Hospital Stakeholders Research Articles

Development of a Hospital-Stakeholder Collaboration Tool Using Mixed Methods to Assess Stakeholder Perspectives for Hospital Service Improvement.

The purpose of this study was to develop the Hospital-Stakeholder Collaboration (HSC) Tool and Hospital Performance Factor (HPF) Tool to explore stakeholder perception and value for hospital service improvement. This exploratory mixed-method study involved three steps: initial tool development (Step 1), validity testing (Step 2), and module development (Step 3). In Step 1, qualitative data collection through literature reviews, focus group discussions, and interviews with hospital management experts led to the creation of the preliminary tools. Step 2 involved qualitative analysis by α 5-member expert panel, followed by quantitative analysis with 36 respondents for validity (Pearson correlation, α = 0.05) and reliability (Cronbach's Alpha, α = 0.6) tests. Step 3 encompassed the final module development. The HSC tool contains 6 domains and the HPF tool contains 4 perspectives. The 6 HSC domains were: 1) stakeholder identification, 2) interactive dialogue, 3) commitment, 4) planning, 5) implementation, 6) change in action and behavior. The 4 HPF perspectives were: 1) stakeholder perspective, 2) financial perspective, 3) internal business process, and 4) staff and organizational capacity. The values of the HSC tool validity and reliability tests were around 0,0046 and around 0,995, respectively. Additionally, the values of the HPF tool validity and reliability tests were around 0,0062 and around 0,995, respectively. This study offers a practical tool for needs assessment for the improvement of service by analyzing direct feedback from hospital stakeholders and measuring hospital performance factors.

A Multi‐disciplinary Team Approach for Educating Providers to Recognize Delirium in the Post Anesthesia Care Unit

AbstractBackgroundPostoperative delirium is common in older adults and has significant associated morbidity and mortality. However, screening is rarely performed in the post anesthesia care unit (PACU). For this reason, clinical researchers of delirium and a tertiary care interdisciplinary delirium Task Force Team proposed to address this area of patient safety.MethodA multidisciplinary team met to complete 3 hospital learning objectives. First, to develop an educational toolkit on PACU delirium identification with feedback from hospital stakeholders on topics to be trained, implementation into medical records, and finalizing training videos/powerpoint/quiz modules. Second, to train every PACU nurse on delirium identification. An EPIC form was created with detailed instructions for completing and documenting the CAM‐ICU and included in the PACU discharge checklist. All PACU nursing staff were assigned the module, and delirium screening was made mandatory for all patients aged 65 years or older. Following module assignment, perceived value, satisfaction, and barriers were surveyed to inform modification of training and implementation. Third, delirium screening rates were monitored.ResultsNurses (n = 110) were assigned postoperative delirium training modules across 3 PACUs starting July 2022 with a 2‐week deadline. Training completion rate was 83% after 3 months. Nurses provided positive feedback on the importance of delirium. Compliance in delirium screening in the PACU was low (<10%). After meeting with nursing staff to hear concerns/barriers to training and implementation, 1 on 1 training with research staff was initiated and all PACU nursing staff completed additional training between September and October. Before project implementation, no delirium screening was performed in the PACU. Over 3 months following completion of training, of 683 patients aged 65 years and older discharged from the PACU, 83 (12%) had delirium screening documented, and 0% were flagged as positive. Rate of screening differed by surgical service and hospital location.ConclusionThis hospital learning study documents the challenges and promise of implementing a PACU delirium screening program in a tertiary care academic medical center. We present data on improved delirium recognition at the hospital level, but variation in compliance rates by surgical service. Future research needs to examine reasons for variable delirium compliance screening.

