Senior Hospital Research Articles

Nurses’ perceptions of the performance of nurse managers and senior hospital management during the COVID-19 pandemic

BackgroundThe first waves of the COVID-19 pandemic had a negative impact on health systems and health professionals, due to the high number of cases and a lack of preparation. The aim of this study was to understand how nurses working in hospital units and in intensive care perceived the performance of nurse managers and senior hospital management during the first two waves of the pandemic.MethodsThe phenomenological approach proposed by Giorgi was used to investigate perceptions of the performance of nurse managers and senior hospital management during the first two waves of the COVID-19 pandemic in Spain. Fourteen clinical nurses who worked on the front line in inpatient units or intensive care units of the Health Services of Extremadura and Madrid in the first (March–April 2020) and second (October–November 2020) waves of the COVID-19 pandemic participated in this study. The data was collected through semi-structured interviews, following a script of themes, in a theoretical sample of nurses who were worked during the pandemic.ResultsTwo main themes emerged from the analysis of the data: (1) perceptions about the performance of nurse managers and senior hospital managers during the first and second waves of the pandemic (health system failure; belief that senior hospital management professionals could have managed the pandemic better; recognizing the efforts of middle management (nursing supervisors); insufficient institutional support) and (2) strategies employed by nurses to compensate for the weaknesses in pandemic management.ConclusionsThe clinical nurses perceived that the nurse managers demonstrated better management of the pandemic than the hospital’s senior management, which they attribute to their proximity, empathy, accessibility, and ability to mediate between them and the senior management. The nurses also believe that the senior management of the hospitals was to blame for organisational failures and the poor management of the pandemic.

Can compassionate leadership of senior hospital leaders help retain trainee doctors?

BackgroundHigh burnout and low retention rates among trainee doctors threaten the future viability of the UK medical workforce. This study empirically examined factors that can sustain trainee doctors.MethodA total of...

Patient safety culture and medication safety in European intensive care units: a focus group study

BackgroundPatients in intensive care units (ICUs) are susceptible to medication errors (MEs) for many reasons, including the complexity and intensity of care. Little is known about patient safety culture, its...

Assessing the impact of a cleaning programme on environmental hygiene in labour and neonatal wards: an exploratory study in The Gambia.

Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training. We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact. Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials. Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.

Qualitative study of challenges with recruitment of hospitals into a cluster controlled trial of clinical decision support in Australia

ObjectiveTo identify barriers to hospital participation in controlled cluster trials of clinical decision support (CDS) and potential strategies for addressing barriers.DesignQualitative descriptive design comprising semistructured interviews.SettingFive hospitals in New South...

Nurse managers' perceptions of the prospective acceptability of an implementation leadership training programme: A qualitative descriptive study.

To explore the prospective acceptability of an implementation leadership training programme prototype for nurse managers in China to implement evidence-based practices, from the perspectives of potential programme participants and deliverers. A qualitative descriptive study was conducted in Spring 2022 at three tertiary hospitals in Hunan, China. We conducted individual semi-structured interviews with unit-level nurse managers (n = 14), including 12 potential participants, and two potential deliverers that have been involved in developing the programme prototype. Interview questions and thematic analysis were guided by the Theoretical Framework of Acceptability. After reviewing the programme content, potential participants and deliverers reported that unit nurse managers would benefit from engaging in the programme, acknowledging that the programme fit with professional nursing values for implementing research evidence. They expressed positive views about being involved in producing academic papers through the training process, and interactive multi-modal training activities such as group work, experience-sharing and coaching. Seven participants were not very confident about being fully engaged in the training, as they could not navigate the English research literature. Both participants and deliverers highlighted factors that would influence their participation, including time constraints, the impact of the COVID-19 pandemic, and support from senior organizational leadership. The training programme prototype was perceived to be useful and acceptable. The multimodal training activities were considered a strength and managers expressed an interest in writing academic papers about their implementation processes. Support from senior hospital leaders and programme deliverers was identified as critical to the training programme's success. The study helps understand nurse managers' perceptions and concerns of participating in an implementation leadership training programme and could inform the development and refinement of similar programmes in various nursing contexts globally.

Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study.

The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.

Educational supervisor's perceptions of their role in supporting residents' learning: a qualitative study.

During the past decade, educational supervision (ES) has gained popularity as a key support mechanism in residents' training. However, few studies have mapped physicians' understanding of their roles as educational supervisors. This study aims to explore how supervisors experience this role and how they approach providing support to residents. We employed qualitative methodology and conducted semi-structured interviews with 13 senior hospital physicians regarding their experiences as educational supervisors. Participants were recruited via e-mail and snowball sampling. Interview transcripts were analysed using inductive systematic text condensation following a four-step procedure: (i) total impression (ii) identifying and sorting meaning units (iii) condensation from code to meaning (iv) synthesising condensation from description and concepts. Our analysis yielded four main themes. We found that while ES was considered important in theory, its purpose appeared unclear in everyday practise. Second, ES was associated with filling multiple and sometimes contradictory expectations. Third, establishing a good relationship between residents and supervisors was considered critical for effective ES. Finally, being a supervisor was described as experiencing a personal cost in the absence of support and resources. The many roles embedded in attending physicians' understanding of ES indicate a wide definition of the supervisory role. Supervisors contribute to residents' training by ensuring educational quality while upholding quality in patient care. Educational supervisors considered themselves to be vital sources of support for residents, but found their role unclear in everyday practice. They strove to manage different expectations resulting from lack of supportive organisational structures.

Managing unwarranted variation in hospital care – findings from a regional audit in Norway

Background/AimThere has been increasing focus and research over the past decades on defining, identifying, visualizing and reducing unwarranted clinical variation in clinical practice. Both clinician-driven initiatives such as the US based “Choosing Wisely” campaign and the top-down driven “Evidence-based intervention programme (EBI)” launched by NHS UK to improve quality of care by reducing unnecessary interventions have shown marginal results. We present the findings from a mixed-methods audit performed to evaluate the compliance by senior hospital leaders of a new regional strategy to reduce unwarranted variation in outcomes and utilization rates.MethodsSeventy-five mid- to senior-division and department leaders from eight hospital trusts in South-Eastern Norway Regional Trust (HSO) were invited to participate in evaluating the response and compliance of the regional leadership strategy for reducing unwarranted variation in patient outcomes and service utilization rates.ResultsThe audit revealed that the aim of reducing unwanted variation was not clearly communicated by senior HSO management. There was varying use of data from the national quality registers and health atlases for quality improvement. One third of the clinical leaders reported a lack of scrutiny of their work and were insufficiently aware of the HSO’s top-management and the hospital’s Boards strategic expectations about the importance of reducing unwarranted variation in their hospital utilization.ConclusionsWe found that the strategic aim of reducing unwanted clinical variation was not clearly communicated by senior HSO management to hospital boards and senior management.The hospitals could benefit from a better understanding of causes of variation by strengthening their efforts to reduce unwarranted variation in utilization rates as a key element in improving health care quality and patient safety. The findings of the audit are relevant for other healthcare organizations trying to improve their quality and reduce unnecessary variation.

Exploring the Significance of the Protection Column Model of Senior Professional and Technical Talents in Hospitals

Senior professional and technical personnel into the hospital senior, due to focus on administrative management, so that the mastery of professional skills cannot be carried out. What's more, some of them have gradually lost their ideals and beliefs after moving to leadership positions, and have inevitably become the key "hunting" objects, and finally slipped into the abyss of illegal and criminal offenses. For the country, medical field, hospitals, individuals, patients and society, this is a great loss. This paper focuses on the strategic long-term development of hospitals, based on the need to adapt to the development of medical and health care, mainly for the "protection of senior professional and technical personnel, value their existence, analysis and discussion of the significance of the protection of senior professional and technical personnel, to achieve the non-administrative mode of senior professional and technical personnel" to discuss.

A socioecological description of the influencing factors to midwives' management of preeclampsia in a Ghanaian tertiary hospital.

