Sustainable Healthcare Delivery Research Articles

The Impact of Leadership Training on Burnout and Fulfillment Among Direct Reports

SUMMARY Goal Burnout, decreased professional fulfillment, and resultant attrition across the medical professions are increasingly recognized as threats to sustainable and cost-effective healthcare delivery. While the skill level of leaders as perceived by their direct reports has been correlated with rates of burnout and fulfillment, no studies, to our knowledge, have directly evaluated whether intervention via leadership training impacts burnout and fulfillment among direct reports. The goal of this study was to evaluate the effectiveness of a leadership training intervention on direct reports’ perceptions of the leadership skills of supervising residents and subsequently on the well-being of the direct reports. Methods We implemented a leadership training program with supervising (i.e., chief) resident volunteers in two surgical residency programs. The leadership training included two sessions of approximately 2 hours each that consisted of interactive didactic and small group activities. The training focused on the following themes: defining leadership (i.e.,characteristics and behaviors), team building, fostering trust, managing conflict, navigating difficult conversations, and feedback. We administered pretraining and posttraining surveys to the direct reports (i.e., junior residents) to assess the perceived leadership skills of supervising residents, as well as burnout and professional fulfillment. Principal Findings Leadership scores significantly improved following the leadership training intervention. Additionally, improvement in leadership scores following training was positively correlated with professional fulfillment among the junior residents (direct reports). Practical Applications The results of this study suggest that incorporating leadership training into residency programs may serve as an appropriate initial intervention to improve the leadership skills of supervising residents, and in turn, improve professional fulfillment and retention among medical professionals. This intervention involved minimal cost and time investment, with potentially significant returns in combating the well-being and attrition crisis. These findings may be applicable across the healthcare field to tackle the impending healthcare worker crisis.

TeleHelp Ukraine: A distributed international telemedicine response to the ongoing war.

Humanitarian crises frequently garner solidarity and robust volunteer recruitment among health care communities. However, a common obstacle is matching providers to those in need across geographic and other barriers. We examined the application of a decentralised governance strategy in establishing an emergency telemedicine response, TeleHelp Ukraine (THU). Using a case study approach, we explored how global networking and technological advancements empower organisations to generate, access, disseminate, and utilise knowledge for sustainable health care delivery. Preliminary results suggest that a non-profit, decentralised model strengthened by robust team dynamics may optimise the distribution of clinical workload and scheduling procedures. Institutional and cultural diversity among health care providers and volunteers fosters the mobilisation of knowledge resources, synergistic collaboration, and tailored care standards that align with both provider and patient expectations. By integrating these diverse, distributed networks, a synergistic effect is achieved, combining effective learning mechanisms with intellectual capital. Our study provides insights into the structure, implementation strategies, dissemination methodologies, and initial results of THU's operation. These findings may inform future emergency telemedicine responses in humanitarian scenarios, thereby reinforcing the practical implementation of health as a human right.

SDG’S and Emerging Synergy: Green Healthcare System for Sustainable Healthcare Delivery in Metropolitan Cities in India

Objectives: This research paper explores the intricate landscape of healthcare delivery in metropolitan cities, focusing on addressing challenges such as environmental impact, resource management, and patient accessibility. Theoretical Framework: This paper investigates the integration of Green Healthcare System principles with Healthcare 4.0 technologies in metropolitan cities The study applies concepts of sustainability from Green Healthcare Systems and technological advancements from Healthcare 4.0 to explore their synergy in enhancing urban healthcare delivery. Method: Using NVivo Pro 12, the research employs qualitative analysis of interviews and field observations to identify key factors, challenges, and opportunities associated with implementing these systems in metropolitan settings. Findings reveal that leadership commitment, stakeholder collaboration, financial resources, and regulatory frameworks are crucial for successful integration. Results and Discussion: The findings reveal the transformative potential of combining green healthcare practices with digital technologies, underscoring the importance of stakeholder collaboration, leadership, and supportive policies in realizing sustainable healthcare delivery. The integration offers a comprehensive approach to meeting Sustainable Development Goals (SDGs) and advancing urban healthcare systems. Research Implications: The research contributes to understanding sustainable healthcare practices in urban environments and provides a roadmap for integrating green initiatives with advanced technologies to enhance healthcare accessibility and quality. Originality/Value: This study enriches the literature on sustainable healthcare by exploring synergies between Green Healthcare System and Healthcare 4.0, offering valuable insights for researchers and practitioners in metropolitan settings.