Employees’ Resilience, Organizational Culture and Sustainable Performance of Tertiary Hospitals in Oyo State, Nigeria

Purpose: The study examined the role of employees’ resilience and organisational culture in the sustainable performance of tertiary hospitals in Oyo State, Nigeria, it examined the nature of relationship that exist among employees resilience level, organisational culture and sustainable performance; examined the influence of employees resilience level on sustainable performance; determined the impact of organisational culture on tertiary hospitals sustainable performance; investigated the moderating role of organisational culture in the relationship between employee resilience level and tertiary hospitals sustainable performance; and examined the impact of medical personnel resilience on patient satisfaction in tertiary hospitals. The conditions of the health workers in Nigeria necessitated this study in order to draw the attention of policy makers and tertiary hospitals Management to the need of coming to the aid of health workers in terms of improved services. Theoretical framework: The aim of employees’ resilience in the tertiary hospital is to ensure effective performance of the health workers and for them to be able to withstand or recover quickly from difficult conditions in the world of works. Noting that they experience serious stress as a result of the mass relocation of health workers in Nigeria to the western world for greener pastures which therefore put pressures on the ones on ground and finding it difficult to cope with the rigor of work. The study proffers solutions to the difficulties being experience by the health workers. When compared with the developed countries, health workers welfare are well taken care of which the reverse is the case in Nigeria. Methodology/Design/Approach: This study adopted quantitative design through a survey approach to answer the research questions raised. Questionnaire was made use of to gather data. The data collected were analyzed using descriptive and inferential statistical techniques of Social Package of Social Sciences, The population of the study comprises of two (2) sets of respondents which are Medical Personnel and Patients, 338 Medical Personnel and 50 patients were given questionnaire and wee returned. Findings: The outcome of the findings indicated that employees’ resilience level has a statistically significant positive and low correlation with sustainable performance ( ). Moreover, employees resilience has a statistically significant positive correlation with organizational culture ( ). In addition, organizational culture had a positive and statistically significant relationship with sustainable performance ( ). The result revealed that organizational culture did not moderate the relationship between employees’ resilience level and tertiary hospital sustainable performance ( ). This implies that organizational culture is not a moderator between employees’ resilience level and tertiary hospital sustainable performance. The results also revealed that patients are satisfied with the communication style of the medical personnel (100%), the explanation mode of the medical personnel (85%), the ways by which the medical personnel relate with them (95%), general relationship (100%), the technical skills of the medical personnel (80%) and awareness of their health issue (100%). The medical personnel are well trained and cultured through their professional ways of discharging their duties to safe lives. It also, charged the Nigerian Government to improve in the working conditions of the health workers. Research, Practical & Social implications: The study resolves by implication that, employees’ resilience and organizational culture have significant relationship with sustainable performance while employees’ resilience level has a statistically significant positive correlation with organizational culture. Employees’ resilience through contextual and behavioural dimensions do not significant predictors on sustainable performance while cognitive dimension significantly predicts of tertiary hospital sustainable performance. The study also clarified that organizational culture is not a moderator of the relationship between employees’ resilience and tertiary hospital sustainable performance. Patients are satisfied with the medical personnel service delivery in these tertiary hospitals. It recommends among others, that medical personnel’s behavioural and contextual dimensions of employees’ resilience should be further enhanced by hospital stakeholders, especially the management to enhance sustainable performance. Originality/Value: The study added value to body of knowledge because its implications both practical and social affirmed that without creating enabling environment, organizational culture, the level of employees’ resilience is advanced and better and appropriate management strategies, organizational culture that will meet up with its optimization level in terms service delivery and effective welfare of health workers should be put in place from time ti time. The study as recommends that medical personnel’s behavioural and contextual dimensions of employees’ resilience level should be further enhanced by hospital stakeholders, especially the management to enhance sustainable performance.

Remote patient monitoring for high-risk oncology patients: A feasibility implementation study.

