bring benefits to all stakeholders in the healthcare sector, contributing positively to its overall realities and outcomes. This paper presents the results of an exploratory pilot study aimed at identifying the coordinates of PR in the Romanian health sector by investigating perceptions on health public relations (HPR), its potential, challenges and opportunities, and stakeholders in healthcare. It is based on qualitative research, using interviews with a mixed group of professionals from the public and private sectors (doctors, medical service coordinators, medical professors, managers, and owners of entities that provide health services and products, and strategic communication professionals working for companies in healthcare). The results are discussed alongside relevant findings provided by previously published studies. In the final part of the article, the author proposes a PR model for entities in the medical area. It emphasizes that HPR should not only be used as a tactical tool or alternative to marketing efforts, nor only intended to manage an undesirable image or deliver damage control after an inconvenient situation or crisis. Instead, HPR services are at their true potential when a strategic approach is applied proactively, based on complex research and planning, designed to engage stakeholders and motivate them towards collaborative communication and sustained effort, based on partnership, for efficient and effective results in the health sector.

Maintaining altruism among nursing professionals

The demanding hospital work environment has increased the need for organizational citizenship behaviour (OCB). It’s essential to maintain the altruistic behaviour of nursing professionals towards each other to enhance the patient experience and provide quality healthcare service to patients efficiently. This quantitative study explored the relationships between OCB constructs based on social identity theory (SIT) and system justification theory (SJT). This study is empirical and cross-sectional in nature; structural equation modeling is performed on two hundred twenty-two nursing professional responses, using IBM AMOS V.22 to test the hypothesized model. Conscientiousness has a mediating effect on the relationship between civic virtue and altruism (Indirect effect=0.19, Boot SE=.057, lower-level confidence interval (LLCI)=.0940, upper-level confidence interval (ULCI)=.3144). Moreover, sportsmanship had a mediating effect on the relationship between civic virtue and altruism with an Indirect effect=-0.06, Boot SE=.023, LLCI=-0.1159, ULCI=-0.0222). The results supported the hypothesis that civic virtue and altruism are directly related and found that conscientiousness and sportsmanship mediate the relationship between civic virtue and altruism. The findings suggest that employees with higher sportsmanship tend to reduce their altruistic behavior in the long run.

The role of primary care attributes in preventing loss or change of usual source of care: a nationwide cohort study.

The existence of a stable usual source of care (USC) is fundamental to the provision of quality health care. However, no longitudinal studies have examined whether core primary care attributes influence the stability of USC status. We aimed to examine the association between primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) and the loss or change of USC. This nationwide cohort study was conducted during the coronavirus disease 2019 pandemic using a representative sample of the Japanese adult population aged 40-75 years. The primary outcome measures were loss of USC and voluntary change in USC during the 12-month follow-up period. Primary care attributes were evaluated in the baseline survey using the Japanese version of Primary Care Assessment Tool (JPCAT). Data were analyzed for 725 participants who had a USC at baseline. Among them, 93 (12.8 %) lost their USC and 46 (6.3%) changed their USC during the follow-up period. Multivariable multinominal logistic regression analyses showed that the JPCAT total score was associated with decreased loss of USC and change in USC. Among the JPCAT domains, longitudinality, comprehensiveness (services available), and community orientation were associated with reductions in both USC loss and change. Our study indicates that primary care attributes play an important role in preventing the loss or change of USC and contribute to the stability of USC status. These findings provide additional rationale for policymakers, healthcare providers, and managers to seek to strengthen core attributes of primary care.

Pengembangan Sistem Cerdas Berbasis Data Mining untuk Meningkatkan Akurasi Prediksi Kebutuhan Obat di Puskesmas Parit Rantang

Effective inventory management is crucial in providing quality healthcare services. Predicting drug needs in the pharmacy warehouse is vital to ensuring adequate availability for patients. This study developed and implemented a prediction system using Artificial Neural Network (ANN) method to forecast drug requirements. Training data comprised drug usage from January 2020 to July 2023, while testing data covered drug usage from August to December 2023. Through several experiments, the best model identified was 12-6-1, with a Mean Absolute Percentage Error (MAPE) of 6.817 and an accuracy of 93.18%. Predictions for Paracetamol drug usage in August were 4603, whereas the actual usage was 4785. This system is expected to enhance drug inventory management efficiency, reduce costs, and improve drug availability for patients.