Video Consultations and Environmental Sustainability - Usability's Impact on Long-Term Use.

The rapid shift to digital healthcare, accelerated by the COVID-19 pandemic, holds promise for sustainable healthcare delivery and climate change mitigation. This study evaluates the Alltid öppet application through the lens of usability and patient satisfaction and their correlation with the intention for continued use. A cross-sectional analysis of primary care patients revealed that alignment with user needs significantly predicts long-term adoption, while frustration during use discourages it. Ease of use did not significantly affect the intention to continue, suggesting that usability alone is insufficient to drive sustained engagement. These findings highlight user-centred design's importance in digital healthcare solutions, suggesting that enduring adoption hinges on value perception and reducing user frustration. As the healthcare sector navigates its digital future, this study offers crucial insights into the design and implementation strategies that could underpin the environmental sustainability and resilience of healthcare systems.

Applied artificial intelligence for global child health: Addressing biases and barriers.

Given the potential benefits of artificial intelligence and machine learning (AI/ML) within healthcare, it is critical to consider how these technologies can be deployed in pediatric research and practice. Currently, healthcare AI/ML has not yet adapted to the specific technical considerations related to pediatric data nor adequately addressed the specific vulnerabilities of children and young people (CYP) in relation to AI. While the greatest burden of disease in CYP is firmly concentrated in lower and middle-income countries (LMICs), existing applied pediatric AI/ML efforts are concentrated in a small number of high-income countries (HICs). In LMICs, use-cases remain primarily in the proof-of-concept stage. This narrative review identifies a number of intersecting challenges that pose barriers to effective AI/ML for CYP globally and explores the shifts needed to make progress across multiple domains. Child-specific technical considerations throughout the AI/ML lifecycle have been largely overlooked thus far, yet these can be critical to model effectiveness. Governance concerns are paramount, with suitable national and international frameworks and guidance required to enable the safe and responsible deployment of advanced technologies impacting the care of CYP and using their data. An ambitious vision for child health demands that the potential benefits of AI/Ml are realized universally through greater international collaboration, capacity building, strong oversight, and ultimately diffusing the AI/ML locus of power to empower researchers and clinicians globally. In order that AI/ML systems that do not exacerbate inequalities in pediatric care, teams researching and developing these technologies in LMICs must ensure that AI/ML research is inclusive of the needs and concerns of CYP and their caregivers. A broad, interdisciplinary, and human-centered approach to AI/ML is essential for developing tools for healthcare workers delivering care, such that the creation and deployment of ML is grounded in local systems, cultures, and clinical practice. Decisions to invest in developing and testing pediatric AI/ML in resource-constrained settings must always be part of a broader evaluation of the overall needs of a healthcare system, considering the critical building blocks underpinning effective, sustainable, and cost-efficient healthcare delivery for CYP.

An Empirical Analysis of Avoidable Medicare Payments and Medicare Payment Variations

This study investigates the determinants of average Medicare payments, focusing on the impact of secondary diagnoses, demographic factors, and regional disparities. Our model reveals that major complications and comorbidities (MCCs) significantly increase average Medicare payments compared to less severe complications (CCs), with coefficients of 7674.13 and 1542.67, respectively. Higher percentages of the elderly living in poverty correlate with increased payments, highlighting the influence of social determinants on healthcare costs. Demographic analysis shows that counties with higher populations of Black, Hispanic, Asian, or other races receive higher Medicare payments, indicating potential racial disparities in healthcare access and quality. Political affiliation also plays a role, with Democrat-voting counties incurring higher Medicare costs. Surprisingly, larger populations served correlate with decreased payments, possibly due to cost-containment programs like Medicare’s Competitive Bidding. State-level analysis reveals significant regional variations, with states like Oregon and Wyoming showing higher payments, while Mississippi and Georgia have the lowest. Our findings underscore the complexity of Medicare funding and the need for targeted policy interventions to address health disparities and ensure sustainable healthcare delivery.