410 Background: Electronic patient-reported symptom assessment surveys are used in remote monitoring interventions to connect care between the patient and clinical care providers through technology with mobile devices and patient portals. Patient responses to the assessments generate alerts sent to the clinicians who proactively manage the patient’s symptoms at home. This study’s purpose was to determine the feasibility of implementing a remote patient monitoring program in a community-based hospital and cancer institute. Methods: We explored the clinical care models used to assess and manage patient symptoms and the perceptions of hospital stakeholders about the barriers and facilitators of integrating the program into hospital clinical systems. This mixed method study disseminated the Readiness for Implementation survey to hospital stakeholders in September 2022 to obtain estimations of the proportion of positive agreement to hospital culture, learning, leadership, and resources for integrating a remote patient monitoring intervention. The qualitative aspect of the study used purposeful sampling to recruit 52 participants from the surveyed sample and additional administrators, clinical providers, staff nurses, and patients to focus groups. Items from the study’s survey that had the greatest proportion of disagreement were identified as the topics for the interview guide and included: 1) participant perceptions of implementing change 2) the change climate, 3) available resources, and 4) barriers and facilitators of remote patient monitoring for oncology patients. Results: All study results will be presented. Survey results from 53 of 63 hospital stakeholders [84% response rate] validated hospital readiness for implementing remote patient monitoring. Feedback from 8 interviews and 5 focus groups [8 administrators, 5 technology specialists, 14 nurse leaders and staff nurses, 13 oncologists, 5 radiation oncology staff, and 7 patients] averaging 6-20 participants per group, were conducted in January 2023. The transcripts were recorded and transcribed verbatim for analysis using Thematic Analysis and found data saturation in 14 interview sessions. Transcripts were independently coded and sorted into thematic categories. Global themes were summarized across domains and consensus among the study team identified three major themes: Integrating change into hospital systems, Relevance to patient care teams, and Patient and Family Centered Care. Each theme contained several subthemes that were similarly explored. Conclusions: A remote patient monitoring intervention was perceived to be feasible and of value by surveyed hospital stakeholders. Participants reported their insight for integrating change and operationalizing hospital systems to improve a patient’s experience and access to care. Future work will evaluate the investment in technology enhancements and staffing resources.

Do hospital-based emergency Medicaid programs benefit trauma centers? A mixed-methods analysis.

Hospital Presumptive Eligibility (HPE) is a temporary Medicaid insurance at hospitalization, which can offset patient costs of care, increase access to postdischarge resources, and provide a path to sustain coverage through Medicaid. Less is known about the implications of HPE programs on trauma centers (TCs). We aimed to describe the association with HPE and hospital Medicaid reimbursement and characterize incentives for HPE participation among hospitals and TCs. We hypothesized that there would be financial, operational, and mission-based incentives. We performed a convergent mixed methods study of HPE hospitals in California (including all verified TCs). We analyzed Annual Financial Disclosure Reports from California's Department of Health Care Access and Information (2005-2021). Our primary outcome was Medicaid net revenue. We also conducted thematic analysis of semistructured interviews with hospital stakeholders to understand incentives for HPE participation (n = 8). Among 367 California hospitals analyzed, 285 (77.7%) participate in HPE, 77 (21%) of which are TCs. As of early 2015, 100% of TCs had elected to enroll in HPE. There is a significant positive association between HPE participation and net Medicaid revenue. The highest Medicaid revenues are in HPE level I and level II TCs. Controlling for changes associated with the Affordable Care Act, HPE enrollment is associated with increased net patient Medicaid revenue ( b = 6.74, p < 0.001) and decreased uncompensated care costs ( b = -2.22, p < 0.05). Stakeholder interviewees' explanatory incentives for HPE participation included reduction of hospital bad debt, improved patient satisfaction, and community benefit in access to care. Hospital Presumptive Eligibility programs not only are a promising pathway for long-term insurance coverage for trauma patients but also play a role in TC viability. Future interventions will target streamlining the HPE Medicaid enrollment process to reduce resource burden on participating hospitals and ensure ongoing patient engagement in the program. Economic And Value Based Evaluations; Level II.

Factors Influencing Utilisation of Hernia Care among Women Seeking Surgical Healthcare: A Study of a Peri-urban Health Facility in Eastern Ghana