In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives' practice and the complex factors that influence the delivery of maternal healthcare. This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives' provision of preeclampsia care using a socioecological model. Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke's six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy. Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives' knowledge of preeclampsia; midwives' self-efficacy; midwives' skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues' work attitudes. Hierarchical decision-making and staff views of women's risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system. Multi-faceted factors play a significant role in midwives' management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

Contextual Factors Influencing the Implementation of a Multifaceted Intervention to Improve Teamwork and Quality for Hospitalized Patients: A Multisite Qualitative Comparative Case Study

Many hospitals have begun to implement models that combine interventions to redesign care for medical patients. These models include localization of physicians to specific units, nurse-physician co-leadership, and interprofessional rounds. Understanding contextual factors, the circumstances surrounding an implementation effort that influence its success, is essential to provide guidance to leaders implementing similar models of care. A multisite qualitative comparative case study was conducted with four hospitals in the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) study. Researchers conducted observations and semistructured interviews with 40 health care professionals and four implementation mentors. Researchers used inductive qualitative content analysis, reviewed fidelity of implementation trends, and performed cross-case analysis to identify contextual factors and their influence on implementation. Four contextual factors were associated with implementation success: (1) senior hospital leader involvement and organizational support; (2) alignment of RESET with organizational, hospital, and professional group priorities; (3) site leaders' engagement in RESET and relationship with one another; and (4) perceptions of need and intervention benefits among professionals. Implementation was optimal when senior leadership was stable and tangibly involved; organizational, hospital, and group goals were aligned; site leaders were committed and collaborated well; and nurses and physicians perceived a need for and benefits from the interventions. Four interrelated contextual factors are associated with the implementation of combined interventions to redesign care for hospitalized medical patients. Hospital leaders should consider these findings prior to implementing similar interventions and be prepared to address challenges related to these factors during implementation.

Adherence to vascular care guidelines for emergency revascularization of chronic limb-threatening ischemia

ObjectiveIn 2022, the National Health Service Commissioning for Quality and Innovation (CQUIN) indicator for vascular surgery, with its pay-for-performance incentive for timely (5-day) revascularization of chronic limb-threatening ischemia (CLTI), was introduced. We sought to assess its effects in terms of (1) changes in the care pathway process measures relating to timing and patient outcomes; and (2) adherence to the Peripheral Arterial Disease Quality Improvement Framework (PAD-QIF) guidelines for patients admitted with CLTI. MethodsA retrospective before-and-after cohort study was performed from January to June 2022 of nonelective admissions for CLTI who underwent revascularization (open, endovascular, or hybrid) at Cambridge University Hospitals National Health Service Foundation Trust, a regional vascular “hub.” The diagnostic and treatment pathway timing-related process measures recommended in the PAD-QIF were compared between two 3-month cohorts—before vs after introduction of the CQUIN. ResultsFor the two cohorts (before vs after CQUIN), 17 of 223 and 17 of 219 total admissions met the inclusion criteria, respectively. After introduction of financial incentives, the percentage of patients meeting the 5-day targets for revascularization increased from 41.2% to 58.8% (P = .049). Improvements were also realized in the attainment of PAD-QIF targets for a referral-to-admission time of ≤2 days (from 82.4% to 88.8%; P = .525) and admission-to-specialist-review time of ≤14 hours (from 58.8% to 76.5%; P = .139). An increase also occurred in the percentage of patients receiving imaging studies within 2 days of referral (from 58.8% to 70.6%; P = .324). The reasons for delay included operating list pressures and unsuitability for intervention (eg, active COVID-19 [coronavirus disease 2019] infection). No statistically significant changes to patient outcomes were observed between the two cohorts in terms of complications (pre-CQUIN, 23.5%; post-CQUIN, 41.2%; P = .086), length of stay (pre-QUIN, 12.0 ± 12.0 days; post-QUIN, 15.0 ± 21.0 days; P = .178), and in-hospital mortality (pre-QUIN, 0%; post-QUIN, 5.9%). Other PAD-QIF targets relating to delivery of care were poorly documented for both cohorts. These included documented staging of limb threat severity with the WIfI (wound, ischemia, foot infection) score (2.9% of patients; target >80%), documented shared decision-making (47.1%; target >80%), documented issuance of written information to patient (5.9%; target 100%), and geriatric assessment (6.3%; target >80%). ConclusionsThe pay-for-performance incentive CQUIN indicators appear to have raised the profile for the need for early revascularization to treat CLTI, engaging senior hospital management, and reducing the time to revascularization in our cohort. Further data collection is required to detect any resultant changes in patient outcomes. Documentation of guideline targets for delivery of care was often poor and should be improved.