Advances in the Design of Renewable Energy Power Supply for Rural Health Clinics, Case Studies, and Future Directions

Globally, effective and efficient healthcare is critical to the wellbeing and standard of living of any society. Unfortunately, several distant communities far from the national grid do not have access to reliable power supply, owing to economic, environmental, and technical challenges. Furthermore, unreliable, unavailable, and uneconomical power supply to these communities contributes significantly to the delivery of substandard or absence of qualitative healthcare services, resulting in higher mortality rates and associated difficulty in attracting qualified healthcare workers to the affected communities. Given these circumstances, this paper aims to conduct a comprehensive review of the status of renewable energy available to rural healthcare clinics around the globe, emphasizing its potential, analysis, procedures, modeling techniques, and case studies. In this light, several renewable energy modeling techniques were reviewed to examine the optimum power supply to the referenced healthcare centers in remote communities. To this end, analytical techniques and standard indices for reliable power supply to the isolated healthcare centers are suggested. Specifically, different battery storage systems that are suitable for rural healthcare systems are examined, and the most economical and realistic procedure for the maintenance of microgrid power systems for sustainable healthcare delivery is defined. Finally, this paper will serve as a valuable resource for policymakers, researchers, and experts in rural power supply to remote healthcare centers globally.

Dynamic Retention Strategies for Mitigating Health Workers Brain Drain

The departure of skilled health workers from Sub-Saharan Africa, Asia, and the Pacific poses a significant challenge for the global health workforce, exacerbating healthcare accessibility issues, labour shortages, and vulnerabilities within healthcare systems worldwide. This study aims to identify brain drain drivers and propose dynamic retention strategies tailored to the unique circumstances of each region, relying solely on secondary data. Drawing upon the Push-Pull and Social Exchange Theory frameworks, the study reviews existing literature, and it was revealed that there is an interplay of push factors, such as low pay, limited professional development opportunities, and challenging working conditions, alongside pull factors, including better income prospects and career advancement opportunities. This study advocates for dynamic retention strategies like enhancing employee engagement, implementing flexible work arrangements, promoting work-life balance, offering competitive compensation, facilitating professional development, and fostering supportive work environments tailored to each region's circumstances were imperative to mitigate the health workers brain drain syndrome. It also suggests the importance of strategic, context-specific interventions in mitigating brain drain and ensuring sustainable healthcare delivery worldwide and ongoing research and evaluation to assess their effectiveness. This can be achieved through collaborative efforts of stakeholders towards safeguarding the global health workforce and promoting equitable access to healthcare services for all. Received: 10 February 2024 / Accepted: 25 June 2024 / Published: 02 July 2024

Impact of Institutional Practices and Surgical Complexity on Sarcoma Surgery Costs: Driving Efficiency in Value-Based Healthcare.