Aims: To assess factors associated with the utilization of quality hernia care among female adults seeking healthcare.&#x0D; Study Design: A descriptive cross-sectional design was used.&#x0D; Place and Duration of Study: Nsawam Government Hospital in the Nsawam-Adoagyiri Municipality of the Eastern Region of Ghana between May 15th and June 15th, 2022.&#x0D; Methodology: We applied a quantitative research method where both self-administered and interviewer-administered strategies were applied to administer a structured questionnaire. A consecutive sampling approach was used to recruit a total of 180 women who sought surgical care. Data was analyzed using STATA version 15 Software. Descriptive statistics, chi-square test, and multiple logistic regression analysis were applied to determine the relationship between the dependent and independent variables. The level of significance was accepted at P=.05 at a 95% confidence interval.&#x0D; Results: Overall, 180 women took part in the study out of the estimated sample size of 189, giving a response rate of 95.2%. The proportion of hernia among the women was 56% out of which the common types were umbilical hernia (32%) and incisional hernia (12%). The rate of utilization of hernia care was 75%. Logistic regression showed that marital status (being single) (aOR = 0.03; 95% CI = 0.002-0.20; P =.001), occupation (traders) (aOR = 0.03; 95% CI = 0.003-0.35; P = .004), and reliance on traditional healers (aOR = 0.11; 95% CI = 0.02-0.74; P = .024) were significant predictors of utilization of hernia care. &#x0D; Conclusion: The study showed a high proportion of hernia cases among women seeking surgical care. The majority of these hernias were inguinal hernia followed by umbilical and incisional hernia. The study suggests that managers at the hospital level, policymakers, and stakeholders in the health sector should ensure the provision of affordable hernia care for women such that early detection would be one of the key strategies to prevent imminent complications or limitations to daily activity.

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.

Relationship between Racial Diversity in Medical Staff and Hospital Operational Efficiency: An Empirical Study of 3870 U.S. Hospitals.

Demand for foreign nurses and medical staff is rapidly increasing due to the severe labor shortage in U.S. hospitals triggered by the COVID-19 pandemic. However, empirical studies on the effect of the racial diversity of medical staff on hospital operations are still lacking. This research gap is thus investigated based on the foreign medical staff working in 3870 U.S. hospitals. Results show that workforce racial diversity has a significantly positive relationship with hospital operational efficiency regarding occupancy rate, manpower productivity, capacity productivity, and case mix index. Notably, this study empirically supports that increasing the ratio of foreign nurses positively affects the overall operational efficiency of hospitals. In addition, the study results also indicate that the hospital location, size, ownership, and teaching status act as significant control variables for the relationship between racial diversity and hospital efficiency. These results imply that hospitals with these specific operating conditions need to pay more attention to racial diversity in the workplace, as they are structurally more sensitive to the relationship between racial diversity and operational efficiency. In short, the findings of this study suggest that hospital efficiency can be operationally improved by implementing workforce ethnic diversity. For this reason, hospital stakeholders and healthcare policymakers are expected to benefit from this study's findings. Above all, the results of this study imply that if an organization adapts to extreme external environmental changes (e.g., the COVID-19 pandemic) through appropriate organizational restructuring (i.e., expanding the workforce racial diversity by hiring foreign medical staff), the organization can gain a competitive advantage, a claim that is supported by contingency theory. Further, investors are increasingly interested in ESG, especially companies that embody ethical and socially conscious workplaces, including a diverse and inclusive workforce. Thereby, seeking racial diversity in the workforce is now seen as a fundamental benchmark for organizational behavior that predicts successful ESG business practices, a claim that is supported by stakeholder theory. Therefore, in conclusion, the findings of this study suggest that workforce racial diversity is no longer an optional consideration but should be considered as one of the essential determinants of competitive advantage in organizations, particularly in the healthcare sector.

Reducing the carbon footprint of a German university hospital: Perspectives from hospital stakeholders

Climate change threatens physical and mental health. Hospitals have a key role in adapting to these impacts. At the same time, hospitals contribute to climate change due to their greenhouse gas emissions. To effectively reduce these emissions, stakeholder involvement is important. This study aimed at identifying possible mitigation measures, barriers, and enablers for their implementation from stakeholders’ perspectives in a German university hospital. We conducted a qualitative study with semi-structured interviews at Heidelberg University Hospital. The participants’ selection was based on purposive maximum variation sampling. The interviews were transcribed verbatim and analyzed using the framework approach, supported by NVivo. Five patients, twelve clinical and twelve administrative employees at different hierarchical levels were interviewed. Stakeholders suggested various possible mitigation measures. Only a few of them were specific to hospitals. Enablers and barriers were attributed to the structural, organizational, mitigation measure, and stakeholder levels. Common barriers on these levels were non-demanding policies, the complexity of organizational structures, the perceived risk of reduced healthcare performance, and lack of awareness and prioritization. Participants formulated enablers, e.g., knowing best-practice examples or hiring a sustainability manager. However, enablers were mostly hypothetical and based on perceived barriers. Profound changes in regulatory frameworks and organizational management would support stakeholders at the investigated hospital in implementing mitigation measures. Furthermore, intensified research about climate-friendly health care and communication of these findings to hospital stakeholders as well as integration of these findings into curricula of the health workforce seems necessary for the climate-friendly transformation of hospitals.