Retained Intraocular Iron Foreign Body Leading to Late-Onset Siderotic Glaucoma: A Challenging Case Report.

BACKGROUND A retained ferrous intraocular foreign body (IOFB), introduced via penetrating ocular trauma, may result in ocular siderosis and visual loss that may occur after days or years. If diagnosis is delayed, therapy may also be delayed, resulting in a poor outcome. The present report presents the case of a 58-year-old man with a retained iron IOFB and late-onset siderotic glaucoma 1 month after the initial trauma. CASE REPORT A 58-year-old man presented with redness and eye pain in the right eye for 1 month after ocular trauma. His visual acuity was very good, with no sign of eye strain. High intraocular pressure had been detected for several weeks, but the B-scan ultrasound and fundus examination were normal and the reason for the high intraocular pressure was unknown. He was later transferred to our senior hospital. The diagnosis of IOFB was confirmed by computed tomography (CT) scan and ultrasound biomicroscopy (UBM). The patient was successfully managed by vitrectomy. CONCLUSIONS This report highlights that a retained IOFB can be challenging to diagnose and that cases associated with siderotic glaucoma require multiple investigations. Early detection of the IOFB using the right tools is vital to reduce the risk of siderotic glaucoma. Although the fundus examination was normal after ocular trauma, the use of CT scan and UBM assisted in finding the IFOB and the patient was successfully treated by vitrectomy.

Senior Hospital Physician Leaders' Perspectives on Factors That Impact Physician Engagement: A Qualitative Interview Study.

Physicians are essential in health-care delivery. Physician engagement, defined as active participation in administrative and leadership activities in their organization, is a useful metric for hospital leaders to evaluate as they develop and implement strategy. The purpose of this study was to gain insight into the perspectives of senior hospital physician leaders on factors impacting physician engagement. Semi-structured interviews were conducted virtually. A purposive sample was used. Hospital physician senior leaders were recruited from Ontario public hospitals in Canada. The interviews were recorded, transcribed verbatim, and analyzed. Ten participants in senior hospital physician leadership positions were interviewed. Seven themes were identified as impacting physician engagement: being seen and being heard, accountability, trust, leadership engagement, intercommunication, organizational stability, and discord within the organization. Saturation of themes was achieved. Two-way communication is essential to physician engagement. Physician input in decision-making processes is a vital way to improve engagement. For this to work, leadership must also be engaged. Trust and accountability are critical attributes for senior hospital physician leaders, especially during times of organizational instability. For physicians whose remuneration model is fee-for-service, new compensation models are required for them to actively participate in hospital decision-making.

Management of covert brain infarction survey: A call to care for and trial this neglected population.

Covert brain infarction (CBI) is highly prevalent and linked with stroke risk factors, increased mortality, and morbidity. Evidence to guide management is sparse. We sought to gain information on current practice and attitudes toward CBI and to compare differences in management according to CBI phenotype. We conducted a web-based, structured, international survey from November 2021 to February 2022 among neurologists and neuroradiologists. The survey captured respondents' baseline characteristics, general approach toward CBI and included two case scenarios designed to evaluate management decisions taken upon incidental detection of an embolic-phenotype and a small-vessel-disease phenotype. Of 627 respondents (38% vascular neurologists, 24% general neurologists, and 26% neuroradiologists), 362 (58%) had a partial, and 305 (49%) a complete response. Most respondents were university hospital senior faculty members experienced in stroke, mostly from Europe and Asia. Only 66 (18%) of respondents had established institutional written protocols to manage CBI. The majority indicated that they were uncertain regarding useful investigations and further management of CBI patients (median 67 on a slider 0-100, 95% CI 35-81). Almost all respondents (97%) indicated that they would assess vascular risk factors. Although most would investigate and treat similarly to ischemic stroke for both phenotypes, including initiating antithrombotic treatment, there was considerable diagnostic and therapeutic heterogeneity. Less than half of respondents (42%) would assess cognitive function or depression. There is a high degree of uncertainty and heterogeneity regarding management of two common types of CBI, even among experienced stroke physicians. Respondents were more proactive regarding the diagnostic and therapeutic management than the minimum recommended by current expert opinions. More data are required to guide management of CBI; meantime, more consistent approaches to identification and consistent application of current knowledge, that also consider cognition and mood, would be promising first steps to improve consistency of care.