Sarcomas present a unique challenge within healthcare systems due to their rarity and complex treatment requirements. This study explores the economic impact of sarcoma surgeries across three Swiss tertiary healthcare institutions, utilizing a consistent surgical approach by a single surgeon to eliminate variability in surgical expertise as a confounding factor. By analyzing data from 356 surgeries recorded in a real-world-time data warehouse, this study assesses surgical and hospital costs relative to institutional characteristics and surgical complexity. Our findings reveal significant cost variations driven more by institutional resource management and pricing strategies than by surgical techniques. Surgical and total hospitalization costs were analyzed in relation to tumor dignity and complexity scores, showing that higher complexity and malignancy significantly increase costs. Interestingly, it was found that surgical costs accounted for only one-third of the total hospitalization costs, highlighting the substantial impact of non-surgical factors on the overall cost of care. The study underscores the need for standardized cost assessment practices and highlights the potential of predictive models in enhancing resource allocation and surgical planning. By advocating for value-based healthcare models and standardized treatment guidelines, this research contributes to more equitable and sustainable healthcare delivery for sarcoma patients. These insights affirm the necessity of including a full spectrum of care costs in value-based models to truly optimize healthcare delivery. These insights prompt a reevaluation of current policies and encourage further research across diverse geographical settings to refine cost management strategies in sarcoma treatment.

Anaesthetic gases and the environment: Is it time for a rethink?

BackgroundGeneral anaesthesia is in common use for patients undergoing surgical procedures, with the option of both inhalational and intravenous anaesthetic techniques. Anaesthetic gases are often excluded from discussions on sustainable healthcare delivery, despite being a significant contributor to the overall environmental impact of healthcare services. MethodsA literature review was carried out on previously published papers on the impact anaesthetic gases have on our environment and at ways to reduce their impact in current anaesthetic practice. The aim was to write a narrative review detailing the areas of concern as well as the current clinical situation in the European setting. Summary/conclusionsThe two classes of inhaled anaesthetic agent most frequently used are nitrous oxide and volatile agents (most commonly sevoflurane, isoflurane and desflurane). Both are recognised greenhouse gases that contribute to climate change.Minor modifications in the use of anaesthetic gases can have a significant environmental impact. These modifications include avoiding nitrous oxide whenever possible, avoiding desflurane (and using sevoflurane instead), using low flow anaesthesia during maintenance, swapping volatile-based anaesthesia for a TIVA technique when clinically appropriate and considering the use of central neuraxial or regional anaesthesia in place of general anaesthesia when possible.

Implementation of a High-Value, Evidence-Based Care Program: Impact and Opportunities for Learning Organizations.

Value-based care is not simply a matter of cost, but also one of outcomes and harms per dollar spent. This definition encompasses three key components: healthcare delivery that is organized around patients' medical conditions, costs and outcomes that are actively and consistently measured, and information technology that enables the other two components. Our objective in this project was to implement and measure a systemwide high-value, evidence-based care initiative with five pillars of high-value practices. We performed a quasi-experimental study from September 1, 2019, to August 31, 2022, of a new care program at the University of Texas Medical Branch. Drawing from the ABIM Foundation's Choosing Wisely Campaign, the program was based on five pillars-blood management and antimicrobial, laboratory, imaging, and opioid stewardship-with interdisciplinary teams led by institutional subject matter experts (i.e., administrative leaders) accompanied by nursing, information technology, pharmacy, and clinical and nonclinical personnel including faculty and trainees. Each pillar addressed two goals with targeted interventions to assess improvements during the first three fiscal years (FYs) of implementation. The targets were set at 10% improvement by the end of each FY. Monthly measurements were recorded for each FY. We tracked performance toward 30 pillar goals and determined that the teams were successful in 50%, 50%, and 70% of their goals for FY 2020, 2021, and 2022, respectively. For example, in the antimicrobial stewardship FY 2021 pillar, one goal was to decrease meropenem days of therapy (DOT) by 10% (baseline was 45 DOT/1,000 patient days; the target was 40.5 DOT/1,000 patient days). We measured quarterly DOT/1,000 patient day rates of 32.02, 30.57, and 26.9, respectively, for a cumulative rate of 26.9. Critical interventions included engaging and empowering providers and service lines (including outliers whose performance was outside norms), educational conferences, and transparent data analyses. We showed that a multidisciplinary approach to the implementation of an evidence-based, high-value care program through a partnership of engaged administrative leaders, providers, and trainees can result in sustainable and measurable high-value healthcare delivery. Specifically, structuring the program with pillars to address defined metrics resulted in progressive improvement in meeting value-based goals at the University of Texas Medical Branch. Also, challenges can be embraced as learning opportunities to inform value-based interventions that range from technological to educational tactics. The results at the University of Texas Medical Branch provide a benchmark for the implementation of a program that engages, empowers, and aligns innovative value-based care initiatives.