Implementation of PM-JAY in India: a qualitative study exploring the role of competency, organizational and leadership drivers shaping early roll-out of publicly funded health insurance in three Indian states

BackgroundThe Pradhan Mantri Jan Arogya Yojana (PM-JAY), a publicly funded health insurance scheme, was launched in India in September 2018 to provide financial access to health services for poor Indians. PM-JAY design enables state-level program adaptations to facilitate implementation in a decentralized health implementation space. This study examines the competency, organizational, and leadership approaches affecting PM-JAY implementation in three contextually different Indian states.MethodsWe used a framework on implementation drivers (competency, organizational, and leadership) to understand factors facilitating or hampering implementation experiences in three PM-JAY models: third-party administrator in Uttar Pradesh, insurance in Chhattisgarh, and hybrid in Tamil Nadu. We adopted a qualitative exploratory approach and conducted 92 interviews with national, state, district, and hospital stakeholders involved in program design and implementation in Delhi, three state capitals, and two anonymized districts in each state, between February and April 2019. We used a deductive approach to content analysis and interpreted coded material to identify linkages between organizational features, drivers, and contextual elements affecting implementation.Results and conclusionPM-JAY guideline flexibilities enabled implementation in very different states through state-adapted implementation models. These models utilized contextually relevant adaptations for staff and facility competencies and organizational and facilitative administration, which had considerable scope for improvement in terms of recruitment, competency development, programmatic implementation support, and rationalizing the joint needs of the program and implementers. Adaptations also created structural barriers in staff interactions and challenged implicit power asymmetries and organizational culture, indicating a need for aligning staff hierarchies and incentive structures. At the same time, specific adaptations such as decentralizing staff selection and task shifting (all models); sharing of claims processing between the insurer and state agency (insurance and hybrid model); and using stringent empanelment, accreditation, monitoring, and benchmarking criteria for performance assessment, and reserving secondary care benefit packages for public hospitals (both in the hybrid model) contributed to successful implementation. Contextual elements such as institutional memory of previous schemes and underlying state capacities influenced all aspects of implementation, including leadership styles and autonomy. These variations make comparisons across models difficult, yet highlight constraints and opportunities for cross-learning and optimizing implementation to achieve universal health coverage in decentralized contexts.

An Industry Analysis of the Hospital Sector in Mangalore – A Study

Purpose: The purpose is to analyze the hospitals and their processes for knowing their functions and commonalities for the benefit of the best hospital choice for patients. In this study, five hospitals of Mangalore have been considered for the analysis. There are a few common things among these hospitals and certain competitive advantages that a few of them have. Hence, analysis is done based on various approaches like marketing, finance, HR, Strategy as well as the service in general. It is also to know the growth, uniqueness, competitive advantage, patient satisfaction, social contribution, and sustainability measures as well as to know the survival ability of hospitals. Design: This study is designed to collect information from various stakeholders of the respective hospitals and to analyze the same using various statistical tools. The data is then interpreted to ensure there is a perfect cross-sectional analysis of each organization from top to bottom as well as bottom-to-top approach. Findings: The findings are based on the data collected about the commonalities and differentiation of services that these five hospitals offer. KMC stands out to be number one among the five. Originality: This is a first of its kind approach to analyze five hospitals in one city in a paper and the entire study is done by the researcher as part of a bigger study. Type of Paper: Empirical Case study.