Performance and risks of ChatGPT used in drug information: an exploratory real-world analysis

ObjectivesTo investigate the performance and risk associated with the usage of Chat Generative Pre-trained Transformer (ChatGPT) to answer drug-related questions.MethodsA sample of 50 drug-related questions were consecutively collected and entered...

Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys

ObjectivesTo compare the total weekly working hours, proportions with work hours above the limitations of European working time directive (EWTD) and time spent on direct patient care in 2016 and...

529 Job Sharing: An Innovative Approach to Increasing Research Resources and Improving Staff Satisfaction

Abstract Introduction Pre-pandemic job openings for clinical research staff increased by nearly 10% a month nationwide yet was outpaced by an increase of greater than 12% in clinical trial activity. With the onset of the pandemic, the gulf between supply and demand widened in research. Simultaneously hospitals were stretched to capacity, staff suffered extreme burn-out and there was a dire need for additional bedside nurses. The pandemic shown a bright light on an age-old problem in nursing, whereas for a nurse to grow professionally, it often required leaving the bedside and giving up vital clinical skills, skills that were suddenly in great demand. The purpose of this project was to create a novel new job role, utilizing existing burn nursing staff to job share a research position, while maintaining their clinical expertise. Methods Nurse leaders from both areas worked in concert with the burn center’s director of research, senior hospital administration, human resources and existing staff to develop a new job role. The job description incorporated the scope and standards for nursing practice in both areas into one document. Additionally, a second-level position was created which allowed bedside nurses to trial the new role without a formal commitment to the permanent position. Staff were scheduled to rotate every 2 weeks between the two areas. Two months following implementation, core research staff and job-sharing staff were polled for feedback on benefits and challenges. Results Staff members (n=4) provided feedback independently from each other. A total of 41 comments were received, 27 benefit responses vs 14 challenges responses. Responses were grouped into themes and both benefits and challenges had 6 themes each. Benefit themes included: increased interdepartmental collaboration / trust (26%), professional growth (26%), supported learning (22%), enhanced screening for research patients (11%), unit-based resources (7%) and prevention of burnout (7%). Challenge themes included: scheduling (29%), variability in training opportunities (21%), role transitioning (21%), communication (14%), success personnel driven (7%), compensation (7%). Anecdotally, study investigators have expressed great satisfaction with the new position and there has been an increased interest expressed by other bedside staff in research involvement. Conclusions The response to the new position has been overwhelmingly positive. Staff entered the trial period realizing that it may be “messy” at first but quickly adapted and have worked through many of the challenges. Based on this early success, we are exploring the viability of cross training additional staff. Applicability of Research to Practice Cross training has been demonstrated to increase efficiencies, improve collaboration, trust and job satisfaction.

Leadership identity construction in a hybrid medical context: ‘Claimed’ but not ‘granted’

In the United Kingdom National Health Service (NHS), the growing number of hybrid clinical leaders has given rise to professional practice and identity struggles. Co-construction theories of leadership point to a need for leaders to engage in significant ‘identity work’ to construct themselves as leaders and to make legitimate claims for a leadership identity to potential followers. Our research aimed to contribute to the leader-follower literature by examining how medical leaders deal with professional identity struggles and changes to traditional work identities. We draw on data from a study of senior hospital doctors (consultant-level doctors from a variety of medical specialties in Health Boards in NHS Scotland). Our findings suggest that most senior hospital doctors in our study struggle to grant leadership identities to their medical leaders who claim such leadership identities, although they seek to see more doctors engaging in leadership. This article contributes to extant research on the influence of medical leadership roles on leader-follower identity construction.