Opportunities and challenges of empowering SMEs for sustainable Healthcare delivery

This paper examines the sustainability practices implemented by healthcare establishments, mainly Small and Medium enterprises (SMEs), We focus on identifying opportunities with challenges involved. This systematic literature analyses 47 studies that explore sustainability practices in the healthcare system globally. The finding from the studies reveals that healthcare organizations with SMEs adopt diverse measures like renewable energy, a reduction, and a response procurement in minimizing the impact on the environment and ensuring financial stability. The challenges SMEs face comprise limited financial resources, lack of expertise, with difficulties accessing information and support. Furthermore, we suggest opportunities for SMEs to enhance sustainability practices with partnerships with other organizations and investing in educating employees. Implementation of sustainability practices will improve the financial stability, and environmental impact, with the wellbeing of healthcare stakeholders. The empirical evidence, comparative studies with cross-disciplinary are needed in exploring the effectiveness of the different suitability practices, potential trade-offs, synergies between sustainability and other organizational goals, the effect of sustainability practice in the financial with non-financial performance on SMEs in healthcare establishment are positive, with cost-effectiveness, efficiencies operations, improving brand reputations and engaging the employee. Established factors like regulating frameworks and government initiatives play a major role in the influence of adopting sustainability practices with cultural factors.

Clinical Utilization of Generic Drugs and Biosimilars for Ulcerative Colitis Treatment: Insights from a Nationwide Database Study in Japan

Introduction: Limited data exist regarding the prevalence and clinical practice involving generic drugs and biosimilars for treating ulcerative colitis (UC) in Japan. We aimed to clarify the clinical usage of these generic drugs and biosimilars for UC treatment in Japan using a nationwide database. Methods: We collected data from 30,675 UC cases, along with their prescriptions for both generic drugs or biosimilars and their original counterparts, using a medical claim database provided by DeSC Healthcare, Inc. We calculated the prescription and penetration rates of generic drugs and biosimilars and demonstrated the transition of these rates. Additionally, the cumulative retention rates between infliximab originator and biosimilar were compared using the Kaplan-Meier method. Results: The prescription rate of generic mesalazine increased from approximately 10% in 2015 to over 30% in 2021. Although the prescription rate of generic molecular targeting drugs (MTDs) also increased from approximately 0.15% in 2014 to 2.5% in 2021, the increment was lower than that of generic mesalazine. The penetration rates of generic 5-aminosalicylic acid and tacrolimus ranged from over 30% to approximately 50%. Infliximab biosimilar achieved an approximate 20% penetration rate, whereas adalimumab achieved <5%. The cumulative retention rates did not differ between infliximab originator and biosimilar. Conclusions: The penetration rates of generics and biosimilars for UC treatment are relatively low compared with those for treatment in other fields and the goal of the Ministry of Health, Labor, and Welfare. Several countermeasures are necessary for the widespread use of generics and biosimilars, ultimately contributing to cost-effective and sustainable healthcare delivery.

Creating a framework for change: transitioning to value-based healthcare in Queensland.