Construction of a multidimensional performance model based on the perceptions of hospital stakeholders

Construction of a multidimensional performance model based on the perceptions of hospital stakeholders

Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study

ABSTRACT In response to the disruptions caused by COVID-19, hospitals around the world proactively or reactively developed and/or re-organized their governance structures to manage the COVID-19 response. Hospitals’ governance played a crucial role in their ability to reorganize and respond to the pressing needs of their staff. We discuss and compare six hospital cases from four countries on different continents: Brazil, Canada, France, and Japan. Our study examined how governance strategies (e.g., special task forces, communications management tools, etc.) were perceived by hospital staff. Key findings from a total of 177 qualitative interviews with diverse hospital stakeholders were analyzed using three categories drawn from the European Observatory on Health Systems and Policies framework on health systems resilience during the COVID-19 pandemic: 1) delivering a clear and timely COVID-19 response strategy; 2) coordinating effectively within (horizontally) and across (vertically) levels of decision-making; and 3) communicating clearly and transparently with the hospital’s diverse stakeholders. Our study gleaned rich accounts for these three categories, highlighting significant variations across settings. These variations were primarily determined by the hospitals’ environment prior to the COVID-19 crisis, namely whether there already existed a culture of managerial openness (including spaces for social interactions among hospital staff) and whether preparedness planning and training had been routinely integrated into their activities.

The first experience in developing a training methodology for the hospital-based health technology assessment in Ukraine

Health technology assessment in the world is increasingly conducted at the hospital level, where the costs, impacts and benefits of health technology can be directly assessed in a specific hospital. One of the urgent issues is the preparation of qualified hospital staff for the implementation of hospital-based HTA. Aim. Develop and conduct the first training on hospital-based health technology assessment for hospital stakeholders of Ukraine. Materials and methods. DACEHTA (англ. Danish Centre for Evaluation and Health Technology assessment) and AdHopHTA (англ. Adopting hospital-based Health Technology Assessment) guidelines were included into the analysis. The methods of content analysis, systematization and data generalization were used. Results. The first training on hospital-based HTA was conducted in the Regional Clinical Hospital named after O. O. Gerbachevsky of the Zhytomyr Regional Council. 9 hospital stakeholders were identified by preliminary semi-structured interview: the medical director of therapy, the medical director of surgery, the deputy director of economic, the head of the monitoring department, the representative of the information and statistics department, representatives of two clinical departments, of laboratory department and department of functional diagnostics. The curriculum was build taking into account he basic HB-HTA skills needed for hospital specialist should possess and included 8 blocks, each lasting 1.5 hours. Each block consisted of both theoretical and practical components and finished with homework, which was discussed at the beginning of the next block. This approach enabled the participants to better assimilate the presented information and carefully complete the homework of each block. Conclusions. The participants of the training noted that the use of hospital-based HTA is the most relevant issue today. Making management decisions based on HB-HTA will allow a more optimized hospital budget usage. At the same time, the participants emphasized the importance of the work of a cross-functional team in conducting HB-HTA with the mandatory involvement of hospital economists. Based on training participants and HTA international experts feedback, a two-week post-graduated course "Hospital-based HTA is a practical tool for making scientifically based decisions at the hospital level" was developed and approved in the NMU named after O.O. Bogomolets.

A Delphi Consensus Study to Define Non-Consultant Hospital Doctor Competencies Essential for a Focussed Curriculum in Major Emergency Management

Introduction:In this era of increasingly fragile hospital systems, major emergency preparation is firmly being placed under the spotlight. The response to major emergencies requires the mobiliZation of numerous resources to ensure an effective, coordinated response. Yet, studies confirm a global deficit in the knowledge and skills of staff responding to these events in Ireland. Non-consultant hospital doctors (NCHDs) provide a useful and necessary surge response during these events, but currently there are no training programs specifically focused on their major emergency training requirements. The aim of this research was to define the essential elements of a focused curriculum for non-consultant hospital doctors responding to a major emergency (ME).Method:A two-step process was employed. Initially, a comprehensive ME competency set was compiled from relevant literature, consulting field-specific experts and from current ME training programs. A sample of experts was paneled from several acute hospitals in Ireland using purposive and snowball recruitment. A modified Delphi process, using on-line surveys, was utilized to identify the competencies deemed essential for NCHDs responding to an ME event.Results:Three Delphi rounds were required to complete this study. Of the 116 initial survey items, 68 competencies were confirmed as essential NCHD competencies, a total reduction of 40%. A 70% consensus rate was applied to 71 survey items in the final round, resulting in an agreement in 68 competencies (96%). A preponderance of the rejected competencies were specific to managerial and administrative tasks, whilst many retained competencies related to direct clinical care.Conclusion:This study has defined the essential elements of a curriculum for NCHD doctors responding to a major emergency in Ireland, using the Delphi methodology. This derived competency set should be useful to national bodies, regional organizations, and hospital stakeholders to allow the creation of bespoke NCHD major emergency training programs.