Applying Lessons from the COVID-19 Pandemic to Universal Health Care

The Universal Health Care (UHC) Act of the Philippines, signed into law in 2019, aims to provide a full range of health services to all Filipinos.1 However, its planned implementation was derailed with the COVID-19 pandemic. We observed a large variation in the pandemic response across regions and countries, highlighting the complex interplay of political, structural, economic, and cultural factors on health. 2 The Philippine national government implemented varying levels of community quarantine, risk communication, travel restrictions, testing and monitoring of at-risk individuals, and vaccination policies to control the pandemic, while the local government units (LGUs) were tasked to adopt and coordinate these policies in their communities. 3&#x0D; The COVID-19 pandemic accentuated the existing weaknesses of our health system, of which inequity is a central problem. Uneven distribution of healthcare personnel, limited resources for testing, and limited access to medicines and supplies were important challenges faced particularly in geographically isolated and disadvantaged areas in the Philippines. LGUs implemented granular policies and context-specific interventions to respond to the varying conditions of communities in terms of local COVID-19 transmission, health system preparedness, health resources, and community responsiveness. 3 Examples of innovative approaches in the LGUs include reorganization of Barangay Health Emergency Response Teams, Zumba sessions of health workers, and backyard gardening of COVID-19 patients. 4 The COVID-19 pandemic highlighted the importance for health systems interventions to take into consideration the preparedness, availability of resources, and vulnerabilities of communities in the Philippines.&#x0D; As we enter the post-pandemic era, we have the opportunity to refine the implementation of the UHC law based on the lessons we learned from the pandemic. For our goal of providing quality health care to all Filipinos to come into fruition, we need to strive for health equity. Health equity refers to having the personal agency and fair access to resources needed to achieve the best possible standard of health for all people. 5,6 Given the socio-economic disparities, cultural diversity, and varied structural barriers present in the Philippines, context-sensitive interventions are important to ensure an inclusive healthcare system where no one gets left behind.7 Moreover, acceptability and feasibility of the health system interventions should be taken into consideration during the planning, preparation, and implementation stages of UHC implementation.&#x0D; In the advent of evidence-based health care, the priority health research agenda globally and in the Philippines now includes health equity research. Research to identify and measure the magnitude of health inequity, and research that evaluate interventions to reduce health inequity are vital as we strive to improve our health care systems.8 Although health equity cannot be measured directly, it is recommended to conduct research in the following areas: a.) difference in health in association with social position; b.) assessment of social and structural determinants of health; and c.) health equity indicators, including healthcare access, healthcare quality, financial protection, and health outcomes.5,9 These research would be essential to create policies and programs to promote health equity.&#x0D; We recognized the importance of strong and resilient health care systems during the COVID-19 pandemic. While important advancements have already been made in the Philippine health care, there is still much room for improvement. As we move forward with UHC in the Philippines, we can incorporate our experience with the COVID-19 pandemic to promote the provision of the best possible health care services for all.

Communicating difficult news in pediatric radiology.

Effective communication is an important aspect of providing quality healthcare. Radiology staff may be called upon to communicate results, even when it is difficult. Simple, efficient communication models can be learned to reduce clinician distress and support patients and families through stressful times. These practical tips ensure essential communication elements are met, including assessing patient and family perspectives, clearly delivering medical information, responding with empathy, and collaborating around next steps. Models such as "Ask-Tell-Ask," "SPIKES," and "NURSE" can be used to disclose results, communicate serious news, and respond to emotion. Lastly, clinicians can also utilize "I wish… I worry… I wonder" statements to align with a patient's hopes and acknowledge a family's concerns, ultimately allowing healthcare professionals to support and guide families through challenging situations.

Review Article on the Role of Effective Leadership in Crisis Management

Effective leadership is critical in various domains, including healthcare, small-scale enterprises, and crisis management. In the healthcare sector, competent leadership is vital for improving patient care quality, achieving targeted health outcomes, and managing crises effectively. Studies highlighted the positive impact of effective leadership on patient satisfaction, reduced health risks, and improved overall healthcare delivery. In addition, effective leadership played a pivotal role in managing the COVID-19 pandemic by directing responses and ensuring public health protection. In small-scale enterprises, research emphasized the importance of leadership style in determining organizational performance. Transactional leadership showed a significant positive effect on performance, while transformational leadership, though positive, did not have a strong influence. The studies recommended prioritizing transactional leadership in the early stages and gradually transitioning to transformational leadership as businesses mature. Overall, these research articles underscore the indispensable role of effective leadership in addressing challenges, inspiring confidence, and fostering resilience. Leadership emerges as a critical driver of positive outcomes, be it in providing quality healthcare, enhancing organizational performance, or navigating crises. The findings offer valuable insights into the significance of strong leadership across various domains and its impact on individual lives and organizational success.

Patient Satisfaction Regarding Quality Nursing Care

Background The significance of patient satisfaction PS with nursing care has been widely recognised as a primary determinant of general PS with hospital service and the general quality of health care provision. Nevertheless the current status of PS with nursing treatment at the state level in Gujarat India has not been determined.Aim The aim was to assess the level of patients satisfaction with nursing care quality in surgical wards.Methods The research investigation was carried out at the U.N. Mehta Institute of Cardiology Research Centre UNMICRC from June 2021 to December 2021. A modified form of questionnaire of Dr. Laschingerrsquos ldquoPS with quality nursing care questionnairerdquo was used as the study tool. Patients operated on with all kinds of heart surgery as well as nine dimensions were included in the study. Patients admitted with wound infections were excluded from this research.Results A total of 178 out of 180 patients were evaluated at random and were approached for interviews using a questionnaire. For patients with a language barrier patient relatives were either interviewed or served as interpreters. Overall the data showed that patientrsquos expectations in some aspects were not sufficiently matched. According to this study nurses need to focus more on privacy and peace of patients.Conclusion Nursing care is the main component of overall patient satisfaction from the time of hospital admission to discharge.

Building Nurse Competency Strategy at Public Health Center in Indonesia: A Descriptive Qualitative Approach

Background:Nurses play a crucial role in providing quality healthcare services to the community, particularly in public health centers in Indonesia. This study aims to explore the building of nurse competency strategies in the public health setting. Methods: Aqualitative research design with a descriptive approach was utilized. Data collection techniques through interviews. The informants consisted of fifteen people, with key informants in the primary setting, and were analyzed using a descriptive-qualitative approach with content analysis techniques. Results:The study results showed that two categories have arisen: the spiritual approach and the technological approach. The research findings on developing the competency of nurses in health services can be realized through education and training based on spiritual and technological aspects of building the competency of nurses. Improving nurse competence can be done through spiritual and technology-based education and training. Conclusion:By implementing the proposed strategies, it is hoped that nurses will be better equipped to provide high-quality care to the community, ultimately improving health outcomes and well-being. The implementation of public health nurses cannot be separated from the role of nurses in a public health center. Community health nurses in a public health center have at least six roles and functions, namely, as nursing case finders, health educators, coordinators and collaborators, counselors, and role models.