Value-based healthcare has been described as the sustainable, equitable and transparent use of healthcare resources to achieve improved experiences and outcomes for people and communities. It is supported by all levels of government in Australia, with recent initiatives championing a shift away from traditional, clinician-centric care delivery to a more contemporary, value-based approach. To date, however, efforts in Queensland have focused on smaller scale siloed models of care and have not extended to the transformational change required to create equitable and sustainable healthcare delivery. The Queensland Health Allied Health Framework for Value-Based Health Care (the Framework) builds on contemporary frameworks with reference to the local context in Queensland and provides a structure and starting point for clinicians and managers to work together with consumers to transform services to focus on preventative health and wellbeing, shifting the focus of care to the community and sustainably improving the quality of care delivered. The Framework outlines key considerations for the design and implementation of new services, including understanding the care pathway, supporting an outcome driven workplace culture, measuring what matters and designing for outcomes. Several key lessons were learnt during the development of the Framework, including the importance of early and sustained consumer partnerships, of establishing a shared definition of value-based healthcare that enables integration across the care pathway and the need for leadership at all levels to actively support the change management process. While developed for Queensland public allied health services, the Framework is intended to be a system-wide tool relevant to all health professionals and services.

Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Factors to vaccine cold chain management for sustainable and resilient healthcare delivery

The efficient distribution and timely vaccine delivery to the masses during any pandemic situation require reliable and efficient vaccine cold chain management (VCCM). Therefore, the present study is an effort to explore the factors of VCCM to develop a sustainable and resilient healthcare delivery system in any health outbreak. The factors of VCCM are scrutinized using Fuzzy-Delphi method and then prioritized adopting Fuzzy-Analytical Hierarchy Process (F-AHP) approach while considering the stakeholders' inputs. Finally, factors are categorized into clusters by implementing a machine learning tool ‘k-means clustering’ algorithm. The results of the study are further validated by conducting extended robustness tests. The findings of the study highlight the factors, namely, cold chain infrastructure, vaccine storage guidelines and availability of skilled professionals as the most important for VCCM. The ′k-means clustering’ algorithm analysis classifies all the 16 factors into three clusters: continuous process improvement (including eight factors), stakeholders' coordination (five factors) and maximum resource utility (three factors). The study can be significantly useful to VCCM decision-makers to implement the prioritized factors by ensuring the advanced cold chain infrastructure and issuing special storage and distribution guidelines to fight against health outbreaks like COVID-19. This is one of the few papers to discuss the factors of VCCM for developing a sustainable and resilient healthcare delivery system in the context of pandemics and stakeholders can address the factors in different clusters at a time.

Retrospective analysis of the impact of electronic medical record alerts on low value care in a pediatric hospital.

Hospital costs continue to rise unsustainably. Up to 20% of care is wasteful including low value care (LVC). This study aimed to understand whether electronic medical record (EMR) alerts are effective at reducing pediatric LVC and measure the impact on hospital costs. Using EMR data over a 76-month period, we evaluated changes in 4 LVC practices following the implementation of EMR alerts, using time series analysis to control for underlying time-based trends, in a large pediatric hospital in Australia. The main outcome measure was the change in rate of each LVC practice. Balancing measures included the rate of alert adherence as a proxy measure for risk of alert fatigue. Hospital costs were calculated by the volume of LVC avoided multiplied by the unit costs. Costs of the intervention were calculated from clinician and analyst time required. All 4 LVC practices showed a statistically significant reduction following alert implementation. Two LVC practices (blood tests) showed an abrupt change, associated with high rates of alert adherence. The other 2 LVC practices (bronchodilator use in bronchiolitis and electrocardiogram ordering for sleeping bradycardia) showed an accelerated rate of improvement compared to baseline trends with lower rates of alert adherence. Hospital savings were $325 to $180 000 per alert. EMR alerts are effective in reducing pediatric LVC practices and offer a cost-saving opportunity to the hospital. Further efforts to leverage EMR alerts in pediatric settings to reduce LVC are likely to support future sustainable healthcare delivery.