Communication transforms the impact of the COVID-19 pandemic on children with cancer and their families.

The COVID-19 pandemic altered healthcare systems globally, causing delays in care delivery and increased anxiety among patients and families. This study examined how hospital stakeholders and clinicians perceived the global impact of the COVID-19 pandemic on children with cancer and their families. This secondary analysis examined data from a qualitative study consisting of 19 focus groups conducted in 8 languages throughout 16 countries. A codebook was developed with novel codes derived inductively from transcript review. In-depth analysis focused on the impact of the COVID-19 pandemic on children with cancer and their families. Eight themes describing the impact of the pandemic on patients and their families were identified and classified into three domains: contributing factors (COVID-19 Policies, Cancer Treatment Modifications, COVID-19 Symptoms, Beliefs), patient-related impacts (Quality of Care, Psychosocial impacts, Treatment Reluctance), and the central transformer (Communication). Participants described the ability of communication to transform the effect of contributing factors on patient-related impacts. The valence of impacts depended on the quality and quantity of communication among clinicians and between clinicians and patients and families. Communication served as the central factor impacting whether the COVID-19 pandemic positively or negatively affected children with cancer and families. These findings emphasize the key role communication plays in delivering patient-centered care and can guide future development of communication-centered interventions globally.

The place of rural hospitals in New Zealand's health system: an exploratory qualitative study.

In Aotearoa New Zealand (NZ) there is a knowledge gap regarding the place and contribution of rural hospitals in the health system. New Zealanders residing in rural areas have poorer health outcomes than those living in urban areas, and this is accentuated for M&#257;ori, the Indigenous people of the country. There is no current description of rural hospital services, no national policies and little published research regarding their role or value. Around 15% of New Zealanders rely on rural hospitals for health care. The purpose of this exploratory study was to understand national rural hospital leadership perspectives on the place of rural hospitals in the NZ health system. A qualitative exploratory study was undertaken. The leadership of each rural hospital and national rural stakeholder organisations were invited to participate in virtual semi-structured interviews. The interviews explored participants' views of the rural hospital context, the strengths and challenges they faced and how good rural hospital care might look. Thematic analysis was undertaken using a framework-guided rapid analysis method. Twenty-seven semi-structured interviews were conducted by videoconference. Two broad themes were identified, as follows. Theme 1, 'Our place and our people', reflected the local, on-the-ground situation. Across a broad variety of rural hospitals, geographical distance from specialist health services and community connectedness were the common key influencers of a rural hospital's response. Local services were provided by small, adaptable teams across broad scopes and blurred primary-secondary care boundaries, with acute and inpatient care a key component. Rural hospitals acted as a conduit between community-based care and city-based secondary or tertiary hospital care. Theme 2, 'Our positioning in the wider health system', related to the external wider environment that rural hospitals worked within. Rural hospitals operating at the margins of the health system faced multiple challenges in trying to align with the urban-centric regulatory systems and processes they were dependent on. They described their position as being 'at the end of the dripline'. In contrast to their local connectedness, in the wider health system participants felt rural hospitals were undervalued and invisible. While the study found strengths and challenges common to all NZ rural hospitals, there were also variations between them. This study furthers understanding of the place of rural hospitals in the NZ healthcare system as seen through a national rural hospital lens. Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. However, context-specific national policy for rural hospitals is urgently needed to ensure their sustainability. Further research should be undertaken to understand the role of NZ rural hospitals in addressing healthcare inequities for those living in rural areas, particularly for M&#257;ori.