Abstract 12575: Diagnoses Associated With Telemedicine Use in Cardiology Clinics During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic led to widespread adoption of telemedicine, which has persisted in healthcare delivery. We aimed to characterize telemedicine use in ambulatory cardiology clinics over 2 years following onset of the COVID-19 pandemic. Question: What diagnoses are associated with telemedicine use in cardiology appointments? Methods: In this retrospective cohort study, demographic and encounter data of all cardiology clinic and telemedicine visits in the University of California Los Angeles (UCLA) Health System from 3/16/2020 to 6/27/2022 were obtained. Encounters were included if they were conducted by physicians, complete with ICD-10 codes, and not missing demographic data. Mixed effects logistic regression was used to model the association of diagnosis class (based on ICD-10 codes) with whether encounter was scheduled as telemedicine, adjusting for age, sex, race, ethnicity, social vulnerability index, date, and zip code. Results: The analysis included 72,878 patients (49.8% women, age 61.5 ± 17.2 years, 57.2% white, 12.5% Hispanic, 82.6% with zip code in a UCLA Health service area) over 248,373 encounters. Each patient had a median of 2 encounters (range 1-82). Of all encounters, 27,894 (11.2%) were scheduled as telemedicine. Telemedicine was more likely used in management of chronic conditions, especially metabolic disorders (adjusted OR [aOR] 2.26, 95% CI 2.10-2.44) and cardiomyopathies (aOR 2.10, 95% CI 1.93-2.28), than for evaluation of undifferentiated signs/symptoms. Telemedicine was less likely used for general exam/screening (aOR 0.52, 95% CI 0.46-0.58) and heart transplant (aOR 0.51, 95% CI 0.50-0.64; Table ). Conclusion: In this study, the most established use case for telemedicine in cardiology was care of chronic cardiac diagnoses among non-transplant patients. Ongoing maintenance of chronic cardiovascular conditions through telemedicine may be a sustainable healthcare delivery model post COVID-19 pandemic.

The Role of Telemedicine in Improving Healthcare Outcome: A Review

Telemedicine is an emerging healthcare delivery model that uses information and communication technologies (ICTs) to give medical services remotely. This model is gaining increasing attention due to its potential to improve healthcare outcomes, particularly in resource-limited settings. Telemedicine has been shown to improve patient access to medical care, reduce healthcare costs, and increase patient satisfaction. Telemedicine also offers medical education and training opportunities, remote consultations and diagnoses, and remote patient health status monitoring. This paper provides an overview of the potential benefits of telemedicine. It highlights some critical challenges to its widespread adoption, including regulatory and policy issues, technical and infrastructure constraints, and data privacy and security issues. The paper concludes by discussing future directions for telemedicine and the need for continued research and innovation to ensure its success as a sustainable healthcare delivery model.

Urip iku urup (life is lit) by service to others: a qualitative study of frontline healthcare workers’ lived experiences providing patient care in Indonesia’s COVID-19-designated hospital

BackgroundWhile COVID-19 affects every walk of human life, it especially implicates healthcare workers at the forefront of the pandemic due to their vulnerable involvement in providing first-line treatment. This study presents the lived experiences of frontline healthcare workers serving in Indonesia’s COVID-19-designated hospital, one of the severely afflicted healthcare settings wherein resource challenges, public health crisis, and political constraints intersect as policy conundrums.MethodsUsing a qualitative exploratory-descriptive approach, this study drew on thirteen in-depth, semi-structured interviews with frontline healthcare workers who have experiences providing first-line COVID-19 patient care in the COVID-19 hospital. The data analysis commenced with the verbatim transcription of the interview data, which was then subjected to a systematic thematic analysis employing hermeneutic phenomenological principles.ResultsThe exploration of the participants’ accounts reveals eight interconnected themes: facing resource scarcity and resignation; experiencing service-induced burnout due to occupational workload; encountering fears of being infected and infecting others; engaging in positivity through social connectedness; having dilemmas over healthcare rationing; developing negative emotions during patient interactions; coping through spirituality and religiosity; and embodying a life of service.ConclusionManaging healthcare in resource-limited, crisis settings presents multifaceted challenges that exceed mere structural modifications, requiring prioritized public health investment to ensure optimal patient care. Therefore, healthcare policy development and implementation should equally emphasize the well-being of frontline healthcare workers to foster sustainable healthcare delivery and achieve improved patient outcomes.