International experience of using report forms for hospital-based health technology asssessment

Hospital-based health technology assessment (HB-HTA) is one of the components of public management and support hospital managers to science-based decision-making regarding the implementation of new and innovative health technologies (HT). HB-HTA includes the processes and methods used to make HTA reports in and for hospitals. Ukraine has already started implementing hospital-based HTA, but a number of steps are still needed to fully implement HTA at the hospitals. One of them is the choice of HB-HTA report form, which will be appropriate to use in the practical activities of hospitals in Ukraine.&#x0D; The purpose of the study is to analyse the international experience of using different HB-HTA report form with the aim of selecting the optimal HB-HTA report form for hospitals in Ukraine. There were analysed different forms of HTA reports in Ukraine regulatory framework, international scientific literature, the AdHopHTA handbook, which included the following countries: Norway, Finland, Turkey, Spain, Austria, Italy, Estonia, Denmark, Switzerland, in international HTA database INAHTA, Canadian and Kazakhstan report databases. The methods of content analysis, systematization and generalization were used.&#x0D; Making managerial decisions about investment or disinvestment in health technology requires information that meets the hospital stakeholders needs. Such scientifically based information is provided by HB-HTA report form.&#x0D; There are a wide range of HB-HTA reports forms in terms of content, subject matter, structure and resources (time and staff). Each is based on the EUnetHTA HTA core model. For introducing a hospital-based HTA, the countries of the world most often choose the mini-HTA form. Mini-HTA supports hospital managers to make science-based strategic decisions of the introduction of new treatment methods, new indications for the use of existing technology, medical equipment, medical devices, or stopping the usage of health technology. The choice between performing a mini-HTA or a more comprehensive hospital-based HTA often requires a balance between the quality and thoroughness and the necessary speed of assessment in a specific situation.&#x0D; From the authors' point of view, the most applicable to Ukrainian context is the mini-HTA form. Adapting mini-HTA and approving it as a recommended report form at the state level will provide an opportunity to more widely HTA usage by hospitals in Ukraine.

Re-envisioning community genetics: community empowerment in preventive genomics.

As genomic technologies rapidly develop, polygenic scores (PGS) are entering into a growing conversation on how to improve precision in public health and prevent chronic disease. While the integration of PGS into public health and clinical services raises potential benefits, it also introduces potential harms. In particular, there is a high level of uncertainty about how to incorporate PGS into clinical settings in a manner that is equitable, just, and aligned with the long-term goals of many healthcare systems to support person-centered and value-based care. This paper argues that any conversation about whether and how to design and implement PGS clinical services requires dynamic engagement with local communities, patients, and families. These parties often face the consequences, both positive and negative, of such uncertainties and should therefore drive clinical translation. As a collaborative effort between hospital stakeholders, community partners, and researchers, this paper describes a community-empowered co-design process for addressing uncertainty and making programmatic decisions about the implementation of PGS into clinical services. We provide a framework for others interested in designing clinical programs that are responsive to, and inclusive and respectful of, local communities.

Perceived barriers and facilitators to the adoption of telemedicine infectious diseases consultations in southeastern Missouri hospitals

Introduction Telemedicine infectious diseases consultations (tele-ID consults) improves access to healthcare for underserved/resource-limited communities. However, factors promoting or hindering implementation of tele-ID consults in low-resource settings are understudied. This study sought to fill this gap by describing perceived barriers and facilitators tele-ID consults at three rural hospitals in southeastern Missouri. Methods Twelve in-depth, semi-structured interviews were conducted with a purposively sampled group of information-rich hospital stakeholders from three rural, southeastern Missouri hospitals with partial or no on-site availability of ID physicians. Our literature-informed interview guide elicited participants’ knowledge and experience with tele-ID consults, perceptions on ID consultation needs, and perceived barriers to and facilitators of tele-ID consults. Interview transcripts were coded using an iterative process of inductive analysis to identify core themes related to barriers and facilitators. Results Perceived barriers to adopting and implementing tele-ID consults included logistical challenges, technology and devices, negative emotional responses, patient-related factors, concerns about reduced quality of care when using telemedicine, lack of acceptance or buy-in from physicians or staff, and legal concerns. Key facilitators included perceived need, perceived benefits to patients and physicians, flexibility and openness to change among staff members and patients, telemedicine champions, prior experiences, and enthusiasm. Discussion Our findings demonstrate that rural hospitals need tele-ID consults and have the capacity to implement tele-ID consults, but operational and technical feasibility challenges remain. Adoption and implementation of tele-ID consults may reduce ID-physician shortage-related service gaps by permitting ID physician's greater geographic reach.